Clinical resources, training and education

Palliative Care Therapeutic Guidelines (access via DHHS Clinicians Health Channel)

The electronically published Palliative Care Therapeutic Guidelines (eTG Complete) from independent not-for-profit organisation Therapeutic Guidelines Limited (TGL) provide detailed guidance for health professionals on a wide range of topics.

The eTG guidelines can only be accessed via purchase/paid subscription. Victorian Department of Health and Human Services (DHHS) funded organisations can gain free access via the Department’s Clinicians Health Channel.

https://www2.health.vic.gov.au/CliniciansHealthChannel

Ready for Community Palliative Care (DHHS Vic online resource)

Ready for Community Palliative Care is an online resource of the Victorian Department of Health and Human Services based on work undertaken by a working party of the Victorian Palliative Care Clinical Network (PCCN).

The resource supports acute hospital staff in their discharge planning for patients who are in the last twelve months of life. Patients may be stable, deteriorating, unstable or actively dying.

The aim of the resource is to make discharge safe and secure for patients, families and carers, whether it is to the person’s home, residential aged care or a disability service.

It includes sections on:

https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/palliative-care/ready-for-community

Essential elements of end of life care (DHHS Vic online resource)

Essential elements of end of life care is an online resource of the Victorian Department of Health and Human Services (DHHS) based on work undertaken by a working party of the Victorian Palliative Care Clinical Network (PCCN).

The resource is designed to assist acute health services to operationalise the National consensus statement: essential elements for safe and high-quality end-of-life care.

It is a resource for boards, executives, managers and clinicians of all disciplines.

The resource includes sections on:

https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/palliative-care/essential-elements

Australian Centre for Grief and Bereavement

The mission of the non-profit Australian Centre for Grief and Bereavement is to build the capacity of individuals, organisations and communities in order to enhance well-being following adverse life events. The Centre is a statewide service with an office located in Mulgrave, Melbourne. The Centre receives funding from the Victorian Department of Health and Human Services as a statewide specialist bereavement service.

Services and resources include:

http://www.grief.org.au/

Australian Commission on Safety and Quality in Health Care

The Australian Commission on Safety and Quality in Health Care (the Commission) was established in 2006 by the Australian, state and territory governments to lead and coordinate national improvements in safety and quality in health care. The Commission’s strategic priorities are in the areas of: patient safety; partnering with patients, consumers and communities; quality cost and value; supporting health professionals to provide safe and high-quality care.

Work program areas include:

https://www.safetyandquality.gov.au/

Australian Institute of Health and Welfare palliative care statistics and data

The Australian Institute of Health and Welfare (AIHW) is an Australian Government body with the formally defined purpose to “create authoritative and accessible information and statistics that inform decisions and improve the health and welfare of all Australians”. The AIHW’s palliative care data includes a range of national and state/territory statistics.

http://www.aihw.gov.au/palliative-care/

Bereavement support standards for specialist palliative care services

The  bereavement support standards document was developed by the Australian Centre for Grief and Bereavement in partnership with the Centre for Palliative Care with funding and other support provided by the Victorian Department of Health.

The bereavement support standards are designed for use by professionals working in all Victorian government-funded adult specialist palliative care services, including community, inpatient, acute and consultancy services, to assist carers and bereaved individuals with elevated risk of developing prolonged or complicated grief or with current psychosocial and/or spiritual distress.

The standards document includes a section on factors impacting on grief reactions (risk factors and factors that enhance resilience) along with a glossary and resource listing.

A copy of the standards can be found on various websites, including the Australian Centre for Grief and Bereavement.

http://www.grief.org.au/ACGB/ACGB_Publications/Resources_for_Professionals_1/Bereavement_Standards_in_Palliative_Care.aspx

CareSearch - evidence based palliative care website with information and resources

CareSearch is an evidence palliative care based website developed at Palliative and Supportive Services, Flinders University funded by the Australian Government. CareSearch includes information for health professionals, aged and other community services workers, academics, researchers and for people with a life limiting illness and their carers and family.

