Person Centred Care (PCC) is an essential component of high quality, safe healthcare and a National Safety and Quality Health Service (NSQHS) Standard in Australia. The NSW Palliative Care Framework acknowledges that services should meet the unique, holistic needs of the individual, their carers and family members are recognised and respected. Furthermore, care should be flexible and responsive to the person’s changing needs and preferences. [add reference - NSW Ministry of Health, End of Life Palliative care Framework Priorities]

During 2020 the Illarrawarra Shoalhaven Local Health District, New South Wales commenced a Healthcare Redesign project to improve consumer and staff satisfaction with the coordination and integration of community palliative care services in the Illawarra Shoalhaven Local Government Area. A series of bereaved carer interviews (n=20) were undertaken, to explore carer experiences of the current community model of care. The interviews we recorded and transcribed verbatim and analysed using the Picker Institute Experience of Care Domains. 

Overall carers were satisfied with the care their loved ones received however, several themes emerged including a lack of bereavement services, the need for earlier referral into the service, streamlining contact numbers and more detailed information on death and dying.

This paper will share these carer experiences/stories, outline the methodology used to conduct and analyse the stories, and describe how the service has used this information to further develop the community palliative care service model.

There is no conflict of interest.

COVID-19 presents an unprecedented challenge for patients, carers and healthcare providers alike. During this pandemic, aspects of palliative care delivery needed to change, though goals of palliative care did not. One concern is ensuring that community-based palliative patients have easy access to anticipatory medicines to avoid unnecessary suffering and unwanted transfers to acute care facilities.

Queensland Health (QH), as part of the COVID-19 response, funded palliPHARM to explore and develop mechanisms that facilitate community patients (those at home and in residential aged care facilities [RACFs]), to have timely access to symptom control medicines.

 

To implement interventions that facilitate community palliative patients having timely access to palliative care medicines. 

 

Interventions were developed after needs-based consultations with stakeholders including:

Needs-based interventions being implemented include:

A Queensland-specific list of palliative care medicines for pharmacists has been endorsed by QH, Pharmaceutical Society of Australia (Queensland Branch) and the Pharmacy Guild of Australia (Queensland Branch). To date, 175 Queensland pharmacies have committed to stock those medicines and received supporting resources. More then 300 GPs and Pharmacists have attended CPD-accredited education concerning anticipatory medicines. An Example Policy and Procedure for RACFs to establish palliative care medicines imprest systems has been endorsed by QH regulation bodies, peak RACF providers and other stakeholders.

Evaluation is due for completion by June 2021. 

Queensland Health (QH) is committed to improving health services for Queenslanders in areas of need including community-based end-of-life care especially in rural and remote parts of the State. QH has funded PallConsult to help meet this need statewide.

To build capacity within generalist community workforce to provide quality end-of-life care and support equitable access to home-based care by providing clinicians with advice, quality resources and education.

Three integrated service arms were developed:

In under one year, over 650 calls have been received across Queensland. Developed clinical resources are in demand e.g. PallConsult NIKI T34TM syringe-driver package component downloads >12,000 and 3,600 hard copies ordered. Reach is extending: >3,400 clinicians have received education. 

The hotlines are increasing communication between generalists and specialists – in 8 months, 62% (168) of doctors who used the hotline have re-used it for other patients. Of 50 anonymous doctors completing a PallConsult satisfaction survey:

An early indication that PallConsult is positively influencing generalist community end-of-life care is a 55% increase in the number of advance care planning documents uploaded to the QH Viewer from regional, rural and remote settings.

Findings from 251 anonymously completed post face-to-face education surveys include:

PallConsult is increasing community-based palliative care capacity across Queensland.

Transitions from hospital to home for people at end of life are frequent and complex; causing distress for families and caregivers. Considerable variation in study design, methodology and populations make it difficult to determine the  most effective intervention models to improve these transitions from current interventions . Our understanding of the mechanisms behind the interventions that target caregivers and how well they can be implemented into practice are limited.  

 

Aim: (1) Evaluate the reporting and methodological quality of intervention studies aimed at improving transitions between hospital and home for caregivers of patients with advanced illness; and (2) Examine their alignment with the Care Transitions Framework (CTF).  

 

A systematic review with narrative synthesis (PROSPERO ID: CRD42020192088). Three databases (Medline, Emcare and PsychInfo) were searched (2000-2021) for prospective studies reporting on interventions targeting transition from hospital to home for people with chronic and/or advanced illness; and their caregivers. Studies that reported intervention components design for caregivers were selected for quality assessment; using the TiDiER checklist and constructs of the Care Transition Framework.

 

1741 papers were identified and 96 met the inclusion criteria. 37 studies had intervention components for caregivers. There was reported variances in study design, intervention and outcomes. Limited studies reported on why an intervention is likely to work; and how well an intervention has worked. Most studies had weaker alignment with the CTF constructs related to person-centred outcomes (n= 11) and carer experiences (n= 3); and much stronger alignment with health service utilisation outcomes (n = 24). 

Future research and policy need to prioritise carer outcomes and consider how to align service measures with carer and patient preferences. The use of the CTF as a reporting assessment tool may also improve reporting quality of complex interventions and consideration of important constructs as needed.

Background
In Gippsland, there is little documented information of the demand for after-hours palliative care, the type of advice given to clients and caregivers, and the processes for a home or hospital visit.

Aim
To identify the number, characteristics and reasons for calls to an after-hours telephone triage service and to examine clinical actions.

Methods
Registered Nurses in the Gippsland region were trained in the use of an electronic telephone triage tool. The tool contains prompt questions for symptoms and algorithms for clinical actions. Nurses completed the tool during or immediately following the telephone call. Descriptive analysis included caller demographics, symptoms and clinical actions.

Results
A total of 78 nurses were trained in using the tool. Between November 2020 and March 2021, 62 calls were documented to community palliative care services (56%) and hospitals (39%). The majority of calls were on weekdays (79%), between 12am-9am (61%) and 5pm-12am (23%). The majority of callers were caregivers (85%) and all clients were registered with community palliative care services. A total of 81 symptoms were documented and most calls were for one symptom (73%). Common reasons for calls included communicating changes in care/setting/symptoms (27%), pain (20%), and client anxiety/restlessness (19%). Calls were in the deteriorating (34%), stable (27%) or terminal (23%) phase. The majority of issues were resolved through the phone call (44%) or a nursing visit after hours (20%). Only 4% (n=3) required ambulance transfer.

Conclusion
Data provides a regional picture of after-hours issues for community palliative care clients and carers which can inform rural health services in workforce planning to ensure adequate access for client and carer needs. The tool provides an evidence base response to need and will increase consistency in practice across the region.