Next stage of Advance Project kicks off for GP's

GPs and general practice managers will be targeted in the next stage of the $2 million Advance Project, which encourages conversations and planning about how and where people wish to die. Following a successful evaluation of the first stage of the project, which targeted general practice nurses, the program is being expanded nationally to GPs and general practice managers.

Launching the new website and updated toolkit of resources today, HammondCare’s Director of Centre for Learning and Research in Palliative Care, Professor Josephine Clayton said extending the program for GPs and practice managers was a common sense next step for the program.

“GPs are in an ideal position to start advance care planning discussions with their patients because of their trusted relationship. They have an essential role in providing palliative care to patients and their families, and starting this conversation early,” Prof Clayton said.

The new Advance Project website and toolkit of resources provides free training about initiating conversations on advance care planning and assessing patients’ and carers’ palliative and supportive care needs. It also includes free booklets for patients.

Prof Clayton said the first stage of the Advance Project implemented last year, which trained over 500 general practice nurses nationally, had received a positive evaluation: “Evidence from the evaluation shows nurses’ knowledge was increased, their confidence grew and their comfort in initiating these conversations also greatly increased. Nurses reported positive impacts for patients and their carers following implementation of the resources in their clinical practice.

“However a barrier identified in the evaluation was that conversations about advance care planning and palliative care were hard for nurses to routinely initiate in their practice without the support and involvement of the GP and practice managers. So what we have provided now is some very practical resources for GPs and nurses to work together to make it easier for them as a team to have a conversation with their patients about how and where they want to die. Importantly, it is also aiming for people to have this conversation earlier, so they are not dictated by a crisis, which may limit their choices.”

The updated resources in the Advance Project include:

• Online learning resources such as eLearning and support for implementing the resources into general practice.
• Individual tele-mentoring for participating clinicians from across Australia.
• Grants and train-the-trainer support for champion networks to deliver face-to-face training and to support implementation of the model into clinical practice.

The Advance Project is available free of charge to all GPs, nurses working in general practice and practice managers throughout Australia. For more information visit: www.theadvanceproject.com.au

The project is funded by the Australian Government Department of Health, with training endorsed by the Australian Primary Health Care Nurses Association (APNA) and accredited by the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM), and delivered by a national consortium led by HammondCare. The consortium includes University of Sydney, Flinders University (CareSearch), Austin Health (Advance Care Planning Australia), University of Queensland, University of Technology Sydney, University of Wollongong and La Trobe University.

Prof Dimity Pond, practising GP in Berowra said: “Australians are living longer, and more and more people now have end of life around chronic disease rather than in times gone past, where people died from infectious diseases or accidents. It’s wonderful that modern medicine can extend people’s lives so long and give them a good quality of life in the process, but there comes a time when we are looking at the end of life and it is important for us to be respectful of people’s wishes and values at that time. In order to do that we need to have a discussion with them about what they would want towards their end of life and this is called advance care planning. As GPs we are ideally placed to initiate conversations about advance care planning. We’re often in a long standing relationship with these patients. They trust us and the general practice environment is non-threatening and makes it easier for them to talk about these issues.”

A/Prof Joel Rhee, practising GP in Hammondville said: “Dying is a universal experience, and so is the wish to die well with dignity and free from suffering, surrounded by loved ones in a familiar environment. And yet, many people in Australia are continuing to die with unmet palliative care needs, with figures from Victoria suggesting that up to two-thirds of people who might benefit from palliative care are not receiving it. We know that a holistic approach to palliative care and supportive care improves the quality of life of patients and their carers and families, because the problems associated with life-threatening illness are detected early and managed well. GPs have a critical role in caring for patients who are at risk of deteriorating health and dying. As GPs, we can identify these patients early so that their palliative and supportive care needs can be assessed and addressed in a timely way. A holistic assessment of palliative and supportive care needs includes not only the patient’s physical symptoms, but also psychological, social, and spiritual concerns and an assessment of their carer’s information and support needs.”