Palliative care scope of practice in acute care

Increasing demand for palliative care within hospitals

Appropriate care for patients with palliative care needs

Within the hospital setting many patients will be identified as requiring palliative care and individuals currently receiving palliative care will be admitted if their condition deteriorates or complexity increases requiring acute medical or surgical condition, pain, or symptom control. [2-4] Due to the nature of the hospital setting, dying patients are frequently given routine and technological care, in preference to individualised and contextual care. [5-7] This highlights the hospital focus on preservation of life which conflicts with a palliative care approach. [8] This can result in patients not being recognised as approaching the end of their lives and this follows through to delays in access to palliative care. [9] It can lead to the use of non-beneficial treatments at the end of life which have the potential to prevent patients from having a comfortable death and can prolong suffering. [10] Gaps in end-of-life care provision within the hospital setting have been recently reviewed and include multiple issues: [11]

• Timely communication with the patient and family
• Culturally appropriate communication
• Standardisation of documentation to support patient and family preferences
• Good interdisciplinary teamwork, particularly where a patient has multimorbidity requiring input from a range of health professionals and organisations
• Identification of goals of care
• Embedding of guidelines and triggers into routine care
• Developing processes that assist clinicians in identifying deteriorating patients
• Organisational readiness to implement a personalised and compassionate approach to care including through communication and care coordination.

Enabling health professionals to provide palliative care

Health professionals within the acute care setting need to have the appropriate skills and resources to provide appropriate care to patients with palliative care needs. While current guidelines define the scope of practice required to deliver palliative care, there is still a need to provide access to evidence-based information and actionable resources to:

• Recognise that a person is approaching end of life to ensure appropriate care, and that their family can be prepared;
• Initiate patient centred communication and shared decision-making for planning current and future care;
• Meet the broad range of patient needs through an interdisciplinary approach;
• Assess and respond appropriately to patient needs;
• Access to opportunities for professional development.

While individual circumstances will determine the needs of people with life-limiting illness, it is important that health professionals within the acute care setting are able to provide them with appropriate care.