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Sharing Current Scottish Practice

Poster abstracts of the month - February

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:

Dining with Death Conversation Menus

DNACPR decisions in Lothian Care Homes

Educational Visit to the Crematorium for Hospice Staff

Enablers and Barriers to Volunteering in Care

End of Life Care in Liver Disease

Dining with Death: Conversation menus as a means of educating people about death, dying and bereavement

Author(s) of poster: Mark Hazelwood, Rebecca Patterson

There is growing consensus that palliative care encompasses a ‘health promoting’ element concerned with encouraging openness about death in society so that people are aware of ways to live and support each other with death, dying and bereavement.

A general societal reluctance to engage with these issues makes it harder for clinicians to initiate timely discussions with patients about their end of life care wishes.

However, finding ways to educate wider society in issues relating to death and dying can be problematic in a culture where raising these issues is variously perceived as too morbid, too difficult or too sensitive to mention.

This poster describes the Dining with Death menu and some of the settings in which it has been used, exploring its potential as an experiential learning tool to enable people to become more open about discussing death and dying.

The Dining with Death conversation menu is a folded piece of A4 card, printed with three ‘courses’ of suggested conversation topics, for example ‘Cremation or burial?’; and ‘What would be in your death plan?’.

It can be used to overcome barriers to engagement in death discussions, intriguing participants and engaging them in non-threatening conversations.


DNACPR decisions in Lothian Care Homes: An audit of current practice

Author(s) of poster: Alice Radley, Lesley Bull, Anne Finucane, Janet Dobie, Sarah Shepard, Marlis Plumb, Louise Wood, Juliet Spiller

Introduction: Care home residents are often frail with multiple co-morbidities. Advance Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are important in this context to help avoid inappropriate resuscitation attempts at the end of life.

Aim: To examine DNACPR decisions in care homes and compare with six good practice standards.

Methods: An audit of 160 residents from 48 care homes across Lothian, between April 2013 - March 2014. Notes of recently deceased residents in whom death was anticipated were audited.


• All audited residents had a DNACPR decision.

•No residents with DNACPR forms had resuscitation attempted prior to death.

•50% (n=80) of DNACPR forms had a documented review time frame.

•99% (n=159) of DNACPR forms were signed by a senior clinician within 72 hours of completion. 96% of these were signed by a General Practitioner.

•A clinical DNACPR decision was discussed with 68% of residents or their family.


•GPs play a central role in facilitating DNACPR decisions in care homes.

•Clearer guidance may be needed regarding the review of DNACPR decisions.

• Discussions with patients and their families about DNACPR decisions are sometimes documented but we highlight an urgent education need in light of a recent Court of Appeal judgement.


Educational Visit to the Crematorium for Hospice Staff

Author(s) of poster: Stuart Murdoch, Hospital Chaplain, Dr Erna Haraldsdottir

Background: It is well recognised that in order to care in an open and honest way for those who are dying and their families health care professionals need to be confident in speaking about issues related to the process of dying, and there are educational needs related to this.

Aim: Develop and deliver an education session, informing hospice clinical staff in relation to the actual processes of cremation to enhance their confidence and ability to support and inform patients and families who wish to talk about the option of the patient being cremated.

Methodology: Visits to the crematorium were organised for maximum 10 staff members per visit, with 39 attending in total lasting for 1 hour and evaluated with questionnaires after the visit.

Results: 19 participants filled out and returned the questionnaire. 17 responded that the visit was Very Informative, and 2 Informative. Key themes emerged were a greater understanding of the cremation process, increased confidence to journey with patient & family’s regarding the cremation process, dispelling myths and understanding of the cremation process, opportunity to explore own personal journey regarding death & dying.

Conclusion: It is evident that educational input around the post death process is highly valuable to staff in terms of building their confidence to journey with patients and their families at end-of-life


Enablers and barriers to the involvement of volunteering in care

Author(s) of poster: Ros Scott, Richard Carling, Jean Hindmarchx

Background: Together for Short Lives and Help the Hospices undertook a joint project exploring the future development of volunteering. As part of the project data was gathered from hospice professionals and volunteers on the barriers and enablers to the development of volunteering in care. This poster describes the findings and the outcomes of the project.

Findings: Responses highlighted a significant involvement of volunteering in care and a clear commitment to further development in this area. Barriers to the development of volunteering included, staff concerns, lack of resources, ability to deliver training to both volunteers and staff, and providing effective support and supervision. Enablers to the development of volunteering in care included: sharing policy, practice, experience and resources, national initiatives and the development of readily available training packages.

Outcomes: There is clearly a willingness to further develop volunteering in adult and children’s palliative care and some clearly identified requirements. A resource was developed based on these findings which combined guidance, signposting and an evaluation toolkit. Case studies from UK, Netherlands and Austria were used to illustrate throughout.


End of Life Care in Liver Disease

Author(s) of poster: Sally Lawton

The key to delivering appropriate palliative and end of life care is the identification, assessment, monitoring and planning of care. We wanted to know if this approach was being used for patients dying of chronic liver disease. The poster displays findings from an audit project that reviewed the notes of twenty patients. It also poses some questions for discussion within the liver service.

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