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In health care the role of evidence in decision making is recognised by health care practitioners and providers, and relates to understanding the balance between the potential benefits and harms of any practice, treatment or intervention. Dr Katrina Erny-Albrecht of CareSearch discusses the importance of independent, critical appraisal and synthesis of evidence into reliable, practical guidance for recipients and providers of care.

The pattern of disease, dying and death has changed dramatically in Australia over the last century. In Australia alone almost 160,000 people die every year. Of these at least 120,000 are expected deaths, meaning that access to palliative care could be of great benefit to both the individuals and their families. But ensuring access to quality palliative care for all who need it is not without its challenges. This is why a group of researchers sought funding from National Health and Medical Research Council (NHMRC) for the Centre of Research Excellence in End-of-Life Care (CRE-ELC).

In my role managing two aged care homes in Melbourne, I have come across a number of challenges which needed to be overcome. I took over one home four and a half years ago and the second 18 months ago, discovering the same basic issues in each home; after the first time, the issues were relatively easy to change. Staff were fractured in the sense that departments did not necessarily rely on each other and work together, and knowledge of clinical issues was only handed over to clinical staff, not to the whole home (not an unusual happening). My idea of sharing with all staff was greeted with a degree of scepticism at first, but staff embraced it quite quickly and then started to discuss things across different departments.

For this discussion, aged care refers to the additional care required for an older person needing regular health professional input either in the community or in an aged care home.

Palliative care is, according to the WHO (World Health Organisation), ‘an approach that improves the quality of life of patients and their families facing the problems 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’.

Many people spend the last stages of their lives in aged care, and for that reason Palliative Care Australia believes that end-of-life care should be recognised as core business for residential aged care.  Increasingly, aged care providers are recognising the need to ensure their workforce have the necessary skills and competencies to deliver high quality end-of-life care. Yet in spite of this recognition, access to quality palliative care services is far from guaranteed in residential aged care – particularly in rural and remote areas.
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We all want the ‘best death possible’ for our loved ones and ourselves as we enter old age. So we need to ask ourselves, what are the barriers to accessing care that can support this, and will looking at the issue from a population or needs-based policy perspective help to ensure end-of-life care becomes core business for all aged care providers?