Health » Overview

Salzburg Global Seminar has long been a leading forum for the exchange of ideas on issues in health and health care affecting countries throughout the world. At these meetings agendas have been re-set affecting policy and practice in crucial areas, such as patient safety and the engagement of patients in medical decision making. In 2010, Salzburg Global Seminar launched a multi-year series of seminars to crystallize new approaches to global health and health care in the face of emerging challenges affecting us now and set to continue on through the coming generation.

Programs in 2016:

Hooked on Health Care: Designing Strategies for Better Health
January 16 to 21, 2016

Better Health Care: How Do We Learn About Improvement?
July 10 to 15, 2016

Rethinking Care toward the End of Life
December 14 Dec to 19, 2016

For past sessions, click here.


Interviews and coverage from our Health programs

Rethinking care toward the end of life - Outcomes from a Salzburg Global Seminar
Rethinking care toward the end of life - Outcomes from a Salzburg Global Seminar
Julie Ling and Sheila Payne 
This article first appeared on the EAPC blog, which will continue to publish more posts on the Salzburg Question series. Julie Ling, Chief Executive Officer of the European Association for Palliative Care, and Sheila Payne, Emeritus Professor, International Observatory on End of Life Care, Lancaster University, UK, were in Salzburg, Austria, to attend this global gathering. Here, they set the scene for a new series of posts that we shall be publishing throughout 2017 to encourage a global dialogue and shine a spotlight on the key topics affecting palliative care. Sixty invited international delegates met in December 2016 to consider global opportunities and challenges in palliative care. They gathered at the Schloss Leopoldskron (some scenes from ‘The Sound of Music’ were filmed here) to discuss and debate seven key questions: How do we engage patients and families to ensure that end of life care honours what matters most to them, with respect for culture and for context at the level of the individual and the population?What are the relative contributions of health care and community-based social care in different contexts? How can they best be joined up to maintain function, independence, and agency for people for whom death is near?How can healthcare systems better support families,  caregivers and community members in caring for people of all ages for whom death is near?How are robust processes established and implemented for arriving at decisions when patients can no longer express their own preferences? What role does public engagement and government have in this?Which are the most promising evidence-based and cost-effective innovations in care towards the end of life? What yields the greatest value to patients, especially in low- resource settings?What can we learn from the systems failures in high-income countries with regard to supporting patients, families and caregivers with palliative care?How can palliative care best be undertaken in the context of societal deprivation or conflict? Salzburg Global (SG) was founded in 1947 with the aim of encouraging intellectual dialogue in post-war Europe. SG aims to challenge leaders to help solve important global issues and since its establishment, SG has been a catalyst for global engagement on critical issues in education, health, environment, economics, governance, peace-building and more. SG achieves this by designing, facilitating and hosting international strategic programmes (seminars). Uniquely, Salzburg Global builds connections with and between people from a broad range of expertise, cultures and professional backgrounds. Over the duration of the seminars, government officials, institutions and individuals at all stages of their professional development and from all sectors are asked to rethink their relationships and identify shared interests, goals and outcomes. A key outcome of the session was aimed to be the development of ‘A Salzburg Statement of key principles guiding care towards the end of life’. It was a testament to the freethinking and originality of the participants that for the first time in the history of SG, the outcome was not a statement, but instead, a set of nine questions. The questions are designed to highlight challenges facing the global community and will be linked to international ‘days’. Each of the nine questions will be explained more fully in EAPC blogs over the coming year. There was snow and plenty of hard work, interspersed with some time to socialise and make the most of the beautiful location and, of course, there was schnitzel, Glühwein and a Christmas market. Find out more.... Follow the global dialogue on Twitter. Using the hashtag #allmylifeQs the nine Salzburg Questions will be debated throughout 2017. Follow the EAPC Blog for more posts in the Salzburg series.
