In-practice presentation

Background
The SEVIAC out-of-hours service for complex and palliative patients has been providing comprehensive care to patients for the past ten years since February 2013. This is achieved through an interdisciplinary approach that involves healthcare providers, support staff, patients and their families. The service has been able to keep patients at home, as they desire, by offering telephone consultations and home visits and avoiding unnecessary referrals to the hospital.

Regular assessments of patients' physical, emotional, and social needs, as well as their overall health status, are the key. The active involvement of patients and families in their care, with clear lines of communication and access to information and support, is also critical to ensuring that patients receive the care they need.

Aim
To revise the activity of the service, including both home visits and telephone consultations, and track the evolution of the number of interactions and the percentage of secondary care referrals over those 10 years of work.

Results
From 2013 to 2014, the service had an average attendance of 3500 consultations per year, with a referral rate of 3-3.5%. Telephone consultations accounted for 55-68% of all consultations. Other consultations started with telephone triage and home visits.
From 2018 to 2022, attendance increased to approximately 5500 consultations per year and the referral rate stabilized at around 5% and telephone consultations around 65%.
In 2020, the referral rate was 3,2%, exceptional due to the pandemic situation.

Conclusions
The exceptional reduction in the referral rate in 2020, due to the pandemic situation, highlights the importance of being able to adapt to changing circumstances to continue providing high-quality care to patients and ensure that their needs are met.
Regularly monitoring and evaluating the activity of SEVIAC and adjusting as needed is mandatory to ensure the care of our patients.

1. At-home care
2. Palliative care
3. Teamwork

Research presentation

Introduction
The integration of specialist palliative care into residential aged care facilities (RACFs) through "needs rounds," an evidence-based approach of monthly triage and risk stratification meetings, has shown to improve the quality of care for elderly residents at the end-of-life.

Objective
This study aimed to examine the impact of introducing specialist palliative care via an appropriate scalable model of needs rounds into RACFs across the Gold Coast Health Service.

Design and Methods
A retrospective cohort study of introducing palliative care Needs Rounds was conducted in 57 RACFs (5615 beds) across the Gold Coast Hospital and Health Service. A mixed-methods qualitative and quantitative evaluation was conducted one-year post-implementation to assess the project's effectiveness, staff confidence, resident end-of-life experiences, and impact on the health service's ED presentations, hospital admissions, and length of stay.

Results
The Needs Rounds project impacted 96% of the RACFs, and there was a significant increase in staff confidence in identifying deteriorating residents. Earlier identification of end-of-life care needs enabled GPs to provide timely and appropriate care to their patients. There was a 20% reduction in ED presentations from RACFs in the first year of operation, and hospital length of stay was also reduced, creating a released bed space to treat approximately 9 additional non-RACF patients each day.

Conclusion
Gold Coast Needs Rounds improved staff confidence, access to specialist palliative care expertise, and the quality of care for residents in RACFs, while reducing the burden on GPs and avoiding unnecessary hospitalisations and ED presentations. This project provides a model for improving access to specialist palliative care in residential aged care that could be adapted to other healthcare systems worldwide. Future studies are needed to explore the facilitators and barriers to the implementation of needs rounds to inform wider adoption and standardisation as part of specialist palliative care in RACFs.

1. Integration of specialist palliative care through "needs rounds" can significantly improve the quality of end-of-life care in residential aged care facilities (RACFs), while reducing the burden on GPs and avoiding unnecessary hospitalisations and ED presentations.
2. The study showed that the needs rounds approach increased staff confidence in identifying deteriorating residents and enabled GPs to provide timely and appropriate care to their patients, resulting in a 20% reduction in ED presentations from RACFs in the first year of operation and a decrease in hospital length of stay.
3. The introduction of specialist palliative care via an appropriate scalable model of needs rounds into RACFs can impact a large number of facilities, as shown by the study, which covered 57 RACFs (5615 beds) across the Gold Coast Health Service. This approach can provide access to specialist palliative care expertise to a broader population of elderly Australians in RACFs, potentially improving their end-of-life experiences and quality of care.

Research presentation

Introduction
Specialist Palliative Care in Aged Care (SPACE) was implemented across Queensland in 2020 to improve end of life care coordination for older people living in residential aged care facilities (RACF). The project aimed to increase the capacity of RACFs and GPs to provide end of life care in place of choice with education, pre-emptive planning, and access to specialist palliative care support. 15 Queensland Hospital and Health Services (HHS) were supported to develop and implement contextually appropriate models of care aligning with core service principles.

Methods
A mixed methods qualitative and quantitative evaluation was conducted one-year post-implementation to assess the effectiveness of implementation, proportion of RACFs impacted by SPACE, staff confidence, and resident end-of-life experiences.

