1. Health Literacy in Palliative Care Tanja Bahro, Consortium Manager, Southern Metropolitan Region Palliative Care Consortium

3. Using mail merge For Excel, you can select data from any worksheet or named range within a workbook. For Access, you can select data from any table or query. For another type of data file, select the file in the Select Data Source dialog box. If the file is not listed, select the appropriate file type or select All Files in the Files of type list. You can use the following types of data files: Files from single-tier, An HTML file that has a single table. A document that contains the header row to be used with the data source Note To prevent being prompted every time you open a data file, you can turn off the Confirm conversion at Open option after you have connected to the worksheet.

4. ??? What is Health Literacy? What are the stats? Why is it relevant to palliative care? What has the project done so far? Where to from here?

5. Definition Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Healthy People 2010

6. WHO definition Health Literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Health literacy implies the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions. Thus, health literacy means more than being able to read pamphlets and make appointments This is very wordy and doesn’t follow health literacy principles

7. Only 41% of people in Australia have adequate health literacy (a) Skill levels 3, 4 and 5 represent adequate or better health literacy. Source: Health Literacy, Australia (ABS cat. no. 4233.0)Health Literacy, Australia

9. Health Literacy Education system Culture and society HEALTH LITERACY Health outcomes Experience with health system

10. Changes in the Health Care System 4 - 6 weeks bed rest in hospital 650 3 weeks in hospital 2 hours a day of diabetic education classes 2-4 days in hospital (M&R Guidelines) 10,000 + outpatient 0-3 hours diabetic education classes written materials internet/telemedicine Treatment of Acute Myocardial Infarction Available Prescription Drugs Treatment of new onset diabetes 35 Years AgoToday

11. Where does it play out? Poorer health outcomes (increased hospitalisation and mortality) Decisions about life prolonging treatment Referral to palliative care Intake and assessment Confusion about services involved and the roles of the different professions

12. Cont. Self administered tools Consenting to, understanding and following treatment including medications Carers ability to identify important signs and symptoms Accessing after hours support may result in emergency departments Understanding processes around death

13. Case example 1 A 71 year old patient with bowel cancer has been prescribed regular laxatives, however even after a week still has very irregular bowel movements. When checking if the patient takes the medicines regularly, the nurse finds that the right amount of medication is missing from the packet. As a result, the doctor prescribes a stronger medication. A week later the nurse finds the patient very ill after having taken the stronger laxatives. What might have happened here? How could it have been prevented?

14. Case example 2 A palliative care nurse has explained wound care for a simple surgical wound to a carer. After two weeks, the wound is not healing and is infected. The nurse explains how to dress the wound again, however, the situation is worse at the next visit. The nurse decided to employ the “teach-back” technique and finds out that the carer had been using the same swab several times over.

15. Challenges for palliative care Lack of awareness of HL issues – Assessing patients by “gut feeling” (based on socio economic status or similar) – Underestimating the impact “I already communicate well with patients” Interventions centering on the patient, not the provider Reliance on written material, that has not been produced with input from consumers

16. What we have done Presentations to service management Presentations to staff and volunteers Competition: call for stories Training in writing for consumers Planned: promotion of teach back technique Health literacy stories to be collected

17. steps to enhance your interactions with patients: Conduct patient-centered appointments Explain things clearly in plain language Focus on key messages and repeat Use a “teach back” technique to check for understanding Use patient-friendly educational materials to enhance interaction.

18. 2 key learnings This is about your communication too! Do not assess someone’s health literacy (neither by gut feeling or tests)