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Salzburg Questions Twitter series on health and palliative care begins
Salzburg Questions Twitter series on health and palliative care begins
Oscar Tollast 
People are invited to take part in a global conversation on the crucial issues affecting care towards the end of life.  The #allmylifeQs hashtag will be in place throughout 2017, and people are invited to answer nine Salzburg Questions using this hashtag on Twitter. Discussions around each question will be led by different individuals and institutions at the heart of the debate and who were involved in a Salzburg Global session in December: Rethinking Care: Toward the End of Life. The launch date for this initiative is Monday (February 20), which coincides with the World Day of Social Justice. Former Minister of Health in Rwanda, Agnes Binagwaho, will lead the first discussion on Twitter, asking: Why aren’t countries accountable to commitment on end of life (#EOL) care for vulnerable people? Following this discussion, there will be eight more Salzburg Questions, which will be spread out throughout the year.  Other Fellows due to lead discussions include Lynna Chandra, Suresh Kumar, Sheila Payne, Emmanuel Luyirika, Richard Harding, Bruce Chernof, Stephen Connor, and Irene Higginson. Salzburg Global is encouraging its Fellows to take part by sharing blog posts around each question, and interacting on Twitter on the day and beforehand.  Potential blog platforms include ehospice, EAPC blog, Palliverse, and IAHPC Newsletter.  People who take part in the conversation are being encouraged to link relevant research to their tweets and blog posts. This research could include papers, studies, seminars or events.  If you’d like to hold a debate, workshop or Q&A event about a question, we recommend filming it so that it can be viewed on a dedicated YouTube channel. The video should be sent to katie.witcombe@kcl.ac.uk A Twitter list of Salzburg Global Health Fellows has been created. If you would like to be added to this list, please let us know by subscribing or contacting us on Twitter at @SalzburgGlobal. List of dates, questions, and people leading discussions 20 February 2017 - World Day of Social Justice - Why aren't countries accountable to commitment on #EOL care for vulnerable people? - Agnes Binagwaho 20 March 2017 - World Happiness Day - Is dying well as important as living well? - Lynna Chandra 07 April 2017 - World Health Day - How have you prepared for your death? - Suresh Kumar 15 May 2017 - World Family Day - Will caring for your dying loved one bankrupt you emotionally and financially? - Sheila Payne 20 June 2017 - World Refugee Day - 145 countries signed http://bit.ly/2ah31bH why do refugees have limited access to quality health care and #EOL care? - Emmanuel Luyirika 17 July 2017 - World Population Day - How and what do you measure to ensure palliative & EOL care? - Richard Harding 28 September 2017 - International Right to Know Day - Doctors, Nurses, do you want to die the way your patients die? - Bruce Chernof 08 October 2017 - World Hospice and Palliative Care Day - Do you know how to access #palliative care when you need it? - Stephen Connor 10 November 2017 - World Science Day for Peace and Development - What future research is needed to improve care for people w advanced illness & towards the end of life? - Irene Higginson
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“What is the biggest mistake people should avoid making when building a palliative care system?”
“What is the biggest mistake people should avoid making when building a palliative care system?”
