A Public Health Approach To Palliative Care: Creating Compassionate Communities-PCRFNI Public Lecture

By Dr Lisa Graham-Wisener

Myself (right) and Dr Paula Brogan, fellow co-secretary on PCRFNI committee

On 25th June 2018, I attended the annual Palliative Care Research Forum Northern Ireland (PCRFNI) Annual General Meeting (AGM) and Public Lecture at Loughview Suite, Ulster University. 

The PCRFNI exists to encourage collaborative efforts among palliative care researchers and practitioners towards influencing policy and practice in Northern Ireland. The forum is funded by the Public Health Agency Northern Ireland and supports the development of research capacity in various ways, including hosting freely available events for those with a palliative care interest.

Many of these events are joint efforts with other organisations, for example a recent workshop on maximising knowledge transfer and exchange by utilising the EMTreK model in May 2018 which was co-sponsored by the AIIHPC. 

I attended the event as co-secretary on the executive committee of the PCRFNI, a role which can be time-intensive at points but which has provided wonderful opportunities for building working relationships across sectors. I would recommend pursuing administrative roles within professional organisations to any early career researcher, with opportunities to be co-opted for committee roles advertised frequently in palliative care organisations such as PCRFNI, the early-career forum of AIIHPC and the Palliative Care Research Society. 

The morning’s AGM was followed by a display of poster presentations of palliative and end of life care research from across N.Ireland. This was a good opportunity to discuss the spectrum of grant-funded and student-led PEOLC research undertaken locally, and personally it was great to see posters from colleagues at both Ulster University and Queen’s University Belfast evidencing collaborative work with Marie Curie and other service providers. I presented two posters, on a critical realist evaluation of a music therapy intervention in PEOLC and on GP perceptions of the adequacy of community-based care for those with advanced heart failure in NI. Although there are benefits to international opportunities for research dissemination, domestic events can have a more diverse representation of delegates from outside of the university sector. This event was an example of one attended largely by clinicians from the health and social care trusts, providing networking opportunities in relation to research dissemination and for fostering future partnership working. 

Prof Allan Kellehear, Keynote Speaker

The afternoon’s keynote speaker was Prof Allan Kellehear, University of Bradford. Prof Kellehear is a medical and public health sociologist and is regarded as the founder of the public health movement within palliative care. The public health approach in palliative care is one that incorporates and advocates health promotion, public education, community development, and civic engagement principles for the end of life. 

Kellehear describes himself as a scholar, not a researcher, and the afternoon’s keynote was suitably challenging. Kellehear raised a number of key points in his address. This included that traditionally there has been a predominant focus on symptom management or health-services based approaches to end of life care, rather than a focus on dying itself. The principals of a public health approach- prevention, harm reduction and early intervention- can readily be applied to the comorbidities of grieving and dying. Other specialisms have been early-adopters of a public health approach to care, yet palliative care has largely developed as an acute-care enterprise. The challenge to adopt a public health approach to end of life care is never so timely according to Kellehear, with international restrictions on healthcare budgets limiting traditional health and social care provision and forcing innovation. With less than 5 per cent of the time for those with a life-limiting illness spent in front of a healthcare professional, there is real opportunity to enact change in that 95 per cent. This refers to palliative care as a social responsibility that each member of a community may contribute towards.

For further reading, Prof Kellehear’s key works include:

  • Compassionate Cities: Public health and End-of-Life Care (Routledge 2005) 
  • Health Promoting Palliative Care (Oxford University Press 1999)
  • Compassionate Communities: Case studies from Britain and Europe (with Wegleitner and Heimerl - Routledge 2016) 
  • International Perspectives on Public Health and Palliative Care (with Sallnow and Kumar - Routledge 2012)

One of Prof Kellehear’s resounding points was on the importance of community development in public health as requiring equal partnership working. The second speaker for the afternoon, Leann Harris, provided a local example of this in action in her role as volunteer co-ordinator for Compassionate Communities North West. This is a partnership of organisations including community groups, Foyle Hospice, local health care professionals, community health groups, and training and education providers. 

Harris’s presentation provided an inspiring example of compassionate communities in action in Northern Ireland which usefully, in addition to client stories, also reflected on the barriers to developing a compassionate communities approach. This included challenges to restoring end of life care to the wider public health sphere of policy, practice and language and of facilitating the principle that end of life care is everyone’s responsibility. 

Leann Harris, Compassionate Communities North West

As a take-home message, the public health approach in palliative care is a young but emergent discipline. Prof Kellehear in his presentation challenged delegates to think more broadly than evaluation, emphasising that creativity and innovation in research methodology is required to foster practice development in this area. 

Author:

Dr Lisa Graham-Wisener, Lecturer in Health Psychology, Queen's University Belfast. Lisa is a member of the AIIHPC Early Career Researcher Forum.

E: lisa.graham@mariecurie.org.uk

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