Keep up to date with new Australian palliative care research evidence
Dr Deborah van Gaans
An ageing population and associated increase in chronic life-limiting disease, highlights the need to incorporate
palliative care best practice guidelines and models within the hospital setting, particularly for non-malignant conditions.
The growing demand for palliative-related care within the hospital setting can be clearly seen in the recent (2019-20) Australian Institute of Health and Welfare (AIHW) data set where there has been an 18% increase in palliative care-related hospitalisations since 2015-16.  Of these hospitalisations 49,200 were for
palliative care and 37,700 for other end-of-life care, equating to 19.3 and 14.8 per 10,000 population, respectively “other end-of-life care” hospitalisations refer to those with a principal or additional diagnosis of Palliative Care, but not a Care Type of Palliative Care. 
AIHW data also reveals the inequity in palliative care provision with only 1 in 6 (16%) public acute hospitals (excluding public psychiatric hospitals) in Australia having a hospice care unit.  There is further inequity in accessibility of in-patient specialist palliative care units with most of them being in New South Wales (32%) and Western Australia (31%).  There is also inequity in the geographical distribution of specialist palliative care inpatient units with around 1 in 4 (26%) in major cities. Inequity associated with diagnosis is also apparent with 1 in 2 (52%) of palliative care hospitalisations, and 1 in 3 (32%) other end-of-life care hospitalisations being for patients with a principal diagnosis of cancer. 
Palliative care scope of practice in acute care
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Within the hospital setting many patients will be identified as requiring palliative care and individuals currently receiving palliative care will be admitted if their condition deteriorates or complexity increases requiring acute medical or surgical condition, pain, or symptom control. [2-4] Due to the nature of the hospital setting, dying patients are frequently given routine and technological care, in preference to individualised and contextual care. [5-7] This highlights the hospital focus on preservation of life which conflicts with a palliative care approach.  This can result in patients not being recognised as approaching the end of their lives and this follows through to delays in access to palliative care.  It can lead to the use of non-beneficial treatments at the end of life which have the potential to prevent patients from having a comfortable death and can prolong suffering.  Gaps in end-of-life care provision within the hospital setting have been recently reviewed and include multiple issues: 
Health professionals within the acute care setting need to have the appropriate skills and resources to provide appropriate care to patients with palliative care needs. While current guidelines define the scope of practice required to deliver palliative care, there is still a need to provide access to evidence-based information and actionable resources to:
While individual circumstances will determine the needs of people with life-limiting illness, it is important that health professionals within the acute care setting are able to provide them with appropriate care.
Page created 01 December 2022