CareSearch includes information for:

Web: https://www.caresearch.com.au/Caresearch/Default.asp

Centre for Palliative Care

The Centre for Palliative Care is part of St Vincent’s Hospital Melbourne and is a Collaborative Centre of The University of Melbourne. The Centre’s website includes:

The Centre’s education and training opportunities include:

The Centre for Palliative Care

Dying2Learn MOOC (massive open online course)

A free five week online course run by Caresearch, the Dying2Learn MOOC (massive open online course) considers different ideas and societal thinking around dying and death in the 21st century, including:

  • The language we use when we talk about dying.
  • How and what people die from now.
  • How art, music, and media have shaped our ideas on death.
  • What happens in the digital world when we die.

https://www.caresearch.com.au/caresearch/tabid/2868/Default.aspx

End-of-life Essentials: education for acute hospital staff

A project of Flinders University, End-of-life Essentials provides e-learning and resources for doctors, nurses and allied health professionals to improve the quality and safety of end of life care in hospitals.

The content of End of Life Essentials has been informed by the National Consensus Statement ‘Essential elements for safe and high-quality end-of-life care’ of the Australian Commission on Safety and Quality in Health Care and is relevant to implementation of the end of life care components of the Commission’s National Safety and Quality Health Service Standards.

https://www.caresearch.com.au/Caresearch/tabid/3866/Default.aspx

Grief and bereavement

Understanding Grief (Palliative Care Australia booklet)

The Understanding Grief booklet published by Palliative Care Australia explains what grief is, the thoughts, feelings and sometimes physical reactions a person can experience and where to find further help.

http://palliativecare.org.au/understanding-grief/

Community palliative care services grief and bereavement support

All community palliative care services provide access to grief and bereavement support for carers and family members. This can extend to 13 months after death.

For specific details of the grief and bereavement support provided by the three community palliative care services in the NW Metro region, contact directly:

Hospital based specialist palliative care services grief and bereavement support

Unlike community palliative care services, access to long term bereavement support for people who need it is not part of the service model for hospital based specialist palliative care services.

The grief and bereavement support available through hospitals will vary from service to service and will depend on availability of staff from the hospital’s allied care team.

For specific details of the grief and bereavement support provided by the specialist palliative care services of public hospitals in the NW Metro region, contact directly:

The Australian Centre for Grief and Bereavement (Bereavement Counselling and Support Service)

The Australian Centre for Grief and Bereavement (ACGB) operates a statewide bereavement counselling and support service for Victoria. The program is funded by the Victorian Government Department of Health and Human Services and provides support for people experiencing grief and bereavement as well as bereavement advice and consultation for workers from other settings to assist their work with people experiencing grief and bereavement.

Services include: counselling; support groups; written resources; remembrance events; practitioner consultation and support. Bereavement counselling is available for anyone in the community, including children and adolescents, who need support following the death of someone close to them. ACGB charges fees in accordance with a schedule dependent on income and personal circumstances.

http://www.grief.org.au/

National Carer Counselling Program (accessed via Carers Victoria)

The National Carer Counselling Program provides free of charge short-term counselling (up to six sessions) on issues related to a person’s caring role, including all palliative care situations and bereavement. In Victoria the program is organised by Carers Victoria.

https://www.carersvictoria.org.au/how-we-help/counselling/about-counselling

GriefLine

GriefLine provides counselling support services free of charge to individuals and families, including: telephone support; online counselling; and in-house one on one counselling.

http://griefline.org.au/

Bereavement support standards for specialist palliative care services

The 32 page bereavement support standards document was developed by the Australian Centre for Grief and Bereavement in partnership with the Centre for Palliative Care with funding and other support provided by the Victorian Department of Health and Human Services through the Palliative Care Clinical Network.

The bereavement support standards are designed for use by professionals working in all Victorian government-funded adult specialist palliative care services, including community, inpatient, acute and consultancy services, to assist carers and bereaved individuals with elevated risk of developing prolonged or complicated grief or with current psychosocial and/or spiritual distress.

The standards document includes a section on factors impacting on grief reactions (risk factors and factors that enhance resilience) along with a glossary and resource listing.

