WA Country Health Service (WACHS) Palliative Care Afterhours Telehealth Service (PalCATS) aims to improve equity of access to specialist palliative care for rural and remote communities and address the identified gaps associated with remote communities across WA having access to specialist palliative care services (SPC). New digital capabilities coupled with clinical expertise aims to respond to the clinical and psychosocial needs of patients and carers by providing virtual care (video-enabled consultation and care) to all smaller WACHS facilities. PalCATS is currently expanding the model into the regional resource centres and Multipurpose Sites, a total of 78 WACHS hospitals. This innovation aligns clinical, patient and carer management with Goals of Patient Care (GoPC) and provides support to the patients, carers and provide specialist support to generalist staff.

Aim

A study has been undertaken to understand the impact of PalCATS on identifying and managing specific domains of palliative care support to patients and their carers, including GoPC and providing specialist support to the generalist workforce.

Method

A mixed methods analysis of the first 100 PalCATS referrals included data from the comprehensive assessment form detailing clinical, psychosocial and cultural domains as well as recent history from the available shared palliative care databases used across WA, and Palliative Care Outcomes Collaboration.

Results

The results identified key interventions required including symptom management (50%), terminal care (15%), revisiting GoPC (73%), psychosocial support (40%) and the need for capacity building for generalist colleagues. Using an innovative assessment protocol, previously unknown palliative care patients to the regional Palliative Care Service were identified (39% of those seen) and who were then able to be referred to the local specialist teams.

The first 100 patients seen by PalCATS had an age range of 41-101 years, were often almost bedbound (60% had AKPS < 60), over half were deteriorating from their underlying illness and 21% were actively dying. Over half had symptom distress rated as moderate or severe and the required updates to their Goals of Patient Care documentation was required to better reflect current preferences. Family support was also provided for 63% of patients seen.

In conclusion the data demonstrates that PalCATS is contributing to improved patient and carer outcomes and continuity of care in line with GoPC. Further study will identify potential areas of need, including pandemic related staff shortages and opportunities to provide multidisciplinary support for psychosocial care using telehealth innovations (e.g. counsellors, spiritual care practitioners) as these services are very difficult to access as outpatients or in the home in regional locations and are vital to supporting patients’ quality of life.

Author : Michelle Macdonald, Clinical Nurse Manager Palliative Care, WA Country Health Service