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Models of Care

Key Messages

  • Not all people at end-of-life will need specialist palliative care but a palliative approach or palliative care should be available when and where it is required. [1]
  • A model of care broadly defines the way health services are organised and delivered. [2-4] The chosen of model of care can affect the quality of the care. [5]
  • Various models for palliative care delivery and their components exist [2,4,5] without a univocally-accepted model. [6] However, models of palliative care appear to show benefits for patients and their carers, with no evidence of negative effects, irrespective of setting or patient characteristics. [4]
  • Effective models are becoming increasingly important as the population ages and as the number of people living with multiple chronic conditions increases.  [2-4,7-11]
  • For older people, community palliative care and palliative care in residential aged care facilities (RACF) have shown to be beneficial but more high-quality research is needed for the benefits and cost-effectiveness to be well understood. [7,9,12-15]

Background

A model of care broadly defines the way health services are organised and delivered. [2,3] It outlines best-practice care and services through core components (the components describe who delivers which particular intervention, when, where, how, to whom, and for what purpose) and principles that sit within a framework that provides the structure for the implementation and subsequent evaluation of care. [3-5]

End-of-life refers to the period during which people live with advanced illness that will not stabilise and from which they will die. It may or may not be limited to the period immediately before death. [5] Multiple services are required to support these people and their families. The model of care used to deliver these services can affect the quality of the end-of-life care. [5]

Evidence Summary

The framework for Australian palliative care is outlined in the National Palliative Care Strategy 2010. Palliative care is provided to meet the needs of people living with or dying from a life-limiting illness and to support their families. Not all people at end-of-life will need specialist palliative care but appropriate care when and where it is required care should be available. [1] A palliative approach and general palliative care can be delivered in many settings and by a variety of professionals, including specialists as well as generalists (GPs, nurses, nurse practitioners, allied health professionals, and carers, and volunteers. [4,16] Specialist palliative care can be delivered in settings such as general hospital wards, dedicated palliative care hospital wards, hospices and in the community. [16] Palliative care teams generally include at least one professional with advanced training in palliative medicine. [16]

Various models for palliative care delivery and their components are found in the literature. [2,4] These models are becoming increasingly important as the population ages and as the number of people living with multiple chronic conditions increases.  [2-4,7-11] Models need to be dynamic to respond to the changing population demands (including the needs of vulnerable populations), the health system structure and the policy, sociocultural and economic context. [4,8,14,16]

People with serious chronic illnesses and unpredictable times of death, and their families often need support over a long period of time. The trajectory model offers a way to support their intermittent needs, and simple or complex ongoing needs, and build towards palliation being the focus of care.  [3,10,11] Care under this model starts early, following a timely referral, even concurrently with potentially curative treatment. [3,10,11] It can also assist a family to cope with the illness and bereavement. [9]

To date, a univocally-agreed model of care for palliative care does not exist as such. [6] A European consortium has proposed a framework for integrated palliative care which pulls together existing validated components of care. The important components of this framework are a multidisciplinary team trained in palliative care with a threefold focus: on treatment (of physical and psychological symptoms), consultation (discussions of care planning and care goals) and ongoing training. [6]

Community palliative care can reduce general health care use and increase family and patient satisfaction with care, which support families to sustain patient care at home. [4,7] There are indications that it increases the chance of home deaths and should be provided for those who wish to die at home but this research is not specific to the care of older people. [4,13,14]

Residential aged care facilities (RACF) provide palliative care. Despite the increasing demand in response to the increase in the older population, there is very little high-quality research about what aspects of palliative care best support residents and their families. [9] Palliative care in a RACF requires effective integration between different providers. Barriers and facilitators for the integration have been identified, but there is limited evidence about an effective integrated model. [12] As with all settings, appropriate outcome measures are required to assess the quality of palliative care provided in residential aged care facilities. [9,15]

Care via a palliative care day centre is a component of a model of service delivery, and systematic reviews demonstrate that attendance at these provide a positive experience.  Some evidence shows day care services generate a renewed sense of meaning and purpose for the person [7] yet evidence is lacking in terms of clinical effectiveness and effect on wellbeing. [17,18]

Quality Statement

There is a lack of well-designed randomised controlled trials (RCTs) which compare models of palliative care; existing systematic reviews often focus more on service components rather than models of care. [2] Many studies do not focus on an older adult population or do not clearly report the attributes of the study population. Comparison of different models of care is hampered by diversity of aims, interventions and outcomes. [4]

