Facing death creatively at St Christopher’s

In this new series, The Arts in Palliative Care, we look at how the arts in palliative care settings can be a powerful and effective way of addressing the practical, psychological, social and spiritual issues that face people at the end of their lives.

Avril Jackson, Information Officer/Editor, European Association for Palliative Care Social Media Team, gives her impressions of the annual conference organised by the Arts Team at St Christopher’s Hospice in south-east London, UK.

 

The Arts get to the crevices of the soul in ways that words can’t.” (Julia Samuel, Psychotherapist, on opening the conference.)

With no specific training about the Arts in Palliative Care, but wanting to prepare for this current series on the blog, I attended St Christopher’s arts conference. This annual event has become a meeting space for art and music therapists, psychotherapists, dramatherapists, community artists, storytellers and writers involved in palliative and end-of-life care.

By the end of the day, I had begun to understand a more creative way of facing death – how the Arts can be used to heal when someone is broken or grieving, to make sense of and provide comfort at the end of life and in bereavement. Grouped under Resilience, Resistance, Revolution and Reflection, presentations, interactive workshops and posters revealed how to unlock channels of blocked communication and encourage self-expression.

Resilience

Francis, a patient, explained how, since becoming ill, he had not played his guitar – a huge part of his life for years. But through a collaborative music project between St Christopher’s and students of the Brit School of Performing Arts Francis took up his music again and performed with one of the students. He said:

Just the participation involves coming out of yourself … putting yourself into some form of expression and creativity … it helps you understand where you are and where you are going.”

Ray Travasso, a music therapist at East Anglia Children’s Hospice, explained how music therapy could be just as powerful and healing to parents as to the children. ‘Music Therapy and Cake’ is the title of a group music therapy session he runs for young children and their families, followed by all-important social time for parents. Music therapy is also part of bereavement support with a hospice community choir that welcomes bereaved mothers as well as non-bereaved people. Led by the mothers themselves, the choir is building their self-confidence and greater resilience.

In her dramatherapy workshop, Mary Smail gave us a taste of facing uncertainty as she creatively combined storytelling, movement and props. I enjoyed the practical involvement and how it felt to be a part of the story. Asked how to base your choice of story, Mary emphasised the need always to be led by the conversation with the patient and only promote stories that you believe in.

Revolution: Art & Ideas, images from the mural-making project created by patients attending the Creative Arts Therapy workshop at St Christopher’s. Photograph courtesy of Alex Ioannou, St Christopher’s Hospice.

Revolution

Maria Mota, an art therapist at St Christopher’s, described the revolutionary mural-making project displayed on the hospice walls. Inspired by a visit to the Royal Academy of Art’s exhibition about Art in the Russian Revolution, patients created their own propaganda posters using different media such as linocuts and collage.

Caption introducing the mural that is displayed in the hospice.

Brexit, cuts in expenditure for health and social care, immigration, global warming and President Trump were frequently referenced. As patients moved between groups there was refreshing and positive comment, occasional clashes and, importantly, “people expressed things they felt strongly about”.

Just a glimpse of three of the many inspiring presentations that helped me to understand what it means to face death creatively. What I loved most was the unfailing emphasis on the patient’s story: whether it was reconnecting patients with former skills and interests, with themselves, or with their families.

Look out next week when Alex Ioannou from St Christopher’s, one of the speakers at the conference, will be writing about dramatherapy in palliative care.

Links

  • Look out for the 2018 conference led by the Arts Team. Check St Christopher’s website for further information on education and training events.
  • Read more post in the Arts and Palliative Care series on the EAPC Blog.

 

 

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France publishes palliative care pathways guidance – Organisation of pathways: Essentials of the palliative approach

Dr Caroline Latapy, Project Manager, Quality Improvement and Safety of Care, at the French National Authority for Health (HAS), explains how they developed a pathway document to identify adult patients who could benefit from a palliative approach.

Dr Caroline Latapy

We are delighted to share with readers of the EAPC Blog our palliative care pathway document that is now available in English as a free download from our website. The aim of the pathway is to develop an integrated palliative approach and help healthcare professionals, in institutions and in the community, provide better care.

Our publication, Organisation of pathways: Essentials of the palliative approach is aimed at healthcare professionals and those working in the social and residential care sector, including doctors, pharmacists, nurses, nursing auxiliaries/healthcare assistants, home helps, social workers, and clinical psychologists.

Why it was necessary to create a pathway

The Haute Autorité de Santé (HAS) – The French National Authority for Health – contributes to the regulation of the French healthcare system by improving health quality and efficiency and has been involved in palliative care for several years.

