MSc, PG Diploma & PG Cert in Palliative Care

Service Organisation & Policy in Palliative Care

7th – 17th May 2019

Background to Service Organisation and Policy module

This module considers the historical and international perspectives of palliative care practice and policy. It will provide you with an overview of ways that services have developed and how this is affected by different cultures, local communities, resources and local and national policies. It considers approaches to needs assessment, organisation theory and local management including financial aspects, quality control and clinical audit. The learning objectives of the module are:

1. To have a detailed understanding of the principles and practice of palliative care and how these are manifested across different professional groups, cultures and countries.

2. To understand the principles of management and organisational theory and apply these to course participants’ own work settings and to develop skills in order to negotiate with and influence others in the management setting, including working in a management team.

3. To develop skills in order to define strategic requirements and produce policies relevant to participants’ own work settings.

4. To be able to develop quality assurance and clinical audit programmes.

Module co-ordinators • Dr Katherine Sleeman, NIHR Clinician Scientist and Honorary Consultant in palliative medicine

• Dr Catherine Evans, HEE/NIHR Senior Clinical Lecturer in Palliative Care & Nursing. Research, Development and Innovation Director, and Honorary Nurse Consultant Sussex Community NHS Foundation Trust

Pre-modular Tasks:

Before the module commences you should collect information for the following four pre-modular

tasks:

Session 2: Critical appraisal - Dr Katherine Sleeman

Session 3: Introduction to needs assessment – Dr Jonathan Koffman

Session 6: Power & authority - Rev Peter Speck

Session 7: Performance management – Kate Heaps

Session 17: Policy in palliative care – Dr Katherine Sleeman

Session 26: Enhancing quality in palliative care – Dr Ping Guo & Marsha Dawkins

Key references:

• Charles B. Handy. Understanding Organisations (4th Edition) Penguin Books 1992

• Anton Obholzer, Vega Zagier Roberts, James Krantz. The Unconscious at Work. Routledge, 1994.

• N. McCaughan, B. Palmer. Systems Thinking for Harassed Managers Karnac Books. 1994.

• Higginson IJ. & von Gunten C. Population-based needs assessment for patient and family care in (eds) Bruera E, Higginson IJ, Ripamonti C, von Gunten C. Textbook of Palliative Medicine, Hodder Arnold, London, 2006.

Location

All teaching will take place in: Dinwoodie Lecture Theatre 1 and 2, Cicely Saunders Institute,

Bessemer Road, London SE5 9PJ

Service Organisation & Policy module timetable

7th – 17th 2019

Week 1

9.30-11.00 11.15-12.45

1.30-3.00 3.15-4.45

Tuesday 7th May 1. How much palliative care does society need? Dr Katherine Sleeman

2. Critical appraisal Dr Katherine Sleeman

3. Introduction to needs assessment: how need is defined and explored Dr Jonathan Koffman

Wednesday 8th May

4. Quality Improvement: A clinical perspective Dr Kim Saint John

5. Wellbeing of staff working in palliative care Dr Ros Taylor

6. Power & Authority Rev Peter Speck

Thursday 9th May 8. Performance management Kate Heaps

9. Palliative care in care homes Dr Clare Ellis-Smith

10. Social inequality at the end of life Joanna Davies Palliative

11. Library session

Friday 10th May 12. Primary Care Dr Stephen Barclay

13. Leadership & Organisation and team management Kate Heaps

Service Organisation & Policy module timetable

7th – 17th 2019

Week 2

9.30-11.00 11.15-12.45

1.30-3.00 3.15-4.45

Monday 13th May 14. Case mix, complexity and costs in palliative care Dr Fliss Murtagh

15. Charles Daniels How does this differ from what we currently do already? Introduction to the IHI Model for Improvement

