connecting end of life care in townsville · - activity 4: palliative care in aged care round table...

Townsville

PALLIATIVECAREQLD.ORG.AU/CELCThis project is administered by Palliative Care Queensland and

supported by funding from the Australian Government through the PHN Program.

The CELC North Queensland projects are administered by Palliative Care Queensland and supported by funding from the North Queensland PHN

through the Australian Government’s PHN program

Mackay

PALLIATIVECAREQLD.ORG.AU/CELCThis project is administered by Palliative Care Queensland and

supported by funding from the Australian Government through the PHN Program.

The CELC North Queensland projects are administered by Palliative Care Queensland and supported by funding from the North Queensland PHN

through the Australian Government’s PHN program

The CELC North Queensland projects are administered by Palliative Care Queensland and supported by funding from Northern Queensland PHN through the Australian Government’s PHN program

PROJECT REPORT 2017 - 2019

CONNECTING END OF LIFE CARE IN

TOWNSVILLE

Page: 2 of 68 CONNECTING END OF LIFE CARE IN TOWNSVILLE PROJECT REPORT | 2017 - 2019

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TABLECONTENTS

OF

Acknowledgements .......................................................................................................................................................... 3

Executive Summary .......................................................................................................................................................... 4

Background.......................................................................................................................................................................... 8

Connecting Systems .......................................................................................................................................................12

Connecting Systems | Activity 1: Training Needs Analysis ................................................................................14

Connecting Systems | Activity 2: Community Survey .........................................................................................31

Connecting Systems | Activity 3: Townsville Palliative Care services and supports mapping and

directory .............................................................................................................................................................................34

Connecting Systems | Activity 4: Palliative Care in Aged Care Round Table ...............................................36

Connecting Practice .......................................................................................................................................................39

Connecting Practice | Activity 5: Practice Development Program .................................................................41

Connecting Practice | Activity 6: I CARE for my resident with palliative needs resource kit ................46

Connecting Practice | Activity 7: CELC-NQ Special Interest Group ...............................................................50

Connecting Community.................................................................................................................................................52

Connecting Community | Activity 8: Community Engagement Activities ...................................................54

Connecting Community | Activity 9: Good Life Good Death expo ..................................................................57

Project recommendations for Townsville ...............................................................................................................60

Definition and Abbreviations ......................................................................................................................................62


Acknowledgements

Palliative Care Queensland acknowledges the Traditional Custodians of the lands and seas on which we live

and work, and pay our respects to Elders past, present and emerging.

Palliative Care Queensland would like to acknowledge all the project participants, residential aged care staff,

all the residents with palliative needs and the Steering Committee members involved for their support and

time in participating in the Connecting End of Life Care – Townsville [CELC-T] project.

This report has been written by PCQ CEO Shyla Mills, CELC Program Manager Marg Adams, Project Officers

Sharon Ho and Smita Gupta.

We understand that time is precious, and life is busy, and we appreciate everyone who has contributed in

sharing experience, knowledge and time with us.

To reference this publication:

Palliative Care Queensland (2019) CELC-T Project Report 2017-2019. Published on website: www.palliativecareqld.org.au/CELC

For more information about this report, Palliative Care Queensland [2019] CELC-T Project Report 2017-2019, please visit our project website at palliativecareqld.org.

au/CELC or contact us directly on (07) 3511 1539.


EXECUTIVE SUMMARY


1 Source from https://itt.abs.gov.au/itt/r.jsp?RegionSummary&region=318&dataset=ABS_REGIONAL_ASGS&geoconcept=REGION&measure=MEASURE&datasetASGS=ABS_

REGIONAL_ASGS&datasetLGA=ABS_REGIONAL_LGA&regionLGA=REGION&regionASGS=REGION

2 Sourced from https://www.agedcare101.com.au/aged-care/qld/townsville/region

Executive Summary

This report presents the findings of the Connecting End-of-Life Care in Townsville [CELC-T] project

conducted from 2017 to 2019. This report was conducted over a 2-year period in two stages. The initial

stage included a focus only on the greater Townsville region, this was then expanded to include the whole

Townsville Hospital and Health service region. The CELC-T project has been administered by Palliative Care

Queensland [PCQ] and funded by the Australian Government through the Northern Queensland Primary

Health Network [NQ PHN].

The purpose of the CELC-T was to improve knowledge and confidence in relation to end-of-life-care [EOLC]

planning hereby assisting in the management of after-hours service need.

The area of land of the Townsville region is 8,001,625.8 ha1. There is a population of 238,233 people in

Townsville with 66.9% of the population at working age1. 12.5% of the population in Townsville is 65 years or

older1. According to a desktop search of residential aged care [RAC] services in Townsville, there is a total of

19 RAC services identified in Townsville2.

The CELC-T project target audience was all residential aged care [RAC] staff, general practice staff, Aboriginal

Medical Services, Hospital and Health Services and community-based palliative care services, community

groups and community members within the NQPHN region.

CELC-T Project Aims and Activities

The CELC-T project recognised that to make improvements in palliative care three areas needed to be

targeted – systems, practice (ie interdisciplinary practice) and community (ie. Culture). Therefore, the project

had three main aims and included nine key activities:

1. Aim 1: Connecting Systems

Understanding current systems, understanding key issues and opportunities and connecting

relevant systems

- Activity 1: RAC Training Needs Analysis

- Activity 2: Community Survey

- Activity 3: Townsville Palliative Care Services and Supports Mapping and Directory

- Activity 4: Palliative Care in Aged Care Round Table

2. Aim 2: Connecting Practice

Improving the knowledge and confidence of the interdisciplinary teams providing holistic care and

connecting teams and roles

- Activity 5: Practice Development Program

- Activity 6: I CARE for my residents with palliative needs resource kit

- Activity 7: CELC-NQ Special Interest Group


3. Aim 3: Connecting Community

Creating community awareness and understanding about palliative care, services and supports and

connecting community groups and members with an interest in palliative care

- Activity 8: Community Engagement Activities

- Activity 9: Good Life Good Death expo

CELC-T Project Participation

• Over 1,200 people directly participated in the CELC-T project activities

o Including 395 in the RAC Training Needs Analysis, 337 in the Townsville Community Survey, 21

in the Palliative Care in Aged Care Round Table, 58 in the Practice Development Program

workshops and 400 in the Townsville Good Life Good Death expo.

• The program was featured in the local media 3 times

o Including ABC North Queensland radio, Channel 7 news and in the Townsville Bulletin.

• 45 Palliative Care Services and Supports were mapped

• Countless community and health professional conversations about loss, ageing, dying and grief occurred

CELC-T Project Outcomes

Key Learnings from our Connecting Systems Activities

Top five challenges to providing palliative care in RAC service Townsville

• Lack of staff/staffing

• Lack of access to resources – medical help/GP/after-hours

• Family request to do something different to the ACP

• Communication – family not wanting to be notified when resident dies

• Poor symptom control

Four key reasons for hospital transfer from RAC services for residents with palliative care needs in

Townsville

• Lack of knowledge

• Family request

• Lack of access to resources – medications after-hours

• Hospital is better suited to care for palliative/end-of-life-care residents


Four key recommendations were identified as part of the Townsville Community Survey

• Increase community confidence to source quality palliative care information

• Increase community confidence in facilitating conversations about end of life

• Improve health professional’s ability to explain the process of end of life care

• Share patient experiences and stories about end of life

Ten opportunities identified from the Townsville Palliative Care in Aged Care Round Table

• Develop local strategy network to ensure sustain conversations and facilitate change

• Facilitate Consumer engagement – Consumer Round table with all RAC services inviting residents

and families

• Goals of Care | Advanced Care Planning – discussions with RACF public and RACF private to

have consistent documentation – work with QAS to identify issues

• Training focus in communication and compassion – embed training needs orientation and

appraisal systems

• Ensure General Palliative Care is on the agenda at every RACF Townsville Meeting

• Paramedics and QAS – Opportunity for linkages/pathways between LARU, Specialist Palliative

Care services and RACF

• Understanding dying pathways – strengths & room for improvements: recognized with case

reviews/death audits attended by Acute/Specialist/RACF staff

• Mapping of GP services & Pharmacy services to RACF – particularly in afterhours

