Effective integration of Palliative Care in Respiratory Setting – Using

Action Research

Marie Lynch, Bettina Korn, Patricia White PhD

Introduction

1. Context 2. Methods of

integration3. Results4. Key learning

No conflict of interest

2010 2013Project

Duration

SitesBarriers Patients

I always think of palliative care as just cancer.

I remember it frightened me, the mention of it, it also

frightened me more when they said morphine, I think

most people think morphine is for people on the way out.

Patient 1 Patient 4

Education Needs - Baseline

0%10%20%30%40%50%60%70%80%90%

100%

Currently have a PalliativeCare Qualification

Interested in AttendingPalliative Care Education

yes

no

All health care staff on the respiratory ward (nurses, doctors, care assistants, physiotherapists)42/49 questionnaires returned (86% response rate)

Action Research

• Recognised method for quality improvement & organisational change

• Approach requires – Collaboration– Empowerment– Reflection

Demonstrate 2 methods of integration

Collaboration Developing Knowledge

End of life care review meetings

Facilitating questions:•What went well in the care of this patient and their family at the end of life?•What didn’t go so well?•What would we do differently?•Would the way this person died be acceptable to me?

Developing Knowledge:

Formal Education Clinical education input: End of life care awareness &

communication skills training:

Developing Knowledge:

Project steering group

14 Steering group meetings over 18 month

period

Focus group with members – pre and post

project timelines

collaboration

Working Together: Journey to improve patient centred care

Respiratory Team

Specialist palliative care

teamPatient

collaboration

Developing the pathway

RESULTS - quantitative Number of patients accessing palliative care 44

RESULTS - qualitative

Patients

Staff

“I wouldn’t be afraid to go into it (hospice) if I had to go into it someday where I would have been before.”

Patient 2

‘The greatest achievement is the shared approach that now exists between the hospice and the respiratory unit’. Respiratory Nurse

I do think that it would have been less effective if it had been a traditional research project… you’d be able to stand up… and present the data but that would have no impact on the patient.

Respiratory Physician

It (day hospice) gave you an idea what the future might hold and how you could deal with it and that was comforting in itself. Patient 3

RESULTS Addressing the barriers

Additional policy and knowledge transfer benefits

Reflection

More focus on quantitative data

‘ Respiratory and palliative care knowledge based values and world views have come together and we have generated a new practice based knowledge base’.

‘There are effects we can’t measure… [for example with] the MDT meetings, there was so much learning that happened within the Respiratory Assessment Unit and staff on the ward and [all] that does filter through and the relationships that were built’ .

How do we know what makes a difference to patient care?

Respiratory Nurses

To Conclude The Patient Voice

• Thanks to Eamonn Rooney

– The Meaning of Palliative Care– The Difference it Makes