Palliative Care MasterClass: an introduction 7 th 8 th March 2019 - - PowerPoint PPT Presentation

Palliative Care MasterClass: an introduction

7th – 8th March 2019

Demographics

• This class of 27 is made of a mix of professionals.
• 4 are specifically specialists in palliative or end of life

care.

• 10 are consultant level,
• 5 registrars (5 of ST4 or above),
• 5 are nurses (3 specialist)
• 3 are AHPs: 1 specialist EoL OT and 1 pharmacist

Locations

• 3 from Scotland
• 1 from Wales
• 7 from the Northwest
• 3 from the Northeast
• 7 from the Midlands
• 2 from London or Greater

London

• 4 from the Southwest

3 1 3 7 7 3 4

Needs analysis

• Response rate of 23 out of 28
• Working in a range of settings:

community settings including:

• End of life care centre
• Hospice
• Community palliative care
• General practice

hospital based acute and secondary care, including:

• acute frailty,
• In-patient care
• out-patient clinics

Time spent with Parkinson’s or dementia patients

• 8 rated their contact as over 70% or as ‘majority’ of time
• 2 rated their contact as regular: with 1-2 patients per day,

and a weekly clinic respectively

• 1 rated their contact as 50%
• 6 rated their contact as 30% or below or as ‘variable’ and

‘not much’

Experience in patient palliative care

• 9 have direct, regular experience

○ work in palliative (4) or end of life care (1) ○ felt they had a strong knowledge or interest in palliative care (2)

• 6 have some experience with palliative care through current working

○ (mostly alongside people with a neurological condition).

• 5 had a reasonable level of knowledge if not experience,

○ training in palliative care (2), through routine general practice (1) or had regular involvement with those experiencing palliative care (1)

• 3 rated their involvement as little or occasional

Key wants and needs: overview

• Improved understanding of pharmacological and non-pharmacological

interventions

• Improved knowledge and use of care planning in a number of forms
• Improved knowledge of specific conditions,

– including dementia, Parkinson’s, PSP and MS, and – improved management of symptoms during palliative and end of life phases

• Better understanding of holistic or community-based palliative care,

– inc spiritual and ethical elements of care, and when it is appropriate to consider elements of care

• Improved communication with both patients and carers

Specific wants and needs: level 1

• Identify the end of someone’s life (n=4), inc through:

– early recognition of the ‘dying phase’ – physiology and psychophysiology of the last days of someone’s life

• Medical management, support (n=2) or possible interventions
• Specific conditions (n=3) (Parkinson’s and dementia)
• Communication with patients and families
• Best practice in palliative care (n=3) inc:

– the ‘scope’ of palliative care (n=1), – updated knowledge on different approaches (n=1) – personal improvement (n=1)

Specific wants and needs: level 2

• Pharmacological (n=4) and non-pharmacological (n=2) interventions, inc

– difficulty swallowing (n=1) – meds management in Parkinson’s at the end of life (n=2)

• Existing local service improvement (n=3) re

– when to begin discussions or care planning (n=2), – how to integrate palliative care into existing services (n=1) – how to improve existing care dramatically (n=1).

• Managing different symptoms at the end of life (n=1) or specifically in

supporting those with a LTC (n=1)

• Communication both with the patient or in support to family and carers.

Specific wants and needs: level 3

• End of life legislation (n=2)

Practical use of advance care planning, care plans & emergency healthcare planning (n=2)

• Challenges routinely faced at end of life (n=1)
• Use of assessments (n=2) and cognitive screening (n=1)
• Specific conditions (n=3) inc

– MS – PSP, CBD / Parkinsonian conditions

– dementia via BPSD

• Own / local services (n=3) re

– establishing community-based service – holistic approaches – ethical and spiritual considerations

Specific wants and needs: level 4

• Management at end of life (n=7) inc

– pain – BPSD – spasticity – medication options for pain – meds management for Parkinson’s

• Having positive, meaningful discussions with patients & families (n=3)
• How do you define a ‘good’ death?
• Exploring spirituality (n=1)

Specific wants and needs: level 5

• Support to family and carers (n=2),
• Peer learning and interaction
• Personal emotions and supporting colleagues in this
• Deliver best possible care (n=3) inc

– objective assessments – better judgements about services / individuals to involve when

What’s next?

• INFO IN SLIDE HERE