Background
Methods
Eligibility criteria
Information sources
Electronic searches
Other sources
Search terms
1. | exp advance care planning/OR exp attitude to death/OR exp bereavement/OR exp terminal care/OR exp hospices/OR exp life support care/OR exp palliative care/OR exp terminally ill/OR death/OR palliate$.mp OR hospice$.mp OR terminal care.mp |
2. | (dying.mp OR death.mp OR end of life.mp) AND (imminen$.mp OR nearing.mp OR last day$.mp OR last week.mp OR last hour$.mp OR final day$.mp OR final week.mp OR final hour$.mp OR critical pathway$.mp) |
3. | 1 OR 2 |
4. | exp delivery of health care/AND (exp models, theoretical/OR exp models, economic/) |
5. | exp Community Health Planning/OR exp health care reform/OR exp decision making, organizational/OR exp planning techniques/OR exp Health Services Needs and Demand/OR exp healthcare disparities/ |
6. | (exp Australia/OR Australia$.mp) AND (exp attitude/OR attitude$.mp OR belief$.mp OR knowledge.mp or “unmet need$”.mp) |
7. | 4 OR 5 OR 6 |
8. | 3 AND 7 (limit publication date to 2001-current) |
Study selection
Data collection process and data items
Assessment of bias
Synthesis
Results
Model/component | Definition(s) |
---|---|
Case management | Case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s holistic needs through communication and available resources to promote quality cost effective outcomes. The definition of case management notes the focus upon the meeting of a client’s health needs. Case management can be placed within a social model of health, within which improvement in health and well-being are achieved by directing efforts towards addressing the social and environmental determinants of health, in tandem with biological and medical factors [31]. |
Consultation model | An approach to care by which specialist advice is provided on assessment and treatment of symptoms, communication about goals of care and support for complex medical decision-making, provision of practical and psychosocial support, care coordination and continuity, and bereavement services when appropriate [37]. Advice is provided without necessarily assuming primary responsibility for care, although there is negotiation of the level of palliative care involvement. |
Health or clinical networks | Health networks are formed when three or more health care agencies (services, organisations or health districts) formally come together to better meet the needs of patients in their service area. These agencies often include hospitals, community health centres, critical access hospitals, physician practices, mental health providers, rural health clinics and other for-profit and not-for-profit health care organizations. These health or clinical networks work to increase access to quality healthcare for local patients and streamline the cost of that care, as well [38]. |
Integrated care | Integrated care is a concept bringing together inputs, delivery, management and organisation of services relating to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve the services in relation to access, quality, user selection and offering care [39]. |
Liaison model | The liaison model combines the education of patients after discharge with educational outreach and clinical support for primary care clinicians. This model may be particularly appropriate in deprived areas, where general practices vary in their capacity to manage chronic illness [40]. |
Managed clinical networks (MCNs) | Clinical networks are linked groups of health professionals and organisations from primary, secondary, and tertiary care working in a coordinated manner, unconstrained by existing professional and [organisational] boundaries to ensure equitable provision of high quality effective services [21]. MCNs address many of the problems that have been identified in the traditional delivery of health services, including: poor coordination and collaboration between health services; changing roles for health professionals; and the need for greater efficiencies, improved access, more equitable service provision, better use of limited resources and quality patient-centred care. More specifically, MCNs aim to develop locally delivered, quality assured care, through the managed integration of, and cooperation between, formerly separate clinical services. Their major focus is on actively involving patients in service design and building seamless services around the patient’s journey to ensure the best treatment gets to the right patient, at the right time, in the most appropriate place and is delivered by the most qualified and skilled professional with the greatest resources [22]. |
Pop-up model | Often palliative needs in rural areas may be intermittent or needs specific. Developing a permanent infrastructure would not be appropriate in these circumstances. Looking at available local resources and gaps would provide a basis for developing a ‘pop-up’ palliative service model that optimises how local resources and services can be used to respond to a specific palliative need [24]. |
