The Re-Working of Mainstream ACP Guidelines and Resources for Pacific Island Populations

Jacqueline Schmidt-BusbyKo Awatea

Counties Manukau District Health Board

Advance Care Planning ConferenceSydney Australia

2-3 May 2016

Contents

• Overview

• Background

• Re-working the Guidelines

• Re-working the Resources

• The Bigger Picture

Overview:

Asian (including Indian)Pacific

Māori

Guidelines for Northern Region

Overview:

of the Counties Manukau population are Pacific

16%

21%63%

Māori

Pacific

NZ Euro / Other

Population Profile

Overview:

16%

21%63%

MāoriNZ Euro / Other

76%

of the Pacific population live in severe deprivation

Population Profile

of the Counties Manukau population are Pacific

Pacific

Overview:

48%

16%

21%63%

MāoriNZ Euro / Other

76%

29%

23%

15-44 Yrs

65 + Yrs

45-64 Yrs

of the Pacific population have one or more LTC*

*Diabetes, gout, CVD, COPD, CHF, Asthma, Bronchiectasis

Population Profile

of the Counties Manukau population are Pacific

Pacific

of the Pacific population live in severe deprivation

Overview:

Manukau Surgical Centre

Localities

CMDHB

Middlemore Hospital Ko Awatea

16 Collaboratives

Manaaki Hauora Supporting Wellness

Campaign

Organisation Chart

Overview:

Manukau Surgical Centre

Localities

CMDHB

Middlemore Hospital Ko Awatea

16 Collaboratives

Manaaki Hauora Supporting Wellness

Campaign

Organisation Chart

Background:

Cook Island Niuean Samoan Tongan

2012 1 1

2013 5

2014 3 1 10 9

Number of advance care plans: Pacific Baseline data: Jan 2012 – Dec 2014

30

Baseline Data

Background:

Cultural factors play an important role on how conversations andactions surrounding death and dying are carried out.

Despite cultural similarities - each Pacific culture is unique;

different languages, customs, rituals and familial expectations

Cultural Differences

Background:

Current Advance Care Planning does not accommodate culturalperspectives, customs or traditions

…for Pacific peoples both as a collective groupand as individual island nations...

Inadequate Resources

Background:

To:

1. Define ACP for Pacific peoples

2. Improve experiences of Pacific patients and families

3. Re-position conversations within Pacific culture

Overall Aim

Background:

By:

1. Providing health workers with relevant information andguidance on cultural concerns relating to death and dyingfor Pacific peoples.

2. Increasing the conversations and awareness of AdvanceCare Plans within Pacific communities.

Overall Aim

Re-working the Guidelines

Re-working the Guidelines

• Which Pacific orientation?

• Cultural competency

• Framing of conversations

• Importance perception: conversation or documented plan?

• The audience

Considerations

Re-working the Guidelines

Which Orientation?

Re-working the Guidelines

An understanding and appreciation of cultural factors that allow effective clinical care

Cultural Competency

Re-working the Guidelines

Who are you?

Framing of Conversation Structure

Re-working the Guidelines

Conversation? OrDocumented plan?

Importance Perception

Re-working the Guidelines

Experienced, committed health workers

The Audience

Re-working the Guidelines

“All speech, written or spoken, is a dead language,until it finds a willing and prepared hearer”

Robert Louis Stevenson

Re-working the Resources

Tonga

Cook Islands

Niue

Samoa

For Who?

Re-working the Resources

What is Advance Care Planning?

Re-working the Resources

Simple Translation?

Re-working the Resources

Which Orientation (again)?

The Bigger Picture

Tongan Versions

Cook Island Versions

Samoan Versions

Niuean Versions

Advance Care Planning: Pasifika

Enabling conversations relies upon cultural awareness, sensitivity, communication and the inter-relationships between patients, families, communities and health workers.

Re-working guidelines and resources makes an important contribution to the provision of information and guidance for health workers, and the choices of treatment and care at the end of life for Tagata Pasifika – Pacific People.

Soifua ma ia manuia lavaJacqueline Schmidt-Busby

Advance Care Planning

(Pasifika)

Collaborative Team:

Expert Group: Fuimaono Karl Puloto-Endemann, Dr Margaret Southwick, Fakavamoeatu Lutui,To’a Fereti, Meg Goodman, Karlynne Earp, Suzanne Joseph, Sitela Vimahi, Jacqueline Schmidt-Busby

Working group: Fakavamoeatu Lutui, Karlynne Earp, Suitupe Sorensen, Meg Goodman, Sierra Faitua, Fakaola Otuafi, Kola Fue, Margaret Tuala,Vainakali Fonohea, Sorrel Renton-Green Jacqueline Schmidt-Busby

Sponsor: Geraint Martin / Denise Kivell

Clinical Lead: To’a Fereti

Project Lead: Jacqueline Schmidt-Busby