Results
All 15 HHS developed and implemented a model appropriate for local context. Extensive stakeholder consultation and codesign enabled effective implementation of the project, improving cohesion and networking across the state. 80% of the 517 RACF across Queensland were impacted by SPACE. There was a significant increase in staff confidence identifying deteriorating residents. Earlier identification of end-of-life care needs enabled GPs to provide timely and appropriate care to their patients.

Conclusions
There was a high level of engagement with SPACE services across Queensland despite aged care lockdowns, limited staffing, and COVID-related redeployment of SPACE teams. The SPACE project had a positive impact on staff confidence, improved access to specialist palliative care expertise, reduced burden on GPs to provide complex end-of-life care, and improved quality of care for residents. The results of this evaluation have international implications for GPS who provide primary care for aging populations. The SPACE project provides a model for improving access to specialist palliative care in residential aged care that could be adapted to other healthcare systems.

1. The SPACE project successfully implemented models of care for end-of-life care coordination in aged care facilities across Queensland. This led to improved access to specialist palliative care support, reduced burden on GPs, and improved quality of care for residents.
2. The outcomes of the SPACE project were achieved through extensive stakeholder consultation and co-design, which facilitated effective implementation and improved networking across the state.
3. Despite the challenges posed by COVID-related restrictions and limited staffing, the project was able to achieve a high level of engagement with RACFs and GPs across Queensland.

In-practice presentation

Aim
Australia’s national peak body for palliative care developed the National Palliative Care Standards for All Health Professionals and Aged Care Services (the Standards). The organisation is recognised internationally as a producer of high-quality standards for palliative care. The Standards are aimed at General Practitioners (GPs) and those working in primary care, to guide best practice delivery of palliative care. The presentation will outline the importance of the Standards to GPs.

Content
The presenters will begin by outlining the context. Access to quality palliative care is a global problem. The estimated demand for palliative care in Australia is expected to increase by 50 percent between now and 2035, and double by 2050. General practitioner clinical input will be vital into the future.

The presenters will outline key elements of the Standards. A focus of the presentation will be under-served and vulnerable population groups who experience barriers to accessing quality palliative care, including but not limited to, Aboriginal and Torres Strait Islander peoples, chronically ill, aged, people experiencing socio-economic disadvantage, and those in rural and remote areas.

The Standards were developed by experts from a range of backgrounds, and as such have broad, practical application and can improve delivery of quality palliative care in non-specialist settings. The nine standards and 67 elements outline best practice palliative care in simple and descriptive terms. The Standards seek to encourage innovative and adaptive approaches to increase access and promote high quality palliative care for all Australians.

Goals
The presentation will acquaint the audience with the Standards. The Standards will improve access to palliative care for all Australians through better understanding of palliative care and its delivery by all health professionals across non-specialist palliative care settings. This will improve the quality of palliative care delivered by GPs into the future.

1. Attendees will take away an understanding of the principles of quality palliative care delivery by General Practitioners and primary health providers as outlined in the Standards.
2. Attendees will learn that the Standards offer a benchmark for quality palliative care, and how to best utilise these Standards.
3. Clinicians will reflect on their understanding of the important role they have in the palliative care approach, which is provided by a broad range of health professionals across a range of health settings.

Rapid impact presentation

Background
The Ospital ng Makati is a tertiary government hospital that is currently on its birthing phase of establishing the palliative foundation in the hospital in terms of the handling the terminally ill and dying patients by providing them quality of life while in the hospital and if still possible, to assist the family in the transition to home care.

Objective
The objective was to determine the baseline knowledge, attitude and practices of the resident physicians who are undergoing training in the Ospital ng Makati.

Methods
A cross-sectional study was conducted among the resident physicians of Ospital ng Makati to know the knowledge, attitude and practices with regards to the assessment of their end of life care understanding. A self-administered validated questionnaire was distributed among the participants from a previous study done by Pamplona that was utilized to facilitate the survey.

Results
A total of 65 people took part in the study, with a median age of 20 to 39 years old. The majority of the participants were female (40%) and Roman Catholic 60 (92.3% ). The department of Pediatrics had a significant number of participants (24.6%). The University of the East Ramon Magsaysay Memorial Medical Center had a significant number of the participants 13 (20%). The majority 25. (38.5%) of the respondents are generally first years. The total of 65 respondents resulted to overall response rate of 56.5%.

Conclusion
The findings demonstrated that knowledge, attitudes, and practices related to palliative care were identified through this cross-sectional report. Interestingly, even though the majority of the participants had no prior exposure or rotation to palliative and hospice care and demonstrated a lack of understanding of the notion of palliative and hospice medicine, they had an appropriate understanding of palliative medicine in general.