Shared care model | A review [28] suggests that three definitions of shared care have been offered: |
1. An approach to care which uses the skills and knowledge of a range of health professionals who share joint responsibility in relation to an individual’s care. This also implies monitoring and exchanging patient data and sharing skills and knowledge between disciplines. | |
2. A narrower approach concerned with joint participation of general practitioners and specialists in the planned delivery of care for patients with a chronic condition, informed by an enhanced information exchange, over and above the routine discharge and referral letters. | |
3. Especially in mental health, shared care can be divided into systematic cooperation about how systems agree to work together and operational cooperation at local levels between different groups of clinicians. |
Review | Review question | Studies | Participants | Setting | Interventions | Quality * | Synthesis | Summary of results |
---|---|---|---|---|---|---|---|---|
[44] | To identify the current evidence on (1) the effectiveness, including cost-effectiveness, of hospices, and hospice care in a patient’s home and in nursing homes and (2) the experiences of those who use and of those who provide such services | Search date: 2003-2009 | People dying from any LLI or their family | Inpatient, RAC, community | EOL care service provided by multidisciplinary team not part of general healthcare | Medium | Narrative | Hospice services are highly valued by patients and their families, reduce general health service use and costs, and increase the likelihood of effective pain management and of death not occurring in hospital |
Designs: comparative and qualitative studies | ||||||||
Number of studies: 18 comparative, 4 qualitative | ||||||||
[41] | To inform future practice, research and policy in specialist palliative day-care by systematically reviewing the evidence for how the structure and process of this form of care relate to outcomes for adults with cancer | Search date: 1872-2003 | Patients with cancer | Day care | Palliative day care | Low | Narrative | There is evidence for high satisfaction among patients selected into day-care, but not yet sufficient to judge whether this improves symptom control or QOL. |
Designs: Any, qualitative or quantitative | ||||||||
Number of studies: 12 | ||||||||
[57] | To evaluate the evidence on the transition process from child to adult services for young people with palliative care needs | Search date: 1990-2008 | Children and young people with LLI | Transition from paediatric to adult services, any setting | Interventions aimed at easing transition | Medium | Narrative | Post-transition patients with cystic fibrosis (and in one study) parents described transition positively |
Designs: any | ||||||||
Number of studies: 92, of which only 2 were evaluative | ||||||||
[45] | To identify the models of inter-professional working that provide the strongest evidence base for practice with community dwelling older people | Search date: 1990:2010 | Older (age 65+) people | Community | Inter-professional case management, collaboration or integrated team models | Medium | Narrative | Weak evidence of effectiveness and cost-effectiveness, although well-integrated and shared care models improved processes of care and have the potential to reduce hospital or nursing/care home use. |
Designs: RCTs | ||||||||
Number of studies: 41 | ||||||||
[51] | To assess whether there was an effect of palliative care teams | Search date: not given | Patients receiving palliative care and their families | Inpatient or community | Multi-disciplinary teams including staff trained to some extent in palliative care | Medium | Narrative and meta-analysis using effect sizes weighted by the square root of sample sizes | Most evidence is available for home care services (improved satisfaction and pain and symptom control with lower costs), with a smaller number of studies of inpatient hospice or palliative care (similar or greater satisfaction, particularly for carers and similar or improved symptom control, quality of life equivocal) and a small number of poor quality studies considering hospital support, although it does seem that these services reduce time in hospital. |
Designs: not defined | ||||||||
Number of studies: 43 | ||||||||
[52] | To identify studies that compare specialised palliative care models between them assessing their effectiveness or cost-effectiveness | Search date: 2003-2006 | Terminally ill patients | Inpatient, community | Four hospice-based models (large free-standing hospice, hospital-based hospice, home-care hospice, telemedicine based hospice), one palliative care unit based at a general hospital and two models of referring specialists at hospital (a full service and a service limited to telephonic support to the staff caring the patient) | Medium | Narrative | No differences were found in control of symptoms, QOL, emotional support or satisfaction between a broad service provided by a team of referring specialists at hospital and telephonic support between specialised PCT and the staff caring for the patient. No differences in effectiveness was found between hospital-based hospices and home-based hospice. |
