s194 - day 2 - 1430 - improving palliative and end of life care (1)

Communication skills &

difficultconversations©

Dr Catherine Millington-SandersClinical Lead and Facilitator

RCGP National Clinical Implementation Lead for EPaCCSLondon Co-Clinical Director for EoLC

Richmond CCG Board Member4th March 2014

Objective for today

• Awareness of difficult conversation workshops objectives

• Recognise themes for difficult conversations

• Identification and Documentation

• Describe experience of ‘ taster ’ workshop

Workshop objectives

• Improve confidence and skills in having difficult conversations

• Recognise / awareness of themes for difficult conversations

• Use SCARS ® framework

• Awareness of multi - professional roles

• Increased awareness ACP and DNACPR

Group work

• What EoLC conversations

do you find difficult in your

role ?

• What makes them difficult

for you ?

• Why is it important to have

these conversations ?

• What is your role ?© 2012 NHS Richmond

Language

• What the professional wants to convey vs. what the patient wants to hear

• What can you say to:

- start the conversation ?

- close the conversation ?

© 2012 NHS Richmond

Bad News

‘ The bad news about breaking bad news is that it is

bad news ’

- Robert Buckman


It may never be easy ,

but it can get easier if you

leave good ‘ SCARS ® ’

Framework :Leave good ‘SCARS ® ’

S – Setting

C – Communicate

A – Ask

R – Reflect / Respond with Empathy

S – Summary


SCARS ®

S = Setting

– set the scene - what you need to discuss

– timing - make sure you have time , but

don’t let it be the reason not to

discuss

– minimise distractions , privacy


C = Communicate with kindness

– show you are listening with your body language

– Listen (is different to waiting to speak)

– Empathy through out

SCARS ®


SCARS ®

A = Ask before you respond

‘ Information Gather ’

– Ask for permission before you start and ask if they want someone else present

– Start with resident’s understanding

– Knowledge - how much does the resident want to know or have expectations tested:

• “ Would you like to know the outcome of the test ? ” • “ How much do you want to know ? ”• “ Are you the type of person that would like to know…”


SCARS ®

R = Respond and Reflect

– show empathy

– respond to resident’s understanding

– respond to emotions

– respond to what they have asked to know

– reflect back comments and questions

– if unsure - ask again© 2012 NHS Richmond

SCARS ®

S = Summary and Plan– review services which could help

– review information discussed

– develop plan together

– document the plan

– set a time for review


Film clip

Care Planning

• General vs Advance – what is the difference?


Identification

How can you recognise patients in the last year(s) of life ?

1. Look for two or more general clinical indicators of deteriorating health :

• Performance status poor ( needs help with personal care, in bed or chair for 50 % or more of the day )

• Two or more unplanned hospital admissions in the past 6 months

• Weight loss ( 5 – 10 % ) over the past 3 - 6 months and/or body mass index < 20

• Persistent, troublesome symptoms despite optimal treatment of underlying condition (s)

• A new event or diagnosis that is likely to reduce life expectancy to less than a year

• Lives in a nursing care home or NHS continuing care unit, or needs care at home

CPR survival rate

• 15 – 20 % in hospital

• 5 – 10 % out of hospital

• 2 – 5 % nursing home


Documentation

Coordinate My Care ( CMC )

• Web based electronic record

• Last year(s) of life

• Consent

• Document wishes and anticipatory care plans

AcknowledgementsSWL Richmond Borough Training Faculty:

Dr Catherine Millington-Sanders – Macmillan GP, EOLC and Cancer Lead for RichmondJJ Nadicksbernd, MSW – EOLC Project Facilitator for Richmond

Dr Marek Jezierski, GP Tutor NHS RichmondDr Marilyn Graham - RCGP South London Faculty, Chair of Education

Dr Darren Tymens – Medical Director for SWL Richmond Borough Team Dr Kieran O’Flynn - Richmond GP and GPwSI at Shooting Star Children’s Hospice

Princess Alice Hospice team: Jane Berg, Head of Education

Dr Lulu Kreeger, Consultant in Palliative MedicineClair Sadler, Senior Lecturer

Gill Thomas, Art Therapist / Practice Educator Lesley Simmons – Lead Long Term Conditions and Palliative Care Community Matron,

Hounslow and Richmond Community Healthcare NHS TrustDr Cathy Burton, Macmillan GP Adviser, LASER Region and Associate Director Primary

Care, SELCNMary Burns- Macmillan Mulberry Cancer Support Manager- patient carer adviser

Caroline Cunliffe, Administrator


Acknowledgements

GP LED: GP Learning, Education and Development in South West London (www.gpled.co.uk)

Dr C E Urch, Lead Consultant in Palliative Medicine at Imperial Heath Care Trust

Royal College of General Practitioners, South London FacultyRoyal College of Nursing

National End of Life Care ProgrammeMacmillan

Dying MattersBritish Geriatrics Society

NWL Health Innovation and Education ClusterSWL Academic Health and Social Care System

St John’s HospiceHounslow and Richmond Community Healthcare NHS Trust


http://www.gpled.co.uk/

For further information contact:Richmond CCG

• Dr Catherine Millington-SandersClinical Lead and [email protected] 07968 097641

• JJ Nadicksbernd, MSWLead [email protected] 07852 615649

Copyright December 2012

mailto:[email protected]

mailto:[email protected]

s194 - day 2 - 1430 - improving palliative and end of life care (1)

Health & Medicine