What do we need to be fit for the future?
Master of Ceremonies Jean Kittson quizzed an expert panel at the start of the 13th Australian Palliative Care conference, unearthing a variety of ideas about how palliative care could be made fit for the future.
Flinders University’s Professor David Currow said dying had changed over the years.
“As we think about the future we have the challenge of how we die and this continues to rapidly evolve. In the early 1900s none of us had warning of our death. Most of the people in this room will get months or years of warning. So we have the initial challenge of how we die and it is rapidly changing with the demographics of our community,” he said.
He said fewer people would be available to care for us as we age and die – predictions are than most people over 50 will be living alone by 2030.
“We have the challenge of emerging technologies in health. Just because we can do things, doesn’t mean we should do them…we need to wade into not just helping people get out of intensive care if that care is clinically futile, but actively engage in ensuring those people don’t get to intensive care in the first place.”
Professor Currow encouraged palliative care professionals to engage with their medical colleagues about end of life care.
“Unless we are doing that on a day-to-day basis, we won’t prevail. Palliative care must be part of the conversation in clinical discussions – but we have forgotten how to have conversations about death and dying because we aren’t exposed to it anymore.”
Dr Gail Eva from Brunel University in London took the view that we cannot lose sight of the “living well” part of the dying process.
“It is important how well we live while we are dying,” she added.
Dr Eva said as a community we need to trust the patient to know what they need and want, instead of deciding for them that they are infirm or unable to do something.
“We tend to make assumptions about what it is reasonable and possible to expect someone to do given that they’re dying and we tend to set that threshold far too low. You are dying so it is normal you will be tired and become disengaged we could curtail the opportunities that we offer to people
“For me, fit for the future is to encourage conversations we need to be having on a societal level about what constitutes a good life – what is the best possible life leading up to the time that you die, because the quality of our dying is going to be defined by that,” she said.
While technology was useful in a practical sense, developing communities is also vital, according to Dr Scott Martin, head of applied physics group at CSIRO.
“The challenge for us is our communities continue to change. Far fewer of our communities are geographic. The real challenge is, what does our community become? Is it a faith based community, sporting community, mutual interest in something else? We are going to have to think very carefully about how we tap into community.”
He said technology exists to help people, we need to make it acceptable to them, and acceptable to medicine.
The emphasis of touch over technology meant palliative care could be losing opportunities, according to Dr Christian Sinclair from the University of Kansas Medical Center, US.
“We bring a lot of humanism back to medicine, but it also blinds us sometimes to what technology can achieve. There are still lots of unmet needs for patients and families,” he said.
“You need heart and a story, but also the data – the science – to change people’s minds. We need to still have conversations with people developing technology to say this is what the people I care for need from technology. If we can do that, then we won’t be left behind and we will meet our patients’ needs in the future,” he said.
The panel agreed a number of factors needed to be in place for palliative care to be fit for the future:
- More exposure and understanding of palliative care in the community
- Improved conversations about death and dying
- Recognition of our patients as living people rather than dying people and what that means for their needs
- An openness to technology
This afternoon another panel of experts, again including Gail Eva and David Currow, was asked: are we fit for the future? And what would you take to governments in terms of proposals or policies, to make the sector fit for the future?
Panel: Professor Joachim Cohen, Associate Professor Katrina Anderson, Emeritus Professor Margaret O’Connor, Professor David Currow and Dr Gail Eva.
Some of their thoughts:
- Evidence based steps to wellbeing: connect, be active, take notice, keep learning and give
- Palliative care is too often seen as an expense, not a solution. Value add needs to be recognised
- Integrated care needs to be more than integration between doctors – it needs to integrate everyone.
- Palliative care needs to approach government with a united voice
- National agreed level of specialists palliative care
- More education for student doctors in chronic and end of life care
- Embed palliative care skills and mindset in the community’s understanding of good health care
- Better quality data for better research