• Recognising dying – clinical and consumer awareness of how to recognise and communicate

dying needs using appropriate common language

• Investigate Nurse Practitioner led Model – case management/case conferencing, linkage

between RACF & Hospital, mentorship and trainings

Key Learnings from our Connecting Practice Activities

Practice development programs participants take home messages:

• There are resources available [for palliative care]

• Communication with everyone involved is important – including family

• Early planning of end-of-life care is needed

• Everyone has role in end-of-life-care

• Palliative care is not giving up


Key Learnings from our Connecting Community Activities

• Attendees would like to know more about Palliative Care and upcoming relative activities

• Statement of choice, and the PCA discussion starters were popular resources

• Free Henna tattoo provides an incentive to attracting people of all ages and inviting them to join our

conversation on palliative care and what matters most. While having henna, it provided an

opportunity to chat with the attendees and know about their perspective on palliative care

• The Before I Die banner is easy for people to engage with and prompts conversation starters

• Positive feedback from 1 GP, who could not gain permission to display the banner in their waiting

room, therefore displayed it in his consult room – he noted that this helped start conversations

about palliative care with his patients

• School art competitions are an effective method to engage schools in conversations about caring

and loss

• Local Councils are very supportive of community initiatives and compassionate communities

CELC-T Project Recommendations

• Consider extending the TNA and PDP into acute and community settings to improve understanding

and connections between and across sectors

• Evaluation of Special Interest Group impact on improving connections and conversations between

sectors to demystify service context and establish collegial respect for challenges and opportunities

to improve good day time planning for people with palliative care needs

• Continue the implementation of the ICARE for my residents with palliative needs resource kit and follow

up on integration

• Continue to facilitate discussions between national projects to avoid duplication of activity and

increase awareness of sector need

• Provide regular/accessible education/information on general palliative care to ‘refresh’ on

knowledge and specific medication and alternative pain management strategies

• Encourage RAC services to provide training and support to staff regarding dealing with increased

pressure from families

• Encourage RAC services linking with innovative models of service to support clinical decision making

and mentorship

• Consider technology to support engagement with clinical support afterhours such as telehealth –

models that need further exploration and can demonstrate impact on outcomes for hospital avoidance

• Add community engagement into future palliative care projects within the region, to extend to

impact of the project and support for service providers and consumers


BACKGROUND


About the project

The Palliative Care Queensland [PCQ] Connecting End of Life Care [CELC] program adapts to local needs.

PCQ developed the first CELC program in 2017 with Northern Queensland Primary Health Network

[NQPHN], following this we have rolled out activities in Mackay, Cairns, Gold Coast, Darling Downs and West

Moreton. Current active CELC projects are underway in Townsville, Cape York and Brisbane North.

The aim of the Connecting End of Life Care in Townsville [CELC-T] project was to improve the capacity

and capability of residential aged care [RAC] staff and General Practice [GP] service providers within the

Townsville Hospital and Health Services [HHS] region. CELC-T aimed to provide quality palliative care and

end-of-life planning thereby assisting in the management of after-hours service need.

This report summarises the first two stages of the CELC-T project, which was conducted over a 2-year period

between October 2017 and June 2019. The initial stage included a focus only on the greater Townsville

region, this was then expanded to include the whole Townsville Hospital and Health service region in stage

two. Stage 1 and 2 have had a specific focused on the RAC setting. The CELC-T project is continuing in 2019-

2020, this will continue to focus on the whole Townsville HHS region and will expand beyond RAC to all

primary palliative care providers within the region.

In parallel to the CELC-T stage two project, PCQ administrated two other CELC projects in Mackay [CELC-M]

and Cairns [CELC-C] which were funding by NQPHN Due to the similar nature of the three projects, often

these three projects were referred to as CELC North Queensland [CELC-NQ].


Key aspects of the CELC-T project included:

• Build relationships, partnerships and linkages with key stakeholders, local, national and federal

projects and relevant peak-bodies

• Collaborate with the primary palliative care workforce to identify gaps and challenges in their

training and leadership needs, and to create a network of support linking them to relevant evidence-

based resources and experts

• Deliver an education program that creates a baseline of knowledge and understanding about caring

for older people in their end phase of life

The CELC-T project recognised that to make improvements in palliative care three areas needed to be

targeted – systems, practice (ie interdisciplinary practice) and community (ie. Culture). Therefore, the project

had three main aims and included nine key activities:

1. Aim 1: Connecting Systems

Understanding current systems, understanding key issues and opportunities and connecting

relevant systems

- Activity 1: RAC Training Needs Analysis

- Activity 2: Community Survey

- Activity 3: Townsville Palliative Care Services and Supports Mapping and Directory

- Activity 4: Palliative Care in Aged Care Round Table

2. Aim 2: Connecting Practice

Improving the knowledge and confidence of the interdisciplinary teams providing holistic care and

connecting teams and roles

- Activity 5: Practice Development Program

- Activity 6: I CARE for my residents with palliative needs resource kit

- Activity 7: CELC-NQ Special Interest Group

3. Aim 3: Connecting Community

Creating community awareness and understanding about palliative care, services and supports and

connecting community groups and members with an interest in palliative care

- Activity 8: Community Engagement Activities

- Activity 9: Good Life Good Death expo

Project Governance

The CELC-T Project Steering Committee [The Committee] provides oversight of the project. The Committee

is responsible for establishing project direction, setting program deliverables and providing leadership in

the development, introduction and implementation of the CELC-T Project. The Committee is comprised of

key stakeholders internal and external to the palliative and aged care sectors and is accountable to the PCQ

State Council.


About Palliative Care Queensland [PCQ]

Palliative Care Queensland [PCQ] is an independent not-for-profit peak body with charitable status

representing the people who care for Queenslanders living with life limiting conditions. Queensland

Compassionate Communities [QCC] is the community arm of Palliative Care.

Our belief: The way we care for our dying is a significant indicator of our society’s values

Our mission: Quality care at the end of life for all

Our vision: To hear Queensland community members say:

“I live in a community where everybody recognises that we all have a role to play in supporting each other

in times of loss, ageing, dying and grief. We are ready, willing and confident to have conversations about

living, ageing, dying and grieving well, and to support each other in emotional and practical ways”.

PCQ has been operating for over 30 years, has over 400 members and is a founding member of Palliative Care

Australia. PCQ members include health professionals across all sectors of health, specialist and generalist

palliative care services, aged care, disability care, peak bodies, as well as consumers and interested members

of the Queensland community. Collectively, the PCQ membership body holds tremendous knowledge and

wisdom about the challenges the sector faces and the opportunities those challenges can bring.

About Northern Queensland Primary Health Network

Northern Queensland Primary Health Network [NQPHN] is an independent, not-for-profit organisation funded

by the Australian Government to commission services to meet the health needs and priorities of our region.

Their purpose is to ensure access to primary health care services respond to the individual and community

needs that are relevant to their culture and delivered by an appropriately skilled workforce.

The NQPHN region covers four HHS of Cape and Torres, Cairns and Hinterland, Townsville and Mackay.

Map from https://www.health.qld.gov.au/maps/mapto/townsville


CONNECTING SYSTEMS

Project Aim 1


TRAINING NEEDS ANALYSIS

Connecting Systems | Activity 1:


Purpose of the Training Needs Analysis

The purpose of the Residential Aged Care [RAC] training needs analysis [TNA] was to identify the specific

clinical and related skills required by RAC staff in the delivery of palliative care for residents and to determine

appropriate methods for developing these skills in the Townsville HHS region.

The primary objective of the TNA was to identify needs related to training in the following five areas:

1. Training Needs Area 1: Knowledge needs

3. Training Needs Area 3: Resource awareness

2. Training Needs Area 2: Confidence needs

4. Training Needs Area 4: Challenges and barriers

5. Training Needs Area 5: Training interest and modality

Identifying their current self-assessed knowledge about palliative and end-of-life care

Awareness of state-wide and national palliative care project resources

Identify their current self-assessed confidence in supporting and caring of palliative or end-of-life care resident

Identification of challenges and barriers in providing excellent palliative care in aged care during after-hours

Training interest and modality preference

TNA methodology

Palliative Care Queensland conducted the TNA in the CELC-T project in two stages

• The CELC-T1 (Greater Townsville region) TNA was conducted in March 2018.

