Considerations for practice for allied health professionals working in palliative care should be no different to those working under any other model of care. Assessment and goal-setting, for example, are standard across the board. However, in palliative care this also includes renegotiating or re-establishing goals consistent with life-limiting illness and quality of life considerations.
It is important for allied health professionals to understand their roles within palliative care in relation to the setting in which they are working, as colleagues may have little experience or knowledge of palliative care. In any setting, the palliative care philosophy of allied health disciplines aims to assist patients to live each day or moment to their fullest, by focusing on managing symptoms and optimising participation, in contrast to an approach aimed mainly at promoting restorative care.
Considerations for specific areas of practice include:
Rural and Remote Services
Palliative care is provided by GPs, as well as by nurses and allied health professionals from community health centres. These health professionals see all the patients in the area, not only those with palliative care needs. Accessing specialist palliative care may be difficult, and local services may consist of only one nurse.
Some allied health professionals will have a working relationship with local community specialist palliative care services, while others may have little experience in palliative care. Referrals to allied health professionals may be lacking in rural and remote areas due to poor understanding of the services that can be provided. Finally, palliative care may not be considered a priority.
Aged Care Services
The philosophy within aged care is similar to that of palliative care, although specialist palliative care approaches and involvement need to be reinforced. Funding is often a driving factor, which influences the level of clinical input. This can mean de-prioritisation of services to palliative care patients, especially as they become increasingly dependent.
Many allied health professionals work within multidisciplinary teams. Some will work in private practice, either as a group of co-located professionals or in isolation. These professionals may come across palliative care patients within their practice. Under the Medicare GP Management Plan, GPs can refer patients to Allied Health private practitioners, such as social workers who may specialise in grief, loss and bereavement counselling.
A major aim in the rehabilitation setting is to support the patient (and carer's) ability to stay at home for as long as possible, given their current functioning and the likely progression of their illness. This can be achieved through training / education and provision of equipment to maintain full or partial independence. If required, allied health professionals can also facilitate referral to community services and schemes and assist by liaising with government and non-government agencies. Consistent practice across disciplines requires applying a palliative care philosophy to any discussions with the patient and carers.
Specialist Palliative Care
There are often limited positions for allied health professionals with a specialist palliative care focus. Social work positions are likely to be common but an understanding of the role of other allied health professionals in palliative care is still evolving. This makes it harder to facilitate holistic patient management.
Inpatient, Acute and Sub-acute Practice
In this setting, patients with palliative care needs should be prioritised as 'essential to treat', in the same way that any other acute or sub-acute patients are treated. Functional goals and education will be a priority. Allied health professionals will also need to be more time-sensitive in relation to the promptness of assessments and swiftness of discharge required for palliative care patients. They may also find themselves in the position of advocating for delayed discharge until appropriate services and supports have been put in position. Awareness and implementation of a palliative philosophy in regard to education and goals may be needed for the staff, patient and family.