Yeji Park 
“When you decide who needs palliative care, it shouldn’t be based on prognosis. In the United States, it is required that two physicians certify that you are likely to die within six months if you want to receive palliative care. This is not a good policy, as we do not have an accurate way to measure when people will end their life. Patients have to give up all curative treatments in order to obtain palliative care as well, but this also is not a good policy. They should be able to make decisions about treatment independently of whether they receive palliative care.” Stephen ConnorExecutive Director, Worldwide Hospice Palliative Care Alliance, USA “The mistake we will be committing unless we are aware of it, is to create walls, not bridges. In the Philippines, there is a trend where the specialists want palliative care to be recognized as a separate specialty and do not want to share skills or tasks with others. We need to be willing to share the knowledge and technology with more people, especially from the grassroots. Because, in the end, it’s not about competing against colleagues from other specialties or among ourselves, but all about making sure that everyone has access to good end of life care.” Liza ManaloHead, Section of Hospice and Palliative Care at the Medical City Hospital, Philippines “In Germany, we have a slightly unusual structure where hospice care and palliative care unit are two different structures with different organizations. The palliative care unit is a part of a hospital where they provide more acute care, whereas hospice is a special care home where people can stay longer. These two work and function alongside each other, but they do not always cooperate closely, and sometimes they even work against each other. This is not helpful when you want to move a topic forward politically in the society. There has to be a joint force.” Claudia BauseweinDirector, Department for Palliative Medicine at Munich University Hospital, Germany “The biggest mistake that has been made, especially within Africa, is the inadequate funding of the entire health care system. Currently in Africa, 15% of the national budget goes to the health sector. In Uganda, it’s only 7%. This is not enough to cover every aspect of health care, especially the palliative care side. In addition, palliative specialists should be recognized and remunerated by the health service commission as such, so that they can fully concentrate on palliative care.” Emmanuel LuyirikaExecutive Director, African Palliative Care Association, Uganda Have an opinion on any of our hot topics this week? Email Salzburg Global Seminar Editor Louise Hallman (lhallman@salzburgglobal.org) with either a short 50-100 word response or a 500-750 word article and we will consider it for publication in the report to be published in early 2017! Download the full newsletter from Day 3 & 4 The Salzburg Global Seminar session Rethinking Care Toward the End of Life, part of the long-running series Health and Health Care Innovation, is being held in partnership with the Dartmouth Institute for Health Policy & Clinical Practice and the Mayo Clinic. Follow online on Twitter with the hashtag #SGShealth.
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End of Life Care – Days 3 & 4 – Learning from our past mistakes
Gayatri Palat and Julie Leng share their countries' experiences and lessons from failures
End of Life Care – Days 3 & 4 – Learning from our past mistakes
Louise Hallman 
“If we want to learn from failure, we have to share our failures,” urged a participant on the third day of the Salzburg Global Seminar session Rethinking Care Toward the End of Life.Recognizing that we learn more from our failures than we do our successes, panelists from four continents shared their countries’ experiences. One failure that needs to be overcome  is the belief that death is always a failure – this is not the case in palliative care, especially when that death is in comfort rather than living in prolonged pain. As one panelist remarked, many life-prolonging treatments are “futile.”Although the UK is often lauded as one of the best countries in the world for palliative care, as one British participant remarked, if she were to rebuild a system from scratch, she would have one piece of advice: be more strategic. Many of the UK’s hospices, especially for children’s palliative care, have been established in an ad hoc fashion over several decades, leading to questions of whether these are being used most efficiently in the places where they are most needed. Fragmentation of services and health insurance is a problem, even in long-established palliative care systems, with patients falling between the cracks of hospital, hospice and home care.However, one should not assume “strategic” means that the palliative care system should only be built once all other care systems have been fully established; palliative care systems should be built alongside and integrated into the rest of the health care system, not simply “added on” later. If palliative care can be integrated, this can strengthen the system at large, remarked on participant, with doctors and nurses carrying over their learning in pain management, communication, etc., into other areas of