Designs: Comparative | ||||||||
Number of studies: 4 | ||||||||
[50] | To determine effectiveness of multi-component palliative care service delivery interventions for residents of care homes for older people. | Search date: to Feb 2010 | Elderly people in aged care | RAC | Multi-component palliative care in RAC, including referral to external services or staff training | Good | Narrative | One study reported higher satisfaction with care and the other found lower observed discomfort in residents with end-stage dementia. Two studies reported higher referral to hospice services in their intervention group, one found fewer hospital admissions and days in hospital, the other found an increase in do-not-resuscitate orders and documented advance care plan discussions. |
Designs: Comparative | ||||||||
Number of studies: 3 | ||||||||
[46] | Not stated | Search date: 1975-2001 | Family members or carers of people with cancer or other advanced disease | Community | Home nursing care, respite services, social networks and activity enhancement, problem solving and education, and group work | Medium | Narrative | The current evidence contributes more to understanding feasibility and acceptability than to effectiveness. |
Designs: Any evaluative | ||||||||
Number of studies: 6 | ||||||||
[47] | To update 2003 review to determine the effectiveness of subsequently published intervention studies targeting informal caregivers needs in cancer/advanced disease | Search date: 2001-2010 | Family members or carers of people with cancer or other advanced disease | Community | One-to-one psychological models, Psychological interventions for patient/carer dyads, Palliative care/hospice interventions, Information and training interventions, Respite interventions, Group interventions, Physical interventions | Medium | Narrative | Of 6 studies evaluating palliative care/hospice interventions, one pre/post study found reduced family anxiety about caring at home but increased wakening and poorer physical health, one cross-sectional survey found high satisfaction; the others found no effect. The one study evaluating respite found caregivers to report satisfaction after implementation. |
Designs: Any evaluative | ||||||||
Number of studies: 33 | ||||||||
[58] | To systematically review the evidence base for the effectiveness of palliative care in improving patient outcomes in HIV/AIDS | Search date: 1980-2003 | Patients with HIV requiring symptom control, psychosocial support or terminal care | Inpatient, hospice, community, long-term care | Multidisciplinary advice and support, terminal care, domestic support, care monitoring and planning, | Medium | Narrative | Home palliative care and inpatient hospice care significantly improve patient outcomes in the domains of pain and symptom control, anxiety, insight, and spiritual wellbeing. |
Designs: | ||||||||
Comparative Number of studies: 22 | ||||||||
[43] | To determine whether hospital-based palliative care teams improve the process or outcomes of care for patients and families at the end of life | Search date: 1977-1999 | Patients with a progressive life-threatening illness, and their family, carers, or close friends. | Hospital | Palliative care teams working in hospitals, defined as two or more healthcare workers, at least one of whom had specialist training or worked principally in palliative care. Included interventions with a hospital/support team component within a broader intervention | Good | Narrative and meta-analysis using effect sizes | All studies except one indicated a small positive effect of the hospital team, including improved symptoms, fewer hospital days and better satisfaction, as well as improvements on process measures such as increased referrals, change in prescribing practices. |
Designs: Comparative | ||||||||
Number of studies: 13 | ||||||||
[53] | To determine whether specialist palliative care teams achieve their aims and improve outcomes for patients with advanced cancer and their caregivers, in terms of improving symptoms and quality of life and/or reducing the emotional concerns of family caregivers | Search date: 2000-2009 | Patients with advanced cancer and their caregivers | Inpatient, community, outpatient, day care | Specialist palliative care offered by professionals specifically trained in palliative and hospice care | Medium | Narrative | The evidence (moderate and low) supports SPCTs working in home, hospitals, and inpatient units as a means to improve outcomes for cancer patients, such as pain, symptom control, and satisfaction, and in improving care more widely, including reducing hospital admissions. The benefit is demonstrated quantitatively. |
