CareSearch Evidence Clinical Practice

The majority of patients referred to palliative care have cancer with a more prodominent focus on the cancer and palliative care model.

A much smaller proportion of people without cancer access palliative care services, despite good evidence of the benefits to their often complex needs.  Reasons for this include: lack of referrals from the treating specialty due to greater difficulty in predicting time to death for non-malignant diseases and a perception that a referral is a sign of giving up.  

There are many illness that may benefit from specialist palliative input. These include neuromuscular disorders (MS, MND, Parkinsons disease), COPD, heart failure, dementia and other chronic life-limiting illnesses.

Palliative care services can be concerned that extending services to non-malignant disease will result in them being overwhelmed with clients. Development of referral pathways between specialities and palliative care services may help to overcome some of these barriers.

Many specialist nurses work alongside palliative care services and vice versa. These relationships are important to help ensure that any patient with a life-limiting illness can access palliative care or a palliative approach and good symptom control. For example, a nurse consultant in heart failure will work closely with a palliative care nurse to manage symptoms and end of life care issues for people with heart failure.

Resources

• Palliative Care Australia has two documents that may be useful:
  • Palliative care service provision in Australia: A planning guide
  • A guide to palliative care service development: A population based approach

       Palliative Care Australia Presentations

• From the ‘Together 2009’ national conference, including Non-Malignant palliative care 
• A power point: Improving access to palliative care for people who have had a stroke
• The Australian General Practice Network has information and resources on Chronic Disease Prevention and Management
• From the Victorian Department of Human Services: MND and palliative care: Interim report on the MND Pathway Project (2008)
• From the Cochrane Collaboration, a Cochrane review: Brettschneider J, Kurent J, Ludolph A, Mitchell JD Drug therapy for pain in amyotrophic lateral sclerosis or motor neuron disease 2010 
• The Gold Standards Framework (UK) has developed a Prognostic Indicator Guide that may be helpful. It is also featured in an edition of End of Life Care
• The National Health Service in the UK has produced an End of life care strategy. July 2008.  
• The NHS has also produced a document: End of life care in heart failure: A framework for implementation

• Barnes J, Campbell C. Palliative care in multiple sclerosis and motor neurone disease. Br J Hosp Med (Lond). 2010 Jan;71(1):21-25.
• Cartwright Y, Booth S. Extending palliative care to patients with respiratory disease. Br J Hosp Med (Lond). 2010 Jan;71(1):16-20.
• Johnson MJ. Extending palliative care to patients with heart failure. Br J Hosp Med (Lond). 2010 Jan;71(1):12-15.
• Jordan A. Extending palliative care to patients with dementia. Br J Hosp Med (Lond). 2010 Jan;71(1):31-35.
• Wilcox SK. Extending palliative care to patients with Parkinson's disease. Br J Hosp Med (Lond). 2010 Jan;71(1):26-30. 
• Skilbeck JK, Payne S. End of life care: a discursive analysis of specialist palliative care nursing. Journal of Advanced Nursing. 2005 Aug;51(4):325-34. 
• Wotton K, Borbasi S, Redden M. When all else has failed: Nurses' perception of factors influencing palliative care for patients with end-stage heart failure. J Cardiovasc Nurs. 2005 Jan-Feb;20(1):18-25. 
• Johnson A, Bonner A. Palliative care challenges: implications for nurses' practice in renal settings. Contemp Nurse. 2004 Jul-Aug;17(1-2):95-101. 
• Davidson PM, Introna K, Cockburn J, Daly J, Dunford M, Paull G, Dracup K. Synergizing acute care and palliative care to optimise nursing care in end-stage cardiorespiratory disease. Aust Crit Care. 2002 May;15(2):64-9.

Return to Areas of Practice page

This page was created on 27 August 2010
Last updated 11 January 2011*