Problem

End of life care can involve multiple services across different settings. Understanding the specific gaps and specific areas of concern will assist in developing ways to improve the care provided. This project identified the care services provided to people during the last 6-months of life and evaluated the degree of integration and communication of services provided.

Design

Involved detailed data collection of health records of people aged 75 years and over who have died, interviews with older people towards the end of their lives, and bereaved family members. The information included service data, older person‘s preferences, treatment and care decisions, communication between the older person, people important to the older person and healthcare and community service staff, and integration of services.

Collaborators

NARI, Mercy Heath, North Western Melbourne Primary Health Network, Northern Health, Western Health, North West Metropolitan Palliative Care Consortium

Themes & Key Findings

• Preferred place of death is not documented
• Care preferences are poorly documented
• People present for symptom management
• Accessing appropriate services at the appropriate time is complex
• Adverse events are common
• Recognition of dying is difficult
• Recognition of dying was earlier in those receiving specialist palliative care than those not
• Families vulnerability impacts on communication
• Good care coordination (GP, case manager, palliative care team) is essential in end of life care
• Informal carers are vital in successful end of life care and they also need to be supported

Main Results

• Preferred place of death unknown in 71% of audit cases
• 53% of audit cases transferred to another place (e.g. unit, facility) in the last week of life
• In 60% of audit cases, recognition of dying occurred on day of death or one day prior
• For the 60% of cases receiving specialist palliative care, meantime for initial contact was 26 days (SD 37) prior to death
• Most people don’t prepare for death, crisis is often the point

Recommendations

• Improve the frequency of conversations and documentation of care preferences towards the end of life
• Integrate informal carers into service provision recognising the vulnerability of families at this time
• Investigate what are the fundamental components of palliative care services which could be easily translated to non-palliative care workers involved with older people
• Prepare both families and formal carers for the likelihood care preferences may change rapidly towards the end of life
• Improve management of pain and access to

Completed October 2018

Project Summary Infographic