Overview
Palliative care is provided, where possible, in the patient’s preferred place of choice. It enables coordinated medical, nursing, allied health and volunteer services including both generalist and specialist providers where needed to meet the care needs of individual patients.
Palliative care service provision occurs across three settings:
- Community settings
- Designated palliative care beds in hospices
- Acute hospitals.
Community settings include the patient's own home, residential aged care facilities or other organisations such as supported care facilities. Inpatient beds are provided specifically for palliative care patients. They are found in various institutions including beds in a rural community hospital, designated beds in a teaching hospital or a purpose-built hospice.
Care is also provided in acute hospitals. Many patients are identified as needing palliative care while in an acute hospital. Some will also be admitted during the course of palliative care to receive treatment for an acute medical or surgical condition, or for symptom control. Health care in rural and remote settings is usually provided by primary healthcare providers who may have supportive relationships with specialist providers.
As palliative care becomes a more significant aspect of Australia’s health system, the models by which palliative care is provided to individuals and to the whole community become increasingly important. The framework for Australian palliative care is outlined in the National Palliative Care Strategy. An overview of service provision showing, the diversity of local approaches, is found in the document A Snapshot of Palliative Care in Australia.
Key messages
Early systematic reviews were inconclusive regarding the effectiveness of palliative care provision due to issues with study methodology and lack of clarity about outcome measures. [1- 5] (Hearn and Higginson 1998; Critchley, Jadad et al, 1999; Smeenk, 1998; Wadhwa & Lavizzo-Mourey, 1999, Wilkinson 1999)
More recent reviews suggest that palliative care may improve outcomes but that the strength of the effect is unclear:
There have also been systematic reviews on various components of palliative care delivery such as palliative day care [9] (Davies and Higginson, 2005). As yet there is no clear picture of effectiveness of different service configurations. A protocol for assessing home palliative care for adults with cancer has been included in the Cochrane Database of Systematic Reviews. [10] (Curiale et al, 2007)
There have been systematic reviews that have looked at the role of palliative care for particular groups such as:
- Aged [11, 12] (Burt & Raine, 2006; Oliver et al, 2005)
- Cancer [13] (Higginson IJ, Sen-Gupta GJ )
- Cultural groups [14] (Krakauer et al, 2002)
- Dementia [15] (Sampson et al, 2005
- General practitioner role and capacity [16] (Mitchell, 2002)
- HIV / AIDS [17] (Harding et al, 2005)
- Intellectual disability [18] (Tuffrey-Wijne, 2003)
- Rural populations [19,20](Evans et al, 2003; Wilson et al, 2006)
- Stroke [21] (Stevens, 2007)
One systematic review has identified several barriers to access and referral to palliative care including a lack of knowledge and education of health professionals and a lack of standardised referral criteria. [22] (Ahmed et al, 2004)
Active research areas
- Health services research in this field is still developing. There are specific considerations relating to the vulnerability of this population that could make such research challenging. There have been some recent initiatives to guide researchers on conducting research with this population [23] (Masso, Dodds 2005)
- The current service delivery model issue is that of the best interplay between specialist palliative care services, other medical specialty providers and non-specialist providers such as general practitioners and community nurses
- Most studies look at general measures such as patient satisfaction rather than specific measures relating to care organisation and processes
- There has been little research on interventions relating to model components. In Australia a large palliative care trial showed the benefit of case conferencing in care provision
- There is uncertainty whether models developed for cancer populations can be generalised to non-cancer populations. The possible role of specialist palliative care with relation to aged care and chronic disease management is also being explored
- The nature and components of the models that could provide the most benefits are yet to be established. How models may need to be modified to meet the needs of particular client groups is still to be determined.
Australian considerations
- There are difficulties in determining applicability of specific models to Australian contexts due to differences between health systems internationally and differences in funding and service arrangements between states and federally
- Australia faces specific issues with regard to models that can be utilised in rural and remote settings and with Indigenous populations.
