Palliative care development in the Caribbean

Categories: Education.

The conference was opened by the Jamaican Minister of Health, Dr Fenton Ferguson, and the keynote speaker was Sir George Alleyne, Chancellor of UWI.

Delegates attended from all over the Caribbean, and were rewarded with an impressive line-up of international speakers, including Liliana de Lima, Executive Director of the International Association of Hospice and Palliative Care (IAHPC), who gave an overview of global development and Dr Jim Cleary, Director of the Pain and Policy Studies Group and UW Carbone Cancer Centre, University of Wisconsin, USA, who spoke about the availability of opioids as essential medicines. The programme also included regional reports from Barbados, Trinidad and Tobago, Granada, Grand Cayman and Jamaica.

The vision of the PCAJ is to promote the availability and delivery of excellent palliative care by healthcare professionals in Jamaica. Most of the Caribbean countries only have isolated palliative care provision (Lynch et al, 2013). However, inspired by the conference, the speakers from each of the represented Caribbean countries agreed that a regional association should be formed to support and encourage further development.

Delivering the QELCA© programme in Jamaica

I was one of the conference speakers but in the week preceding the event I was invited by Dr Dingle Spence of Hope Institute and Audrey Callum, Secretary of the PCAJ  to deliver the QELCA© programme (Gillett and Bryan, 2015) to a group of eight professionals from the University Hospital of the West Indies and Hope Institute. This group comprised four Consultant Anaesthetists who work in intensive care, and nurses (four in total) from ITU, the chemotherapy unit, outpatients and oncology. 

QELCA©, an end of life care education programme, was designed by St Christopher’s Hospice, London, originally to be delivered by hospice nurses to senior clinical nurses working in acute hospitals.

Teams from the same department or organisation spend five days based at a hospice or specialist centre in small groups of up to six. This ensures that all of the participants from one team or care group share the same or equivalent experience.

Using the hospice, or the practice of specialists, as a learning resource, participants are offered a first-hand experience of observing and being alongside practitioners as they deliver expert care to patients and their families at the end of life.

In addition to this practice experience, the five-day programme combines classroom discussion and reflection facilitated by experienced specialist palliative care professionals. The programme then continues with six months facilitated Action Learning so that action plans for self, team and organisation, formulated by the participants on the final day of the five-day placement, can be supported in practice and learning from the programme, consolidated.

This was not only the first time the QELCA© programme had been delivered outside of the UK but also the first time it had been delivered to an interdisciplinary team.

Classroom activities were facilitated by me and Dr Dingle Spence, and practice experience was gained by observing a ward round at Hope Institute Hospital, accompanying Dr Spence on home visits, by interviewing patients and by a visit to a small independent nursing home that provides care for the dying.

The primary objective of this new team will be to set up a palliative care outpatients’ clinic at the hospital and, in time, as skills and confidence grow, to consider offering an on-call palliative care consultancy to other teams within the hospital.

References 

Gillet K and Bryan L (2015) ‘Quality End of Life Care for All’ (QELCA): the national rollout of an end-of-life workforce development initiative. BMJ Supportive & Palliative Care. Published Online First 26 March 2015: doi:10.1136/bmjspcare-2014-000816

Lynch T, Connor S, and Clark D (2013) Mapping Levels of Palliative Care Development: A Global Update. Journal of Pain and Symptom Management Vol. 45 No. 6