Thursday, November 3, 2011

End of Life Care

Jeanne Arthur, HCCA consumer rep, attended an End of Life Care workshop in Sydney on 19 October, presented by Les Storey, FRCN, FHEA, RN, MScm.

Les Storey, who is from the UK, has extensive qualifications and experience in the development of strategies for end of life care.  His presentation included information about the National End of Life Programme in the UK.

Despite losing his hearing aids, Les engaged the twenty or so attendees at the workshop quickly and with humour. Most of the attendees at the workshop were from New South Wales. Most were engaged in working with older and dying people.

The workshop began with some searching questions – When do we start talking about end of life?  Where do we want to die? How comfortable do we feel about talking about death?  Answers to these questions included “As soon as possible”; “Give as much choice as possible”; “Not very comfortable”.

Les discussed the End of Life Care Strategy, Preferred Priorities for Care. This program teaches trainees to be honest and open and to identify possible triggers for discussion, ask questions, record the answers, share information and evaluate the process. It aims to minimise the instances of people leaving hospital with false hopes of recovery from terminal illnesses and address the problem of out of hours care for dying people.

The Preferred Priorities for Care key questions are:
In relation to your health what has been happening to you?
What are your preferences and priorities for future care?
Where would you like to be cared for in the future?
Preferred Priorities for Care focuses on people’s wishes concerning their end of life care and not only their wishes in respect of death itself. Sometimes this may be a compromise between what is desirable and what is actually possible, but it is important to have the conversation, to identify issues and resolve them insofar as it is possible, keeping in mind that the preferred priorities may change as circumstances change
Advance Care Planning is a voluntary discussion which asks participants to look to the future, taking into account the best interests of the dying person.  It can help in situations where people lose capacity and it aims to improve the quality of death by reducing inappropriate hospital admissions and unwanted clinical interventions.
Les also spoke about the Liverpool Care Plan, which is an integrated care pathway that is used at the bedside to drive up sustained quality of the dying in the last hours and days of life.

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