Palliative Care

from Silverbook – https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/silver-book/part-a/palliative-care

Clinical Context and Palliative Care in Australia

Current State of End-of-Life Care:

• Mismatch in Care Preferences:
  • Low proportion of people dying at home contrasts with their stated preference.
  • Australia has half the home death rate compared to countries like New Zealand, the US, Ireland, and France.
• Factors Influencing Preferred Place of Death:
  • Connectedness to community
  • Family presence
  • Availability of services and equipment
  • Complexity of caregiving and decision-making
  • Preference for receiving care at home is stronger during the last months of life.

Principles of a ‘Good Death’:

• Knowing when death is coming and what to expect
• Reasonable control over the process
• Ensuring wishes are respected
• Choice to leave when it is time
• Avoiding prolongation of dying
• Choice and control over the place of death
• Control over who is present at the end
• Time to say goodbye
• Arrangement of important affairs
• Access to ‘hospice-style’ quality care anywhere
• Necessary information and expertise
• Pain and symptom control
• Dignity and privacy
• Spiritual or emotional support
• Strengthening relationships and relieving family burdens

Shifting Healthcare Focus:

• Moving away from hospital-centric end-of-life care.
• Supporting community-based care during the last months of life.

Palliative Care Overview

• Definition:
  • World Health Organization: Improves the quality of life for patients and families facing life-threatening illness through prevention and relief of suffering.
  • Palliative Care Australia: Person-centred and family-centred care for those with active, progressive, advanced diseases with little or no prospect of cure, focusing on optimizing quality of life.
• Palliative Approach:
  • Recognizes death as inevitable.
  • Focuses on care rather than cure.
  • Aims to improve comfort and function.
  • Addresses psychological, spiritual, social, emotional, and cultural needs.
  • Involves families as partners in care.
• End-of-Life Care:
  • Last few weeks of life when death is imminent.
  • Increased need for services and support.
  • Includes terminal phase, death, and bereavement care.

Current Statistics:

• 160,000 people die annually in Australia; 100,000 deaths are predictable.
• 40,000 receive specialist palliative care; 60,000 do not.
• Palliative care can be provided for years, months, weeks, or days before death.
• Reduces hospitalizations, emergency visits, and improves quality of life for those cared for at home.

Palliative Care Availability:

• Provided in various settings: general practices, residential aged care facilities (RACFs), acute hospitals, and community services.

Impact of Palliative Care:

• Fewer hospital episodes
• Shorter hospital stays
• Reduced emergency department visits
• Increased quality of life for those receiving home care

Definitions:

• Palliative Care: Early identification, impeccable assessment, and treatment of pain and other physical, psychosocial, and spiritual problems.
• Palliative Approach: Focus on care and comfort, improving or optimizing comfort and function, addressing comprehensive needs, involving families.
• End-of-Life Care: Intense phase requiring coordinated care, including terminal phase and bereavement support.

Legal Context and Voluntary Assisted Dying (VAD)

• Euthanasia: Illegal in all Australian states and territories.
• Voluntary Assisted Dying (VAD):
  • Legal in Victoria since June 19, 2019.
  • Involves self-administration of medication to cause death under strict legislative criteria.
  • Health practitioners can conscientiously object and cannot initiate the discussion.
  • Separate from advance care planning and palliative care.

National Palliative Care Strategy

• Focus: Living well with chronic illness, maximizing quality of life.
• Guiding Principles:
  • Person-centred care
  • Recognizing death as part of life
  • Valuing carers and providing necessary care
  • Ensuring care is accessible, high-quality, and evidence-based
  • Recognizing everyone’s role in palliative care

Role of General Practitioners (GPs):

• Essential in advance care planning and providing palliative care for terminally ill patients in the community and RACFs.
• Supported by specialist palliative care services for complex problems, ethical dilemmas, spiritual issues, and bereavement management.