Providing Palliative Care for the Child with Cancer: The Experience of GPs

Background Childhood cancers are rare and general practitioners (GPs) have limited experience in caring for these children and even less in providing their palliative care. Most families prefer that their child is cared for at home in the palliative phase of their illness, with professional support from those known to them (Chambers and Oakhill 1995, Vickers and Carlisle 2000, Craft and Killen 2007). A community based qualitative study examined the experiences of ten GPs following their involvement in the care of a child with cancer receiving palliative care within the family home. Methods Data collection was through 1:1 in-depth interviews and facilitated case discussion supported by field notes and grounded theory analysis (chronological comparative data analysis identifying generated themes). Social worlds theory was used as a framework to aid examination, and facilitate critical understanding, of the experiences of the GPs. Findings This presentation focuses on five of the findings relating to the experiences of the GP; the impact of minimal contact; lack of knowledge and experience, uncertain role, out of hours service provision and the emotional toll. Findings highlighted that GPs often have to re-establish their role at the child’s transition to palliative care. Factors hindering the GP in this process include a deficit of specialist knowledge and experience of paediatric palliative care and lack of role clarity. Conclusions/points of interest Strategies for enhancing the role of the Macmillan team in supporting GPs have been identified by this study, such as enhanced collaborative working. Findings have also provided further confirmation of the substantial variation in out of hours medical palliative care provision; with evidence that some GPs work beyond their remit in providing informal out of hours care. This presentation details the findings of one aspect (the experiences of GPs) of a wider study that explored the experiences of 54 community based health professionals (GPs, community nurses and allied health professionals) who had been involved in caring for a dying with cancer receiving palliative care at home (Neilson 2009).

Teaching Rules or Teaching Creativity: a Paradigm Shift

Structure is everything in a screenplay we are told. If indeed there are any rules to screenwriting then this would be carved in tablets of stone. Within pedagogical frameworks we are diligent in our instruction of the three acts, advocating it as a paradigm. We pass on tools for the analysis of character that are gleaned from psychology. But I have seen students struggle with this toolbox. They feel constrained by concrete techniques. So often seeing principles as rules, structure as restriction. The stifling of free-form ideas is further compounded by the plethora of books that claim the path to glory lies only in structural devices. Some even purport to have a formula, a simple prescriptive model that will bestow almost certain success. Yet this is an industry that abhors formula, that hungers for the fresh and the new. Without bravado, imagination and experimentation with character and form, the best structured screenplay in the world is merely a typing exercise. As educators we have a duty to retain a balance between letting a student’s mind dance and keeping them to the tempo. This study will compare a variety of diverse structures, from Hegel to Alcoholics Anonymous, Kubler Ross to Jung. It will analyse recent journal articles, on both new techniques in teaching creativity and new approaches to the instruction of screenwriting, to suggest a model of how best to inform the application of structure to HE students and keep creativity uppermost. A structure of emotional truth. An equal appreciation of both the tools of our craft and an imaginative exploration of character and world that can unlock our originality and our artistry.