Palliative Care

The Team

The Palliative Care team at the Royal Adelaide Hospital has coped with considerable change in 2007.

There have been a number of comings and goings of our staff for travel, project work and maternity leave, and staff who have stepped up to fill gaps have made an enormous contribution.

Together with the Mary Potter Hospice, Calvary North Adelaide, the team continues to provide a comprehensive service to inpatients, the community and to other healthcare providers. In particular there is an important ongoing relationship with the Women’s and Children’s Hospital where Dr Michael Briffa provides medical support to their Palliative Care nursing team.

Palliative Care has continued to evolve and it is apparent that specialist Palliative Care Services cannot deliver palliative care to all those who are in need of palliative care. Increasingly we are working towards a model where the specialists provide support for generalist or primary care providers.

This has been articulated well in a NZ Cancer Treatment Working Party document (February, 2007)which states that “Generalist palliative care will be available throughout the course of a life-limiting illness, with specialist palliative care provided on the basis of assessed need, rather than simply diagnosis or prognosis.” It goes on to state that “Palliative care is provided according to an individual’s need, and may be suitable whether death is days, weeks, months or occasionally years away.”

The multi- or inter-disciplinary nature of palliative care is emphasised, and if we think about using the specialist palliative care team when needs are more complex, complexity is defined as a level of need that exceeds the resources of the generalist team, in any domain of care -physical, psychological , spiritual.

Mapcare

This is a new resource produced by a group of senior Adelaide nurses led by Heather Broadbent, as Palliative Care Council Mapcare Project Officer. Copies of the resource are on the wards but it is also available on the intranet under Resource - Corporate share - Palliative Care Resource Tool - MAPCARE. There is a wealth of information to help look after and plan ongoing care for patients needing palliative care, and to assist in making appropriate referrals for specialist palliative care advice.

Outreach and Education

The Medical Specialist Outreach Assistance Programme (MSOAP) continues with Medical staff visiting Port Lincoln, Ceduna and the lower Eyre Peninsula, as well as Port Pirie and the Mid-North. Based on submissions to the Australian Government, additional funding has been made available for 2007-8, so that visits can be scheduled on a more frequent and regular basis. In between visits, telephone support is available to GPs and community Palliative care nurses.

Telemedicine links have been established with Darwin after the signing of an MOU between the two services, and telemedicine continues with Broken Hill and Far West Area Health service of NSW for teaching. It is hoped that clinical visits will commence soon.

Meanwhile the palliative care teaching programme continues with University of Adelaide lectures, medical students visiting the Mary Potter Hospice in Years 1,4,5,6 and exam appearances. The team has also looked after a number of students on the PEPA programme (Programme of Experience in Palliative Care). Acting CNC, Karen Jacquier has also maintained the Residential Aged Care seminar programme and the Palliative Care Day which are both ongoing – contact the office for details.

Opportunities exist for Advanced Training in Palliative Medicine or for the Diploma in Palliative Medicine for Rural or General Practice trainees.

Research

The service has also been recruited as a site for the Palliative Care Clinical Studies Collaborative (PaCCSC). PaCCSC is an emerging collaboration of research sites around Australia working together to further the evidence base for the use of medications within the community for people with a life limiting illness.  The evidence gathered will be used in improving clinical practice in palliative care and, depending on study findings, registration for new indications with the Therapeutic Goods Administration and applications for subsidy to the Pharmaceutical Benefits Advisory Committee.

Memorial Service

The RAH Memorial Service is held every year on the first Sunday in November in the RAH Chapel, usually at 3pm. It is open to any patient, family member or member of staff who would like to attend, and aims to remember and to celebrate the lives of loved ones who have died either at the RAH or elsewhere.

The RAH Chaplains lead the service with help from members of the Palliative Care team including the Grief Counselling team.

The Future

With announcement of the State Health Plan, which excluded Palliative Care from the proposed Marjorie Jackson-Nelson Hospital, there are clearly significant challenges ahead to ensure access to specialist palliative care for those who need it in the acute hospital setting.

Palliative Care itself continues to be challenged as to how it measures outcomes. With this in mind we have had medical and nursing representatives at recent Palliative Care Outcomes Collaboration (PCOC) meetings interstate and if data entry problems can be resolved we will plan to embark on this process.

Life is never dull and it seems that the end of life isn’t either!

STAFF ACTIVITIES AND INTERESTS

Dr Mary Brooksban
Chair , Melanoma Guidelines Palliative Care Chapter Working Party – nearly finished
Chair, Prostate Cancer Guidelines Palliative Care Chapter Working Party- due 2008
Chair and contributor, Palliative Care Seminar, World Institute of Pain meeting, Budapest, September, 2007
In preparation: Topical review of palliative care for the journal Pain
Ongoing – FAChPM Curriculum development

Dr Michael Briffa
PaCCSC co-ordinator
Secretary, FAChPM
Special interest in Paediatric Palliative Care

Dr Rebecca Seidel
PCOC representative

Dr Leonie Zadow
Special interest in anorexia-cachexia
Hypnosis in Palliative Care

Karen Jacquier  Acting CNC
Palliative Care Resource Nurse in Aged Care Programme.  Poster presented at Palliative Care Australia Conference, August 2007.