16. Different models of care Dr Sabrina Bajwah

Tuesday 14th May 17. Policy in Palliative Care Dr Katherine Sleeman

18. Rehabilitation Dr Rebecca Tiberini

19. International perspectives: a systems approach Dr Ping Guo and Dr Kennedy Nkhoma

Wednesday 15th May

20. Quality Assurance Dr Catherine Evans

21. Epidemiological needs Assessment: principles and challenges

22. Palliative Care in Sub Saharan Africa Professor Julia Downing

Thursday 16th May

23. Place of Death Dr Rebecca Wilson

24. Ageing in Palliative Care Dr Catherine Evans

25. Improving environments for end of life care in hospitals settings Dr Hedley Finn

Friday 17th May 26. Enhancing quality in palliative care: patient-centred measures Dr Ping Guo and Marsha Dawkins

27. Is Palliative Care a public Health issue? Dr Libby Sallnow

Evaluation of module

Tuesday 7th May

Session 1: How much palliative care does society need? Dr Katherine Sleeman, NIHR Clinician Scientist and Honorary Consultant in palliative medicine, Cicely

Saunders Institute

Summary:

This introductory session will provide an overview to the module, posed through a series of questions: How much palliative care does society need? Who needs it? When do they need it? Where do they need it? And, at what cost?

Recommended Reading:

• Clark D, The development of palliative medicine in the UK and Ireland (chapter 1); De Conno F,

• Blumhuber H, Rocafort J. The development of palliative medicine in Europe (chapter 2); Ryndes T,

• von Gunten C. The development of palliative care in the USA (chapter 3B); Merriman A, The development of palliative care in Africa (chapter 5); All in Textbook of Palliative Medicine (eds)

• Bruera E, Higginson IJ, Ripamonti C, von Gunten C. Textbook of Palliative Medicine, Hodder Arnold, London, 2006

Session 2: Critical appraisal Dr Katherine Sleeman, NIHR Clinician Scientist and Honorary Consultant in palliative medicine, Cicely

Saunders Institute

Pre modular task:

To read papers for discussion in the session.

Papers will be circulated in due course

Session 3: Introduction to needs assessment: how need is defined and explored Dr Jonathan Koffman, Reader in Palliative Care, Cicely Saunders Institute

Summary:

This is the first of two sessions session that will introduce you to the concepts of need and needs

assessment. In this first session we will introduce you to the theory of need, and current approaches

to needs assessment in palliative care.

Pre-modular task:

During group work, you will be expected to present your pre-module assignments that best describe

your local population and where need is currently being met.

By the end of the session you will be able to:

1. Define and contrast different approaches to assessing need.

2. Debate the levels of met and unmet meet based on participants’ local data.

3. Appraise the extent to which the assessments consider different components of need, including those within Bradshaw’s taxonomy of need and the NHS Executive guidance on needs assessment.

4. Develop approaches for conducting your own needs assessment.

Recommended reading:

• Higginson IJ. & von Gunten C. Chapter 31. Population-based needs assessment for patient and family care in (eds) Bruera E, Higginson IJ, Ripamonti C, von Gunten C. Textbook of Palliative Medicine, Hodder Arnold, London, 2015.

• Higginson I.J. Hart S. Koffman J. Selman L. Harding R. Needs assessments in palliative care: an appraisal of definitions and approaches used, Journal Pain and Symptom Control 2007;33:500-505

• Koffman J, Harding R, Higginson IJ. Palliative Care: the magnitude of the problem in Mitchell G (ed) Palliative Care: A Patient-Centred Approach Routledge, Oxford, 2008.

Wednesday 8th May

Session 4: Quality Improvement: A clinical perspective Dr Kim Saint John

Summary:

Not available

Session 5: Wellbeing of staff working in palliative care Dr Ros Taylor

Summary:

You bring who you are to the bedside’. This phrase has always echoed with me. Working with death

and loss must take its toll on all health professionals. For many this might be a small part of their work

– but for those in palliative care, in all countries and settings, there is constant immersion in suffering,

with the risk of harm to the health professional, which means harm to patient care.

