Australian and New Zealand Society of Palliative Medicine & the Australasian Chapter of Palliative Medicine
Recommendations from the Australia & New Zealand Society of Palliative Medicine on referrals, care planning, oxygen therapy, feeding tubes & medication review. ANZSPM is a specialty medical society that facilitates professional development and support for its members and promotes the practice of palliative medicine.
Target referrals to bereavement services for family and caregivers of patients in palliative care settings to those experiencing more complicated forms of grief rather than as a routine practice.
There is no empirical basis for the practice of offering routine referrals to bereavement services to family and care givers of patients in palliative settings. Most bereaved family and carers are resilient and only a small proportion of individuals will develop pathological responses that might not resolve without professional help.
Evidence suggests psychosocial interventions are more effective for people with more complicated forms of grief. Grief is considered complicated when an individual’s ability to resume normal activities and responsibilities is persistently disrupted after six months of bereavement. Six months is seen as the appropriate minimum threshold for complicated grief since studies show that most people integrate bereavement into their lives by this time.
- Schut, Stroebe, Interventions to enhance adaptation to bereavement. J. Palliat. Med. Dec 2005
- Schut, Stroebe, Effects of support, counselling and therapy before and after the loss: can we really help bereaved people? Psychologica Belgica 2010, 50-1&2, 89-102.
- Zech, Ryckebosch-Dayez, Delespaux, Improving the efficacy of intervention for bereaved individuals: toward a process-focused psychotherapeutic perspective. Psychol. Belg. Sep 2010
- Hall, Beyond Kübler-Ross: Recent developments in our understanding of grief and bereavement. InPsych. Dec 2011
- Wittouck et al, The prevention and treatment of complicated grief: a meta-analysis. Clin. Psychol. Review. Sep 2011
Fellows from the Australian and New Zealand Society of Palliative Medicine and Australasian Chapter of Palliative Medicine (ANZSPM/AChPM) convened a working group to produce an EVOLVE list for palliative medicine. The Royal Australasian College of Physicians (RACP) assisted this working group in compiling a list of 15 clinical practices in palliative medicine which may be overused, inappropriate or of limited effectiveness in a given clinical context based on a desktop review of similar work done overseas.
This list was then sent out to all ANZSPM and AChPM members, seeking feedback on whether the items fully captured the concerns of clinicians in an Australasian palliative medicine context and if not, whether any items should be omitted and/or new items added. 40 responses to this email were received. Based on these, 3 items were removed leaving a shortlist of 12. An online survey was then sent to all ANZSPM and AChPM members asking respondents to rate each item against three criteria from 1 (lowest) to 5 (highest), and to nominate any additional practices worthy of consideration.
The criteria used to rate the practices were strength of evidence, significance in palliative care and whether palliative care physicians could make a difference in influencing the incidence of the practice in question. Based on the 114 responses to this survey, the top 5 were selected.
- 1 Do not delay discussion of and referral to palliative care for a patient with serious illness just because they are pursuing disease-directed treatment.
- 2 Limit routine use of antipsychotic drugs to manage symptoms of delirium.
- 3 Do not use oxygen therapy to treat non-hypoxic dyspnoea.
- 4 Target referrals to bereavement services for family and caregivers of patients in palliative care settings to those experiencing more complicated forms of grief rather than as a routine practice.
- 5 To avoid adverse medication interactions and adverse drug events in cases of polypharmacy, do not prescribe medication without conducting a drug regime review.