The Haute Autorité de Santé decided to help improve knowledge and information that would lead to better patient care, claiming that:

  • Palliative care does not just mean caring for people in their final days or weeks of life but is something that can be introduced earlier on, during the progression of a life-limiting illness, in order to improve the quality of life of the patients and of their family;
  • Palliative care is the responsibility and the concern of all healthcare professionals and those working in the social care sector and residential care facilities;
  • Palliative care is not the exclusive preserve of dedicated units or teams and can be given wherever it is needed, whether in the patient’s home, a medical welfare establishment, or a hospital.

First steps to creating the pathway

First, we set up a multidisciplinary and multi-professional working group of 17 professionals and representatives of patients with general practitioners, a geriatrician, a neurologist, a respiratory specialist, an oncologist, palliative care specialists, nurses, a psychologist, a psycho-oncologist, representatives of patients and a representative of volunteers.

As the project manager, I searched the literature to identify and select the relevant references, analysed and summarised the available literature in the form of an evidence report and wrote a draft document. The members of the working group revised the wording and created an initial version. Thirty-two professionals and representatives of patients, and users of the healthcare system constituted the peer review group: they gave a formal opinion on the content and form of the initial version, which was amended according to their comments.

The final version of the text, as well as the evidence report, was submitted to the HAS bodies responsible for validation and the HAS board validated the document giving authorisation for its dissemination.

We have heard that several professionals have commented that the document has helped them to understand the palliative approach, to improve the patient’s pathway and to teach palliative care to students or professionals involved in continuing education.

Links and resources

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Rebel Rebel – how David Bowie shone a spotlight on palliative and end-of-life care

New series: The Arts in Palliative Care, looks at how the arts in palliative care settings can be a powerful and effective way of addressing the practical, psychological, social and spiritual issues that face people at the end of their lives.

Rebecca Patterson, Director of Good Life, Good Death, Good Grief, Scotland, UK, looks at how palliative care has become part of the world’s largest arts festival.

Rebecca Patterson

The Edinburgh Festival Fringe is home to cutting-edge arts and comedy events that challenge existing ideas and tackle subjects not often dealt with elsewhere. Where better for a palliative care consultant to relax, open a bottle of wine, and explore the connections between culture, humour, palliative care and David Bowie?

In a lamp-lit room in the Quaker Meeting House overlooking the rooftops and cobbles of the City of Edinburgh, Cardiff-based palliative care consultant, Mark Taubert, was interviewed by Mark Hazelwood, Chief Executive of the Scottish Partnership for Palliative Care. In front of an appreciative audience, the two Marks discussed Dr Taubert’s experiences of working in palliative care, the impact of David Bowie’s death, and an unwanted visit from the Daily Mail.

Mark Hazelwood interviewing Mark Taubert (right).

This unique event was held as part of Death on the Fringe, a hand-picked series of shows that look at death and dying from different perspectives – some serious, some comical – but all contributing to the debate on death and end-of-life matters. Every Death on the Fringe performance has its own unique take on the subject. Organised by the Scottish Partnership for Palliative Care, the aim of the project is to encourage Fringe audiences not to steer clear of this tricky subject matter and to point them towards some brilliant, entertaining and important events.

From a street mural of David Bowie

In his event, ‘Rebel Rebel – how Bowie shone a spotlight on palliative and end-of-life care’, Mark Taubert told the story of his conversation with a patient the day after David Bowie’s death. Somehow, connecting with each other over their shared loss eased what can so often be uncomfortable – an open and honest conversation about declining health, death, and preferences for care.

This conversation, and the music video of the song ‘Lazarus’, prompted Taubert to write a posthumous letter to David Bowie. A letter that was later the subject of the sole tweet sent by Bowie’s son in the weeks following his death. A letter that went viral over social and print media. A letter that has inspired a musical composition premiered on BBC Radio 3. A letter that has been read out aloud by Jarvis Cocker and Benedict Cumberbatch. Why so much fuss over a letter? Probably best to read it yourself here. 

It is clear that Taubert is a Bowie fan – Bowie provided a soundtrack to many of the significant events in his life. But for him, there’s more to it than that. Bowie was a rebel, and that is something Taubert can identify with.

Working in a society where death is seen as medical failure, do most palliative care specialists feel like rebels? Is it rebellious to think that there might come a time in someone’s life when they might choose to refuse intrusive medical interventions? Is it rebellious to think that medicine isn’t solely about prolonging life at all costs to a person’s comfort? Is it rebellious to suggest that there are some actions we can all take to prepare for our own death and, in doing so, make life easier for ourselves and those we care about?

