GP Connect Clinical Feature by Dr. Cory Lei, MBBS FRACGP CHIA, General Practitioner, Clinician Assist WA GP Clinical Editor (WAPHA), Hospital Liaison GP (SCGOPHCG)
Surveys show most Australians express a wish to die at home but for the majority, this does not occur. Over half of all Australians die in hospitals and around a third in residential care. This represents one of the lowest rates of deaths occurring at home among OECD countries1.
Acknowledging that what constitutes a good death is highly individualistic, people often prefer to die comfortably at home, surrounded by friends and family and with appropriate care services. Other important factors include knowledge and awareness of their condition and the process of dying, dignity and privacy, control over pain and symptom relief, and access to spiritual and emotional support.
The home setting may provide a more private, comfortable, familiar environment that allows people to have an enhanced sense of control and dignity. Yet, despite individual preferences and the benefits of dying at home, there are many reasons why this doesn’t occur.
Barriers to dying at home include a lack of discussion about death and advance care planning, increased pressure on families to provide care, social isolation, funding challenges, and a lack of support services and medical care.
GPs can play an important role in supporting patients who wish to die at home through discussion and preparation of advance care planning documentation, helping patients to understand their condition, counselling and supporting patients and their family members, providing interventions for symptom management, and referring to specialist palliative care services when required.
When caring for a dying patient at home, important considerations include:
- discussing with the patient and carers what is likely to be involved in terms of care, and whether any additional equipment will be required
- informing carers and family what to expect when the patient is dying, and what to do following the death
- emotional, religious and cultural well-being needs.
The newly reviewed palliative care clinical pathways on Clinician Assist WA provide GPs with guidance on managing patients with varied palliative care needs, from evaluating new patients to the management of common symptoms.
Changes to Home Care Packages from November this year will enable recipients to access additional funding at the end of life under the new Support at Home program. Details of the eligibility assessment are included in the New Palliative Care Patient clinical pathway, which also includes a dying at home section with practical points of discussion, links to a checklist to go through with patients and take-home resources.
Information about services that are available to support GPs are also included on the Palliative Care Advice and Palliative Care Services request pages.
Providing palliative care to patients can be a meaningful and fulfilling role with a deep sense of purpose. GPs wishing to provide palliative care can explore the range of resources available on Clinician Assist WA and reach out to palliative care specialist advice services.
Useful resources for GPs:
- Clinician Assist WA – Palliative Care
- End of Life Directions for Aged Care – Primary Care Toolkit
- Palliative Care Australia – Supporting palliative care patients who choose to die at home
- Palliative Care WA
References:
1. Swerissen, H and Duckett, S., 2014, Dying Well. Grattan Institute
ISBN: 978-1-925015-61-4. https://grattan.edu.au/wp-content/uploads/2014/09/815-dying-well.pdf