Wednesday 26 April 2023
On Wednesday, 26 April, we are offering you the option to attend workshops at an additional cost of R1 200 for the full day (including lunch and tea/coffee) or R750 for a half day (including tea/coffee). PALPRAC, PatchSA and HPCA will each present two workshops – one in the morning and one in the afternoon. Delegates may choose to attend any one of the three workshops on offer in each of these time slots.
Workshop titles and the presenting organisations are as follows:
| Moderated by PALPRAC | Moderated by PatchSA | Moderated by HPCA | |
|---|---|---|---|
| 08h00 – 12h30 | The management of treatment-resistant and complex pain in the palliative care setting | Managing children’s total pain and distressing symptoms through whole-person care | Home-Based Palliative Care |
| 12h30 – 13h30 | Lunch | Lunch | Lunch |
| 13h30 – 17h00 | Integrating palliative care into the ICU setting | The law, ethics, and shared decision-making in children’s palliative care | Providing dignity and relief from suffering at the end of life |
Workshop Descriptions
Morning workshops: 08h00 - 12h30
Managing children's total pain and distressing symptoms through whole-person care
Moderator: PatchSA
This workshop, moderated by PatchSA and facilitated by Dr Justin Baker* and PatchSA members from across South Africa, is a case-based exploration of complex pain in a 12-year-old boy experiencing phantom limb pain following an amputation for Osteosarcoma.
During the workshop participants will explore all aspects of his total pain including physical, psychological, social, spiritual, and cultural. Both pharmacological and non-pharmacological treatments will be addressed by a multi-disciplinary team including palliative care paediatricians, nurses, allied health care practitioners, psycho-social professionals, and integrative therapists.
Participants will leave with a comprehensive pain management plan and an approach to help them manage similar challenging cases in practice.
*Dr Justin Baker
- Chief, Division of Quality of Life and Palliative Care (QOLA)
- Director, St Jude Global Palliative Care Program
- St Jude Children’s Research Hospital, Memphis, Tennessee (USA)
Home based palliative care
Moderator: HPCA
“During the last decade, there has been significant shift from hospital centered to Home Based Care (HBC), both in the Public and Private Health Sectors. In the Public Health Sector, the shift has been driven by the National Department of Health (NDoH) Strategy for the Reengineering of Primary Health Care (PHC), and in the Private Health Sector, it has been driven by the spiralling costs of hospital care. So much so, that some Medical Aids have even established their own Home Based Care programmes and are exploring establishing “hospital” @ home. The purpose of this workshop is:
- To contextualise Home Based Care within the South African healthcare system
- To present the NQF 2 and NQF 3 Occupational Qualifications for Home Based Carers
- To present and discuss the Hospice Home Based Care Inter-disciplinary Model
- To identify and discuss the modus operandi and respective roles of members of the Interdisciplinary team (i.e. Medical Practitioners; Professional Nurses; Social Workers; and Home Based Carers) in the delivery of Home Based Care.
- To streamline Home Based Palliative Care as an integral part of the continuum of Palliative Care from diagnosis with a life-threatening illness, through end-of-life and bereavement.
Facilitator: Dr Ewa Skowronska CEO, HPCA
Presenters:
Josef Lazarus Advisor: Strategic Development, HPCA
Sonia Thomson Coordinator: HPCA Home Based Care Training Programme
Fiona Shraga Nursing tutor e-learning Certificate Course in Palliative Care Nursing; Introduction to PC Course Co-ordinator.
Lerato Rangaka CEO, Tsupe Hospice Helderberg Hospice & Stepping Stone Hospice Inter-disciplinary Disciplinary Teams
Robert de Wet CEO, Helderberg Hospice
Dr Danette Barnard Medical Doctor
Thandi Sililo Professional Nurse
Dianne Waddington Social Worker
Andiswa Sigadla ENA-HBC
Tersia Burger CEO, Stepping Stone Hospice
Margi Bollman Professional Nurse
Marshia Maningi Home Based Carer
Programme
08:00 Welcome and introduction (Dr Ewa Skowronska)
08:15 Home Based Care within the S.A. healthcare context (Josef Lazarus)
08:45 Training of Home Based Carers (Sonia Thomson; Lerato Rangaka, Fiona Shraga, Marshia Maning)
09:15 The Role of the Inter-disciplinary Team in the delivery of Home Based Palliative Care (Helderberg Hospice Team, Stepping Stone Hospice Team)
10:15 Tea / Coffee
10:45 Key Questions for Workshop Discussion (Dr Ewa Skowronska)
11:00 Workshop Discussion
12:15 Workshop Summary & Close
The outcome of the workshop will contribute towards a Position Paper on Home Based Palliative Care within the South African healthcare context.
Morning workshops: 08h00 - 12h30
The management of treatment-resistant and complex pain in the palliative care setting
Moderator: PALPRAC
Facilitators: Dr Milton Raff, Dr Mark Hosking, Dr Craig Howes, Dr Michelle King, Dr Margie Venter
Pain is one of the most common and distressing symptoms in patients with advanced cancer. Many patients will not obtain optimal relief with conventional first-line therapies and approaches. In some patients, increasing doses of first-line opioids might lead to significant toxicities, necessitating a change in management. In all these cases, additional expertise is required to offer patients adequate pain control.