Designs: Comparative Number of studies: 40 | ||||||||
Studies indicated either benefit in favour of a palliative care team or no difference. Some studies suggested lower costs. | ||||||||
Quality of life, when measured, less often was different between groups and tended to deteriorate over time. | ||||||||
[60] | To explore the use of telehealth in relation to palliative care in the UK | Search date: 1999-2011 | Adults, relatives, or carers with palliative care needs or health professionals in the UK | Inpatient, community, outpatient, RAC | Telehealth | Low | Narrative | Advantages of telehealth include improved access to health professionals and decreased time loss and costs for patients, optimized time use and increased productivity for health professionals, and improved service efficiency for providers. On the negative side, the service becomes depersonalized for both patients and clinicians, confidentiality issues may arise, and potential legal implications for health professionals, including clinical risk management, may be a concern. Clinical staff may be required to perform additional research tasks such as data collection, which might not be considered the main objective when they must compete with the pressures of providing a service. Nonetheless, it appears |
Designs: Any | ||||||||
Number of studies: 27 | ||||||||
to be both feasible and practical to make greater use of telehealth initiatives in order to provide a more equitable palliative care service that is meant not to replace but to enhance the traditional model. | ||||||||
[61] | To provide a comprehensive literature review and critical appraisal of intervention studies with family caregivers of loved ones on hospice | Search date: 1983-2008 | Family caregivers of patients receiving palliative care at home in the US | Community | Videophone support, emotional support, self-care/stress reduction, massage | Low | Narrative | Generally positive findings but limited by methodological weakness and mixed results. |
Designs: Any evaluative | ||||||||
Number of studies: 5 | ||||||||
[54] | To assess evidence about interventions to improve palliative and end-of-life care | Search date: 1990-2005 | People with terminal illness (for example, advanced cancer) and chronic, eventually fatal illness with ambiguous prognosis (for example, advanced dementia) | Any | Case management, coordinated supportive cancer care, nurse care management, in-home support, interventions targeting management and informational and relational aspects of continuity | Medium | Narrative | Moderate evidence supports multidisciplinary interventions that target continuity to affect utilization outcomes. Evidence is strong for reducing readmissions in heart failure, but insufficient evidence was available for other conditions. Successful interventions involved multidisciplinary teaming, addressed patient needs across settings and over time, and facilitated communication by personal and technological means. |
Designs: SRs and any evaluative | ||||||||
Number of studies: 9 SRs and 12 studies focused on continuity | ||||||||
[48] | To establish whether community SPCS offering home nursing increase rates of home death compared with other models | Search date: Earliest records-2011 | People with LLI receiving EOL care | Community | Practical nursing support with or without domestic support, education, transition support, tele-support | COI declared | Meta-analysis using OR | Meta-analysis indicated a significant effect on home deaths for SPCS with home nursing versus other care; however, the only two RCTs found no effect. Symptom management or QOL was not compromised and costs were not higher in any study that measured these. |
Designs: Comparative | ||||||||
Number of studies:9 | ||||||||
[62] | Does case conferencing improve care planning in palliative patients? | Search date: 1990-2005 | Palliative population | Community, inpatient, RAC | Case conferencing between GPs and other healthcare professionals and families | Medium | Narrative | Case conferences were generally acceptable to GPs. Participant perceived benefits included: improved communications between participants; increased GP knowledge about the patient’s illness; interactive discussions with other healthcare professionals as a result of the face-to-face communication; improved inter-professional respect particularly as GPs often did not have a good idea of the roles played by other health providers; a learning opportunity for all participants; a mechanism for de-briefing, particularly when dealing with particularly difficult patients; reduced professional isolation; increased team building and promotion of a team approach to caring for terminally ill patients. Patient outcomes included: assisting in discharge from hospital; improved practice; reduced inappropriate medications, including identification of medication-related problems; increase patient and carer awareness of services; identification and resolution of problems; reduced primary care visits; maintenance of function and independence; increased use of services. No effect observed on quality of life or survival; effect seemed to be limited to outcomes the care teams had direct influence on. |