A copy of the standards can be found on various websites, including the Australian Centre for Grief and Bereavement.

http://www.grief.org.au/ACGB/ACGB_Publications/Resources_for_Professionals_1/Bereavement_Standards_in_Palliative_Care.aspx

HealthPathways Melbourne (for GP teams)

HealthPathways Melbourne, an initiative of the Eastern Melbourne Primary Health Network (EMPHN) and North Western Melbourne Primary Health Network (NWMPHN), is an online portal designed to be used at the point of care by GP teams working in the northwest and eastern regions of Melbourne.

HealthPathways aims to guide best-practice assessment and management of common medical conditions and includes detailed information and links on palliative care topics.

https://melbourne.healthpathways.org.au

Integrated Cancer Services and the Victorian Cancer Plan 2020-2024

Victoria’s Integrated Cancer Services (ICS) are the Victorian Cancer Clinical Network and comprise clusters of hospitals and associated health services that deliver care for people with all types of cancers within a geographic area, including public hospitals, community-based services, general practitioners and other primary health organisations, private hospitals and supportive care services.

Within the context of the Victorian Cancer Plan 2020-2024,the role of the ICS is to build relationships, implement best practice models of care, improve the effectiveness of cancer care and monitor systems and processes to improve performance.

Links to Victorian Integrated Cancer Services are found on the following government web pages;

https://www2.health.vic.gov.au/about/health-strategies/cancer-care/integrated-cancer-services

Medicinal Cannabis - Victorian and national legislation and policy framework

Following the Victorian Parliament’s passing of The Access to Medicinal Cannabis Act 2016The Office of Medicinal Cannabis within the Department of Health and Human Services (DHHS) has been established to oversee the operation of Victoria’s medicinal cannabis framework.

From a patient/clinician perspective, it is necessary to understand how the Victorian legislation interacts with national drug laws regarding the cultivation, manufacture and supply of medicinal cannabis products. These national laws and regulations are overseen by the Australian Government Office of Drug Control and the Therapeutic Goods Administration (TGA).

In summary:

  • All legal pathways to accessing medicinal cannabis require the support and monitoring of a treating medical team, who need to seek and obtain the appropriate approvals on behalf of the patient.
  • The key gateways to accessing medicinal cannabis are the Special Access Scheme (SAS) and Authorised Prescriber (AP) processes of the TGA. See the TGA’s ‘Access to medical cannabis products in Australia: Resource for doctors’, for a one page diagrammatic summary.
  • All patients eligible for the new Victorian scheme will still need to go through the TGA approvals process (i.e. the Victorian and Australian Government schemes, although independent, operate together in a complementary way).
  • The initial priority patient group for access to medicinal cannabis under the Victorian legislation is children with severe intractable epilepsy. Eligible patient groups under the Victorian legislation may be expanded in the future based on the advice of an Independent Medical Advisory Committee.
  • The TGA’s SAS and AP processes are not restricted to the Victorian eligible patient group – a doctor may apply to the TGA for special access for patients with any indication for whom they believe treatment with medicinal cannabis is appropriate.
  • The TGA may also allow access to medicinal cannabis for the purposes of clinical trials, which may be conducted to develop an evidence base to support safety and efficacy of medicinal cannabis.

In addition to considering types of patients eligible for medicinal cannabis, both the national and Victorian legislation include a considerable focus on processes for the cultivation and supply of medicinal cannabis. This includes importation and the production of medicinal cannabis in Australia. For example, under the TGA SAS/AP processes, if stock is available in Australia (Step 3A in ‘Access to medical cannabis products in Australia: Resource for doctors’) access tends to be significantly quicker and easier than if product must be imported (Step 3B).

Accordingly, the Victorian legislation is partly about encouraging the development of a new local/Victorian supply of medicinal cannabis products and reducing the need to source imported products.

