Original Research Article Exploring barriers to the provision of palliative care in Australia
AM S J
Kieran G Allen Third Year Medicine (Undergraduate) Monash University
Kieran is a joint recipient of the 2009 Monash University Chris Silagy Award for his exceptional project in the Community Based Placement Program. Kieran is currently placed at Eastern Health. He hopes to further his interests in palliative care and its implementation into the health profession training programs.
Sadid F Khan Fourth Year Medicine (Undergraduate) Monash University
Sadid also received the 2009 Chris Silagy Award with partner Kieran Allen for their project into palliative care as part of their Monash University Community Based Placement Program. He has numerous interests in medicine and surgery, as well as in medical education.
Palliative care provides assistance for people living with a terminal medical condition, for which the primary goal of treatment is improving quality of life. There are numerous barriers to the provision of palliative care. There is little research into barriers to the provision of palliative care and little with an Australian context. This research explores barriers to palliative care in Australia through questionnaires and interviews with stakeholders. One hundred and one questionnaires were given to South East Palliative Care (SEPC) community nursing and allied health staff, general practitioners and aged care facility staff. Five interviews were conducted with representatives from SEPC, Palliative Care Australia and two aged care facilities. Most agreed that palliative care was essential in the community, hospital and aged care setting. Four major themes were identified from interviews: 1.) Education & stigma barriers; 2.) Communication barriers; 3.) Aged care barriers; and 4.) General practice barriers. Inadequate prescriptions of pain medication were a significant issue. These themes were supported by questionnaire data, with 25.6% identifying education and 28.2% identifying resources as major barriers. Knowledge of palliative care was poor in both aged care staff and GPs, only 8.3% and 38.5% respectively answering all palliative care questions correctly, compared to 64.2% amongst SEPC staff. The study addresses a deficit in previous research, identifying barriers to palliation in aged care. The data collected has potential for further research or interventional approaches to improve the provision of palliative care for Australians.
Introduction
have been found to be inexperienced in the management of pain in palliative care. [9,11] Consequently, many patients experience severe pain in the final stages of their lives. [9,12] This failure of adequate pain management may be attributable to the fears of doctors in prescribing palliative doses of analgesia, often due to anxiety surrounding physical or psychological addictions to opiates or the stigma associated with analgesia-related deaths. [9,11] This study seeks to further investigate the barriers to the provision of palliative care in an Australian context, through cross-sectional qualitative and quantitative data collection. It aims to explore barriers relevant to the provision of community palliative care, as well as grossly assessing knowledge of palliative care in healthcare professionals and determining potential suggestions to address any identified barriers.
Methodology
The World Health Organisation (WHO) defines palliative care as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention of suffering... and treatment of pain and other problems – physical, psychological and spiritual.’ [1]
The methodology aims to elicit the best understanding of the barriers to the provision of palliative care through the involvement of the following stakeholders:
Much of the current research into barriers to the provision of palliative care relate to psychological and spiritual issues. Research into barriers to palliative care is scarce in an Australian context. Additionally, there are deficiencies in the literature relating to the provision of palliative care in aged care facilities; a setting where many palliative patients reside. [2-5]
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The provision of palliative care is impeded by barriers of varying nature. Often these barriers involve interactions between healthcare professionals, particularly General Practitioners (GPs). [2-6,10] Improvement is required in both the frequency of referrals and communication with palliative care facilities. Additionally, there is a need for increased communication and interactions between aged care facilities and palliative care providers. [2,9] Inadequate teaching and experience of palliation in the medical profession has been seen to be a major issue, repeatedly being identified by doctors as a major contributor to an apparent lack of understanding. [3-6,10] A large proportion of doctors (72-76%)
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Community palliative care nursing and allied health staff from South East Palliative Care (SEPC) Aged care facility (ACF) carers & nursing staff Palliative Care Australia - the peak body for palliative care policy advocacy and implementation in Australia GPs.
The results were gathered using a combination of questionnaires and semi-structured interviews. The questionnaire was distributed to SEPC, aged care staff and GPs. Consent for participation was implied upon completion and return of the questionnaire. The questionnaire contained three collection methods. The first required respondents to indicate the degree to which they agreed with a given statement, using a Likert scale (strongly disagree=1, disagree=2, neutral=3, agree=4, strongly agree=5). Secondly, questions were posed to ascertain the respondent’s level of knowledge surrounding palliative care. Open ended questions enabled the collection of qualitative responses, allowing respondents to elaborate on their beliefs surrounding barriers to palliative care. Questionnaires were distributed to 30 SEPC staff, 30 aged care staff
Australian Medical Student Journal
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