News
Anticipatory Care Plans reduce inappropriate hospital admissions
A study in this month’s British Journal of General Practice found that more use of anticipatory care plans in primary care helped to reduce unplanned hospitalisations by 52%.
Surveys show that when asked, most people say they would prefer to die at home, yet most people die in hospital. Admitting someone to hospital when they are dying can often cause additional stress and discomfort to individuals and their families at a most distressing time. Not only are such inappropriate unplanned hospital admissions unwanted by individuals and their families, but they are also extremely costly and put stress on NHS systems. Thus, finding ways of enabling people to stay at home in the last days of their life gives individuals and families what they want, while saving the NHS considerable sums of money.
In this study efforts were made to focus the extended primary care team around patients at risk of admission to hospital, aiming to enable people to be cared for at home or in community settings, rather than being admitted to hospital. Identifying patients at high risk of admission to hospital, and providing them with supported choices around their possible future care options allows them to be more involved in making decisions.
Anticipatory care plans (ACP) are documents used to record discussions between patients and those involved in their care, regarding the patient’s future preferences for treatment and care. A person’s ACP includes information about that person’s wishes in the event of an expected deterioration in their health. With the patient’s consent, the plan can then be shared to ensure that their wishes regarding their final stages of care are widely known.
Dr Adrian Baker, a GP from Nairn, and his colleagues found that more use of ACPs in primary care helped reduce unplanned hospitalisations by 52% because more was understood regarding patients’ wishes surrounding medical interventions. ACPs did not affect the number of deaths of patients who took part in the study, compared to the control group, but the number of patients who died in hospital and the hospital bed days used in the last three months of life were significantly lower for those with an ACP, saving those patients from medical procedures they may not have wished to endure.
Dr Baker said: "Today’s NHS is all about patient choice, but few patients seem to understand the choices available to them in their final few months. Anticipatory care plans are a good way of looking at the options available with a view to ensuring that the wishes of loved ones are fully understood by everyone involved in their care so that unplanned hospitalisation can be avoided.
“We are faced with an ageing population, which is estimated to see 22 per cent of the population aged over 65 years by 2035. GPs have knowledge of a patient’s full medical history and often have a relationship based on trust. They are uniquely placed to broach this issue with the patient to help ensure their final wishes are met.”
Baker, A., Leak, P, Ritchie, L.D., Lee, A.J and Fielding, S. (2012) Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation British Journal of General Practice, February 2012
At Good Life, Good Death, Good Grief we believe it is never too early to plan ahead, since planning for illness and death when you’re healthy means there is less to think about if you get sick. For more information about planning ahead see: planning for the future.
Margo MacDonald MSP proposes new Assisted Suicide Bill
Margo MacDonald, Independent MSP for the Lothians recently lodged a proposal for a Bill to legalise assisted suicide in Scotland. This move comes a year after a majority of Scottish Parliament members voted against her previous Bill on the issue.
MacDonald’s recent proposal is for “a Bill to enable a competent adult with a terminal illness or condition to request assistance to end their own life, and to decriminalise certain actions taken by others to provide such assistance.” There are several key differences between the new proposals and the previous proposals:
· the eligibility criteria are narrower
· a “pre-registration” form would be required
· there is no requirement for psychiatric assessment
· the proposal doesn’t include voluntary euthanasia
· written requests do not need to be witnessed
· there is no requirement for the presence or assistance of a physician, and a new role of “licensed facilitator” is suggested.
The consultation on these proposals runs until 30 March 2012, and all are welcome to comment. More information about the Bill is available on the Scottish Parliament website.
The Scottish Partnership for Palliative Care has produced a useful overview of the proposals, including a flowchart illustrating the proposed process for the provision of assistance to commit suicide.
Tribute to those who bequeath their bodies to medical science
In Memoriam is an anthology bringing together the work of professional writers and students as a tribute to the selfless people who bequeath their bodies for the teaching and research of medical students and staff.
Launching on 18 February in Dundee, the theme of the book is Death and Life. Within it, Dundee University Chaplain, Fiona Douglas, has written about the gratitude of the students for their ’Silent Tutors’ and their annual Service of Thanksgiving.
As well as life stories of some of the people who donated their bodies to medical science, the book includes a selection of poetry, elegy and prose. Contributors include:
- John Carey, emeritus professor at Oxford
- Costa Book of the Year Winner, Christopher Reid
- Alan Warner, the Scottish novelist whose Morven Callar and The Sopranos have been made into films.
A sequence of photographs by Calum Colvin gives a haunting image of the singular life moving from light to shadow, and the book includes a beautiful piece by Professor Aidan Day on Tennyson’s haunting poem, In Memoria.
