Tag Archives: #PALLANZ

Adapting to a brave new world. Telehealth in palliative care

Posted on by
Reply

We’ve certainly had a change in our practice of palliative care with technological developments and more recently, change has been accelerated by the pandemic.

This fascinating work by Palliverse’s very own Dr Anna Collins and teams at St Vincent’s Hospital, North Adelaide Palliative Care Service and Peter MacCallum Cancer Centre really accurately described what it’s been like for me working as a palliative care physician using telehealth. It’s been terrific for some aspects – we can quickly review the patient without having to drag them into hospital, preserving their energy and disrupting their lives less. However, I really struggle when patients are deteriorating and when they speak languages other than English as their first language.

Their research found that “palliative care patients and doctors at each site found telehealth wasn’t only acceptable (91 per cent and 86 per cent respectively) but also satisfactory (72 per cent and 65 per cent) in most situations.”

In their studies, “involving interviews and surveys of 130 palliative care patients and their doctors following a telehealth appointment, patients in rural and regional area reported telehealth as being highly satisfactory. Doctors too rated it highly satisfactory when a visual link (not just audio) was used, or if the appointment was for a routine review.

“However, patients were less satisfied when care goals or future planning were discussed, and doctors reported it as being less satisfactory when the patient’s condition was changing or rapidly worsening, or if patients spoke a language other than English.

“And both patients and doctors found telehealth unsatisfactory in the presence of changing or unstable symptoms, such as pain which required medication adjustment or change.
image of older patient speaking with a doctor on an iPad screen
Photo by Tima Miroshnichenko on Pexels.com

Safer Care Victoria and the Palliative Care Clinical Network hosted a webinar ‘Clinical Conversation Webinar: Adapting to a Brave New World – the role of Virtual/Telehealth in Palliative Care’

The webinar recording is now available on the Safer Care Victoria Clinical Conversation Webinar Series website.  

 

The Dame Quentin Bryce Palliative Care Nursing Research Fund – Applications are now open!

Posted on by
Reply

Applications are now open for The Dame Quentin Bryce Palliative Care Nursing Research Fund – a new funding opportunity created to support research into palliative care nursing. The funds are offered by the Centre for Palliative Care (c/o St Vincent’s Hospital) and the Department of Nursing, The University of Melbourne.

Existing scholarship holders are eligible to apply (though please check the terms and conditions of your scholarship before applying).

Applications close on 25th June 2022. Please see the website here for more information and send any enquiries to shs-research@unimelb.edu.au

My digital afterlife

Posted on by
Reply

Our lives are increasingly digitised. I remember when my grandparents died, we went through their paper phone contact book to find out who we had to call. Now, with everything from banking to social media taking place online, things have changed.

How can we prepare for our #digitaldeath, after our bodies have died? What will your #digitalafterlife look like? #EOLC #pallanz

Here is a link to an animated video https://youtu.be/9UOe7otnRDw

Sonia

Bedside Lessons – 8. Forequarter Amputation

Posted on by
Reply
Photo by Fausto Marqués on Unsplash

He was found on the floor after having fallen down while walking back from his bathroom. A human arm should not have been able to bend at the odd angle that his arm was in. He was in terrible agony and an ambulance was called to take him to hospital.

I met him the next morning on the post-acute ward round. Overnight he had his fractured arm operated on, and screws and plates had been installed in order to fix the broken limb. He needed help with toileting and needed help with feeding. His other limb had been affected by cancer some years ago and had been removed along with his shoulder in an operation called forequarter amputation. It was terrible luck that his remaining arm had been badly injured.

Continue reading →

Bedside Lessons – 7. DNA

Posted on by
Reply

Labels are easily applied to people but are not always appropriate. DNA – Did not attend is one of the commonest labels that can be given to patients and often no attempt to check their actual circumstances is actually made. DNA is a label that sticks to someone and can bias clinicians against patients without allowing them a chance to explain themselves.

Here’s a story about a patient that I met on a home visit many years ago which changed my thinking about the DNA label and labeling in general.

Continue reading →

Palace of Care – Unfinished Business

Posted on by
1
Photo by Firmbee.com on Unsplash

I don’t feel well. I’m having trouble breathing. I feel so tired, but all I do is sleep. I’m feeling too weak to walk to the toilet, I almost fell over last night.

The nurses told me that you’ve had bad pain, but that you didn’t want to take pain relief.

I need to finish sorting out my legal affairs, I don’t want to leave too much for my friend to have to deal with.

Our social worker can help you with that stuff, she can talk to your friend. What else is bothering you? You look worried.

Doctor, I think I don’t have much time left, I feel so terrible, I don’t even have energy to talk to my sisters back home. Why do I feel so bad?

You’re getting worse, it’s the cancer, your body can’t handle it anymore. I think you are dying, and you might only have days left to live.