References
- Hearn J & Higginson IJ 1998 Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review Palliat Med 12(5):317-32
- Critchley P, Jadad AR, Taniguchi A, Woods A, Stevens R, Reyno L & Whelan TJ 1999 Are some palliative care delivery systems more effective and efficient than others: a systematic review of comparative studies Journal of Palliative Care 15(4): 40-47
- Smeenk FW, van Haastregt JC, de Witte LP & Crebolder HF 1998 Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: a systematic review BMJ 316:1939-1944
- Wadhwa, S Lavizzo-Mourey R 1999 Do innovative models of health care delivery improve quality of care for selected vulnerable populations? A systematic review Joint Commission Journal on Quality Improvement 25(8):408-33
- Wilkinson EK, Salisbury C, Bosanquet N, Franks P, Kite S, Lorentzon M, Naysmith A 1999 Patient and carer preference for, and satisfaction with specialist models of palliative care: a systematic review of the literature Palliative Medicine 13(3):197-216
- Finlay IG, Higginson IJ, Goodwin DM, Cook AM, Hood K, Douglas HR, Normand CE 2002Palliative care in hospital, hospice, at home: results from a systematic review Ann Oncol 13 Suppl 4:257-64
- Higginson IJ, Finlay I, Goodwin DM, Cook AM, Hood K, Edwards AG, Douglas HR, Norman CE 2002 Do Do hospital-based palliative teams improve care for patients or families at the end of life?improve care for patients or families at the end of life? J Pain Symptom Manage 23(2):96-106
- Thomas RE, Wilson S, Sheps S 2006 A literature review of randomized controlled trials of the organization of care at the end of life Can J Aging 25(3):271-93
- Davies E, Higginson IJ 2005 Systematic review of specialist palliative day-care for adults with cancer Support Care Cancer 13(8):607-27
- Curiale V, Cella A, Luzzani M, Prete C. Home-based palliative care for adults with cancer. (Protocol) Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD006510. DOI: 10.1002/14651858.CD006510
- Burt, J Raine, R 2006 The effect of age on referral to and use of specialist palliative care services in adult cancer patients: a systematic review Age & Ageing 35(5) 469-76
- Oliver DP, Porock D & Zweig S 2004 End-of-life care in U.S. nursing homes: a review of the evidence Journal of the American Medical Directors Association 5(3): 147-55
- Higginson IJ, Sen-Gupta GJ Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med. 2000 Fall;3(3):287-300
- Krakauer EL, Crenner C & Fox K 2002 Barriers to optimum end-of-life care for minority patients Journal of the American Geriatric Society 50(1):182-90
- Sampson E.L, Ritchie CW, Lai R, Raven PW & Blanchard MR 2005 A systematic review of the scientific evidence for the efficacy of a palliative care approach in advanced dementia International Psychogeriatrics17(1): 31-40
- Mitchell GK 2002 How well do general practitioners deliver palliative care? A systematic review Palliative Medicine 16(6) 457-64
- Harding R, Karus D, Easterbrooks P, Raveis VH, Higginson IJ & Marconi K 2005 Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence Sex Transm Infect 81(1):5-14
- Tuffrey-Wijne I 2003 The palliative care needs of people with intellectual disabilities: a literature review Palliative Medicine 17(1):55-62
- Evans R, Stone D & Elwyn G 2003 Organizing palliative care for rural populations: a systematic review of the literature Family Practice 20(3): 304-310
- Wilson, DM, Justice C, Sheps S, Thomas R, Reid P, Leibovici K. 2006 Planning and providing end-of-life care in rural areas Journal of Rural Health 22(2) 174-81
- Stevens T, Payne SA, Burton C, Addington-Hall J & Jones A 2007 Palliative care in stroke: a critical review of the literature Palliative Medicine 21(4):323-331
- Ahmed N, Bestall JC, Ahmedzai SH, Payne SA, Clark D & Noble B 2004 Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals Palliative Medicine 18(6): 525-42
- Masso, M, Dodds, S, Filders, D et al, Ethical Research in Palliative Care: a guide through the Human Research Ethics Committee process, Centre for Health Service Development, University of Wollongong, 2004, 37p.
This page was created on 04 January 2008 and is due for review in January 2010
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