Help needed to navigate ‘complex’ end-of-life care: RACGP

Jolyon Attwooll

18/01/2023 12:46:15 PM

Investing in care coordinators and identifying gaps in access are among the keys to quality end-of-life care, a college submission to the ACSQHC suggests.

GP and patient in end-of-life care
Communication can be enhanced by the established relationship patients have with their GP.

Patients need more guidance for the ‘complex’ process of navigating end-of-life care services in Australia, according to the RACGP.
That is one of the recommendations in a submission sent this week to the Australian Commission on Safety and Quality in Health Care (ACSQHC), which is gathering feedback for an update to its current end-of-life care National Consensus Statement.
The college advises that an ageing population and greater prevalence of life-limiting chronic disease will mean an increase in the number of patients requiring GP care at the end of their lives.
It also highlights the importance of identifying access gaps for specialist palliative care and recommends monitoring and accountability for states and territories to address the issue.
‘Furthermore, as it is currently complex for GPs and their patients to navigate the range of services that are available, the RACGP also recommends investment in the provision of service directories and care coordinators to assist patients with the appropriate services,’ the submission states.
According to the college, deprescribing should be included in the statement ‘as a component of comprehensive care’ for patients towards the end of their lives.
‘Deprescribing is a positive, patient-centred intervention, conducted under medical supervision, that reassesses the role of all medicines with a view to stopping those with no clear benefit, may cause harm, are being used for an indication that is no longer an issue and no longer fit with the current goals of care,’ the submission states.
The RACGP also recommends changes be made to MBS item numbers 160–164, which are defined as ‘prolonged professional attendance when a patient is in imminent danger of death’.
These should be clarified to make it clear they are available for palliative care and not just urgent life-saving care, the college contends in its feedback.
Associate Professor Morton Rawlin is a Victorian GP, as well as the Chair of the Expert Advisory Group for the Silver Book, the RACGP’s aged care clinical guide.
He says that end-of-life discussions and planning frequently occur with patients’ GPs, who often manage the process.
‘Communication with the patient and their family members is key and this is enhanced by the established relationship patients have with their GP,’ he told newsGP.
‘This can be time consuming and needs to be recognised.’
He also highlights the importance of interdisciplinary discussion and collaboration, which ‘also needs to be recognised in the busy GP schedule’.
Just as the college outlines in its submission, Associate Professor Rawlin points out differences in access around the country.
‘Palliative care services are not equally available across Australia and as such some of the multidisciplinary teams come in different formats and these are locally managed by GPs,’ he said.
‘With the development of these statements, State and Federal governments will need some investment into this area to ensure equity.’
The National Consensus Statement was first published in 2015 and is designed to set out suggested practice for end-of-life healthcare.
It includes a series of guiding principles as well as 10 ‘essential elements’ for safe, high-quality care.
Authors of the new ACSQHC consultation draft say evidence surrounding end-of-life care has evolved since the statement was first published, with an update designed to work in the findings of rapid literature reviews as well as feedback from primary and community care.
Among the recommendations put forward from a rapid literature review conducted by Flinders University’s Research Centre is that the ACSQHC consider development of a clinical care standard for bereavement care.
The draft ACSQHC update also references the voluntary assisted dying (VAD) laws that have been passed in Australian states since the original statement but does not address them in detail ‘as each state has its own legislation that regulates access’.
Guidance on end-of-life care is provided in the RACGP Aged care clinical guide (Silver Book), which is available on the RACGP website.
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Dr Claire Louise Hepper   19/01/2023 10:32:50 AM

Helping people overcome the barriers to quality end of life care and supporting them through the caring, dying, grieving is precisely what Compassionate Community organisations already do.
Instead of investing in paid coordinators and creating service directories that will require continual update, how about investing in the work already being done in the community. Increases death literacy in a town, increases social connections, takes the pressure off GPs and Health Services and improves end of life care without the expenses associated with creating a paid position and another layer of medicalised complexity.
Dr Claire Hepper