Impact case study database

Eastwood’s film practice research makes death and dying accessible to a general audience, and to professionals and medical students within the field of palliative care. Eastwood has used two distinct art forms, a feature length film (ISLAND) [3.1] and a multiscreen video installation (The Interval and the Instant) [3.2], to reach diverse audiences and create opportunities for engagement and increased familiarity with a challenging subject. Through UK and international screenings, exhibitions and targeted talks and workshops, Eastwood has made use of innovative contexts to give unprecedented visibility to palliative care and to the end of life. At the same time Eastwood’s work has led to an increased understanding amongst programmers, scholars, and audiences of filmic art as a medium of ethical substance [5.1].

Development of ISLAND educational and training toolkit for palliative care professionals

A 2018 report from the Royal College of Physicians (Bailey and Cogle 2018) states that doctors and medical staff struggle with difficult conversations with dying patients and must be better educated in all aspects of palliative care.

Dr Andreas Hiersche, Lead Clinician in Palliative Care, Brighton & Sussex University Hospitals commissioned The Interval and the Instant at Fabrica. A group of 20 of his trainee doctors visited the exhibition in November 2017 and produced coursework in response to the artwork. Testimonials from these sessions were used in the design of the educational toolkit [3.4]. Eastwood was then invited by Dr Hiersche, to run a session for third year medical students, contributing to the continuation of their professional development at this now annual session, where Dr Hiersche attests:

‘There is no doubt in my mind that this extraordinary film is a gift to anybody who wants to expand their horizon and explore death and dying in a non-threatening and accessible way […] It allowed the students to participate in an experience that neither classroom based nor clinical teaching could afford them […] We would certainly like to continue working with the film in our programme at the medical school.’ [5.9]

Feedback from the sessions [5.6], as well ISLAND, and additional research on The Interval and the Instant [3.3], helped build the ISLAND toolkit [3.4] to prepare doctors, nurses and medical students for their encounters with palliative patients [5.3, 5.4, 5.5].

Eastwood and his collaborator, the production company Hakawati set up a working group with established partners Mountbatten and Martlets hospices, and new partners St. Oswald’s Hospice and BARTS & The Royal London Hospital, and ran pilot training sessions between February and July 2017 using ISLAND as a tool for reflective learning [5.2].

The sessions were initially held at the Royal London Hospital (RLH) with second-year undergraduate medical students (43 attendees) and second year foundation doctors (28 attendees) led by Dr Anna Moore, Undergraduate Medical Education Fellow, Simulation Centre, who wanted to share this experience with junior medical students:

'Having watched ISLAND I wanted to show it to our junior medical staff and students because of its very clear focus on the people who are followed in the film […] As healthcare professionals we frequently do not have the time to explore ideas like this with the people we care for, often to the detriment of both our relationship with them, and their care as a whole.

ISLAND is a unique tool which gives viewers an insight both into the experiences of people approaching the end of their lives and the emotions that dealing with death and dying as a healthcare professional can elicit. I cannot think of a better way of educating healthcare professionals on this extremely important part of the job of caring for patients. Feedback from the sessions highlighted the value that ISLAND plays in preparing healthcare professionals for dealing with death and dying as qualified practitioners, as well as giving important insights into some of the aspects of the death and dying that are less well recognised.’ [5.3]

A further two screenings were then held at St. Oswald’s with medical consultants and nurses [5.3, 5.4], and a further three screenings at Martlets (55 attendees) to third-year undergraduate medical students [5.5]. ISLAND was also presented to groups of nurses from Mountbatten at screenings in December 2017 and September 2018 [5.4]. Watching ISLAND allowed medical staff and students to participate in an experience not available in the classroom or clinical teaching and rethink future experiences with palliative care patients. One student said the film ‘really highlighted that hospices are places of living’ [5.5]. Approximately 150 trainee doctors and nurses participated in these sessions, to which they attest [5.5]:

• ‘…the film has made me less scared of palliative care.' (Nursing Society, University of Brighton)

• 'It has increased my awareness of what can be done to ease people's deaths and how dedicated nurses can be.' (Cruse Bereavement Care, Lincoln)

• 'Opened my eyes to know that it is okay to offer support to the patient's families.' (Derbyshire Community Health Services, NHS Trust)

