By Yasmin Noone

A national end-of-life care pathways program should be implemented to enable aged care residents to die well in their location of choice, according to new findings published in Medical Journal of Australia this week.

A La Trobe University study on The Good Death project has found that by improving end-of-life care practices in residential aged care, staff can negate the need to unnecessarily rush the dying to hospital for treatment in their last moments and thereby improve the quality of an individual’s last days.

The study, led by research fellow at La Trobe University- Dr Dell Horey, tested the acceptance and feasibility of a best-practice approach to end-of-life care pathways.

The pathways, which aimed to optimise the use of medicines to manage symptoms at the end-of-life, were introduced throughout 14 participating aged care facilities across Victoria and South Australia.

The study found that unnecessary transfers to hospital — where residents were returned immediately from hospital to the aged-care facility after an urgent referral — fell from 14 per cent to two per cent when care was consistent with best practice.

The paper also stated that end-of-life care pathways would be encouraged and more widely accepted if a national program was established to support the use of end-of-life care pathways.

In an accompanying editorial, Professor of General Practice and Palliative Care at the University of Queensland, Geoffrey Mitchell, said that a ‘whole-of-system’ planning for deaths in hospitals and aged care facilities is also needed.

Professor Mitchell noted that the uptake of end-of-life care pathways in the Good Death project ranged from 10 per cent to 68 per cent of eligible patients by the end of the study.

Four of 14 facilities were routinely using a care pathway, which was a “very good outcome”.

“It is now time to move to policy adoption at the hospital level, and thence to individual clinician practice”, Professor Mitchell wrote.

CEO of Palliative Care Australia, Dr Yvonne Luxford, agreed with the paper’s findings but called for policy to be holistic and cover the whole palliative experience, not just end-of-life care.

“The improved consistency in approaches to care, collaboration between care team members and reduction in unnecessary transfers to hospital are some of the benefits demonstrated by the use of EOL care pathways in the Good Death project,” says Dr Luxford.

“All of these would no doubt contribute to better outcomes for residents at the end of their lives, and it is great to see this emphasis within aged care.

“At a broader level, we need to ensure that residents receive high quality end of life care throughout their trajectory, not just in the terminal phase.

“Programs that promote choice and dignity for residents through advance care planning, explores their values and preferences, helps them to live well until the end, and coordinates good end-of-life care are beneficial for staff, residents and their families.

“We can see evidence of this in local projects such as the Living and Dying Well in north-west Tasmania, and the Gold Standard Framework in Britain.”

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