Specialist palliative care

Receipt of SPC for the predictable deaths population was shown to be considerably lower for older people, people dying from non-malignant conditions, and in community-based settings (outpatient clinics and MBS services). Consistent with other studies, this report highlighted that receipt of SPC continues to be largely delivered to cancer patients, with 2 in 3 people dying from cancer receiving SPC. This pattern was observed for both the SPC population and the population in need of palliative care. This likely reflects predictability of decline and the history of hospice care being largely focused on cancer patients (Seow 2017)

Receipt of SPC among the non-cancer group was highest for people dying from renal/liver diseases, which perhaps reflects the progressive and fatal trajectory of these conditions increasing referrals to SPC, especially in the final few weeks of life.

Receipt of first SPC service in the last year of life tended to occur in the last weeks of life (median of 15 days before death). This may reflect greater referrals to inpatient SPC in the last days of life (median of 9 days before death), as receipt of SPC was considerably earlier when it was first accessed in outpatient clinics (median of 63 days before death) or through MBS-subsidised specialist consultations (44 days). It is likely most people who first received inpatient SPC died during this admission, especially for people dying from organ failure and frailty. Referrals to SPC largely occurred as inpatients in the last week of life (median of 5 days before death compared with 16 days for cancer deaths). Consistent with this finding, older people received SPC much later than younger people (8 days before death compared with around 32 days for those aged less than 65), which may reflect older people having less clear early signs indicating the need for palliative care (due to their advanced age, lacking a terminal diagnosis or not knowing they were entering the terminal phase; (Lloyd et al. 2016).

These findings are consistent with other studies that have shown median time from initiation of SPC to death was 18.9 days (based on a systematic review from 23 countries). This suggests that early integration of palliative care is not routine practice in most countries, despite what is recommended and supported by the evidence suggesting at least 3-4 months of SPC provides the maximum benefit (Davis et al. 2015, Jordan et al. 2020). Studies have also suggested that the late referral to SPC for organ failure patients may reflect lack of patient awareness of the life limiting or progressive nature of their condition, a fear of hospice care not providing sufficient symptom relief, uncertain prognosis and the illness trajectories of these conditions being longer and having unpredictable fluctuations. These may complicate the provision of cost-effective SPC services (Rosenwax 2016).