Designs: Any evaluative | ||||||||
Number of studies: 20 | ||||||||
[59] | To test the efficacy of a palliative care model in patients with dementia | Search date: 1966-2003 | People with advanced dementia | RAC, acute hospital | Dementia Special Care Unit (DSCU), palliative care plans aimed at maximising comfort and minimising invasive or aggressive treatment (including hospitalisation) | Medium | Narrative | Patients in the DSCU had lower discomfort and fewer transfers to acute medical setting but higher mortality; the study in the acute hospital setting found no effect on length of hospital stay or reduction in painful interventions. |
Designs: Any evaluative | ||||||||
Number of studies: 2 | ||||||||
[49] | To determine if providing home-based end of life care reduces the likelihood of dying in hospital and what effect this has on patients’ symptoms, quality of life, health service costs and care givers compared with inpatient hospital or hospice care. | Search date: 1950-2009 | Adults receiving terminal care at home who would otherwise require hospital or hospice inpatient care. | Community | EOL care at home providing active treatment for continuous periods of time by multidisciplinary healthcare professionals | Medium | Meta-analysis using risk ratio | Those receiving home-based end of life care were statistically significantly more likely to die at home. There was some evidence of increased patient satisfaction with home-based end of life care, and little evidence of the impact this form of care has on caregivers. No statistically significant differences were found for functional status, psychological well-being or cognitive status. |
Designs: Comparative | ||||||||
Number of studies:4 | ||||||||
[42] | To determine whether the provision of palliative day care services (PDS) have a measurable effect on attendees’ wellbeing | Search date: 1978-2009 | Patients with LLI | Day care | Holistic, individualized palliative care, including medical and nursing care, allied health and complementary therapies, social support, | Medium | Little evidence of impact on QOL but people report that attending PDS is a valuable experience that allows them to engage with others and to be supported in a restorative environment. | |
Designs: Any evaluative | ||||||||
Number of studies:35 | ||||||||
[63] | To review the impact of the Gold Standards Framework (GSF) since its introduction to the UK in 2001 | Search date: NR-2008 | People receiving EOL care | Primary care | Toolkit to improve the quality, coordination and organisation of EOL care | Medium | Narrative | Evaluation to date has focused on the GSF’s impact on care processes rather than outcomes. The GSF has proven acceptability and can influence multidisciplinary collaboration, communication, assessment and care planning |
Designs: Any | ||||||||
Number of studies:27 | ||||||||
[55] | To identify and analyse all published RCTs that focus on the organization of EOL care provided to persons who are terminally ill, near death, or dying | Search date: NR | People who are terminally ill, near death or dying | Inpatient, community | Multidisciplinary care, staff training | Low | Narrative | Community or home-based EOL care compares favourably with more traditional or conventional hospital-based and episodic medical care in improving symptoms and in the opinions of patients and caregivers |
Designs: RCTs | ||||||||
Number of studies:23 | ||||||||
[56] | To systematically review the evidence for effectiveness of specialized palliativecare | Search date: earliest records-2007 | Terminally ill | Community, inpatients, outpatients | Multidisciplinary care and support, education, caregiver support, coordination, | Medium | Narrative | Evidence was most consistent for effectiveness of SPC in improvement of family satisfaction with care (7 of 10 studies). Only 4 of 13 studies assessing QOL and 1 of 14 assessing symptoms showed a significant benefit of the intervention; however, most studies lacked statistical power. There was evidence of significant cost savings in only 1 of 7 studies that assessed this outcome. |
Designs: RCTs | ||||||||
Number of studies: 22 |
Ref | Model of care | Setting/ | Referral/ | Delivery personnel | Communication/ | Intensity/ | Comparator | Outcomes | Findings | Quality* |
---|---|---|---|---|---|---|---|---|---|---|
population | access | coordination | complexity | |||||||
