The Advance Project – supporting a team approach to advance care planning and palliative care in everyday general practice

A blog post written by Professor Josephine Clayton, Senior Staff Specialist Physician in Palliative Medicine, HammondCare and Professor of Palliative Care, University of Sydney and Associate Professor Joel Rhee, General Practitioner and Associate Professor of General Practice, HammondCare Centre for Positive Ageing and Care, University of Wollongong

Dying is a universal experience, and so is the wish to die well.

Most people want to die with dignity, free from suffering, and surrounded by loved ones in a familiar environment. And yet, many people in Australia are continuing to die with unmet palliative care needs. Recent figures from Victoria suggest that up to two-thirds of people who might benefit from palliative care are not receiving it.

We urgently need a way to enable people in the community to have difficult conversations about their end-of-life care wishes much earlier - before a crisis arrives. We also need a more systematic way to identify people early, who might be at risk of deteriorating and dying, and to assess their holistic palliative and supportive care needs, so these needs don’t get missed.

The general practice is a great place for this.

General practices provide ongoing care for a large number of patients with chronic, progressive, and eventually fatal illnesses, and so have an essential role in providing palliative care to patients and their families. GP’s and nurses in the community are often the ones who know us best, have our trust, and often also the trust of our family or loved ones.

We believe that effective, strategic teamwork can help general practices to incorporate palliative and supportive care assessments into the routine care of patients. This setting also enables advance care planning conversations to start early, when a patient is still relatively well, so they don't miss out on the opportunity to plan for their future care. Nurses can work with GPs to identify a patient’s most important symptoms, concerns and priorities, and can facilitate the GP reviewing and addressing these issues in a systematic way.

This is the reason we have developed the Advance Project.

Just over three years ago, we were grateful to receive funding from the Australian Government Department of Health, to develop and launch an Australia wide, multi-component training program for nurses working in general practice. The training was endorsed by the Australian Primary Health Care Nurses Association (APNA).

The aim was to support nurses working in Australian general practices with training and resources to assist them to initiate early and structured conversations about advance care planning. In addition, the aim was to support general practices with the tools to identify people early who might need a palliative approach to their care and enable nurses to thoroughly assess the persons’ symptoms, concerns and priorities as well as the needs of their carers.

The training program included specially designed resources, online training modules, workshops held across Australia and tele-mentoring from a specialist palliative care nurse. Over the next couple of years, approximately 500 nurses in general practices across all states and territories of Australia were upskilled through the Advance Project.

Feedback about the training was overwhelmingly positive, with nurses reporting positive impacts for their patients and carers following implementation of the Advance Project resources in their clinical practice.

Nurses who participated rated highly the quality and relevance of resources and training to their clinical practice and value for their patients. Our evaluation also revealed evidence of significant improvements in nurses’ confidence, comfort, knowledge and attitudes towards initiating conversations about advance care planning and assessing patients’ and carers’ palliative care needs.

As a result of the learning from those first two years, we have expanded our vision for the project.

We have broadened the scope of our training, from a focus primarily on GP nurses, to a systematic and team based approach, focused on the whole general practice team – GPs, nurses, and practice managers. With the same aim, of initiating advance care planning and assessment of patients’ and their carers’ palliative and supportive care needs through a team based, structured, routine screening process, that would start the conversation and assessment process early in a general practice context.

We have developed a new and updated Advance Project Toolkit, based on comprehensive evaluation, consultation and an updated literature review. The toolkit includes resources specifically designed for GPs, nurses, practice managers, patients and carers.

The new toolkit has been officially recognised as an accepted Clinical Resource by the Royal Australian College of General Practitioners (RACGP) and endorsed by APNA according to approved quality standards criteria. The training for General Practitioners has been accredited by the RACGP and the Australian College of Rural and Remote Medicine (ACRRM) and the training for general practice managers has been endorsed by the Australian Association of Practice Management. The modules for general practice nurses has been revised and updated and re-endorsed by APNA.

“This has been immensely useful, helping me to gain confidence on a difficult topic that I concede isn’t well incorporated so far into our daily practice” GP TRAINING PARTICIPANT

The training is available free of charge, and can count to CPD hours where relevant.

The free tele-mentoring has also been expanded to provide support for GPs, practice managers and general practice teams. An experienced palliative care nurse is available to provide individual telephone mentoring and coaching.

And train-the-trainer support is being provided to selected champion networks, so that these networks can deliver face-to-face training and support implementation locally.  

We believe that the new program will enable a systematic and team-based approach to initiating advance care planning and palliative care in general practice.

Ultimately, that will result in better care for people in need across Australia.

The Advance Project is funded by the Australian Government and led by HammondCare in collaboration with CareSearch and various universities and health organisations.

Register today or learn more about the Advance Project at https://www.theadvanceproject.com.au
Or email us at advanceproject@hammond.com.au
 

Professor Josephine Clayton, Senior Staff Specialist Physician in Palliative Medicine, HammondCare and Professor of Palliative Care, University of Sydney

Associate Professor Joel Rhee, General Practitioner, HammondCare Centre for Positive Ageing and Care, and Associate Professor of General Practice, University of Wollongong