10 RACs were eligible to participate

• The CELC-T2 (Townsville HHS, excluding the Greater Townsville region) TNA was conducted in

September/October 2018.

9 RACs were eligible to participate

The TNA methodology aimed to maximise engagement of aged care staff recognising the challenges with

variety of shift times and general capacity. Therefore, the CELC TNA includes two parts:

1. All RAC staff training needs survey (The All staff survey)

o Staff were divided into three categories, recognizing scope and role differences. The All staff

survey was used to analyse all five training needs areas


2. Facility manager training needs analysis focus group questions (The FM Questionnaire)

o A structured interview questionnaire developed to guide the CELC-T Project Officer to ask a

series of questions to all identified levels and roles of RAC staff and Facility managers. The FM

Questionnaire was used to analyse training needs area 4 and 5 only

TNA tool development

The All staff survey tool and the FM Questionnaire tool were developed based on recommendations from the

Palliative Approach Toolkit and discussions with The Committee members [CELC-T1 and CELC-T2]. The tools

were adapted slightly between CELC-T1 implementation and CELC-T2 implementation, based on feedback

from CELC-T1 participants and the experience of the project team.

TNA data collection methodologyParticipation eligibility

A total of 19 RAC services were identified as eligible to participate in the CELC-T TNA. These RAC services

were identified with NQPHN team.

10 identified during CELC-T1 and 9 identified in CELC-T2.

These RAC services are listed below.

CELC-T1 CELC-T2

Arcare North Shore Blue Care Bluehaven Aged Care Facility

Blue Care Shalom Elders Village Sandy Boyd Aged Care Hostel Palm Island

Blue Care Townsville Mt Louisa Aged Care Facilty Canossa Residential Services Trebonne

Bolton Clarke, Rowes Bay Churches of Christ Care Palms Aged Care

Carinity Fairfield Churches of Christ Care Rockingham Aged Care

Good Shepherd Nursing Home Dalrymple Villa - low care assisted living

Loreto Home for Aged Care Eventide Aged Care Facility

OzCare Villa Vincents Lower Burdekin Home for the Aged (Ayr)

Parkland Kirwan Lower Burdekin Home for the Aged (Homefield)

Regis Kirwan

Data received

79% of the eligible services participated in CELC-T TNA

o CELC-T1 TNA: 100% of the eligible services participated

• All staff survey: 80% of eligible services participated

• Facility Manager Questionnaire: 90% of eligible services participated

• Note: the 1 service that did not participate in the FM Questionnaire did participate in the All staff survey.


o CELC-T2 TNA: 56% of the eligible services participated

• All Staff Survey: 56% (5/9) of eligible services participated

• Facility Manager Questionnaire: 56% of eligible services participated

• Note: 4 services did not participate in either of The All staff survey or the FM Questionnaire.. The key reason for declining to participate in the TNA was capacity of the RAC

Data collection: The All staff survey

The All Staff Survey was collected through paper based and online survey tools.

A total of 381 All Staff Survey responses were collected from 14 RAC services from CELC-T Project

A total of 200 responses were collected from 8 RAC services from CELC-T1

A total of 181 responses were collected from 5 RAC services from CELC-T2

The All staff survey were divided into three categories, recognizing scope and role differences. Participation

per category for CELC-T TNA was as follows:

• Category 1: RNs, ENs, Managers, Quality staff and Education staff

o 83 Category 1 staff participated in CELC-T TNA All Staff Surveys

• Representing 22% of the TNA all participation

• Category 2: Allied Health, Carer/Assistant in Nursing [AINs]/Personal care workers [PCW], Team

Leaders, Activities Coordinators/Officers and Pastoral/Spiritual carers


• Representing 46% of the TNA All Staff Survey participation

• Category 3: Reception staff, cleaners and domestic staff, laundry staff and volunteers


• Representing 32% of the TNA All Staff Survey participation

The majority of participants were from Category 2 (46%), which is reflective of the bulk of the RAC workforce.

Data collection: FM Questionnaire

The FM interviews data was collected through face-to-face interviews for CELC-T1. Due to the short turn

around to conduct The All staff survey, a revised methodology was undertaken to capture the feedback of

RAC Facility Managers located in the Townsville HHS. Methods included telephone interviews or an email

with a PDF version of the manager survey.

All Facility Managers had an opportunity to contribute their feedback to the TNA arm of the project.

Facility Managers unable to participate in the TNA survey were provided with an opportunity to discuss

perceived challenges and opportunities in providing care to their residents with palliative needs, particularly


after-hours. Contact with Facility Managers was ongoing, enabling Facility Managers to provide formal and

informal feedback about the needs of their staff.

A total of 14 FM Questionnaire responses were collected from 14 RAC services from CELC-T Project

A total of 9 responses were collected from 9 RAC services from CELC-T1 A total of 5 responses were collected from 5 RAC services from CELC-T2 1 FM covered two RAC


RAC Training Needs Analysis implementation process

Introductory email to RAC Facility Managers

Telephone and or email follow up to all RAC to confirm postal address

Information packages circulated

FM Questionnaire and The All staff survey completed

Returned to PCQ and manually entered into survey monkey

• Introductory email circulated to all RAC Facility Managers in the Townsville HHS region – 20 RAC

Facility Managers (note 1 FM covered two RAC services)

• Facility Managers provided with an information package containing details on CELC-T ‘About the CELC-T

project flyer’ and copies of the finalised CELC-T surveys. Category 1,2,3; proposed distribution process for

The All staff survey; in RAC services discussed and key contact identified

• The All staff survey packs were circluated

• The FM Questionnaire was circulated – managers

were invited to complete during the meeting or

return to Project Officer at a time convenient

• Hand delivered

• Expressed post

• Printed by Facility Manager

• The All staff survey distribution plan – feedback was sought from the group regarding the draft survey

distribution plan. The suggestion of conducting ‘survey week/s’ at the facility and/or identifying key

contact at each site to assist with circulation/collection of survey was considered by the Facility Manager

as the most appropriate way to proceed with data collection

• Phone or email contact was encouraged to answer questions


TNA Promotion

Several strategies were undertaken to assist with the promotion and participation of staff in the CELC-T

TNA, including:

• Promotional flyers and posters

• Updates on social media platforms including Facebook, Twitter, Linked In, PCQ eNews, NQPHN

Communications platforms

• Local Steering Committee and associated networks

• Local conference and workshops hosted in the Townsville HHS region

TNA participation Incentive

Incentive prizes were allocated to the RAC services with the highest percentage of staff completing the

survey per staff category each staff category to encourage individual and facility participation.

CELC-T1

• Category 1 - 2 Palliative Care Nurse Australia Nurse Grant (valued over $1500 each)

• Category 2 - 2 x $50 Coles voucher

• Category 3 - 2 x $50 Coles voucher

CELC-T2

• Category 1 - registration for one person to attend the Palliative Care in Queensland Annual Summit

and Awards Dinner and Good Life Good Death Expo in Brisbane 2nd and 3rd December 2018. The

prize includes economy airfares and one-night accommodation in Brisbane for the event. (Valued

over $1000)

• Category 2 - $50 Coles Voucher for the team

• Category 3 - $50 Coles Voucher for the team

Survey confidentiality

Palliative Care Queensland regards the confidentiality of the survey data to be of utmost importance.

Data from each of the participating RAC facilities was collected on paper-based surveys and entered into

SurveyMonkey by the Project Coordinator. No personal identifiable information is presented in this report.

Additionally, the responses are combined and summarised in a report to further protect the anonymity of

participants.


Reporting of CELC-T TNA key findings

The findings have been presented in line with the five Training Needs Areas

• Training Needs Area 1 results: Current knowledge about palliative and end of life care3

• Training Needs Area 2 results: Their confidence in supporting and caring of palliative or end-of-life

care resident4

• Training Needs Area 3 results: Awareness of state-wide and national palliative care resources5

• Training Needs Area 4 results: Identification of challenges and barriers in providing excellent

palliative care in aged care during after-hours

• Training Needs Area 5 results: Training interest and modality preference

Both CELC-T1 and CELC-T2 shared similar findings and therefore the results were combined in this report.