Page last updated 16 August 2017 
 
  • References

  • About PubMed Search

  1. Palliative Care Australia (PCA). A Guide to Palliative Care Service Development: A Population Based Approach (551kb pdf). Canberra: PCA; 2005.
  2. Luckett T, Phillips J, Agar M, Virdun C, Green A, Davidson PM. Elements of effective palliative care models: a rapid review. BMC Health Serv Res. 2014 Mar 26;14:136.
  3. Department of Health, Western Australia. Rural Palliative Care Model of Care (407kb pdf). Perth: WA Palliative Care and Cancer Network, Department of Health, Western Australia; 2008.
  4. Brereton L, Clark J, Ingleton C, Gardiner C, Preston L, Ryan T, et al. What do we know about different models of providing palliative care? Findings from a systematic review of reviews. Palliat Med. 2017:269216317701890.
  5. Health Quality Ontario. Team-Based Models for End-of-Life Care: An Evidence-Based Analysis. Ont Health Technol Assess Ser. 2014 Dec 1;14(20):1-49.
  6. Siouta N, Van Beek K, van der Eerden ME, Preston N, Hasselaar JG, Hughes S, et al. Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease. BMC Palliat Care. 2016 Jul 8;15:56.
  7. Candy B, Holman A, Leurent B, Davis S, Jones L. Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence. Int J Nurs Stud. 2011 Jan;48(1):121-33. Epub 2010 Sep 16.
  8. CareSearch. Models of Service Delivery [Internet]. 2017 [updated 2017 Feb 23; cited 2017 Aug 16].
  9. Hall S, Kolliakou A, Petkova H, Froggatt K, Higginson IJ. Interventions for improving palliative care for older people living in nursing care homes. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD007132. doi: 10.1002/14651858.CD007132.pub2.
  10. Joanna Briggs Institute. Palliative approach to care for people with advanced dementia. Best Practice: evidence-based information sheets for health professionals. 2011;15(5):1-4.
  11. Van Mechelen W, Aertgeerts B, De Ceulaer K, Thoonsen B, Vermandere M, Warmenhoven F, et al. Defining the palliative care patient: A systematic review. Palliat Med. 2013 Mar;27(3):197-208. doi: 10.1177/0269216311435268. Epub 2012 Feb 6.
  12. Davies SL, Goodman C, Bunn F, Victor C, Dickinson A, Iliffe S, et al. A systematic review of integrated working between care homes and health care services. BMC Health Serv Res. 2011 Nov 24;11:320. doi: 10.1186/1472-6963-11-320.
  13. Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2013 Jun 6;(6):CD007760. doi: 10.1002/14651858.CD007760.pub2.
  14. Luckett T, Davidson PM, Lam L, Phillips J, Currow DC, Agar M. Do community specialist palliative care services that provide home nursing increase rates of home death for people with life-limiting illnesses? A systematic review and meta-analysis of comparative studies. J Pain Symptom Manage. 2013 Feb;45(2):279-97. Epub 2012 Aug 20.
  15. Parker D, Hodgkinson B. A comparison of palliative care outcome measures used to assess the quality of palliative care provided in long-term care facilities: a systematic review. Palliat Med. 2011 Jan;25(1):5-20. doi: 10.1177/0269216310378786. Epub 2010 Sep 3.
  16. Kurti L, Wallace A, Thomas J, Wise P. Evaluation of the National Palliative Care Strategy 2010. Final Report (1.3MB pdf). Australia: Urbis for Commonwealth Deprtment of Health; 2016.
  17. Bradley SE, Frizelle D, Johnson M. Patients' psychosocial experiences of attending Specialist Palliative Day Care: a systematic review. Palliat Med. 2011 Apr;25(3):210-28. doi: 10.1177/0269216310389222. Epub 2011 Jan 12.
  18. Stevens E, Martin CR, White CA. The outcomes of palliative care day services: a systematic review. Palliat Med. 2011 Mar;25(2):153-69. doi: 10.1177/0269216310381796. Epub 2010 Oct 7.

Models of Care

Definition

  1. A model of service delivery … is about the framework for the delivery of care, referred to as a ‘model of care’ in the literature. A model of care broadly defines the way health services are delivered. 
  2. A 'Model of Care' broadly defines the way health services are delivered. It outlines best practice care and services for a person, population group or patient cohort as they progress through the stages of a condition, injury or event.