Overview
Palliative care is provided across the spectrum of health settings, where possible, to meet the needs of patients living with or dying of a life limiting illness and their families. 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 Australia’s document Service provision in Australia: A planning guide describes service provision occurs across three settings:
- Community settings
- Inpatient designated palliative care beds
- Acute hospitals.
Community settings include the patient's own home, residential aged care facilities or other locations such as supported care facilities. Inpatient designated palliative care beds can include beds in a rural community hospital, designated beds in a teaching hospital or a purpose-built hospice. Many anticipated deaths still occur in acute hospitals and many patients are identified as needing palliative care while in an acute hospital. [1]
While death at home is often cited as preferable for the patient, there is a new caution of presenting this as a ‘gold standard’ of care. The complexities of place of care are being analysed in the literature. Environment, society, health policies, individual illness and socio-economic factors are increasingly being acknowledged as factors that shape the place of care and death. [2-3] Patient preference, carer coping and therapeutic considerations appear to influence the place of end of life care for cancer patients. [3]
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. The National Health and Hospitals Reform Commission has identified caring for people at the end of life as a key reform area. A Victorian State review has also recommended an integrated approach of hospital based palliative care consultancy teams. [4]
Key messages
Early systematic reviews in the 1990s were inconclusive regarding the effectiveness of palliative care provision due to issues with study methodology and lack of clarity about outcome measures. [5-7]
Recent systematic reviews have not reached consensus regarding the efficacy of specialist palliative care – more methodologically sound research using standardised palliative care interventions and measures are needed. [8-10] This mirrors the conclusions of other work conducted in the 2000s. [11-12]
There have also been systematic reviews on various components of palliative care delivery such as palliative day care [13]. As yet there is no clear picture of effectiveness of different service configurations.
There have been systematic reviews that have looked at the role of palliative care for particular groups such as:
- Aged [14-15]
- Cancer [16]
- Cultural groups [17]
- Dementia [18]
- General practitioner role and capacity [19]
- HIV / AIDS [20]
- Intellectual disability [21]
- Rural populations [22-23]
- Stroke [24]
- Severe persistent mental illness. [25]
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. [26]
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 [27]
- 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 [1]
- 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. [28]
- 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. [29-32]
- 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.
- There has been growth and change in the pattern of hospice benefit use in the USA as nursing homes have expanded their hospice programs. This has implications for clinical and financial arrangements within nursing homes. [30]
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. [1]
- Australia faces specific issues with regard to models that can be utilised in rural and remote settings and with Indigenous populations. [33-34]
References
- Gordon R, Eagar K, Currow D, Green J. Current funding and financing issues in the Australian hospice and palliative care sector. J Pain Symptom Manage. 2009 Jul;38(1):68-74.
- Gruneir A, Mor V, Weitzen S, Truchil R, Teno J, Roy J. Where people die: A multilevel approach to understanding influences on site of death in America. Med Care Res Rev. 2007 Aug;64(4):351-78.
- Murray MA, Fiset V, Young S, Kryworuchko J. Where the dying live: a systematic review of determinants of place of end-of-life cancer care. Oncol Nurs Forum. 2009 Jan;36(1):69-77.
- Victorian Government Department of Human Services. Review of hospital-based palliative care consultancy teams. Melbourne: Victorian Government Department of Human Services; 2007.
- Hearn J, Higginson IJ. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliat Med. 1998 Sep;12(5):317-32.
- Wadhwa S, Lavizzo-Mourey R. Do innovative models of health care delivery improve quality of care for selected vulnerable populations? A systematic review. Jt Comm J Qual Improv. 1999 Aug;25(8):408-33.
- Wilkinson EK, Salisbury C, Bosanquet N, Franks P, Kite S, Lorentzon M, Naysmith A. Patient and carer preference for, and satisfaction with, specialist models of palliative care: a systematic literature review. Palliat Med. 1999 May;13(3):197-216.
- García-Pérez L, Linertová R, Martín-Olivera R, Serrano-Aguilar P, Benítez-Rosario MA. A systematic review of specialised palliative care for terminal patients: which model is better? Palliat Med. 2009 Jan;23(1):17-22. Epub 2008 Nov 27.
- Zimmermann C, Riechelmann R, Krzyzanowska M, Rodin G, Tannock I. Effectiveness of specialized palliative care: A systematic review. JAMA. 2008 Apr 9;299(14):1698-709.
- Thomas RE, Wilson D, Sheps S. A literature review of randomized controlled trials of the organization of care at the end of life. Can J Aging. 2006 Fall;25(3):271-93.
