Palliative Care Works (PCW) is a UK-based charity which seeks to develop palliative care in resource limited health settings. PCW has just released a series of five new training videos on palliative care. Ruth Woolridge, a nurse who pioneered palliative care in Kenya and Rwanda, writes about the videos and how they were developed.
At PCW, we wanted to enhance opportunities for palliative are training, so we created a series of films that reflect the local situation and challenges which many health care providers face in providing palliative care in low and middle income countries (LMICs).
Our starting point was to ask our colleagues in LMICs, “What are the most important topics for the films?”
Unanimously, “communication skills” was their first response, then a variety of topics which included: use of morphine, end of life care, what is palliative care, issues around palliative care and children and the importance in making a full assessment.
We formed a small team to write the scripts and take the project forward. We all agreed that the training element of the films would be strengthened if they were linked to the Palliative Care Toolkit and Trainer’s Manual.
The topics were selected with relevance for an audience ranging from doctors – with little experience of palliative care and using morphine – to community health workers, social workers, pharmacists, nurses and spiritual leaders. It was decided that five films of around 10 to 12 minutes in length with strong themes and 3 key learning points in each film would make the most impact from an education perspective.
Film One : “What is palliative care?”
Tedros is a man with advanced cancer of the prostate who can no longer work or support his family. He is breathless and in great pain. The senior doctor in the scenario wants to send him to the tertiary hospital for further treatment. The younger doctor and nurse have attended a palliative care course and explain the merits of palliative care to get Tedros home on morphine and to be with his family as his illness advances.
Film Two: Assessment of a Patient in Palliative Care
Communication and listening skills are illustrated as the doctor makes a full assessment of Mary. She is a mother and a patient with advanced breast cancer. Mary has worries about how to talk to her husband, and to her children, as well as coping with an offensive – smelling breast wound and increasing pain.
Film Three: Managing Pain and Morphine
This film opens with two doctors discussing Mary’s pain, how to manage her increasing pain and start her on morphine. One of the doctors has reservations about using morphine. Issues around morphine are discussed along with using the WHO analgesic ladder and how to prescribe morphine. The doctor discusses Mary’s pain with her and how they are going to manage it together.
Film Four: Family Conference at End of Life
In this scenario the social worker conducts a family conference in the next room as the mother’s condition deteriorates. Three family members gather with the social worker. They all have differing opinions on Asli’s future care. Skillfully and gently the social worker shares information about Asli’s advanced illness and brings harmony support and comfort to the family.
Film Five: Talking with Children
This film is a conversation between a paediatric palliative care nurse and the social worker over coffee. They discuss the challenges of talking to children about death and the questions children ask. This film explores ways to talk to children and how to really listen to their anxieties and support them.
Each film – which can be downloaded from the Vimeo platform or from the Palliative Care Works website and is accompanied by the script. The scripts can be translated into any language and used by trainers in any way they wish to for training courses.
The script comes with accompanying notes for the facilitator. Points and times in the film are indicated where they might stop the film and share issues raised. For example from Film Two the facilitator might ask the trainees to make a list of Mary’s problems. From Film Four the trainer might discuss communication skills and how the social worker broke new information to the family.
The facilitator is also given the links to resources in the Palliative Care Toolkit and Trainer’s Manual. Both give information that extend learning on the three key learning points that are highlighted that accompany each film. The Palliative Care Toolkit and Trainer’s Manual are both free to download on the PCW and from the WHPCA websites
We know that powercuts can frequently interrupt training sessions so having the script available means that training can continue even when the power is off. The scripts can be used by anyone wishing to act out the scenarios for training purposes.
Palliative Care Works hopes that this series of five films will contribute as an introduction to palliative care where training has been postponed due to the pandemic. Also in places where there are few health care workers with skills in palliative care and little training is available. There is also a place for them to be used in clinical training sessions within a hospital setting.