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EOL Essentials Project News

EDITION 4

Welcome to the June edition of End-of-Life Essentials news. This newsletter aims to keep you informed with what’s happening in the project and end-of-life care. 

What’s New in the Project?

• Sector News

• Latest Evidence

• For Your Notice Board

• Next Newsletter

What's New in the Project?

Hooray - eLearning modules now available!

On June 24th our first three modules were launched at an event held at the Flinders Centre for Innovation in Cancer, Adelaide. Guest speakers included Professor Villis Marshall (Chair of the Australian Commission on Safety and Quality in Health Care), Ms Meg Brassil (consumer representative and advocate) and Professor Ken Hillman (Professor of Intensive Care, Liverpool Hospital) who officially launched the modules. The day was led by Professor Michael Kidd (Executive Dean, Faculty of Medicine, Nursing and Health Services, Flinders University).

Pictured left to right, Ms Meg Brassil, Kim Devery, Professor Kidd, Professor Hillman, Professor Marshall.

The newly available modules are free to access. Here is what you can expect to find in the modules:

 

Module 1 - Dying, a normal part of life

Outlines the opportunities and challenges in managing end-of-life issues in acute care hospitals. You will also learn about the importance of conversations and recognising the patterns of common illnesses and why this matters in end-of-life care. You will be prompted to reflect and identify your own skills in end-of-life care and how to improve them.

Watch, listen and learn from leaders such as Dr Peter Saul, a senior specialist in intensive care and a patient who, in the final stage of his life, wanted you to know about what he regarded as important.

 

Module 2 - Patient-centred communication and shared decision-making

Outlines the essentials for end-of-life conversations. Watch, learn and then practice how to increase the effectiveness of your communication across a range of common end-of-life matters.

 

Module 3 - Recognising the end-of-life

Deals with telling the truth with kindness, understanding uncertainties of prognostication, realising the opportunities for conversations about how much time remains.

Go to our website at www.caresearch.com.au/EndofLifeEssentials and discover more resources and education. The next 3 modules will be available in October 2016.

Sector News

Care of elderly patients hospitalised at the end of their life

The largest systematic review of the care of elderly patients hospitalised at the end of their life has found more than a third received invasive and potentially harmful medical treatments. The analysis of 38 studies over two decades, based on data from 1.2 million patients, bereaved relatives and clinicians in 10 countries including Australia, found the practice of doctors initiating excessive medical or surgical treatment on elderly patients in the last six months of their life continues in hospitals worldwide. The UNSW Australia-led study, published in the International Journal for Quality in Health Care, has prompted researchers to call for better training for hospital doctors and more community education to reduce the demand for non-beneficial treatments at the end of life. You can read more about the research work from the University of New South Wales News.

Royal Australian College of Physicians releases End-of-Life Care Position Statement

Fostering a medical culture that enables physicians to sensitively and openly discuss end-of-life care preferences with patients is among 28 recommendations made by RACP in its Improving Care at the End of Life: Our Roles and Responsibilities Position Statement. The policy identifies five elements of good end-of-life care:

  • diagnosing dying or the risk of dying;
  • respecting patient autonomy;
  • respecting the patient’s best interests when making treatment decisions;
  • managing symptoms; and
  • supporting carers and family.
Read the College’s newly released end-of-life position statement.

Latest Evidence

Each month we will feature a few articles that cover topics relevant to end-of-life care in hospitals:

  • Jansen J, Naganathan V, Carter SM, McLachlan AJ, Nickel B, Irwig L, et al. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016 Jun 3;353:i2893.
    Too much medicine is an increasingly recognised problem, and one manifestation is inappropriate polypharmacy in older people. The authors draw together evidence from the psychology, communication, and decision making literature. For each step of the shared decision making process the authors describe the unique tasks required for deprescribing decisions; identify challenges for older adults, their companions, and clinicians; give practical advice on how challenges may be overcome; highlight where more work is needed; and identify priorities for future research.
  • Elliott RA, Lee CY. Poor uptake of interdisciplinary medicine reviews for older people is a barrier to deprescribing. BMJ. 2016 Jun 28;353:i3496.
    In their recent article about deprescribing through shared decision making, Jansen and colleagues note that many of the triggers for deprescribing can be identified only by a medicine review and that this review can be triggered by important “life transitions.” These include hospital admission, residential care admission, referral to an aged care assessment service (ACAS) due to functional decline, or referral to a community nursing service for medicines management support.
  • White DB, Ernecoff N, Buddadhumaruk P, Hong S, Weissfeld L, Curtis JR, et al. Prevalence of and factors related to discordance about prognosis between physicians and surrogate decision makers of critically ill patients. JAMA. 2016 May 17;315(19):2086-94.
    Although misperceptions about prognosis by surrogates are well documented, an important barrier to progress is the lack of a clear understanding of the causes of these misperceptions. The conventional assumption is that surrogates’ inaccurate expectations arise from misunderstandings of physicians’ assessments of prognosis. However, insights from decision psychology suggest that other mechanisms may plausibly influence individuals’ risk perceptions, such as optimism biases and alternative value systems that lead surrogates to have beliefs about prognosis that differ from physicians’. The authors sought to quantitatively determine the prevalence of physician-surrogate discordance about prognosis and to qualitatively understand reasons that surrogates sometimes hold beliefs about prognosis that differ from physicians’ assessments. 

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 quality end-of-life care (237kb pdf) for your service. You can use this poster to reflect on your own and your team’s abilities in end-of-life care. Ask yourself, or discuss with your team, these questions:
What do you find most challenging?

  • When a patient and family’s expectation of the future is very different from clinical realities
  • Interdisciplinary team disagreements or stresses about end-of-life care
  • Poor coordination of care or delays in decision-making
  • Not knowing how to recognise patients who could be in the last 12 months of life
  • Not knowing where to seek assistance when a patient is suffering.
Grow your confidence and abilities in end-of-life care. You will find many evidence-based and free resources at the End-of-Life Essentials website www.caresearch.com.au/EndofLifeEssentials. 

Next Newsletter

August 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

 

End-of-Life Essentials is based on the Australian Commission on Safety and Quality in Health Care’s National Consensus Statement: Essential elements for safe and high-quality end-of-life care, and the Commission provides ongoing advice to the project.

End-of-Life Essentials is funded by the Australian Government Department of Health

Copyright © 2016 CareSearch, palliative care knowledge network project, All rights reserved.


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