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Image courtesy of Michael Leunig
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Identifying which patients are approaching the end-of-life phase is crucial to delivering appropriate health care. Recognising end of life is sometimes approximate, so understanding and communicating this uncertainty is crucial. You can learn more in Module 3 - Recognising the End of Life.
Three new free education modules will be available from mid October, so register your interest on our website to start or continue your learning.
Please support our project and join in our 'Thunderclap' (a message shared simultaneously on social media) to herald the launch of our next modules.
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Sector News
The Australasian College for Emergency Medicine (ACEM) is the peak professional organisation for emergency medicine in Australasia. They have significant interest in ensuring the highest standards of medical care for patients are maintained in emergency departments (ED) across Australia and New Zealand.
It is inevitable that for some patients, the commencement of end-of-life care (EoLC) care will occur in the ED. Appropriate training will ensure that EoLC planning and discussions are considered part of the emergency physician's skill set and ensure that the patient's goals of care are understood and appropriately provided. This policy on end of life and palliative care in ED aims to encourage honest discussion and awareness of planning within the community, ensure that ED staff are confident in providing good EoLC and that EDs have systems and processes in place to recognise and appropriately care for patients at end-of-life.
Carer Gateway is a free national online and phone service that provides practical information and resources to support carers. The interactive service finder helps carers connect to local support services and includes a website and phone service for carers to access practical information and support. Carer Gateway is a new national service funded by the Australian Government.
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Latest Evidence
Each month we will feature a few articles that cover topics relevant to end-of-life care in hospitals:
- Hshieh TT, Yue J, Oh E, Puelle M, Dowal S, Travison T, et al. Effectiveness of Multicomponent Nonpharmacological Delirium Interventions: A Meta-analysis. JAMA Intern Med. 2015 Apr 1;175(4):512-520.
Delirium, an acute disorder with high morbidity and mortality, is often preventable through multicomponent nonpharmacological strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies to date. Nonpharmacological delirium prevention interventions are effective in reducing delirium incidence and preventing falls, with a trend toward decreasing length of stay and avoiding institutionalization. Given the current focus on prevention of hospital-based complications and improved cost-effectiveness of care, this meta-analysis supports the use of these interventions to advance acute care for older persons.
- Hagiwara Y, Ross J, Lee S, Sanchez-Reilly S. Tough Conversations: Development of a Curriculum for Medical Students to Lead Family Meetings. Am J Hosp Palliat Care. 2016 Sep 20:1049909116669783.
Conducting a family meeting is an advanced skill. This paper discusses four themes in which students required improvement: 1) Discussing prognosis, 2) Explaining palliative care/hospice, 3) Avoiding medical jargon, and 4) Discussing cultural/religious preferences. Evaluation showed that the following were needed; 1) Ask more about the degree of knowledge family members want, 2) Ask religious beliefs, and 3) Assess family members’ level of education (p < 0.001). Qualitative analysis of group debriefings suggested that student perception of the OSCE experience was positive overall. Students found the case to be realistic and immediate feedback to be helpful.
- Gysels M, Reilly CC, Jolley CJ, Pannell C, Spoorendonk F, Moxham J, et al. Dignity through integrated symptom management: lessons from the Breathlessness Support Service. J Pain Symptom Manage. 2016 Sep 17. pii: S0885-3924(16)30297-4.
Dignity is poorly conceptualized and little empirically explored in end of life care. A qualitative evaluation of a service offering integrated palliative and respiratory care for patients with advanced disease and refractory breathlessness uncovered an unexpected outcome, it enhanced patients' dignity. Dignity is an integrated concept and can be affected by influences from other areas such as illness-related concerns. The intervention shows that targeting the symptom holistically and equipping patients with the means for self-care, realized the outcome of dignity.
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For Your Notice Board
Each month we will feature a fact sheet, a poster or other resource that you can print and share on you notice board or in your tea room.
This month we highlight a poster from the Australian Commission on Safety and Quality in Health Care on health literacy for clinicians.
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Next Newsletter
November 2016
The End-of-Life Essentials News is distributed on the first Wednesday of each month. You are also welcome to forward the newsletter to others who may be interested or follow this link to subscribe to the newsletter. To share something, please email eolessentials@flinders.edu.au
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