[64] | Case management | Community-dwelling ‘seriously chronically ill’ (<2 year life expectancy)with COPD or CHF (N=192) | Patients receiving treatment from one of multiple managed care organizations | Nurse case-managers, supported by medical director, social worker and pastoral counsellor | Primary care physician, health plan case manager and community agencies | NR | Usual care, including telephone-based medical and disease- oriented case management | Self-management, preparation for EOL, symptoms, QOL, medical service utilisation | IG reported lower symptom distress, greater vitality, better physical functioning and higher self-rated health. ED utilisation was equivalent across groups | Poor |
Case management | Rural community-dwelling patients newly diagnosed with advanced cancer (N=322) | Patients identified by the VA Medical Centre’s tumour board | PC advanced practice nurses, supported by PC physician, psychologists, and ‘other team members’ | Referral to medical teams and community resources as required | 4 face-to-face sessions with monthly telephone follow-up and group shared medical meetings | Usual care at VA Medical Centre | QOL, symptoms, depression, days in hospital, ED visits | IG higher scores for QOL and mood, but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or ED visits. | Good | |
[68] | Consultation | ICU inpatients with a terminal or preterminal condition (N=20) | Patients identified by intensivist indicating that (s)he believed treatment should not be escalated or should be withdrawn | PC physician, registrar, resident and clinical nurse consultant | None indicated | Daily ward rounds | Usual ICU care | ICU and hospital length of stay and satisfaction with quality of care of families, intensivists, and bedside nursing staff, ICU and hospital mortality, the number of medical teams caring or consulting for the patient | No statistically significant differences | Poor |
[69] | Consultation | Hospital inpatients with LLI | Referrals received from all medical services and inpatient units | PC physician and nurse, hospital social worker and chaplain | Liaised with hospital subspecialists, attended discharge meetings, electronic discharge information sent to GP | NR | Usual inpatient care | Symptom control, levels of emotional and spiritual support, patient satisfaction, total health services costs, survival, number of advance directives at discharge, and hospice utilisation | IG had fewer ICU admissions, lower 6-month net cost savings, and longer median hospice stays. There were no differences in survival or symptom control. | Good |
[67] | Case management | Oncology inpatients and outpatients referred to PC service (N=159) and their caregivers | Referred by oncology inpatient or outpatient services | SPC service NOS, GP | Follow-up communication in both arms via faxed or posted letters, and telephone communication between family physician and specialist, or domiciliary nurses present at specialist team meetings acting as an intermediary | Single case conference via telephone and follow-up as required | Usual oncology inpatient or outpatient care | QOL, caregiver burden | No significant differences in magnitude of change in QOL from baseline but IG showed better maintenance of some physical and mental health measures of QoL in the 35 days before death | Poor |
[70] | Consultation | Outpatients with New York Heart Association functional classes III and IV CHF (N=13) | NR | SPC NOS | NR | Initial consultation + monthly for 5 months | Usual cardiology care | Anxiety, depression and QOL | Low recruitment and attrition precluded analysis | Poor |
[71] | Consultation | Acute care inpatients with advanced dementia (N=32) and their caregivers | Recruited from acute medical wards | SPC NOS | Copies of ACPs were placed in the medical notes and sent to GPs and RAC (where relevant) | Up to 4 consultations | Usual inpatient care | Caregiver distress, decision satisfaction, QOL and (if the patient died) satisfaction with EOL care | Attrition precluded analysis | Poor |
[72] | Consultation | Oncology outpatients with newly diagnosed metastatic non–small-cell lung cancer (N=151) | Recruited from oncology outpatients | PC palliative care physicians and advanced-practice nurses | Care coordination NOS | Average number of 4 SPC visits | Usual oncologic care | Anxiety, depression, QOL, survival, health service use | IG had higher QOL, lower depression and longer survival despite less aggressive EOL care | Good |
Attributes of effective palliative care
Country | Attributes of palliative care service delivery recommended by national policy |
---|---|
Australia [23] | • Provide enhanced, coordinated support for carers, volunteers, communities of carers and carer respite |
• Provide coordinated, flexible local care delivery for people at the end of life regardless of where they live and address any barriers | |
• Further improve the skill and confidence of the generalist workforce | |