I thought so, I just need to sort my stuff out…

Then you’d be able to let go?

Yes, I don’t think I can hold on for much longer.

I think I can make you more comfortable, putting up with pain will use up your energy even faster, and make you more tired. Can I increase your pain relief a bit? It might make you less tired.

Okay, if you think it will help.

We’re going to get you through this, and even if you fall asleep we will continue to try to make you comfortable. We’re going to get you through this. This is our social worker, she can help you with your stuff.

Thank you doctor.

Please let us know if there is anything else we can help you with. I’ll see you later.

[Wave goodbye]

Palace of Care – Lockdown Locks and Roadblocks

Posted on by
1
Photo by Mirza Babic on Unsplash

You really need a haircut.

Yeah, lockdown hair. I usually look different, like in my ID photo, I have a nose and a mouth under my mask.

So what do you want?

I’m here to find out how you are.

I can’t keep anything down, whatever I swallow comes back up. I’m too scared to eat anything. There’s something wrong with my poos too, haven’t been for four days, usually go twice a day. Last time it was black and sticky.

Do you have pain?

No, no pain but my tummy is getting bigger, sometimes it’s hard to breathe.

Hmm, listening to your tummy it’s very quiet on the left side, but loud on the right side. What do you think is going on?

I’m feeling worse, much more tired the last few days. What’s happening in my tummy?

We know that you have cancer in your tummy. It can act like speed bumps on a road, slowing down your gut traffic, that’s why your poos have slowed down. If there are enough speed bumps in your tummy they can act like a road block, then traffic can’t get through, and has to come back up, that’s why you’ve been vomiting. We can try to loosen up the roadblock with steroid medication, and we can try and push the traffic through with another medication, but…

But…Go on tell me, I need to know.

Continue reading →

I think therefore I am? – My Toe Con Dryer?

Posted on by
1
Photo by Braňo on Unsplash

Here’s a short story that I have shared with children of various ages who are losing or have lost their mothers.

Prior to Medical School I completed a Biochemistry degree. I learnt all about the important biochemical reactions that sustain life as we know it. Some of the most important reactions require mitochondria, which are present in each and everyone of our cells.

Mitochondria can be thought of as the power plants of each cell. They allow energy to be released, keeping each cell, and each person alive. Without mitochondria we could not live at all.

Another special thing about Mitochondria is that they were likely an introduced species, likely to have developed on their own. Millions of years ago they struck up a relationship with the rest of the cell, and the successful partnership has continued on ever since.

An interesting thing about mitochondria is that they are only passed onto the next generation by the female of the species. Thus in each cell of our bodies there exists a tiny part of our mother, our mitochondria, which if not present, we could not be alive at all.

This started when the very first mother passed on her mitochondria to her children, and from her female children to their children, right until the current day.

No-one can ever take mum away from you. Even though mum may be dying, she will live on in every single cell of your body, along with your memories of her.

Bedside Lessons – 2b. What Daisy saw.

Posted on by
Reply
Photo by Alejandro Ortiz on Unsplash

Hi everyone,

This was the result of a writing experiment in which I re-examined the case discussed in https://palliverse.com/2021/10/25/bedside-lessons-2-the-grandma/ from the point of view of a fictional 7 year old grand-daughter:

Grandma is my BFF by Daisy

My grandma taught me to read when I was only 4 years old.

She told me about alot of cool worlds.

We visit them in some of the games we play.

My grandma is my bestest friend fourever.

In the picture I drew of her she is wearing a cape.

That was when we played supa-heros together.

We had the funnest time ever.

I laughed so much I almost wet my pants.

You want to know a secret?

Grandma is my fave.

It was scary when Grandma got sick.
She had bad pain in her tummy, and was shivering then mum called 111.
I visited Grandma in hospital.
It’s a ginormous place.
The nurses were nice to me.
That doctor is a meanie.
She made mum and Grandma cry.
Something is wrong.
Was it me?

Continue reading →

I think therefore I am? – Clarification

Posted on by
1
Photo by Jeremy Bezanger on Unsplash

The following are my own personal professional views and do not represent those of my employer or of Palliverse in general.

I’m not interested in debating the pros and cons of assisted dying, everyone is entitled to their own opinions. In Nov 2020, 82% of eligible voters voted in the referendum, 65% of the voters supported the End Of Life Choice Act 2019. Aotearoa/NZ clearly stated it’s opinion last year, and in two days’ time it will become law.

I do not want my patients to be caught in the middle of two warring ideologies.

I am not here to argue, I am here to listen to my patient, I am here to learn from them. They are the expert when it comes to what they are going through and their suffering is defined by them, not by me.

I think that we in Hospice/Palliative Care need to build a bridge and get over ourselves. Our focus should be on our patients, not on ourselves.

Please treat patients with respect, they weren’t born yesterday, but they might die tomorrow.

Continue reading →