In summary, from a Victorian scheme ‘supply of product’ perspective:

  • Once a local/Victorian supply of medicinal cannabis is established, the Victorian legislation directs that access to this supply is restricted to the groups specified as eligible (currently children with severe intractable epilepsy).
  • Other groups of people considered in need of medicinal cannabis by their doctors will not be eligible to access the local/Victorian manufactured supply, except in exceptional circumstances. Rather, via the TGA SAS/AP processes referenced above, doctors will need to access supply from sources other than the Victorian scheme.
  • Note: The doctors of Victorian scheme eligible children also need to gain approval via the TGA SAS/AP processes before being able to access the local/Victorian product.

The Frequently Asked Questions (FAQ) of the DHHS Office for Medicinal Cannabis includes further information on a range of topics, including:

  • What is the Victorian Access to Medicinal Cannabis Scheme?
  • How does the Victorian Access to Medicinal Cannabis Scheme interact with Commonwealth medicinal cannabis legislation?
  • What is medicinal cannabis?
  • What are the benefits of medicinal cannabis?
  • Is there a difference between cannabis/marijuana and medicinal cannabis?
  • Who can access medicinal cannabis?
  • When will additional eligible patient groups be added?
  • How do I apply?
  • I am not an eligible patient under the Victorian scheme. Can I still access medicinal cannabis?
  • Is it now legal for me to smoke cannabis for medicinal purposes?
  • I have found medicinal cannabis products available online. Are these products legal?

The DHHS Office of Medicinal Cannabis website also includes links to the Victorian Law Reform Commission report on medicinal cannabis that was tabled in parliament in October 2015, along with recently published research on medicinal cannabis.

Web: https://www2.health.vic.gov.au/public-health/drugs-and-poisons/medicinal-cannabis

National Consensus Statement: Essential elements for safe and high quality end-of-life care

The National Consensus Statement ‘Essential elements for safe and high-quality end-of-life care’ was published in 2015 by the Australian Commission on Safety and Quality in Health Care. The Consensus Statement aligns with the Commission’s National Safety and Quality Health Service Standards but provides recommended, rather than mandatory, practice. It also aligns with the National consensus statement: essentials elements for safe and high-quality paediatric end-of-life care and the National consensus statement: essential elements for recognising and responding to acute physiological deterioration. It is intended that these documents be applied together.

The 44 page Consensus Statement includes sections on:

  • Guiding principles
  • Patient-centred communication and shared decision-making
  • Teamwork and coordination of care
  • Components of care
  • Use of triggers to recognise patients approaching the end of life
  • Response to concerns
  • Organisational prerequisites
  • Leadership and governance
  • Education and training
  • Supervision and support for interdisciplinary team members
  • Evaluation, audit and feedback
  • Systems to support high-quality care

https://www.safetyandquality.gov.au/our-work/end-of-life-care-in-acute-hospitals/ and   https://www.safetyandquality.gov.au/publications/national-consensus-statement-essential-elements-for-safe-high-quality-end-of-life-care/

Paediatric Palliative Care, including RCH, Basic Symtpon Contol clinical tool and QuoCCA

The Victorian Paediatric Palliative Care Program (VPPCP)

The VPPCP section of the Royal Children’s Hospital website provides a range of information and links about paediatric palliative care, including ‘Basic Symptom Control in Paediatric Palliative Care’, a clinical tool published by the UK non-profit organisation Together for short lives.

http://www.rch.org.au/rch_palliative/

Basic Symptom Control in Paediatric Palliative Care (a worldwide clinical tool published in the UK)

Basic Symptom Control in Paediatric Palliative Care is a clinical tool published by the UK non-profit organisation Together for short lives.

http://www.togetherforshortlives.org.uk/professionals/resources/2434_basic_symptom_control_in_paediatric_palliative_care_free_download

Quality of Care Collaborative for Australia in Paediatric Palliative Care (QuoCCA).

Further information and training about paediatric palliative care is available as part of the Australian Government funded project, Quality of Care Collaborative for Australia in Paediatric Palliative Care (QuoCCA).

https://www.caresearch.com.au/caresearch/tabid/3682/Default.aspx

National consensus statement on essential elements for safe and high-quality paediatric end-of-life care

The National Consensus Statement ‘Essential elements for safe and high-quality paediatric end-of-life care’ was published in 2016 by the Australian Commission on Safety and Quality in Health Care. The Consensus Statement aligns with the Commission’s National Safety and Quality Health Service Standards but provides recommended, rather than mandatory, practice. It also aligns with the National consensus statement: essentials elements for safe and high-quality end-of-life care and the National consensus statement: essential elements for recognising and responding to acute physiological deterioration. It is intended that these documents be applied together.

