Background 

Significant international research demonstrates the benefits of timely access to palliative care (PC) for patients with advanced cancer, including improved symptom management and quality of life. Care Plus is an integrated practice change, across four metropolitan tertiary public hospitals for specified advanced cancers, whereby all patients reaching the nominated trigger point (i.e. at diagnosis or relapse) is automatically offered an ‘extra layer of care’ with specialist PC services, alongside their usual oncology care. 

 

Aim 

To describe how Care Plus, a new PC referral pathway, was established within existing systems of a tertiary public hospital alongside the usual oncology service and the practice change challenges experienced by a PC nurse consultant. 

 

Methods 

PC clinicians, oncologists, patients and their carers, were invited to participate in individual, semi-structured interviews via Zoom or telephone, during the implementation phases of practice and post-practice change. Interview transcripts were thematically analysed by making codes with emerging themes via NVivo. Inter-researcher discussions and member-checking maintained rigour and validity. 

 

Results 

From June 2021 to June 2022, 18 patients received Care Plus at this specific site. A total of 11 interviews were completed, including four with patients and seven with clinicians. Integrated PC within usual oncology care fostered collaborative confidence and flexibility to address the complex care needs of advanced cancer patients, their families, and carers, and was well received by all participants. Prior to Care Plus, no on-site palliative inpatient or outpatient clinics were available to introduce the activities and benefits of early PC to patients and their carers. Care Plus has demonstrated a collaborative, feasible, flexible, scalable integrated PC pathway, fostering effective partnerships and confidence with the oncology service teams. 

 

Conclusion 

The Care Plus referral pathway provides access to timely & optimal PC to advanced cancer patients, their families and carers. 

Introduction: The NSW Clinical Excellence Committee describes M&M meetings as “a key opportunity for clinical staff to engage in the processes of patient safety and quality improvement”. It is widely recognised that patients receiving palliative care move frequently between care services including acute hospitals, community services and palliative care units. This results in multiple treating teams being involved in a patient’s care. Without collaboration in quality improvement activities such as M&M meetings, it is not possible to improve patient care in its entirety across different services. Despite this, M&M meetings traditionally occur within discrete services.

 

Method: After initial consultation with staff, including the formation of a working group with clinicians from across the acute hospitals, community and palliative care units, a Combined Service M&M Meeting structure was designed covering the geographic area of the Northern Beaches of Sydney. Bimonthly meetings were established with members from across all these services with a rotating chairperson. Other clinicians were invited to attend as appropriate. Any participant could escalate a case to the M&M meeting. Each meeting ran for one hour with two cases being presented to allow adequate time for discussion and feedback. A questionnaire was completed by participants assessing satisfaction.

 

Outcomes: In the initial 24 months a median of 16 participants attended per meeting. Cases presented were varied by team presenting and issue for presentation. Participants were satisfied with the format of the M&M and highlighted the benefits of increased awareness of external teams and improved communication between teams.

 

Conclusion: M&M meetings are increasingly recognised as a core component of quality improvement. Given the frequent movement of patients receiving palliative care across multiple settings, other palliative care providers could benefit from a regular M&M meeting across services.

Introduction: While a natural response to loss, the grief associated with bereavement following caring for someone dying at home, is often complex. Complexity occurs because the caring experience has often involved complete relinquishment of aspects of a prior life, high responsibility for extended time, extensive changes, and sometimes trauma.   

 

Bereavement recovery requires people to move through a major revision of their assumptions about the world, a reworking of their continued relationship with the person who died, and many practical and emotional adjustments, all quite dependent on their unique predeath experiences.  And many bereavement models do not adequately link the pre and post-death experiences. 

 

Aim:  To develop a bereavement model that assists carers in their bereavement into their experiences in a helpful and more wholistic way.

 

Method: When staff of a community-based palliative care service debriefed with each other, they collected feedback from what they were commonly hearing and developed a pictorial model to represent the layers of experience.  Bereaved carers provided comments at their sessions as the model was refined, until little new feedback was received.

 

This emergent model assisted the bereaved carer in gaining insight into their situation and facilitated their emotional expression. The normalising and affirming experience promoted the client’s adaptation to the transition and a healthier grief trajectory. 

 

Discussion: Many people respond to pictures, graphs and diagrams alongside language-based interventions, due to their learning styles and capacity for comprehension and engagement.  Visual tools like the Rollercoaster Model may assist those overwhelmed or suffering from high stress or trauma, to gain perspective, track progression, be reassured about what is ‘normal’, and to assist articulation of their experiences.

