The increasing need for palliative and end-of-life care in acute care

The demographic characteristics of the Australian population are changing and there is an increasing percentage of the population living longer with chronic illness and complex multi-morbidity. Many of these conditions are life-limiting and may require palliative care. Within the hospital environment many will be cared for by generalist clinicians with support from palliative care specialists where available and as needed.

  • 3 in 5 patients (60%) who died in hospital received palliative care [1]
  • In 2019-20 there were 49,200 palliative care and 37,700 for other end-of-life care hospitalisations [1]
  • 41-72% of people dying from a life-limiting illness would benefit from palliative care [2]
  • 1 in 3 patients in hospital are likely to be in the last 12 months of life [3-5]
  • Average length of stay for terminal admissions is 10.6 days - there is time to recognise that they are dying and to initiate palliative care [6-7]
  • 2 in 3 deaths are for people with cancer, cardiovascular disease or respiratory disease - of these most are cared for by generalist clinicians [6]

Many people express a wish to die in their own home. Yet currently just over 50% of deaths occur in hospital/medical services, and hospital admissions for palliative care are increasing. [8] In the immediate future, hospitals are likely to remain the place of death for many people experiencing an expected death.

Guidance for palliative care in the acute care setting 

While acute health care services will develop their own processes and systems to provide palliative and end-of-life care, the National Consensus Statement: Essential elements for safe and high-quality end-of-life care provides guiding principles and elements so that safe, timely and high-quality end-of-life care can be achieved.

National Consensus Statement definitions:

Essential Elements for Safe and High-Quality End-of-life Care defines end-of-life care as care within the last 12 months of life. Active dying occurs during in the terminal phase of life where death is imminent and likely within hours or days, or occasionally weeks. Palliative care which aims to improve the quality of life of patients and their families facing life-limiting illness is relevant across both end-of-life and terminal care.

The Australian Commission on Safety and Quality in Health Care have developed in collaboration with the Australian Government, States and Territories, private sector providers, clinical experts patients and carers a set of National Safety and Quality Health Service Standards. These provide a consistent statement on the level of care consumers can expect from health service organisations including at the end of life.

The Delivering and Supporting Comprehensive End-of-life Care: A User Guide provides strategies and suggested practice for end-of-life care that health services and clinicians can utilise to meet the essential elements of safe and high-quality end-of-life care and the National Safety and Quality Health Service (NSQHS) Standards (second edition) requirements.

The Palliative Care Outcomes Collaborative (PCOC) helps palliative care providers to identify and measure the impact of their service delivery on people with a life-limiting illness, their families and carers.

End of Life Law provides accurate State and Territory information to aid in the challenging legal issues that are often associated with end-of-life decision-making.

Delivering and Supporting Comprehensive End-of-life Care: A User Guide

Position statements

Current position statements highlight how palliative care is currently undertaken within the acute care setting:

The Australian Commission on Safety and Quality in Health Care Rapid Review of the Literature on End-of-life Care (1.15MB pdf) highlights new and emerging issues including care delivery considerations during a pandemic. It also provides best practice processes and organisational prerequisites for the implementation and delivery of end-of-life care.

  1. Australian Institute of Health and Welfare (AIHW). Palliative care services in Australia [Internet]. Canberra: AIHW; 2022 [updated 2022 Oct 28; cited 2022 Nov 22].
  2. SA Health. Palliative Care Needs in South Australia (690kb pdf). Adelaide, SA: Government of South Australia; 2019.
  3. Milnes S, Orford NR, Berkeley L, Lambert N, Simpson N, Elderkin T, et al. A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital. BMJ Support Palliat Care. 2019 Mar;9(1):92-99. doi: 10.1136/bmjspcare-2015-000864. Epub 2015 Sep 21.
  4. To TH, Greene AG, Agar MR, Currow DC. A point prevalence survey of hospital inpatients to define the proportion with palliation as the primary goal of care and the need for specialist palliative care. Intern Med J. 2011 May;41(5):430-3. doi: 10.1111/j.1445-5994.2011.02484.x.
  5. Mudge AM, Douglas C, Sansome X, Tresillian M, Murray S, Finnigan S, et al. Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study. BMJ Support Palliat Care. 2018 Jun;8(2):213-220. doi: 10.1136/bmjspcare-2017-001441. Epub 2018 Mar 2.
  6. Australian Institute of Health and Welfare (AIHW). Deaths in Australian hospitals 2014-15 [Internet]. Canberra: AIHW: 2017 [cited 2022 Dec 1].
  7. Bloomer MJ, Hutchinson AM, Botti M. End-of-life care in hospital: an audit of care against Australian national guidelines. Aust Health Rev. 2019 Oct;43(5):578-584. doi: 10.1071/AH18215.
  8. Australian Bureau of Statistics (ABS). Classifying Place of Death in Australian Mortality Statistics [Internet]. Canberra: ABS; 2021 [cited 2022 Nov 22].

Last updated 24 November 2022