3 Note: results collected only from the CELC-T2 All staff survey for this training needs area




Training Needs Area 1 results: Current knowledge about palliative and end-of-life care

This question aimed at gaining an understanding of what participants feel palliative care means. All answers

provided could be considered correct (other than don’t know).

This question asked participants to rate their current knowledge about palliative care and end-of-life-care.

Most respondents (59%) indicated their current knowledge of palliative care and end-of-life care is good/

excellent. As expected, Category 1 rated their knowledge as higher than category 2 and 3. 6% of Category

2 and 13% of Category 3 staff indicated their knowledge was poor to extremely poor. The project team

recommends that the PDP focus support and education needs to all categories and ensure that category 3

staff are included as well.


Training Needs Area 2 results: Their confidence in supporting and caring of palliative or end-of-life care residents

The purpose of this question was to determine how confident participants feel about having discussions with

residents or their families about life and death.

In all three categories the majority of staff rated their confidence level as reasonable.

As expected, Category 1 rated their confidence as higher than category 2 and 3. However considering that

the majority of their residents will have palliative care needs while living in the facility the project team

recommended a focus on communication techniques be integrated into the PDP to improve confidence in this

specific area.


Training Needs Area 3 results: Awareness of state-wide and national palliative care resources

This question aimed at identifying the percentage of category 1 and 2 staff who have accessed specific

palliative care resources. The awareness of existing resources was lower than the project team expected,

therefore PDP resource kits promoting linkages to existing resources was recommended.

Note: This question was only asked in the CELC-T2 survey.

This question was aimed at Category 1 staff members to gain an understanding of their confidence levels in

relation to their knowledge of advance care planning and associated documents.

75% of respondents indicated they are reasonably confident/very confident in their knowledge of advance

care planning and associated documents. 25% of respondents indicated they were not confident or did not

know their current knowledge of advance care planning and associated documents. Therefore as advance

care planning would be considered a core role for Category 1 staff, our preference would be to see this

rated higher.


The purpose of this question was to gain an understanding of what specific advance care documents/labels

Category 2 and 3 staff are aware of. As expected, Category 2 staff had a greater awareness of specific advance

care documents than Category 3 staff. However, the overall awareness of these documents are lower than

expected, therefore PDP resource kits promoting linkages to existing resources was recommended.



Training Needs Area 4 results: Identification of challenges and barriers in providing excellent palliative care in aged care during after-hours

Barriers included lack of staff knowledge and confidence to care for the deteriorating resident. This is at odds

with the feedback from staff when asked to measure knowledge and confidence.

All staff survey results:

Main barriers in the provision of providing excellent palliative care in aged care during afterhours

Category 1 Staff Category 2 Staff Category 3 Staff

• Lack of staffing

• Knowledge and Confidence

• Communication - between GP, Families, staff

• Clarity surrounding roles - who does what

• Lack of education

• GP knowledge of palliative care

• Access to after-hours support

• Lack of hospice

• GPs willing to write palliative medicines orders

• Poor symptom management

• Unclear expectations - goals of care unclear

• Staffing – limited skill and knowledge

• Staffing – not enough

• Funding

• Symptom management

• Access to training/education

• Access to resources – specialist services/general practitioners

• Consumables for cares

• Catering for resident individuality – interests, beliefs, cultural background

• Communication – not be notified if resident dies

• Appropriate accommodation – for privacy

• Supporting residents who don’t have family

• Admin staff have no training in this area

• Quiet and comfort for resident and family

• Being respectful of care recipient and family.

• Being able to let family know we are here to help in all ways possible and they can be safe to ask.

• Having enough trained staff

• To be able to suit everybody’s needs and best care also accommodation to people’s beliefs

• Family may prefer hospital

• Funding

• Training and education for staff and caregivers

• Integration of palliative approach across settings/continuity of care

“Family demanding resident to be sent to hospital. Staff not knowing how to explain to families. Difficulty contacting GP for adequate pain relief.” – Category 1 staff

It should be noted that many responses across all staff categories indicated that residents were admitted to

hospital admissions because of family requests, prior advance care planning decisions and a lack of knowledge.


Top identified reasons as to why palliative/end-of-life residents with palliative/end-of-life needs are transferred to hospital afterhours

Category 1 and 2 Staff Category 3 Staff

Advance Care Plan - Requested in APR Lack of knowledge

Education – staff, resident and family Request by family

Distressed family Improved comfort

Decline in health (assessment) More resources available including access to doctors

Hospital better - More pain relief, a comfortable area Challenges accessing after-hours support

Symptom management - Pain management

Skill mix after-hours – not as many staff available

after-hours

Facility managers identified barriers and gaps in relation to the provision of palliative care to

residents after hours are:

• Lack of resources

• Lack of consistency with staffing

• Difficulty cementing ongoing skills or career path in this area

• Inadequate staffing resources e.g. hard to care for resident that requires 1:1

• Lack of regular staff, high turnover

• Restrictions on calls after-hours/lack of access

• Friction with hospital when families want to send resident to hospital and unable to convince them

otherwise

• Family who want to do different to the ACP

• Lack of collaborations from GPs

• Lack of access to medications after hours

General responses across all categories suggest a perception by staff and families that hospital transfer of

the resident will equate to better comfort care and symptom management afterhours as staff have identified

there are challenges in accessing afterhours support. Another identified reason as to why residents are

transferred to hospital afterhours is due to family distress and by the request of the family.

FM Questionnaire results

The main barriers and gaps to providing palliative care to residents after-hours is due to a lack of resources,

inadequate staffing, lack of afterhours support, lack of access to medications and family who want a different plan

to the ACP.

“Planning ahead and getting orders in place during the day - especially before the weekend. If we are at a point and can't get what we need afterhours support, we transfer to hospital. The things that we need is education - some of our RNs are very junior look for education for them and AINs and personal care workers PCW” – Facility Manager


Training Needs Area 5 results: Training interest and modality preference

The All staff survey results

Identified interested training topics

Category 1 Staff Category 2 Staff Category 3 Staff

1. Breaking bad news

2. Communication skills

3. Medication management of symptom

4. Palliative care in general

5. Advance Care Planning

6. Recognising dying

7. Palliative Care – law and ethics

8. Case conferencing

1. Grief and bereavement

2. Palliative care in general

3. Advance Care Planning

4. Communicating with relatives and families

5. Coping with death and dying

6. Hands on experience

7. Allied health role in palliative care

8. Understanding the dying process

9. Self-care

10. Supporting families

1. Breaking bad news

2. Communication skills

3. Understanding my role in the team supporting resident and family

4. To be able to access palliative care training in general

Preferred learning style – all categories

Participants were asked to identify their preferred learning style to receive palliative care education to help

develop education delivery strategies. 41% of respondents indicated on average, the top four preferred

learning styles to receive palliative care education are by: computer or iPad leaning modules (30%), face-to-

face (62%), practical skills workshop (39%) and attending a conference or workshop off-site (32%).



Scheduling of training

Of the staff who responded to this question, 50% identified that they would be happy to attend palliative care

training if it was scheduled during work time. 14% of staff stated their preference would be for palliative care

training before or after work. Reasons identified included that they would be less likely to have distraction if

training was held offsite.

FM Questionnaire results

The Facility Managers identified four recommended training structures for future education sessions:

• Face to face workshops

• Webinars

• Onsite training - short timeslots no longer than 2 hours in duration

• Online modules

CELC-T2 FM7 identified face-to-face training and online modules are the recommended training structures.

Face-to-face training was recommended but only for short 30-minute training sessions due to the facility’s

inability to cover for a large amount of staff for a long period of time. Online modules were recommended as

online training can be done in the staff’s own time or scheduled before or after their shift.

Facility managers also recommended using relatable case studies as a methodology to engage staff.

7 Note: This question was only asked in the CELC-T2 FM Questionnaire.


Summary of CELC-T TNA key findings in relation to the five training needs areas

Five training needs areas Summary of Results

Training Needs Area 1: Current knowledge about palliative and end of life care

The self-rating of current knowledge for category

1 and 2 was relatively high compared to category

3 staff who indicated they have just ‘moderate’

current knowledge. However, other questions

indicated that there are gaps in knowledge about

what palliative care means.

