ACP in Care Homes

“Definitely thinking back to those days where people were not thinking about these kinds of things. We were not always doing the right things for the residents, the appropriate things.” Care home staff member.

For the last year I have been working as part of a team to embed Anticipatory Care Planning (ACP) in 20 care homes across Edinburgh. Like the staff member above, many people involved in looking after care home residents appreciate that admission to hospital is not always what the resident wants when they are acutely ill. Some just really don`t want to go to hospital at all and others feel that their quality of life is now such that if they were seriously ill they would prefer to be kept in the home they know with treatment being provided there, even if that meant they couldn`t get all the possible treatments for their condition. We were keen to see whether training the care home staff in how to discuss ACP`s with their residents and how to use the completed ACPs in an emergency would reduce the number of avoidable admissions to hospital.

The care home staff immediately got it. They all want to provide high quality person centered care and they hate to see residents ending up in hospital when it is unlikely to help them. When this did happen many staff felt as if they had somehow failed their residents. What is more, many of them were already having conversations about the future, but they found them difficult at times and didn’t know how to use this information in the best way. The GPs were also delighted to get some help with gathering the information they needed to create a high quality ACP. They all wanted to do their best but had been overwhelmed with the time needed to do it properly. The idea that the person having a ‘good conversation’ with residents or relatives with someone that knew them well seemed obvious to everyone. In most situations that person was a member of the care staff.

The staff were really positive about the tools we showed them that together comprise the ‘7 Steps to ACP for Care Homes’. They were brief, simple and included lots of explanation. Although anxieties still remained. Much of the time people arrive in care homes from hospital, where they have been pretty unwell. They and their relatives are going through a huge readjustment. Trying to figure out the present is a challenge and thinking about how to direct future care seems impossible to some when they are new to the home. For some, even when the initial dust has settled conversations about their or their relative`s plans for the future are still not easy. I have been having these conversations with care home residents and their relatives for years and sometimes I still don`t get it right.  Our trainer was able to work with staff to help with this. It can be really useful to have a few phrases you are comfortable with to help introduce the subject and to be able to back that up with some written explanation.

Getting the GPs on board was also pretty straightforward. They saw immediately the logic of the system we offered and we were also able to help train some of their admin staff to take on the basic data entry. As one practice manager said to us: “If it is an admin task that needs to be done, please don`t ask the GPs to do it. Our team does it much better!”.

So, the questionnaires were completed and passed to the GP, the ACPs were entered as special notes in the residents Key Information Summary (KIS), that form was printed and returned to the care home. The next big challenge was using the ACPs in an emergency. Whenever a resident becomes suddenly acutely unwell it is scary for those looking after them. Particularly when we started, some staff would feel better calling for an ambulance. Through work with our trainer they became confident in using the ACP to guide their actions and to help guide the actions of out-of-hours doctors and ambulance crews. It was really useful for the staff that we helped them complete reflective logs of each of the acute events and then met with them to discuss all the episodes every 6-7 weeks. It was a happy coincidence that many nurses needed to complete reflective logs for revalidation so were keen to do it with our help.

 

phase 3 care home rectangle clip with logos 0 1 (2)

Care home staff are busy people and I often worried that they would struggle with what was, in some ways, extra work. So it was wonderful at our recent end of program celebration to see so much enthusiasm from the staff about ACP. Person after person thought that this process had helped them deliver far better care for their residents. It was heartening to be able to share with them that there had been a 32% reduction in potentially avoidable admissions to hospital from their homes over the first ten months of the programme. However, I was even more pleased to see just how positive they were. It gave me a lot of hope for the future. Talking of the future, I now really hope we can sustain them. Some care homes have up to 30% turnover of staff so the effect of other programs has faded over a few years. We have tried to address this by recruiting several `ACP Champions` in each home and training them to carry the message onwards. We’re also developing an implementation package to support the ‘7 steps’ toolkit with training material, videos, leaflets etc.

