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Hello everyone, I'm erin Matsumoto, I work as a palliative care specialist in Japan and as I own a tote tote about my uh biography. I'm also my candidate of my master's course in palliative care at King's College London. Uh These are um Axa islands where I live, I live on such small islands and need an airplane to move out, but thanks to the technology, I study of kcl, the online and I'm very delighted to be with you today uh with high interest in global health. The focus is of this webinar are the connection between a good death and culture and some tips for respecting patient's values um accessible to keep paper about a good death, understand the linkage between a good death and culture. Get four tips on helping to respect patient's values. First, I will introduce you to the definition of palliative care, what is palliative care, w. H. O. Says palliative care, improves the quality of life of patient's, and that of their families or facing challenges associated with life threatening illness, whether physical, psychological, social or spiritual the quality of life of caregivers improve as well a good death. It's a big theme and sometimes reluctant to talk about because it is very personal and spiritual. When tomo, global health gave me a proposal for this webinar. I started reading some articles and decided to show you a key article in this field. Uh I will introduce you a systematic review about a good death published in 2020 this one uh When they analyzed the data extracted from the articles to level categories were identified. The first one is core elements for a good death, which illustrated as the red inner circle and the second level is main themes or factors that shape the concept that is indicated as the blue other hexagon out of hexagon. A lot of patient's descriptions of a good death fall within a series of core elements which include control of pain and symptoms, feeling of closure, being able to give to others, preparation for death still being and still being seen as a person. The main themes that were considered a factors that shape the concept tend to differ across the groups, they include asia culture, financial issues, religion, disease, and life circumstances today. As we have the participants who are interested in global health. Among these themes, I would like to choose the culture to share with you, culture and society, culture, shapes the meaning people give to illness, suffering and dying. The differences regarding the notion of a good death may differ across cultures in, in the western. Some argue that care of the self is nowadays considered as as an individual project, however, others found the views about death and dying were both influenced by personal and family concerns, particularly in some cultures, there is greater trust and increased willingness to allow family members and others to care for them and participate in decision making. For example, japanese patient's with cancer do not consider autonomy to be essential for a good death, rather they prefer a passive decision making smile in a cage is recent study, elderly japanese people regarded trusting my physician to be the most important component of a good death, the least commonly supported them themes for a good death were knowing what to expect in one's future and knowing how long one has until death. These findings emphasize the importance of the japanese entrusting pattern of Oh mukasey, which means entrusting the decision to a medical expert. Furthermore, in the japanese, as well as in the chinese cultural context, good family relationships are considered key requirements for a good death, although the importance of family support at the end of life is emphasized and expected the dying also has a strong desire not to be burden on the family, although the importance of some attributes of the good death differ between us europe and Asian cultures, there is considerable agreement about concordance with others, pain and symptom control, preparation for death completion and contributing to others, not being a burden to others and maintenance hope what we concern about a good death. As healthcare professionals, I think uh there are two important things we care about first a good death for each person is highly individual and changeable over time, we need to accept this thing and the second one is dying people are free in their wishes and choices, for example control of pain and physical uh physical symptoms is universally considered to contribute to a good death. However, in cultural contexts where financial aspects to limit the access to health care of medicines, patient's tended to put an emphasis on this core element and expressed great concern about it. Whereas in contexts where health access is secured, more importance was placed in aspects such as being able to participate in treatment decisions than in pain control. Healthcare staff should be aware of their own value systems and the risk of imposing them on the concept of good death or good or bad death. Current definitions of good death specify a social ideologies of death and dying. They point out the risk that an ideologies of good death can lead to labeling of good and bad dying and thus too good and bad patient who are dying, dying would be strongly shaped and controlled by society, so we need to await new. We need to be aware that dying people are free in their wishes and choices, so how can we deliver a good death, respecting the patient's own value as I work as a palliative care specialist. It is very difficult sometimes to always respect patient's own values here. Are some tips uh that I always care about, first improve your communication skills, second understand the difference between sympathy and empathy, third work with an inter professional team, fourth be honest uh first improve your communication skills uh do you have you ever heard of vital talk or spikes um video talk uh They also launched up, uh launched an app, so you can download it uh It tells us how to deliver bad news to the patient who are suffering from diseases, second spikes, which is developed in the u s. Depending on which country or systems you will practice your clinical residency uh Some of them may offer you. the course is based on vital talk or spikes. For example, um in japanese oncology residency programs, we need to take a one day course of spikes uh. Uh The second one understanding the difference between empathy and sympathy when we sympathize with someone, we add our own sorrow, fear, or our pity to the other person's feelings, we see others in our perspective. For example, when someone falls down a hall, a person who sympathizes will say you are so pitiful. When we empathize, we try to reflect back the feeling that person has when we empathize and do not judge patient's values, their preferences or their choices, It will help us avoid imposing them on the concept of good or bad death uh. I found the youtube video which illustrates this well about uh this well, so for further information, you can watch it so uh working with an interdisciplinary team. You all may know how important it is to work with a multi professional team. A lot of benefits may be derived from the interdisciplinary approach since it is the way to achieve holistic and comprehensive care in compact sing, the complex physical, psychological and spiritual needs of patient's and their families being fourth being honest, not being afraid of powerlessness. Some of you may know sheila an cassidy who is an english doctor, known for her work in the hospice movement from her book, share ing the darkness. Um I would like to refer to these phrases because they are exactly what every palliative care specialist has when we face the patient sorrow, slowly as the years go by. I learned about the importance of powerless, I experience it in my own life and I live with it in my work. The secret is not be afraid of it not to run away the dying, no we are not god all they ask is that we do not dessert them at this stage of the journey of being there of simply being, it is in many ways the hardest part, so uh in this webinar, you learned access the key paper about a good death, understand the linkage between a good death and culture, Get four tips on helping to respect patient's values. Thank you very much for your listening. This is my twitter account mostly in japanese. I tweet about information on palliative care residency programs experiences at kcl and female korea. Please follow me see you soon that's it.