3. Comprehensive assessment

Comprehensive assessment enables the evaluation of physical, environmental, social, cultural, emotional, psychosocial and spiritual needs. Comprehensive assessment can also determine the need for inclusion of an Aboriginal liaison officer or palliative care Aboriginal health worker, as required, or the use of the Health Care Interpreter Service.

Action

Processes are in place to ensure comprehensive, culturally appropriate and holistic assessment is undertaken for all people identified as having end of life and/or palliative care needs.

Evidence

Comprehensive assessment is important to facilitate identification of all End of life and palliative care needs for the person, their family and carers throughout their experience.

Considerations and resources

Holistic assessment should be multidisciplinary and occur through a combination of dedicated services or specified referral pathways to existing services, as appropriate. This may require virtual care access where resources are limited.

Assessment is to include use of a validated symptom assessment tool, distress screening tool, and a screening or assessment tool for identification of carer needs, availability and capability.

Examples of assessment tools include Resource Utilisation Groups-Activities of Daily Living (RUG-ADL), Australia-modified Karnofsky Performance Status (AMKPS), Symptom Assessment Scale (SAS) and Palliative Care Problem Severity Score (PCPSS).

Using virtual care

Referrers should consider the questions and use the tools and information below when providing virtual palliative and end-of-life care.

Inform the patient, their family or carer of the virtual care modalities available, and document their preferences. Based on availability and mutual agreement, this could include their ability and willingness to travel due to wellbeing, ease and cost of travel, personal and family commitments, spiritual needs, and available technology. More on consumer support.

If in-person assessment is not needed, which available virtual care modality will provide the highest quality assessment? Be aware that 55% of communication comes from facial expressions and body movement. More on ways of delivering virtual care.

Tell the patient how they can change an appointment type when mutually suitable alternatives are available. This will vary depending on the specific service.

Has the patient, family or carer received information and support on how to use the technology to access their virtual appointment? Consider awareness of calls from private phone numbers, and/or access to the link for their virtual appointment (i.e. link to videoconferencing platform/virtual room).

Should others attend the appointment? Consider the multidisciplinary advantages of having a GP, specialist, other health professionals, family and other important people attending the appointment in a virtual or hybrid context.

Do all people attending the VC appointment understand virtual care processes and etiquette? Consider factors such as lighting, framing, background, background noise levels, position of the camera and screens. Clinicians may need to provide information, model good etiquette and provide direction to patients, family and carers attending.

If an appointment is urgent, is there enough travel time or is virtual care a more viable option?

Does the patient, family or carer need support to navigate the virtual care platform? Consider the need for an additional clinician, family or carer to be available to support the patient. Provide virtual care education resources as required.

Does the patient need a pre-appointment test run? This should be performed using the same device that will be used in the virtual appointment. It is also preferable to conduct this from the normal location where the appointment will occur. It can be helpful to provide a demonstration when the patient, their family and carer are attending an appointment in-person. A troubleshooting guide is available to assist patients resolve any technical issues.

Who else needs to attend the appointment? Any person who can support the patient can be included in a virtual consultation with their consent. If the patient does not have decision-making capacity, is the person responsible attending the appointment? Is a support person needed? Has the patient identified a family member/carer to be included in their care discussions? Has the clinician considered the multidisciplinary advantages of having the GP, family, specialist, other health professionals and other relevant people to attend the appointment?

What happens if the patient, family, or carer deteriorates, or the technology fails while I’m providing care virtually? Each team should have its own protocols for escalating care or managing technology failures during an appointment. Measures could include:

• Confirming the patient’s address and contact number at the start of any consult
• Being able to call an ambulance or other emergency service
• Organising an urgent visit
• Contacting a family member
• Enacting the backup process if the connectivity is poor or the technology fails

More about consumer support

For more virtual care resources, see:

• Virtual care in practice guide
  Information to support healthcare providers to deliver virtual care.
• Virtual care palliative care resources for clinicians and consumers
  Resources supporting health professionals, patients, families and carers to access and use virtual care as part of palliative care.