This session will focus on the literature relating to resilience, occupational stress in palliative care

together with strategies to sustain team and personal well-being, avoiding burn-out and compassion

fatigue.

Recommended reading: Resilience: A framework to support hospice staff to flourish in stressful times

A collaborative document between Hospice UK and the Point of Care Foundation, including a

comprehensive literature review of occupational stress.

Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. Preventing occupational stress in healthcare

workers. Cochrane Database of Systematic Reviews 2015, Issue 4

Kamal A., et al. (2016) Prevalence and predictors of burnout among hospice and palliative care

clinicians in the US J Pain Symptom Manage. 51(4): 690-696

Goodrich J. (2012) Supporting hospital staff to provide compassionate care:

Do Schwartz Center Rounds work in English hospitals? J R Soc Med 105: 117–122

Guardian Feb 2017: An alarming number of cancer medics suffering burnout and stress

Cooke G. (2013) A survey of resilience, burnout and tolerance of uncertainty in Australian general

practice registrars. BMC Medical Education 13:2

Further reading: Shanafelt T.(2017) The business case for investing in physician well-being JAMA Internal Medicine 177(12):1826 Guo Y. (207) Burnout and its association with resilience in nurses: a cross-sectional study Journal of Clinical Nursing 27 (1-2): 441

Zambo-Anderson E. (2015) Identifying stress and burn-out in physical therapists Physiotherapy

101:e1072

Session 6: Power & Authority within Teams Rev Peter Speck, Former Health Care Chaplain and Hon Senior Lecturer, Cicely Saunders Institute

Summary:

This session will explore our understanding of teamworking, together with the concepts of power

and authority as they may operate within teams.

Pre-modular tasks

To help prepare for this session please reflect on these questions

1. What is my role and what kind of management activities do I have to carry out whilst

managing myself in that role?

2. What is the primary task of the team I work in, and how does that relate to the purpose of

the organisation as a whole?

3. What kind of anxieties are inherent in the nature of my work?

4. What are some of defences used in relation to these anxieties and pressures – both within

myself and in the wider organisation?

5. What authority do I exercise and where does that authority come from?

6. What power do I have, or am perceived to have?

7. What inhibits my use of any power/ authority I have at work?

Recommended reading

• Obholtzer & Roberts The Unconscious at Work. Routledge, 1994 (2nd edition 2019)

Thursday 9th May

Session 7: Performance Management Kate Heaps, Chief Executive Greenwich & Bexley Community Hospice

Summary: This session aims to examine the importance of staff development and performance management as well as exploring the skills and tools you can use to motivate staff or resolve issues. Pre-modular task: Before the session you may like to reflect on any specific issues that you have previously faced/currently face and what mechanisms have been helpful in moving situations on to get improvements in performance. Recommended reading:

• Understanding Organizations – 4th Edition (2005) Handy C. Penguin

• Managing Without Profit: The Art of Managing Third-Sector Organizations – 2nd Edition ( 2002) Hudson M. Directory of Social Change

Further reading:

• Team of Teams – New Rules for Engagement in a Complex World (2015) McChrystal S, Silverman D, Collins T, Fussell C. Penguin

Session 8: Palliative care in care homes Dr Clare Ellis-Smith, Research Associate, Cicely Saunders Institute

Summary:

Not available

Session 10: Social inequality at the end of life Joanna Davies, Dunhill Medical Trust PhD Research Training Fellow, Cicely Saunders Institute

Summary:

Not available

Session 11: Library session

Friday 10th May

Session 12: Primary Care Dr Stephen Barclay, University of Cambridge

Summary: In the UK, 44.5% of all deaths occur in the community, in peoples’ own homes or in care homes: General Practitioners, Community Nurses and Primary Care teams have lead responsibility for their care. This session will focus on the important role of these generalist Primary Care services in Palliative and End of Life Care: strengths, weaknesses, opportunities for development and optimal ways of working with specialist Palliative Care teams. It will include a discussion of the importance of continuity of care out-of-hours and the potential for Electronic Palliative Care Coordination Systems (EPaCCS) to provide informational continuity. Recommended reading:

