Consultant in Palliative Medicine Marie Curie Hospice Edinburgh Realising Realistic Medicine Implications for Palliative and End of Life Care Dr Juliet Spiller Consultant in Palliative Medicine Marie Curie Hospice Edinburgh Juliet.spiller@mariecurie.org.uk

Realistic Medicine is clearly not all about Palliative Care But Palliative Care is, and always has been, about Realistic Medicine Values, shared decisions, person-centred, individualised approach, focus on what matters to you, benefit/burden balance Those who choose to specialise in Palliative Care have this at the core of all they do.

Palliative Care is everybody’s job – “no time”, “no knowledge”, “something extra/different from my job” Realistic Medicine is everybody’s job – makes more sense particularly caring for people with long term and life-limiting conditions – “yes that’s my job” Realistic Medicine - opportunity for SPC to explicitly support: - “mainstreaming” of a palliative care approach - Creative ways to engage with experts (patients, carers and volunteers) (eg “Building the Best”, “ Hospice without Walls” etc)

Realising Realistic Medicine - PEoLC IDENTIFICATION of palliative need - SPICT, SPARRA etc EQUITY Postcode, diagnosis, culture etc HEALTH LITERACY –shared understanding (trust, empowerment, enabling decisions) EDUCATION Patients, carers, clinical staff, volunteers, social carers, care home staff etc ANTICIPATORY CARE PLANNING National ACP, ReSPECT, KIS etc RESEARCH – what works, patient experience, carer experience, sharing good practice

“This case was never really about the decision-making process, that didn’t really come up at all. It was - why didn’t they talk to my mum . Why didn’t they explain to her what was possible? Why didn’t she get the chance, when she so desperately wanted it, to talk about what was going to happen?” Kate Masters – daughter of Janet Tracey – explaining why her dad pursued the case against Cambridge University Hosp Trust

Step change not marginal change ‘You can make incremental change, you can improve, by asking everyone to do two jobs, to deliver performance, using current measures, and to improve, and you can do the improvement in 5-10% of your job, and delivery in the rest. But if you’re asking people to do new job descriptions, new teams, new ways of communicating it’s too much to ask for people to do in 10% of their time; and no-one can do it alone.’ Dr Albert Mulley, Director for Global Healthcare Delivery Science What types of studies have been undertaken (designs used/characteristics of the study populations).

Realistic Research What types of studies have been undertaken (designs used/characteristics of the study populations).