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Decision Assist – Creating Palliative Care Linkages

Presenter: Ms Carolanne Barkla

The Project is managed by a consortium of national health and aged care organisations:

Decision Assist

Palliative Care Linkages Project

Aim: to enable enhancements of l inkages between service providers involved in the delivery of palliative and end of l ife care services to older Australians. Project team: • Chief Investigator: Prof. Patsy Yates • Project Manager: Annie Parks • Linkages Facilitators: Diana Harrison, Wendy Gain • Research Fellow: Dr John Rosenberg

Expected outcomes

Changes in awareness, knowledge, confidence, attitudes and skills:

• Increased awareness and communication with local services and resources

• Increased use of effective linkage strategies as identified in the review

• Improved knowledge, skills and confidence in advance care planning, and palliative care

Palliative Care Linkages Project

1. Explain the seven key linkage strategies identified in the literature review

2. Explore the ways in which these evidence-based strategies are being implemented by the demonstration projects

3. Identify the barriers and initial outcomes of implementing these strategies

1. What does the evidence tell us? Seven organisational strategies that promote linkages between services:

1. Formalised agreements

2. Role clarification

3. Written and verbal communication pathways

4. Multidisciplinary team structures and practices

5. A designated “linkage worker”

6. Knowledge exchange and upskilling

7. Continuous quality improvement

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2. Demonstration projects

• Partnerships between aged care services (community and/or residential facilities) and specialist palliative care services

• One or more linkage strategies to be implemented

• Strategies for sustainable linkages

2. Demonstration projects

Partnering organisations Number of partners

Residential aged care facilities 32

Home-based aged care services 10

Specialist palliative care services 15

Hospices 4

Ambulance service 1

GPs 1

Medicare Locals 2

Loca l government 1

2. Demonstration projects

Strategies: No. of projects nominating strategy

Formalised agreements 5

Role descriptions 3

Communications pathways 16

Multidisciplinary care 7

Linkage workers 10

Ski lls and knowledge exchange 9

Continuous improvement 3

2. Demonstration projects

Rockhampton

Gympie Brisbane (4)

Nambucca

Hunter Valley

Sydney

Melbourne (3)

Launceston

Warracknabeal

Maryborough

Echuca Adelaide (2)

Broken Hill

Perth

3. Evaluation data sources

• Organisational audits

• After death audits

• Staff surveys

• Interviews

• Linkage Facilitators’ Diaries/site visits

S1. Formalised agreements

• Barriers o “Si lo” mentality

o Formalised agreements not consistently present

• Enablers o Exis ting good will

o Executive buy-in

• Preliminary outcomes o Stronger informal linkages

o Developing MOUs

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S2. Role clarification

• Barriers o Resistance to change

o Limited knowledge of other services

• Enablers o Good understanding of roles and responsibilities

• Preliminary outcomes

o Linkage worker role trials

S3. Communication pathways

• Barriers o Resourcing and workloads

o Case conferencing not common

o Varied use of advance care planning

o Low use of technology

• Enablers o Exis ting communication practices – eg: referrals,

assessments, shared care plans

o End of life care pathways

S3. Communication pathways

• Preliminary outcomes o Referral forms, assessment tools, shared care plans

o Shared advance care planning documentation

S4. Multidisciplinary teamwork

• Barriers o Varied frequency and formats

o Varied understanding of communication and MDT practice

• Enablers o Routine sharing of care plans evident

• Preliminary outcomes

o Strong MDT = exchange of information

S5. Linkage workers

• Barriers o Funding

o Not common in aged and palliative care

• Enablers o Exis ting linkage roles in place

o Models for further development

• Preliminary outcomes o Increased communication, shared knowledge, continuity

of care

o Successful facilitation of linkages between service

S6. Knowledge exchange and upskilling • Barriers

o Pal liative Approach appropriate but not fully integrated

o Low confidence in conversations about goals of care

• Enablers o Strong support for goals of care conversations

o Good knowledge of palliative and end of life care, and advance care planning

• Preliminary outcomes o Informal and in-house strategies planned

o Accessing external sources planned

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S7. Continuous quality improvement • Barriers

o Not initially viewed as part of service change

o Linkage data not routinely collected

• Enablers o CQI i s universally familiar

o Applicable elsewhere: eg: Advance Care Planning

• Preliminary outcomes o Integrated service change

Summary

• Wide-ranging linkage strategies

• Highly contextualised settings

• Multiple strategies appear to increase success of individual strategies

• Wider benefits

Sustainability strategies

• Recognition of palliative care as core business for aged care services o Executive buy-in

o Strategic integration

• Ongoing strengthening of partnerships between aged and palliative care in all settings of care

• Development of broader networks

For further information

DECISION ASSIST – PALLIATIVE CARE LINKAGES PROJECT Project Manager: Annie Parks T: 07 3138 6262 E: annie.parks@qut.edu.au