- Finlay IG, Higginson IJ, Goodwin DM, Cook AM, Hood K, Douglas HR, Normand CE. Palliative care in hospital, hospice, at home: results from a systematic review. Ann Oncol. 2002;13 Suppl 4:257-64.
- Higginson IJ, Finlay I, Goodwin DM, Cook AM, Hood K, Edwards AG, Douglas HR, Norman CE. Do hospital-based palliative teams improve care for patients or families at the end of life? J Pain Symptom Manage. 2002 Feb;23(2):96-106.
- Davies E, Higginson IJ. Systematic review of specialist palliative day-care for adults with cancer. Support Care Cancer. 2005 Aug;13(8):607-27. Epub 2005 Jun 14.
- Burt J, Raine R. The effect of age on referral to and use of specialist palliative care services in adult cancer patients: a systematic review. Age & Ageing. 2006 Sep;35(5):469-76.
- Oliver DP, Porock D, Zweig S. End-of-life care in U.S. nursing homes: a review of the evidence. J Am Med Dir Assoc. 2005 May-Jun;6(3 Suppl):S21-30.
- 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. Barriers to optimum end-of-life care for minority patients. J Am Geriat Soc. 2002 Jan;50(1):182-90.
- Sampson EL, Ritchie CW, Lai R, Raven PW, Blanchard MR. A systematic review of the scientific evidence for the efficacy of a palliative care approach in advanced dementia. Int Psychogeriatr. 2005 Mar;17(1):31-40.
- Mitchell GK. How well do general practitioners deliver palliative care? A systematic review. Palliat Med. 2002 Nov;16(6):457-64.
- Harding R, Karus D, Easterbrooks P, Raveis VH, Higginson IJ, Marconi K. Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence. Sex Transm Infect. 2005 Feb;81(1):5-14.
- Tuffrey-Wijne I. The palliative care needs of people with intellectual disabilities: a literature review. Palliat Med. 2003 Jan;17(1):55-62.
- Evans R, Stone D, Elwyn G. Organizing palliative care for rural populations: a systematic review of the evidence. Fam Pract. 2003 Jun;20(3):304-10.
- Wilson, DM, Justice C, Sheps S, Thomas R, Reid P, Leibovici K. Planning and providing end-of-life care in rural areas. J Rural Health. 2006 Spring;22(2):174-81.
- Stevens T, Payne SA, Burton C, Addington-Hall J, Jones A. Palliative care in stroke: a critical review of the literature. Palliat Med. 2007 Jun;21(4):323-31.
- Woods A, Willison K, Kington C, Gavin A. Palliative care for people with severe persistent mental illness: a review of the literature. Can J Psychiatry. 2008 Nov;53(11):725-36.
- Ahmed N, Bestall JC, Ahmedzai SH, Payne SA, Clark D, Noble B. Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals. Palliat Med. 2004 Sep;18(6):525-42.
- Masso M, Dodds S, Filders D, Yeatman H, Eagar K. Ethical research in palliative care: a guide through the human research ethics committee process. Centre for Health Service Development, University of Wollongong. 2004: pp37.
- Shelby-James TM, Currow DC, Phillips PA, Williams H, Abernethy AP. Promoting patient centred palliative care through case conferencing. Aust Fam Physician. 2007 Nov;36(11):961-4.
- Rigby J, Payne S, Froggatt K. Review: what evidence is there about the specific environmental needs of older people who are near the end of life and are cared for in hospices or similar institutions? A literature review. Palliat Med. 2010 Apr;24(3):268-85. Epub 2009 Nov 19.
- Stevenson DG, Bramson JS. Hospice care in the nursing home setting: a review of the literature. J Pain Symptom Manage. 2009 Sep;38(3):440-51.
- Stuart B. The nature of heart failure as a challenge to the integration of palliative care services. Curr Opin Support Palliat Care. 2007 Dec;1(4):249-54.
- Agren Bolmsjo I. End-of-life care for old people: a review of the literature. Am J Hosp Palliat Care. 2008 Aug-Sep;25(4):328-38. Epub 2008 May 7.
- To T, Boughey M. Referral patterns to a palliative care service in rural Australia servicing Indigenous Australians. Intern Med J. 2010 Nov;40(11):722-6.
- McGrath PD, Phillips EL. Insights from the Northern Territory on factors that facilitate effective palliative care for Aboriginal peoples. Aust Health Rev. 2009 Nov;33(4):636-44.
This page was created on 04 January 2008
Last updated 23 February 2011*
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