medicine. Another example of what not to do came from the US: In order to receive hospice care under Medicare, patients must have been given a prognosis of less than six months to live and agree to stop pursuing all other curative treatments. As few doctors are willing to give such a prognosis, many people are ineligible for hospice care. “We should not have put a prognosis requirement on palliative care,” lamented an American participant. “Palliative care access should be based on symptom severity,” he added. Many palliative care systems have been put in place assuming that palliative care is only for the end of life, when indeed palliative care models can also be applied at other stages of illness, perhaps even aiding a recovery.Transplanting a palliative care model from one country to another without appreciating the local cultural sensitivities surrounding death and end of life care, is rarely successful. In India, once palliative care is offered, patients prefer to leave the hospital and die at home rather than transfer to a hospice. However, national health insurance does not cover this, forcing institutionalization. Whereas, in Nepal, many choose to die in temples to have a holier experience, leading to the question of how can these informal hospices be brought into the wider palliative care system? ECHOing innovations To drive improvement in health care we need evidence. “In resource poor settings, it is even more important to generate evidence of effectiveness,” said one panelist in a discussion of “which are the most promising evidence-based and cost-effective innovations in end of life care?”Health care outcomes should be measured from the point of view of those using it, another participant remarked, and in the case of palliative care, that means not only the patient but also their families and caregivers.One such measure that has been developed is the African Palliative Care Association (APCA)’s African Palliative care Outcome Scale (POS). The POS addresses “the physical and psychological symptoms, spiritual, practical and emotional concerns, and psychosocial needs of the patient and family.” Using the POS, medical staff are able to help reduce the patient’s pain and anxiety and increase family confidence in the patient’s care over a series of hospice visits. Pain relief can be the most effective measure of palliative care success, but in many countries, staff are not sufficiently trained or the number of doctors who are trained is few. One solution is to train and empower nurses to prescribe and administer pain relief.  Once evidence has been gathered, sharing this knowledge is important, not only through training and journals, but also by using innovative tools such as “Extension of Community Health Outcomes” – ECHO – which is a “telementoring” (“not telemedicine”) platform, enabling doctors and patients across diverse and remote geographies to connect virtually in large video tele-conferences, sharing their experiences across a wide community of practice. Care at the margins If palliative care is about making sure that all people have the chance of a “good death,” then how do we ensure this is all people – including society’s most marginalized?Marginalized people struggle to access health care services in general, and palliative care is unfortunately no exception. These patients can be hindered by cost barriers, social stigma, or a lack of health literacy.In many cases, despite knowing these barriers exist, health care systems are failing to serve such patients. Providing care for free (or included in insurance) rather than means-testing can reduce the cost barrier to at-home palliative care, especially for those without family support. Active outreach to the homeless is also vital. In countries where homosexuality is still illegal, access to palliative care can be especially difficult for the LGBT community; social stigma needs to be tackled. Prison populations are aging rapidly; continued incarceration of the elderly will necessitate significant changes in prison conditions.For those in conflict zones, palliative care is often not considered a priority. For those fleeing conflict, they may find themselves in a country with profoundly different approaches to end of life care and death. Issues can arise when considering how to be culturally sensitive while still avoiding more harmful traditional practices, such as witchcraft and superstitions, but when and where appropriate and possible, host countries should be cognizant and respectful of the cultural differences of their refugee and migrant populations.Download the full newsletter from Days 3 & 4 The Salzburg Global Seminar session Rethinking Care Toward the End of Life, part of the long-running series Health and Health Care Innovation, is being held in partnership with the Dartmouth Institute for Health Policy & Clinical Practice and the Mayo Clinic. Follow online on Twitter with the hashtag #SGShealth.
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Cultural Nuances in Palliative Care
Cultural nuances in palliative care
Cultural Nuances in Palliative Care
Chris Hamill-Stewart 
