General practice and palliative care: Where does one end and the other begin?

Amanda Lyons

7/03/2018 10:20:14 AM

GPs can often find themselves providing palliative care near the end of their patients’ lives, but many would like to see greater funding and recognition of these skills.

Associate Professor Joel Rhee believes GPs’ palliative care often involves providing care to people with advanced illnesses.
Associate Professor Joel Rhee believes GPs’ palliative care often involves providing care to people with advanced illnesses.

It can be difficult to talk about the end of a person’s life, especially for health professionals, whose role is usually to try to prolong life. However, as GP and Chair of the RACGP Cancer and Palliative Care Specific Interests network Associate Professor Joel Rhee told newsGP, there comes a time when such conversations are unavoidable.
‘Everybody dies. We have 100% mortality and so far no one’s found the cure for death,’ he said.
As the Australian population grows older and lives longer with a rising burden of chronic disease, there can be a significant overlap between GPs’ provision of whole-of-person care and the work of palliation.
‘GPs’ palliative care often involves providing care to people with advanced illnesses,’ Associate Professor Rhee said. ‘Many of the patients I look after at the end of their life might have cancer, but they die with the cancer rather than from it, or from other causes such as dementia or even just frailty – becoming progressively weaker with lots of illnesses and comorbidities.
‘In such cases it’s very blurred in terms of where palliative care starts and primary care stops.’
There has long been criticism from many in the Australian healthcare sector that palliative services in general are underfunded and resourced, particularly in rural and remote areas. GPs, who specialise in long-term holistic care, are in many ways very well-placed to step into that breach.
‘It’s obviously important to equip our specialist palliative care services,’ Associate Professor Rhee said. ‘But to provide palliative care to the majority of Australians also requires the generalists being able to provide that care.
‘I think there needs to be further investment and consideration for encouraging GPs, practices and practice nurses to really engage with and provide palliative care as well.’
A recent announcement from the Federal Government of an $8.3 million pilot program to trial better ways of providing palliative care services at home may point the way towards beginning to address that need. The trial will coordinate services from GPs, palliative specialists and hospitals and will be administered by 10 Primary Health Networks throughout Australia.
While Associate Professor Rhee welcomes news of the Federal Government’s investment in exploring options for palliative care in the community, he remains acutely aware of the challenges involved.
‘The first question is, how long are we going to provide care before patients pass away?’ he said. ‘If you decide, for instance, it will be for the last 48 hours of their life, how do you predict that?
‘Sometimes  I believe in my mind a patient has 48 hours, and then the patient picks up and lives another two years. It’s a good thing that they lived through it, but it is so challenging to work out the last 48 hours of someone’s life.
‘In an ideal world you want a situation where you can give a bit more time and provide support for longer time period than just the last few hours.’
Another challenge presented by the trial is that of coordinating all care providers, as miscommunications can have dire consequences for palliative care patients.
‘That’s where I think the Primary Health Networks have a big challenge, in trying to work out the best way to set up [the trial] so that GPs, carers, nursing staff and specialist palliative care physicians are all communicating properly,’ Associate Professor Rhee said.
‘So I think there are definitely challenges – but there are a lot of opportunities, as well.’
Associate Professor Rhee would like GPs to know that although taking on the responsibility of palliation for a patient may seem daunting, the efforts are well worth it.
‘After 10–20 years of seeing the same patient, the GP is often asked to do [palliative care] because of the trust and the relationship they have built with their patient over the years,’ he said.
‘I find it is really a very rewarding experience, being able to look after people at the end of their life; it is an honour, and I think most GPs would want to be involved.’

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Bambi Markus   8/03/2018 1:46:12 PM

Glad to see funds being allocated for this important accept of primary care. There is a huge need for simple but specialized care in aged care facilities where most people need palliation. These are the non cancer chronically ill patients who do not traditionally tick all the boxes for palliative care.