Palliative Care Australia: driving leadership, access, and quality

A guest blog post by Chelsea Menchin, National Project Manager, Palliative Care Australia

  • 5 November 2020
  • Author: Guest
  • Number of views: 333
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Palliative Care Australia: driving leadership, access, and quality

Palliative Care Australia (PCA) is the national peak body for palliative care services in Australia. In the ninth blog for our National Palliative Care Project series Chelsea Menchin, National Project Manager at PCA discusses what activities they’ve planned and how they will align with the priorities in the National Palliative Care Strategy.

Program of Experience in the Palliative Approach (PEPA) and its alignment to the National Palliative Care Strategy

A guest blog post by Suzanne Cosgrove, National Manager, Program of Experience in the Palliative Approach (PEPA)

  • 4 November 2020
  • Author: Guest
  • Number of views: 303
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Program of Experience in the Palliative Approach (PEPA) and its alignment to the National Palliative Care Strategy

In the eighth blog for our National Palliative Care Project series, Suzanne Cosgrove, National Manager for PEPA, discusses the projects aims to enhance the capacity of health professionals to deliver a palliative approach and how their education activities align with the guiding principles and goals set out within the National Palliative care Strategy.

Do family meetings for hospitalised palliative care patients improve outcomes and reduce health care costs? A cluster randomised trial

  • 4 November 2020
  • Author: CareSearch
  • Number of views: 0
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Hudson P, Girgis A, Thomas K, Philip J, Currow DC, Mitchell G, Parker D, Liew D, Brand C, Le B, Moran J.

Background:
Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications.

Aims:
To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice.

Design:
Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted.

Results:
297 dyads recruited; control (n = 153) and intervention (n = 144). The intervention group demonstrated significantly lower psychological distress (Diff: -1.68, p < 0.01) and higher preparedness (Diff: 3.48, p = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures.

Conclusions:
Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications.

It is feasible to flag 'near end-of-life' status in older patients from routine general practice data

  • 2 November 2020
  • Author: CareSearch
  • Number of views: 0
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Cardona M, Williamson M, Jones M, Ní Chróinín D, Gullotta J, Hillman K, Lewis ET, Morgan M. 

Method:
A retrospective chart review was used to assess the feasibility of identifying these indicators in the data (160,897 patients from 464 practices across Australia). Conditional logistic regression was used to assess the independent contribution of nEOL indicators in patients aged 75-84 and ≥85 years using a case-control design matching by practice.

Results:
The strongest indicators for nEOL status were advanced malignancy, residential aged care, nutritional vulnerability, anaemia, cognitive impairment and heart failure. Other indicators included hospital attendance, pneumonia, decubitus ulcer, chronic obstructive pulmonary disease, antipsychotic prescription, male sex and stroke.

Discussion:
Consideration of routinely collected patient data may suggest nEOL status and trigger advance care planning discussions.

Strengthening palliative care in the hospital setting: a codesign study

  • 2 November 2020
  • Author: CareSearch
  • Number of views: 0
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Virdun C, Luckett T, Davidson PM, Phillips J.

Objective:
To identify actions required to strengthen the delivery of person and family centred hospital-based palliative care so that it addressed the domains of care identified as important for inpatients with palliative care needs and their families.

Methods:
A codesign study involving a workshop with palliative care and acute hospital policy, consumer and clinical representatives in Australia. A modified nominal group process generated a series of actions, which were thematically analysed and refined, before being circulated to participants to gain consensus.

Results:
More than half (n=30, 58%) of the invited representatives (n=52) participated in the codesign process. Nine actions were identified as required to strengthen inpatient palliative care provision being: (a) evidence-informed practice and national benchmarking; (b) funding reforms; (c) securing executive level support; (d) mandatory clinical and ancillary education; (e) fostering greater community awareness; (f) policy reviews of care of the dying; (g) better integration of advance care planning; (h) strengthen nursing leadership; and (i) develop communities of practice for improving palliative care.

Conclusions:
Changes to policy, practice, education and further research are required to optimise palliative care within hospital settings, in accordance with the domains inpatients with palliative care needs and their families consider to be important. Achieving these changes will require a whole of sector approach and significant national and jurisdictional leadership.

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