Conclusion: The Rollercoaster Model is a unique and useful therapeutic and educative tool to assist in supporting bereaved carers.

Background: Social Work (SW) is a crucial component of the Palliative Care Multidisciplinary team. It seeks to address psychosocial, emotional, and psychospiritual needs of a person with life limiting illness.

Research acknowledges that people may experience existential and psychosocial suffering, in addition to physical symptoms, at end of life. By identifying stressors early in a person’s health journey we are potentially able to reduce its impact on their end of life experience.

Our Palliative Care Social Work (PCSW) service identified gaps in effectively triaging and reaching those on their waitlist in a timely manner. Subsequently, some patients died before accessing the service.

Aim: To reduce the number of referred community patients on the waitlist from 20% to 10%, over a 3 month period.

Method: As a result of applying quality improvement methods, a standardized referral tool was developed. It adopts the Palliative Care Problem Severity Score, assisting in determining the urgency of referrals based on identified psychosocial stressors.

Education was provided to Community Nurses on the use of the tool, and the scope of the PCSW service. Pre and post surveys were conducted to ascertain participants understanding of the service, and confidence in referring.

Results: We tracked the number of referrals received each week, over the course of the project. 

With each intervention we noted an increase in referrals, however, also a steady downward trend of number of patient’s on the waitlist.

Over the 3 month period we were able to reduce the mean number of community patients on our waitlist from 20% to 7%.

Conclusion: Through the implemented interventions, we are able to determine level of urgency of referrals, and prioritise accordingly. With consistent use of these interventions, we anticipate continued equitable and timely access to SW services, contributing to enhanced quality of life for community palliative care patients.

Background: Shared decision-making is needed between consumers and clinicians to ensure care is ‘valuable’ and meaningfully improves peoples’ lives. Patient Decision Aids (PDAs) are clinical tools that support shared decision-making through: 1) stating the decision that needs to be made and appropriate options available; 2) discussing the potential benefits, harms and unknowns of each option; and 3) clarifying congruence between options and patients’ personal values. Evidence demonstrates PDAs lead to benefits for patients and carers however, widespread adoption has not occurred due to challenges in implementation.

 

Aim: To explore barriers, enablers and implementation of a generic PDA for use at the EOL.

 

Methods: Semi-structured interviews were conducted with multidisciplinary clinicians and consumers from various contexts across Queensland. Interviews were transcribed and analysed using grounded theory and interpreted in the context of the COM-B Framework and Behaviour Change Wheel.

 

Results: 17 clinicians (medical, nursing, allied health), and 15 consumers (patients and carers) from metropolitan, regional, and rural areas participated in a single confidential interview. Challenges identified included power imbalances in healthcare, and the need to tailor a PDA intervention to varying: 1) clinical scenarios (sudden and progressive decline); 2) levels of health literacy; and 3) desire to participate in shared decision-making. Respondents felt the PDA was best implemented within a bundled approach (clinical tools, education, support and resources) with emphasis on clinicians and consumers being empowered to draw upon the core principles of shared decision-making in any context. A range of practical approaches were identified to increase capability, opportunity, and motivation of clinicians and consumers to engage in shared decision-making.

 

Conclusion: Successful implementation of the generic PDA at the EOL is believed to be dependent on underpinning the clinical tool within a broader framework of shared decision-making to enable behavioural and cultural change.

The arts are predominantly used in palliative care as a therapeutic tool with both Music and Art Therapy being integral to many palliative care service offerings. The arts more broadly are not used so regularly. Visual, creative, performance and expressive arts have the capacity to bring people together, to create a safe environment, facilitate conversations and unlock people's creative selves. Using the arts in this way enables trust relationships to be established quickly, improve death literacy, encourage end of life conversations as well as enabling people to engage in creative pursuits that can improve their sense of wellbeing and connection to their communities. This presentation will explore a range of arts based approaches I have undertaken over many years including visual arts projects used with oncology staff, craft projects used with clinic patients, performance projects used as a health promotion tool for the wider community and a story telling project used to encourage participants to share their experiences of death and grief with an audience. The aim of the presentation is to demonstrate that you don't need to be a professional artist or therapist to utilise arts in health based approaches, it only takes willingness, partnership with artists and community arts organisations and creative thinking. The beneficiaries of these approaches are patients, carers, staff and the wider community as demystifying death and grief empowers people to have conversations, make plans and take control of their lived experiences.