Sharing Current Scottish Practice

Poster abstracts of the month: August

The SPPC Annual Conference in 2014 featured 40 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on:

The Role of an Occupational Therapist and Physiotherapist with a Hospital Palliative Care Team: An Impact Assessment

The Role of the Social Worker in Palliative Care

The Use, Effectiveness and Acceptability of Telemedicine Interventions in the Provision of Palliative Care in Rural Populations

This Is Me

Understanding the barriers to identifying carers of people with supportive and palliative care needs in primary care

The Role of an Occupational Therapist and Physiotherapist with a Hospital Palliative Care Team: An Impact Assessment

Author(s) of poster: Rosemary Cairns, Michelle Lennox, Lesley Goodman

Funded from Macmillan Cancer Support, this is a three-year project looking at the addition of an Occupational Therapist (OT) and Physiotherapist (PT) to an already established hospital palliative care team of nurses, doctor, social worker, pharmacist and complementary therapist. Inspiration for the project came from complex patient discharges. The team wanted to explore what difference there would be by having an OT and PT educated specifically to a specialist palliative care approach. Both the OT and PT brought a wealth of knowledge and experience to the service and in turn they have gained an enormous amount. For example enhanced communication skills to enable advance care planning discussions, the ethos of thinking ahead and recognising the individual needs of patients to a specialist level. A key role is to liaise with generalist OTs and PTs and provide advice to support palliative care patients. Both the OT and PT are now studying towards the Graduate Certificate in Palliative Care.

The Role of the Social Worker in Palliative Care

Author(s) of poster: Kirstie Barke, Social Worker, University Hospital Ayr; Josaleen Connolly, Macmillan Project Lead, NHS Ayrshire and Arran

Social workers operate within a multi-disciplinary team and assess individuals care needs and where possible offer practical solutions. Social workers operate within the local community and the hospital setting however they are not trained in specialist palliative care. I have undertaken a distance learning degree module with the University of the West of Scotland – Practical Palliative Care. This module gave me an opportunity to increase my knowledge in palliative care and provided me with 5 days shadowing various members of specialist palliative care teams in the hospice, hospital and the community. My experiences of this programme have included learning more about the importance of communication between different disciplines and that palliative care is not only applicable in the care of patients with a malignant disease diagnosis. I have increased my knowledge and understanding of recognising when palliative care can be of benefit in advanced diseases as well in the management of common symptoms including pain. I have gained insight into the advantages of advance care planning and I also have a better understanding of bereavement services and the services and support that are available.

The Use, Effectiveness and Acceptability of Telemedicine Interventions in the Provision of Palliative Care in Rural Populations

Author(s) of poster: Zoe McQueen, Anne Finucane, Claudia Pagliari

Inequalities in the provision of palliative care have been well-documented between urban and rural populations, with rural areas experiencing poorer accessibility to specialist services. With increasing prevalence of chronic conditions, this disparity will only increase, and it is, therefore, essential to find methods which will enhance available resources. Telemedicine has been a proposed solution. The aims of this systematic review were to identify the use of telemedicine interventions within palliative care in rural settings, assess their effectiveness, and identify provider and user acceptability, to then inform and guide service development in Scotland. An electronic search of MEDLINE, EMBASE, PsychINFO and CINAHL was performed. A total of 3112 papers were identified and 16 papers were included in this review. A range of telemedicine applications have been found to be effective and acceptable and there appears to be a perceived need for telemedicine across palliative rural communities in Scotland. However, there is lack of evidence besides users’ subjective perceptions. Future research needs to move from qualitative, descriptive studies to clinical trials in order to assess the effectiveness of these interventions. To optimise their use, the needs of the targeted populations must be assessed and each specific intervention tailored accordingly.

This Is Me

Author(s) of poster: Stirling, I., Baird, L., Campbell, S., Carmichael, L., Cassidy, M., Follett, M., Irvine, F

Critical reflection on two MND case studies highlights how communication difficulties threaten the quality of care. Further reflection and a review of the literature by the multidisciplinary team emphasises the need of a person-centred document, ‘This Is Me’; which enhances the scope and depth of communication between patients, their families and the multidisciplinary team from the time of initial diagnosis through to end of life care. The ‘This Is Me’ document is developed, and piloted across all areas of the organisation to enable timely conversations to take place, key information to be shared, improve collaboration in decision-making, create solid foundations for care plans and offer person-centred care.

Results: On-going evaluation, using both questionnaires and interviews, so far indicates the positive benefits of ‘This Is Me’ as a communicative tool throughout the illness trajectory. It is being used in the community, in day services and in the In-Patient Unit.

Conclusion: The ‘This Is Me’ project is enhancing the depth of communication between patients, their families and the multidisciplinary team within the Ayrshire Hospice. ‘This is Me’ allows staff, patients and carers to enjoy timely conversations, share key information, improve collaboration, create solid and offer person-centred care.

Understanding the barriers to identifying carers of people with supportive and palliative care needs in primary care

Author(s) of poster: Emma Carduff, Anne Finucane, Marilyn Kendall, Alison Jarvis, Nadine Harrison, Jane Greenacre, Scott Murray

Background: Caring for someone at the end of life can be physically and emotionally demanding. Carers are often ambivalent about their own needs and are reluctant to self-identify as a caregiver in need of support.

Aims: To explore the barriers to, and strategies for, identifying carers of people at the end of life in primary care, and to understand why carers do not self-identify. Methods Literature review, synthesis of data from previous research, and focus groups with carers and health professionals.

Results:

1.Transition into the caring role was a gradual process and carers did not necessarily identify with being a ‘carer’, meaning support was often initiated in response to a crisis.

2.As the patient deteriorated, caring was all-encompassing meaning that carers were managing competing demands and prioritised the needs of the patient, often at the expense of their own.

3. GPs were perceived to lack knowledge about available services and their reactive approach meant carers were less likely to see their needs as legitimate and ask for help.

Conclusions: Strategies to identify and support carers need to be commenced early in the illness trajectory to prevent crises. Primary care teams need to work together to ensure that carer’s needs are legitimised so that they are empowered to self-identify.