Participants of Rethinking Care Toward the End of Life agree on several important principles of palliative care. They all want to ease pain and suffering, ensure that care is focused on the needs of the patient, and they all aim to provide a “good death” – whatever that may look like. However, across cultural boundaries, the pursuit of these ideals may look vastly different, or face different challenges.Over the past four days, participants have emphasized how the needs and desires of the patients, the challenges for doctors and nurses, and the attitudes and approaches of all those involved vary drastically across geographic and cultural boundaries. As one of the major themes of discussion from the session, Salzburg Global explored this further. We spoke with the facilitators of the Culture Café event, examining the cultural nuances, different methods and approaches to palliative care, and the different attitudes from the citizens themselves towards death.Nandini Vallath, from India, emphasized how the culture in India has affected peoples’ attitude towards death: “There’s a lot of death and dying acceptance in India – religion, history and culture contribute to this. The rituals of life talk about life and death as a cycle. There’s no fear of the finality of death – the belief is that death is a transition into another life,” she explains. In the case of India, a big issue is the dissonance between doctor and patient. “What is making palliative care more difficult is the doctor community. They talk the language of the modern science – there is a death-denying culture. Society is very accepting, but the professional community is not.”Speaking about the Philippines, Liza Manalo explained how religion is an important factor in peoples’ attitude towards death and a “good death,” saying, “If you ask the average Filipino what makes for a good death, they’ll say faith and family make for a good death.” She continues, “We’re conscious that part of good palliative care and a good death is psychosocial support and spiritual care. By doing this, we take a holistic and spiritual approach to palliative care, and in this sense, we are very good at it.” Religion as an important factor was a sentiment shared by Ivan Odiit Onapito from Uganda. However, he also emphasized the shared cultural history of the people. He told us: “Africa is an oral culture – we use stories to share experiences and to find meaning in things. We use this culture of storytelling, which has been with us for many centuries, as a tool to provide spiritual care.” He emphasizes how useful these stories can be in communicating with patients: “We learn about patients through the medium of stories, and, from this, we look at strengthening their support structures – usually their communities and their families.”Kathy Kirkland, from the US, and Franziska Kopitzsch, of Germany, both implied that their respective cultures have difficulty outright confronting death. Kirkland explained how the US approach is much less community-based, and also told us: “The conversations that occur around dying are often separate, with health care providers having one conversation with each other, and families and patients having a separate conversation.” American doctors take an impersonal approach towards their patients, which may not always be in their best interests. Kopitzsch spoke about palliative care for those around the patient. She believes “[Germans] don’t know how to grieve.” She explained that there is “no tradition, ritual or celebration when people die.” Here, she touched on the wider issue of palliative care not just for the patient, but their family and loved ones. With less sense of a shared culture or religion, it seems that people find it more difficult to approach the topic of death, and to deal with the death of a loved one.Yi-Jong Suh explains that in South Korea they are experiencing changes in attitudes towards death and palliative care. “Perhaps as a result of the traditional culture of Confucianism, we never used to talk about parents’ deaths and dying... We were always silent on these matters.” He also tells us how when people discuss their plans for end of life care for a family member, they often don’t include them in the conversation. However “Korean culture is changing, and we’re more willing to confront these issues.” Koreans are opening up to providing palliative care across the board, and people are becoming more “individualized” and willing to openly discuss these issues.Ultimately, the facilitators of Culture Café have made it clear that history, religion, and culture all have a profound impact on the application of palliative care. Whether it is incorporating cultural aspects of communication into interactions with patients, avoiding the topic of death entirely, or in its effects on the people surrounding a palliative patient, the cultural differences that practitioners and social workers need to take into account when administering palliative care are an inescapable pool of opportunities and challenges. Download the full newsletter from Day 3 & 4 The Salzburg Global Seminar session Rethinking Care Toward the End of Life, part of the long-running series Health and Health Care Innovation, is being held in partnership with the Dartmouth Institute for Health Policy & Clinical Practice and the Mayo Clinic. Follow online on Twitter with the hashtag #SGShealth.
