TalkCPR was developed in an attempt to encourage palliative care patients and medical professionals to have conversations about DNACPR (Do Not Attempt Cardiopulmonary Resuscitation Decisions) as a part of advance care planning and to improve and inform communication and dialogue between patients and their healthcare professionals.
To this end 5 online videos http://talkcpr.wales/talk-cpr-videos/ were produced by Dr Mark Taubert at Velindre cancer Centre, together with patients, carer representatives and healthcare professionals, with support from NHS Wales, Byw Nawr and the Bevan Commission. The videos are designed for both professionals and patients and explain DNACPR in palliative care and the issues surrounding this subject.
This idea was developed further and a video media pad was produced to help access for people in areas with limited data and streaming services. The same online videos can be shown to inpatients, GP surgeries and taken on house visits, to try and help people to understand what DNACPR is. One TalkCPR video media pads was sent out to each GP practice in Wales and has been sent to teams within the inpatient setting.
DNACPR is often a subject which is discussed very late on, when patients are nearing the end of life and TalkCPR hopes to encourage medical professional and patients to have this discussion earlier and dispel any myths surrounding this sensitive subject.
Some palliative care patients who have accessed the openly available online videos on http://talkcpr.wales or on Youtube or via Twitter, have approached their healthcare professional, turning the table on the usual approach (where a HCP brings the topic up). GPs who received the video catalogue responded positively saying that the video media pad is easy to use and gives very clear explanations.
In 2017 and 2018, a collaboration with Falmouth University led to several exhibitions of graphic designs to promote Advance Care Planning discussions. https://www.bma.org.uk/connecting-doctors/bmacymruwales/b/weblog/posts/art-and-medicine-nhs-70-exhibit-looks-critically-at-resuscitation-in-palliative-illness
A Velindre cancer patient has recently written a British Medical Journal article about his experience with this resource. (1)
This project has also received widespread international attention, and the resources are used in England and Scotland. More recently, the TalkCPR resources are being used in the African country of Lesotho.
The TalkCPR project has been published in a peer-reviewed scientific journal and can be accessed here:
https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-018-0370-9(1) Cass Keith “Twitter helped me decide that I’m not for resuscitation” BMJ 2018; 362 :k2784 https://www.bmj.com/content/362/bmj.k2784
Early Palliative Care Intervention Metastatic Breast Cancer Clinic
Palliative care integration into metastatic breast clinic at Velindre Cancer Centre and Acute Oncology Services
Patients with an incurable cancer diagnosis often have physical, psychological, social and spiritual problems as a consequence of their disease. Palliative care aims to improve patient’s wellbeing and quality of life (QoL) by alleviating symptoms and problems. Evidence exists (2010) that early palliative care intervention can improve patients QoL, mood and even prolong survival.
The Early Palliative Care project funded by Welsh Government through the End of life board, had two arms, of which palliative care integration into metastatic breast clinic was one and acute oncology service integration was the other.
After 1 year a survey was filled in by healthcare professionals directly involved in the clinic. (46 colleagues were invited; 24 anonymous replies (57% response rate)). The survey asked a series of questions including the IMPACT of palliative care within the service and on advance care planning and if, in their opinion, palliative care presence should continue after the project ends or even be extended into other oncology sites.
Healthcare professional’s opinion on IMPACT of Palliative care in metastatic breast clinic: • 50% SIGNIFICANT POSITIVE IMPACT on patient care• 70% moderate/significant POSITIVE IMPACT on relatives care• 58% moderate/significant POSITIVE IMPACT on their job /role• 55% moderate/significant POSITIVE IMPACT on their communication
In summary the project achieved• Better integration of palliative care and oncology for metastatic breast cancer i.e. pre clinic discussion on EVERY patient• Improved communication between hospital specialist palliative care team to primary care as a detailed letter was sent on EVERY patient reviewed by palliative care.• 49% of patients who attended over the 12 month period were reviewed by palliative care and a holistic (physical, psychosocial and spiritual) assessment undertaken by palliative care. • More advance care planning.
Shared learning across teams.
Acute Oncology Early Palliative Care Project Velindre:
Background: The National Chemotherapy Advisory Group report 2009 recommends an acute oncology service (AOS) in every UK hospital with an emergency department. Patients discussed in Acute Oncology Service settings are often very unwell, at the start of their cancer journey, and may have multiple challenging symptoms.
Aims: Will earlier palliative care intervention in AOS meetings result in an increase in palliative care involvement? As a comparative baseline we used data from Royal Sussex County Hospital, where an acute admission AOS data collection was carried out: in 53 patients with cancer, palliative care were involved in four cases (7.5%).
Methods: As part of this project, our palliative care team started to attend AOS meetings at Velindre Cancer Hospital on a daily basis. After initial embedding, a strategy to collect data was designed and an audit cycle was carried out.
Results: Through integration of the palliative care team into Acute Oncology Service meetings, key areas of advance care planning were addressed and discussions with patients were planned. Of 100 patients assessed during the AOS reporting period, 80% were not known to a palliative care team/provider. Of all patients analysed, 28% required no palliative input, 29% were signposted to another palliative care team, 27% received same day face to face palliative care review and 16% required verbal advice only to a generalist team member. Advance care planning discussions in the sample of patients who needed some palliative care input were held within a two week time frame in 61% of cases.
Discussion: Significant findings included large population (80%) unknown to palliative care services at AOS entry point, but with high level of unmet need. 72% had palliative care needs. 29% had received their cancer diagnosis within the last month.
Conclusion: AOS meetings appear to be a valid entry point for referral to palliative services, despite many AOS patients being at the start of their cancer diagnosis.