Delirium update at #ANZSPM17 Update

delirium @#ANZSPM17

We think delirium is a pretty big deal here at Palliverse, having devoted quite a few blog posts over the years to discussing this important issue in palliative care.

Well, delirium will be the focus of the first session at the upcoming 4th Australian and New Zealand Society of Palliative Medicine (ANZSPM) Medical & Surgical Update for Palliative Medicine (#ANZSPM17), which will be held between June 23-24th at the Royal Children’s Hospital, Melbourne, Australia.

Chaired by @Meera_Agar – the lead author of the seminal paper examining the role of antipsychotics in the management of delirium symptoms in the palliative care setting, which was published in JAMA Internal Medicine earlier this year – the session will feature presentations from Professor Agar, as well as:

  • Dr Simon Allan, palliative care physician, Director of Palliative Care at Arohanui Hospice in New Zealand and the current President of the Australasian Chapter of Palliative Medicine, the Royal Australasian College of Physicians,
  • Dr Chris Moran, geriatrician from Alfred Health and research fellow at Monash University, and
  • Dr Justin Dwyer, psychiatrist and Medical Director of the Psychosocial Cancer Care service at St Vincent’s Hospital, Melbourne.

After the presentations, a panel discussion involving the speakers will offer the audience plenty of opportunities to further explore this hot topic in palliative care.

Of course, delirium is just one of the many great topics that will be examined in detail during the fourth iteration of this biennial meeting. To find out more about the #ANZSPM17 Update, and to take advantage of the early bird registration rate until May 24th, go to: https://willorganise.eventsair.com/QuickEventWebsitePortal/2017-anzspm-update/update

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Advance care directives, palliative care, and euthanasia

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[Image by Nick Youngson]

Why do palliative care people bang on about advance care planning all the time?

Well, when you break it all down, advance care planning is all about respect. Respecting the values, goals and preferences of the person making the plan. And palliative care is really big on respecting people’s preferences and values, especially when it comes to their end-of-life care.

Unfortunately, when it comes to respecting people’s choices around their health care, the law has been lagging behind. Existing laws around advance care plans and medical decision making are often confusing for patients and families, as well as their treating clinicians. Fortunately, this is all about to change in Victoria.  Continue reading

‘Be Open. Be Ready. Be Heard’. New Online Education Resources available from Advance Care Planning Australia.

Have you checked out the new online education resources available from Advance Care Planning Australia?  If not, read on…

Continue reading

Raise awareness for World #Delirium Day 15 March 2017

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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.

iDelirium, a federation of the Australasian Delirium Association, European Delirium Association and American Delirium Association, has launched World Delirium Day (#WDD2017) in an attempt to raise awareness of delirium and improve its management.

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.

Healthcare communication – A network for our region

Palliverse was lucky enough to be present for the excellent Teaching communication in Healthcare conference in Melbourne hosted by the Cancer Council Victoria last December.  At this conference multiple members of the European Association of Healthcare Communication including Jonathan Silverman and current president Evelyn Van Weel -Baumgarten joined local representatives of EACH Peter Martin and Megan Chiswell.
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During the event the key message was of the importance of communication skills to be able to provide care that is patient-centred, empathetic, safe, ethical, efficient and high-quality.  Unlike many other clinical skills communication is also largely universal in that it is practiced by clinicians in all encounters.  Supporting communication skills education is therefore a critical way of improving the quality of care provided by our healthcare system.

Continue reading

free Australian webinars on advance care planning and palliative care

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Decision Assist is running a series of free webinars on advance care planning and palliative care.

For those of you new to webinars, you can watch the presentation live on the internet and interact with the presenters, or just watch the presentation later. Some health services and aged care facilities are watching them together as part of their continuing professional development or education programs.

Here is a link to register. The next one is presented by Ilsa Hampton, CEO, Meaningful Ageing Australia

Decision Assist Aged Care Webinar Series – Grief, trauma and loss
Tuesday 6 December 2016 | 1.30 pm – 2.15 pm AEDT

http://www.webcasts.com.au/decisionassist061216/

Regards, Sonia (who also works for Decision Assist!)

