The Growing Need for Palliative Care Services in Ireland
Ireland has been identified as the country in Europe with the most rapidly rising need for palliative care. People often think of palliative care in terms of hospices and patients who are approaching the end of their lives. However, according to Ruth Usher, Assistant Professor in the Discipline of Occupational Therapy at Trinity College Dublin, palliative care is actually an approach that seeks to improve the quality of life of patients, and their families, throughout their lives. The Palliative Hub states that palliative care is “about having the best quality of life for however long life remains,” and helping people to be “free from pain, symptoms, and suffering.” As well as medical guidance, patients might work with counsellors, dietitians, and music and art therapists, which can improve overall quality of life.
There is now a push towards integrating palliative care approaches into primary care services. According to gov.ie, primary care is “all of the health or social care services that you can find in your community, outside of hospital. It includes general practitioners (GPs), public health nurses and a range of services.” Person-centred services are being recognised as essential, particularly as part of Sláintecare, the Government’s ten-year programme to transform Irish health care and social care services. This programme includes a revised palliative care policy, which will look towards providing people with the care they need to relieve pain and suffering.
The Government website states that it is their “core objective” to “shift most people’s care to the community. This will help reduce waiting lists and waiting times.” An important goal is to avoid hospital admissions when possible, and to help people to continue to live at home in their communities and receive treatment from their primary healthcare providers.
WHO have stated that it is not necessary for most palliative care to be provided by palliative care specialists. Improved education and resources are required for general healthcare providers so that they are trained in how to incorporate palliative care techniques into primary care. Specialist palliative care services can be provided to patients with advanced palliative care needs.
In order to further investigate what resources and supports could potentially be helpful to enhance palliative care provision within primary care services, Ruth has been working as a Trinity academic consultant with the All Ireland Institute of Hospice and Palliative Care (AIIHPC). Ruth’s project with the AIIHPC focused on occupational therapists and physiotherapists around Ireland who are working in primary care. Their project sought to facilitate the provision of training and education for these healthcare professionals so they could integrate palliative care approaches into their primary care work.
The AIIHPC approached Ruth last year requesting her help with this education and training project, based on her expertise as a practitioner of occupational therapy and her skills as a researcher and academic. Ruth’s ongoing research is focussed on assisted decision-making capacity of older people and the role of occupational therapy in assessing and supporting older people. Her combination of skills and knowledge made her highly suited to this project, for which she was asked to design and conduct surveys and focus groups with the participating occupational therapists and physiotherapists, and to evaluate the impact of the programme.
The AIIHPC wanted to use the ECHO (Extension for Community Healthcare Outcomes) Model in their training programme which, according to the report produced by Ruth, “employs teleconferencing technology to support and train healthcare professionals remotely.” The AIIHPC asked Ruth to work on evaluating how impactful this model could be in delivering education and training on palliative care skills to occupational therapists and physiotherapists practising in primary care settings across Ireland, particularly in remote areas. The overall aim was to achieve better outcomes for patient care. The project sought to democratise access to educational tools across Ireland through use of the online videoconferencing tool Zoom, which allowed for the structuring of a “Hub and Spoke” education and training programme.
The “Hub” consisted of senior healthcare professionals with relevant specialist palliative care experience from specialist palliative care and hospice settings. It was led by Palliative Care National Clinical Therapy Leads and facilitated by an allied health professional with academic, research and clinical experience in palliative care delivery. The “Spoke” was the twenty-six primary care healthcare professionals from across the country who were taking part in the study.
Using Zoom meant that each participant could log in remotely every two weeks, over a period of four months. The participants could learn from specialists and experts in the field, as well as from their peers, and engage in discussion. Ruth sought to track how the participants responded to the training, and how their perceptions of palliative care and their role in administering it changed over time.
A significant barrier to incorporating palliative care techniques into primary care is that healthcare practitioners do not feel confident enough in providing recommendations to patients with long-term or life-threatening illnesses. This is understandable given the often serious nature of the patient’s situation. Sometimes palliative care supports are not recommended until a crisis point, which increases the stress levels of patients and their families. But because the ECHO programme allowed these healthcare workers to have access to up-to-date expert knowledge in the area, their confidence level improved significantly. They also had a community of people they could reach out to if they needed help with a particular query.
One participant stated: “I now feel more confident to discuss pain with a client, and its impact.” Another participant reported feeling “more comfortable with the appropriate language to use and how to phrase questions.”
According to Ruth’s report, there was a statistically significant improvement in participants’ self-rated confidence in knowledge and skills after the ECHO programme was complete. The report states that “95% of participants reported that ECHO was an effective format to enhance clinical knowledge and 75% reported it was an effective format to enhance clinical skills.”This means that a low-cost model has demonstrated large impacts, particularly as participants reported that they would continue to share these ideas among their peers, and to develop their skills further. This is a positive result as there is a growing need for palliative care in Ireland, but limited resources. It indicates beneficial steps in improving patient care and positive outcomes when helping people in their communities so that, despite dealing with ongoing and potentially serious illnesses, they can continue to enjoy life and live it to the full.
Article by Dr Kate Smyth, Consultancy Development Officer, CONSULT Trinity, Trinity Research and Innovation.
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