Counselling end of life patients and their caregivers

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Published: 27 Mar 2017
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Dr Nandini Thatte - Cipla Palliative Care and Training Centre, Pune, India

Dr Thatte speaks with ecancer at IAPCON 2016 to explain the role of counsellors for end of life patients and their caregivers.

She talks about how to empower both patients and families in order to make better end of life decisions.

The counselling staff work as a close team and further their education by attendance at conferences and through mentoring; they also have the support of a research and training department which helps to provide a wide range of educational and research material.

Dr Thatte concludes by discussing the future priority of her team to become a centre of excellence for palliative care and be able to disseminate their knowledge and experience to the wider palliative care community.

Every patient who comes in is assigned a counsellor and what we do is we ensure that they know that there is an emotional support available to them, it may be the patient, it may be the family caregiver. While they are dealing with their end of life issues or their decision making during the care plan we have seen that it really helps them because advanced care planning involves so much tough decision making and a lot of the emotions are getting in the way. No matter how old you are and how sorted you are you don’t really want to lose someone that you love and it is really, really difficult. So we as a team are there to help them ensure that they are at peace with the decisions that they make and that is more important because they are going to live with the memory of how their loved one died and that is going to affect them when they are going to be maybe in the last stages themselves. It is going to, more importantly, affect their entire life that follows. So we are there to ensure that they are at peace with what they are doing right now, they are in reality and they are accepting whatever is happening to their loved ones, to them, to their life. And then we are helping them cope with the loss, anticipatory grief or the retrospective grief, whatever it is. Where is it real we want them to be strong enough to cope on their own because that is when the medical team or the professional caregivers retract. So as a psychology team it is our prerogative to ensure that when we let them go out of our centre, even beyond the patient’s death, we have empowered them enough to get back on their feet and try to live as normally as possible and ensure a better quality of life for the ones who survive as well. For the patients we ensure that we are helping them deal with their mental luggage.

How do you maintain your education?

Basically as a team we have a lot of in-house sessions that we hold where all the team members come together to discuss cases or to discuss just concepts like how do we extend bereavement care, why is it important? What do we do when a patient is suicidal – how do we help a young widow cope? It could be anything but what we have found very effective is having the in-house team come together and discuss the patient or the case or the concept from all angles, from all expertise.

The second part is we do attend a lot of conferences and workshops and encourage clinical postings in other institutes that help us learn from experience and other mentors from those institutes. Of course, coming down to regular journal articles and some online course material as well, any information that we find online. That is something that is constantly on and we have a research and training department who help us. If we can’t find something very easily they help us to find course material that could be helpful or research articles. And of course we have a good academic library so it’s a combination of all and that has brought us a very good mix of old theories plus what are the latest developments and that’s how we do it.

What are the future priorities of your team?

The first ultimate priority is improving ourselves in patient care and being the centre of excellence for that. Secondly I believe we would like to build an evidence base that will help us disseminate the knowledge and spread the expertise and share it with the palliative care community.