Great news for WA palliative care folk, with one of the big names in palliative care visiting Perth as part of National Palliative Care Week 2018. Dr Puchalski will be appearing at free events for the public and for those working in palliative care, thanks to the PaSCE team from Cancer Council WA. See below for more details, via PaSCE:
The Palliative and Supportive Care (PaSCE) team, from Cancer Council WA, is delighted to bring Dr Christina Puchalski to Perth, Western Australia from Washington D.C., USA during the 2018 National Palliative Care Week. We hope Dr Puchalski’s visit to Perth will enable WA health professionals to learn more about the science of spirituality and the integration of spirituality in their practice.
One sign of a good conference is when weeks after the conference (and beyond), it inspires you and changes your practice. The Australian Palliative Care Conference closed in Adelaide more than two weeks ago and I am still digesting the (at-times challenging) content from the plenary sessions, panels and breakout presentations.
If you were unable to attend the conference, or would like to revisit the many excellent presentations and themes, luckily Marie McInerney from Croakey was there to provide excellent reporting, with ten articles about the conference. You can even catch up on the conference tweets in her reports (including some from Team Palliverse).
Catch up at the Croakey site (and keep reading for the rest of their excellent Australian health coverage).
“Hippocratic is a feature-length film exploring the life story of this acclaimed Indian physician, Dr MR Rajagopal. From cowardly child to fearless visionary, this compelling tale sees its hero come full-circle to rediscover the first principals of medicine.
This exquisite first-person account tells the story of an extraordinary global health leader in Dr MR Rajagopal, or Dr Raj, who is described by the New York Times as ‘the father of palliative care in India’.
Dr Raj is a small man with a big dream: a pain-free India.
His mission is to bring ethical practice to modern medicine through whole person care. To achieve this he must provide universal access to essential, and heavily restricted, pain medicines.
Hence, this spiritual leader of ethical medicine now shares the story of his life’s work. Reflecting on effecting change and relieving unnecessary human suffering in a country of 1.25 billion people, almost one sixth of the world’s population.Continue reading →
Delirium is a favourite topic of ours at Palliverse – it is experienced by many people with palliative care needs, including at the end of life, and is often distressing to the person, their loved ones and health professionals providing care. Despite this, it remains poorly recognised, underdiagnosed and poorly treated – not least because the evidence base is still growing.
They have suggested some Actions to Take on #WDD2017. I’ve listed them below & with some thoughts on how to take action.
Commit to using the term ‘delirium’
If you hear someone using terms like “agitated”, “restless”, “aggressive” or “pleasantly confused”, think – could this be delirium? I use the term delirium, document it and make sure it’s communicated in the medical record and letters. Recognising and diagnosing delirium allows us to educate patients and their loved ones, as well as providing the best delirium care possible.
Screen your patients for delirium
People at risk of delirium, who should be screened, include those with serious illness, those aged over 65 years and those with underlying cognitive impairment. This includes many of the people cared for by palliative care services! The diagnosis of delirium may be missed, delayed or misdiagnosed without screening, as signs may be subtle (especially in hypoactive delirium). There are multiple simple bedside screening tests for delirium, and although not all these have been validated in the specialist palliative care setting, they are still useful. The 4AT is a freely available screening tool that can be administered by any health professional and does not require training.
Listen to patient and family stories about the experience of delirium
What may seem “pleasantly confused” to staff members can be very distressing for the delirious person and their families. Being agitated, aggressive or “just not themselves” can be distressing for patients and families to witness – it is important to acknowledge these emotions and provide education about delirium. (See “Michael’s Story: the fear on his face was palpable” for a wife’s experience of her husband’s undiagnosed delirium.)
Engage your leadership in a discussion of delirium
If the above isn’t enough to convince your leadership to take note, delirium also increases the risk of health care complications like falls, pressure injuries, prolonged length of stay, and mortality. For those in Australia, World Delirium Day is a great time to introduce your leadership to the recently released Delirium Clinical Care Standard (which we’ve covered here before).
Educate health professionals about delirium
Delirium does not “belong” to just one group of health professionals or one specialty. It’s common, especially in palliative care, and important for us all to know about it. Some of my favourite educational resources are freely available at the Scottish Delirium Association, plus this 5-minute video from UK-based Delirium Champion Dr MS Krishnan. (I’ve shared this before but it’s worth sharing again!)
As a final bid to raise awareness, you can participate in a #WDD2017 Thunderclap via your Facebook, Twitter or Tumblr account, to alert your friends and followers to the importance of delirium.
Excellent writing from Kate Swaffer, with links to some of her previous posts. Her blog is essential reading for anyone who works with people living with dementia.
World Dementia Council members 2016
It is already mid January 2017, and I’ve not yet posted a blog, so am hoping to rectify the today! I started this ages ago, but have had trouble paddling since December so have not achieved very much at all. Anyway, it may be worth looking back and reflecting as we prepare for yet another year. The years certainly fly by so quickly as one gets older, which I wrote about many years ago, but cannot find that particular blog.
As I have a lot of new followers of this blog, I thought I’d highlight a few from over the years (easier than writing a new one, by the way!). The grief of dementia is one of the most unspoken of topics, not our grief families feel as we change and lose function, then die, but the grief we feel as we lose capacity and as our abilities change to disabilities, and we are…
Grief and loss is something we will all face at different times throughout our lives. Whether it is the death of our pets, our friends, our children, siblings or parents; the experience and expression of grief in response to these losses can be a very personal and individual thing. Grief can also arise in anticipation of loss. For those living with life-limiting illness, living with the loss of social role and professional identity can be especially challenging.
Thoughts about old, new and future losses can be particularly common during the festive season. For some of us, it may represent an anniversary of the death of a loved one, and bring with it painful memories of loss. Some might be facing their first Christmas ‘alone’, while others may be grappling with the possibility of celebrating their ‘last Christmas’.
While living with grief and loss is a personal experience, we don’t have to endure it on our own. As a community, there are many ways that we can support each other. Join Palliverse and Palliative Care Australia CEO Liz Callaghan (@PCACEO) to reflect on 2016 and talk about grief and loss.
Carers and people with palliative care needs are especially welcome, as are health professionals, researchers, policymakers and interested community members!
Delirium robs dying people of their autonomy, dignity and last conversations with loved ones, at a time when every moment is precious.
Symptoms are highly distressing to experience and watch. Confusion, incoherent communication, poor attention, agitation, drowsiness and hallucinations are some markers of this common complication for people dying in hospital from cancer and other advanced illnesses. On average one in three people in end-of-life hospital care are affected.
Doctors commonly prescribe antipsychotic medications to try to relieve these symptoms. However, our study just published in JAMA Internal Medicine, raises serious concerns about their safety and efficacy.
So, what are we to do for people experiencing delirium, who are robbed of their mental awareness and ability to communicate?
Kasia’s research aims to improve sustainable acute care health delivery for an ageing population, while her clinical experience includes general medical and acute palliative care. In her PhD, Kasia developed an approach to measure nurse-sensitive outcomes, which is currently being used to evaluate a Government-funded implementation of a cognitive identifier. Kasia has a passion for identifying and researching the structures and processes which impede or enable quality patient care, and sharing her learning and inquiry with nursing students, industry and professional groups. Here, Palliverse asks her about her latest research project and dipping her toe into the world of social media.
Dr Kasia Bail (image via Dr Bail)
Your research has led to a new concept in the care of older people with complex medical problems, “Failure to Maintain”. What does this mean?Continue reading →
Here are the first ten tips that came to mind for the management of delirium in specialist palliative care.* Of course, there are many more to list. Please share your top tips in the comments. Continue reading →
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