Background:
Comprehensive information is available about what is important for optimal hospital-based palliative care, from patient and family perspectives. However, enabling this in practice remains elusive.
Aim:
To co-design recommendations informing practice, policy, education and research that strengthen the delivery of palliative care in the Australian hospital setting.
Methods:
A co-design approach, incorporating a facilitated workshop followed by online feedback. Eligible participants included identified professional leaders in hospital palliative care (clinical or policy focused) and consumer representatives invited through the IMPACCT Consumer Advisory Group. An information pack was provided to participants containing a synthesis of research findings on what consumers have said is important for optimal hospital palliative care, along with 3 key questions. Notes were taken throughout the workshop, which was also audio-recorded. Thematic analysis of collected data informed a first draft of recommendations that was circulated for online feedback and consensus. Ethical approval was obtained (2019/ETH03307).
Results:
Thirty participants attended including representatives from medicine (n=5), nursing (n=6), allied health (n=2), state and national policy roles (n=9), consumer (n=4) and research team (n=4) perspectives. Nine actions were identified as required to strengthen inpatient palliative care provision being: 1) evidence-informed practice and national benchmarking; 2) funding reforms; 3) securing executive level support; 4) mandatory clinical and ancillary education; 5) fostering greater community awareness; 6) policy reviews of care of the dying; 7) better integration of advance care planning; 8) strengthen nursing leadership; and 9) develop communities of practice for improving palliative care.
Discussion:
This study provides a detailed set of recommendations to enable improvements in palliative care within the Australian hospital setting. The fact these have been co-designed with patients with palliative care needs, their families, senior palliative care clinicians, policy experts and consumer representatives ensure these are centred around making changes to enhance end-user (patients and families) experience.
Conclusion:
The need to enable improvements in hospital based palliative care is not disputed. This study provides a clear set of specific recommendations to inform practice, policy, education and research into the future. Envisaging interventions and developing prototypes of how each recommendation could be implemented and tested within clinical practice is an important next step.