“…ACP is a very good programme for us to do our job as expected from us” (Care home deputy manager).

“The ACP pathway helped. It helped tremendously. I don’t think we would get anywhere without using it. Explaining each stage more fully to the resident, and he understood why we were asking. He said it was a relief and a comfort to talk about it.”  (Care home champion)

“I find that staff are initially shocked that someone might not want to go into hospital for treatment and might want to be kept comfortable in the care home. It’s been really important in providing us with confidence to speak about what people’s wishes are if they become really unwell.” (Care home champion)

“If you want to enhance your practice you have to buy-in to this process. We are supporting person-centred care and this supports us from the very beginning. They’re telling us what they want and we are here to facilitate that.” (Care home manager).

Long may it continue and let`s spread the word.

Dr Andrew Mackay, ACP GP Advisor to the Edinburgh Health and Social Care Partnership ACP team.

Written on behalf of the Edinburgh Health and Social Care Partnership’s Long Term Conditions Programme ACP team.

For more information and resources relating to ACP visit the ACP toolkit.

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“ACP is not for me!”

paul baughan

“I don’t have time to do an ACP.”
“That document is too big.”
“GPs have enough work without this.”
“Someone else should be doing it.”

These are all comments which I have heard my GP colleagues say when the topic of Anticipatory Care Planning comes up. And if I’m honest, there have been occasions when similar thoughts have gone through my head. But Anticipatory Care Planning is so much more than any document or the needs of a particular professional group, and I have come to realise that it is a fundamental component of our work in general practice.

Some of the most rewarding consultations I have had, started with an exploration of ‘what matters most‘ to someone. Recognition of such priorities enables the most effective use to be made of limited consultation time. And often I am surprised that the most important aspect of someone’s care is not what I thought it was going to be.

Take for instance my patient John, who has significant heart disease and was frustrated about the poor control of his blood pressure. I could see John’s irritation and was determined to find a new combination of drugs that would work better than the last.  Each switch to a different medication required more blood tests and close monitoring, and unfortunately many of these new drugs made John feel dizzy and light-headed.

One day John told me that his greatest pleasure in life was spending time with his grandchildren, and until recently he would drive them to and from school each day.   Side effects from his medication were preventing this, which in turn caused John to feel stressed. Only by understanding his priorities were we able to make progress.  He was willing to accept the risk of a slightly higher blood pressure if it meant he could safely drive his grandchildren and ‘feel useful’.

So, after discussion we stopped his medication, put the BP monitor to the side, and instead explored other aspects of his future care which were important to him. His Key Information Summary was updated to include his thoughts about cardiopulmonary resuscitation and he set about appointing a welfare power of attorney. John was able to start driving again and his levels of frustration reduced, as did his blood pressure!

ACP desktopAnticipatory Care Planning is not a one-off event. It is a process that starts with a conversation and which can develop and evolve over time. The beauty of general practice is that we have opportunities to initiate that conversation and contribute to the development of an ACP over weeks, months and sometimes years.

Professionals working in other parts of health or social care can also make a big contribution to ACP. Tools such as My ACP can support this process, and stimulate helpful discussions within families.  There is still a challenge translating information from hospital clinic letters and My ACP onto the KIS. I welcome recent progress with the new national digital platform, which in time will allow a wider group of people to contribute to an electronic shared ACP.

So, ACP is not just for me. It is for all professional groups working across health and social care, and most importantly it is for the person, their family and carers.

Paul Baughan, GP, Dollar Health Centre, Clackmannanshire

For more information and resources relating to ACP visit the ACP toolkit.

What works in care co-ordination in palliative and end of life care

PEOLC evidence bundle coverWe have recently published a resource that reviews the evidence on continuity and care coordination in palliative and end of life care. This blog post gives an overview of the document and its features.

Why focus on care coordination?

Good care co-ordination can help to improve people’s quality of life, right up to the end of life.