• Hoare S, Slote-Morris Z, Kelly M, Kuhn I, Barclay S (2015). “Do patients want to die at home? A systematic review of the UK literature, focused on missing preferences for place of death”. PLOS ONE: 10(11): e0142723. doi:10.1371/journal.pone.0142723

• Barclay S, Froggatt K, Crang C, Mathie E, Handley M, Iliffe S, Manthorpe J, Gage H, Goodman C. (2014) “Living in uncertain times: trajectories to death in residential care homes” British Journal of General Practice: 64 (626); 576 – 583.DOI: 10.3399/bjgp14X681397

• Hoare S, Kelly M, Prothero L, Barclay S. (June 2018) “Ambulance practitioners and end-of-life hospital admissions: an interview study”. Palliative Medicine; 32(9): 1465 – 2473 DOI: 10.1177/0269216318779238

• Petrova M, Riley J, Abel J, Barclay S (2016). “A crash course in EPaCCS (Electronic Palliative Care Coordination Systems): eight years of successes and failures in patient data sharing to learn from”. BMJ Supportive and Palliative Care: e-pub DOI:10.1136/bmjspcare-2015-001059

Further reading:

• Buck J, Webb W, Moth L, Morgan L, Barclay S (e-pub Feb 2018) “Persistent inequalities in Hospice at Home provision: findings from a service evaluation” BMJ Supportive and Palliative Care: doi.10.1136/bmjspcare-2017-001367

• Green E, Knight S, Gott M, Barclay S, White P (Jan 2018). “Patients’ and carers’ perspectives of palliative care in general practice: a systematic review and narrative synthesis of the literature” Palliative Medicine: 32 (4); 838 – 850 doi/10.1177/0269216317748862

• Fleming J, Farquhar M, Cambridge City over-75s Cohort (CC75C) study collaboration, Brayne C, Barclay S. (April 2016). “Death and the oldest old: attitudes and preferences for End-of-Life Care. Qualitative research within a population-based cohort study”. PLOS ONE: 11(4): e0150686. doi:10.1371/journal.pone.0150686

Session 13: Leadership & Organisation and Team Management exercise Kate Heaps, Chief Executive, Greenwich & Bexley Community Hospice

Summary:

This session explores a range of approaches to Leadership and Management and how they fit within certain situations and organisations. It explores the impact of different organisational cultures on teams and their effectiveness. The role-play exercise builds on the Power and Authority in Palliative Care Settings session delivered by Rev Peter Speck and will give you an opportunity to discuss very real day-to-day management (and personal) issues, and how they all potentially impact on staff, patient and family care. You will be asked to break into teams and choose a Chairperson to represent you. You will then be asked to share with your colleagues the most urgent and pressing issues in the scenario, and why you feel your colleagues should be aware of them. The objective of the exercise is to sell your personal case to best effect, but at the same time remain sympathetic to the wider and possibly more important issues your colleagues are experiencing within the Hospice.

Recommended reading: Understanding Organizations – 4th Edition (2005) Handy C. Penguin

Further reading: Management and Organisational Behaviour – 5th Edition (1999) Mullins C. Pitman Publishing

Monday 13th May

Session 14: Case mix, complexity and costs in palliative care Professor Fliss Murtagh, Professor of Palliative Care, Hull York University

Summary:

This session will review some of the recent developments in capturing complexity in palliative care,

the meaning and importance of case-mix, and some of the different funding models in palliative

care.

Recommended reading:

http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/end_of_life_care.pdf

• care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug19;363(8):733-42.

