As a person’s illness progresses, care may be delivered by multiple providers, services and specialist care teams. Understanding the values, goals and preferences of the person, their family and carers – and communicating these effectively during transitions within and between care settings – will help to support the delivery of effective, person-centred, coordinated care.[1-3]
A key factor influencing the type of service to provide people with life-limiting illnesses is the intensity of their needs and preferences.[1, 4-6] People affected by life-limiting illness can experience a variety of needs that can vary in complexity and severity during the illness trajectory. This includes:[1, 6-10]
- Management of physical symptoms including pain, weakness, fatigue and dyspnoea
- Management of psychological symptoms
- Need for social support
- Culturally specific needs related to language problems and information disclosure preferences
- Need for information about treatment, diagnosis or prognosis
- Spiritual and existential concerns including hope, loss of meaning and uncertainty
- Financial concerns including loss of income and medical costs
- Legal concerns including preferences for end-of-life care and advance care directives.
A range of services and health professionals are required to meet each of these needs. Communication within and between services and individuals plays an important role in coordinating this care. Verbal communication between care providers should be supported by written information to ensure seamless care and to avoid the provision of care that does not align with the person’s preferences.
Michelle requires care from multiple care providers.
Her bone scan identifies that she also has metastatic deposits on her spine which causes her back pain. Following these results Michelle’s medical oncologist referred her to the radiation oncologist and a plan for palliative radiation therapy has been put into place.
Michelle attends her planning appointment at the radiation therapy department. She sees Jeremy Peters, the radiation therapist, who responds to her questions about palliative radiotherapy. He orientates her to the radiation therapy department and the different types of equipment used in the planning process and the delivery of radiation therapy.
- What are the main sources of distress for Michelle at this time?
- What specific communication strategies did Jeremy use to help Michelle understand her treatment?
- What additional communication strategies could Jeremy use to improve this interaction?
- What communication strategies should Jeremy use to achieve coordinated care?
- Palliative Care Australia. National Palliative Care Standards. 2018; 5th Edition:[Available from: http://palliativecare.org.au/standards].
- Palliative Care Australia. What is Palliative Care? 2015 [cited 2019 January 23]; Available from: https://palliativecare.org.au/what-is-palliative-care.
- Therapeutic Guidelines Ltd, Overview of Palliative Care. 2018: Melbourne.
- Palliative Care Australia. Palliative Care Service Development Guidelines. 2018; Available from: http://palliativecare.org.au/quality.
- Palliative Care Australia. Identifying Palliative Care Needs. 2017 [cited 2018 22/6/2018]; Available from: https://www.caresearch.com.au/caresearch/tabid/1507/Default.aspx.
- Palliative Care Outcomes Collaboration. PCOC Clinical Manual 2018 [cited 2019 31 January]; Available from: https://ahsri.uow.edu.au/content/groups/public/@web/@chsd/@pcoc/documents/doc/uow129133.pdf.
- Mitchell, G.K., Palliative care in australia. The Ochsner journal, 2011. 11(4): p. 334-337.
- Murray, S.A., et al., Palliative care from diagnosis to death. BMJ, 2017. 356.
- Lloyd, A., et al., Physical, social, psychological and existential trajectories of loss and adaptation towards the end of life for older people living with frailty: a serial interview study. BMC Geriatrics, 2016. 16(1): p. 176.
- Palliative Care Outcomes Collaboration. PCOC Assessment Tools. 2019 [cited 2019 Febraury 2]; Available from: http://www.pcoc.org.au/.