All health professionals have a role

Demand for palliative care in the acute care setting is significant and is projected to increase steeply in coming years. 

Five in ten deaths in Australia occur in hospital. Many are expected deaths. The pivot from treatment and intervention to palliative care with its focus on quality of life and the preferences and values of the person is important. This is also true for patients receiving care within the last 12 months of life.

87,000 palliative care-related hospitalisations 2019-20 [1]

5 in 10 deaths occur in hospital [2]

Approximately 4,000 palliative care specialists [1]

170,000 total deaths in 2021 - projected to reach 400,000 in 2060 [3]

Training and access to support is required to enable non-palliative care health professionals with varying levels of experience to provide appropriate palliative care at the end of life - this includes end-of-life care for people within the last 12 months of life and terminal care where death is imminent.  A review of best practice processes for end-of-life care and the requirements for its provision in the Australian health context has identified broad themes of importance. [4]

Based on these findings and available evidence CareSearch has developed an acute care section to help all health professionals to take on this role.

Person-centred care

Person-centred care reflects the related concepts of dignity, worth and human rights. It sees care providers listening and responding to the needs and preferences of those in their care. Good communication is essential. 

‘Often clinicians lack confidence or are reluctant to initiate early conversations about death and dying due to a knowledge and skills deficit in end-of-life care.’ [4] 

CareSearch Communication pages provide access to a number of useful mnemonics to help including SPIKES, REMAP, and PREPARE. Our Partner Project End of Life Essentials has education.

Clinician capacity

The Australian Commission on Safety and Quality in Health Care has made recommendations for clinicians to improve the clinical care provided to people at the end of life and support the shift from a curative to a palliative approach to care. Clinicians will need to recognise the need for palliative care and know how to respond appropriately. Validated tools for triage and prognosis are available and can help identify people with palliative care needs and those requiring specialist referral.

Clinicians should:

  • Provide care with kindness and compassion, and maintain patient dignity and privacy
  • Review medications and prioritise comfort measures, pain control and symptom management
  • Avoid unnecessary monitoring and interventions
  • Communicate openly and honestly with patients and families about prognosis and share decision-making
  • Be aware of common risks of harm for patients at the end of life.

Caring for family and bereavement support

The family is an important unit of care and systems should consider their perspective both while the patient is alive and into the family’s bereavement. [4]

The bereavement support needs of family members will vary and be influenced by clinical setting within the hospital. A personalised approach involving clinical and non-clinical staff is needed.

Organisational readiness 

The acute care sector is part of a broader health system. Patients and their families need support to navigate and safely transition within as well as to and from hospital.  Where possible they should have privacy when care is provided, and receive culturally responsive care. Optimising planning and guidance for palliative care delivery and teamwork across the hospital can positively influence care delivery and transitions for people receiving care at the end of life.  

Read some of our Palliative Perspectives blogs related to care delivery in acute care: 

  1. Australian Institute of Health and Welfare (AIHW). Palliative care services in Australia [Internet]. Canberra: Australian Institute of Health and Welfare; 2022 [cited 2022 Dec 2]. 
  2. Australian Bureau of Statistics (ABS). Classifying Place of Death in Australian Mortality Statistics [Internet]. Canberra: ABS; 2021 April 14 [cited 2022 Dec 2].
  3. Palliative Care Australia and KPMG. Investing to Save - The economics of increased investment in palliative care in Australia. Canberra: KMPG; 2020.
  4. Rawlings D, Devery K, Tieman J, Tait P, Chakraborty A. Rapid review of the literature on end-of life care. Sydney: ACSQHC; 2021.

Page created 05 December 2022