Following on from the previous post on the importance of communication in health care – I noted another, slightly different article in the current issue of the Internal Medical Journal “Impact of providing patients with copies of their medical correspondence: a randomised controlled study”.
Firstly, its is refreshing to think that simple and practical tools such as this are being examined. As a consumer, I relish tangible information or products, as they provide ongoing reinforcement and guidance. This is especially true in a health setting, where I cherish every physiotherapy exercise sheet given to me – both as a reminder of my condition and a guide to potential improvement.
This trial examined the utility of providing consumers at an endoscopy clinic with written information in the form of clinical correspondence with the GP and procedure report, compared against routine care (no written information). The results demonstrated patient’s really valued the information; with almost all the patient’s wishing to continue receiving correspondence, perceived it improved their understanding of the disease, and slightly improved overall satisfaction. However this didn’t translate to improved health-related outcomes; with no improvement in anxiety or depression levels.
The information we usually provide to our patients is far more complex than an endoscopy report, and patients are often fatigued, distracted by pain and nausea, or may have limited English. Patient information may serve many purposes and provide value to consumers, and plays a particular role as a communique with carers and other health providers who may not receive more formal correspondence in Palliative Care.
We don’t expect patient information to cure anxiety or depression, but can it be a subjective good due to effects in empowering patients and carers? If consumers place value in something I believe it can translate to value to the health system, as only objective goods are stuck under the prime magnet on the fridge door. We may need to revise how we measure this.
How can we improve communication about medical treatment and future care?
The Journal of Clinical Oncology has published a paper about how we can have conversations about treatment decisions better. They found that patient coaching and question prompt lists were effective in improving communication.
Patients who had the one hour coaching session were three times as likely to ask about prognosis…. but discussions about prognosis were still rare and patients were often overly optimistic about their prognosis.
The intervention improved communication between oncologists and patients.
Most patients with advanced cancer say they want honest, sensitive communication about end-of-life issues. These conversations help patients and their families prepare, make informed decisions, and avoid potentially burdensome aggressive medical treatments near death.
Yet, patients are often misinformed about cancer survival and curability.
Those with over-optimistic prognosis estimates are more likely to die in a hospital and receive burdensome aggressive care that does not help the person.
Doctors often do not know their patients’ preferences about end-of-life issues.
The paper suggests that an intervention to improve communication around these issues was partly successful.
Having worked in (what were then referred to as) nursing homes whilst I was training,
I had often wondered about the implications of labels and terminology in the context of an aged care facility. For instance, did working in a nursing ‘home’ somehow diminish, in some eyes, a respect for the clinical skills required and level of care provided in this setting?
One of the most obvious distinctions to me at that time, was that for nurses ‘Betty’ was not a patient. Of course, she had a care plan, but she was a resident among a community of other residents. We espoused healthy ageing, ageing in place, and of course, our nursing care was underpinned by the principles of what we now refer to as a palliative approach.
Residential aged care is no doubt a complex area impacting profoundly on various social and health factors across different levels of our society. What feels like home for some residents, may not feel so homely to others. But how should health care professionals view aged care facilities? And do our Elders receive care appropriate to their needs?
I’m not convinced the answers to these questions are by any means straight forward. But I want to share what I found to be a very interesting and somewhat challenging read from Professors Jane Phillips and David Currow. It can be accessed freely from the journal Collegian here.
Palliverse is a fan of twitter and social media in general increasing awareness and uptake of palliative care. This analysis of search terms in twitter shows that awareness of palliative care looks to be increasing in the US, compared to in the UK where it is well established.
Internet search query analysis can be used to demonstrate the rapidly increasing public awareness of palliative care in the USA McLean, S., Lennon, P., Glare, P. BMJ Support Palliat Care. 2017; 0:bmjspcare-2016-001171v1-bmjspcare-2016-001171.
A lack of public awareness of palliative care (PC) has been identified as one of the main barriers to appropriate PC access. Internet search query analysis is a novel methodology, which has been effectively used in surveillance of infectious diseases, and can be used to monitor public awareness of health-related topics.
We aimed to demonstrate the utility of internet search query analysis to evaluate changes in public awareness of PC in the USA between 2005 and 2015.
Methods Google Trends provides a referenced score for the popularity of a search term, for defined regions over defined time periods. The popularity of the search term ‘palliative care’ was measured monthly between 1/1/2005 and 31/12/2015 in the USA and in the UK.
Results were analysed using independent t-tests and joinpoint analysis. The mean monthly popularity of the search term increased between 2008–2009 (p<0.001), 2011–2012 (p<0.001), 2013–2014 (p=0.004) and 2014–2015 (p=0.002) in the USA. Joinpoint analysis was used to evaluate the monthly percentage change (MPC) in the popularity of the search term. In the USA, the MPC increase was 0.6%/month (p<0.05); in the UK the MPC of 0.05% was non-significant.
Although internet search query surveillance is a novel methodology, it is freely accessible and has significant potential to monitor health-seeking behaviour among the public. PC is rapidly growing in the USA, and the rapidly increasing public awareness of PC as demonstrated in this study, in comparison with the UK, where PC is relatively well established is encouraging in increasingly ensuring appropriate PC access for all.
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 (email@example.com or firstname.lastname@example.org).
We hope you can join us for a great discussion about this important study!
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…
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.
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?