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Palliative Care Congress: Towards evidence based compassionate care – day two

Author: Dr Sarah Russell
20 March 2018

Dr Sarah Russell, Head of Research at Hospice UK, reports on day two of the Association for Palliative Medicine’s Palliative Care Conference in Bournemouth.

Nearly 500 delegates registered for the Congress and over 150 posters were displayed over the two days, representing ideas and knowledge across multiple settings. You can read the online abstracts published by BMJ Supportive and Palliative Care (one of the official journals of Hospice UK) here . What was fascinating about the day was the breadth of sessions from clinical practice, research, models of care and service improvement to mention just a few.

What caught my eye today? The day began early with the Association of Palliative Medicine Masterclass about new anti-coagulants and palliative care – with a reminder from Professor Simon Noble that thrombosis is the main cause of chemotherapy-associated death,  not sepsis as you might think. At the same time the Palliative Care Research Society’s Research Governance Masterclass discussed in depth how hospices can engage with, generate and lead the production of research evidence.

The opening plenary featured the hugely inspiring Professor Miriam Johnson, Director of the Wolfson Palliative Care Research Centre, who provoked us to consider how important it is in heart failure and palliative care to manage uncertainty, and enable good relationships across teams and training across disciplines. Professor Johnson shared some of the research about the use of subcutaneous furosemide infusions as well as challenged assumptions about terminologies used in palliative, end of life, supportive and patient-centred care. The key message was “why should another layer of care increase mortality” i.e. palliative care makes a positive difference to patient care.

Later on, we enjoyed a double act from Professors David Currow  and Johnson on ‘Opioids for Breathlessness: knowns and unknowns.’ In a highly informative session, we learnt that small differences make big changes, such as looking at the detail of the data is important to show the minimal, clinical important change that makes a meaningful change to a person’s life, e.g. reducing breathlessness enough so that a person can do what they want to do. Which measures will be the most reflective of a person’s experience? What is the right question to ask, for example  ’can you get dressed or make a cup of tea now’ rather than ‘is your breathlessness worse or better?’ Much discussion was had about the use of opioids including needing to know more about their pharmacokinetics in non-cancer populations. Examining the detail of the design of current and future studies is important to understanding the therapeutic window of opioids’ use in breathlessness (e.g. sustained vs immediate release morphine) as well as side effects. Morphine has a known safety profile and should be prescribed for the right patient with due care in monitoring.

I enjoyed the APM Science committee session on how to design a research question. Key messages were on having a clearly defined and focussed research question using the Patient, Population  or Problem Intervention Comparison Outcomes (PICO) framework. I loved the metaphor from Professor Paddy Stone from The Hitchhiker’s Guide to the Galaxy, written by Douglas Adams: “42 is the answer – but what actually is the question?” Paddy reminded us that research methodology will be guided by a clearly defined research question.

Other highlights included Clinical Associate Professor of Psychiatry, Dr Jacinta Tan from Swansea University discussing severe enduring eating disorders with considerations of anorexia being a terminal illness. Julie Kinley, from St Christopher’s Hospice in south east London, explained how an individual (enabling and developing), organisational (whole  team learning), and appreciative system models of facilitation influenced end of life in care homes.

Huw Williams, a General Practitioner from Cardiff presented fascinating (albeit perhaps unsurprising – but good to have its robust evidence) findings about out of hours incidents including medication, access to care and advice, treatment (non medication) and information transfer across providers.

As the two days drew to their end, the exhibitor stands packed up, the conference organising committee thanked the speakers, delegates and the organisers Munro Smith Ltd, and the conference was closed. There was a quiet and consistent conversation amongst the delegates. Old friends and colleagues had caught up, new friendships were made, collaborations planned, and information and knowledge shared. The Association of Palliative Medicine and Palliative Care Research Society’s Palliative Care Congress 2018 had motivated the heart, stimulated the brain and fed the soul: now let us turn that into action to make a difference to those we provide care for.

Next year the conference will be in Harrogate on 21-22 March. For more information visit Association of Palliative Medicine’s Palliative Care Conference

The second day of the Association for Palliative Medicine and Palliative Care Research Society Palliative Care Congress in Bournemouth was on the 16th March 2018. For a report on day one of this year’s conference read here

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