PELP Framework supports high-quality end-of-life care
An article written by Prof. Liz Reymond MBBS (Hons), PhD, FRACGP, FAChPM, Director of caring@home
In Australia, only a small proportion of people die suddenly; most die from conditions with a predictable trajectory, experiencing a prolonged period of disability, frailty and illness and then dying at an older age ‘with unpredictable timing from a predictably fatal chronic disease’ [1] If death is expected, it can be planned for.
The guiding principles for safe and high-quality palliative and end-of-life care include that care should be person-centred, and align with a person’s values, needs and wishes. [2] To achieve this aim, clinicians need to plan for end-of-life care in a timely manner and have ongoing discussions with patients and their families and carers to clarify their wishes.
The new caring@home Prompts for End-of-Life Planning (PELP) Framework guides proactive, quality end-of-life care across all care settings. It is based on work undertaken in the UK [3] and Australia. [4] The PELP Framework supports health professionals to undertake proactive end-of-life planning as their patient’s needs transition from curative to palliative, and to facilitate a high-quality end-of-life care according to the patient’s preferences.
The PELP Framework identifies triggers to help health professionals to identify patients approaching end of life. This allows for timely discussions and planning to meet patients’ needs. These ongoing discussions enable preparation of person-centred management plans that align with the person’s wishes and reduce the need for decision making in emotionally charged reactive situations.
The PELP Framework identifies four clinical end-of-life processes:
- Advance care planning and person-centred care based on need (at risk of dying)
- Transition of focus of care needs from restorative to palliative (likely to die soon)
- Terminal care needs (dying)
- After-death care (bereavement).
Under each clinical end-of-life process are a list of prompts for the health professional to consider given the person is in that stage of their illness trajectory.
Implementation of the PELP Framework into routine practice can help clinical services to provide quality person-centred care that is aligned with patients’ preferences and delivered at the right time and in the right place. It will support meeting the National Palliative Care Standards for All Health Professionals and Aged Care Services [5] and National Palliative Care Standards for Specialist Palliative Care Providers. [6]
The PELP Framework was developed by caring@home, a National Palliative Care Project, funded by the Australian Government. It has been developed in collaboration with a National Advisory Committee, including Palliative Medicine Specialists, Nurse Practitioners, General Practitioners and Nurses.
Visit the caring@home website to learn more. Or you can contact the project via email here or call 1300 600 007.
Authors
Prof. Liz Reymond MBBS (Hons), PhD, FRACGP, FAChPM
Director
caring@home project
Reference
1. Australian Commission on Safety and Quality in Health Care. Safety and quality of end-of-life care in acute hospitals: A background paper. Sydney: ACSQHC; 2013.
2. Australian Commission on Safety and Quality in Health Care. Essential elements for safe and high-quality end-of-life care National Consensus Statement. Sydney: ACSQHC; 2023.
3. Shaw KL, Clifford C, Thomas K, Meehan H. Review: Improving end-of-life care: A critical review of the gold standards framework in primary. Palliative Medicine. 2010; 24(3):317-29.
4. Reymond L, Cooper K, Parker D, Chapman M. End-of-life care: Proactive clinical management of older Australians in the community. Australian Family Physician. 2016; 45(1/2):76-8.
5. Palliative Care Australia. National Palliative Care Standards for All Health Professionals and Aged Care Services. Canberra: PCA; 2022.
5. Palliative Care Australia. National Palliative Care Standards for Specialist palliative Care Providers. Canberra: PCA; 2022.