This is a subject Taubert is passionate about, for example, he has been instrumental in creating videos and websites for the TalkCPR campaign in Wales, which encourages conversations around the topic of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR). Taubert also raises awareness through his work with Byw Nawr (Live Now), a Welsh initiative working to encourage planning ahead for the last years of life. Death on the Fringe itself is part of a similar Scottish initiative, Good Life, Good Death, Good Grief, which works to promote more openness about death, dying and bereavement.

Taubert pointed out that in death, as in life, David Bowie showed people an alternative path – a path where people can make choices about how they die. Perhaps there are few among us who can turn our death into a work of art as Bowie did. But there are choices we can all make to share our wishes about what we’d want when our health is in irreversible decline and we’re approaching the end of life.

Links

 

 

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Breaking Barriers: Towards a WHO policy for strengthening palliative care education for all healthcare professionals

Frank Elsner, Phil Larkin, Stefan Lorenzl and Piret Paal explain why it’s important that all EAPC members contribute to a new EAPC online survey to evaluate the core elements of palliative care and shape our teaching and learning strategies.

Left to right: Frank Elsner, Stefan Lorenzl, Piret Paal and Phil Larkin

The World Health Organization (WHO) has made a strong commitment to supporting and developing palliative care structures as an important component of integrated treatment for young and old throughout the life course (World Health Organization, 2014). To ensure optimal responses to palliative care needs, educating healthcare professionals and volunteers is of major importance (Elsner et al, 2016). There is some evidence that a lack of knowledge regarding palliative care among the healthcare workers limits access to palliative care services (Hawley, 2017). To break this barrier, the need for palliative care education has to be addressed at many levels simultaneously.

Understanding that palliative care is about providing the best possible health in any chronic or life-threatening condition is often misunderstood within the wider healthcare community. The possibility that palliative care could be provided parallel to curative therapies, or even integrated soon after diagnosing the life-threatening condition, is far from being a common understanding and practice. Hence, it is to be expected that many healthcare providers, due to the lack of education or personal barriers, perceive referring to palliative care as a medical failure. In such situations, only those with strong private support systems are able to take care of themselves to keep up the necessary resilience. Others, lacking self-care structures, sink deeper into tiredness, irritation, and withdrawal – all known barriers to providing good care.

To diminish the feeling of failure is to choose early palliative care over the “there is nothing we can do” approach. Here, it is important to understand that palliative care does not replace any other forms of care but complements and completes the ongoing approach to care. The strengths of palliative care lie in collaboration, networking, promoting an interdisciplinary approach, and being conscious of the need for self-care. For education, this means creating toolboxes and modules that support healthcare providers’ decision making, even in situations of limited resources.

To improve postgraduate palliative care education, the WHO European Region in collaboration with the newly proposed EAPC Reference Group on Palliative Care Education and Paracelcus Medical Private University (PMU) in Salzburg – a WHO Collaborating Centre – are working towards innovative solutions to cultivate and support interdisciplinary and intersectional collaboration across different healthcare sectors.

The collaboration between the PMU and the WHO started in 2016 to look at developing a structure for a pan-European curriculum to assist in the promotion and embedding of palliative care into healthcare professional curricula at undergraduate and graduate level. The collection and collation of diverse palliative care curricula has so far resulted in numerous educational and training programmes for specialist palliative care in nursing, medicine and paediatrics from across Europe. It should be noted that in many European countries, palliative care initiatives are just being launched, mainly as a result of the pioneering work of small voluntary working groups, without any governmental funding or recognition. For this reason the current WHO collaboration addresses in particular healthcare professionals in the Eastern European region and Central Asia. Together, we look for opportunities to support their efforts towards providing better health to their patients.

There is an agreement between WHO and PMU to provide an online learning environment for strengthening palliative care education of all healthcare professionals by 2020. The goal is to break down the myths about palliative care and support healthcare professionals’ collaborations across all fields of responsibility.

Please contribute to the EAPC online survey 

The proposed EAPC Reference Group on Palliative Care Education, which will be under the direction of Prof Frank Elsner, has agreed that the core curriculum will be built along the ten competencies proposed by Claudia Gamondi, Philip Larkin and Sheila Payne in their White Paper (Gamondi et al, 2013). For this reason, an online survey has been launched to evaluate the core elements of palliative care.

