AUSTRALIA has only half the number of palliative care doctors needed to provide good quality care for chronically and terminally ill patients despite increasing demand, a new academic study has found.
Published in the midst of Australia’s hotly contested end-of-life debate, the study by the PM Glynn Institute at Australian Catholic University (ACU), is significant because its bolsters the Catholic Church case that state governments should fix Australia’s existing health system, not consider legislation to allow voluntary assisted dying.
The ACU study found that Australia currently has 0.9 specialists per 100,000 people in the population, even though industry benchmarks require a full-time equivalent rate of two palliative care physicians per 100,000 people.
“People say voluntary-assisted dying is about giving patients a choice but if dying patients cannot access the palliative care services they need, they don’t really have a free choice,” PM Glynn Institute Director Dr Michael Casey said.
“We need to do more to ensure that everyone who needs good quality palliative care can access it, wherever they are and whatever their circumstances, before considering a momentous step like voluntary assisted dying.”
Tasmania is poised to become the third state to legalise after Western Australia and Victoria, while Queensland MPs are set to vote on euthanasia legislation later this year.
There are calls for delays to Tasmania’s euthanasia legislation after government agencies identified 139 “implementation issues” — some serious — and an independent review backed an exemption for faith-based hospitals and aged care.
While attempts to legalise euthanasia (also known as voluntary assisted dying) remain fraught, palliative care is widely recognised for enhancing the quality of life for people with chronic or life-limiting conditions, including those close to death.
ACU report author Dr Cris Abbu said more doctors and nurses need to be encouraged to choose to work in palliative care.
“Palliative care remains one of the least preferred specialisations of medical students for future practice and the rates of full-time equivalent palliative medicine physicians and palliative care nurses have remained unchanged since 2013 despite the increasing demand,” Dr Abbu said.
The report recommends an active recruitment program with student scholarships and government subsidies to train an additional 225 specialist doctors.
Dr Abbu said the failure to provide appropriate community-based palliative services was also placing strain on public hospitals, which currently provide 86% of palliative care hospitalisations.
“Given an ageing population and an increase in the incidence of chronic illnesses, both of which imply increasing need for palliative care services, the burden on public hospitals is likely to increase in the future unless we find workable alternatives,” Dr Abbu said.
The report recommends developing integrated models of palliative care service provision to reduce the burden on hospitals, using community-based care to support people in their homes, in aged care, in boarding houses, and for the homeless.
It also recommends strengthening the knowledge and role of GPs in palliative care provision, and planning for end of life care a standard part of clinical practice.
The ACU study adds weight to KPMG report released in May last year that overhauling Australia’s palliative care system could save $450 million, by boosting funding for at-home end-of-life services.
“As we prepare for an ageing population and other unexpected stresses to our health care system, like COVID-19, we must look seriously at reforming our system to ensure it can meet people’s needs into the future,” Palliative Care Australia chair Professor Meera Agar said at the time.
Brisbane Archbishop, Mark Coleridge is also a strong palliative care advocate.
“It’s not just about managing pain, nor is it just about spending a lot of money,” Archbishop Coleridge said after the KPMG report release last May.
“Comprehensive palliative care sees beyond the pain to the whole person and makes good economic sense. That’s why it has to be the right option.”
The new ACU study also found better specialist services were needed for palliative care of terminally-ill children.
Dr Abbu said palliative care for children was often overlooked because the number of hospitalisations is small compared to older cohorts.
“Sadly, the rate of palliative care hospitalisations for children under 15 has increased by more than 10% a year annually since 2011-12. We need a dedicated policy focus to ensure they have the best possible care,” he said.
The full report can be found here.