The Living Well in Communities team has been working with test sites in Dundee, East Ayrshire, Fife, Glasgow City, and Renfrewshire Health and Social Care Partnerships to deliver Commitment 1 from the Scottish Government’s Strategic Framework for Action on Palliative and End of Life Care:

We will support Healthcare Improvement Scotland in providing Health and Social Care Partnerships with expertise in testing and implementing improvements to identify those who can benefit from palliative and end of life care and in the co-ordination of their care.”

This work is coming to a close in March 2019.

Exploring the evidence on different approaches

Drawing on the priority practices outlined in the World Health Organization practice brief on continuity and co-ordination of care, we identified six key approaches to continuity and care co-ordination in palliative and end of life care:

  • Early integrated palliative care
  • Collaborative planning of care and shared decision making
  • Case management for people with palliative and end of life care needs
  • Intermediate palliative care at home
  • Technology to support continuity and care coordination
  • Building workforce capacity

Working with the Evidence and Evaluation for Improvement Team, we summarised the available systematic-review level evidence on these approaches.

Presenting the evidence visually

As with our Living Well in Communities with Frailty evidence review, we produced visual summaries for each of the approaches. These provide key information on the different approaches to care coordination, and an introduction to the more detailed evidence summaries. The visual summaries include

  • a brief description of each approach,
  • the rationale behind them,
  • the potential benefits,
  • enablers,
  • brief commentary on the quality of the evidence, and
  • links to further reading and examples of local good practice.

 

Visual summary
Early integrated palliative care visual summary
Case mgmt summary
Case management evidence summary

 

We hope that this document will provide a useful overview of the systematic review-level evidence on key approaches to care co-ordination in palliative and end of life care, and highlight the potential benefits of these approaches.

You can access the review, Continuity and Co-ordination in Palliative and End of Life Care: evidence for what works by clicking on the document image below:

PEOLC evidence bundle cover

 

Care Co-ordination Short Stories

A number of Palliative Care professionals who attended our Palliative and End of Life Care Delivery Group on 8th November kindly shared some insights into how to better understand care co-ordination. You can find out more by looking at the slides from the day here.

Sandra Campbell (National Clinical Lead) presented on the importance of timely, sandrasensitive conversations. Conversations should begin at the point of need by whoever is identifying the need / transition. The Palliative Care Identification Tools Comparator can be used to allow people to make more informed choices about their care and treatments when they have an irreversible illness. Significant conversations happen at the right time, in the right place with the right person.
deans.jpgDeans Buchanan (Consultant in Palliative Medicine, Lead Clinician) spoke about Health Transitions in Human Stories. Stories are very important to how we understand and communicate with one another. Most patients’ stories will have been interrupted by their illness and this can affect their response to treatment. The A, B, C, and D approach of dignity conserving care (Attitude, Behaviour, Compassion and Dialogue) is one method being tested to remind practitioners about the importance of caring for their patient.

Heather Edwards (Dementia Consultant, Care Inspectorate) gave a good overview of Bereavement. Heather highlighted the importance of preparation for death and the value of the care home staff in supporting families. Bereavement can cause an emotional toll on the staff as well as families but it’s important that we also support them as they are also grieving having developed relationships with the residents and their families.

Lynne Carmichael (Respite & Response Team Manager, Ayrshire Hospice) presented on carers and the Carers Support Needs Assessment Tool (CSNAT). One of the first barriers is many carers do not recognise themselves as a carer and often put their own needs to the side to care for a loved one. The CSNAT tool helps provide support for family members and carers of those with a life limiting condition.

lynne

Jo Hockley (RN PhD, Usher Institute, University of Edinburgh) presented on Care Co-joordination and Care Homes. As the population of over 80’s increases, they are becoming increasingly frail and more dependent, resulting in increased pressures on healthcare professionals supporting care homes. The main issues are:

– Lack of recognising the dying
– Lack of healthcare support to palliative care
– Lack of support staff

