clinical focus
The way that we conducted the study and the data that were
available doesn’t allow us to come up with any firm conclusions in
that regard, but it was interesting to see.
So you are hoping health systems around the world take these
findings into consideration when looking at time restrictions
for palliative care. How does the timeline for palliative care in
Australia compare with other countries?
Yes. The example we give in the paper is with regards to the US.
It’s interesting that this study was accepted and published in a US
journal, so I think it’s relevant for that audience. In that setting, there
is a restriction on access to hospice care to an expected time until
a death of six months. Having not worked in the US health system,
I’m not sure how this is applied.
We said in the study that our findings did show an association
between earlier initiation and less acute care use, and so if the
reason for restricting access to a set time before death is to come
up with a cost saving to the health system, the findings of this study
show that there is potential that having a more planned and flexible
approach to initiating palliative care may lead to some cost savings
at the end of life.
Of course, this is a single study, and observational studies tend
to be more prone to things like risk of bias. So it’s pleasing that this
study when put into the body of literature is fairly consistent with
findings from elsewhere in Australia and also findings from groups
in Canada.
Interestingly, I was reading – in the same edition of the journal in
which this study was published – some Taiwanese data that show
that there may be an association between earlier initiation and
less acute care costs, and the associations and the trends tend to
not be simple. So, in the Taiwanese study I was reading, if people
are in hospice care for long periods of time, there is a high cost
associated to that, so from an individual-to-individual level, earlier
initiation may not be associated with reduced hospitalisation. But
these studies looked at population averages, so these findings
argue against restricti ng access to community-based palliative care
to a set time before death.
What message would you want to send to Australian policy-
makers and those across the globe about offering earlier
palliative care?
As I mentioned in my previous answer, I think it’s important that
these findings are taken in the context of the body of evidence
available. That’s from both the health services research point of
view, but also from the clinical quality of palliative care point of
view, and that these findings are another brick in the wall. I think
policymakers need to look at the totality of findings and use those
to inform policy.
From a West Australian point of view, having a fairly open-ended
access to palliative care provides an opportunity – and one that’s
been taken in this study – to look at how the timing affects or is
associated with hospitalisations. So, we’ve got a scenario where we
can test and we can look at these data, whereas, in settings where
there is a set time restriction to community-based palliative care,
that opportunity is not available.
I think that’s the reason that these findings seem to have been
quite well-received in terms of allowing us to look at those
associations, and so, I think it’s something for policy-makers to be
aware of. It’s pleasing, as I’ve said, that it is consistent with other
studies and other findings that have been emerging in this area over
the past couple of years. ■
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