 

#4APCRC: 4th Australian Palliative Care Research Colloquium

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Members of team Palliverse had the pleasure of attending the 4th Australian Palliative Care Research Colloquium between October 27-28th, which was once again held in the comfortable surroundings of the Rendezvous Hotel in Melbourne, Victoria.  Continue reading

THE 5TH VITAL SIGN: PREVENTION AND MANAGEMENT OF ACUTE AND CHRONIC PAIN WORKSHOP

Palliative doctors and trainees and those interested in pain management might want to check out the upcoming pain management workshop at the shiny new Victorian Comprehensive Cancer Centre.

“This workshop is ideally suited to general practitioners, perioperative physicians, anaesthetists and pain specialists who seek an update on evidence-based management of acute pain in the perioperative setting. We will also highlight the latest research aimed at reducing the transition of acute pain to subacute and chronic pain and its associated morbidity.”

For more information see here 

Saturday, November 12th 2016

Peter MacCallum Cancer Centre,
Victorian Comprehensive Cancer Centre,
Melbourne

I think therefore I am/Palace of Care – Hospice New Zealand 2016 Conference Keynote Presentation

Hi everyone,

Here is a copy of my slides from the Keynote presentation that I made on 16/09/16 at the Hospice New Zealand 2016 Conference.

I was intentionally being provocative and I was purposefully trying to challenge the audience’s mindset with the material that I presented, as I believe that New Zealand Hospice/Palliative Care needs to be “shaken up,” if it is to remain relevant. Now it’s your turn, you have been warned…

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I am working on a version which will have clickable links, and also on a recorded live performance of the presentation. In the meantime the slides with comments have been loaded onto the Palliverse Instagram account.

Cheers,

James

#ANZSPM16 Wrap up

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Days two and three of the Australian and New Zealand Society of Palliative Medicine (ANZSPM) 2016 Conference: The Changing Landscape of Palliative Care was just as brilliant as the first. The plenary sessions featured:

  • Merryn Gott (@MerrynGott) spoke about the ‘last taboo’ in our community: the invisible and sometimes unexpected costs of providing care at the end of life, which are often not explored in clinical and almost never measured in policymaking and research. She also discussed  the impact of culture, ethnicity and gender on who is bearing these financial and non-financial costs. To find our more, read her open access @PalliativeMedJ article here.
  • Meera Agar (@meera_agar) discussed the growing evidence base around delirium care in the palliative care setting. Management of this complex, distressing, life-threatening, but often reversible syndrome is challenging. Non-pharmacological strategies and a system-wide approach to organizing and delivering care are crucial, as research into various drug treatments continue to demonstrate a lack of clear benefit and the potential for harm. Meera recommends iDelirium for more information about this important area of palliative care.
  • Pippa Hawley reflected on the lack of evidence around the use of medicinal cannabis – despite the immense interest from (and considerable experience of) our communities. How should clinicians respond while the scientific and legal issues are sorted out? Ask questions, keep an open mind & work with our patients!
  • Douglas McGregor explored the interface between heart failure and palliative care. He referenced Sarah Goodlin’s open access article, Merryn Gott’s study while discussing prognostic uncertainty and clinician paralysis; and observed that most guidelines still see palliative care as relevant only at the very end of life, rather than a key component of chronic disease management. Amy Gadaud’s (@agadoudreview was flagged as a good place to start when considering issues around early integration.
  • Sam Bloore stimulated and inspired delegates with his fascinating talk about dying well in a culture of bitcoin and botox. How can palliative care adapt, survive and thrive in this changing cultural landscape characterized by information overload, mindless distraction and incoherence? We must remain a “subversive” counterculture and continue to strive towards caring deeply and meaningfully!

In addition to these amazing plenaries, fully (and at times even over-)subscribed workshops on the overlap between palliative care and addiction medicine / chronic pain, aged care, literature and the arts were held, alongside numerous excellent oral and poster presentations from specialists and trainees. The enthusiastic and well-informed audience present during all of the sessions was another highlight for me (and I’m sure all of the other speakers and delegates)!

It’s been a wonderful few days in Perth. A big thank you to the Conference organizing committee, chaired by Derek Eng (@dr_engd), for inviting team @Palliverse to be part of this great event. Thanks also to all of you for engaging with #ANZSPM16 on social media. Keep an eye out for our upcoming tweet chats, during which we will continue the conversation about the changing landscape of palliative care!