Emerging health and social policy considerations for safe and quality end-of-life care in Australia – the evidence, gaps and challenges

Abstract

Recognition of the importance of end-of-life care will enable improvements in the quality of care delivered to patients and their families. Australia is experiencing an increasing number of deaths, (many expected), with an aging population who are living longer, often with multimorbidity. This makes end of life care a priority. The last year of someone’s life takes place in a complex healthcare system, with increasing pressures on care delivery, placing the spotlight on health service providers to ensure that teams and individuals are supported and enabled to provide such care. Two rapid literature reviews identified best practice principles and processes for delivering safe and high-quality end-of-life care in acute care, aged care and community settings. The reviews identified that end-of-life care is experienced within the whole health and social care system, including hospital admissions interspersed with care in the community, outpatient and emergency department visits and potentially admission to a hospice. Much of this last year of life is spent at home, which may be a personal residence, an aged care facility, prison, supported accommodation or even on the streets. Transitions across settings requires seamless care, as well as organisational readiness to deliver safe and culturally appropriate care. This is more important now with end-of-life care subject to quality assurance mechanisms within the National Safety and Quality Health Service Standards (2nd edn): Comprehensive care. This requires all sectors to work collaboratively when caring for someone at the end of their life in order to see positive changes in care outcomes.

Experiences of engaging a death doula: qualitative interviews with bereaved family members

“…Public health, aged care, acute care, primary care and families and relationships must work together to seamlessly support those who are dying and their families. 49 This also speaks to the difference between care as a technical provision and care and caring in the familial context.…”

A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care

“…12 Enhancing the quality of end-of-life care is a key priority to ensure that the provision of care is consistent with the unique needs of both patients and their families. 13 The quality of healthcare that patients receive at the end of life is critical to reducing distress and grief associated with the reality of approaching death for both the patient and their family or caregivers, [14][15][16] maximising patient autonomy in decision-making, 17 preserving patient dignity, [18][19][20] and ensuring a patient's level of comfort. 21 However, several studies have reported a broad range of unmet needs among patients receiving end-of-life care services that impact their quality of care, such as inadequate communication regarding expectations for end-oflife care, 22,23 poor coordination of services contributing to delayed diagnosis and treatment, 24 and a lack of emotional support.…”