What's On News January 2018 Improving care at the end of life

News

Improving care at the end of life

Monday 29 January 2018

Key documents

• Advance care planning: start the conversation
• End of life education plan
• Advance care planning procedure
• Adult resuscitation plan
• Statement of choices form

New resources

The End of Life working group is pleased to launch a number of resources to support improved end of life care including:

• Statement of Choices form to document patient’s health choices/wishes and supports Advance Care Planning conversations
• Adult Resuscitation plan (replacing the Recommendations for Clinical Care form) to document a plan of care that aligns with patient wishes
• Advance care planning procedure which outlines the management of the above advance care planning documents

For patients who are actively dying, the end of life pathway has been revised and an observation chart for palliative care has been implemented to assess and document patient symptoms. The observation chart can be used alone or in conjunction with the early warning tool. There are also resources to support the care of the bereaved.

Background

There is a perception that healthcare is very much about curing illness, repairing injuries and restoring function and many people, including clinicians struggle with conversations about care when cure or restoration of function is not possible, including care towards the end of life.

We know that care provided in the last 6 to 12 months of life impacts on symptoms, quality of life, and distress and grief for patients and their loved ones. In addition, patients who receive earlier palliative care have improved quality of life and psychological parameters and also live longer, despite receiving less aggressive care at the end of life. Unfortunately, many patients who are at the end of life undergo treatments or processes that are not beneficial because we have not taken the opportunity earlier in their care to discuss what is most important to them.

A systematic review conducted in 2016 of a range of studies found that, on average, a third of patients receive non-beneficial treatments until they die. Non-beneficial treatments include any treatments, procedures or tests administered to patients who are naturally dying which:

• will not make a difference to their survival
• will probably impair their remaining quality of life
• may cause pain or prolonged suffering
• may leave them in a worse state of health than before

Recognising when a patient is approaching the end of life is critical to delivering compassionate and appropriate care. Effective end of life planning involves open communication with patients to help them consider, discuss and document their values and preferences for care.  We have a shared responsibility to discuss what matters most to patients and their families when they are facing difficult treatment decisions. It is also important that the plan of care is reviewed as the condition of the patient changes.

Further information

Please contact:

• Dr Anne Leditschke, Senior Specialist, Complex-wide Adult Intensive Care
• Dr Cara O’Callaghan, General Physician, Staff Specialist
• Prof. Janet Hardy, Medical Director Cancer Care Services (Acting)
• Dr Rohan Vora, Palliative Medicine Consultant
• Michelle Daly Director of Social Work and Psychology
• Palliative Care Clinical Nurse Consultants

References:

1. Australian Commission on Safety and Quality in Health Care National Consensus Statement: Essential elements for safe and high-quality end of life care
2. J.S. Temel et al Early Palliative Care for patients with metastatic non –small cell lung cancer.  New England Journal of Medicine2010 (363), 733-742
3. M.Cardona-Morell et al Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem. International Journal for Quality in Health Care, 2016, 28 (4), 456-469

Further reading:

• Dr Atul Gawande. Being Mortal: Medicine and what matters in the end (2014)
• My Care My Choices
• Dying to Talk
• Advance Care Planning Australia