We ask all EAPC members to contribute to this survey. In addition to evaluating the listed competencies, we are very interested in learning about your individual learning and teaching experiences. Can you share your most valuable lesson in palliative care or give good teaching examples? Irrespective of your level of experience or involvement in teaching or practising palliative care, your expertise will be much appreciated. We hope this survey will enable you to express what, in your opinion, lies at the heart of palliative care – that all healthcare professionals should be aware of and should form the basis of our teaching and learning strategies.

If you don’t have time to complete the survey but would like to share a story about palliative care education experiences, add your topic and email address and we will contact you.

We look forward to hearing from you and thank you for supporting this important European project.

Links

More about the authors . . .
Prof. Dr. Frank Elsner, Associate Professor for Palliative Medicine at the RWTH Aachen University in Aachen will chair the newly proposed EAPC Reference Group on Palliative Care Education.
Prof. Dr. Phil Larkin, President, EAPC, Professor of Clinical Nursing (Palliative Care), University College Dublin and Our Lady’s Hospice and Care Services, Dublin, Visiting Professor, Paracelsus Medical University in Salzburg.
Prof. Dr. Stefan Lorenzl, Professor of Neurology (LMU) and Professor for Palliative Medicine at the Paracelsus Medical University Salzburg.
Dr. Piret Paal, Coordinator of the EAPC Spiritual Care Reference Group (Education), EPICC Participant, Researcher and coordinator at the WHO Collaborating Centre for Nursing Research and Education at the Paracelsus Medical University in Salzburg, Austria.

References

Elsner, F; Centeno, C; Ellershaw, J. PallMed 2016. Early integration needs early education, Palliative Medicine 2016, Vol. 30(9) 805–6.

Gamondi, C. Larkin, P., Payne, S. (2013). Core competencies in palliative care: an EAPC White Paper on palliative care education – part 1. European Journal of Palliative Care, 20(2), 86-145.

Hawley, P. (2017). Barriers to Access to Palliative Care. Palliative Care, 10, 1178224216688887. doi:10.1177/1178224216688887

World Health Organization (2014). Strengthening of Palliative Care as a Component of Integrated Treatment throughout the Life Course. Journal of Pain & Palliative Care Pharmacotherapy, 28(2), 130-134. doi:10.3109/15360288.2014.911801.

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What future research is needed to improve care for people with advanced illness and towards the end of life?

Salzburg Public Debate on Palliative and End of Life Care . . .

On this, World Science Day for Peace and Development, the #allmylifeQs series launches its final, and perhaps most important, question: What future research is needed to improve care for people with advanced illness and towards the end of life?

Irene Higginson, Professor of Palliative Care & Policy and Director of the Cicely Saunders Institute, King’s College London, explains why research is so important, and what you can do to support it.

Professor Irene Higginson

Palliative care puts the person before the disease. (View our video here). Our role is to look after the whole person and those close to them, and this means assessing and offering the very best in therapies, treatment and care, to help people live well despite their illness as well as controlling symptoms at the end of life. The person-centred approach does not mean that we have it right yet; it should mean striving to improve what we do.

As a doctor trained dually in palliative medicine and public health medicine, I have long been concerned that the treatments, therapies and services that we can offer patients and families need to improve. In the future, I want to be providing patients and families with better treatments, therapies and care, especially in the hard to manage areas.

Research needs to test and discover better treatments for the many complex physical problems and symptoms that people have, such as breathlessness, fatigue, frailty, pain and nausea, as well as for emotional, social and spiritual issues. There is a need for research into better ways to support those who currently miss out on the best in palliative care, especially those groups that form part of growing populations (such as older people with multiple morbidity) who are most likely to require palliative care in the future. We also need to be realistic. Health and social care resources are constrained in many countries, so we need research into solutions that are cost-effective. Research into better services is also vital, as services are a key component to influencing quality of life for people.

Those close to the patient often provide so much, and research into ways to support them is urgently needed. We work closely with our Patient and Public Involvement (PPI) group, whose feedback and insights enable us to steer our research according to the needs and concerns of the people who will directly benefit from advances in palliative care practice and provision. Pam Smith, one of our PPI members, describes her reasons for becoming involved in the work of the Institute:

“Without ongoing research into palliative care, the lives of the people suffering from advanced illness, and also the lives of their carers, will never be improved. A compassionate society cares about the people who live in it!”

Scientific discovery takes time to progress. Palliative care has had some major successes over the years, but now we need to be thinking about what people will need in five to ten years’ time, and what research, investment, workforce and capacity are required to deliver this.

