Palliative Care: breaking the nexus

In a UMCCR Seminar delivered during National Palliative Care Week 2023, Chair of Palliative Medicine at University of Melbourne Professor Jennifer Philip suggested new thinking is required to translate evidence into practice that benefits people with advanced illness.

Timely access to palliative care for people with cancer is proven to reduce suffering, improve survival, and decrease acute hospitalisation rates. Despite these benefits, many Australians are still hesitant to access palliative care, with social stigma and systemic barriers holding them back.

According to Professor Philip, the way we talk about care in advanced illness is part of the problem.

“We need to have a more sophisticated conversation around what’s important to us if we have an illness that is not going way,” she said.

“At the moment most of our conversation around this, if you look at the media, is framed around ‘battles’ or ‘fighting the war’, and that’s not very helpful for people who are experiencing ongoing and progressing illness.”

For most patients, palliative care is not accessed until very late, if at all. Professor Phillips’ work through the CarePlus study aims to address barriers to widespread, early adoption of palliative care, including negative connotations associated with the name.

“Sometimes palliative care is used as a euphemism that things are going really badly and death is soon,” she said. “As long we continue to do that it will catch up with whatever name we use, be it hospice, supportive care, or palliative care.”

“My hope is to break that nexus of ‘I referred to palliative care and they died, so it’s a self-fulfilling prophecy’. If I refer to palliative care and patients continue to live well, then that can help make the conversation around future referrals easier.”

The goals of the CarePlus Study are to improve the quality of care in the last three months of life for people with advanced cancer by monitoring health service use, and particularly reduction of rates of acute hospitalisation. If not solely for ethical reasons, for economic ones as well.

Hospitalisations account for 80% of cancer care costs in the last 12 months of life, putting a heavy financial burden on the system. Early palliative care is a high value proposition, improving health outcomes for patients with advanced cancer at lower cost.

“As palliative care services become more stretched they become more focused on later and later. This study was a direct attempt to address that,” said Professor Philips.

“Early palliative care is best delivered in an outpatient setting because it requires relatively fewer resources and it’s aligned with what’s happening elsewhere in their care, such as treatment or chemotherapy.”

Professor Jennifer Philip is the appointed Chair of Palliative Medicine, University of Melbourne, St Vincent’s Hospital and in collaboration by the Victorian Comprehensive Cancer Centre. Jennifer is a palliative care clinician, researcher and teacher whose particular areas of interest include improving the ways supportive and palliative care are delivered, ensuring care is underpinned by high quality evidence and that it is delivered by well trained professionals and carers. She leads the Palliative Nexus group.