Joey first up, can you tell us a bit about your background?
As a young doctor I spent some time working in a palliative care hospital in the early 90’s. It was such a privilege to be working with people at end of life - with the opportunity to make a difference to quality of life and well-being of patients, and their family members. That experience made me decide to devote my career to Palliative Medicine.
I came to realize that for so many Australians, the central managing point of their clinical care is their GP practice. And that GP’s, and their practice nurses, are the ones who know the patient best, have their trust, and often also the trust of their family or loved ones.
What is the genesis of the Advance Project?
After some very challenging experiences early on, I realised that many people don’t have the chance to discuss the care they would want if they were approaching the end of life. Because we don’t ask them – or if we do, it’s too late.
This leads to a key question – what if we could start these conversations much earlier? Before we are in the middle of a crisis? And in a routine way, that would be less daunting – both for the patient, the family, and the health care team.
It became clear that we needed a routine screening process, that would start the conversation early, in a low key way, using a structured format. That would take the pressure off all parties. And well before there was a crisis or incident. As part of care and advice people were already receiving in their GP practice.
This was the genesis of the Advance Project.
How long has it been running – and has it been successful?
We launched in 2016, with a key focus on GP practice nurses. In the last two years over 500 nurses in general practices across all states and territories of Australia were upskilled through the Advance Project multi-component training program.
Feedback has been overwhelmingly positive, with participants rating highly the quality and relevance of the resources, and the value of the training to their clinical practice and to their patients.
Nurses reported positive impacts for their patients and their carers following implementation of the resources into their clinical practice. And our evaluation also found evidence of significant improvements in the nurses’ confidence, comfort, knowledge, and attitudes towards initiating conversations about advance care planning and assessing patients’ and their carers’ palliative care needs.
So what’s new for 2019?
Our expanded goal is to promote a team-based approach – so we are now focused on supporting GPs, nurses and practice managers.
We are continuing to provide support to nurses in general practice, but have developed new training for other team members in primary care, including new online training modules specifically designed to meet the learning needs of general practitioners and practice managers.
And there’s now a new and updated toolkit resulting from comprehensive evaluation and consultation, designed specifically for GPs, nurses and practice managers. The new and updated Advance Project Toolkit has been officially recognised as an Accepted Clinical Resource by the Royal Australian College of General Practitioners (RACGP) and endorsed by the Australian Primary Health Care Nurses Association (APNA) according to approved quality standards criteria.
The free tele-mentoring has been expanded to provide ongoing support for not only nurses, but also GPs, practice managers and general practice teams. An experienced palliative care nurse is available to provide individual telephone mentoring and coaching regarding implementing the Advance Project resources into general practice. And train-the-trainer support will be available for selected champion networks. So that these networks can deliver face-to-face training and support implementation locally.
What do you see this expanded approach achieving?
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.
Josephine Clayton is a Specialist Physician in Palliative Medicine at HammondCare’s Greenwich Hospital in Sydney, Professor of Palliative Care at the University of Sydney, and Director of the Advance Project.
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