It is recommended that the PDP focus support

and education needs to be targeted to all staff

categories.

Training Needs Area 2: Their confidence in supporting and caring of palliative or end-of-life- care residents

Across all 3 staff categories, most staff from

category 1 and 2 are reasonably confident in

having discussions about end of life with patient

and their families. It is recommended that a focus

on communication techniques be integrated into

the PDP education to improve confidence in this

specific area.

Training Needs Area 3: Awareness of state-wide and national palliative care resources

The awareness of existing state-wide and national

palliative care resources was lower than the

project team expected, therefore PDP resource

kits promoting linkages to existing resources was

recommended.

Training Needs Area 4: Identification of challenges and barriers in providing excellent palliative care in aged care during after-hours

Multiple barriers were identified by staff and facility

managers including system level issues, training

needs and operational issues. This was found to be

at odds with the feedback from staff when asked to

measure their confidence and current knowledge.

Training Needs Area 5: Training interest and modality preference

To promote learning, multimodal trainings methods

are recommended and the inclusion of case

studies as a learning technique. Majority of staff

indicated they were interested in more training

in communication techniques, understanding the

dying process and Advance Care Planning.


COMMUNITY SURVEY



Purpose of the Townsville Community Survey

The purpose of this community focused survey was to explore

Townsville’s:

• Public knowledge about palliative care

• To gain an understanding about how the Townsville public

are accessing and sharing information about palliative care

• Promote awareness of palliative care

Townsville Community Survey Development

The Townsville Community Survey Report was open from 14th February 2018 to 2nd April 2018 and

compromised a range of activities designed to maximize opportunities for community to participate. Activities

particularly focused on social media promotion and an incentive prize to complete the survey.

The Community survey questions were adapted from five different surveys:

1. Queen’s University Belfast: Exploring public awareness and perceptions of palliative care: a

qualitative study (2014)

2. Powell River Hospice Society and Powell River Division of Family Practice: Palliative Care

Community Survey (2017)

3. Hospice New Zealand: Public perceptions of hospice and palliative care and attitudes to death and

dying survey (2010)

4. Scottish Partnerships for Palliative Care: Public awareness of palliative care (2018)

5. Palliative Care Australia website community survey poll (2018)

Key findings of the Townsville Community Survey

A total of 337 completed the survey and survey promotion had a reach of over 6,500 on social media.

Key findings of the survey included

• 70% respondent indicated that they are ‘not very confident’ about accessing information and

support about palliative care and end of life issues

• 68% respondents indicated that don’t feel confident in having conversation about palliative care

• 60% indicated they learned about palliative care through their personal experience and the next

highest response was through friends, families and coworkers

• 82% respondents would choose quality of life over length of life

In addition ‘grey feedback’ received from social media engagement indicated that health professional’s

explanations and approach to end of life care were not always understood by community members.


Four key recommendations were identified as part of the Townsville Community Survey

1. Increase community confidence to source quality palliative care information

2. Increase community confidence in facilitating conversations about end of life

3. Improve health professional’s ability to explain the process of end of life care

4. Share patient experiences and stories about end of life


TOWNSVILLE PALLIATIVE CARE SERVICES AND

SUPPORTS MAPPING AND DIRECTORY



Purpose of the Townsville Palliative Care services and support mapping and Directory

The Townsville Palliative Care Services and Support mapping and Directory

was developed as a result from the TNA and community survey due to many

people stating they were not aware and did not know about community

resources and how to access them.

Methodology

In 2017 – 2018 Palliative Care Queensland undertook a community

services and supporting mapping activity within the Greater Townsville

Region to identify a variety of services and supports available for people

with palliative needs. This mapping also included services and supports that

exhibited at the Townsville Good Life Good Death expo.

Service mapping ensures that services are not being duplicated and available services are known - particularly

after-hours and community-based non-government organisation[NGO] services. Service mapping also

stimulates conversations about palliative care as the underlying question is “do you provide any supports for

people experiencing loss, ageing, dying and grief?” Many services underestimate what they do in this space

and this service mapping activity has enabled them to validate any supports they currently provide or what

they are considering providing in the future.

The CELC-T Steering committee recommended that the directory be held within mycommunitydirectory, an

online tool which is already being utilised by other NQPHN projects and many local councils in Queensland.

Once the mapping was completed Palliative Care QLD worked with mycommunitydirectory to create a

centralised source of information where community members in Townsville can find all support services

available and what services they provide.

Key findings of the Townsville Palliative Care Services and Supports Mapping and Community Directory

A total of 45 services and supports were identified within the Greater Townsville region and provided to

mycommunitydirectory. These are now available in the live search function on their website and app.

A Townsville Palliative Care Services and Supports Directory PDF is also available to download from the

mycommunitydirectory website – this is updated every time a service or support updates their contact details

therefore is very useful for General Practice and RACs.

Townsville

PALLIATIVECAREQLD.ORG.AU/CELC_NQ

The CELC NQ projects are administered by Palliative Care Queensland and

supported by funding from Northern Queensland PHN through the

Australian Government’s PHN program

Palliative Care Services

and Support Directory

TOWNSVILLE

Developed by the Connecting End of Life Care (CELC) Townsville project

www.palliativecareqld.org.au/CELC (07) 3511 1539 [email protected]


PALLIATIVE CARE IN AGED CARE ROUND

TABLE



Purpose of the Townsville Palliative Care in Aged Care Round Table

The purpose of the Palliative Care in Aged Care Round Table meeting was to

facilitate an informal discussion surrounding the current model of palliative care

service delivery in RAC – specifically the 10 facilities captured in the CELC-T project.

The Palliative Care in Aged Care Round Table was an invite-only event, it provided

the opportunity for local stakeholders to discuss challenges, opportunities and vision

for a sustainable model of Palliative Care in Aged Care in Townsville.

Methodology

The event was held on 29 June 2018 and was attended by 21 out of 22 attendees who

were formally invited including:

• Local members of the Townsville Community [Consumers, Clinical Leaders from Acute, Specialist

Palliative Care, RAC, PHN, General Practice, Legal]

• Palliative Care Queensland

• Palliative Care Australia

• Council Of The Ageing Queensland [COTA QLD]

• Canberra Hospital and Health Services

Key findings of the Townsville Palliative Care in Aged Care Round Table

Top key issues identified

• Lack of clarity of PC RAC vision Townsville

• Symptom management - availability of skilled staff to deliver breakthrough medications during night

• Lack of skilled workforce

• Limited GP support afterhours – lack of continuity of care

• Poor communication with consumers and families about transition to palliative care

• Goals of care and Advance Care Planning documentation – inconsistency with documentation being

accepted e.g. ARP

• ED staff challenged with recognizing dying

• Inappropriate referrals to ED | hospital afterhours

• Aboriginal and Torres Strait Islander representative not apparent

10 opportunities identified

• Develop local strategy network to ensure sustain conversations and facilitate change

• Facilitate Consumer engagement – Consumer Round table with all RAC services inviting residents

and families

• Goals of Care | Advanced Care Planning – discussions with RAC services public and RAC services

private to have consistent documentation – work with QAS to identify issues

• Training focus in communication and compassion – embed training needs orientation and

appraisal systems


• Ensure General Palliative Care is on the agenda at every RAC Townsville Meeting

• Paramedics and QAS – Opportunity for linkages/pathways between LARU, Specialist Palliative Care

services and RAC services

• Understanding dying pathways – strengths & room for improvements: recognized with case reviews

/death audits attended by Acute/Specialist/RAC services staff

• Mapping of GP services & Pharmacy services to RAC services – particularly in afterhours

• Recognising dying – clinical and consumer awareness of how to recognise and communicate dying

needs using appropriate common language

• Investigate Nurse Practitioner led Model – case management/case conferencing, linkage between

RAC services & Hospital, mentorship and trainings

Round Table follow up activities

Following the Palliative Care in Aged Care Round Table four follow up meetings were held monthly with the

executive/directors from NQPHN, Townsville Hospital Palliative Care Team and Palliative Care Queensland.

The ten opportunities were discussed at each of these meetings to ensure they were followed up or

embedded into other activities existing within the different organisations.


