Dr Stephen Hutchison MD FRCP (Glasg)
Retired Consultant Physician in Palliative Medicine,
Highland Hospice Inverness and NHS Highland

This package of eLearning modules offers an exploration of what caring for patients really means, ascertaining wishes and conveying clinical decisions about DNACPR and how can this be done accurately and sensitively?

CARE24
An exploration of what patient care really means

The desire to care for people is ubiquitous amongst clinicians and is often a prime motive for a medical career. Participants will be encouraged to acknowledge the many legitimate reasons for choosing a medical career, and to recognise the wish to care as foundational. We will then proceed to identify the components of care and how these can be incorporated into every clinical encounter. Participants will be provided with a variety of simple mental prompts to facilitate good care every time.

Duration: Approximately 25 minutes

Giving prognosis
How can this be done accurately and sensitively?

Giving a prognosis in the face of advanced disease is a significant challenge for the clinician, not least because it is a very inexact science. Participants will be presented with some simple rules to guide discussion about prognosis. Some conversational phrases will be suggested and participants will be encouraged to adapt these to their own style of communication.

Duration: Approximately 10 minutes

Discussing DNACPR
How to ascertain patient wishes and convey clinical decisions about resuscitation

The clinical decisions about resuscitation status and the completion of associated documentation are usually straightforward. However clinicians frequently identify the conversations which need to take place with patients and families as the most challenging part of the process. Using the acronym ˜RESUSC™ participants will be presented with a comprehensive approach to these discussions. Using common patient and family scenarios, participants will be invited to write down the sort of phrases they would actually use, and these will then be examined to identify appropriate, and inappropriate, ways of presenting the information. Finally participants will be encouraged to use some tried and tested means of communication, adapting these to their own way of speaking.

Duration: Approximately 25 minutes

Delirium in terminal disease
A helpful guide to possible causes

Delirium is common in terminal disease and is distressing for the patient, family, and clinician. Using the acronym ˜DELIRIUM™ the causes can be quickly identified, thus guiding investigation and treatment.

Duration: Approximately 14 minutes

Taking morphine in advanced disease
Acknowledging and alleviating fears

Patients are often alarmed when faced with the necessity of using morphine or other strong opioids in order to achieve control of symptoms in advanced disease. Four common fears will be identified, and participants will be taught how to raise and discuss these with their patients. A patient information leaflet which helps to support these discussions will be provided.

Duration: Approximately 12 minutes.

Breathlessness in advanced disease
Identifying the causes of breathlessness in the palliative care patient, and a guide to management

Breathlessness is a common and distressing symptom in advanced disease. Using the acronym ˜BREATHE™ the causes of breathlessness in this context will be identified. The presentation will then focus on clinical management of reversible causes and then on the means of achieving symptomatic control of breathlessness where the underlying cause is not reversible. Finally, participants will be taught how to address and alleviate the almost ubiquitous fear amongst patients with severe breathlessness, that of choking to death.

Duration: Approximately 25 minutes