1. Have a thorough understanding and consideration of what Palliative and Hospice medicine is, considering its significance in the medical practice
2. Will consider forming more advocacy groups to help promote a comprehensive understanding of palliative concepts both the medical professionals and laymen alike
3. To stir up research opportunities for follow-up cross-sectional analysis in other training hospitals all over the world

Rapid impact presentation

Palliative care can offer relief from physical and emotional distress, provide support, and improve quality of life for both the patient and their family during the terminal phase of an illness. This case presentation discusses the care provided for a 55-year-old male diagnosed with metastatic colon cancer, who received palliative and hospice care from the time of diagnosis until his eventual passing. The patient's physical and emotional symptoms were managed through a combination of medications, counseling, and emotional support using family medicine and palliative medicine tools. The patient's family was also offered emotional and practical support throughout the patient's illness, with the goal of enhancing the patient's quality of life and providing comfort to the family during this difficult time. The case highlights the importance of a multidisciplinary approach to palliative care, and the critical role of family medicine and hospice care in the terminal phase of an illness. It also underscores the significance of providing compassionate care that respects the patient's wishes and values, as well as the needs of their family. Moreover, the case brought to light the gaps of the healthcare system in providing equitable access to high-quality palliative care for all patients, irrespective of their socio-economic status.

1. Providing equitable access to high-quality palliative and hospice care remains a challenge, particularly for indigent families in developing countries.
2. The provision of palliative and hospice care can significantly enhance the quality of life of patients with advanced cancer and their families, even in resource-limited settings.
3. A multidisciplinary approach that includes emotional and practical support, as well as physical symptom management, can help patients and families cope with the physical and emotional challenges of advanced cancer.

Rapid impact presentation

Objectives
This paper aims to present a patient with terminal cancer whose values, preferences and wishes were honored and respected utilizing person-centered and family-focused approaches in order to experience a good death.

Subjects and methods
A 68 year old female with stage IV breast cancer was referred for end-of-life care. Priority was given to alleviate her pain and restlessness. Concurrently, her requests to be with family and hold family vigils despite being in the hospital were granted. Personal wishes rendered included: reading the bible, listening to her favorite songs, bedside prayers, and meticulous self-care like hair and make-up. Continuous communication between the family and the healthcare team was ensured to optimize management.

Outcomes
Tools used in the family’s evaluation of the patient’s death were the Good Death Inventory (GDI) and Brief Grief Questionnaire (BGQ). Based on the primary caregiver’s GDI answers, she agreed her mother had a good death in majority of the domains particularly in receiving physical psychological comfort, diminished burden of care, being respected, attaining life completion, and dying a natural death. On her answers to the BGQ, there was absence of complicated grief 3 months after the death of her mother.

Conclusion
More than optimum medical management, there is a need to be able to fulfill the patient’s spiritual, emotional and psychological needs to help them attain a good death and prevent complicated grief in their loved ones.

1. A person-centered approach to end-of-life along with good communication with the family can help achieve a good death.
2. Physicians should encourage patients to express their values, preferences and wishes to their families.
3. The Good Death Inventory and Brief Grief Questionnaire are tools that can help in the evaluation of palliative care services.

Aim
To provide an overview of the Rural Generalist Palliative Care Registrar training pathway in North West Tasmania.

Content
Australian rural health outcomes are poor, with increased mortality rates in rural Australia compared with cities. (1) Australian Institute of Health and Welfare Report 2019 (2) revealed that rural Australians had less access to community Palliative Care. Hospitalisations for Palliative Care were growing faster than any other type of admission to regional and rural hospitals. A 2016 systematic review (3) found that rural residents prefer to die at home. Despite this, regional areas had less specialist led Palliative Care with half as many doctors per 100,000 people than metropolitan areas. Palliative care services are challenged with workforce capacity, particularly in more isolated areas.

To address this shortage, in Northwest Tasmania a newly implemented pathway for rural generalist training aims to future-proof a General Practitioner workforce that can provide quality palliative care in patient's local communities and hospitals.

Early evaluation of the post revealed the learning, experience, and value of the post. The presentation will explore the development of the post, experience of the registrars and outcomes of training.

Goal
To share our experience of training Rural Generalists in North West Tasmania with other rural health practitioners.

References
(1) Adair T, Lopez A. Widening inequalities in premature mortality in Australia, 2006-16. Australian Population Studies. 2020;4(1):37-56.
(2) Australian Institute of Health and Welfare. Palliative care services in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2019 [cited 2020 Jun. 24]. Available from: https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia.
(3) Rainsford S, MacLeod RD, Glasgow NJ. Place of death in rural palliative care: A systematic review. Palliat Med. 2016;30(8):745-63

By the end of this presentation and discussion, participants will be able to:
1. Understand the importance of palliative care experience for rural generalist training.
2. Reflect on the learnings from the context of their own experience with rural GP training.
3. Share ideas for potential rural palliative care registrar training projects.