Session 15: How does this differ from what we currently do already? Introduction to the

IHI Model for Improvement Dr Charles Daniels, consultant in Palliative Medicine atNorth West London Hospitals NHS Trust

Summary:

The session is an introduction to QI. By the end we will seek to have addresses elements of these questions:

• What do we mean by Quality?

• How do we know that improvement has occurred?

• How do we currently improve services?

• From the experiences in the room, we will explore how effectively we achieve sustainable improvement?

• What are some key elements of QI methodology?- Inquiry, change vs transition; failure or learning?

• Introduction to The model for Improvement methodology. And to the PDSA (Plan, Do, Study, Act) cycle.

• Additionally, the membership, structure, and leadership support required for a QI team are analyzed.

Recommended reading list:

• The Improvement Guide. Gerald J. Langley et al (2009) Jossey Bass.

• Living Leadership. A guide to Ordinary Heroes George Binney. (2009). Prentice Hall

Session 16: Different models of Care Dr Sabrina Bajwah, Senior Consultant and Honorary consultant, Cicely Saunders Institute

Summary:

During this session, we will look at:

• Why do we need different models of care?

• Different models of palliative care

• What the future holds

• How to develop and evaluate a model of palliative care

• Future research priorities in this area

Tuesday 14th May

Session 17: Policy in palliative care Dr Katherine Sleeman, NIHR Clinician Scientist and Honorary Consultant in palliative medicine, Cicely

Saunders Institute

Summary: This session will start with an introduction to health policy: what is it, and who makes it? The global context of palliative care policy will be described, and the UK policy landscape will be used to understand the effectiveness of palliative care policies. We will examine evidence on how policy is made, and how to communicate effectively with policy makers. We will examine prioritization of palliative and end of life care in health policy in England, and implications for practice and research internationally. Pre-modular tasks: If possible, be prepared to talk about palliative care policies in your own setting. Recommended reading:

• Wye L, Brangan E, Cameron A, Gabbay J, Klein JH, Pope C. Evidence based policy making and the 'art' of commissioning - how English healthcare commissioners access and use information and academic research in 'real life' decision-making: an empirical qualitative study. BMC Health Serv Res. 2015 Sep 29;15:430.

• Macintyre S, Chalmers I, Horton R, Smith R. Using evidence to inform health policy: case study. BMJ. 2001 Jan 27;322(7280):222-5.

Session 18: Rehabilitation in Palliative Care Dr Rebecca Tiberini, Director of Wellbeing Services at St Michael’s Hospice in Hastings

Summary:

Palliative care services face challenges to respond to the needs of an aging population demographic where people are living longer, often with chronic conditions and greater levels of disability. At the individual level, physical function and independence are important dimensions of health-related quality of life and represent high priorities for patients with advanced illness. At a strategic level, national drivers are directing palliative care provision to increase patient choice and control, blur boundaries between long term conditions and palliative care and support patients to be cared for, and die, in their place of choice (most frequently home). Rehabilitation has much to contribute to future models of palliative care provision. This session introduces ‘rehabilitative palliative care’ - a shift in the paradigm of palliative care practice towards empowerment, enablement and self-management – and will explore the potential impact of this approach at a patient, organisational and strategic level. Recommended reading:

• Tiberini and Richardson. Rehabilitative Palliative Care: Enabling people to live until they die – a challenge for the 21st century. Hospice UK, 2015. https://www.hospiceuk.org/what-we-offer/clinical-and-care-support/rehabilitative-palliativecare/resources-for-rehabilitative-palliative-care

• Ambitions for Palliative and End of Life Care: National Palliative and End of Life Care Partnership, 2015. http://endoflifecareambitions.org.uk/wp-content/uploads/2015/09/Ambitions-for-Palliative-and-End-of-Life-Care.pdf

• Cotterell P. Striving for independence: experiences and needs of service users with life-limiting conditions. Journal of Advanced Nursing. 2008; 62(6).

