Palliative care – How, when and where to refer

Palliative care – How, when and where to refer



okay um we might get started on next one so this is about palliative care week how sorry palliative care how when and where to refer so palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life threatening illness through the prevention and relief of suffering by means of early identification and assessment and treatment of pain and other issues such as physical psychosocial and spiritual that that's the World Health Organization definition of palliative care and palliative care is for all people living with a life limiting illness at any stage of their disease not just at the end of life so palliative care provides relief from pain it affirms life and regards dying as a normal process it intends neither to hasten nor postpone death integrates the psychological and spiritual aspects of patient care offers a support system to help patients live as actively as possible and to help families cope during the patient's illness and umber Eve mantilla zatt eeeem approach to address the needs of patients and their families and it's applicable from early in the course of an illness in conjunction with other therapies that may be intended to prolong life such as chemotherapy or radiation therapy and includes investigations needed to better understand and manage distressing clinical complications patients who in the last 12 months of their life you know need palliative care for a variety of reasons a medication review so to stop any inappropriate medications or to switch drugs that are currently being taken orally to liquid or subkey ten years or to be delivered by syringe driver to prescribe new medications that may be necessary to manage the symptoms that us that are associated with with the illness and with end-of-life symptoms reviewing and ceasing interventions that are not necessary or that that are not aimed at comfort and symptom control and very important to review the person's psychosocial needs and spiritual needs what rituals are going to be important for that person for their family at the time of of their death and after their death the guiding principles for palliative care from the Victorian end-of-life and palliative care framework are basically seven principles so acknowledging that dying is part of life the person is central to their care their carers are also very important it's making sure that people have information that they can discuss openly understanding their decision making needs and the legal implications of that making sure that they have access to high-quality and coordinated services which are monitored for their quality now this looks like a slide that we had in my last presentation who can benefit from palliative care will it was it's a very similar slide to who can have an advance care directive very important for people who are in the last year of their life so people living with cancer advanced chronic disease progressive neurological conditions historically you know palliative care was really only provided to people with a diagnosis of cancer but it's now well recognised that everyone who's diagnosed with the life-limiting illness can benefit from palliative care and I was all just reading an article the other day about frailty and older frail people and the benefits of palliative care for that group of patients so not necessarily you know living with any particular life limiting illness often when we talk about end-of-life care I know in a hospital situation they're talking about terminal care they're talking about you know those last hours or days of life but I'm sure people like yourselves who are in the community are aware that you know when we're talking about end-of-life care we're talking about 6 to 12 months or even 12 to 24 months as being the end stage of someone's life so it's important to be clear about exactly what what we're talking about palliative care Australia talks about end-of-life care has been that part of life where a person is living with and impaired by an eventually fatal condition even if the prognosis in is ambiguous or unknown and the Australian Commission on safety and quality in health care define end-of-life care as care that includes both care delivered when a patient is imminently dying and interventions that may be required by a patient who is living with a life limiting illness and is likely to die within the next 12 to 24 months so often people historically were referred very late in their illness and to some extent you know that still occurs that people are referred at their transition from curative treatment to palliative treatment whereas the more contemporary model is engaging palliative care services much early in a person's disease so that those services can operate alongside curative or restorative approaches that makes the transitional easier for the patient when the time comes to end-of-life care so in Australia palliative care is mainly provided by primary health providers by a multidisciplinary team that provides the palliative approach or by specialist palliative care provider so primary providers obviously being GPS and district nurses community pharmacists the multidisciplinary team often in aged care and other non specialist palliative care settings with a focus on comfort care and reducing symptoms and distress and specialist palliative care teams don't need to see all patients receiving palliative care but it's their role to review patients who have complex needs or either medical or psychosocial needs and work alongside those primary health care providers in order to provide good end-of-life care so when to refer for palliative care again the surprise question comes up would I be surprised if this person was to die within the next few months weeks or days and if you're not surprised consider you know that communication with the patient and with their family about the prognosis and then start to think about preferences for care preferred place of care those are resources that help recognize someone who may be in the last 12 months of their life and designed for use in a primary care setting looking at deteriorating health and identifying people who are at risk of dying within the next 12 months so that we can start to have those appropriate conversations about advanced care planning and about palliative care I haven't used the gold standard's prognostic indicator guidance but I've you know have used the SPECT tool and it's actually a really useful brief document community palliative care services provide holistic care including nursing care allied health care respite and practical support as well as information equipment medications and access to medical review and assessment in people's home inpatient palliative care provides care to patients who require complex symptom and pain management or end-of-life care the beds might be located within an acute hospital or in purpose-built sub acute units or even in standalone services consulting this consultancy service provide advice support education and training to treating teams across hospitals acute and subacute services in metropolitan Victoria palliative care consultancy services are located in every metropolitan house service except the Ionia and there's a palliative care consultancy in each or all region in terms of outpatient clinics they provide interdisciplinary assessment care planning and interventions early in the care pathway of a person diagnosed with a life limiting illness and day hospices provide activities and psychosocial and emotional support for people with life-threatening illness and also respite for carers so there's a range of services that you can refer to and these websites give you links to agencies and their locations and what services they can provide in metropolitan and regional and rural areas so there are different referral processes between these different services providers so it's really important to you know be aware of what the eligibility criteria are what kind of referral process is required there's also disease specific support services for people who are receiving palliative care and their support for families and carers available from these different services so the support that a family receives during that end-of-life phase can have a big impact on you know how they're going to experience bereavement after the person has died and again clear link between advanced care planning and palliative care so the palliative care Australia position statement on advanced care planning says quality end-of-life care is realized when it meets the person's needs and upholds their care preferences advanced care planning provides a mechanism to improve the quality of end-of-life care for people advanced care planning offers everyone and especially people living with a terminal condition their families and significant others the opportunity to take control of decisions which affect their care and similarly to the advanced care planning site on care pathways health pathways sorry there's a palliative care site which again has that step-by-step guidance for primary care in how to refer where to refer and how to access additional support it's limited to health professionals in north western and eastern Melbourne PHN catchments only so that that is a bit of a catch but you can contact the primary health care network to request access and or to book a live demonstration about how to use the site in your practice and these are just some more places where you can find out more information about advanced asourian advanced care planning about palliative care

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