An integrated respiratory and palliative care service for patients with advanced lung disease
An article written by Dr. Julie McDonald
Patients with advanced lung disease have a higher symptom burden, and poorer quality of life, than that of an advanced lung cancer patient. They also experience recurrent hospital admissions which contribute to high healthcare costs. Although early palliative care referral is recommended for this cohort, referrals to specialist palliative care remain low, as physicians remain uncertain about who and when to refer.
St Vincent’s Hospital Melbourne developed an integrated respiratory and palliative care service for patients with advanced lung disease. The service helps overcome the barriers to palliative care referral, through delivering disease-orientated care alongside seamless integration of early palliative care concepts, such as symptom control and future care discussion. The developed service provides both a specialist outpatient clinic (OPC), and has home visit (HV) capacity, to help overcome barriers to clinic attendance in this breathless cohort of patients.
Our recent article describes the model of care provided within the service, as well as the potential reduction of acute hospitalisations and hospital costs. [1] Evaluation of the clinical reviews described the high levels of breathlessness action plans and disease-specific action plans completed, as well as frequent advance care planning discussion and advance care directive completion. We describe the impact of the service, with a reduction in acute hospital admissions, total length of stay, and outpatient appointments. These reductions in health care utilisation culminated in substantial cost savings for the hospital.
A second piece of research evaluated the service through qualitative interviews, where patients, caregivers, and general practitioners described their perspectives of the integrated service. Results revealed the service was highly valued for providing personalised and holistic care, with high communication standards. [2]
These results demonstrate an integrated respiratory and palliative care service which is both highly valued by consumers and exhibits substantial hospital level outcomes.
St Vincent’s Hospital Melbourne provides an integrated model of palliative care for three other chronic disease streams: advanced liver disease, renal disease, and heart failure. St Vincent’s recognises the early introduction of palliative care provides both good quality care and significant economic return on investment.
References
- McDonald J, Marco D, Howard R, Fox E, Weil J. Implementation of an integrated respiratory palliative care service for patients with advanced lung disease. Aust Health Rev. 2022 Dec;46(6):713-721. doi: 10.1071/AH22103.
- McDonald J, Fox E, Booth L, Weil J. Qualitative evaluation of an integrated respiratory and palliative care service: Patient, caregiver and general practitioner perspectives. Thoracic Society for Australia and New Zealand Annual Scientific Meeting. Virtual ASM March 31 - April 2, 2022. Presented as E-poster presentation TP233. (2022), Abstracts. Respirology, 27: 88-220. https://doi.org/10.1111/resp.14226
Useful links
Impactful Integration of Care – Delivery of an Integrated Respiratory and Palliative Care Service. Safer Care Victoria Palliative Care Clinical Networks - Clinical Conversation Webinar. J McDonald.
Understanding Palliative Care. St Vincent's Foundation. Video link. M. Boughey and A. Crettenden
Dr. Julie McDonald
Respiratory and Palliative Care Physician
MBChB Dist, FRACP, FAChPM
St Vincent’s Hospital Melbourne