Population potentially in need of palliative care
There is currently no nationally consistent data collection or methodology to establish need or unmet need for palliative care in Australia. This study builds on previously published palliative care need studies (using epidemiological mortality-condition approaches), by exploring in greater depth the range of services received (not just specialist palliative care) for an estimated population in need of palliative care.
This report highlights that nearly all the population in need of palliative care visited a GP (94%) and over 1 in 2 (55%) had at least 1 consultation with specialists who treat common life limiting conditions (based on MBS-subsidised claims) in the last year of life. Consultations with specialists other than palliative care specialists were far more common for the population receiving SPC. Cancer patients were over twice as likely to see 3 or more specialists and 5 times as likely to have consultations with palliative care specialists than people dying from organ failure. People dying from frailty were less likely to have specialist consultations and GP and nurse attendances than people dying from other causes. Because 38% of the predictable deaths population (or 85% of the non-SPC population) with dementia were in residential aged care at the time of death, their access to health care providers may have been limited, given the current challenges for delivering GP services in residential aged care (Reed 2015).
Evidence suggests that integrating palliative care services with disease-related care to provide multidisciplinary care can achieve better outcomes for people with complex life-limiting conditions. Based on the available data for this study, first consultations with palliative care specialists tended to occur at least 6 months after first consultation with other specialists. The median number of days from first consultations with palliative care specialists to death was 47 days, compared with 210–273 days before death for first consultations with disease-specific specialists. The analysis also showed that consultations with most disease-specific specialists reduces in the last 3 months of life (except for oncologists and nephrologists).
Further, last consultations with palliative care specialists tended to occur in the last weeks of life (median of 8 days before death), and even closer to death (2 days) for people dying from frailty. While it appears that palliative care specialists are solely involved in the care of patients in the last weeks of life, the data presented here does not capture informal discussions/case conferencing that may occur between palliative care specialists and other specialists in the last weeks of life regarding the management and treatment of their patients with complex conditions.