More work will need to be done around linking care homes into the system. This will hopefully be aided by a similar study to the Teaching Nursing Home pilot whereby the public/professional perception of care homes change, encouraging a career pathway in care homes for health and social care professionals, to help increase the workforce and establish more community engagement in care of frail older people.

marie cureRichard Meade (Head of Policy and Public Affairs, Marie Curie Scotland) offered an insight in Looking Beyond 2021 and thinking about the future. As the population is living longer, more people will be diagnosed with multi-morbidities, including dementia, frailty and cancer, and will therefore require increased palliative care. This in turn will increase the pressures on every care setting, the workforce, resources and the way we deliver care, and we must act now.

Anne Finnucane (Research Lead, Marie Curie Hospice Edinburgh) presented on the Key anneInformation Summary (KIS) and a recent study undertaken on those who died with an advanced progressive condition in 2017 with a KIS in place. A KIS is a shared electronic clinical summary used to guide urgent care in the community and emergency hospital admission. It helps to communicate key elements and preferences from the person’s Anticipatory Care Plan (ACP) to help with future care needs.

 

AliAli Guthrie (Learning & Development Advisor) discussed Personal Outcomes: towards a Shared Understanding. A Personal outcomes approach is focusing on what is important to people in their lives. They often relate to maintaining or improving wellbeing and feature in the National Health and Wellbeing Outcomes in the new Health and Social Care Standards.

 

For further information, please contact a member of our team at hcis.livingwell@nhs.net

Follow us on Twitter:@LWIC_QI, @turnersara99 @paulbaughan, @sandracampbellc65402031

Understanding the success factors in Care Co-ordination

Our local Palliative & End of Life Care (PEOLC) test partners came together on 8th November 2018 to exchange knowledge and understand the success factors for care co-ordination. The morning session provided an opportunity for the five health and social care partnership test sites to share the improvements in care co-ordination that they have been taking forward locally. Each site has approached this challenge in a different way, working with different population groups, in different settings and with a variety of different interventions.  However, the objective to improve the co-ordination of palliative and end of life care remains consistent across each area, with promising early outcomes now emerging from this work.

map

 

Test Sites

We have five main test sites involved in identifying those who would benefit from a palliative care approach:

  • Dundee
  • Fife
  • East Ayrshire
  • Renfrewshire
  • Glasgow

 

Experts from Marie Curie, Ayrshire Hospice, Care Inspectorate, University of Edinburgh and The Scottish Social Services Council (SSSC) were on hand to provide short stories and share current thinking to help with our understanding of Care co-ordination.

whos here today

 

The afternoon was a World Café format – a world café is a simple, effective and flexible format for hosting large group dialogue. It provides an opportunity to exchange and share knowledge. Test site leads led the table discussion and answer any questions in relation to their site and Care Co-ordination.

world caFE

Evaluation Comments

“This was a great day, what an opportunity to have a day with space to network, think and create for the future”

“Everyone’s opinion counted”

“Open environment to discuss palliative care with professionals in different areas”

“Rich conversations”

“Great opportunities to learn what is happening and being developed across Scotland and a chance to network and share ideas”

“Really valuable sharing and networking; very much stimulated ideas for us to test”

“Group discussions, listening to different ideas and realising that we are all wishing and working for the same outcome”

 

Key to good care co-ordination in PEOLC

Attendees tested out Mentimeter, a fun and interactive tool for presentations, to create a word cloud describing the key to good care co-ordination:

mentimeter

Closing comments from Paul and Sandra

Paul Baughan and Sandra Campbell (National Clinical Leads) provided some words from the day:

“There are many different components to good co-ordination of care at the end of life.   This gathering allowed those testing new ways of working to meet and share their progress with like-minded individuals and experts in the field of palliative care.  This knowledge exchange is mutually beneficial and has provided a renewed impetus for our five test sites to make progress with their change ideas.”

