The report of the Senate Inquiry into Palliative Care in Australia has provided some welcome acknowledgment of an issue that everyone needs to think about and discuss – one in which information, care and support are not available evenly across the country. It has also provided some important insights into what can be achieved in rural and remote areas by primary care professionals backed up by specialised support. Specialised palliative care services are less likely to be available locally in rural and remote areas. This means that nurses in primary and aged care services with the capacity to provide some general palliative care as part of their usual practice are critical in those areas for providing people with the choice of spending the end of their life in their local communities. The pathways that country people follow between primary and hospital care in local, regional and city services may affect the critical access points for information about choices and access to palliative care. Nurses are a critical link in the information chain at many points. Telehealth has the potential to link people and their health care providers in rural and remote communities with specialist palliative care advice. Face-to-face consultation with a local health professional is always best, but a video consultation with a palliative care team or other specialist can provide additional support. Practice nurses and nurse practitioners can play a role in facilitating this support through the MBS items for telehealth consultations with specialists (http://www.mbsonline.gov.au/telehealth). CareSearch at http://www.caresearch.org.au is funded by the Australian Government Department of Health and Ageing as an online resource of palliative care information and evidence, including links to help with finding palliative care and other relevant services. Palliative Care Australia at www.palliativecare.org.au has a wealth of online information as well, including a brochure about morphine and other opioid medicines in palliative care. Supply of medicines for pain management, and related advice, can be a particular issue for people in rural and remote communities who do not have a pharmacist nearby.
Culturally safe care when addressing end of life needs is also an essential part of rural palliative care, given the variety of cultural backgrounds of Australia’s rural population and the higher proportion of Aboriginal and Torres Strait Islander people in rural and remote communities. Aboriginal and Torres Strait Islander people have a strong connection with country. Understanding this, and possible cultural obligations, can make final stages of life more comfortable for patients and their families. Monitoring the effectiveness of government responses to reports such as the Palliative Care Inquiry is part of the continuing work of the Alliance. At present there is a strong focus on the implementation of health reforms such as Medicare Locals, block funding for small hospitals, the Living longer, living better reforms in ageing and aged care, and the National Disability Insurance Scheme. The 12th National Rural Health Conference, to be held in Adelaide 7-10 April 2013, is an important forum for sharing successes and new ideas, and for building on the wealth of existing experience for improving health for country people in the future. The Conference’s call for abstracts, which closed recently, is in effect a point-of-time audit of contemporary issues influencing health and wellbeing of people in rural and remote areas. The health of Aboriginal and Torres Strait Islander people is an area of key concern among the more than 500 abstracts received. Many abstracts confirm continuing concerns about chronic conditions including mental health, cardio vascular disease, poor oral health and diabetes. Under the theme Strong Commitment, Bright Future, the Conference will provide excellent opportunities for rural people to share their experiences and strategies for delivering successful health services in even the most remote locations. You can keep in touch with all 12th Conference developments at www.ruralhealth.org.au or follow developments on Twitter: @NRHAlliance #ruralhealthconf
The most effective models of palliative care consider the wishes of people with advanced life-limiting disease, taking into account the probable trajectories of their diagnosed conditions. A person’s eHealth record can help with the location of the advanced health care directive. 13