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The views and opinions expressed in our blog series are those of the authors and are not necessarily supported by CareSearch, Flinders University and/or the Australian Government Department of Health.
In 2017 Palliative Care Australia undertook a review and update of the reference documents A Guide to Palliative Care Service Development: A population based approach and Palliative Care Service Provision in Australia: A planning guide. Together these key reference documents have provided a framework for the ongoing development of palliative care policy within the health care system for the last fifteen years.
As a young doctor I spent some time working in a palliative care hospital in the early 90’s. It was such a privilege to be working with people at end of life - with the opportunity to make a difference to quality of life and well-being of patients, and their family members. That experience made me decide to devote my career to Palliative Medicine.
I had some experiences at that time that stayed with me.
I had a patient, Marion, who had been a school principal. Marion had suffered a severe stroke. She had survived but was very incapacitated, confined to bed and unable to communicate. She was being kept alive, surviving on a feeding tube, and facing a life of care and dependence. Her specialist was very committed to her survival.
Let’s be frank, end-of-life care can be tricky. Yes, dying is normal, but it hasn’t been a major focus in the acute hospital systems. Health care professionals working in acute hospitals can find themselves challenged by patients with end-of-life care needs. Doctors, nurses and allied health professionals can be in a situation where they do not know how to best respond to a patient with end-of-life needs. Appropriate end-of-life interventions can be missed.
With 52% of Australians dying in acute hospitals, end-of-life care is essential knowledge for all health care professionals.
I 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.