[The following essay by Dr Adrian Dabscheck, an experienced palliative care physician in Melbourne, explores the evolution of our society’s views towards death and reflects on the role of palliative care and voluntary assisted dying in this context – Chi]
During a recent period of enforced rest, I had time to reflect on my attitude to the recently enacted voluntary assisted dying legislation in Victoria and consider my response.1 I will detail my reaction to the Act and why I have chosen to become a so-called conscientious objector.
In his essay Western Attitudes Toward Death,2 French historian Philippe Ariès illustrates the evolution of our attitudes to death.
Initially, and for millennia, there had been a general resignation to the destiny of our species for which he used the phrase, Et moriemur, and we shall all die. This was replaced in the twelfth century by the more modern concept of the importance of one’s self, and he used the phrase, la mort de soi, one’s own death. Continue reading →
07/12/17 – Update – Attendees please note that tomorrow morning in Auckland there will be a Railway Workers Strike meaning that road traffic will likely be much heavier than usual. We have asked attendees to arrive at 8.45am for a 9am start, please factor in the strike traffic delay when planning your travel for tomorrow morning. If you arrive early you can visit our on-site Cafe Totara for a fresh Barista-made coffee, with a range of fresh food available as well, all prepared on-site. An email update will be sent to attendees who have already registered.
Hi everyone,
Can healing occur at the end of life?
To whom does compassion need to extend to at the end of life?
These are the type of questions that will be explored in Totara Hospice South Auckland’s education centre this Friday morning, 08 December 2017 9am to 12pm.
We are privileged to be hosting two international speakers.
“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 →
Crazy Socks for Docs – by Dr Eric Levi @DrEricLevi
June 1st. #CrazySocks4Docs. But not just for Docs only. This day is for nurses, dentists, pharmacists, social workers, physiotherapists, psychologists, dietitians, speech pathologists, audiologists, respiratory therapists, anaesthesia techs, paramedics, medical students, veterinarians and all other specialties that work in the health care industry for patients. Continue reading →
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 →
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.
Delirium is a syndrome associated with a sudden change in a person’s mental function that interferes with their thinking and awareness. It is a common problem that confronts many patients, families and clinicians in the palliative care setting. Delirium usually develops as a result of a serious medical condition, which can often be found and treated. However, the symptoms of delirium – such as fluctuating confusion, reduced attention, disturbed sleep-wake cycle, and/or hallucinations – can be very distressing for everyone involved, and may persist for many days to weeks.
Medications – including antipsychotics such as haloperidol and risperidone – are often used to manage the symptoms of delirium. But do they actually work?
To join in on the conversation, you will need to sign up for a Twitter account
To find out more about how to participate, check out our guides here and here
What? We will be discussing the following topics during the journal club
Topic 1: Why was the study conducted? Are the study questions / aims relevant to you and/or your work?
Topic 2: How was the study conducted? What did you like about the study methodology? Would you have done anything differently?
Topic 3: What were the main findings from the study? Were you surprised by any of the study results?
Topic 4: Has this study changed the way you think about delirium in the palliative care setting? Why and why not? What’s next?
If you would like more information, or are having trouble accessing the paper, please feel free to contact us via Twitter (@Dr_Chi_Li or @palliverse) or by email (chi.li.australia@gmail.com or palliverse@gmail.com).
We hope you can join us for a great discussion about this important study!
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…
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 →
palliverse.com 