Bruce Rumbold, 180610

Palliative Care Unit, School of Public Health, La Trobe University, Victoria

Strengthening palliative care through health promotion

Downstream and Upstream

• Clinical services• Individual focus • Specific problem-solving• Expert interventions• Biological science

perspectives dominant

• Public health• Community focus• Network analysis• Culture change• Social science

perspectives dominant

Health Promotion

• Preventive strategies• Harm-minimisation strategies• Early interventions• Community development• Participatory/partnership relationships• Ecological approach to health & safety

Public Health & Palliative Care• Public health approaches:– Health promoting palliative care– Compassionate communities

• Need health promoting palliative care services to facilitate and contribute to compassionate communities

• Need to locate end of life care outside the health services for genuine and sustainable community change to take place.

The tiered approach Fitch, M. (2000) Supportive care for cancer patients, Hospital Quarterly 3: 39-46

ALL PEOPLE

MANY

SOME

FEW

The step-up approach with increasing specialisation or intensity for more complex needs

Respectful and dignity conserving careGood communication and information

Screening for need.

Link with self-help and peer support programsAccess practical assistanceParticipate in psycho-educational groupsBehavioural interventions eg relaxation.

Specialist care for identified issues eg depression, anxiety, relationship problems and more complex physical or social issues.

Intensive or comprehensive care for acute or complex and multi-factorial psychological and social problems.

Conceptualising Health Promoting Palliative Care

HEALTH SERVICE

REORIENTATION

GOAL: A HEALTH PROMOTING PALLIATIVE

CARE SERVICE

Develop personal

skills

Create supportive

environments

Build public policy

Strengthen community

action

Community café conversations on death, dying, loss and care

Café to GoCafé to Go

Could holding Could holding a café in your a café in your community be community be a possibility?a possibility?

Consortium logo Strengthening Palliative Care in Victoria through Health Promotion

Examples of successful implementation that encourage community conversations

Book and journal club discussions on publications like Tuesdays with Morrie or The Spare Room

Café Conversations in local communities

Movie nights that address death and dying with discussion afterwards such as The Bucket List or Tulip

Do you belong to other groups in your Do you belong to other groups in your community?community?

Be brave and look for Be brave and look for opportunities to use ideas opportunities to use ideas such as these as a way to such as these as a way to encourage people to talk encourage people to talk about life and lossabout life and loss

Multicultural club

Key components of project

• Coordination/leadership– A designated, appropriately-skilled person/group

accountable to palliative care services and community

• Consultation– A resource group of interested people from various

community sectors

• Support– Local expertise, La Trobe University PCU

• Proven strategies and resources

Terms of the partnership: The checklistRequire at least one of 1-4, all of 5-7

1. Prevention2. Harm-minimisation3. Early interventions4. Changing settings or environment5. Participatory/partnership6. Sustainable 7. Evaluated

What else could be done?What else could be done?

Seek partners to organise: Seek partners to organise:

• Plant a Tree and Remember Mum on Plant a Tree and Remember Mum on Mothers Day eventMothers Day event

• A Community Christmas Tree of A Community Christmas Tree of RemembranceRemembrance

• Community information sessionsCommunity information sessionsEG:

Coping with ChristmasLiving with griefLiving with Life threatening illnessHow to Care, What to Say

……………………the list goes onthe list goes on

www.treesformum.com

Invite community kitchen facilitators, physical fitness group leaders, school peer support leaders, youth group leaders….

What else could be done?What else could be done?

• Reflective place at the cemeteryReflective place at the cemetery

• Support program for carersSupport program for carers

• Death education in schoolsDeath education in schoolsEg: Café conversations

Visiting an elderly friend in aged care program

Loss and grief art show

Memory boxes

Project findings to dateProject findings to date

LEADERSHIP ROLE for palliative care services in initiating end of life discussions in local communities

NON- THREATENING approach that draws on people’s experiences and questions is effective in initiating end of life discussions

DIVERSE rewarding PARTNERSHIPS Requires a LONG TERM COMMITMENT; continuing

attention rather than occasional promotions PC VOLUNTEERS are key AMBASSADORS in linking

palliative care services with local community structures and needs.

Larger issues to be addressed

• Governance: locating end of life care policy – more than a health issue

• The shameful death and social exclusion