CareSearch Blog: Palliative Perspectives

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“Something vital was missing throughout that process for Maria and her family.”

A guest blog post by Dr Joel Rhee BSc(Med) MBBS(Hons) GradCert(ULT) PhD, FRACGP

  • 27 September 2016
  • Author: CareSearch
  • Number of views: 5803

Doctor and nurse holding clip boardsI remember a patient some years ago. I’ll call her Maria. She was a lovely Italian woman, in her late 80’s, with a very supportive family.
Maria had developed very complex medical problems. She had heart issues, kidney problems and quite severe diabetes. In the last year of her life she had recurring kidney failure and breathing difficulties. She was going in and out of hospital every three or four weeks.
The medical team did their very best for her – they were very focused on her medical issues and her symptoms, and she received excellent medical care. A lot of focus was given to how best to look after her kidneys, her heart, her pain and her difficulty with breathing. As her problems multiplied and her needs became increasingly complex, the care she received continued to be excellent.
However, looking back, I realise that something was overlooked. Something vital was missing throughout that process for Maria and her family.
Maria was going through the last months of her life.  
How she was feeling?  How was all this affecting her?  What was her current quality of life?  What were her wishes? What were her fears?
It’s not unusual for the care that patients receive in that situation to be quite challenging and invasive, and that can continue right up to the time they die. And of course that treatment is vital.  But what was needed, along with the excellent medical care, was a broader assessment of her needs.  A conversation with Maria was needed.
I believe that general practice nurses are right in that space.
The general practice nurse is a key member of the care community. Many have long-term involvement in their practice and in providing care within their community and as the population ages, we are finding more and more patients with chronic and complex needs, like Maria who really need care with their general practice, rather than their hospital.  They want to be managed well, in their own community, by people they trust, people they have formed relationships with.
That’s why Advance is designed to provide specific training for general practice nurses in how to raise these questions and discuss these issues with patients like Maria.
Advance logo 
It builds on all their training, experience and skills, to give them extra training that will help them really make a difference for that group of patients.
Advance will help them with making early assessments of a patient’s supportive care needs, and learning about how the patient would like to be managed in the future.
It helps with learning about how to have those sometimes difficult, but very important conversations that can fill the gap in care that Maria experienced. I believe Advance can make a really significant difference in the care we provide for people at this most important time of their life. In what for many will be their last days.
General practice nurses can lead the way in identifying and helping to meet those needs and I really encourage you, as a general practice nurse, to look further into Advance. There is plenty of information on the website, and you can get started today. You can learn online, in your own time.
Apart from the online training, which I believe is really excellent, there are a range of other benefits and opportunities for further learning and professional support. 
For further information about Advance, contact or check out the website at

Portrait photograph of Dr Joel Rhee

Dr Joel Rhee BSc(Med) MBBS(Hons) GradCert(ULT) PhD, FRACGP


1 comments on article "“Something vital was missing throughout that process for Maria and her family.”"

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Jennifer Tieman

27/09/2016 10:09 PM

Thanks, Joel, for telling us about the Advance project. Primary care is a very important space and general practice nurses area key contact for patients and their families.

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