Uptake of advance care planning increasing among providers

A national palliative care program for residential aged care is leading to an increase in advance care planning and the use of end-of-life care pathways and family conferences, according to an evaluation.

A national palliative care program for residential aged care is leading to an increase in advance care planning and the use of end-of-life care pathways and family conferences, according to an evaluation.

The Palliative Approach Toolkit, a step-by-step framework for residential aged care facilities to implement palliative models of care, provides educational, clinical and management resources for staff, as well as resources for friends and family.

The program, including hard copies of the guide, online resources and workshops to show staff how to use the approach, has been rolled out nationally by the Department of Social Services.

Professor Deborah Parker, director of the Centre for Applied Nursing Research, led the development of the toolkit and will present on its evaluation at the Australian Palliative Care Conference in September.

“The toolkit has been a real catalyst for helping to move the sector forward, in highlighting that palliative care or a palliative approach for older people living in residential aged care is really important,” Professor Parker told Australian Ageing Agenda.

“It’s provided a resource and impetus for people to say ‘what are we going to do, and how might this resource set us on our way?’.”

As part of an evaluation, providers who attended workshops were asked to volunteer for death audits to help determine the toolkit’s outcomes. This involved providers monitoring what happened to residents who died before staff came to a workshop and what happened to residents who died after the learnings of the toolkit had been implemented.

Professor Deborah Parker
Professor Deborah Parker

After implementing the toolkit, providers were more likely to engage residents and their families in palliative care conferences to discuss their future wishes – in 61 per cent of cases, compared to 45 per cent of cases prior to the toolkit, according to the audit.

Providers were also 16 per cent more likely to commence an end-of-life care pathway to refine the symptom management and care required in the final days or weeks of life, the evaluation found.

Professor Parker said that keeping people in facilities was the main goal and it was positive that results showed only a small percentage of people were transferred to hospital in their last week of life.

“That’s great information to know; that it is possible within this sector to provide quality end-of-life care for people and they don’t have to go to hospital,” she said.

Preliminary data suggested the toolkit may reduce the length of hospital stays, however, Professor Parker said further analysis was needed.

Positive response

Due to the huge varieties within the sector, she said it was hard to get a feel on a national project but these initial findings seemed positive.

“Some people are very advanced in their programs and will take this project and value add [while] some people are just thinking about how they can get a standardised approach across their organisation or facility,” she said.

“People have taken it up across the country in different ways – some organisations have invested in a whole of organisation approach to incorporate the toolkit framework and resources into changing their practice. Some people have already got something in place…. they might only use particular resources,” said Professor Parker.

“It’s looking very positive. There will always be exceptions, but people are moving in the right direction and over time things will continue to improve.”

The Palliative Approach Toolkit is currently being adapted in Canada, United Kingdom and Europe.

The 13th Australian Palliative Care Conference will be held 1 – 4 September at the Melbourne Convention and Exhibition Centre. Register here.

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Tags: centre-for-applied-nursing-research, deborah-parker, end-of-life-care, palliative care, palliative-approach-toolkit,

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