Frances Kraus, Candle Project Leader, St Christopher’s Hospice, London

With thanks to Nigel Hartley, Director of Supportive Care

The St. Christopher’s Schools Project The St. Christopher’s Schools Project -promoting healthier attitudes -promoting healthier attitudes

to death and dyingto death and dying

Health Promotion in End of Life Care

• Social – friendships, recreation, work, ‘normality’

• Psychological – anxiety, depression, loss

• Spiritual – meaning, reconciliation, reunion

• Physical – ‘health’ versus ‘sickness’

…we mustn’t forget that in many circumstances dying is ‘normal’ and can be ‘managed’…

Why do it?Why do it?

“As a society we do not discuss death and dying”

End of Life Care Strategy DOH 2008

A few facts…

• End of life care strategy 2008

• Rising expectations of healthcare

• Split and dispersed families

• Single person households

• Changes in demographics and disease

• BBC poll 2005 – little change in public attitudes

• Healthcare Commission 2007 – 54% of complaints were

about how a death was handled

• Constrained financial and professional resources

How To Do It?How To Do It?

• Public education meetings

• Art exhibitions

• Talks with community groups

The St. Christopher’s Schools project

• working through change• why children?• aims/objectives• structure• funding• information pack

StructureStructure

• Ages• Timing• Relationship with head/class

teacher• Parental Consent• Introduction/preparation• First session at school• First visit to Hospice

Structure cont….

• 2nd and 3rd meetings• children and patients working together• artists and artwork• final meeting/celebration• parents• feedback• changing views of both life and death

Safety and responsibility:

• Prepare and support• Children• Staff from hospice and other institutions – colleagues• Parents and families/carers – engage, respond• Appropriate personnel and skills

Recent development & Recent development & current innovations:current innovations:

• Care Homes and schools working together

• Arts council England proposal – 15 care homes a year

• joined with local community group such as schools, college, faith group, pub, scout group etc.

Recent developments & Recent developments & current innovations (cont.):current innovations (cont.):

• Four week projects supported by St Christopher’s staff

• Expectation that care home and community group will carry out project annually – sustainability

• St Christopher’s as a ‘hub’• Quarterly education and support

sessions at St Christopher’s

• Project endorsed by Sir Mike Richards – National Clinical Director for Cancer and End of Life Care

“ I thoroughly commend the approach and I would be delighted to see similar projects being developed across the country”

NHS NW ProjectNHS NW Project

• Conference BlackpoolFeb 2009 100 attendees

• Workshops in April 2009• Conference Feb 2010• 50 attendees, feedback from 3

new projects

Evaluation – some comments from children:

…I felt happy doing the art – it took my mind off death and put my mind on understanding that we all have to die someday……my grandmother died in the hospice and I wasn’t allowed to go…I enjoyed seeing that it was OK really……at the start I felt a bit scared and shakey ‘cos I thought it would smell and be full of sick people, but they were just normal……I enjoyed hearing the stories and making the art – the food was good too……I felt very happy and proud of myself when my parents came to see what we’d learned…it wasn’t anything like a hospital……I felt really nervous and it made me feel a little sad……I was happy when my mum and dad came and they were happy……I thought it was going to be boring, but I had fun at the party…

Evaluation - some comments from patients

…I loved the kids coming here – it makes it all feel so normal and OK…

…Watching the staff and others talk to the children – it showed me a way to talk to my own grandchildren…

…I’m glad you take this seriously – I feel I’ve got something that the children can learn from…

…I came alive again when the teenagers were here – they’ve got all their life ahead of them

An excerpt from a letter from the class teacher:

…thank you so much for the thoughtful and creative journey you led the children, staff and parents on this term. We learned much about ourselves, each other and our community. We have allsigned up to the hospice fundraising walk, and hope that our input will make a difference. The wonderful banners which are now on display at theschool look fantastic – next years year five are alreadyasking about coming along next year…

Example…I am old and wrinklyI wonder if I could have had kids.I hear voices of an owl.I want another life.I am old and wrinkly.I pretend to be in heaven.I feel cold inside.I touch the fur of my catI worry about the time I die.I cry when things dieI am old and wrinkly.I understand that people have to die sometimes.I say that I care for animalsI dream that I will get to do different thingsI try to keep my cat healthyI hope my plants will growI am old and wrinklyI want to thank everyone who helps meI am old and wrinkly…

(written by 9/10 year olds during a St. Christopher’s ‘Schools Project’)

Promoting healthier attitudes to the end-of-life makes sense

It is our responsibilityto make it happen!