Following VICS Optimal Care Summits consultations on pancreatic cancer (2017) and lung cancer (2019), the Victorian Department of Health identified timeliness of advance care planning and referral to palliative care for people with metastatic cancer as possible areas for improvement. BSWRICS led a statewide scoping project to understand current practices relating to palliative care referral and advance care planning in Victoria.

The final report from the project made 18 recommendations to address variations in the timing of access to palliative care and advance care planning, collection and storage of data, promotion of palliative care services, processes, models of care, and research and quality improvement activities.

Recommendations

Study of patterns of end-of-life care

Timing of access to palliative care and advance care planning (ACP)

Recommendation 1: Patients of metastatic/advanced cancer receive a timely referral to specialist palliative care (defined as at least three months before death) alongside or in addition to the usual care.

Recommendation 2: Patients with metastatic/advanced cancer have access to and are given the opportunity to undertake ACP early in their pathway of care.

Recommendation 3: Patients with metastatic/advanced cancer are given the opportunity to document their preferences for care in an advance care directive (ACD) and/or to appoint an medical treatment decision-maker (MTDM).

Collection and storage of data

Recommendation 4: Include data items specific to hospital-based consultancy palliative care in the population-wide Victorian Admitted Episodes Dataset (VAED).

Recommendation 5: Strengthen the data collection around community and ambulant/outpatient palliative care recorded in the Victorian Integrated Non-Admitted Health (VINAH) dataset to enable future capture of all settings of palliative care provision and allow for more complete benchmarking over time in and across sectors.

Recommendation 6: Advocate to expand outpatient palliative care services to improve access to early palliative care and ensure this activity is recorded reliably.

Qualitative review of medical records

Promotion of palliative care services

Recommendation 7a: Promote to health services/professionals delivering cancer care that palliative care services are as essential in treating metastatic/advanced cancer as other disciplines and should be provided concurrently with other cancer treatments.

Recommendation 7b: Encourage more palliative care teams to participate in multidisciplinary meetings (MDMs) to represent a ready and reliable way of highlighting the need for palliative care referral.
Recommendation 8a: Disseminate information about palliative care education programs within the cancer sector to heighten awareness of and access to palliative care education.
Recommendation 8b: Promote early palliative intervention so clinicians may consider timely referral of all patients with advanced/metastatic cancer to specialist palliative care.

ACP processes, models of care and research and quality improvement activities

Recommendation 9: Health services develop rigorous processes (to meet the statutory record-keeping requirements of the Medical Treatment Planning and Decisions Act 2016 (PDF) that will enable them to identify if a person has an ACD on admission and ensure the documentation is uploaded into the medical record.

Recommendation 10: Review existing palliative care models in rural and regional areas to identify ways to improve patient access to specialist palliative care support (e.g. expanding access using telemedicine).

Recommendation 11: Explore community and outpatient palliative care models and undertake quality improvement activities to reduce hospital admissions for end-of-life care and achieve more proactive and anticipated palliative care in the home.

Analysis of gaps in ACP

Recommendation 12: Health services that treat patients over the age of 65 and look after patients with cancer and chronic illnesses have dedicated EFT to offer them ACP.

Recommendation 13: The cancer workforce of each health service includes ACP leaders, champions and/or trained staff in their allocated EFT.

Recommendation 14a: Health services implement specific processes to record the details of a patient’s MTDM in the medical records and make it easy for clinicians to access those details.
Recommendation 14b: Health services have processes to ensure the MTDM field is captured on admission.

Recommendation 15: Clinicians receive regular and routine ACP education using readily-available resources such as Advance Care Planning Australia’s Learning Hub, face-to-face
training and train-the-trainer for health professionals and ACP webinars available from Cancer Council Victoria.

Recommendation 16: All Victorian health services have policies, procedures and guidelines that include the necessary ACP information content and standardised consumer information, and ensure their ACD consumer information aligns with the Victorian template.

Recommendation 17:  All Victorian ACD forms follow the Victorian ACD template.

Recommendation 18: Hospital patient administration systems (PAS) include a field for MTDM.