Community palliative care
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Unit 637
September 2026
The purpose of this activity is to discuss community palliative care and highlight the critical role that general practitioners play in providing palliative care and referral pathways for consultative and shared care input from specialist palliative care services.
In Australia in 2019, approximately 15% of deaths occurred in private residences. Around 30% of deaths occurred in residential aged care homes and 51% in hospital or medical services. This means that for nearly half (15% and 30%) of these deaths, the bulk of medical care would have been led by a general practitioner. To provide this care, there are currently a variety of care models in use: some patients are managed at home or in residential aged care homes by their general practitioner alone; some in residential aged care homes in metropolitan areas have general practitioner and residential in reach; and many benefit from shared care arrangements between a general practitioner and CPC services.
CPC services are free, location-specific, nurse-coordinated programs across Australia that aim to support people with terminal conditions and their carers to live in the community as well as possible, supporting their health beliefs and wishes as well as supporting them to die in their place of preference. CPC nurses provide additional domiciliary assessments and recommendations for symptom and care management, including coordination of additional input from palliative medicine specialists, allied health professionals, and bereavement and volunteer services as required. Many nurses have specialist palliative care experience or additional qualifications; some are nurse practitioners. CPC services generally do not directly provide personal care like hygiene, although they can provide support in educating carers.
All CPC services operate under the national palliative care standards for specialist palliative care providers, and CPC services are increasingly being accredited under these standards.
CPC services can receive referrals from other health professionals, a patient’s family or the patient themselves. Many will have inclusion criteria as CPC services are experiencing increasing demand (eg with expected prognoses of less than 1 year).
Dementia, ischaemic heart disease, chronic lower respiratory diseases, cerebrovascular disease and lung cancers were the five leading causes of death in Australia in 2024. As the leading causes of death become primarily non-malignant conditions involving older-aged persons, the numbers of persons dying in private residences and residential aged care homes is likely to increase. Therefore, it is critical that general practitioners and aged care homes can provide palliative care as well as referral pathways for consultative and shared care input from specialist palliative care services.
Terry, a man aged 79 years, has been your patient for over 10 years. He has a past history of a left cerebrovascular accident 6 months ago. After the stroke, Terry experienced mild right-hand weakness and transient ischemic attacks. Terry has ischaemic heart disease and underwent stenting 10 years ago following acute myocardial infarction. He has peripheral vascular disease and grade 3 chronic kidney disease.
You have also cared for Terry’s wife, Margery, during this time. They have four children and eight grandchildren.
You were notified of Terry’s admission to hospital 3 weeks ago following another stroke. You have just received notification that he has been discharged home. The neurology discharge summary states that Terry has had a significant ischaemic left middle cerebral artery cerebrovascular accident. During admission, he was treated for aspiration pneumonia and seizures with intravenous antibiotics and intravenous levetiracetam, respectively. He is unable to weight bear or self-care and is bed bound. The neurology team have told Terry’s family that his prognosis is poor and that he is at high risk of further strokes and aspiration.
Lorraine, aged 68 years, has metastatic high-grade serous ovarian cancer. At diagnosis, she had surgery and chemotherapy. The cancer has progressed through multiple lines of chemotherapy.
Lorraine has recently been discharged from hospital following admission for another small bowel obstruction that has resolved with conservative management, including a nasogastric tube inserted for 3 days, antiemetics and analgesia. Her bowels are now opening. The hospital palliative care team was involved during her admission. They have referred Lorraine to the CPC team and have discharged her with a modified diet for the prevention of bowel obstruction, a new analgesia regime and rationalisation of medications.
Duncan, aged 77 years, was admitted to the aged care home you visit 6 months ago. He had been a patient of your regional town clinic prior to this, although he attended rarely, mainly because he lived 40 km out of town on a large property. He has hypertension and hypercholesterolaemia and had an acute myocardial infarction 20 years ago. He has presented previously for various farm-related injuries. He has osteoarthritis of the lumbar spine, bilateral knees and feet.
Duncan had been living at home with his wife, Jessica. His son’s family also lives on the property. The move to the nursing home was prompted when Jessica became unwell, and it was obvious she was struggling to manage his dementia behaviours and increasing care needs.
You diagnosed Duncan’s dementia 8 years ago and suspect it is mixed vascular–Alzheimer’s dementia. He refused to see a geriatrician as he did not want to travel the 100 km to the nearest specialist. As he slowly deteriorated, you needed to stop him driving, including on the property, and help Jessica with power of attorney for property issues and personal banking.
Min, aged 58 years, has non-small cell lung cancer. She has a non-English speaking background (she speaks Mandarin and conversational English), is divorced and lives alone. She has two children, a daughter living nearby and a son overseas. Her disease has progressed despite two lines of chemotherapy so far.
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