Assessing palliative care needs

Patient assessment is a critical step in identifying palliative care needs. Assessment should address prognosis, current and anticipated symptoms, distress, and the availability and support needs of family and caregivers.

Identifying concerns

GPs need to consider the palliative care needs of all patients with advanced life-limiting illnesses including metastatic cancer, end stage organ failure and advanced degenerative neurological conditions. Assessment should address prognosis, current and anticipated symptoms, distress, and the availability and support needs of family and caregivers. Identifying which other members of the multidisciplinary team might be valuable is also important.

Key points

Consider the palliative care needs of all patients with advanced, life-limiting illnesses, such as:

  • Metastatic cancer
  • Any diagnosis of end-stage organ failure (e.g. congestive heart failure, chronic obstructive pulmonary disease, chronic renal failure) with increasing disability, frequent hospitalisation, and/or decreasing benefit from therapies
  • Advanced degenerative neurological conditions.
  • A palliative approach should be considered for any patient when you would not be surprised if they died within the next twelve months, i.e. the 'surprise' question (642kb pdf).
  • SPICT can help identify people at risk of deteriorating and dying with one or multiple advanced illnesses and support palliative care needs assessment and care planning.

Prognostic Indicator Guidance - the surprise question (642kb pdf)

Consider the need for, and timing of, advance care planning conversations, recognising that:
  • Many patients are waiting for their doctor to raise this topic, and the setting of a GP consultation is an appropriate opportunity
  • Many patients appreciate the willingness of their doctor to discuss their concerns and values, with the goal of improving their quality of life.

For many patients advance care planning is not a single set of decisions, but an ongoing conversation, which needs to be appropriately documented and reviewed.

It is important for the patient to identify a substitute decision maker, and to talk to that person about their wishes and concerns.

Discuss and review the goals of care for current medical conditions, recognising that there are common transition points that will affect these goals of care, including:

  • diagnosis of a new condition, or worsening of a pre-existing condition
  • burden of treatment starting to outweigh benefits
  • increase in dependency, decreasing performance state
  • increase in suffering and distress.

Use a simple tool to methodically review symptoms in palliative care patients e.g. the PEPSI COLA tool and the Distress thermometer.

Where symptoms or distress do not respond to initial management, consider early referral to specialist palliative care services.

e aware that referral for specialist palliative care is not limited to a particular diagnosis or life expectancy, but to the patient’s level of need. Check local HealthPathways for referral processes.

NCCN Distress thermometer (167kb pdf)

Where carer burden or distress is high, or there are complex psychosocial needs, consider early referral to specialist palliative care service

  • Burden of treatment may be starting to outweigh benefits
  • At this time a medication review may be useful. This is where a pharmacist reviews the medicines and provide a succinct report to the GP. After discussion of the pharmacist’s report and findings the GP can then discuss with the patient (and carer) at the next appointment.
  • This activity is funded for GP and pharmacist by the commonwealth government. GP payment for the review under MBS will not occur until after the second patient consultation. Pharmacist services are claimed through a separate federal funding programme known as the 7th Community Pharmacy Agreement (7CPA).

Last updated 24 August 2021