So with this #allmylifeQs, I am asking all of you who read this to speak to four other people today about why you think that research is important, and what you can do to support it.

Links and Resources

Coming up on the EAPC Blog . . .
To mark Human Rights Day on 10 December 2017, a final blog post will draw together the key issues of the nine questions discussed in this series.

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Room for some art? – Addressing the difficult topics of death, dying and resuscitation

In this new series, The Arts in Palliative Care, we look at how the arts in palliative care settings can be a powerful and effective way of addressing the practical, psychological, social and spiritual issues that face people at the end of their lives.

Today, Dr Mark Taubert, Clinical Director for Palliative Medicine Velindre NHS Trust, Bevan Commission Fellow and Clinical Lead at Byw Nawr, Wales, UK, describes an inspiring project with graphic design lecturers and students from Falmouth University.

Mark Taubert with Nicola Salkeld, a lecturer on the Moth project at Falmouth University, during discussions about the Talk CPR project with graphic design students.

How do we bring together the sometimes disparate topics of art and medicine? This formed part of the discussions at a recent national UK healthcare conference. In September 2017, a health and social care conference took place in Swansea, Wales, bringing together the Welsh National Health Service, academia and industry. This Bevan Commission annual conference event showcased the progress of Prudent Healthcare in Wales and provided a great opportunity to discuss how we can all promote and deliver these Welsh principles – in very different, creative ways – one of which I outline here.

I have been a member of the Welsh Bevan Commission for some years, initially on their Exemplar scheme and now as a fellow and adviser. During this time, I have tried to bring the difficulties my patients and their proxy face into sharper focus and to explore how they would address some of these difficult, even awkward conversations. The Bevan Commission, as well as the Welsh End of Life Care coalition, Byw Nawr, and Velindre NHS Trust have all facilitated this journey.

The Talk CPR project (see my earlier post on the EAPC Blog) has multiple facets, but one includes work with graphic design lecturers and students from Falmouth University. I met them in 2017 to discuss ways we could create visual and graphic stimuli to talk about future wishes surrounding death, dying and matters such as wishes about cardiopulmonary resuscitation. This resulted in the students creating some inspiring artwork that looked at it from a very different angle, compared to what we in mainstream healthcare tend to do. Below are just some of the images, and I will let them speak for themselves. You can see more of them on the website of the Moth Project at Falmouth University.

Theo Hallas: The Conversations Project

“My aim was to help those, whose loved ones are either terminally ill or reaching the end of their life. The posters are a prompt to encourage difficult conversations to happen before it is too late. To establish an understanding of the patient’s wishes and needs around issues such as Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), which can be discussed and understood more fully to ensure that death, can be as peaceful and as respectful as possible.”

Alicia Bray-Whitworth, Jemma Edwardes, Sarah Lebaigue: Let’s Talk CPR – A campaign video to raise awareness of the effects of CPR

“Wanting to avoid isolating the audience with the graphic reality of what CPR can do to a fragile, terminally ill patient. We decided to tell our story using stop-frame animation; this gave us creative license to talk frankly about the issues. Using the rhythm of a heart beat with a calm, authoritative narration of the facts and statistics. We chose not to include any emotive background music, wanting to create space for a logical rational thought process to take place, making it easier to talk more openly about our hopes for our last moments.”

The Art and Medicine session at the Bevan Commission conference outlined the above work and showcased the creative results. It was a packed event,  chaired by distinguished Professor John Wyn Owen who, amongst many roles, is a professorial fellow of the Royal Society for Public Health. He introduced the topic of art and medicine, explaining that these were once considered to be unrelatable. I then outlined the work of Talk CPR and Falmouth University to the audience. The artwork was on display for all conference delegates to view and created much discussion. We heard from the audience how the arts can and should also be an agent for change. During the session, I learned about many other Welsh healthcare projects that need to incorporate such art, and it created a dialogue on how this can be done.

Summing up, Professor Wyn Owen outlined how the arts and humanities touch many people’s lives, encompassing those things that make life worth living, but also contributing to a country’s civilisation and enhancing the quality of health and wellbeing.

Acknowledgement
Thank you to the following students from Falmouth University who created artwork for this project:

The Plan: James Cook, Joe Arnold, Hannah Hosegood, Sam Baker.
Let’s Talk CPR: Alicia Bray-Whitworth, Jemma Edwardes, Sarah Lebaigue.
The Conversations Project: Theo Hallas.
Little questions, big conversations: Florentino  Alameda Monteiro, Poppy Andruskevicius, Adele Bright, Ellie Woodman.
#talkdeath: Martha Holmes, Lucy Scholes, Theo Penrice.

