MAKING DIFFICULT CONVERSATIONS EASIER:

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MAKING DIFFICULT CONVERSATIONS EASIER

• THE CARDS, THE KIT,
• AND THE QUILL
• Dr. Eric Fairbank, Director of Palliative Care
• South West Healthcare, Warrnambool

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Difficult conversations

• Communication is a vital skill for health
  professionals offering end of life care.
• But
• We continue to pretend that our lives will never
  end! Dont mention dying!
• Who is going to start the conversation?
• We tend to wait for the right moment.

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The Rose

• its the one who wont be taken
• that cannot seem to give,
• and the soul afraid of dying
• that never learns to live.

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The Clear Moment of Death

• the only thing that scares me about the
  moment of death is that I may come to it
  unprepared
• Ian Gawler.

5
The scene

• Physical deterioration, symptoms
• Tired, weak
• Sense of being a burden
• Cheated, frustrated, sad
• Powerless, helpless

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How to respond

• We do not fail if we do not cure, but we do
  fail, if in our attempts to cure, we cause our
  patients to sacrifice their healing journey
• Dr. Michael Barbato
• Palliative Care
  Physician
• 
  NSW Australia

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Health Promoting Palliative Care

• Bring your attention, genuine interest, and
  compassion
• Develop courageous therapeutic relationships
• Provide effective strategies, a sense of control
  and dignity, encourage hope, peace of mind
• Improve community resilience

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The cards, the kit, and the quill.

• GoWish cards
• Palliative Care The Doing-it-in-Style Kit
• Advance Care Planning

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Would you like a game of cards?

• Easy to learn
• Even entertaining
• Statements on the cards could be important to
  you, if you were seriously ill
• How do you want to be treated?
• Who do you want around?
• What matters?

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GoWish Solitaire

• 35 cards, and a wild card. Read the statements on
  the cards, and sort them into 3 piles
• very important
• somewhat important
• not important
• Choose the top 10
• The wild card is for something that is important
  that isnt on the other cards
• Discuss your choices

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GoWish Pairs

• Play with the person who might become your MEPOA
• Play together, or separately
• Compare the cards,
• Discuss the differences
• www.codaalliance.org

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Palliative Care The Doing-it-in-Style Kit

• 10 steps to take
• Understand as much as you can about your illness,
  and what to expect later.
• Be organised
• Complete an Advance Care Plan
• Make opportunities to resolve unfinished
  business
• Live as well as you can
• (Wellness
  Wheels)

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Palliative CareThe Doing-it-in-Style Kit

• 6. Learn about meditation, and mindfulness
• Record your story in a life review
• Put legal and financial matters in order,
  particularly a will
• Perhaps give some thought to funeral
• Make use of available resources

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Things we could talk about

• Here is a list of things we could talk about.
• You may have some suggestions as well.
• Between us, we can decide the priorities.

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The Glow Worm Poem

• I wish I were a glow worm,
• A glow worms never glum,
• Its hard to be unhappy,
• When the sun shines out your bum!

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Things you could read about

• Palliative Care Victoria
• About series
• pain , fatigue, nausea and vomiting,
• the process of dying, what to do when
  someone dies, etc.

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Things you could look up

• Palliative Care Knowledge Network
• www.caresearch.com.au
• Palliative Care Victoria
• www.pallcarevic.asn.au

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This is my life

• In particular
• important relationships
• roles and achievements
• passions, hobbies, interests,
  activities
• decisions, turning points, ups downs
• things I have learned about life
• things I would like to say
• my hopes and dreams for my family

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What will matter
Michael Josephson

• ..so much becomes irrelevant
• there is so much that wont matter
• What will matter is not your memories,
• but the memories that live
• in those who loved you
• Choose to live a life that will matter.

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The Quill Advance Care Planning

• 3 steps
• Appoint someone to speak for you, if you couldnt
  speak for yourself.
• Talk to your Medical Enduring Power of Attorney
  (MEPOA)
• Put it on paper.

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The Medical Treatment Act Victoria 1988

• The right to refuse medical treatment
• Agent, alternate agent the power to refuse
• The Refusal of Treatment Certificate
• Witnesses
• The issue of competency

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Important medical points

• CPR (cardiopulmonary resuscitation) in
  perspective
• Life prolonging treatments
• Palliative care treatments will always be
  continued
• Food and water will be offered while this is
  feasible.

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The Emergency Plan

• Cardiopulmonary Resuscitation (CPR)
• If I have no pulse, and am not breathing
• Option A
• Option B (1) (2)
• Option C (1) (2)

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Life prolonging treatments

• May, or may not, be beneficial
• High tech. or low tech.
• A reasonable outcome?
• Palliative Care always
• Artificial hydration/ feeding
• Nothing to prolong the dying phase

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Life prolonging treatments

• A. I want the following life prolonging
  treatments...
• but only if the doctors expect a reasonable
  outcome. To me, a reasonable outcome
  means..

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Life prolonging treatments

• However if I become so seriously ill that my
  doctors consider that my condition has become
  irreversible and terminal, I want to be allowed
  to die naturally with well managed pain, in
  comfort, and with dignity. I request that life
  prolonging treatments that would only prolong my
  dying be discontinued.

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Life prolonging treatments

• B. I do not want life prolonging treatments at
  all. If they have been commenced I request that
  they be discontinued. I want to be allowed to die
  naturally with well managed pain, in comfort, and
  with dignity.

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Supplementary questions

• Is there anything that would make you more
  comfortable?
• Where would you be preferred to be cared for if
  you become seriously ill?
• If it would be helpful, are there any other
  people..to involve in discussions?
• Please tell us about any personal, cultural,
  religious or spiritual beliefs and practices that
  you would like respected.

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And remember

• The most powerful therapeutic tool youll ever
  have is your own personality.
• Dr. David Sackett
• (father of evidence based medicine)
• Who you are matters more than what you know.
• Dr. Rachel Remen
• (Kitchen Table Wisdom)

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Difficult conversations will be made easier if
you

• Bring your attention, genuine interest, and
  compassion
• Develop courageous therapeutic relationships
• Provide effective strategies, a sense of control
  and dignity, encourage hope, and peace of mind
  using the cards, the kit, and the quill !