Living longer, dying better
A blog post written by Prof Liz Reymond MBBS [Hons], FRACGP, FAChPM, PhD
The care that people receive as they approach the end of their life really does matter. It matters to the person, it matters to the people who love them, and it is a reflection of our societal values.
Everyone is affected by death during their lives and everyone dies; indeed, death is a universal health outcome. We need to do end-of-life care well.
Decision Assist, funded by the Australian Government Department of Health, recognises that GPs and aged care workers should be supported to provide quality end-of-life care to meet the needs of older Australians.
To help support GPs, ANZSPM, as a part of Decision Assist, is promoting a framework of care that is based on a palliative approach and suitable for people in the last year of life and can help guide clinicians to provide high quality end-of-life care focussing on a person’s preferences for care and proactive delivery of holistic comprehensive care.
Use of the framework is commenced by asking what has become known as the Surprise Question: “Would you be surprised if this person were to die in the next 6 to 12 months?” Factors that trigger the asking of the Surprise Question can be tailored by each individual clinician according to their patient load and practice. Some suggested triggers have included: the patient has had their 75th birthday, or is diagnosed with a new life-limiting illness, or chooses to stop treatment for a life limiting illness, or has had several unexpected hospitalisations in a short space of time.
The framework is based upon three prognostic trajectories – the first for a prognosis of about six to 12 months, the second less than six months, and the third less than a week. Each prognostic trajectory is associated with a key clinical process and they are, respectively: advance care planning, development of a comprehensive care plan or case conference and initiation of a terminal care management plan.
Work in the United Kingdom and Australia indicates that the implementation of such a framework into routine general practice allows people at the end of life to receive the right care in the place of the person’s choosing and at the right time.
"Decision Assist offers GPs a range of resources that support the optimal run out of the three key clinical processes that underpin the framework. To access any of these resources, including clinical services and professionally accredited education packages, please see www.decisionassist.org.au.
It would be great to hear from clinicians who have used any of the Decision Assist resources, especially those who have been mindful of the framework and used it to proactively manage an older patient in the community. Please feel free to comment on your experiences below.
Some ways that you can learn more:
- Hear more about the framework of care
- Undertake an ACRRM and RACGP accredited clinical audit to improve your delivery of end of life care to older Australians
- View videos that are an introduction to the management of common palliative care symptoms: pain, dyspnoea, nausea and vomiting, delirium
Dr Reymond holds the position of Deputy Director, Metro South Palliative Care Services
(MSPCS) and Director of the Brisbane South Palliative Care Collaborative Queensland.