Their lecturers, Nikki Salkeld and Ashley Rudolph, made this project happen and are the driving force behind the Moth project at Falmouth University.

Links

  • Follow Mark Taubert @DrMarkTaubert
  • Read more post in the Arts and Palliative Care series on the EAPC Blog.
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Art therapy and the restoration of capacity in palliative care

NEW SERIES: The Arts in Palliative Care . . . we shall be looking at how the arts in palliative care settings can be a powerful and effective way of addressing the practical, psychological, social and spiritual issues that face people at the end of their lives.

Today, Irene Renzenbrink, art therapist and social worker from Melbourne, Australia, looks at how the arts can unlock opportunities for creative expression.

Irene Renzenbrink working on a project.

Although the benefits of art therapy in reducing anxiety and depression in oncology and palliative care patients are well known, services are still limited by lack of funding and the perception that these services merely offer simple diversion. However, the use of the arts in therapy can restore a sense of capacity that is often lacking when patients feel helpless, passively undergoing their experience of illness. According to Nigel Hartley (in Monroe and Oliviere, 2007), patients are often “surprised by their artistic efforts, giving them an unexpected feeling of self- worth as well as a new sense of meaning to their living and dying.” Family members, friends and staff can also experience the relationship with the patient in a ‘fresh and new way’.

Figure 1

When Mrs Hinson (pictured here) was a patient at St Joseph’s Hospice in East London, UK, in 1964, she gave her doctor, Cicely Saunders, a description of various symptoms and ills and then went on to say, “Well doctor, the pain began in my back, but now it seems that all of me is wrong.” It was through conversations with patients and Saunders’ holistic training and deep compassion that the concept of total pain was born. (Clark, 2014). However, a focus on everything that is wrong can lead to what is known in expressive arts therapy as ‘problem saturation’. While it is, of course, essential to focus on pain and symptoms in order to relieve a patient’s suffering there is also a danger that opportunities to ‘lift the spirits’ through imaginative creative expression will be missed.

Figure 2

“I feel broken.”

A devoted but exhausted daughter whose elderly mother was dying was encouraged to use some art materials while we sat together at the patient’s bedside. She painted a cup that was cracked but it still held her favourite raspberry tea. ( Fig.2) Surprised and pleased by her efforts, she went on to say, “ I feel broken. I feel like I’m losing myself.” She went on to ‘mend’ the crack in the cup with glue as if to restore her sense of self.

A man in his late 50s who often felt that he had been defined and judged by his history of addiction, unemployment, and estrangement from family, was being treated for incurable and terminal cancer. Familiar with art therapy after being involved in a rehabilitation programme he used soft pastels to draw what he called, “Life’s ups and downs.” (Fig. 3)

Figure 3

“Life’s ups and downs.”

 

When I asked him about the inner heart that he had drawn with a wavy line inside the larger red heart, I was deeply moved by his reply: “That’s the part of me that’s still whole.”

We must not forget that art-making in the context of a therapeutic relationship can help patients make visible some of their deepest thoughts, feelings and aspirations. Opportunities to engage the imagination can also lighten their mood and restore a sense of capacity.

When a patient feels broken and says that “all of me is wrong” we can help them to discover or reconnect with that part of themselves that still feels whole.

References

Clark, D. ‘Total pain’: the work of Cicely Saunders and the maturing of a concept. September 25, 2014, End of Life Studies, University of Glasgow. Retrieved from endoflifestudies.academicblogs.co.uk September 25, 2017.

Hartley, N, in Monroe, B. and Oliviere, D. ( Eds) (2007), Resilience in Palliative Care: Achievement in Adversity, Oxford University Press.

Renzenbrink, I. in Gilbert, P. ( Ed.) 2013 Spirituality and End of Life Care, Pavilion.

More about the author . . .
Irene Renzenbrink is an Australian social worker and art therapist who has worked in the field of palliative and bereavement care for 40 years. She is currently completing a doctorate in Expressive Arts Therapy at the European Graduate School in Saas Fee, Switzerland. A member of the International Work Group on Death, Dying and Bereavement, Irene will be teaching Master Classes for Cruse Bereavement Care in the UK in early 2018.

Read more post in the Arts and Palliative Care series on the EAPC Blog. We shall be publishing one post each week from therapists, health professionals and others involved in bringing the arts into a palliative care setting.  

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