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Skip to 0 minutes and 9 seconds Well done. You’ve almost finished the course. And now I’m going to introduce the recommendations that we’d like to make about integrated palliative care. Our recommendations are at three levels. The first level is the policy level. And we can think of that as the macro level. So it’s national level policies, regional level policies. The next level is at meso-level. So those may be policies about institutions, organisations in which people deliver palliative care, but can cross a number of sectors. And then the final level can be thought of as the micro-level. And that’s at the level of the patient.

Skip to 1 minute and 0 seconds And it’s the patient and the professional and their family members, wherever the patient is located, in whatever bed they’re in, whether they’re at home, in a hospital, in a hospice, in a care home, or in another sort of institution. So starting now at the macro-level, which is at policy level, we’d like to make five recommendations. And they are– to make sure that integrated palliative care is visible in all national level policy. So that’s policy for people who have palliative care needs, not just with cancer, but with heart failure, with COPD, with other chronic and life-limiting conditions. That there’s earmarked funding for those initiatives so that they can actually happen.

Skip to 1 minute and 57 seconds It’s right and appropriate that you have policies, but you need to have dedicated funding. Our other view is that those policies should be measurable. So we need to make sure that there are indicators or measurable outcomes so that countries or regions can keep track of what is being delivered, how it’s been delivered, and the quality of that delivery. That’s done through things like benchmarking or audit, or other national statistics that are kept on palliative care. And lastly, we think it’s really important that the public is made aware of what integrated palliative care should be, so engaging the public and helping them to understand why integrated palliative care is important is the final recommendation at this level.

Skip to 2 minutes and 52 seconds So what are the recommendations that we make at a meso-level, the level of organisations? Well, the first thing is to address any gaps that are identified in services and in organisations. And one of the really important things that we found is that communication systems and structures should enable and facilitate really good levels of integration. That may be about the hardware, how you do it, using electronic or other systems, or it may be just in a multi-disciplinary team meeting, so people getting together face-to-face. We think that integrated palliative care is best delivered in multi-disciplinary teams.

Skip to 3 minutes and 44 seconds And those teams need to draw on people who are not just specialist palliative care experts, but other teams that are involved in the care of the patient. And they may be from social work, may be from cardiology, may be from other disease-focused care. And those people need to work together to make sure that care is as seamless as possible across their own organisation, but across other organisations and then other sectors. It’s important to point out here that integrated care is not a one size fits all scheme. And it’s not a way to address inadequate resources, so resources in any one organisation cannot be made up for by just implementing integrated care.

Skip to 4 minutes and 42 seconds So the package of care delivered to patients should fit the patient. There shouldn’t be just one size that fits all. But the structures and the organisations need to have integration as a key feature. So that’s the second level of integrated palliative care. So at the final level, the micro-level, and this is the level of patients and families and health professionals and other care workers who interact with them, there are four recommendations. And the first one is that communication with patients and families must be personalised, attending to their needs.

Skip to 5 minutes and 35 seconds And one of the best ways to do this is to assess patients and families regularly to make sure that we can identify their needs before it becomes a crisis, that we understand their world views, their values, their preferences and wishes for care. The second level is that we need to make sure that patient’s families, their carers, the people who are important to them who may not be family members but may be friends or other people, like neighbours, who provide care, are included in the assessment and are included in that integrated package.

Skip to 6 minutes and 20 seconds The third level is that thinking about the plans that are made for care, they need to be integrated so that they cross the different sectors and agencies that provide care for the patient. And to do that is the final recommendation we need. We need those communication systems to be formalised so that they’re not ad hoc, they don’t just happen. They are part of a system of care, a system of communication. That means that planning is done in a proactive way to make sure that the experiences of patients and families are the best that they can be.

Skip to 7 minutes and 10 seconds So to sum up– what we suggest is that integrated palliative care involves delivering care to patients and families using this little mantra– right care at the right time by the right person.

Recommendations for Palliative Care

In this final film, Sheila Payne introduces the recommendations from the InSuP-C project. These recommendations focus on three different levels: policy; organisations; and the individual patient and their family.

Using the Discussion below, we invite you to reflect on your experience and learning over the past three weeks while taking part in this course.

In particular, we are interested to know the following:

  • What are your thoughts about palliative care now you have done this course?
  • How do you think this compares with what you thought in Week 1?
  • What aspect of the course has been the most useful to you and why?

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This video is from the free online course:

Palliative Care: Making it Work

Lancaster University