Watch the official opening of 23OPCC! There are speeches from special guests and Salvation Jane sings a cover of “We shall be known" - written by MaMuse. 

How do we create large-scale change in a complex system? The answer must include co-designing with users and building a change community. Prof. Hsien Seow will share 3 co-design principles from his palliative care research that will help you build stronger change communities and ultimately lead you to shape health care systems and improve outcomes for patients and families facing life-limiting illness.

 The demographics of living and dying continue to evolve rapidly even in high-income countries.  The social and health systems delivering care continue to be challenged as these changes manifest themselves. 

We will not have the community or professional workforces to provide care for many people who have life-limiting illnesses in the future. How we plan for and respond to these challenges is, arguably, the biggest issue facing palliative care services internationally.  

The challenge is in education (of friends, families, and health professionals), research (health services research defining the very best models of care especially in the context of emerging technologies) and systems delivery. 

Only an intersectoral approach is going to deliver the quality of care that the community has come to expect.  This will involve social services, health services, treasury, and our social security systems. This will still be in the context of the funding for palliative care having to compete against every other part of health for its core funding.  

The decisions that we make now will have far reaching effects into the care that generations ahead will experience. Careful evaluation of the optimal models of care and the outcomes we, as a community want to achieve, are urgent and necessary conversations.

Palliative care is an important medical specialty that is often ignored in LMIC like those in the Pacific region. However, despite this, the need for palliative care services remain present and pressing as burdening health issues overwhelm health systems in the Pacific. As Pacific Island nations try to meet the need of ageing populations, chronic conditions and the complications of rising non-communicable diseases within limited health resources opportunities, to ensure health workers are trained to navigate and address these needs are being sought. However, current specialty training programmes, including those for palliative care, require health workers from LMIC in the Pacific to travel to the developed countries that offer them for lengthy periods that put huge pressures on the health systems in the LMIC. From the perspective of Samoa, a Pacific Island nation that has unmet needs in the space of palliative and end of life care, I would like to open a discussion in how this model could be changed to support LMIC Pacific Island nations like Samoa obtain palliative care training for health workers in country in a way that is supported for success and sustainability with the help and support of our bigger brother nations in the Pacific.

The continuing trend of medical subspecialisation and major advances in technology mean that new treatment frontiers are crossed every day. Whilst these advances clearly benefit many patients, the downside is that the quest to “do more” in a narrow technical sense is commonly associated with incidence of non-beneficial, inappropriate and burdensome care interventions. With the best of intentions, narrow medical specialists often cannot see that achievement of a short term apparent technical success can be burdensome and lead to an unsatisfactory end of life experience. In part this is driven by the mistaken view that a successful clinician is judged largely be the delivery of potentially life prolonging interventions (whether or not they do in fact prolong life in a meaningful way).

I have previously argued that the required clinical leadership to, for example, not offer dialysis to a bed bound elderly person with dementia, needs courage and an environment where the holistic quality of care, including the best end of life care, is of equal value to other therapeutic interventions. Even in the area of oncology, which has largely embraced the palliative care paradigm, medical heroics are still often seen.

At a practical level, this value shift can be difficult to achieve in most acute clinical environments. Whilst engagement of palliative care services is increasing, it is often too late to be of material benefit and after a period of burdensome treatment.

One way to restore an holistic mindset to acute care decision making is to embed expertise from palliative care in selected acute medical units, rather than use this expertise as a referral of ‘last resort’. I piloted such an initiative before I left clinical Nephrology nearly 20 years, in frustration at some of the decision making of my colleagues. I am aware of similar pilots in General Medical units at times. Even the presence of a palliative care medical or nursing specialist at unit and divisional meetings can be reset the discussion and clinical decision making. 

A strong message to acute clinicians from palliative care is that the palliative approach is far more than specific interventions at the very end of life but rather one of symptom control and quality of remaining life, which can be a surprisingly long and rewarding period of time. 

This audience knows all this but the challenge is getting the message to the other players in the health system. Whilst the major benefit is improved quality of end of life care, the impact on the sustainability of the health system from limiting non-beneficial treatment is also substantial.

The need for high quality, accessible palliative care has never been greater. Our panel will discuss what it takes to design, deliver, and integrate quality palliative care into our health systems, and will share their insights and experiences gained over long careers in palliative care. Topics discussed will include the use of innovative approaches and technologies for improving care development, the role of primary care providers, the need for culturally appropriate palliative care and the requirements for creating and sustaining a qualified and experienced workforce.