SPIRALS

As the end of my first (very busy) week in Sydney approaches, I have been reflecting on what I have been learning during my Churchill Fellowship visits so far and realising that a few themes are recurring.

First is the support for the concept of advance research planning whilst also recognising the challenges that accompany its implementation. The questions people ask about how it could work and the problems they would forsee depends very much on their role or background, but always seems to acknowledge that it would be an improvement on the current situation. People often have a story to tell about a negative experience they have had with a particular study, or a difficult conversation, and their frustration with the outcome and the unsatisfactory compromise they (and others) have had to come to as a result.

Second is the central role of relationships and the importance of 'knowing'. This is both in terms of how family members may come to know the values, wishes and preferences of the person they are representing, and also the value of people who anticipate future periods of changing cognition knowing that they have had conversations with those close to them and have plans in place for their future which can bring some comfort.

Third is around the inequalities that are experienced by particular groups who are under-served or marginalised in health and care, and the need to pay attention to ensuring that these groups are not further excluded. This includes First Nations and Indigenous people in both Canada and Australia, where work to build and restore trust has been mentioned in many conversations, and also for groups who often experience social exclusion such as people living with dementia. 

The image accompanying this blog is of a water feature at sunny Darling Harbour (officially called Tidal Feature but often known as the spiral fountain), which I chose because some of the themes coming up in conversations are beginning to feel as though they are 'coming back round'. I am looking forward to meeting lots more people and groups over the next two weeks and seeing where the patterns of these new conversations might seem familiar - and also where they are new!