HealthPathways for palliative care symptom control COORDINARE

HealthPathways is a free online portal that supports healthcare professionals to make assessment, management and referral decisions for medical conditions. Pathways are ‘localised’ by general practitioner (GPs) to meet needs that are specific to the region they cover.

The ACT and Southern NSW (SNSW) HealthPathways is a collaborative project between the Southern NSW Local Health District, Capital Health Network – ACT PHN, ACT Health and COORDINARE – South Eastern NSW PHN.

Palliative care HealthPathways enabling GPs

In 2015, based on GP feedback, a suite of 14 new palliative care pathways were localised in consultation with specialists from Canberra Hospital and Calvary Public Hospital’s Community Specialist Palliative Care Service (operating from Clare Holland House) in the ACT.

These pathways aim to capture the elements of palliative care that a GP might encounter either when deciding that a patient requires an initial need for palliative support or when a patient is nearing end of life. The pathways cover topics such as new palliative care patient, managing palliative care emergencies, pain management and symptom control. They enable GPs to provide appropriate assessment, triage and management of palliative and end of life care needs.

Screening and identification

Assessment and management of symptoms

Triage and referral

Continuity of care planning

Supporting clinical decision making – anytime, anywhere

In 2019, the ACT and Southern NSW HealthPathways site transitioned to a mobile-friendly platform, allowing clinicians to use HealthPathways on multiple devices, such as desktop, remotely via laptop, tablet or mobile phone. This means patient care can occur not only at a desk in a general practice but also in a patient’s home or aged care facility, if needed.

In the same year, the palliative care pages of the site were reviewed in consultation with the palliative care specialists at Clare Holland House in the ACT, with support from the ACT and Southern NSW GP clinical editing team. This review also saw consultation with the Southern NSW Local Health District Palliative Care Manager to ensure that patients diagnosed with a life-limiting condition were referred early and to the most appropriate service.

This site now has a suite of 31 palliative care pages, incorporating referral and clinical pages and 14 pathways specifically covering common symptoms encountered in the management of a person in palliative care.

Promoting best practice palliative care

The ACT and Southern NSW HealthPathways can promote best practice palliative care as below:

• Patients with unmet end of life or palliative care needs are identified earlier
• Enhanced involvement of GPs in end-of-life discussions with patients, families and carers
• Improved and standardised management of end of life symptoms, including appropriate medications
• Improved conversations for planning end of life, including place of care, death and after-hours support options
• Access to and use of pathways by clinicians to support their decision making anywhere anytime.

All clinical pathways include links to relevant resources, including culturally and linguistically diverse and Aboriginal and Torres Strait Islander resources where they exist and are appropriate.

The palliative care pages of this HealthPathways have seen more than 100% increase in views in the three years from 2019 (when the most recent review was finalised) compared with the previous three-year period.

Tips for others

• Identify GP champions who are actively engaged in supporting high-quality palliative and end-of-life care.
• Develop a strong sense of community in local areas supporting personalised and tailored patient centred care - a  collaborative and agile clinician base to develop services to meet the needs of the community within available resources.
• Build strong engagement and relationships with palliative care specialists. Their support in reviewing HealthPathways provides confidence to users that they match local procedures and guidelines as well as providing a resource tool for reference when supporting GPs in managing their patients.