• Runacres, F et al. ‘The horse has bolted I suspect’: A qualitative study of clinicians’ attitudes and perceptions regarding palliative rehabilitation. 2017; 31(7)

Session 19: International Perspectives: A systems approach Dr Ping Guo, Research Associate & Dr Kennedy Nkhoma, Research Associate, Cicely Saunders

Institute

Summary:

Not available

Wednesday 15th May

Session 20: Quality Assurance Dr Catherine Evans, HEE/NIHR Senior Clinical Lecturer in Palliative Care & Nursing, Cicely Saunders

Institute

Summary: This session will explore the difference between quality systems: total quality management, continuous quality improvement and quality assurance, and the pros and cons of each. More specifically the session will focus on the following: What is Quality?

• Concepts

• Definitions The Role of Quality in Healthcare

• Reasons for pursuing quality in healthcare

• Issues surrounding quality in healthcare Models of Quality in Healthcare

• Donabedian model, Maxwell model

• Government initiatives e.g. Clinical Governance

Approaches for Introducing Quality (including issues)

• Quality assurance

• Quality control

• External accreditation

How to Assess Quality in Palliative Care (including brief outline and some of the issues)

• Standards and clinical guidelines

• Clinical audit

• Quality of life measures

• Outcome measure

• Evaluation of services

• Patient/carer satisfaction surveys

• Qualitative approaches

• External accreditation programmes

Practical Session Course participants will be given the opportunity to design an audit for evaluating an out-of-hours palliative care service. Recommended reading:

• Campbell SM, Roland MO and Buetow SA. Defining quality of care. Soc Sci Med. 2000; 51: 1611-25.

• Seow et al Audit and quality improvement in palliative care research In E. Bruera et al (eds)

Textbook of Palliative Medicine and Supportive Care, 2nd Edition, 2015

Further reading:

• Higginson IJ. Clinical and organisational audit in palliative medicine in (eds) Doyle D, Hanks G,

Cherney N, Calman K. Oxford Textbook of Palliative Medicine, Oxford 2004.

• Darzi A. Quality and the NHS next stage review. Lancet. 2008; 371: 1563-4.

Session 21: Epidemiological needs assessment: principles and challenges Dr Jonathan Koffman, Reader in Palliative Care, Cicely Saunders Institute

Summary:

This session represents part two of our needs assessment series. In our first session we defined need

as the ‘the population’s ability to benefit from healthcare’, which critically implies that we must be

able to understand the characteristics of the populations we serve and then provide care that is

deemed to be effective.

Being able to understand and estimate a population's need is invaluable for those planning services,

however, the methods used are often poorly developed. We will appraise three different approaches

that have attempted to estimate need for palliative care across different populations. These

approaches use different combinations of mortality statistics, combined with symptom prevalence,

disease prevalence or hospital use. We will compare and contrast each of these in order to arrive at a

position where we can reliably estimate the needs of the population and critically consider what

services they require.

Recommended reading:

•Gómez-Batiste X, Martinez-Munoz M, Blay C, et al. Identifying needs and improving palliative care

of chronically ill patients: a community-oriented, population-based, public-health approach. Curr

Opin Support Palliat Care 2012; 6(3): 371–378.

•Higginson IJ. Health care needs assessment: palliative and terminal care. In: Stevens A and Raftery J

(eds) Health care needs assessment. Oxford: Radcliffe Medical Press, 1997, pp. 1–28.

•Rosenwax LK, McNamara B, Blackmore AM, et al. Estimating the size of a potential palliative care

population. Palliat Med 2005; 19(7): 556–562.

