End-of-Life and Palliative Care Education and Training Framework

Learning items within the three domains are presented at three levels of expertise that outline what health professionals and staff need to know and do, these levels are know as the continuum of learning.

The level of expertise required for each profession is dependant on the degree of involvement in the person’s care and the responsibilities in caring for the person with end-of-life and palliative care needs, their family and carers.

Learning items at each level are incremental, in relation to the depth and breadth of knowledge, and the complexity of related skills increases at each expertise level. An individual or group at extension level will therefore have the knowledge and skills defined at the preceding levels.

Continuum of learning

Intended audience

• Service providers (organisations and individuals) as an overarching document in the identification of required education and training.
• As the foundation document from which service providers may develop more detailed competency frameworks for knowledge and skills acquisition.
• Health professionals and other staff, health care service and organisational managers, education and training organisations and health care educators.
• A range of settings including, but not limited to, primary care, hospital, community, disability, residential aged care and specialist palliative care.
• Both specialist and generalist service areas.

The following core principles underpin practice in end-of-life and palliative care.

Person, carer and family centred care

Person, carer and family centred care is “…an approach to the planning, delivery and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, the patient and families”.

A person-centred approach gives consideration to the diverse needs of all people, recognising the importance of their beliefs, culture, goals, wishes, concerns, spirituality, religious, emotional, social and special needs.

It reflects the primacy of the person, placing them at the centre of care.

Communication

Communication is a critical clinical skill in providing end-of-life and palliative care. It is relevant to all interactions between the person, their family/carer(s) and the health professional.

Effective communication during end-of-life care facilitates shared decision-making and planning for dying and death.

Effective communication between health care professionals is essential for coordination of care that is responsive to changing priorities, phases and settings of care, transition between services and ultimately quality of care.

Safety, quality and risk management

All health professionals are responsible for delivering quality health care and all sectors must adhere to defined safety, quality and risk management principles defined in the relevant industry standards, including but not limited to:

• National Safety and Quality Health Service Standards (second edition)
• Aged Care Quality Standards
• National Standards for Disability Services
• National Safety and Quality Primary Health Care (NSQPHC) Standards (in development).

Ethical and legal decision-making

Health professionals are faced with a range of ethical issues in the context of providing end-of-life and palliative care.

A knowledge of the relevant legislation and sensitive management of these ethical issues is essential for the provision of high-quality care.

Building capacity

Building capacity is a strategic approach which allows individuals and health care teams to enhance existing knowledge, skills and confidence in supporting end-of-life and palliative care, at point of care through access to information, training and mentoring support.

It enables health professionals and staff to perform effectively and to adapt to change. It is a collaborative process which benefits from true partnering, building upon existing capacity and is inclusive of each health professional or group.

Planning ahead

Thinking about future healthcare choices and making decisions about future healthcare is known as advance care planning.

Advance care planning promotes care that is consistent with a person’s goals, values, beliefs and preferences.

It involves ongoing discussions between the person, their family/carer and health professionals, ideally leading to the completion of Advance Care Planning Documents, including:

• a written Advance Health Directive that records treatment decisions to ensure a person’s wishes are respected when they lose capacity to make or communicate their preferences
• an Enduring Power of Guardianship to appoint a substitute decision-maker to make healthcare decisions on the person’s behalf when they are no longer able to do so.

A Goals of Patient Care process should be commenced by clinicians during an episode of care to document the appropriate level of escalation of care, based on the person’s preferences in the context of their underlying medical condition.

Interprofessional collaboration

Interprofessional collaboration occurs when health professionals from different disciplines work together to identify needs, solve problems, make joint decisions on how best to proceed, and evaluate outcomes collectively.

It supports high quality person-centred care and achieves common goals through teamwork, within and across care sectors and settings.