The 44 page page paediatric national consensus statement includes

  • Guiding principles
  • Family-centred communication and decision-making
  • Teamwork and coordination of care
  • Use of triggers to recognise children approaching the end of life

https://www.safetyandquality.gov.au/publications/national-consensus-statement-essential-elements-for-safe-and-high-quality-paediatric-end-of-life-care/

After the Loss of a Child: A Resource for Parents of Children in Palliative Care

After the Loss of a Child: A Resource for Parents of Children in Palliative Care is a 32 page booklet published by the Australian Centre for Grief and Bereavement. It is designed for parents of children in palliative care, but is also a useful resource for any parent who experiences the loss of a child.

The booklet looks at common issues and processes occurring both before and after the death, and provides information and helpful tips for navigating the grief experience of parents and families both immediately and in the long term. It includes sections on:

  • Before the death
  • After the death
  • Grief
  • Grief and relationships
  • Parenting after the loss of a child
  • Grief over time
  • Seeking help

http://www.grief.org.au/ACGB/ACGB_Publications/Paediatric_Palliative_Care.aspx

Palliative Care Australia

The “I’m a health professional” section of the website of Palliative Care Australia has a range of information and links for health professionals involved in supporting people with life-limiting illness and their families.

http://palliativecare.org.au/im-a-health-professional/

Palliative Care Clinical Network (PCCN)

The Palliative Care Clinical Network (PCCN) is one of 10+ clinical networks that are part of The Victorian Government’s Safer Care Victoria initiative. The PCCN provides clinical leadership in the implementation of policy directions and program initiatives in Victoria and undertakes projects to enhance the availability of clinical tools and resources for palliative care.

Palliative Care Clinical Studies Collaborative (PaCCSC)

The Palliative Care Clinical Studies Collaborative (PaCCSC) is an Australian Government national research network run by Flinders University that aims to:

  • Generate high quality research evidence to support the use of medicines and other interventions at the end of life to better manage or alleviate symptoms in patients such as: pain; confusion; breathlessness; appetite; and gastrointestinal problems including nausea; bowel obstruction; and constipation.
  • Build capacity within the health workforce in the conduct of high quality clinical research in patients nearing the end of life and the translation of research results into clinical practice.

https://www.caresearch.com.au/Caresearch/tabid/2476/Default.aspx

Palliative Care Curriculum for Undergraduates (PCC4U)

PCC4U is an Australian Government funded project led by Queensland University of Technology in collaboration with the Queensland Government, Flinders University and Curtin University of Technology. It promotes the inclusion of palliative care education as an integral part of all medical, nursing, and allied health undergraduate and entry to practice training, and ongoing professional development.

http://www.pcc4u.org/

Palliative Care Outcomes Collaboration

The Palliative Care Outcomes Collaboration (PCOC) is a national program run by the Australian Health Services Research Institute (AHSRI) of the University of Wollongong. PCOC utilises standardised clinical assessment tools to measure and benchmark outcomes in palliative care. Participation in PCOC is voluntary and can assist palliative care service providers to improve practice. This PCOC website outlines how this is achieved through an outcome improvement framework which is designed to:

  • provide clinicians with the tools to systematically assess individual patient experiences using validated clinical assessment tools,
  • define a common clinical language between palliative care providers to support assessment and care planning,
  • facilitate the routine collection of national palliative care data to drive quality improvement through reporting and benchmarking,
  • provide regular patient outcomes reports and workshops to facilitate service-to-service benchmarking, and
  • support research using the PCOC longitudinal database.

The PCOC data set includes the clinical assessment tools: Palliative Care Phase, Palliative Care Problem Severity Score (PCPSS), Symptom Assessment Scale (SAS), Australia-modified Karnofsky Performance Status (AKPS) Scale and Resource Utilisation Groups – Activities of Daily Living (RUG-ADL).