•Murtagh F.E.M. Bausewein C., Verne J., Groeneveld I.E., Kaloki Y.E.,Higginson I.J. How many people

need palliative care? A study developing and comparing methods for population-based estimates,

Palliative Medicine 2014, Vol 28(1) 49–58 DOI: 10.1177/0269216313489367

Session 22: Palliative Care in Sub Saharan Africa Professor Julia Downing, honorary professor at Makerere University, Kampala, and the Director of

Education and Research for the International Children's Palliative Care Network (ICPCN)

Summary:

• To demonstrate service development in the context of developing countries

• To illustrate the essential link between research and service development

• Focus on epidemiology and palliative care in Africa

Thursday 16th May

Session 23: Place of Death Dr Rebecca Wilson, Research Associate, Cicely Saunders Institute

Summary:

This session will explore people’s preferences for place of death and the different factors impacting

on where they die, taking an international approach. The policy and practice implications of differing

trends in place of death will be discussed, thinking about the ageing of the populations and those

dying from progressive diseases other than cancer. The learning outcomes of the session are:

1. To understand how people formulate preferences for place of care and death

2. To be aware of the complex evidence on the factors influencing death at home

3. To debate the trends in place of death in different countries and the implications of these for

service planning

4. To discuss the findings in relation to the future of palliative care, particularly in terms of care

for older people and extending services beyond cancer.

Recommended reading:

• Gomes B, Higginson I (2006). Factors influencing death at home for terminally ill patients with

cancer. British Medical Journal 332:515-521.

• Gao W, Ho YK, Verne J, Glickman M, Higginson IJ, on behalf of the GUIDE_Care project (2013)

Changing Patterns in Place of Cancer Death in England: A Population-Based Study. PLoS Med 10(3):

e1001410. https://doi.org/10.1371/journal.pmed.1001410

• Pivodic L, Pardon K, Morin L on behalf of EURO IMPACT, et al. Place of death in the population

dying from diseases indicative of palliative care need: a cross-national population-level study in 14

countries. J Epidemiol Community Health 2016;70:17-24.

Session 24: Ageing and Palliative Care Dr Catherine Evans, HEE/NIHR Senior Clinical Lecturer in Palliative Care & Nursing, Cicely Saunders

Institute

Summary:

Although most deaths occur among people who are older, there is relatively little policy concerning their specific needs towards the end of life. Populations worldwide are ageing, leading to a dramatic increase in the numbers of people living into their seventies, eighties and nineties and increasingly even past 100 years. Patterns of disease in the last years of life are also changing, with more people dying from chronic debilitating conditions, such as cardiovascular disease, chronic obstructive pulmonary disease, cancer and dementia. In this session we will appraise the relative evidence why palliative care services urgently need to be developed to meet the complex needs of older people. By the end of the session course participants will be able to: 1. Define and understand key characteristics of an ageing population encompassing demographic, illness and environmental factors 2. Consider the implications of these factors for policy and clinical practice Recommended reading:

• Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K: Frailty in elderly people. Lancet 2013, 381:752-762.

• Gill et al Trajectories of Disability in the Last Year of Life. NEMJ 2010; 362:1173-1180 NEoLC Intelligence Network: Deaths from Alzheimer's disease, dementia and senility in England

2010/

http://www.endoflifecare-intelligence.org.uk/resources/publications/deaths_from_alzheimers

Further reading:

• Evans CJ, et al. Rapid Scoping Review of Service Delivery Models to Maximise Quality of Life for Older People at the End of Life. 20th March 2018 WHO Kobe Centre, Japan http://www.who.int/kobe_centre/mediacentre/news/EOLC_report/en/

• NICE Multimorbidity: clinical assessment and management 2016 nice.org.uk/ guidance/ng5

Session 25: Improving environments for end of life care in hospital settings Hedley Finn

Summary:

No information available

Friday 17th May

Session 26: Enhancing quality in palliative care: patient-centred measures Dr Ping Guo, Research Associate & Marsha Dawkins NIHR Knowledge Mobilisation Fellow, Cicely

Saunders Institute

Session overview

This session introduces the concept of patient-centred care and relevance of outcome measures to

demonstrate the quality in palliative care, and covers the following main learning objectives:

• Define the patient-centred care

• Impact of outcome measure to demonstrate quality in palliative care

• Selecting outcome measures for use

• Relevance of data collection and feedback

• Overview of POS use internationally

• Resources to support the implementation of outcome measures

Pre-modular tasks:

• Consider your own experience of using outcome measures in your practice.

