Research conducted in The Prince Charles Hospital, Brisbane using conversational analysis of direct observation during initial Palliative Care outpatient consultations highlighted that patients have a very limited understanding of what palliative care is. Often palliative care is thought to involve care that occurs only immediately before death. This occurs despite referrals being made by medical professionals. Therefore, we surmised that either these clinicians also do not understand the scope of palliative care, or they are not effectively communicating this to the patients they are referring.

We set out to try to better understand clinicians’ attitudes to palliative care and how we could improve their understanding of the full scope of palliative care enabling them to be able to communicate this better with patients.

The project was focused on the thoracic team at The Prince Charles Hospital, being one of the major referring teams. To assess understanding an anonymised survey was undertaken using the Knowledge and attitudes towards hospital and palliative care (KAHP) scale and several free text questions aimed at barriers and facilitators to palliative care referrals. Both medical practitioners and senior nursing staff were invited to complete the survey electronically.

19 responses from roughly 100 invited clinicians were received. 13 of these were from medical practitioners. Overall, clinicians felt that patients would benefit if palliative care was initiated earlier in the course of the illness, that palliative care improved symptom control and met the needs of the family better than conventional care. However, clinicians felt that discussing palliative care could cause patients and families to lose hope and that telling patients that they are dying is difficult. Despite this more than half of the respondents felt knowledgeable enough to discuss palliative care and well trained to take care of the symptoms in life limiting illnesses. Highlighted barriers to palliative care referral included a lack of time, not discussing palliative care with the patient and patients not being ready for palliative care. Potential facilitators to easier referral included clearer referral processes, increased knowledge about local resources, access to patient brochures and an increased profile of palliative care.

This led to the development of educational materials for clinicians with Palliative Care Australia (PCA) and the ‘More than they think campaign’. Resources developed included a brochure, posters, slide show, video and a local services factsheet. These materials have been rolled out in The Prince Charles Hospital as part of an education program to the Thoracic department. They have also been made available via the PCA website for use by other services. We are currently in the process of evaluating the effectiveness of this education campaign.