The potential for a structured approach to palliative and end of life care in the community in Australia?

Abstract

The demand for palliative care (PC) in Australia is expected to increase as the population ages and the number of people with chronic and life-limiting conditions rises. With limited specialist PC resources available in the community, general practitioners (GPs) will increasingly provide and co-ordinate palliative and end-of-life (EOL) care. The majority of the last year of life of people with a life-limiting illness is spent in the community, hence, GPs are well placed to identify and care for people who may benefit from a palliative approach to care. Currently, many people at EOL access PC care in a reactive, ad-hoc, fashion that is dependent on the knowledge, skills and interest of relevant health professionals. National standards and policy documents provide guidance for quality care at the EOL for all Australians. However, no mechanism has been proposed to ensure that such standards are routinely operationalised within the community. The Gold Standards Framework (GSF) is a potential base on which an EOL framework for community care in Australia may be built. The GSF is an evidenced-based organisational system for providing best practice EOL care in general practice and residential aged care. It facilitates the identification of people for whom a palliative approach may be appropriate and provides a structure for the identification of needs, pro-active care planning and ongoing monitoring of progress. Where the GSF has been implemented in the United Kingdom, significantly improved care processes have been reported. While there are numerous barriers to the uptake of an unmodified GSF in Australia, it may provide the framework on which a structured model of PC in general practice is developed. We will examine the potential for such a structured approach to EOL care in the community and general practice in Australia.