Target Audience
This guideline is intended for clinical staff, particularly medical and nursing staff, involved in early intervention palliative care discussions and patient support caring for someone with a life limiting illness
Purpose
The purpose of this document is to outline an approach to providing care and medical treatment for patients towards the end of patient’s life. The goal is always to maintain the patient’s dignity and comfort from diagnosis inclusive of patient centered care and care that encompasses social, spiritual and cultural needs.
This guideline supports clinical staff to:
1. Recognise patients who are at risk of deteriorating and dying
2. Initiate discussion with the patient and/or family about the plan of care and medical treatment in a timely and sensitive manner
3. Make decisions about treatment to be provided in the event that the patient’s clinical condition suddenly deteriorates
4. Understand the Advance Care Planning process, including where to search for relevant documents and how to initiate discussions so that patients can be seen and supported with Advance Care Planning out in the community
5. Document and effectively communicate the plan of care across the care continuum
6. Develop a plan of care in collaboration with the patient and/or family that promotes the patient’s values, is clinically appropriate and delivers care to the dying patient to ensure a comfortable and dignified death.
7. Navigate the process for the complex patient at the End of Life where there are many clinical teams involved
Definitions
To be able to provide high quality care and medical treatment at the End of Life it is important to understand the progressive phases which can contribute and the different terminology. The following definitions are taken from the Australian Commission on Safety and Quality in Health Care Background Paper on End of Life Care in Acute Hospitals (2013), National Consensus Statement: Essential Elements for Safe and High Quality End-Of-Life Care in Acute Hospitals (2014), the Department of Health Best Care for Older People Everywhere Toolkit (2012), Advance Care Planning a strategy for Victorian Health Services (2014) and the Medical Treatment Planning and Decisions Act (2016):
Advance Care Directive
A document that sets out a patient's binding instructions or preferences and values in relation to the medical treatment of that patient in the event that the patient does not have decision-making capacity for that medical treatment. An advance care directive may contain either or both of the following:
(a) An instructional directive.
(b) A values directive.
Advance Care Planning
Advance care planning is the process of planning for future health and personal care whereby the patient’s values, beliefs and preferences are made known so they can guide decision making at a future time when that patient cannot make or communicate his or her decisions.
Non-beneficial treatment
Non-beneficial treatment refers to interventions that will not be effective in treating a patient’s medical condition or improving their quality of life. Non-beneficial treatment may include interventions such as diagnostic tests, medications, the provision of artificial hydration and nutrition, the provision of intensive care, and medical or surgical procedures.
Palliation
To palliate is to alleviate a symptom without curing the underlying medical condition. The term is used widely in health care to refer to treatments or interventions (including surgical) that are focused on alleviation of pain or other symptoms and is not necessarily limited to care provided for eventually fatal conditions. Palliation in relation to End-of-Life care is the relief of symptoms and suffering to help a patient feel more comfortable and to improve the quality of their life. Palliation of symptoms is a key goal of care for both End-of-Life and palliative care.
