Helping dying patients say goodbye

Telling the truth kindly is necessary so people can prepare for the end.
Dr Sally Greenaway with her ‘It Takes a Team’ project poster for the CEC Executive Clinical Leadership Program graduation. Picture: David Thomson Photography

“You need to know you’re leaving before you can say goodbye.”

These poignant words from a patient illustrate how vital it is to constantly improve end of life care, as Blacktown Hospital has endeavoured to achieve with a recent project.

The project, ‘It Takes a Team’, brought together nursing and medical staff from cardiology and gastroenterology at the hospital.

Their findings included three key aims: to skill up nursing and medical staff in recognising when a patient is approaching the end of their life, to empower nurses to share their observations that a patient is dying with doctors, and to improve staff skills in discussing this sensitive topic with patients and families.

The project was led by Supportive and Palliative Medicine director Dr Sally Greenaway as part of her undertaking the Clinical Excellence Commission’s Executive Clinical Leadership Program.

“People often refer to this conversation as ‘breaking bad news’, but I like Professor Peter Saul’s phrase ‘telling the truth kindly’,” Sally said.

“Most people want some control over their goodbyes and their death. Not just getting their legal affairs in order, but thinking about the last things they want to do, where they want to die and who they want there with them.

“If we notice the signs too late then people miss the opportunity to prepare.”

The project’s long-term aim is to assess every patient as to whether they may be approaching the end of their lives, and have sensitive and culturally appropriate conversations about their care goals, treatment options and resuscitation plans.

Aside from the project itself, Sally said she benefited from the opportunity to undergo the Executive Clinical Leadership Program.

“It helped me to be a better and more effective leader and bring about effective change,” Sally said.

“The best way to be an effective leader is to be part of the team and understand what it’s like at the coalface. I commend the people who do the work every day and are brave enough to ask whether we can do better.”

Sally attended the graduation ceremony last Thursday, July 25, where NSW Health Secretary Elizabeth Koff told participants she was delighted to see them join more than 3000 other NSW clinicians who have completed the course.

“I’m always very proud at these graduations to see the real passion and commitment NSW Health staff have for patient safety and improving how we care for patients,” Ms Koff said.