“It was an excellent day, with really engaging conversations and sharing of best practice… and great to hear about such good work across the country.”

Next Steps

Paul and Sandra are currently working on an evidence bundle for Care Co-ordination alongside the Evidence and Evaluation for Improvement Team (EEvIT), the first draft will be ready at the end of January. The evidence bundle will inform which interventions help people to die in their preferred place of death, which interventions help to decrease the percentage of hospital deaths, and the interventions that increase the percentage of deaths at home and in hospices.

 

For further information, please contact a member of our team at hcis.livingwell@nhs.net

Follow us on Twitter:@LWIC_QI, @turnersara99, @paulbaughan, @sandracampbellc65402031

Reflecting on our palliative care work: thoughts from Sandra Campbell

 

Sandra presenting
Sandra presenting at our recent learning event on identification.

Our Nursing National Clinical Lead for Palliative and End of Life Care, Sandra Campbell, reflects on a year of supporting the Living Well in Communities palliative care work.

What a year! I have loved every minute! Unfortunately the secondment is only one day a week, but fortunately I am able to be flexible with time. I am certainly very grateful to my line manager in my substantive post as Nurse Consultant for Cancer and Palliative Care in NHS Forth Valley for that.

The main purpose of the clinical lead role is to support the Living Well in Communities Team within the ihub at Healthcare Improvement Scotland to deliver on Commitment 1 of the Strategic Framework for Action on Palliative and End of Life Care 2016-2021:

  • Identification of need
  • Coordination of care

The programme has six test sites across Scotland: Dundee, Glasgow City, Perth and Kinross, East Ayrshire, Fife, Western Isles, and Renfrewshire.

Reflecting back to April 2017, it was hard to imagine how these individual projects would evolve, but it has been amazing to see them unfold due to excellent local leadership within each of the Health and Social Care Partnerships, the guidance and support of assistance improvement advisors in each area and the support of the Living Well in Communities team.

Dr Paul Baughan and I, as clinical leads, have supported from a clinical advisory aspect. A Palliative Care Identification Tools Comparator resource has been developed and is available to support teams in understanding the various tools that can support the identification of palliative care. Paul has supported two webex education sessions, and I will be delivering a webex on the key principles in Caring for People in the Last Days of Life and how this relates to coordination of care.

The test sites will test some of these tools, which will inform wider learning across Scotland. This work will be developed further to inform a resource for care staff in care homes on how and when to use particular tools at different trigger points. Three events will share this learning: the first of which took place on the 31st May (and really saw the Strategic Framework for Action for Palliative and End of Life Care come to life) and a further two are planned for October 2018 and March 2019.

All of the work fits perfectly with the agenda in Realising Realistic Medicine, supporting anticipatory care planning that ultimately enables the right thing to be done at the right time, by the right person, to the right quality standard, with the right outcome.

What is needed is:

  • Good assessment and care planning
  • Good decision making
  • Good care
  • Good quality of life until death
  • Good death
  • Good bereavement

The opportunity for the test sites on the project is to try out different ways of working to improve care and make best use of resources available. Enhancing the generalist support is vital if we are to ensure as many people as possible can remain in their own homes as long as possible.

Other developments

New guidance to support Confirmation (previously verification) of Death will be available shortly from the Scottish Government.

Macmillan has supported projects within the test sites with funding of £120,000.

Macmillan and the Scottish Ambulance Service are in early conversations about developing a national project to improve end of life care and prevent inappropriate admission to hospital and reduce inappropriate CPR.

A key aspect of the clinical lead role is to engage with other stakeholders and we do this on an ongoing basis. People and organisations we have engaged with include:

I have also set up a nurse leads group – now reporting to the Scottish Government, SEND and SPPC. We have a practical work plan that includes bereavement. This group is about sharing best practice across all areas. Standardising care at end of life is helpful to teams and welcomed in the absence of a framework such as the Liverpool Care Pathway.

