A pilot program operating in Western Australia is enhancing processes and approaches to palliative care.
While the Palliative Care Champions in General Practice pilot has been operating across nine GP clinics for the past 12 months, it has resulted in the creation of several resources that will be of wider benefit.
Tish Morrison, WA Primary Health Alliance (WAPHA) activity lead for palliative care, told Medical Forum the project worked by each participating clinic having a nominated member of their team as their palliative care champion.
“That person then works to look at how you introduce advanced care planning as part of routine practice, and also, how does general practice start to think about identifying patients who might have unmet palliative care needs,” she said.
Champions included GPs, practice managers and practice nurses who took part in monthly learning groups, while online webinars were held for all GPs at the participating clinics.
Ms Morrison said the project resulted in all of the GPs and practice nurses undertaking advanced care planning training.
The training they completed was a simplified version, created specifically for the purpose of this project.
“Some of the training is hours long and health professionals don’t always have that time, so we made that much more user friendly,” Ms Morrison said.
That training is now available online for other health professionals to benefit from.
Before the project began audits were carried out at each of the participating clinics to set a baseline position.
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Prior to the pilot “very few” of the GPs at the participating clinics had taken part in any advanced care planning education in the past two years, Ms Morrison added.
“And that mattered, because the form had changed in WA Health, so it might be that they didn’t feel up to date with what was required.”
The baseline audits completed ahead of the pilot found just 30% of GPs routinely discussed advanced care planning as part of their chronic disease management plans for people with complex needs, while about 60% of GPs routinely included advanced care planning as part of routine health assessments in older people.
Ms Morrison said these rates could be improved through an enhanced focus on advanced care planning as well as other issues raised in the audits, such as GPs being sometimes reticent to bring up advanced care planning with patients.
“GPs are time poor, so to start a conversation that the patient’s not ready for perhaps causes a bit of a blow out in terms of time,” Ms Morrison said.
“There was a bit of ‘if the patient’s interested, then they’ll ask’, but as the older age group is more likely to be led by the doctor there was maybe a bit of a disconnect of expectations.”
Also created as a result of the pilot was a draft policy about the introduction of advanced care planning and routine health assessments. It was provided to each clinic taking part so they could adapt it to their own practice.
“That meant that if they had a turnover of staff, then there was a policy that they could reference and work within,” Ms Morrison said.
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She hopes to compile all of the resources developed so far within an online toolkit for GPs to access.
There is potential for additional resources to be created as part of a continuation of the pilot, which is expected to see at least four clinics in the town of Esperance take part in a follow-up project.
Ms Morrison said the most recent pilot program highlighted a number of aspects that GPs could consider in regard to advance planning.
“Be on the front foot with older patients and those who have complex needs about advance care planning, because sometimes things change quickly and people are denied the opportunity to really see what matters to them.
“Give that information to the families and their carers so that they’re confident that they’re making good decisions on their behalf.”
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