Over the past year I have been privileged to work with the Great Southern Palliative Care Service as a registrar in Albany. From this vantage point I see some emerging trends.
First is managing patients in the community setting, especially rural and regional patients. By integrating naturally occurring community networks with specialist palliative care, patients can remain at home for as long as reasonably possible.
Increased awareness and education of the normal dying process improves patient and family experiences by bringing greater meaning in their last days and reducing unnecessary hospital attendances. Providing early palliative care to patients with life-limiting disease improves quality of life measures. Discussing Goals of Care and Advanced Health Directives empowers patients and families in treatment decision-making.
Regional WA has increased funding for palliative care and improved clinical nurse availability to provide practical support for patients and their families. This enables patient assessment in their own communities and access to specialist palliative care through telehealth, regional clinics and on-the-ground clinical nurse expertise.
Quality community palliative care requires collaboration between a patient’s general practitioner, well-equipped and skilled community palliative care nursing service and a versatile specialist team.
Technology
If COVID-19 has brought us anything, it is video conferencing. This has particularly helped assess and manage patients in rural and regional communities and rapid integration of video conferencing and the WA Country Health Tele-Palliative Care program (operational before COVID-19) has been a game-changer.
Rural patients can access specialist care “in the moment” without leaving home. This has helped change their quality of life in providing patient care in the comfort of their own environment, implemented and monitored by skilled nursing.
A growing trend is utilising novel methods to help with pain and dyspnoea. In 2019, morphine sulphate was TGA-approved for the treatment of chronic breathlessness providing a valuable pharmacological tool.
Patient-controlled analgesia has been adapted and changed for subcutaneous use. Those with difficult to control incident or breakthrough pain can self-administer subcutaneous opioids. A continuous ambulatory delivery device (CADD) with opioid cassettes lasting up to five days can deliver ongoing analgesia. These methods improve symptoms, reduce the burden on community nursing and allow patients more freedom.
Voluntary Assisted Dying (VAD) will become operational in Western Australia in mid-2021 and continues to divide the palliative care community. WA Health is working on processes for how patients will navigate through the assessment process, how and where medications will be dispensed and how we will support staff through this significant change.
Key stakeholders such as hospices, community palliative care providers and private facilities will have to work towards their VAD position and consider its impact on their staff, fundraising supports and community opinion.
Many believe firmly that the core essence of palliative care is neither to hasten or postpone death and therefore hold that VAD has no place in the palliative care. But keeping a patient’s choice central and providing a safe space for patients with life-limiting illness will need to guide the specialty.
Key messages
- Managing patients at home is now more enabled.
- Novel methods for pain and dyspnoea are available.
- A collaborative approach is essential.
Author competing interests – nil