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End of Life Care – Day 2 – Finding the patient’s pigeons
End of Life Care – Day 2 – Finding the patient’s pigeons
End of Life Care – Day 2 – Finding the patient’s pigeons
Louise Hallman 
On the second day of Rethinking Care Toward the End of Life, panelists from the US, Singapore, Canada, Uganda and the UK considered: how do we engage patients and families to ensure that end of life care honors what matters most to them? Not all patients want to live at all costs. Many want to enjoy what is left of their lives. “Death is not always a failure” of medical care, remarked one panelist. “We are so afraid of death that we harm people” by keeping them alive.One panelist shared an anecdote of a prize-winning pigeon fancier in Scotland who was told by his doctors that he would live longer if he gave up his sport and his birds. His daughter, upon showing the visiting doctor her father’s collection of pigeon racing awards and prized birds, clearly stated: “My father would rather die than give up his pigeons.” When considering a patient’s – or rather a person’s – end of life care, clinicians and families need to consider what actually matters most to the patient, and add life to their days and just days to their life. Patients and their families need a great amount of help and support toward the end of the patient’s life. Too often, palliative care specialists are brought in so late that neither the patient nor their families have a relationship with these new doctors. Developing a good relationship with patients and families depends on good communication. In countries where multiple languages and dialects are spoken, every opportunity should be made to ensure patients can access information and express their preferences in their mother tongue. As one panelist identified, there are three opportunities to communicate well with patients and their families. Firstly, before they are even sick. Providing people information about end of life care choices when they are still well could help reduce the anxiety and distress of terminal illness and the taboo and fear surrounding death. “Death is a stage of life,” added another participant.Secondly, during illness; medical options and alternatives to medical interventions need to be clearly communicated so that patients can partake in the “shared decision-making” process about their care.And finally, after death; sensitive, ongoing communication with bereaved families can help further learning and improve systems for future patients.Cultural understanding was also highlighted. Different faiths and cultures view death differently, and offering patients and their families spiritual as well as medical and community support can be of great help. Meeting the preferences of those who can no longer express them “Next week will be worst week for palliative care specialists!” exclaimed one panelist in the fifth and final discussion of the second day of Rethinking Care Toward the End of Life.As he went on to explain, the coming week will see many far-flung family members come home for the holidays and visit their loved ones in palliative care units, hospitals and hospices – bringing with them entirely different opinions about the patient’s care.Patients may have clear ideas of how they wish to spend their final days, however, these wishes may not be shared with their immediate next of kin, direct caregivers or wider families, prompting fierce debate on how best to treat the patient if and when they become incapacitated and unable to express their own preferences. As one participant pointed out,  offspring of incapacitated parents often feel it is their duty to keep their ailing parent alive as long as possible – even if this is of great discomfort to the patient. Keeping their parents in an expensive hospital, rather bringing them home to die in familiar comfort, can also be seen as a sign of respect.Some countries, such as Singapore, have passed laws that enable people (sick and well) to outline their preferences in “advanced care directives,” detailing whether they wish to be intubated, resuscitated, kept in hospital, brought home, etc. Such “living wills” can help avoid clashes between patients and their families.Another way to mitigate against such divergences in preferences would be to have frank, open and honest discussions between family members about what care we want at the end of life – even before we get sick. By discussing these underlying general values during wellness, caregivers and families can be better placed to make more specific decisions during illness – and be reassured that they are carrying out their filial duties. Children (i.e. minors) who are terminally ill have their end of life care decisions legally entrusted to their parents. Palliative care providers need to be especially sensitive in their communication with young patients and not simply assume that they are too young to understand or be able to express any preference. “We need to upgrade our communications skills as often as we upgrade our clinical skills,” pointed out one participant, a pediatric palliative care specialist.Much of the discussion surrounding palliative care focuses on cancer patients and their pain management, however there are many more patients who have end of life needs. As our populations age, dementia is increasing, bringing with it complex care needs. Often dementia patients do not wish to disclose their diagnosis to family members, lest they view and treat them differently. Despite their declining health, dementia patients should still be included in decisions about their care, with questions focusing on their emotional, rather than simply medical, needs. (Palliative) care in the (online) community How can we support patients and families within their communities?If enabling people to stay in their homes and communities is preferable to dying in a hospital, how can this be best supported? While patients may want to die surrounded by their loved ones, not all families are prepared for or able to carry out this care-giving role. Support and care needs to be offered to the caregivers as well as the patient to help them fulfill this role. We also need to acknowledge that caregivers might not be the next of kin or even a family member.One tool that has been developed to help patients and their families is the “Virtual Hospice” in Canada. The first online platform of its kind in world, the website offers practical advice and instructional videos on such things as how to lift patients in and out of bed. These videos reduce strain on local nursing resources, often called out to demonstrate the same skills repeatedly, and offer an immediate source of information to families in need. “People are saying ‘I no longer feel alone’ to a website,” explained one panelists, demonstrating how online communities can be a powerful and supportive resource.While no participants were advocating for the replacement of in-person care with virtual assistance, online tools can help “plug the gaps” in care provision – especially for rural communities. Developing these tools necessitates active listening to identify where those gaps are. Download the full newsletter from Day 2 The Salzburg Global Seminar session Rethinking Care Toward the End of Life, part of the long-running series Health and Health Care Innovation, is being held in partnership with the Dartmouth Institute for Health Policy & Clinical Practice and the Mayo Clinic. Follow online on Twitter with the hashtag #SGShealth.
