Palliative care provides support and treatment for distressing symptoms and experiences of illness rather than focusing on disease-modifying treatments. It addresses the physical, psychosocial and spiritual health needs of patients, their families, friends and carers.1 It is estimated that about 1% of general practice consultations in Australia involve palliative care, advance care planning or end-of-life care.2
Palliative care priorities patient comfort, affirms dying as a natural and inevitable part of life and addresses the adverse impact of grief and loss that death brings.1 The cultural and spiritual significance of death and grief is important, and diversity of practices and customs around end of life and bereavement need to be recognised and respected.3 Sensitivity in language and clinical approach is required.4 Respecting culture and kinship is particularly important when caring for Aboriginal and Torres Strait Islander peoples and their communities.5 Experiences of colonisation and discrimination should be also considered when caring for Aboriginal and Torres Strait Islander peoples and communities.6 Care is also required to ensure that every effort is made to allow people to have their end-of-life decisions respected and honoured wherever possible, including being able to return to Country or being in the communities they consider their home.7
In the past, palliative care was often not introduced until late in a patient’s illness trajectory, frequently in the last few days or weeks of life when symptoms had become severe.1 It is now recognised that introducing palliative care earlier has a beneficial effect in improving outcomes from a symptom perspective. The scope of illness recognised as benefiting from palliative care has also broadened in recent years, including non-cancer diagnoses such as human immunodeficiency virus (HIV) and cerebrovascular and neurological disease.8 The demand for palliative care services has grown with this broader scope of application.
In 2018–19, there were over 83,000 palliative care-related hospitalisations in Australia.9 Over half of these were for people aged 75 and over,9 and the number of people who need end-of-life palliative care is expected to increase in coming years.10 The increased rate of comorbidity will be a significant factor for general practitioners (GPs) to manage. Palliative care commonly involves multimorbidity, chronic progressive illnesses with protracted disease courses and diseases with complex symptoms and high symptom burden.11
There are no dedicated Medicare Benefits Schedule items specific for advance care planning and palliative care in general practice,12 however the increased demand to provide high quality palliative care and the introduction of voluntary assisted dying laws in Australian jurisdictions11 has seen an expansion of the supports available to general practice and primary care services in providing palliative care.13 It is important for GPs and general practice registrars to maintain and build their skills in palliative care so that they can assist with addressing symptoms and navigating the complexities of services and care for people with palliative care needs.