Thinking Beyond the Protocol: How Do We Provide Care That Patients REALLY Want?

Dr Chris Moy, Cathy Wright, Helen Smith, and Kate Jurgens

A download of available presenter’s session slides are available by clicking the following links:

  • Chris’ session is available by clicking here,
  • Sepehr’s session is available by clicking here,
  • Cathy’s session is available by clicking here.

Pre session summary
The term “patient-centred care” is frequently used to describe what we think we do in health. In reality, care is more often driven by protocols, procedures, guidelines, pathways and practices based on risk aversion and fear of legal consequences. While these must obviously be respected, if blindly followed, they may in fact undermine the care of older patients whose goals and wishes often change as they near the end of their lives.

This session looks at the challenge to balance the protocols and rigidity that sometimes dominates our thinking in caring for these often vulnerable people- and looks at decision-making and care which genuinely attempts to align with their goals and wishes- in trying to make decisions as if “in their shoes”.

In this session:

  1. Dr Chris Moy will discuss basic ethical, legal and practical concepts in end of life decision-making and care which can be applied in day to day real world situations- and particularly in applying substitute-judgement decision making or acting “as if in the person’s shoes.”
  2. Dr Sepehr Shakib will consider issues of polypharmacy and de-prescribing in aged care and near end of life situations- and how quality care in medication management is as much about knowing when to stop medications as when to start them- in the quest to provide care in line with what patients really wish for.
  3. Ms Cathy Wright will look at how a recent Coroner’s finding has driven a pattern of automatic transfer of residents of aged care facilities who sustain head injuries- even where this may not be of any medical benefit or be in keeping with a resident’s wishes.  And she will offer a suggestion about how planning for these situations can improve the appropriateness of responses.
  4. Ms Helen Smith and Ms Natarsha Emerson will then consider the difficult issue of individuals with swallowing difficulties who are often prevented from eating solids or drinking fluids because of the risk of choking or aspiration. These restrictions can have a major impact on the quality of life and dignity of some of these individuals. In this interactive session, participants will step through the type of thinking that is required to balance the complex legal, ethical and practical aspects to get a result in care as close as possible to where an individual’s wishes lie.
  5. And throughout the session, Ms Kate Jurgans will offer important psychosocial considerations inherent in all these situations.

Post session summary

  • When is it the right time to discuss End Of Life?
    • Need triggers to start e.g. health crisis, wills ect. Actualising the person’s wishes
  • No right or wrong answers, key message is have the conversation about what the person would have waned. 7 step pathway is a tool to do this
  • Important to recognising individual values and ethics as well as the legal and what is best for the person.