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“How can we ensure that the preferences and needs of patients and families are met when providing palliative care?”
Amber Barnato shares her opinions during the session "Rethinking Care Toward the End of Life"
“How can we ensure that the preferences and needs of patients and families are met when providing palliative care?”
Yeji Park 
“The key to delivering good palliative care is to start the process at the right time. It should not start at the later stage when the end is near. The doctor who initially delivers the treatment needs to convince the patient that there is another team who are going to take care of the patient until the end. Otherwise, the patient will refuse to even take palliative care. After that, palliative care has to be holistic, comprising of medical care, psychosocial support and also, financial and livelihood support when you are dealing with low-income countries with a lot of people living in poverty.” Jagannath JayanthiExecutive Committee Member, Pain Relief and Palliative Care Society, India “I think patients and families need to be engaged in three ways, and they are all about conversation. First of all, we need to have more conversation at the beginning between the treatment team, the medical team and the patient and family. After someone has died, we need to have real conversations with the family about how it went. Beyond that, we need to have patients and families who are willing to work on the team together, to design and deliver the system better. In addition, we have to have the fridge magnet – the reliable place to call in an emergency.” Anya HumphreyPatient and Family Advisor, Canadian Fund for Health Care Improvement, Canada “I think the most important thing is to listen. To listen carefully to the patient and to the family, and to read in between the lines – not just the words, but the body language and the meaning behind the words. In general, families want the best for the patients, but that is not necessarily true. They may not realize that what they think is the best for the patient may not be the same as what the patient wants. I think we need to distinguish between those things.” Cynthia GohSenior Consultant, Division of Palliative Medicine at the National Cancer Centre, Singapore “When the patient with a terminal case comes to our hospice, we start by assessing the five needs: social, psychological, medical, spiritual, and financial need. With every visit, we reassess the need of the patient so that we can provide the right support at the right time. Through this reassessment, we could meet the expectation of the patients and family members. Sometimes I find family members coming to volunteer for us after the death of the patient, or patients donating their belongings to our organization. I think these indicators prove that our work has met most of their expectations.” Tandiyar SamirGeneral Manager, Josaab Foundation for Social Development, Egypt “One of the things I teach first and foremost to medical students is to try to avoid focusing on their own goals, but to stay present, mindful, and curious so that they can listen to what patients and family members are saying, including their nonverbal communication. In addition, I teach students how to manage their own discomfort when patients go through emotional moments. We usually have a natural compulsion as humans to try to reassure or comfort them. However, I teach students ways to acknowledge the discomfort and sit with it, rather than trying to deflect or distract the situation.” Amber BarnatoTenured Associate Professor of Medicine, Clinical and Translational Science, and Health Policy and Management, University of Pittsburgh, USA “Particularly in palliative care, we need to understand the cultural context behind this responsibility. We have seen in today’s discussion that the cultural context, which changes by country, has all to do with the way caregivers, families and patients interact. And in that interaction, it is not only the cultural aspects of the patients and families but also those of the caregivers that need to be acknowledged, in order to enable the three of them to work as a team around the quality of life of the patient.”Juan Pablo UribeDirector General, Fundación Santa Fe de Bogotá, Colombia Want to join the conversation? Tweet @SalzburgGlobal using the hashtag #SGShealth Download the full newsletter from Day 1 The Salzburg Global Seminar session Rethinking Care Toward the End of Life, part of the long-running series Health and Health Care Innovation, is being held in partnership with the Dartmouth Institute for Health Policy & Clinical Practice and the Mayo Clinic. Follow online on Twitter with the hashtag #SGShealth.
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