SYDNEY — 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, according to new research.
The study by the PM Glynn Institute at Australian Catholic University found that across the country there is less than one palliative specialist (0.9) per 100,000 people, despite the recommended rate of two per 100,000 people.
At the same time, the need for palliative care is growing at a rate faster for children then adults.
In addition, despite public demand for such home-based care, most terminally ill patients requiring palliative care live their last days in a hospital.
The report was released just days prior to the final report of the Royal Commission into Aged Care Quality and Safety. Royal Commissioners Lynelle Briggs and Tony Pagone included greater investment in specialist palliative care access and quality in a dozen of its 148 recommendations.
“Too few people receive evidence-based end-of-life and palliative care and instead experience unnecessary pain or indignity in their final days,” the commissioners said.
Palliative care access and provision requires “immediate attention” alongside food and nutrition, dementia care, and the use of restrictive practices in aged care facilities “besieged by neglect” across the nation, they added.
The Royal Commission report also highlighted “an urgent need” to improve the availability of palliative care for younger people.
Palliative care enhances the quality of life for people with chronic or life-limiting conditions, including those who are close to death.
A report released last May revealed that more than AU$450 million could be saved through better funding of palliative care services and a national strategy on end-of-life care.
Cris Abbu, author of the ACU report, said more doctors and nurses needed to be encouraged to specialize in “this important work.” The report recommends a recruitment program with student scholarships and government subsidies to train an additional 225 specialist doctors.
It also recommends developing integrated models of palliative care 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 said strengthening the knowledge and role of general practitioners in providing palliative care was important, and planning for end-of-life care should be a standard part of clinical practice.
The study found better specialist services were needed for palliative care of terminally ill children, who are often overlooked, as the number of hospitalizations is small compared to older cohorts.
“Sadly, the rate of palliative care hospitalizations for children under 15 has increased by more than 10 percent a year annually since 2011-12,” said Abbu. “We need a dedicated policy focus to ensure they have the best possible care.”
The reports add support to groups asking governments that are considering passing assisted suicide laws to first address serious flaws identified in health and aged care services.
“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,” said Michael Casey, director of the PM Glynn Institute.
“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.”