• 'This session has made me realise that giving people choices and communications with patients so that they are able to open up and have the chance to express maybe something they would like to say about the way they would like to die or any other important messages.’ (Student nurse, RLH)

• 'It has given me the courage to respect everyone’s choice on how they want to be treated when dying.’ (Student nurse, RLH)

• ‘…now I see that although a slightly greater degree of sensitivity is required, these patients should be treated just like any other patient.’ (Medical student, Martlets)

Feedback from all the sessions [5.6] was consolidated in the construction of the ISLAND toolkit [3.4] which launched in November 2019 [5.2] to prepare doctors, nurses and medical students for their encounters with palliative patients, and to contribute to continuing professional development [5.3, 5.4, 5.5].

Informing public understanding of death and dying

Through its cinema release, ISLAND has reached thousands of people (the film’s trailer has been shared 34,000 times, with 50% international site visitors [5.9]). By engaging members with ISLAND, the film [3.1] has helped raise public understanding and informed the public of death and dying, speaking to members of the public post screening during Q&A sessions [5.7]:

‘It made what could have been thought of as a difficult topic - not that way at all, just a normal part of life’

‘ISLAND’s fantastic portrayal of humanity […] in life and death gave me great strength’.

‘Having now witnessed a death for myself, I can tell you first-hand how amazingly helpful your film was. Having seen the film, I was so much better prepared with what to expect and, consequently, much calmer and relaxed […] I had the strength to stay with him through periods of fast and heavy breathing. Didn’t panic when breathing paused. Most importantly, I was not squeamish about the body. All this is thanks to your film’.

The film has provoked debate in the UK and beyond and raised awareness, attitudes and understanding on the visibility of hospice care and those with terminal illness [5.8], and gained media and press attention featuring on BBC Breakfast, Sight and Sound, The Sunday Times, The Guardian and more. [5.10 & 5.11].

ISLAND has gained large public interest through events across the UK taking place between November 2017 and December 2018 including a total of 21 cinema screenings (including at the Irish Film Institute, Bristol Watershed Cinema and Southampton Harbour Lights Picturehouse)and at film festivals (Screening Rights Film Festival, Human Rights Film Festival) [5.8] which have been accompanied by targeted sessions featuring professional respondents. Audiences praised the film for ‘bringing death back into the communities’ with one member of the public stating that‘the film is a great contribution […] to open people up to talking about death and dying’ [5.7]. In autumn 2019, ISLAND was released on video on demand via MUBI, Amazon, iTunes, greatly increasing reach with international audiences. Since March 2018 @ISLANDFilmUK has made 154,480 impressions [5.9].

Through public events, screenings and feedback collated from these sessions, ISLAND was able to inform public knowledge of death and dying, creating a space for people to openly talk and think about death and dying, and confront the reality of death, making it a part of daily existence and less frightening.

Influencing professional training and practices internationally

Hakawati have promoted the educational toolkit to their regional networks and beyond, with a number of hospices and universities having licensed the toolkit/film, including Martlets, Mary Stevens Hospice, Brighton/Sussex Medical School, University of Birmingham (School of Nursing), University of Brighton (Centre for Memory, Narrative and Histories), and the University of Exeter. The project has received significant recognition within palliative care, with palliative care consultant Kathryn Mannix hailing ISLAND, in a foreword to the toolkit, as ‘a film to set the record straight after decades of inaccurate, misleading and over-dramatized screen portrayals of dying’ [5.3].

Further promotions have been conducted internationally following requests from organisations to licence the toolkit in Australia (Calvary Health Care), USA (OHSU School of Nursing, Michigan State University College of Human Medicine, Hospice House Williamsburg), Canada (Simon Fraser University Library, King's University College), Germany (University Medicine Greifswald) and Spain (Universidad Internacional de la Rioja).

Since the release of the film and its toolkit, around sixty-five universities and hospices across the UK requested to license the toolkit [5.9] in 2019. Although, this process has been put on hold due to the COVID19 pandemic, Eastwood and Hakawati begun negotiations in 2020 for the licensing of the film to over 25 university libraries and 20 hospice libraries across the country, potentially reaching thousands of clinical staff, trainees and volunteers. Plans are also underway to broadcast ISLAND internationally and to make the film available to international universities and hospital libraries.