Participation in PCOC can also provide evidence for organisations and palliative care services to meet core actions in the National Safety and Quality Health Service Standards.

Web: Palliative Care Outcomes Collaboration (PCOC) homepage

Palliative Care Victoria

The “For Healthcare Professionals” section of the website of Palliative Care Victoria has a range of information and links for health professionals involved in supporting people with life-limiting illness and their families.

http://www.pallcarevic.asn.au/healthcare-professionals/

Palliative matters: Stories about living, dying and palliative care (Palliative Care Australia)

‘Palliative matters: Stories about living, dying and palliative care’ is a Palliative Care Australia initiative available through their website and/or via a free email email subscription. It provides a range of articles and stories from people living with a life-limiting illness, carers and friends, health professionals and others.

http://palliativecare.org.au/palliative-matters/

Palliverse

Palliverse describes itself as a place where:

  • Like-minded people involved in palliative care meet;
  • Ideas and issues related to palliative care are exchanged and discussed; and
  • Funding opportunities are explored and shared.

https://palliverse.com/

Program of Experience in the Palliative Approach (PEPA)

The Program of Experience in the Palliative Approach (PEPA) is a nationally funded program run in Victoria by the Centre for Palliative Care.

Victorian PEPA aims to improve the accessibility of quality palliative care in the community by increasing the skills and confidence of health professionals who are caring for people with serious illness, and their families.

PEPA activities include:

  • Workshops on the palliative approach
  • Supervised clinical placements
  • Post-placement support activities

https://pepaeducation.com/

Safer Care Victoria

Safer Care Victoria is the peak state authority for leading quality and safety improvement in healthcare. Safer Care Victoria oversees and supports health services to provide safe, high-quality care to patients “every time, everywhere”.

Created in response to the recommendations within the report Targeting Zero: supporting the Victorian hospital system Safer Care Victoria works to eliminate avoidable harm and strengthen quality of care.

Staffed and led by clinicians and researchers, Safer Care Victoria provides secretariat support for the Victorian Clinical Council and works closely with the Victorian Agency for Health Information and the Department of Health & Human Services. The operation of the Palliative Care Clinical Network (PCCN) transferred to Safer Care Victoria in 2017.

https://www2.health.vic.gov.au/hospitals-and-health-services/safer-care-victoria

Supportive and Palliative Care Indicators Tool (SPICT™) University of Edinburgh (UK)

The Supportive and Palliative Care Indicators Tool (SPICT™) was developed by the University of Edinburgh to:

  • Help identify people whose health is deteriorating
  • Assess them for unmet supportive and palliative care needs
  • Plan care

The SPICT™ includes clinical indicators for: cancer; dementia/frailty; neurological disease; heart/vascular disease; respiratory disease; kidney disease; liver disease; other conditions.

It is referenced as part of the Victorian Department of Health and Human Services (DHHS) online resources Ready for Community Palliative Care and Essential elements of end of life care.

The SPICT™ can be downloaded free of charge via a registration process.

http://www.spict.org.uk/

The Palliative Care Bridge (NSW based)

The Palliative Care Bridge is a statewide-NSW palliative care education program coordinated and delivered by the HammondCare consortium, comprising HammondCare, Sacred Heart Health Service and Calvary Healthcare Sydney.

The Resources section of the Palliative Care Bridge website includes educational videos on a wide variety of palliative care topics.

The website also includes links to books for purchase, including HammondCare’s The Palliative Care Handbook and The Pain Book.

http://www.palliativecarebridge.com.au/

Victorian Palliative Medicine Training Program (VPMTP)

Funded by the Victorian Department of Health and Human Services and run as part of the Centre for Palliative Care, the Victorian Palliative Medicine Training Program (VPMTP) aims to build and sustain a high quality palliative medicine workforce in Victoria. This includes providing palliative care specialists, as well as doctors from other specialities, with the necessary knowledge and skills to practice palliative medicine as part of their clinical workload. VPMTP runs a range of workshops and mentoring programs, along with advanced specialist training in palliative medicine.

http://www.vpmtp.org/