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Strategy for palliative care reflects shift in approach - Waikato DHB

Fuseworks Media
Fuseworks Media

Peter Kirk, palliative care specialist and clinical director of Waikato Hospital Palliative Care, with Gordon Giddings, medical director of Hospice Waikato.

Palliative care specialist Peter Kirk says the new Waikato Palliative Care Strategic Plan reflects "a big shift in our approach to palliative care that has been happening for a few years now".

That shift includes better coordination, more focus on what patients and their families want, a changing view of when and how patients interact with palliative care, and a push for equity and improved access to services and support particularly for Maori and rural people.

It also moves palliative care away from ‘last few days’ care, to being a positive involvement earlier in care.

"Relatively recently, palliative care was only involved in the last few days before someone died, but that’s not true anymore," Peter Kirk says. "We are coming to understand the importance of using palliative care earlier to support someone with life-threatening or life-ending illness and giving them quality of life."

"Research indicates palliative care can make a difference not just to quality of the life remaining, but also the length of it."

Kirk says different life-limiting conditions require different responses from a palliative care service.

"Palliative care is not just about cancer. It applies to any illness or condition that is entering an end state. Respiratory failure, renal failure, heart failure and motor neurone disease are now included just as much as cancer.

These conditions follow very different paths. Some have a sudden decline to death. Others create long-term limitations on a person’s life with some serious episodes and eventually death. And sometimes there is a long, gradual decline with increasing physical and mental frailty, which creates its own issues in terms of deciding when intervention is appropriate.

"How and when a person interacts with palliative care will depend on what condition they have."

And also where they are. There is a strong trend to deliver palliative care as close to home as possible. GPs (general practitioners), community based nurses and allied health staff are most often the health professionals providing a person and their family with care and support. However sometimes specialist palliative care input is needed.

Rather than coming to Waikato Hospital, which can be stressful for patients and families, Waikato DHB and Hospice Waikato are looking at ways of bringing specialist care to where patients are - at home or in perhaps a residential care facility - through video links.

Hospice Waikato has funding from the Ministry of Health for a project called Hospice Anywhere which will extend specialist palliative consultations into patients’ homes. Led by Hospice Waikato medical director Gordon Giddings, the teleconferencing project has already run "pilots" in Thames and Tokoroa to learn how patients feel about virtual consultations, compared to a face-to-face meetings.

Peter Kirk explains that the same patients have personal experience of both options (a "virtual" meeting with a specialist using teleconferencing, and a physical meeting), so they can compare the experience.

"So far there seems to be no difference in terms of patient satisfaction. We need to do more research on this, but it is very encouraging."

Waikato covers a huge geographical area, with many rural communities and small towns, and "virtual health" technology will help specialist palliative advice and care reach out to people in a more cost-effective and yet personal way.

About Waikato Palliative Care

Waikato palliative care involves community based GPs and district nurses, specialist child and youth services, and adult hospital and hospice services, with Waikato DHB and Waikato Hospice working together as a combined service with the motto "one programme two sites".

"Our aim is to provide the best care we can, at home, in a clinic, or in a hospital. Our vision is to improve the quality of living and dying in our community."

The Waikato Palliative Care Strategic Plan 2016 -2021 sets out six priorities for action:

Improve access for Maori

Improve access for those in rural and deprived communities

Educate and support the primary care workforce

Strengthen the palliative care services provided to children and adolescents and young adults

Increase the availability of nursing and allied health professionals to support patients and their whanau/families

Ensure the specialist workforce is resourced and trained to support the increasing patient load and the non-specialist workforce.

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