Caring for all in the last year of life: making a difference.
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Inaugural presentation by Prof. Scott A. Murray, St Columba's Hospice Chair of Primary Palliative Care, Primary Palliative Care Research Group, Centre for Population Health Sciences: General Practice Section, University of Edinburgh. April 21, 2009
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Caring for all in the last year of life: making a difference.
- 15. General Practice Teaching Team with student prize winner
- 18. Murray S, Sheikh A. Serial interviews for patients with progressive diseases. Lancet 2006; 368: 901-902. Kendall M, Harris F, Boyd K, Sheikh A, Murray S, Brown D, Mallinson I, Kearney N, Worth A. Key challenges and ways forward in researching the “good death”. BMJ 2007; 334:521-524. Living and dying well
- 20. World Mortality Rate 100 % 100% 100% 100%
- 22. GP has 20 deaths per list of 2000 patients per year Challenge 1 Quality end of life care for all Death High Low Many years Function Death High Low Months or years Function Organ failure 6 Acute 2 Dementia, frailty and decline 7 Death High Low Weeks, months, years Function 5 Cancer
- 24. Murray SA, Boyd K, Kendall M, Worth A, Benton TF, Clausen H. Dying of lung cancer or heart failure: prospective interview study of patients and their carers in the community. BMJ 2002;325:929-32. Scott Murray Kirsty Boyd Marilyn Kendall Allison Worth Fred Benton Hans Clausen
- 27. Implications for Service Planning and Redesign We need services which meet the typical needs of people on these three different trajectories “ Well, this certainly scuppers our plan to conquer the universe”
- 29. Copyright ©2005 BMJ Publishing Group Ltd. Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005; 330:1007-1011. Challenge 2 Palliative care approach early, at diagnosis of life-threatening illness .
- 30. Sentinel events Caring for people with organ failure: 3 stages Stage 1 Physically well Stage 2 Active supportive and palliative care Stage 3 Terminal care Death High Low Time Function
- 31. Sentinel events Caring for people with organ failure: 3 stages Gold standards Framework Liverpool Care Pathway Care Plan Stage 1 Physically well Stage 2 Active supportive and palliative care Stage 3 Terminal care Death High Low Time Function
- 36. Murray SA, Kendall M, Grant E, Boyd K, Barclay S, Sheikh A. Patterns of social psychological and spiritual decline towards the end of life in lung cancer J Pain Sympt Man 2007; 34: 393-402 His old friends won’t even take a cup of tea with me now I’ve got cancer” Mrs LR.
- 37. Lung Cancer - psychological trajectory Four times when distress was common 1. At diagnosis 2. After initial treatment 3. At recurrence or disease progression 4. At terminal stage
- 39. “ living with uncertainty” “ It was like a black hole” “ It’s much worse the second time round” “ You don’t know what is is going to happen to you, fear is the worst thing” “ great nurses and departments they are so caring”
- 40. .
- 42. Murray SA, Kendall M, Grant E, Boyd K, Barclay S, Sheikh A. Patterns of social psychological and spiritual decline towards the end of life in heart failure. J Pain Sympt Man 2007; 34: 393-402
- 44. Multi-dimensional distress Glioma Physical Frailty Bowel Cancer PhDs AIDS Debbie Cavers Anna Lloyd Emma Carduff Katharine Thompson Janet Sikasote
- 45. Establishing c ore set of assessment and outcomes measures Dan Stark Irene J Higginson Michael Sharpe, David Weller, Aziz Sheikh, Scott Murray, Marie Fallon Implementing interventions in palliative care
- 46. Challenge 4: reaching all in need Murray SA, Grant E, Grant A, Kendall M. Dying from cancer in developed and developing countries. BMJ 2003;326:368-72. Liz Grant
- 49. Approaching integration (n=4) Localised provision (n=11) Capacity building activity underway (n=11) No hospice-palliative care activity yet identified (n=21)
- 50. Mg/capita Source: International Narcotics Control Board By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2008 (156 Countries) Botswana Swaziland Namibia Mozambique Lesotho Global Mean (5.5708 mg) Austria (121.45 mg) France (42.30 mg) United Kingdom (28.56 mg) Germany (24.42 mg) Global Consumption: morphine 2005 Global mean 5.5708 mg Africa Regional mean 0.4865 mg Botswana 0.6028 mg Lesotho 0.0050 mg Mozambique 0.0056 mg Namibia 0.0665 mg Swaziland 0.2290 mg
- 60. “Living and Dying Well” Promote a public discourse about death, dying and bereavement National Action Plan for Palliative and End of Life Care in Scotland Our research findings and advocacy are highlighted Elizabeth Ireland
Hinweis der Redaktion
- May I thank Sir Timothy O’Shea for that most kind introduction. Firstly, I would like to thank St Columba’s Hospice for the generosity in establishing this Chair of Palliative Care strategically placed in General Practice, and also for establishing the Chair of Palliative Medicine to which Marie Fallon was appointed at the same time. I would also want to thank John Smyth and John Savill and many others at the University for their vision and work in taking this development forward. Edinburgh University is good at identifying and backing important developments and I strongly believe that this is such a case. I consider it indeed a great honour to take up and establish this Inaugural Chair especially as it helps consolidate the growing significance of the Primary Palliative Care Research Group. Let me also thank my family, Mary a General Practitioner in Dalkeith, who has been very supportive in many ways, and our children, Andrew, Susie and Iain. May I also thank so many people for attending from throughout Scotland, it’s superb that there’s so many people here today, and also Tony Delamothe from the BMJ for attending and illustrating their keen interest in palliative care in general, and our work in Edinburgh in particular.