In caring for the dying patients and those close to them, it is important that staff provide care in accordance with the key principles, which I discussed in an earlier blog post.

You can follow Sandra on Twitter and contact her at 

sandra.campbell2@nhs.net

Palliative and End of Life Care: Focus on Identification

Michelle Church, Improvement Advisor, reflects on our recent learning event, which explored ways of identifying people who could benefit from a palliative approach to their care.

On 31st May 2018, test site participants from six health and social care partnerships (HSCPs) and key delivery partners across Scotland joined the Living Well in Communities team to learn and share knowledge about tools that can support identification of people who could benefit from a palliative approach to their care.

Making the case for early identification

Kirsty Boyd, consultant and lecturer in Palliative Medicine, talked about the many benefits of earlier identification:

  • Helps people say what matters to them.
  • Increases the opportunity for people to participate in decision-making.
  • Reduces the risk of later regrets and poor outcomes.
  • Gives people time for planning ahead, resulting in fewer crises.
  • Reduces unplanned admissions of low benefit.
  • Encourages medication review and treatment planning.
  • Improves continuity and coordination of care by sharing information.

 How can we do earlier identification?

Our national clinical leads, Dr Paul Baughan and Sandra Campbell, gave an overview of the visual resource the LWiC team have developed to help compare different identification tools that are currently used in Scotland. Sandra did a before and after survey of how aware and confident participants were about the variety of tools.

How did we mobilise knowledge?

Experts from across the UK shared their tools, knowledge and experience of doing identification. People got the chance to participate in interactive workshops looking at the tools that a number of palliative care test sites. Some insights from the sessions are included below:

Anticipal and eFI electronic tools

FAST and PPP tools

PPS and SPAR Tools

SPICT4ALL and carers identification

What did people think of the event?

People felt that they had learnt about why, when and how to use different tools to support identification and inform practice. People really liked that they had the chance to network with experts and colleagues.

Overwhelmingly, the take home message was that earlier identification and communication is key to supporting those who would benefit from a palliative approach to their care.

What did you likeTake home message

What next?

HSCP palliative care test sites are now using the comparator to consider what tools will benefit local people and services and how people identified can be supported. This work will contribute to the vision that by 2021 everyone who could benefit from palliative care will have access to it and will support the Realistic Medicine ambition of shared decision-making and a personalised approach to care.

Reflecting on our palliative care work: thoughts from Paul Baughan

Paul Baughan 2Dr Paul Baughan, our palliative care GP clinical lead, discusses the benefits of early palliative care, highlights a resource that we’ve developed to compare different palliative care identification tools, and looks ahead to future work on care planning and care coordination.

Having worked within General Practice for over 20 years, I have seen the transition from hospital-based care to community care for a wide variety of clinical conditions and diseases. We look after many more people who are living with complex medical diagnoses well into their 80s, 90s and beyond. It can be difficult to identify when a palliative approach to care should be considered, and as a result we sometimes find ourselves on the back-foot, reacting to events and changes in clinical condition. Often, with the benefit of hindsight, it might have been possible to anticipate and plan for these episodes before they happen.

This is one of the reasons that I have enjoyed the opportunity to work with Healthcare Improvement Scotland and five test sites across Scotland (Dundee, East Ayrshire, Fife, Glasgow, and Perth and Kinross) to explore how we might identify people who could benefit from a palliative approach to their care at a much earlier stage.

Although a variety of different electronic and paper ‘tools’ have been developed by academics to help identify those who might benefit from a palliative approach to their care, it can be confusing to know which tool to use, and in which situation. Some are electronic, some are designed for particular diseases such as cancer or dementia, or for particular settings such as care homes.  Some tools are intended for health professionals and some for the general population. I have therefore enjoyed working with the team in Healthcare Improvement Scotland to design a resource which will help health and social care professionals become more familiar with the different identification tools, and most importantly, decide which one suits them best. Our five test sites have chosen different identification tools to use within their local Health and Social Care Partnerships.

