Core Modules

module 1 | Activity 9: Personalising palliative care

There are many factors that determine the type of palliative care a person needs and the type of services that they require can change throughout their illness.[1, 2] Palliative Care Australia has defined three broad groups based on the complexity of individual needs for palliative care:[3]

Level of need for palliative care

Figure 2: Conceptual model of level of need for palliative care among people living with a life-limiting illness. Source: Palliative Care Australia. (2018) Palliative Care Service Development Guidelines.[3]

A key factor influencing the type of service required by people with life-limiting illnesses is the intensity of their needs.

Straightforward and predictable needs:

  • This group comprises people whose needs can generally be managed through their own resources (including with the support of family, friends and carers) and/or with the provision of palliative care by their existing healthcare providers (including GPs, community nurses, geriatricians, oncologists, medical specialists and other health professionals).
  • People in this group do not usually require care delivered by specialist palliative care providers.

 
Intermediate and fluctuating needs:

  • This group includes people who experience intermittent onset of worsening symptoms (such as unmanaged pain, psychological distress and reduced functional independence) that can result in unplanned and emergency use of hospital and other health services.
  • People in this group may require access to specialist palliative care services for consultation and advice. They will also continue to receive care from their existing healthcare providers in whichever care setting they are in (community, hospital or aged care setting).

 
Complex and persistent needs:

  • This group comprises people with complex physical, psychological, social and/or spiritual needs that are not able to be effectively managed through traditional primary care methods.
  • People in this group can require more ongoing direct care by specialist palliative care providers. However, this care should occur through partnerships and shared care models with primary care providers and can occur across all care settings.

 

Key concepts to consider:[1-5]

  • All people affected by life-limiting illness have a right to healthcare that is appropriate to their needs
  • Not everyone with a life-limiting illness will require access to a specialist palliative care service. For many people, care needs can be met by community and personal resources and the support of primary or aged healthcare services
  • As a healthcare professional, you are likely to encounter people in a variety of settings who may benefit from palliative care. All healthcare professionals, therefore, need knowledge and skills in providing this care.

Settings for providing care

People living with a life-limiting illness will need to have palliative care provided in many different settings. These settings can be divided into two broad settings, as represented in the diagram:[3]

Settings for providing palliative care

Figure 3: Settings for Providing Palliative Care [3]

 

Community-based settings

Hospital-based support
  • People’s homes
  • Residential aged care
  • Accommodation for people living with a disability or mental ill health
  • Correctional facilities
  • General practices
  • Community palliative care clinics and day centres
  • Inpatient palliative care beds
  • Other inpatient beds (such as acute, subacute or other beds)
  • Outpatient services, specialist rooms and other ambulatory clinics
  • Intensive care units
  • Emergency departments
  1. Compare and contrast the different levels of palliative care needs. Can you think of a person you have cared for who had a life-limiting illness and what level of palliative care need they may have had at that time?
  2. What factors can influence the level of need for palliative care services? Consider:
    • Issues associated with a person’s health needs
    • The personal resources and strengths they can draw from.
  3. How might different settings impact on a person’s (and their family’s) palliative care?
  1. Palliative Care Australia. National Palliative Care Standards. 2018; 5th Edition:[Available from: http://palliativecare.org.au/standards].
  2. Therapeutic Guidelines Ltd, Overview of Palliative Care. 2018: Melbourne.
  3. Palliative Care Australia. Palliative Care Service Development Guidelines. 2018; Available from: http://palliativecare.org.au/quality.
  4. Palliative Care Australia. What is Palliative Care A4 Brochure. 2015  [cited 2019 January 23]; Available from: https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2016/05/What-is-Palliative-Care-A4.pdf
  5. Palliative Care Australia. What is Palliative Care? 2015  [cited 2019 January 23]; Available from: https://palliativecare.org.au/what-is-palliative-care.