CONNECTING PRACTICE

Project Aim 2

PRACTICE DEVELOPMENT PROGRAM

Connecting Practice | Activity 5:


Purpose of the Practice Development Program

The Practice Development Program [PDP] was developed in response to the findings of the TNA to address

the training needs of the RAC services staff in the Townsville HHS region.

The purpose of the PDP was focused on:

• Improving staff knowledge about quality palliative care and confidence to deliver quality palliative care

• Reducing perception of barriers

• Build linkages to existing resources

PDP methodology

Target audience

The PDP are collaborative sessions targeted at Palliative Care services in the Townsville HHS region,

Northern Queensland Primary Health Network, GPs, Practice Nurses, Allied Health, QAS and aged care

providers to deliver education and training systems.

Promotion

The CELC-T PDP was promoted through various strategies, this included

• Social media posts via Facebook and Twitter

• NQPHN communications team

• PCQ eNews

• CELC-T Steering Committee networks

• Direct emails and telephone contact with key contact persons for each RACF e.g. Director of Care,

facility/quality manager, educator

• As an incentive to encourage attendance of RAC staff at each site a complimentary copy of the

Australian Pain Society: Pain in Residential Aged Care: Management strategies book [valued at

$100] to any RAC who sent 2 or more staff members to a session. This process was consistent across

all CELC project sites

PDP implementation

The PDP was implemented through various delivery modes such as: webinars, workshops, education

mornings and resource folders. The content of the workshops was flexible to enable maximum participation of

staff from all levels and experience.

Webinars

The five topics included in the webinars were discussed with the CELC-T project The Committee based on the

results of the TNA.


The topics included were:

• PCC4U: Free Palliative Care online education resources

• Communication skills, underpinning palliative care

• Talking about grief and loss

• After bad news has been broken – how to continue the conversation

• Compassion underpinning your care – for yourself and others

The webinars were developed based on the recommendations from the

TNA and discussion with the CELC-T Steering Committee members.

Therefore, it was recommended that the webinars be made to address the

education needs, provide opportunities to discuss case studies and to work

collaboratively with professional stakeholders.

Where possible, webinars were recorded. Copies of these sessions will be available for participants via PCQ

website. Several RAC services and GPs provided feedback relating to challenges accessing webinars because

of unreliable technology.

Workshops

The PDP workshops consisted of five 2-hour workshops and were hosted at various locations in the

Townsville HHS region, including Eventide Nursing Home Charters Towers and NQ PHN Townsville over

three days [21/03/19 - 22/03/19, 02/04/19]. The workshops were designed to be face-to-face participative

groups to address educational needs based from the TNA results and with The Committee’s input.

The topics included in the workshops were:

• Identifying complex residents at high risk for requiring after-hours support

• Identifying goals of care for people with palliative needs

• Symptom management for people with palliative needs

• Understanding your role in the team when caring for people with palliative needs

• Palliative care is everybody’s business – What is palliative care?

A total of 58 participants attended the PDP workshops across the 3 days. 48 participants provided evaluation

feedback, giving a response rate of 83%.

Morning education sessions

The Education breakfast sessions are designed to be a collaborative education morning open to all Palliative

Care Queensland members, palliative care (Primary care, aged care, general practice, disability sector and

acute hospital staff) and specialist palliative care health professionals as well as anyone with an interest in

palliative care in Queensland. The sessions are included: a panel of speakers discussing the topics based on

their experience in relation to the topic. The topics were chosen based on the World Health Organisation’s

definition of palliative care and the results from the TNA.

Practice Development Program

For North Queensland Residential Aged Care and General Practice Staff

Keep up to date

with palliative

care in age care resources

The Connecting End of Life Care in North Queensland Network (CELC NQ Network) will meet

quarterly for 1.5hrs via video conference - an ideal way to keep up to date with best practice

palliative care in aged care.

Practical opportunities to improve your service

Understanding palliative care - https://palliativecare.org.au/

Palliative care information - www.caresearch.com.au

Online & telephone support - https://palassist.org.au/

Qld government information for end of life - https://www.qld.gov.au/health/support/end-of-life

Advance Care Planning (ACP) - www.metrosouth.health.qld.gov.au/acp

Evidence based resources- www.palliaged.com.au

Centre for Palliative Care Research & Education (CPCRE) - https://www.health.qld.gov.au/cpcre

Palliative care knowledge network - www.caresearch.com.au

Therapeutic Guidelines for palliative care - https://www.tg.org.au/

Aboriginal and Torres Strait Islander care - https://healthinfonet.ecu.edu.au/

Cognitive impairment - www.safetyandquality.gov.au/our-work/cognitive-impairment/better-way-to-care

CELC NQ Practice Development Program website: https://palliativecareqld.org.au/celcnq_pdp/

More information:

www.palliativecareqld.org.au/celcnq_pdp/

Palliative care is everybody's business

The CELC projects are administered by Palliative Care Queensland and supported by funding from the Australian Government through the PHN Program

PEPA - clinical placements - www.pepaeducation.com/

ELDAC - toolkits and linkage opportunities - www.eldac.com.au/

PCC4U - online training module - www.pcc4u.org/

FREECELC NQ Network

I care for my residents with palliative needs by planning for after hours care needs

5 tips for

improving my care

Staff lanyard card and poster available

Order your posters or lanyard cards for your team: email [email protected]

Recommended websites for residents and families

Recommended websites for staff

Palliative Care in Aged Care video resources

The CELC NQ Network will be launched in April 2019

Email - [email protected] to register your interest in joining this network.


Where possible, webinars were recorded. Copies of these sessions will be available for participants via PCQ

website. Several RAC services and GPs provided feedback relating to challenges accessing webinars because

of unreliable technology.

Evaluations

Participants were given an evaluation form to provide feedback about the session they attended.

This form came in two methods:

1. a scanned PDF evaluation form where participants filled out the form and emailed it back or

2. a paper-based evaluation form where a PCQ Officer gave the form to the participant and

collected it after

The results of the evaluation are found in the next section.

Limitations

The process of capturing written evaluations for the education events conducted via model of webinars was

difficult to achieve. Despite best efforts of sending PDF and electronic links to feedback forms, return rates

are not optimal.

CELC-T PDP results

The PDP results are presented in line with the four purposes of the PDP

1. Improving staff knowledge about quality palliative care and confidence to deliver quality

palliative care

a. There was a 44% positive shift in the knowledge rating pre and post the PDP activities – from

a 49% pre (good/excellent) to a 93% post

b. There was a 45% positive shift in the confidence rating pre and post the PDP activities – from

a 47% pre (good/excellent) to a 92% post


2) Reducing perception of barriers

A key focus underpinning all the PDP activities was to discuss the barriers identified in the TNA and

encourage the participants to explore their own methods of overcoming these. Some of these were captured

in the evaluation survey when they were asked what changes they would make post the PDP activity:

• Provide more palliative care education and resources for all staff

• Support teams/staff involved with palliative care

• Debrief more often

• Improve relationships with allied health and GPs

• Start conversations

3) Build linkages to existing resources

Resource folders were provided at all face-to-face PDP activities. These provided linkages to existing

resources and were highlighted throughout the PDP activities as well.

PDP participants shared some key take home messages:

• There are resources available

• Communication with everyone involved is important – including family

• Early planning of end-of-life care is needed

• Everyone has role in end-of-life-care

• Palliative care is not giving up


I CARE FOR MY RESIDENTS WITH PALLIATIVE NEEDS

RESOURCE KIT



Purpose of the ICARE for my residents with palliative care needs resource kit

The ICARE for my residents with palliative care needs resource kit, was an extension to the PDP resource

kit which aimed to link services to existing resources and provide guidance for planning for afterhours

palliative care needs.

A new resource was developed in conjunction with all the CELC-NQ projects (CELC-M, CELC–C and CELC-T)

which was referred to as the 5 elements of ICARE for my residents with palliative needs framework. It aimed to

provide a practical decision-making framework to assist staff when caring for a resident with palliative care

needs and avoid unnecessary transfer to acute care facilities after-hours.

