Written by Associate Profesor Kim Devery, RePaDD Member and Project Lead, End-of-Life Essentials.

I was pleased to be recently asked by the Research Centre for Palliative Care, Death, and Dying (RePaDD) to talk about the project I lead, End-of-Life Essentials (EOLE). RePaDD at Flinders is home to EOLE. Funded, since 2015, by the Australian Government Department of Health, EOLE has built on major national initiatives to produce education and implementation resources for use by doctors, nurses and allied health professionals who work in acute hospitals. Hospitals are the places where most Australians die, and hospitals have been identified as providing care that is not always appropriate [1]. So it is ambitious but reasonable that the long-term goals of EOLE encompass both individuals and systems including that:

Clinicians

• Are aware and capable of quality end-of-life care
• Know that a dying patient is not their professional failure

Hospitals

• Are places where Australians can safely die
• Are key places in enabling appropriate end-of-life care

Systems

• Enable prompt identification of patients at the end of life
• Uphold processes and priorities that enhance excellent end-of-life care.

EOLE works in collaboration with the Australian Commission on Safety and Quality in Health Care and has integrated pivotal works such as National Consensus Statement Essential Elements for Safe and High-Quality End-of-Life Care and the National Safety and Quality Health Service Standards to strengthen the project goals. An approach that imparts quality and relevance to the work we do.

For clinicians, who work in hospitals, there is much focus on prolonging life and reversing illness. Being able to shift skills to reaffirm the compassionate preparation of bodies and minds for death requires a well-informed and considered mind shift. EOLE has been able to educate and remind clinicians about what is important for individuals who face the end of life. Through our research we know that our project is increasing knowledge, skills and confidence of hospital clinicians in end-of-life care. Beyond that we have learnt more about:

• Compassion in the emergency department.
• Using ‘prognostic uncertainty’ in conversations about patients’ future goals of care.
• Salient learnings from EOLE modules that have been most important.
• Managing differences of opinion amongst staff regarding patient care management.
• The biggest challenge when engaging with a dying child and supporting families and friends.

Knowledge of what is important to patients at the end of life provides direction to EOLE. This includes allowing and empowering patients: to know what is happening in their illness and health care, to look back and review their life, to understand their own legacy, to consider and prepare how to spend precious and diminishing time, to set aside the thought of dying, to share and give love, to say goodbye and to receive compassionate and expert care by trusted clinicians.[2,3,4]

There is an army of talent behind EOLE. Firstly, our National Advisory Group (NAG) of experts provides a critical eye and wise advice to the project team. In addition, over 80 doctors, nurses, and allied health professionals from around Australia have maintained peer review of all education and resources. Further, the project has a committed team that includes co-lead Deb Rawlings, Project Manager Vanessa Heading, Researchers Huahua Yin and Megan Winsall, and steering marketing is Jane Durbridge. We work to produce new evidence-based resources, engage and network with the sector, evaluate the impact of our work and disseminate, far and wide, our project. Each peer reviewer, NAG and team member brings enthusiasm, commitment, and great skill in progressing EOLE in all areas. Together we all work to improve the way end-of-life care happens in hospitals.

The EOLE team acknowledge the importance of this work and we are working to grow and expand the evaluation of our impact. We welcome collaboration and feedback, so feel free to get in touch.

Email: eolessentials@flinders.edu.au

Web: https://www.endoflifeessentials.com.au

LinkedIn: End-of-Life Essentials

Twitter: @EOLessentials

References

1. Productivity Commission 2017, Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services, Report No. 85, Canberra.
2. Gott M, Small N, Barnes S, Payne S, Seamark D. Older people’s views of a good death in heart failure: implications for palliative care provision. Soc Sci Med. 2008 Oct;67(7):1113-21. doi: 10.1016/j.socscimed.2008.05.024. Epub 2008 Jun 26. PMID: 18585838.
3. Steinhauser KE, Alexander SC, Byock IR, George LK, Tulsky JA. Seriously ill patients’ discussions of preparation and life completion: an intervention to assist with transition at the end of life. Palliat Support Care. 2009 Dec;7(4):393-404. doi: 10.1017/S147895150999040X. PMID: 19939302.
4. Virdun C, Luckett T, Davidson PM, Phillips J. Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important. Palliat Med. 2015 Oct;29(9):774-96. doi: 10.1177/0269216315583032. Epub 2015 Apr 28. PMID: 25921707; PMCID: PMC4572388.