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Doctors encouraged to proactively manage end-of-life care

Proactive doctors can help patients to avoid unnecessary and burdensome interventions.

General practitioners have been encouraged to take a proactive role in identifying people with advanced chronic conditions that will lead to death, in an article published in the latest issue of Australian Family Physician.

The journal article encourages GPs to embed a framework of care, based on a palliative care approach, into routine practice in order to help them deliver care that is aligned with patients’ preferences and proactively prepare them for end of life.

“Would you be surprised if your patient were to die in the next 6-12 months?”

“A framework using a palliative care approach can support GPs to develop proactive, patient-centred management plans that avoid the need for decision making in emotionally charged situations,” the article said.

“Most older people would prefer and benefit from care focused on their unique goals and quality of life, rather than that aimed at extending biological life. This approach can prevent unnecessary and burdensome interventions, as well as unwanted hospital admissions, and support Australians who wish to die at home (reportedly 70%).”

The framework was developed by the Australian and New Zealand Society of Palliative Medicine under the Australian Government initiative, Decision Assist, for palliative care of aged-care patients in a community-based setting.

It is a tool that requires GPs to answer the question “Would you be surprised if your patient were to die in the next 6-12 months?”. Their response guides them through a flowchart with three trajectories, based on the patient’s prognosis. Each trajectory explains the relevant key clinical process – advance care planning, holding a case conference or commencing a terminal care management plan – and what should occur following clinical improvement or deterioration.

Lead author of the article, Dr Liz Reymond, is a palliative medicine specialist with a GP background who is deputy director of Brisbane’s Metro South Palliative Care Service.

“Many GPs say they infrequently practice palliative care, while in reality, they care for many of these older people whose health conditions are likely to lead to death in the near future. GPs have an essential role in caring for these patients and proactively planning their end-of-life care,” said Dr Reymond.

“By using this framework, GPs would be able to develop informed management plans in accordance with their patient’s personal choices for end-of-life care.”

Taree GP, Dr David Healey, who is helping to educate colleagues about the framework, said it makes it easier for GPs to evaluate elderly patients and discuss their changing needs.

He said patients are often aware their health is declining and welcome the opportunity to discuss end-of-life matters.

Australian Family Physician is published by the Royal Australian College of General Practitioners.


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