The 5 elements include:

1. Identify the goals of care

2. Clarify your role in the care plan

3. Anticipate and plan for symptoms

4. Review the care plan regularly

5. Equip yourself with knowledge

Methodology

The ICARE for my residents with palliative needs resource kit has evolved from comments we received from the

training needs analysis [TNA] conducted with residential aged care [RAC] staff in the Mackay HHS, Townsville

HHS and Cairns HHS. Staff identified the need for ready access to information and support about:

• Palliative care and symptom management

• Communication with residents/family, team members and other service providers

• Advance care planning

• Where to gain practical hands on experience with other services providing palliative care

• Supporting residents and family with grief and loss

The items in the ICARE for my residents with palliative needs resource kit include National Projects identified

resources such as:

a. Resource folders – to access extra information

• Policy and strategy information

• Resource links & flyers for palliative statewide/national projects

• PCC4U information including a USB stick – links to self-directed learning modules

• Caring for Aboriginal and Torres Strait Islander peoples

• Advance Care Planning & Communication resources

b. Lanyard cards

c. Posters

• ICARE for my residents with palliative needs 5 elements poster


• ICARE for my residents with palliative needs comic poster

• CELC-NQ Equip yourself knowledge

d. palliAGED Practice Tips booklets

• palliAGED Practice Tips for Care workers from Aged Care

• palliAGED Practice Tips for Nurses in Aged Care

ICARE for my residents with palliative needs resource kit distribution summary

The ICARE for my residents with palliative needs resource kit was distributed by courier mail [pack and send] to 9

facilities in Mackay HHS region. Upon delivery/collection of the ICARE for my residents with palliative needs

resource kit, a signature by the facility’s collector was requested to indicate the resource kit was received.

One RAC declined to receive the ICARE for my residents with palliative needs resource kit.”

Preliminary evaluation

As the ICARE for my residents with palliative needs resource kits were provided in the last month of the project,

the evaluation is only considered preliminary.

A total of 11 out of 19 RAC services in the Townsville HHS region provided feedback on the ICARE for my residents with palliative needs resources kit with a response rate of 58%.

• 4 out of 11 (36%) RAC services provided comments stating the ICARE for my residents with

palliative needs resource kit is very helpful and useful with one facility stating they are planning on

ordering more resources from the ICARE for my residents with palliative needs resource kit for their staff

• 2 out of 11 (18%) RAC services have said they have shared the ICARE for my residents with palliative needs resource kit with their staff

• 4 RAC services have indicated they have not used the ICARE for my residents with palliative needs resource kit due to the resource kit being left in the clinical manager’s office who is currently away

• Other RAC services that have responded indicated that they have not had time to go through the

resources and have left the resource kit in an open staff area where staff can peruse through it (e.g.

staff room, medications rooms etc.)


““Very good. Passing onto the Clinical Nurse when she comes back from leave”

““The information and brochures are very good and will be sure to use it”

““Put the box in the medication room for RN’s and EN’s to have a look at”


CELC-NQ SPECIAL INTEREST GROUP



Purpose of the CELC-NQ Special Interest Group

The CELQ-NQ Special Interest Group [CELC-NQ SIG] is a 1-hour video

conference that runs bi-monthly. The purpose of the CELQ-NQ SIG is to

keep an ongoing connection up to date best practice, systems improvements

and education opportunities related to palliative care in aged care.

CELC-NQ SIG conversations will be held by webinar starting from 25 June

2019.

CELC-NQ SIG Methodology

The CELQ-NQ SIG topics were developed based from what health care

professionals [Category 1] stated are a priority in relation to Palliative Care

from the TNA. These topics include:

• Palliative care and symptom management

• Communication with residents/family, team members and other service providers

• Advance care planning

• Supporting residents and family with grief and loss

• How do we help residents/clients decide ‘what matters most’ to them?

• Where to gain practical hands on experience with other services providing palliative care

• Palliative care emergencies

• Self-care and self-compassion: looking after yourself

The development of the dates and times were discussed with the CELC-T Steering Committee members and

feedback identified from the TNA. It was decided the video conferences will run bi-monthly from 2pm to

3pm during a non-busy period of the day. The regular meeting time bi-monthly will increase the potential for

clinical education to be embedded into usual practice.

The online mode of delivery will extend the opportunity for participation of staff working in regional and

rural facilities and increase linkages to other service providers. Discussion items will be centred around local

community priorities and issues raised by relevant stakeholders.

CELC-NQ SIG Implementation

The CELQ-NQ SIG will be available for interested clinicians within the NQPHN region to participate. In June

2019, flyers were distributed widely via email and post throughout Northern Queensland, particularly in

Cairns, Mackay and Townsville.

BI-MONTHLY SPECIAL INTEREST GROUP

CONVERSATIONS VIA WEBINAR

The CELC-NQ Special Interest Group (SIG) is an online group which connects bi-monthly to talk about palliative and

end-of-life care. We encourage all health professionals within the Northern Queensland PHN area to grab a tea or

coffee and join these conversations. Sessions are held via zoom on the fourth Wednesday bi-monthly (except over

the summer break) from 2pm-3pm.

FREE FOR ALL

NQ HEALTH

PROFESSIONAL

STAFFNorth Queensland

PALLIATIVECAREQLD.ORG.AU/CELC_NQ

The CELC NQ projects are administered by Palliative Care Queensland and

supported by funding from Northern Queensland PHN through the

Australian Government’s PHN program

CELC NORTH QUEENSLAND - SPECIAL INTEREST GROUP

The CELC NQ projects are administered by Palliative Care Queensland and supported by

funding from Northern Queensland PHN through the Australian Government’s PHN program.PALLIATIVECAREQLD.ORG.AU/CELC_NQ

DateConversation Topic

25 June 2019 Palliative care and symptom management

28 August 2019 Communication with residents/family, team members and other service providers

23 October 2019 Advance care planning

26 February 2020 Supporting residents and family with grief and loss

29 April 2020 How do we help residents/clients decide ‘what matters most’ to them?

24 June 2020 Where to gain practical hands on experience with other services providing palliative care

26 August 2020 Palliative care emergencies

28 October 2020 Self-care and self-compassion: looking after yourself

Each SIG conversation session will be facilitated by a member of the Palliative Care Queensland team with a focus on

a new topic each conversation. The conversations will include practical examples, case studies and linkages to relevant

resources. Participants are encourage to ask questions and be involved in the conversation, or simply listen and learn

from this group of people with a similar interest.

Register to participate: www.celc_nq_sig.eventbrite.com.au


CONNECTING COMMUNITY

Project Aim 3


COMMUNITY ENGAGEMENT ACTIVITIES

Connecting Community | Activity 8:


Purpose of the Connecting Community activities

The CELC-T project engaged with the community through a variety of methodologies enabled the project to

gain deep understanding of opportunities and challenges of community engagement within the framework of

palliative care.

Community Activities had three focuses:

• Community engagement – starting conversations around loss, ageing, dying and grief in an open,

honest and friendly environment, and to help people understand that end-of-life shouldn’t be

considered a taboo subject

• Information sharing – showcase services, supports and resources related to end-of-life in the form

of exhibition boots, presentations, discussions and handouts. To facilitate networking opportunities

for local service providers, community organisations, groups and members

• Education – to share information, stories and best-practice in relation to palliative end-of-life

through education sessions free for the community to attend with health professionals

Community Activities

Activities included:

• Community Conversation Starter Activities

o Public information booths (i.e. shopping centre booths and markets)

o Before I die banners

o Awareness campaigns – what matters most thought boards

• Participation in community events

o Chronic disease management expo – Townsville Aboriginal and Islander Health Services (TAIHS)

o NAIDOC Week

o Belgian School Parade

o Dying to Know day

o Queensland Palliative Care Film Night


o James Cook University Marketing Day

o Mater Hospice Community Connect provider expo

o Community Aged Care Round Table

o Townsville City Council activities

o National Palliative Care Week – Light up the Townsville Bridge

Key findings of the CELC-T community activities

The project shared many learnings from participating in these community activities. Some of these included:

• Attendees would like to know more about Palliative Care and upcoming relative activities

• Statement of choice, and the PCA discussion starters were popular resources

• Free Henna tattoo provided an incentive to attracting people of all ages and inviting them to join our

conversation on palliative care and what matters most. While having henna, it provided an

opportunity to chat with the attendees and know about their perspective on palliative care