However, identifying those who might benefit from a palliative approach to their care is just the first step.  It is the conversations that follow, between the health and social care professionals and the person, that are important. And then of course the care planning that results from these discussions. This is our next area of focus at Healthcare Improvement Scotland. We are now working with our test sites to explore how best to plan, coordinate and deliver care to those who are living with a progressive life-limiting condition.

This is an exciting phase of our work, as each test site is considering innovative and practical ways to provide this care within existing resources, and across health and social care. We will have the opportunity to share some of the learning from across Scotland in the Autumn, with the full outcomes from our test site projects available in 2019.

Back at my own general practice, my colleagues and I will continue to see an increase in the number of people with complex progressive life-limiting conditions in the years ahead. Therefore, the outcomes from the five test sites will be very relevant to the work that we do on a daily basis. We know that a proactive, multi-professional, care planning approach is required, and eagerly await advice from the test sites regarding how best to achieve this.

Meet Rob Corrigan!

Rob square b&w

I have never been one for blogging or being photographed, I never enjoy being centre of attention for that matter! However in the interest of challenging myself and trying to improve, I fancy having a go at it, particularly given the excellent blog debut my colleague and fellow project officer Gemma Stewart recently produced.

I have been part of the Living Well in Communities (LWiC) team for over a year now. My current role is to provide project support to the palliative and end of life care workstream, which aims to support health and social care partnerships across Scotland to test improvements in the identification of people who could benefit from a palliative approach to their care, and care coordination.

I find this a hugely interesting and engaging workstream to work on. It’s an emotive subject, which is really helping me challenge and think through my ideas and perception of what palliative care is, and can be. To date my biggest learning point has been around the necessity of good conversations. Whether that is with a professional or a loved one.

Like Gemma I have a varied background, having studied social science at an undergraduate level, then criminology and criminal justice at a master’s level. My studies led me to a role in the third sector with Victim Support Scotland, in which I was part of the day-to-day running of the Edinburgh service. I then took up a role with Healthcare Improvement Scotland, working for a number of teams, including networks and knowledge exchange, and my current role with LWiC.

The LWiC team are a hard-working bunch, with a real commitment to providing a high quality of work that supports people to live at home or in a homely setting. We are always happy to answer any questions about our work – so please do get in touch.

 

Comparing tools that can help to identify people who could benefit from a palliative care approach

PC tools comparator cover

We have recently published a resource that compares different tools that could be used to identify people who could benefit from a palliative care approach. This blog post gives an overview of the document and its features.

The benefits of early identification

Early identification of people who could benefit from a palliative approach to their care has many advantages. It can allow people to make informed choices about what medical treatments and care they would like to receive, or not receive, and to prioritise things that are important to them when length of life may be short, or when the presence of irreversible illness has altered life for that person.

Palliative care identification tools

It can be very difficult to recognise when someone is nearing the end of their life due to a chronic, progressive medical condition, frailty or old age. A number of tools are available to help identify individuals who could benefit from a palliative care approach at an earlier stage.

Comparing different tools – at a glance

We have designed a visual resource comprising a table and a decision tree (see below) to make it easier for Health and Social Care Partnerships to compare the key features of different identification tools, and to select the tools that are most appropriate for their contexts.

PC tools table

Palliative care tools decision tree v0.7

 

This resource is not intended to be a comprehensive literature review, but rather a visual comparison of some of the main identification tools that are currently used in Scotland. There are brief outlines of all of the tools featured in the comparison table and decision tree, together with links to some key research and further information on these tools.

We have focused on tools that were identified in a literature review by Maas et al, and discussions with palliative care clinicians in Scotland. Some have been validated and others have not. We have tried as far as possible to include information on the limitations of different tools.

You can access the palliative care identification tools comparator on the ihub website by clicking on the document image below:

 

PC tools comparator cover