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RACGP aged care clinical guide (Silver Book)

Silver Book - Part B

Palliative care approach

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Last revised: 13 Jan 2020

  • Palliative care aims to improve the quality of life of patients and their families facing problems associated with life-limiting illness.
  • Early identification, assessment and treatment of pain and other problems, including physical, psychosocial and spiritual, leads to prevention and relief of suffering.
  • The role of general practitioners (GPs) and general practices is central and critical to an effective and comprehensive palliative care approach in which everyone has a role to play.
  • A palliative care approach is a broad approach that includes end-of-life and specialist palliative care.
  • Palliative care is a core activity for those looking after and supporting older people, including their families and carers, and should be evidence based and person centred.
  • There are many tools and resources available to support GPs and others to build on the work they already do in palliative care.

Palliative care aims to improve the quality of life of patients and their families facing problems associated with life-limiting illness. This is achieved through the prevention and relief of suffering by means of early identification, assessment and treatment of pain and other problems, including physical, psychosocial and spiritual.1

It is not possible to rely exclusively on expert palliative care services to address the growing palliative care needs of people who have life-limiting conditions. A palliative care approach can be actioned by any healthcare professional to meet the needs of people with chronic life-limiting conditions by using palliative care knowledge and expertise.2 The role of general practitioners (GPs) and general practices is central and critical to an effective, comprehensive palliative care approach.

A palliative care approach recognises that death is inevitable, and focuses on the care rather than cure of a person with multiple chronic conditions (refer to Part A. Multimorbidity), frailty (refer to Part A. Frailty) and/or a life-threatening or life-limiting illness. The goal of a palliative approach is to improve or optimise a person’s level of comfort and function, and to offer appropriate treatment for any distressing symptoms.

A palliative approach addresses a person’s psychological, spiritual, social, emotional and cultural needs. Families are welcomed as partners in this approach. A palliative approach recognises that for older people with multiple chronic conditions, frailty and/or a life-threatening or life-limiting illness, this is often the last chapter of their life, the length of which can be unknown.3 Figure 1 illustrates the relationship between a palliative care approach, end-of-life care and specialist palliative care.

Relationship between a palliative care approach, end-of-life care and specialist palliative care

Figure 1.

Relationship between a palliative care approach, end-of-life care and specialist palliative care


Part B. Palliative care approach highlights the essential components of providing healthcare to older people in both residential aged care facilities (RACFs) and those in the community, while complementing Part A. Palliative and end-of-life care, which focuses on assisting in clinical decision making.

Depending on the underlying diagnosis and needs, different trajectories have been identified and are discussed in Part A. Palliative and end-of-life care. With increasing age, frailty and multimorbidity, more and more older people are living with chronic conditions and their trajectory of illness will be progressive. For example, of the residents in a residential aged care facility (RACF):

  • more than half have a diagnosis of dementia on admission4
  • there is a high incidence of distressing symptoms5
  • almost all likely to die at the facility6 and a significant proportion of them within the first year.

Palliative care and end-of-life care should therefore be core business for aged care, but the quality of end-of-life care in this setting is variable.7

The role that GPs play in palliative care is fundamental; however, it is difficult to quantify the current level of activity in this area because of limitations in data sets. The estimates for GP activity vary between one in 100 GP consultations8 and one in 1000 GP encounters,9 with 95% being for people aged ≥65 years.

There is indisputable evidence of the clinical need for a palliative care approach, evidence that GPs already provide care in this area, and evidence of the need to support a growing role for GPs to provide and lead ongoing care.

The Australian National Palliative Care strategy has identified guiding principles and goals of palliative care in Australia,10 which equally apply to a palliative care approach:

  • A focus on person-centred care
    • This is essential because individual care needs will differ and change over time.
    • Care needs to be responsive to the individual’s values and preferences.
    • Care needs to be holistic, sensitive and culturally appropriate.
  • Death is recognised as a part of life
    • A focus on quality of life is an important goal for a palliative care approach.
    • Help and support people to prepare for end of life in a meaningful way for them by sensitively discussing dying and experiences of dying.
  • Carers are valued, and receive the support and information they need (refer to Part B. Families and carers )
    • Carers are providers and recipients of care.
    • Carers’ needs should be considered in care planning and their role acknowledged, respected and support provided in bereavement.11
  • Care is accessible
  • Everyone has a role to play in palliative care
  • Care is high quality and evidence-based
    • There is strong and growing evidence-based literature on best care for patients with palliative care needs.

Transforming and making a palliative care approach real is complex, and requires all systems and sectors to play their role and part in making it happen. The GP’s role is critical as a generalist who brings a comprehensive person-centred approach to care to ensure patients receive appropriate care.12 The GP can support a palliative care approach by:

  • identifying patients who would benefit from a palliative care approach
  • engaging in open dialogue with the patient (or the alternative decision maker) about the patient’s wishes
  • communicating and leading care planning processes centred on what matters to the patient
  • providing proactive and systematic care as part of a care team.

There are many tools and resources available; Part A. Palliative and end-of-life care offers clear practice tips and approaches and identifies multiple resources and tools to support provision for high-quality and evidence-based care.

  1. World Health Organization. WHO definition of palliative care. Geneva: WHO, 2018. [Accessed 18 August 2019].
  2. Sawatzky R, Porterfield P, Lee J, et al. Conceptual foundations of a palliative approach: A knowledge synthesis. BMC Palliat Care 2016;15:5. [Accessed 18 August 2019].
  3. Palliaged. A palliative approach. Adelaide: Flinders University, 2018. [Accessed 18 August 2019].
  4. Dementia Australia. Statistics. Melbourne: Dementia Australia, 2019. [Accessed 20 August 2019].
  5. Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 2006;31(1):58–69. [Accessed 20 August 2019].
  6. Australian Institute of Health and Welfare. Palliative care services in Australia Canberra: AIHW, 2018. [Accessed 18 August 2019].
  7. Productivity Commission. Reforms to human services – End-of-life care in Australia. Sydney: PC, 2017. [Accessed 18 August 2019].
  8. Department of Health. Final report: Research into awareness, attitudes and provision of best practice advance care planning, palliative care and end of life care within general practice. Canberra: Department of Health, 2017. [Accessed 18 August 2019].
  9. Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2015–16. Sydney: Sydney University Press, 2016. [Accessed 18 August 2019].
  10. Department of Health. National Palliative Care Strategy. Canberra: DoH, 2018. [Accessed 18 August 2019].
  11. Aoun SM, Breen LJ, Howting DA, Rumbold B, McNamara B, Hegney D. Who needs bereavement support? A population based survey of bereavement risk and support need. PLoS ONE 2015;10(3):e0121101. [Accessed 18 August 2019].
  12. Australian Medical Association. Palliative approach in residential aged care – 2015. Canberra: AMA, 2015. [Accessed 18 August 2019].