Background and Aims
In rural communities, health disparities among rural residents are well acknowledged. A recent scoping review addressing barriers to palliative care in rural communities identified three issues which formed the basis for this collaborative project. (1) Inadequate knowledge and awareness of PC among both service users and providers; (2) poorly structured PC systems; and (3) communication gaps/challenges between providers and patients/families and cultural barriers.
The aim of this project was to investigate the introduction of a palliative care anticipatory toolkit through a collaborative engagement with rural aged care facilities in the Mildura region of Victoria. Our focus was on both the needs of the rural aged care facilities and the capacity of the palliative care team at the local community health service to provide support. The participating organisation is the largest community health service in the region and is focused on translating evidence into practice and addressing health inequity. More specifically, our aims of the project included the following:
- To co-design a palliative care assessment toolkit for rural residential aged care workers, aimed to identify and appropriately refer residents in need of palliative care.
- To provide education and training to aged care staff on the early identification of residents in need of palliative care.
- To implement, validate, and evaluate the feasibility and acceptability of the toolkit.
What We Did
The PCAT project consisted of three phases. Phase one involved the co-design of the PCAT project with stakeholders and partner organisations. Phase two included the audit of five to six deceased resident from each participating aged care site; an interview with a clinical staff representative from each site; and two PEPA educational training sessions for all aged care employees per site. The final stage, phase three involved the analysis of the deceased residents audit, individual interviews, and post PEPA session surveys in order to collate the project findings and formulate the recommendations of the toolkit.
Outcomes
The audit and interviews found GP involvement in EOL care in rural and remote areas to be an issue: A lack of GP involvement in advanced care planning, and GP’s being reluctant to visit aged care sites (with some lacking knowledge/confidence in PC treatment/medications).
The audit and interviews found ‘family meetings’ to be lacking:Family meetings took place in 50% of cases (to discuss residents deterioration); End of life discussions and PC discussions with family difficult, not well prepared for the PC process (lack the understanding).
The aims of the PEPA sessions addressed the needs identified in the audits and interviews: Educational sessions for new to aged care staff; Informed best practice systems in EOL/PC, and advanced care directives. PEPA sessions were considered valuable, and supported behavioral change through improved knowledge in the identification and management of residents with palliative care needs.
Impact on Aged Care Workforce
The PCAT toolkit is a valuable resource for rural and remote aged care facilities, in supporting staff to provide residents with optimal PC.
Resources Developed
PCAT project resources consist of the online audit questionnaire, individual aged care employee interview template, the PEPA PowerPoint presentation for the two education training sessions for aged care facility employees, and the post session survey to determine the outcome of the PEPA training. These resources can be accessed by request to the lead researcher (Dr Hanan Khalil h.khalil@latrobe.edu.au).
Next Steps
The next steps of this project are publish the findings and recommendations, and presented at an applicable conference.
Key Findings
This project focused on addressing key barriers to palliative care and end of life care (PC/EOL) in rural communities, such as limited knowledge of PC/EOL, structural gaps, and communication challenges between health and service providers and families. Through collaboration with rural aged care facilities in Mildura, Victoria, the team co-designed a PC/EOL assessment toolkit, provided training to staff, and evaluated its feasibility. The findings emphasized the toolkit's value in enhancing PC/EOL, identifying needs, and empowering staff. Educational sessions also addressed gaps in knowledge and practice. This initiative supports rural facilities in delivering equitable and effective PC/EOL to residents.
