David Oliver’s recent blog in the BMJ End of Life Care in hospital is everyone’s business, reports on the findings of the recent Royal College of Physicians Audit into End of Life Care. The two main findings, a need to increase the number of specialist palliative care doctors and specialist palliative care nurses in hospital and to ensure that newly qualified doctors have more knowledge and confidence dealing with end of life situations, match the aims of our recently established charity PATCH Palliation And The Caring Hospital
PATCH is presently a Scottish charity but the issues are the same throughout the UK. It was inspired by the Acute Palliative Care Unit in Ninewells Hospital, Dundee. This was established in 2009 with charitable money but is now NHS funded. Based on ten-year hospital palliative care team data, we believe there is a population of patients in a busy acute hospital who benefit from an intensive palliative care approach from a number of disciplines including social work, occupational therapy, physiotherapy, pharmacy, spiritual care, and pain service in a dedicated on site unit.
Some returned to their parent ward perhaps to continue treatment and 40% of patients were able to go home with properly organized support. As 36% of patients lived alone, if local community services were not available, going to a nursing home, community hospital or a hospice was arranged. Crucially, nurses and doctors, junior and senior can see for themselves what palliative care offers in a busy acute environment.
It is also a teaching resource going some way to allay fears surrounding palliative care. The first time I accompanied a palliative care nurse speaking with a patient, many years ago when I was quite a senior doctor, I felt really uncomfortable. This was not the sort of conversation I had ever had before – she asked the patient what he understood was happening and then gently explained what the doctors were thinking. He was upset, I thought everything was unraveling. But it didn’t and the patient and family were very appreciative and were able to plan for the future. I needed help to see this and to show me how.
This model promotes joint working between specialists. Patients and families benefit from this close collaboration and palliative care specialists have much to learn from other specialists. Overall it raises the profile of palliative care in hospital. See Palliation and the caring hospital – filling the gap.
The lessons learnt from the Unit influenced PATCH. The Unit as a model of care, works in Tayside but other places have different services in place as well as different staff, management, and personalities. PATCH encourages applications from people “on the ground’ who see how palliative care could be improved in their own hospital.
We have funded hospital nurses to do MSc’s or graduate certificates in palliative care; part-funded a Research General Practice trainee to study the reasons for patients with advanced cancer being admitted for pain out of hours supported a further GP trainee to develop an App to assist the conversion of opioids and fully funded a communications course in the Clinical Skills Unit, University of Dundee to improve the young doctors’ confidence speaking with relatives of a seriously ill family member.
In 2015, we launched Scottish – wide and are now working with hospices and specialist palliative care services in two other regions to develop short training courses for nurses in the acute setting. These courses involve palliative care staff and hospital staff working by the bedside so that training is relevant to the difficulties faced in a busy acute ward Presently the majority of patients referred to palliative care have cancer. It is often harder to know in non-cancer conditions when any potential benefit of treatment may outweigh the burden. Such complex areas may benefit from the approach described in The Opposable Mind by Roger Martin [Martin RL. The Opposable Mind, Harvard Business School Press 2007] i.e. holding several apparently opposing views simultaneously. In this case the patient may get better but there also may be some benefit in discussing their care with a palliative care specialist. PATCH welcomes applications from all specialties if there is a potential project which may make a difference e.g. Medicine for the Elderly, Intensive Care, Accident and Emergency.