Palliative care aims to prevent and relieve suffering and improve the quality of life for people with a life-limiting condition and their families (WHO 2019). Although the terms are sometimes used interchangeably, end-of-life care refers to care for people who are likely to die within the next 12 months (ACSQHC 2015).

In Australia, government agencies, as well as private and not-for-profit bodies, deliver palliative care. Palliative care occurs in almost all health care settings, including neonatal units, paediatric services, general practices, community settings and residential aged care services.

Specialist palliative care services operate from professional inpatient services, hospices and community-based specialist services (Department of Health 2019). The demand for palliative care services is likely to increase in the future due to a growing and ageing population, as the disease burden is greater among older age groups (AIHW 2019; WHO 2014).

Data on this page

Current data sources do not allow for reporting on aspects of palliative care and end-of-life care provided in Australia. For example, the AIHW does not have access to data on topics such as palliative care-related expenditure; community-based palliative care services; Medicare Benefits Schedule-subsidised services provided by general practitioners and non-palliative care medical specialists; and the number of palliative care beds in hospitals, both acute and subacute. The AIHW is working with Australian and state and territory governments, as well as other relevant stakeholders to expand the available national palliative care and end-of-life care information. A Palliative Care and End-of-Life Care Data Development Working Group, reporting to the Australian Health Ministers’ Advisory Council, is steering the development of a set of national priorities for such information over the next 10 years.

Hospitalisations

A person may receive palliative care (hospitalisations that involved specialist palliative care) or other end-of-life care (hospitalisations where a diagnosis of palliative care was recorded, but that care was not necessarily delivered by a palliative care specialist) as an admitted patient in hospital, and may require one or more hospitalisations while receiving this care. Some of these patients will die in hospital.

Admitted patient data from public and private hospitals show that, in 2017–18:

  • there were 79,900 palliative care-related hospitalisations, 57% for palliative care, and 43% for other end-of-life care
  • just over one-third (36%) of all admitted patients who died in hospital had received palliative care
  • over half (55%) of palliative care hospitalisations recorded a principal diagnosis of cancer.

From 2013–14 to 2017–18, palliative care hospitalisations increased by around one sixth (or 17%) to 45,600 (Figure 1), a similar rate to the increase for all hospitalisations over the same period.

See Hospital care.
 

The number of palliative care hospitalisations increased from 38,977 in 2013–14 to 45,561 in 2017–18.

Medicare services

The Royal Australian College of Physicians describes palliative medicine as ‘the specialist care of people with terminal illnesses and chronic health conditions in community, hospital and hospice settings’. Palliative medicine physicians work collaboratively with a multidisciplinary team of health professionals to ‘provide end-of-life care, provide relief from pain and symptoms of illness, and optimise the quality of life for a patient’ (RACP 2020). Some of these services may be subsidised under Australia’s universal health insurance scheme, Medicare. In 2018–19:

  • 16,800 patients received a Medicare-subsidised palliative medicine specialist service
  • 89,400 Medicare-subsidised services were provided by palliative medicine specialists
  • $7.0 million was paid in benefits for Medicare-subsidised palliative medicine specialist services, at an average of $416 per patient
  • Western Australia recorded 725.8 subsidised palliative medicine specialist services per 100,000 population, more than double the national average rate of 355.0.

Between 2014–15 and 2018–19, Medicare benefits paid for all palliative medicine specialist services increased by 31%.

Medications for palliative care treatment

The use of prescription medications to provide ‘relief from pain and other distressing symptoms’ (WHO 2014) is an important part of palliative care. In most cases, this involves medications being prescribed by the treating clinician. In 2004, the Australian Government introduced the Pharmaceutical Benefits for Palliative Care Section as a subsection of the Pharmaceutical Benefits Scheme (PBS) schedule to improve access to essential and affordable medications for patients receiving palliative care. Palliative care-related prescriptions, as described below, refer to medications prescribed by approved prescribers and subsequently dispensed by approved suppliers (community pharmacies or eligible hospital pharmacies) under the Pharmaceutical Benefits for Palliative Care Section. It should be noted that patients receiving palliative care can also access medications in the general listings of the PBS/Repatriation Pharmaceutical Benefits Scheme (RPBS) schedule, such as oxycodone; however, these medications are not included in the following information.

In 2017–18:

  • more than 1.1 million palliative care-related prescriptions were provided to more than 550,000 patients
    • the majority (94%) of these medications were prescribed by a general practitioner; other clinicians prescribed 5.2% and palliative medicine specialists prescribed less than 1%
  • $20.6 million was spent in benefits for medications included in the PBS/RPBS Palliative Care Section (an average of $67 per patient). The average cost per patient ranged from $56 in the Northern Territory to $150 per patient in the Australian Capital Territory.

See Medicines in the health system.

Workforce

The palliative care workforce consists of a number of professional groups, including specialist palliative medicine physicians, palliative care nurses, general practitioners, pharmacists, other medical specialists (such as oncologists and geriatricians), as well as other health workers, support staff and volunteers.

Nationally, in 2017, there were 250 employed specialist palliative medicine physicians and 3,400 employed palliative care nurses. The majority of doctors employed as specialist palliative medicine physicians were women (64%), which is double the female proportion of all employed medical specialists (32%).

See Health workforce.

Outcomes

The Australian Palliative Care Outcomes Collaboration (PCOC) is a national palliative care outcomes and benchmarking program. PCOC’s primary objective is to systematically improve patient outcomes, including pain and symptom control. As participation in PCOC is voluntary, data reported by the program represents a subset of specialist palliative care services delivered in Australia.

For the 133 specialist palliative care services participating in PCOC in 2018:

  • more than three-quarters (77%) of PCOC episodes were characterised by a cancer diagnosis
  • inpatient (hospital/hospice) services were more likely to achieve better outcomes for patients across all benchmarks than community care services
  • 94% of patients’ care commenced on the day of, or the day after, the date they were ready for palliative care
  • almost 9 in 10 (88%) patients had urgent needs (i.e. unstable phase) managed in 3 days or less
  • over half (56%) of patients who began experiencing moderate to severe distress from pain had this improved to absent/mild distress.

Where do I go for more information?

For more information on palliative care services, see:

Visit Palliative care services for more on this topic.

References

ACSQHC (Australian Commission on Safety and Quality in Health Care) 2015. National consensus statement: essential elements for safe and high-quality end-of-life care. Sydney: ACSQHC.

AIHW (Australian Institute of Health and Welfare) 2019. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease Study series no. 19. Cat. no. BOD 22. Canberra: AIHW.

Department of Health 2019. National Palliative Care Strategy 2018. Canberra: Department of Health.

RACP (Royal Australian College of Physicians) 2020. Australasian Chapter of Palliative Medicine. Sydney: RACP. Viewed 25 March 2020.

WHO (World Health Organization) 2014. Global atlas of palliative care at the end of life. Geneva: WHO.

WHO 2019. WHO definition of palliative care. Geneva: WHO. Viewed 30 August 2019.