Dr Jalila Ibrahim, a second-year General Practice Specialist Trainee at St Ann’s Hospice and Stockport NHS Trust, UK, explains the background to her longer article published in the January/February issue of the European Journal of Palliative Care.
St Ann’s Hospice in Manchester, is a very busy and much-prized hospice. It serves the local community providing invaluable inpatient facilities, outpatient clinics as well as day activities and therapies to encourage patients to remain sociable during their stay and to allow for easy access to specialist doctors. As a junior doctor, I have worked within many different specialities but never before had I truly noted the importance of clear and effective communication.
Those patients seen within Palliative Medicine are often struggling with complex physical, social and emotional symptoms. Although difficult conversations become more ‘normal’ for us, the healthcare professionals, we can never fully understand the true extent of the distress to the patient. By optimising the conditions in which we have these conversations, we can allow patients to actively and comfortably participate in their personal management plan so that as healthcare professionals we can fully address their ideas, concerns and expectations.
I found that many of the hospice patients were hard of hearing and could not fully understand or follow important conversations. Visual impairment was also widespread but not addressed and so written information became useless to some patients. After review of previous research, I found that there were few studies related to the prevalence of these impairments. As well as this, national statistics estimated that the prevalence of sensory impairment (hearing impairment, visual impairment or mixed impairment) is increasing due to the extended ageing of the population. In November 2013, my colleagues and I decided it would be a useful exercise to audit the number of patients within the inpatient unit who suffered from a sensory impairment, whether the impairment was identified on admission and whether any steps were taken to ensure the patient could communicate and limit the effects of their impairment.
The results were far from ideal:
- Sensory impairment was prevalent amongst 58% of inpatients
- Visual impairment was the most prevalent type of impairment (55%) amongst these patients
- The lack of questioning on initial assessment resulted in just 64% of those who had an impairment, being identified.
There are ways in which the effects of the patients’ impairment can be minimised. Use of magnifying glasses, and large-print written material can help those who suffer from a visual impairment. For those with hearing impairment, pocket talkers can be used to amplify sound. Visual aids and interpreters are useful for patients with more profound deafness. We recommend mandatory staff training in order to improve the identification of affected patients, including information on the various resources that can be made available to facilitate communication. We also recommend a thorough documentation of sensory impairment at the time of admission.
With these steps, we hope that we can all help to make even the most difficult conversations, a more positive experience for our patients.
Read a copy of the full article in the European Journal of Palliative Care
This post relates to a longer article, ‘Identifying patients with sensory impairment within a hospice setting’ by Jalila Ibrahim, Alison Phippen, Ashique Ahamed and Samantha Kay, published in the January/February 2015 issue of the European Journal of Palliative Care (vol. 22.1). If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.
Are you coming to Copenhagen?
See you at the 14th World Congress of the European Association for Palliative Care – Copenhagen, Denmark, 8-10 May, 2015. Follow us on Twitter @EAPCOnlus – our official congress hashtag is #eapc2015
Veniți la Copenhaga?
Vă așteptăm să participați la cel de-al 14-lea Congres Mondial al Asociației Europene pentru Îngrijiri Paliative – Copenhaga, Danemarca, 8-10 Mai, 2015. Urmăriți-ne pe Twitter @EAPCOnlus – hashtag-ul official al congresului este #eapc2015