Specialist palliative care in aged care: repeated cross-sectional effectiveness evaluation

Quality palliative and end-of-life care is required to meet the growing need in aged care. The aim of the Specialist Palliative Care in Aged Care (SPACE) service was to enhance equitable access to specialist palliative and end-of-life care for residential aged care residents in Queensland, Australia.

Local SPACE teams were established in each of 15 adult health services in Queensland. These teams provided services into residential aged care facilities in alignment with the statewide service principles of: (1) comprehensive resident-focused care; (2) streamlined service; and (3) capacity building. The SPACE teams provided advice for managing complex care and built generalist capability through education, training, mentoring and support for care planning. The effectiveness of SPACE was assessed through a repeated cross-sectional design. Data, including postdeath questionnaires, staff knowledge and confidence, organisational change, and resident and family experience measures, were collected in 6-month intervals.

There were significant differences in the response distribution for place of death and for advance care planning across collection periods. Staff knowledge and confidence improved significantly in all areas assessed. There was also a significant change in the proportion of providers who improved palliative care policies, procedures or guidelines. Staff and resident stories attributed avoidance of unnecessary hospital admissions, improved quality of end-of-life care aligned with preferences, and improved coordination and continuity of care to SPACE's involvement.

The SPACE service demonstrated that a principle-based, adaptable model for accessing specialist palliative care can improve staff capability and improve end-of-life outcomes in residential aged care.