• The Before I Die banner is easy for people to engage with and prompts conversation starters

• Positive feedback from 1 GP, who could not gain permission to display the banner in their waiting

room, therefore displayed it in his consult room – he noted that this helped start conversations

about palliative care with his patients

• School art competitions are an effective method to engage schools in conversations about caring and loss

• Local Councils are very supportive of community initiatives and compassionate communities

In general, people we engaged with, as part of our community activities, stated they had a:

• Greater level of understanding of the benefits of early conversations about health care choices and

understand who in the community can assist them to achieve their wishes at end-of-life

• Better understanding of the benefits of palliative care and the positive impact it can have on

individuals and families in supporting people as they live with life-limiting illnesses

• Increased confidence in starting discussions related to loss and dying

““This made me think of palliative care completely differently – its makes me focused on what I want rather than what I don’t have anymore” Health student


GOOD LIFE GOOD DEATH EXPO

Connecting Community | Activity 9:


Townsville Good Life Good Death Expo

Over 29-30 June 2018, Palliative Care Queensland held its inaugural North

Queensland Community Expo at the Ville Resort in Townsville. The expo was

titled Good Life Good Death expo [the Expo] in line with the inaugural Brisbane

2017 Expo and was considered a great success.

The free 2-day Good Life Good Death expo had over 400 attendees, 10

volunteers, 35 exhibitors and 20 expert speakers. Over 240 people attended the

educational sessions.

The purpose of the Townsville Good Life Good Death Expo

Four key purposes for the Good Life Good Death expo were identified:

• Start conversations around loss, ageing, dying and grief in an open,

honest and friendly environment, to help people understand that end of

life shouldn’t be a taboo subject

• Showcase services and resources related to end of life in the form of

exhibition booths, presentations, discussions and handouts

• Facilitate networking opportunities for local service providers,

community organisations, groups and members

• Share information, stories and best practice in relation to palliative and end of life through breakfast

sessions, a round table and expert panel sessions

Results of the Townsville Good Life Good Death expo

There are 3 main aspects to the Expo

• Community Aspect

• Exhibition and Information Aspect

• Education Aspect

Over 400 people attended the Good Life Good Death expo in Townsville

• 47% Health Professionals

• 53% Community Members

o Including 6% identifying as a carer and 2% identifying they have a palliative condition

In total 35 exhibitors attended the Expo. These included local, Queensland and National Exhibitors

• 100% of exhibitors said that they enjoyed the Expo

• 94% of respondents said that they would exhibit again and/or recommend the Expo to a friend or

colleague


The Education aspect to the Expo was sponsored by the Connecting End of Life Care in Townsville project,

administered by Palliative Care Queensland and funded by Northern Queensland Primary Health Network

• 61 people attended the Education Breakfasts

• 157 people attended the Expert Panel Sessions across the two days

By starting these conversations, sharing information and showcasing services and resources available the

outcomes we achieved were that all attendees:

• Had a greater level of understanding of the benefits of early conversations about health care choices

and understand who in the community can assist them to achieve their wishes at end of life

• Had a better understanding of the benefits of palliative care and the positive impact it can have on

individuals and families in supporting people as they live with life-limiting illnesses

• Had increased confidence in starting discussions related to death and dying

100% of respondents who provided feedback told us that they enjoyed the Expo and the majority indicated

they would attend again.

““End of life is a big fact of life and it is being discussed in a very big way in Townsville”

Michael Clarke, ABC Radio North Queensland


CELC-T PROJECT RECOMMENDATIONS

FOR TOWNSVILLE


The following are recommendations for the Northern Queensland Primary Health Network in the Townsville HHS region:

• Consider extending the TNA and PDP into acute and community settings to improve understanding

and connections between and across sectors

• Evaluation of Special Interest Group impact on improving connections and conversations between

sectors to demystify service context and establish collegial respect for challenges and opportunities

to improve good day time planning for people with palliative care needs

• Continue the implementation of the ICARE for my residents with palliative needs resource kit and follow

up on integration

• Continue to facilitate discussions between national projects to avoid duplication of activity and

increase awareness of sector need

• Provide regular/accessible education/information on general palliative care to ‘refresh’ on

knowledge and specific medication and alternative pain management strategies

• Encourage RAC services to provide training and support to staff regarding dealing with increased

pressure from families

• Encourage RAC services linking with innovative models of service to support clinical decision making

and mentorship

• Consider technology to support engagement with clinical support afterhours such as telehealth –

models that need further exploration and can demonstrate impact on outcomes for hospital avoidance

• Add community engagement into future palliative care projects within the region, to extend to

impact of the project and support for service providers and consumers


DEFINITION AND ABBREVIATIONS


Definition and Abbreviations

Abbreviation Definition

AIN Assistant in Nursing

The All staff survey All residential aged care staff training needs analysis focus questions

CELCConnecting End of Life Care https://palliativecareqld.org.au/celc

CELC-C Connecting End of Life Care - Cairns

CELC-M Connecting End of Life Care - Mackay

CELC-NQConnecting End of Life Care - North Queensland Inclusive of CELC-T1, CELC-T2, CELC-M and CELC-C projects

CELC-TConnecting End of Life Care – Townsville (inclusive of CELC-T1 and CELC-T2 projects)

The Committee CELC-T Steering Committee

Connecting End of Life Care – Townsville 1 [CELC-T1]

First phase of the CELC-T project from October 2017 to June 2018

Connecting End of Life Care – Townsville 2 [CELC-T2]

Second phase of the CELC-T project from June 2018 to June 2019. Continuation of the CELC-T1 (first phase)

End-of-life-care [EOLC]

Includes physical, spiritual and psychosocial assessment, and care and treatment delivered by health professionals and ancillary staff. It also includes support of families and carers, and care of the patient’s body after their death. People are ‘approaching the end of life’ when they are likely to die within the next 12 months Source: Queensland Government - Care at the end of life: https://www.qld.gov.au/health/

support/end-of-life/care/palliative

The ExpoGood Life Good Death expo

www.goodlifegooddeathexpo.org.au

Facility Manager [FM]The leadership role title of the positions varied with some identifying as Director of Nursing, some as facility managers

FM Questionnaire Facility manager training needs analysis focus group questions

GP General Practitioner

HHS Hospital and Health Service

LARULow Acuity Response Unit Source: Department of Health – Queensland Ambulance Strategy 2016-2021: https://www.

ambulance.qld.gov.au/docs/qas-strategy-2016-2021.pdf


Abbreviation Definition

NAIDOC‘National Aborigines and Islanders Day Observance Committee’. This committee was once responsible for organising national activities during NAIDOC Week and its acronym has since become the name of the week itself Source: NAIDOC Week: https://www.naidoc.org.au/about/naidoc-week

NGO Non-government organisation

NQPHN Northern Queensland Primary Health Network

Palliative Care

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual Source: World Health Organisation: https://www.who.int/cancer/palliative/definition/en/

PCAPalliative Care Australia Source: www.palliativecare.org.au (Italic and small font)

PCQPalliative Care Queensland www.palliativecareqld.org.au

PCW Personal care worker

PDP Practice Development Program

RAC Residential Aged Care

SIG Special Interest Group

Specialist palliative care

Supports and educates the palliative care sector and provide specialist additional supports for people and their families who have complex and persistent issues related to their care Source: Palliative Care Australia - Palliative Care Service Development Guidelines (2018)

- http://palliativecare.org.au/wp-content/uploads/dlm_ uploads/2018/02/PalliativeCare-

Service-Delivery-2018_web2.pdf

QASQueensland Ambulance Service Source: www.ambulance.qld.gov.au

TAIHSTownsville Aboriginal and Islanders Health Services Source: https://www.taihs.net.au/

TNA Training Needs Analysis

TNA Category 1 staff RNs, ENs, Managers, Quality staff and Education staff

TNA Category 2 staffAllied Health, Carer/Assistant in Nursing [AINs], Team Leaders, Activities Coordinators/Officers and Pastoral/Spiritual carers

TNA Category 3 staffReception staff, cleaners and domestic staff, laundry staff and volunteers

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(07) 3511 1539

[email protected]

www.palliativecareqld.org.au/CELC

connecting end of life care in townsville · - activity 4: palliative care in aged care round table...

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