• Enhance online palliative care support to ensure adequate numbers of skilled palliative care specialist providers across all disciplines | |
• Include end of life and palliative care competencies in all care worker training packages | |
• Enhance and legitimise the role of specialist consultancy services in providing direct clinical advice, education and training, advocacy for end of life issues and training places | |
• Record and track advance care planning within electronic health records | |
• Develop sustainable models of quality palliative care in the private sector | |
• Develop the role of the general practitioner in palliative care | |
• Undertake further research and ongoing monitoring of the relative cost of care | |
Canada [79] | • Availability and access to services |
• Education for healthcare providers | |
• Ethical, cultural and spiritual considerations | |
• Public education and awareness | |
• Support for family, caregiver and significant others | |
Ireland [80] | • Provision of physical, psychological, social and spiritual support, with a mix of skills, delivered through a multi-professional, collaborative team approach |
• Patients and families are supported and involved in management plans | |
• Patients are encouraged to express their preference about where they wish to be cared for and where they wish to die | |
• Carers and families are supported through the illness into bereavement | |
• The overall whole time equivalent (WTE) SPC nurse to bed ratio should not be less than 1:1 | |
• In each day care centre, there should be a minimum of one WTE SPC nurse to every 7 daily attendees. | |
• There should be a minimum of one WTE specialist palliative care nurse per 150 beds in each acute general hospital | |
• There should be a minimum of one WTE specialist palliative care nurse in the community per 25,000 populations. | |
• There should be at least one WTE physiotherapist per 10 beds in the specialist palliative care inpatient unit, with a minimum of one physiotherapist in each unit | |
• There should be a minimum of one WTE community physiotherapist specialising in palliative care per 125,000 population. This post should be based in the specialist palliative care unit | |
• There should be at least one WTE occupational therapist per 10 beds in the specialist palliative care inpatient unit, with a minimum of one occupational therapist in each unit. | |
• There should be a minimum of one WTE community occupational therapist specialising in palliative care per 125,000 populations. This post should be based in the specialist palliative care unit | |
• There should be at least one WTE social worker employed per 10 beds in the specialist palliative care unit, with a minimum of one social worker in each unit | |
• There should be a minimum of one WTE community social worker specialising in palliative care per 125,000 population. This post should be based in the specialist palliative care unit | |
• Specialist palliative care services in all other settings, including general hospitals and the community, should be based in or have formal links with the specialist palliative care unit | |
• All specialist palliative care units should provide day care facilities for patients and carers | |
• Appropriate transport should be provided for patients to and from the centre | |
• There should be one point of entry to hospital services for palliative care patients, and subsequent referrals should be speedily organised | |
• In Accident and Emergency, the patient’s condition should be rapidly assessed, and the patient should be referred to the appropriate team without delay | |
• The specialist palliative care team in the community should be an inter-disciplinary consultant-led team | |
• The specialist palliative care team should be based in, and led by, the specialist palliative care unit in the area | |
• Specialist palliative care nurses should provide a seven-day service to patients in the community | |
• Arrangements should be made for the transport of patients receiving palliative care to different care settings, when required | |
• Bereavement support should begin early in the disease process, long before the death of the patient. | |
• Multidisciplinary assessment to ensure that all needs are identified early and individualised plan is established | |
• Allocate a care coordinator to each dying person | |
• Provide access to clinical care for each dying person (medical services, respite care, counselling, etc.) | |
New Zealand [81] | • Provide access to support services for dying patients and their families |
• Ensure dying people and their families have access to essential palliative care (initial and specialized palliative acre)- at least one local palliative care service in each district health board | |
• Provide induction and ongoing training for volunteers in the community assisting in palliative care | |
• Provide flexible palliative care to meet varying and specific needs | |
• Inform the public about PCS. |