Mrs Holly Pitt1,2, Miss Kathleen Bray1,2
1Peter MacCallum Cancer Centre, Melbourne, Australia, 2Parkville Integrated Palliative Care Service, Melbourne, Australia
Biography:
Holly Pitt, Nurse Unit Manager – Palliative care, Peter MacCallum Cancer Centre.
A highly motivated and compassionate senior nurse with over 17 years in palliative care across inpatient, consultancy and community settings. Committed to education, research, respectful leadership and management roles, ensuring commitment to the delivery of equitable, quality palliative care, with a strong focus on positive work culture and wellbeing.
Specialist Certificate in Palliative Care, Melbourne University 2010. Facilitator for Peter MacCallum’s CARE program 2021-24 and Your Thoughts Matter, 2024. Recipient of the VCCC Research Partnership post in 2021 and lead in the End-of-Life working group at Peter MacCallum.
Abstract:
Background: Voluntary Assisted Dying (VAD) was legalized in Victoria in 2019. As of June 2023, 1312 Victorians had been dispensed VAD medication. 81% of these patients had or were accessing palliative care. VAD has become increasingly relevant for the palliative care sector. Understandings of VAD complexities have changed over time and lived experience has demonstrated evolving challenges. This highlights the need for a broader scope of education, assessment and support services to ensure clinical excellence and optimal palliative care for patients accessing VAD.
Aim: To reflect on the successes and challenges of VAD implementation in our palliative care unit, assess need for targeted support and professional development and highlight key areas for improvement.
Method: A mixed methods study using survey format, field notes from multidisciplinary team meetings, precinct wide education, department debriefs, ethics review/clinical case discussions, and informal discussions with clinicians, including VAD navigators. Clinicians within the palliative care unit were invited to participate. Analysis used simple descriptive statistics and narrative analysis.
Results: Analysis of results from a single survey demonstrate a shift in challenges for staff. At implementation staff identified understanding the VAD process (66.6%), legal requirements (62.5%) and complex communication (50%) as the main challenges. At 3 years post implementation the most challenging factors were family distress (47.8%), patient distress (43.8%) and complex communication (43.4%).
Implications for practice: These findings inform education and practice supports for use by palliative care services across the country.
Conclusion: VAD implementation in a palliative care setting requires an evolving and progressive approach. A broader scope of learning and support around ethics and moral distress is needed to ensure wellbeing for clinicians, patients and families.