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Making the best of hard times

Annual Conference 2017

Wednesday 20th September 2017, Royal College of Physicians Edinburgh

The Scottish Partnership for Palliative Care Annual Conference took place on Wednesday 20 September, at the Royal College of Physicians, Edinburgh. The full programme for the day can be viewed here.

A recording of the day is available, with huge thanks to Catriona Forrest of the University of Glasgow End of Life Studies group: Conference 2017 film

Introducing the conference, Chief Executive Mark Hazelwood explored the multiple layers of meaning suggested by the title, referring both to the hard times people naturally experience at the end of life, and the hard times currently being faced by those working in the sector with declining resources and increasing pressures. Referring to Prof David Clark’s book To Comfort Always, he reminded delegates of some of the wealth of Scottish contributions to the field of palliative care over the last 170 years.

Exploring the Experience of Serious Illness

Professor Havi Carel

Opening speaker Professor Havi Carel gave a presentation “Exploring the Experience of Serious Illness”. Speaking via video link from Bristol University, the philosophy professor characterised the relationship between philosophy and illness as a two-way street: philosophy is a tool that can help people throughout their illness; and philosophers can learn much from the experience of illness.

Drawing on her personal experiences with breathlessness, Prof Carel suggested that illness can offer an opportunity for philosophical growth and education, strengthening characteristics like patience and reflection.

She highlighted that breathlessness is a symptom with symbolic significance, with breathing often used as a metaphor for life and death (as in phrases like “breath of life”, “to the last breath”). She explored the experiential side of breathlessness, namely how a person’s world shrinks and becomes hostile, and how breathlessness restricts choices and can curtail activities.

Professor Carel’s research project Life of Breath can be found here: https://lifeofbreath.org/

Sharing Knowledge, Sharing the Load
Dr Jeremy Keen

Dr Keen, Consultant in Palliative Medicine at Highland Hospice opened with an exploration of his own personal feelings of helplessness as a doctor in the face of death. Doctors cannot stop someone dying, so how do they live with that “incompetence”? Punctuating his presentation with powerful quotations from Ivan Illich and Stephen Jenkinson, Dr Keen spoke of the pressures the medical profession feel to measure the effectiveness of what they do. Could a focus on outcomes move practice of palliative care to what can be measured, rather than what is important?

Dr Keen moved on to explore how he as a palliative care doctor could support others dealing with end of life care situations, sharing Highland Hospice’s experience with knowledge sharing network Project ECHO. Project Echo uses tele-mentoring across a community of practice to share support and expertise across Highland region. Video testimonials illustrated that a range of heath and social care professionals across the Highlands are finding the project of huge benefit to their confidence and the quality of care they’re able to provide.

Jeremy Keen's PowerPoint slides are available here: Jeremy Keen's presentation

Death and dying at the frontiers of medical possibility
Dr Nazir Lone

After the break, Dr Nazir Lone, Critical Care Doctor with NHS Lothian, spoke on “Death and Dying at the Frontiers of Medical Possibility”. Around 12 percent of deaths in Scotland occur in critical care – higher than the percentage of deaths that take place in hospices. Critical Care specialists are habitually faced with the need to make difficult decisions, working under time pressures that make it hard to have in-depth complicated and important discussions with patients and families. These conversations are often made more difficult by unrealistic public preconceptions and expectations about outcomes drawn from the mass media. There is a need for more public awareness and education and the work of Good Life, Good Death, Good Grief is an helpful part of this.

Highlighting research done by himself and others, Dr Loan explored the consequences of ‘surviving ICU’ – though over 80% of patients leave ICU alive this does not mean that they leave ICU in good health. Many people’s lives are forever changed by the event that brought them to ICU, including their ability to work and support themselves, and this can have knock-on effects for their family. The ICU experience can also have a negative impact on families - almost half of the relatives of those who die in ICU exhibit symptoms of PTSD.

Awareness of these wider effects are important for healthcare professionals who both want to support people to make the right decisions, and to create an ICU experiences that minimises the negative long-term effects for patients and their families.

Nazir Lone's PowerPoint slides are available here: Nazir Lone's presentation

How is it for you? Exploring realities and practicalities where integration meets palliative care

Diana Hekerem

In the final pre-lunch session, Diana Hekerem, Head of Strategic Commissioning Support at Healthcare Improvement Scotland explored Strategic Commissioning in the context of palliative and end of life care. Making use of digital polling equipment, the session was fully interactive – delegates responded to a series of questions asked by Hekerem, and graphs of responses were immediately displayed on the big screen. Within the session Hekerem explored delegate’s understanding of strategic commissioning jargon, their thoughts on how to measure success in palliative care, and their priorities for spending money. She urged delegates to become actively involved in working to influence the strategic commissioning process.

More information can be found on the ihub site here: http://ihub.scot/strategic-commissioning-improvement-support/

Diana Hekerem's PowerPoint slides are available here: Diana Hekerem's presentation

Breakout Sessions

Following lunch, delegates had an option of different breakout sessions. Dr Jo Bowden discussed findings from research into improved care for people with lung cancer in Fife; Dr Robby Steel considered “Who is really using services and what do they actually want?”; Susanne Gray, Dr Katie Clark and Joyce Dunlop shared learning from their project on community care service provision; Dr Georg Bollig from the Hospital of Southern Jutland introduced the concept of the Last Aid course.

PowerPoint slides from the breakout sessions are available here:

The People’s Poster Prize was then awarded to Sharon Lambie of NHS Greater Glasgow and Clyde for her project: Do cloth bereavement bags make a difference when handing back patients’ belongings to bereaved relatives/carers compared to the current plastic bags within the acute hospitals across NHS Greater Glasgow and Clyde?

Speaking up or acting out? On advocacy, marginalisation and ethical practice
Professor Deborah Bowman

The closing speaker was Professor Deborah Bowman, Professor of Medical Ethics and Law at St George’s University of London. She used her extra-curricular interest to draw an analogy between the worlds of theatre and healthcare. Among the similarities she noted were the unspoken conventions and norms that surround both endeavours. Both are also tied up with notions of meaning and identity.

She went on to explore issues of marginalisation and advocacy within that framework. For instance, she observed that in theatre, as in medicine, there are multiple perspectives on the shared experience. In life as in theatre we are all restricted in our view by the particular experiences, thoughts, interests and prejudices we bring with us.

Deborah Bowman's PowerPoint slides are available here: Deborah Bowman's presentation

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