‘Responsive’ palliative care needed

Palliative care must receive an elevated status in the Australian healthcare system to counteract the challenges of an ageing population, according to one of Australia’s specialist medical colleges.

The Royal Australasian College of Physicians (RACP) was recently invited to appear before the Senate Committee on Community Affairs as witness in the Senate Inquiry into Palliative Care.

The RACP called for full and adequate funding for a modern and responsive palliative care service, allowing for high-quality out-of-hospital care.

The Senate Inquiry has been established with wide-ranging terms of reference to report on palliative care arrangements across Australia, including funding arrangements, the palliative care workforce and advanced care planning.

Australia reportedly faces ongoing challenges from an ageing population, an increase in the rates of complex and chronic disease, and a tightening of resources to address these issues, according to RACP president, Dr Leslie Bolitho.

“Palliative care is clearly an important component of the health system for an ageing population, and for that reason, we welcome this inquiry,” Dr Bolitho said.

“Government interventions should facilitate palliative medicine specialists, along with general physicians, general practitioners, nurses and other carers as members of multi-disciplinary teams to deliver palliative care in the setting that reflects the needs and preferences of patients.

“Shifting this service away from acute hospital wards will result in a better experience for the patient as well as delivering savings to the health system.”

The role of the physician in palliative medicine is crucial, according to Associate Professor Rohan Vora, president-elect for the Australasian Chapter of Palliative Medicine of the RACP.

“Palliative outcomes are based on expert symptom management, assessment of functionality, assessment of mood and cognition, carer support and advanced care planning,” Professor Vora said.

“Twenty-five per cent of the specialist palliative physician’s time should be spent educating and capacity building the non-specialist workforce in end of life care to meet the growing demands placed on palliative medicine physicians.”

Dr Bolitho stressed admission to palliative care was not a terminal diagnosis in itself, but rather often takes place in parallel with curative treatments with patients  being discharged as they stabilise.

However, where a terminal diagnosis was given, the patient and their family must be prepared and supported, including assistance with advance care planning choices.

“As a community we need to consider the often confronting task of how we address our endoflife care,” Dr Bolitho said.

“A considered discussion with family members to determine their treatment preferences as well as legal and spiritual affairs can significantly improve a patient’s experience in the last phase of their life, while also assisting in the grieving process for family and loved ones.”