• Identify ways in which they have been used to demonstrate quality of care.

Recommended reading:

• Antunes B, Harding R, Higginson IJ, Euroimpact obo: Implementing patient-reported

outcome measures in palliative care clinical practice: A systematic review of facilitators and

barriers. Palliative Medicine 2013.

• Collins ES, Witt J, Bausewein C et al. A systematic review of the use of the palliative care

outcome scale and the support team assessment schedule in palliative care. Journal of Pain

and Symptom Management 2015; 50: 842-853.

• Evans C, Benalia H, Preston NJ et al. The selection and use of outcome measures in palliative

and end-of-life care research: The MORECare international consensus workshop. Journal of

Pain and Symptom Management 2013; 46: 925-937.

Further reading:

• Currow DC, Allingham S, Yates P, Johnson C, Clark K & Eagar K. Improving national hospice/palliative care service symptom outcomes systematically through point-of-care data collection, structured feedback and benchmarking. Support Care Cancer 2015; 23: 307-315.

• Bausewein C, Simon ST, Benalia H, et al. Implementing patient reported outcome measures (PROMs) in palliative care – users’ cry for help. Health and Quality of Life Outcomes 2011; 9: 27.

• Hearn J & Higginson I. Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Quality in Health Care 1999; 8: 219-227.

• Higginson IJ & Wei. Caregiver assessment of patients with advanced cancer: concordance with patients, effect of burden and positivity. Health and Quality of Life Outcomes 2008; 6: 42.

• James Lind Alliance. Palliative and end of life Priority Setting Partnership (PeolcPSP); Putting patients, carers and clinicians at the heart of palliative and end of life care research report. https://palliativecarepsp.org.uk/

Session 27: Is palliative Care a public health issue? Dr Libby Sallnow, St Christopher's Hospice and UCL Marie Curie Palliative Care Department

Summary

No information available

Session 28: Evaluation

Assignment Question:

This is currently under review by our external examiners. Will be circulated by 7th May 2019.

Requirements for electronic submission:

Upload your assignment, no later than Friday 6th September 2019 by 5pm via Keats.

1/ Please ensure you put your Student ID Number on your assignment (not your name). Your Student ID Number is on your student card, and is also on the module attendance list. Please do not put your KCL user number (K number) on your assignment.

Your assignment file should contain all the annexes, figures, etc. Do not upload them as separate files.

The College policy says that you should receive feedback on your work within 4 weeks of the submission date. In distinct circumstances, such as over public holidays, feedback may take slightly longer to release. This includes the Christmas holidays. Therefore you should receive your marks by the Friday 4th October 2019.

(We are able to permit a variation of 5% in the word count either way. However, 5% is deducted

from the final percentage mark for work which is up to 10% over the word limit. Moreover, 50% of

the mark awarded is deducted from the final percentage for work that is more than 10% over the

word limit).

Tables, references, bibliographies and appendices are not included in the word count but it is

recommended that longer tables should be added as an appendix. Abstracts should be kept brief and

are NOT part of the word count.

Although there is no guidance on font/spacing, we would advise essays and dissertations should be

word-processed in a legible font size (often 12) with 1.5 or double line spacing and margins of 2.5 cm

- The font/spacing needs to be clear to the marker and easy to read.

Please see the Course Handbook for more information on how to write an assignment.

Denmark Hill location map and Cicely Saunders Institute.

Please click on the link below, which will show you different travel options to get to

Denmark Hill.

https://www.kcl.ac.uk/study/campus/denmark-hill.aspx.