Enhancing palliative care delivery in a regional community in Australia

Abstract

Although access to palliative care is a fundamental right for people in Australia and is endorsed by government policy, there is often limited access to specialist palliative care services in regional, rural and remote areas. This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales.Expert consultation and an eclectic literature review were undertaken to develop a model of palliative care service delivery appropriate to the needs of the target population and resources of the local community. On the basis of this review, a local palliative care system that is based on a population-based approach to service planning and delivery, with formalised integrated network agreements and role delineation between specialist and generalist providers, has the greatest potential to meet the palliative care needs of this ACCESS TO PALLIATIVE CARE is a fundamental right for people in Australia and is endorsed by government policy. 1,2 Access, a key component of all palliative care service delivery models, implies fairness not determined by geographical location. [1][2][3][4][5] Despite this ideal, the increasing demand for palliative care in regional, rural and remote areas, combined with the limited number of palliative care specialists, presents considerable challenges for health service planners. 6,7 This discussion document reviews the evidence pertaining to model-of-care development, the policy environment and existing rural palliative care models in operation in rural Australia. This review was conducted to inform the development What is known about the topic? The provision of palliative care in rural and remote areas presents significant service delivery challenges, but it is not known how best to address these challenges. What does this paper add? This paper explores issues related to palliative care service delivery in a rapidly expanding regional coastal community. The paper outlines a populationbased planning strategy to enhance capacity. What are the implications for practitioners?The authors propose the development of a palliative care service that builds upon the existing specialist service with greater involvement of generalist providers and ensures service development and delivery is explicitly linked to consumer needs. Mid-north coast New South WalesThe mid-north coast consists of the Coffs Harbour, Bellingen and Nambucca local government areas (LGA) which now reside within the central network of the recently created North Coast Area Health Service. Although the reorganisation of the area health service boundaries in NSW occurred subsequent to the completion of this need assessment, this does not alter the significance of these findings. 8 This area has a population of 97 774 people, with the largest concentrated population residing in the Coffs Harbour LGA and the remaining population in smaller coastal townships, which are popular holiday des...

Multi‐faceted palliative care intervention: aged care nurses’ and care assistants’ perceptions and experiences

“…Focus groups were undertaken at the mid-point of the R-PAC Project (Table 1) to assess aged care personnel's perceptions and experiences of the multi-faceted palliative care intervention. This action research project involved all residential aged care facilities (n = 9) within a defined geographical location in Australia with a population base of approximately 67,000 peoples (Phillips et al 2006b). Each facility was given an opportunity to host a focus group, with the first four facilities who responded to this invitation chosen as the focus group sites.…”

Residential aged care: the last frontier for palliative care

“…The question route for this study was designed to allow exploration and probing of key issues defined from a literature review, needs assessment (Phillips et al. 2006) and local key informant interviews (see Table 1).…”

Populations who die without specialist palliative care: does lower uptake equate with unmet need?

“…These include the elderly, those in rural and remote areas, members of indigenous communities, people from lower socioeconomic backgrounds, people from non-English speaking backgrounds and those without caregivers. 1,[6][7][8][9][10][11][12] People with life-limiting illnesses other than cancer also have lower rates of accessing palliative care despite evidence of the high symptom burden and inadequacies of end-of-life care for these people. 13 It cannot be assumed however that lack of uptake automatically equates with unmet needs.…”