1. The North West End of Life Care Programme for Domiciliary Care Step 1 workshop

2. Plan of session Review of ‘To Do’ List from last workshop Introduction to the North West End of Life Care Model What systems need to be in place to identify individuals in the last year of life? Starting a Supportive Care Record Case studies and discussion Foretelling and Forewarning – when is it appropriate to open/hold discussions? Case studies and discussion Recording individual’s wishes End of Life Care Policy/philosophy..

3. First Days of Death Last Days of Life Increasing decline 6 months Advancing disease One year + Death NORTH WEST END OF LIFE CARE MODEL 12345

4. Prognostication or diagnosing dying??? ‘Forecasting/Foreseeing’ Longer term Often refers to a 6-12 month period May link in with Gold Standards Framework and/or Advance Care Planning Often in relation to last few days - or week(s)? of life In line with commencement of end of life care plan (or equivalent) Prognostication Diagnosing dying

5. What do we need to do to identify individuals in the last year of life?

6. Why prognosticate? THE question…“How long do I have to live?” Support individuals, families and professionals to make decisions about the appropriateness of palliative treatments Provide individuals and families with the opportunity to think about where they wish to be cared for Allow time for individuals and families to take practical steps to prepare for their own deaths To enable access to particular resources To provide ongoing supportive care

7. How to prognosticate???? There is guidance available, however, the ‘SURPRISE QUESTION’ is often referred to... Resources to support this process  The Gold Standards Framework Prognostic Indictor Guidance’(PIG)  ‘A Quick Guide to Identifying Patients for Supportive and Palliative Care’ Why is it difficult?

8. Illness trajectories and individuals (Lynn and Adamson, 2003)

9. Using the Supportive Care Record for End of Life Care Let’s have a go using case studies Jenny Jones Michael Andrews

11. Planning ahead... (Discussing end of life wishes) Why is it important to think and plan ahead? What sort of things could be planned for? Does everyone want to do it?

12. Planning ahead... (Discussing end of life wishes) Jenny Michael When and how would it be appropriate to have discussions about end of life issues? How can we initiate/support such discussions? Do you facilitate discussions?

13. Recording wishes Recognised ‘system’ in the organisation, so EVERYONE knows where/how wishes are documented Good teamwork (especially with DNs, GPs, Macmillan Nurses Consider use of existing format, ie, PPC or equivalent or Best Interests at End of Life Promote an ‘open’ attitude to holding discussions with individuals and families

14. To conclude... Any questions??? Consider additional workshop for key staff around end of life care planning End Of Life Care Policy Next time – ‘To do’ list Evaluation forms