Australia has only half the number of palliative care doctors needed to provide good quality care for chronically and terminally ill patients despite increasing demand, a study by Australian Catholic University (ACU) has found.
Palliative care is care which enhances the quality of life for people with chronic or life-limiting conditions, including those close to death.
The study, conducted by the PM Glynn Institute at ACU, found the number of people being hospitalised for palliative care is growing at an average rate of 5% a year and services are not keeping pace.
For children, the growing demand is even more dramatic. The rate of palliative care hospitalisations for children under 15 has increased by more than 10% a year annually since 2011-12.
Three times as many children (786) were hospitalised for palliative care in 2016-17, compared with 255 six years earlier.
Despite public demand for home-based palliation, few community services exist and most terminally ill patients requiring palliative care are forced to live their last days in hospital.
Report author Dr Cris Abbu said industry benchmarks required a full-time equivalent rate of two palliative care physicians per 100,000 people in the population. Australia currently has 0.9 specialist per 100,000 people.
“Palliative care remains one of the least preferred specialisations of medical students for future practice and the rates of full-time equivalent palliative medicine physicians and palliative care nurses have remained unchanged since 2013 despite the increasing demand,” said Dr Abbu. “We need to encourage more doctors and nurses to choose this important work.”
The report recommends an active recruitment program with student scholarships and government subsidies to train an additional 225 specialist doctors.
Dr Abbu said the failure to provide appropriate community-based palliative services was also placing strain on public hospitals, which currently provide 86% of palliative care hospitalisations.
“Given an ageing population and an increase in the incidence of chronic illnesses, both of which imply increasing need for palliative care services, the burden on public hospitals is likely to increase in the future unless we find workable alternatives,” Dr Abbu said.
The report recommends developing integrated models of palliative care service provision to reduce the burden on hospitals, using community-based care to support people in their homes, in aged care, in boarding houses, and for the homeless.
It also recommends strengthening the knowledge and role of GPs in palliative care provision, and planning for end of life care a standard part of clinical practice.
The study found better specialist services were needed for palliative care of terminally-ill children. Dr Abbu said palliative care for children was often overlooked because the number of hospitalisations is small compared to older cohorts. “Sadly, the rate of palliative care hospitalisations for children under 15 has increased by more than 10% a year annually since 2011-12. We need a dedicated policy focus to ensure they have the best possible care.”
Institute Director Dr Michael Casey said palliative care was a particularly important issue with the legalisation of voluntary-assisted dying in Victoria last year and plans to introduce it in WA and under the newly-elected Queensland Government.
“People say voluntary-assisted dying is about giving patients a choice but if dying patients cannot access the palliative care services they need, they don’t really have a free choice,” he said.
“We need to do more to ensure that everyone who needs good quality palliative care can access it, wherever they are and whatever their circumstances, before considering a momentous step like voluntary assisted dying.”
With thanks to ACU.