End-of-life care responds to the resident’s physical, social, spiritual and psychological needs. These may frequently change. This means that decisions need to be made about medical treatments and end-of-life wishes of the resident as well as the family's needs.
End-of-life family conferences allow for consensus decision making that involves the family. They can support families to identify realistic goals of care, whilst also assisting people to deal with their own distress. [1-3] Staff in RAC often meet with families to discuss routine care of residents, formal palliative care case conferences are less well known. They are sometimes referred to as family meetings.
Palliative care case conferences are:
- a key process in a palliative approach to care
- a way of supporting families
- a way of identifying unmet needs, of obtaining and sharing information
- an opportunity to review advance directives and ensure care is consistent with them
- held when it is recognised that the resident’s health status is changing and a palliative approach is needed
- not only arranged when death is expected within days
- opportunities for all stakeholders to share information, contribute to, and agree on goals of care.
The Palliative Approach Toolkit utilised case conferences as part of a wider project to improve the provision of palliative care in RAC. The project reported that:
Families found that the case conferences:
- allowed them to express concerns and feelings
- recognised and respected their views
- gave them access to information about their relative and about what to expect.
Successful case conferences require:
- a skilled leader to facilitate the meeting
- everyone to understand the reason for the meeting and what the objectives are
- an agenda and a specified time limit
- a note taker to ensure that relevant information is documented appropriately and acted upon
- representation from key members of health care team, responsible for medical, nursing, personal, spiritual and allied health care.
Family conferences require well developed communication skills within the healthcare team. An appropriate plan or skills for health care providers are essential when communicating in family conferences.
The National Standards for Palliative Care for Australians state that patients and their family's wishes are acknowledged and guide decision making and care planning. Patients and families bereavement needs should also be identified and they should be offered information and support.
Aged care accreditation standards require that residents specialised care needs are identified, comfort and dignity are maintained and emotional support is provided.
There is funding available under the Aged Care Funding instrument (ACFI) for the provision of palliative care to residents. A funding claim requires a palliative care plan to be developed by a GP or specialist palliative care nurse. A case conference is one way of identifying the palliative care needs of the resident and the support needs of the family. Information gained can be used to develop a comprehensive and holistic care plan and may support an ACFI claim.