Christopher Reid, whose wife bequeathed her body to medical science, has contributed a new poem in which he writes:
Yet he’d felt her floating away
like the belle of the ball,
rapt in the embrace
of a rival partner,
while he had had to look on:
envious, impotent, shrivelling,
back to the wall
In Memoriam is being launched on Saturday 18 February 2012 at 6pm in the University of Dundee’s Dalhousie Building. More information is available here: weblink.
More information about donating your body to medical science is available here: weblink.
Launch of new palliative care information website
A new Scottish website designed to provide members of the public with information about palliative care has been launched.
The Palliative Care zone brings together a range of information on different aspects of palliative care with the aim of making it easier for people to access quality-assured information on palliative care.
Mark Hazelwood, director of the Scottish Partnership for Palliative Care, said: “Many tens of thousands of people in Scotland live with advanced or life threatening illness. Even more people are supporting a friend, colleague or family member who is affected.
“The Palliative Care Zone is for all these people. It will help them get all the information which they need, whether that information is about managing symptoms, arranging a holiday or planning ahead to cope with possible further deterioration in their condition. Palliative care is about getting the best out of life, even where a cure may not be possible. This zone provides a wealth of practical and useful information, as well as signposting to other resources.”
The palliative care zone is divided into six sections:
Symptom Control - describes some of the symptoms most common in a progressive condition, and provides information on how they can be managed.
Talking About My Condition - offers some simple advice to help people feel more comfortable asking questions to find out what they need to know. It also contains information on how to talk to children, and sources of support for people with learning disabilities.
Babies, Children and Young People – this section directly links to the Together for Short Lives website. Together for Short Lives is a voice for children and young people who are not expected to live to reach adulthood and their families. They work to ensure that these families have the best quality care and support wherever they live and whenever they need it.
Practical Help – provides information about different people who can help with palliative care needs, enabling people with progressive conditions to be as independent as possible and still do the things they enjoy. This section also directs users to organisations that can provide information on finances.
Planning for the Future – this section provides information and advice on the important decisions an individual might need to make regarding their future care, and also provides information on legal issues.
Preparing for Death and Bereavement - aims to provide supportive information to help in the time leading up to death, and to support family and friends in their bereavement.
The Palliative Care zone is part of NHS Inform, a website hosted by NHS 24 and designed to provide members of the public with a single source of trusted health information. The Palliative Care zone is the final outcome of the work of Living and Dying Well short life working group 4, and has been produced with significant support and input from NHS Forth Valley, Macmillan Cancer Support and the Scottish Partnership for Palliative Care. Any comments or feedback on the new site can be emailed to the Scottish Parntership for Palliative.
Launch of Good Life, Good Death, Good Grief
Good Life, Good Death, Good Grief officially launched in Edinburgh on 22nd November. The launch was marked by Dining with Death, a 2-course lunch with conversation menu to illustrate some of the principles of the alliance.
The launch was attended by Liz Lochhead, Scotland’s poet laureate, who shared her personal experiences and read a poem about death and grief. Delegates also witnessed the premier of 20 takes on death and dying, a short film in which members of the Scottish public talk about death, dying and bereavement.
Over a 2-course lunch at Howies Restaurant, delegates were encouraged to follow a ‘conversation menu’ addressing questions such as ‘What things do you think make for a good death?’ and ‘How would you like to be remembered?’.
The 70 invited guests heard from Kate Lennon, Chair of Good Life, Good Death, Good Grief, about the aims, visions and values of the new alliance, which hopes to make Scotland a place where there is more openness about death, dying and bereavement.
One couple who understand the importance of talking about death is Scott and Llana McNie, who organised their toddler daughter’s funeral before she died.
The parents lost their three-year-old daughter Sienna to brain cancer in April, three months after they were told she couldn’t be cured.
Her parents say the reluctance among medical professionals to talk about Sienna’s death meant they almost didn’t get the chance to bring her home to die.
Scott added: “We found the doctors didn’t want to talk about palliative care options for Sienna. No one asked us where we wanted her to die.
“If we hadn’t been so willing to talk about Sienna’s death she would have spent her final weeks in a hospice rather than with her family and that would not have been right for us as a family.
“We had to accept she was going to die to make sure she had the best possible time while she was with us.
“We also wanted to give her the best funeral we could arrange, complete with a pink coffin in a pink carriage pulled by white horses and 100 pink balloons.
“To organise that took planning and we wanted to do it when we were still in the right frame of mind to do it.
“Death is a fact of life and when it’s a child it is very, very sad, but not talking about it can only make the situation worse.”
Good Life, Good Death, Good Grief currently has over 100 members. Membership is free, and open to all groups, organisations and individuals who wish to support the aims and objectives of the alliance. Sign up here.
Links
Short film: 20 takes on death and dying twenty takes on death and dying
Media coverage of the launch
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