This workshop offers an advanced forum for palliative care specialists and other clinicians to improve their confidence and knowledge base in complex pain management.
Participants will learn how to identify patients with treatment-resistant or complex pain and understand the role of nociplastic pain. Participants can explore various alternative pain management strategies through didactic lectures and case-based small group work. Feedback and discussion in the large group will further enhance shared learning.
Complex pain requires a holistic, team-based approach, addressing all bio-psycho-social needs of patients to ensure optimal outcomes. This workshop will primarily focus on pharmacological and interventional strategies.
Learning objectives:
After this workshop, participants should be able to:
- Identify and understand treatment-resistant or complex pain
- Understand the role of nociplastic pain
- Outline the fundamentals of methadone as an alternative opioid
- Identify suitable patients for various types of interventional pain management strategies
- Treat difficult-to-manage opioid toxicities: neuroexcitation, hyperalgesia, allodynia and delirium
- Utilise best practices for safely converting from one opioid to another
Places are limited
Afternoon workshops: 13h30- 17h00
Integrating palliative care into the ICU setting
Moderator: PALPRAC
The Covid-19 pandemic has clearly identified the need to integrate a palliative care approach and/or services into the ICU setting. This interactive workshop will cover the following topics:
- Setting the scene – the what and why not
- Ventilation settings in the ICU/palliative care and organ donation context
- Medication guidelines for palliative care scenarios
- Communication tasks
- Organ donation in the context of brain death and circulatory death
- Legal and Ethical considerations in the ICU/ palliative care and organ donation context
The law, ethics and shared decision making in children’s palliative care
Moderator: PatchSA
Facilitators:
- Prof Julia Downing, CEO of the International Children’s Palliative Care Network (ICPCN)
- Dr Michelle Meiring, Paedspal, UCT and PatchSA
- Dr Lyndal Gibbs, Paedspal
- Lucy Jamieson, The Children’s Institute, University of Cape Town
Ethical issues in children’s palliative care are challenging enough notwithstanding complexities around shared decision making and guardianship in the South African context. In order to approach these problems, a sound knowledge of legal aspects around guardianship and informed consent is necessary and practitioners need to know how to apply ethical principles to make sound decisions that are made with the patient and the family and not just for them. Paternalism is still rife in settings where caregivers are not empowered or where guardianship is complicated.
This case-based workshop, facilitated by Prof Downing, will provide participants with the necessary background information to manage a complex dilemma. Dr Meiring will address issues around shared decision making, Dr Gibbs will revise basic ethical frameworks including the concept of Ubuntu and Lucy Jamieson will address legal issues around guardianship in South Africa.
Intractable Pain: Providing dignity and relief from suffering at the end of life
Moderator: HPCA
Introduction
Intractable pain is defined as a permanent severe pain condition, mostly unaffected by drug administration (Science Direct, Intractable Pain, 2020)1
The psychological condition of the patient is an important factor in the development of intractable pain. The pain threshold can be decreased, and the pain perception intensified by the hopelessness of the situation and the depressive stage that the patient faces.
In following a holistic palliative care approach, intractable pain is recognised as only one aspect of what is, in effect, intractable suffering.
The purpose of this workshop is:
- To understand and unpack intractable suffering and how this differs from chronic, acute and end-of-life pain.
- To present, discuss and explore a palliative care approach towards intractable suffering.
The workshop will include presentations from a panel of experts who will share their experiences in relieving intractable suffering and case studies from clinical professionals. The session will include perspectives from the patient, the family and the Inter-disciplinary palliative care team.
Facilitator: Fiona Shraga Nursing tutor e-learning Certificate Course in Palliative Care Nursing, HPCA Introduction to PC Course Co-ordinator
Presenters:
Doctor: Dr. Dalene Van Jaarsveld: Hospice Bloemfontein
Dr. Janet Stanford: Knysna Hospice
Nurse: Hilary Grey: Knysna Hospice
Social Worker: Christie Mitchell: Stepping Stone Hospice
Spiritual Counsellor: Hanneke Lubbe: Hospice Bloemfontein
Patient: TBD
Programme
13:30 Welcome: Fiona Shraga
13:45 Introduction of the topic: Tersia Burger, CEO of Stepping Stone Hospice
14:00 The Role of the Inter-disciplinary Team: Doctor, Nurse, Psychosocial worker, and Spiritual Counsellor.
– The perspective of intractable suffering presented by specialists from an interdisciplinary team.
– Exploration of a different way to treat intractable suffering
– Beliefs and cultural aspects about illness, suffering, and dying.
15:00 Tea / Coffee
15:30 Workshop Discussion
16:30 Workshop Summary & Close
[1] https://www.sciencedirect.com/topics/nursing-and-health-professions/intractable-pain
Thursday 27 April 2023
17:30 - 19:00
Navigating the Private Sector
We will be hosting an informal workshop, Navigating the private sector, in response to many requests.
It is not a strategy or negotiation session, merely a sharing of updates, practical information and possible solutions for the common problems we all experience.
Topics under discussion: updates on medical scheme palliative care programmes; unpacking various care models and teams in existence for inspiration; exploring solutions for efficient team communication, billing, after-hours cover, scripting of S6 medicines and death declarations; how to set boundaries in care for personal sustainable practice.