Death is sometimes quick and unexpected, and we have no choice in the matter. More often though, it’s a long, slow process that affords us the chance to choose how we spend our final days. Or it would, if our public health system wasn’t plagued by outdated policies, inefficient spending and ill-equipped health professionals. That’s where our new Master of Palliative Care comes in.
Until very recently, the majority of Australians died unexpectedly. However, the current reality is that most Australians will experience an expectant death at an older age, and with one or more progressive chronic illnesses – cancer, heart failure, chronic renal failure, chronic obstructive pulmonary disease, cognitive impairment and/or other neurological conditions.
Most people desire to remain as independent and as well as possible in their preferred place of care, which is usually at home. Palliative care is essentially about helping people facing an expectant death to achieve this goal.
While there are many definitions of palliative care, it’s best described as a philosophy of care focused on enabling people with a progressive life-limiting illness to live as well as possible, with minimal discomfort and suffering and in the manner they wish until they die. It also includes supporting a patient’s family through the process, too.
In Australia, the average age of a person receiving palliative care is 75 years. While most people consistently state they desire to die at home, the reality is the majority finish up dying in hospital. For many people, their preferred place of care and death are likely to be two very different locations, with most electing to spend as many days as possible at home and only electing to be transferred to hospital when their care needs exceed available community resources or when death is imminent.
Reconfiguring community-based care, as well as our palliative care services and their associated funding mechanisms, is required if we are to enable more people facing an expectant death to spend more days at home.
We know that 10 per cent of the Australian healthcare budget is actually spent on care for people during their last year of life, but a large proportion of these funds are spent on treatments that are quite burdensome and offer few benefits for people living with advanced disease.
Designing new, appropriately targeted and funded models of care is crucial if we are to address this reality. Health professionals need to be part of, if not leading, that process. And, they need to understand and be prepared to apply public health principles to strengthen palliative care provision in their local health service, as well as nationally and globally, especially in Oceania and Asia.
In addition to policy and funding reforms, we also need to ensure that every health professional understands and acknowledges the role they play in providing palliative care. This requires a health workforce with the capabilities to deliver the best evidence-based palliative care in any setting. The key to achieving this is access to high-quality palliative care education.
Our new Master of Palliative Care program will be the first interdisciplinary postgraduate palliative care qualification to be offered by a university in NSW. The master, due to be launched in 2019, will target experienced health professionals across all clinical disciplines, as well as those working in policy and education. It’s designed to meet future palliative care needs, and is configured to drive policy and clinical practice reforms that will demonstrably improve palliative care outcomes for all patients and their families.
For example, one of the first ideas we’ll be exploring in the degree is unconscious biases. Our patients come from all walks of life. As such, we need to be cognisant that our own backgrounds, personal experiences, societal stereotypes and cultural context all converge to unintentionally impact our decisions and actions. Recognising and overcoming unconscious biases is essential to ensuring the care we provide to people with differing values and beliefs, and those from vulnerable populations, is optimised.
Our masters students, in addition to exploring advanced symptom management, pharmacology and complex communication skills, will look at how changing societal expectations are driving the establishment of policies and practices that foster more compassionate communities, and their role in this emerging social movement. The degree will outline the innovation required in aged care policy and practice to ensure the care provided in this setting is of equal quality to that provided within our specialist palliative care services.
Recently, we’ve seen a rapid escalation in new treatments and healthcare costs, a growing incidence of elder abuse, increasingly complex advance care planning and the enactment of Physician Assisted Suicide legislation in Victoria. As such, Australia needs healthcare professionals who can focus on and challenge outdated practice, actively contribute to legal and ethical debates and uphold the principles of social justice.
Good palliative care offers the potential of improving patient and carer outcomes, especially into and beyond bereavement, whilst also improving the use of scarce healthcare resources. There are compelling humanitarian, moral, ethical, and clinical imperatives for palliative care.
This new masters will also consider the future role of technology in all of its guises – ranging from artificial intelligence, to adaptive technology, remote monitoring, and social robotics – and how these advances will enable more people to remain at home for longer while receiving the best evidence-based palliative care.
There’s no question that Australia’s health care system is ripe for innovation. By preparing our health professionals to be those innovators society needs, more Australians with palliative care needs, regardless of where they live, will be able to spend more days in their place of choice, and receive the best and most cost-effective palliative care we, as a nation, can provide.
It’s time to change the way dying is managed in Australia.
Faculty of Health