Looking through an interesting document from the US Department of Health and Human Services (aka health and social care in UK parlance), I see that, as in the UK, not a lot of patients express their wishes for future care. The American evidence suggests that people value acp, and recognition that they have a chronic illness is a good time to start. You need a structured system for discussion: initiating a guided discussion, introduce the subject of acp and offer information, prepare documents and then review preferences regularly. Some patients think some health states are worse than death, and invasiveness and lngth of treatment affect their views. There is lots of other useful material. This is important, because it suggests that acp should routinely be part of all health and social care when people have long-term conditions, and identifying a condition is a good and tactful time to start a discussion. There might be a lot less worry about making these decisions at the time that people lose mental capacity or towards the end of life when ‘euthanasia’ rears its ugly head. Much better to do it earlier.

Kass-Barthelmes, BL and Hughes, R. (2003) Advance Care Planning: Preferemnces for Care at the End of Life. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/endliferia/endria.htm

The Agency for Healthcare Research and Quality has loads of interesting, well-written and authoritative stuff: I’ll come back to it. http://www.ahrq.gov

The production organiser for the musical I’m appearing in writes to urge us to learn our lines, even though it’s difficult for us older people; she and I are the same age, over 60. I think saying things like this encourages discrimination against older people. As far as I know, all the evidence is that it’s a ‘use it or lose it’ scenario, so actually learning our lines is good for our overall ability to remember. Looking up the valuable http://www.helpguide.org/ site (it seems to be something to do with American Rotary, who knows why, or perhaps they just fund it) which gives advice on all sorts of personal mental health things, I found some useful tips of keeping your memory capacity green: http://www.helpguide.org/life/improving_memory.htm . Apparently a good move is to take lots of aerobic exercise, on the ground that this improves oxygen in the brain, and to exercise your brain by doing new things or old things in new ways. They suggest showering and dressing with you eyes shut, just to make your brain work harder.

A House of Lords Report on an EU organ donation policy notes that Britain ‘lags far behind’ many EU countries in achieving organ donation, but is against presumed consent, because we do not have enough trained staff to properly inform people in some medical crisis about what’s going on. We find that people do want to donate their organs, but often there seems to be not enough time to discuss it fully at the right time.
Links to the evidence and reports: http://www.parliament.uk/parliamentary_committees/leuscommg.cfm.

Pics of the rebuilding at St Christopher’s, now under way, in solidarity with all colleagues working through a difficult time, to make things better in the future:
Builders’ yard

Interesting paper in Australian Social Work this quarter, which I get because I’m on the editorial board. This is a systematic literature review about how palliative care services deal with people who have suicidal thoughts, about 30% of patients according to one study. As opposed to many situations, you cannot assume in palliative care that someone with suicidal thoughts (I refuse to call it ideation; unnecessary technical jargon) is mentally ill. So what do palliative care services do?

The paper argues that it is barriers in people’s social lives and psychological perceptions of what is happening that leads them ot think about killing themselves. One of the most important of these is if they feel they are being a burden to their family. Another is where they have a doctor who is strongly anti-suicide; it means they feel they can’t talk about their problems. So my prescription for active social work based on this article is to aim to reduce the caring burden on families. Also good is encouraging carers to talk about the positives for them of being caring (there are many for a lot of people and we talk too much about ‘burden’) and helping people to talk over suicidal feelings and adjust to how they are coping with their illness. You can also give them useful things to spend their time on. I think these are all good moves to prevent suicide, or suicidal worries.

Robertson, M. (2008) Suicidal ideation in the palliative care patient: considerations for health care practice. Australian Social Work. 61(2): 150-67.