Palliative care outcomes

In 2022, 61,100 patients received palliative care from the 180 palliative care services voluntarily participating in the Australian Palliative Care Outcomes Collaboration (PCOC) program. This section provides information on the characteristics and outcomes for patients receiving palliative care from the palliative care services participating in PCOC over the period 2018 to 2022. 

Note, as participation in PCOC is voluntary, not all services participate in PCOC. The data presented in this section therefore describe a subset of all palliative care delivered in Australia. Further information about PCOC is described below and in the Data sources section. 

The information in this section was last updated in November 2023.

Key points

In 2022, among 61,100 patients who received palliative care from the 180 palliative care services participating in PCOC program:

  • 3 in 5 (63%) patients had a diagnosis of cancer
  • 1 in 2 (52%) patients died – of these 67% died in hospitals, 22% at home and 10% in residential aged care facility
  • 3 in 4 (77%) palliative care episodes ended within 30 days, with most ending within 2 weeks (62%)
  • almost 9 in 10 (87%) unstable phases (urgent needs) were resolved within 3 days or less
  • 9 in 10 palliative care phases that started with absent/mild patient pain remained absent/mild at the end of the palliative care phase – 89% for pain severity and 88% for distress from pain
  • 3 in 5 palliative care phases that began with moderate/severe patient pain reduced to absent/mild by the end of the palliative care phase – 61% for pain severity and 58% for distress from pain.

Downloads

PDF VERSION OF THIS SECTION

LATEST DATA TABLES

Overview of patients, episodes of care and phases

In 2022, among 61,100 patients receiving palliative care from the 180 palliative care services participating in PCOC:

  • more were men (52%) than women 
  • almost 2 in 3 (63%) had a diagnosis of cancer (Figure PCOC.1)
  • 1 in 2 (52%) died – of these 67% died in hospital, 22% at home and 10% in residential aged care. 

For further details on the characteristics of these patients, see Tables PCOC.1–3.


In 2022, there were 79,500 palliative care episodes reported to PCOC, equating to an average of 1.3 palliative care episodes per patient. Among these palliative care episodes:

  • there were slightly more episodes in inpatient settings than in community settings (occurring in the patient’s usual residence, such as home or aged care) – 40,700 compared with 38,800, respectively (Table PCOC.1)
  • median age at the start of the episode of care was 77 years (Table PCOC.4)
  • almost 3 in 5 (56%) referrals were from public hospitals, and around 8% each from general practitioner, private hospital and community palliative care service (Figure PCOC.1).

There were 75,300 episodes that ended (closed episodes) in 2022. Among these closed episodes:

  • 3 in 4 (77%) ended within 30 days, with most ending within 2 weeks (62%; Figure PCOC.1)
  • inpatient episodes were generally shorter in duration than community episodes – with a median duration (elapsed days) of 4 days in inpatient setting compared with 21 days in community setting (Table PCOC.7):
    • The proportion of inpatient episodes that ended within 2 days was 3 times as high as for community episodes (35% vs 11%) and twice as high for episodes that ended within 14 days (84% vs 37%, respectively).
    • The proportion of community episodes that ended 15 days or after was 4 times as high as for inpatient episodes (63% vs 16%) and 9 times as high for episodes that ended 31 days or after (45% vs 4.8%, respectively).
  • 1 in 2 (52%) inpatient episodes ended with the patient dying, while the corresponding proportion was 30% for community episodes. The most common reason for community episodes ending was the patient admitted for inpatient care, accounting for 1 in 2 (53%) episodes (Table PCOC.6).  


In 2022, there were 176,300 palliative care phases recorded in PCOC, with just over half (52%) occurring in community settings (91,000 compared with 85,300 in inpatient settings). On average, patients had 2.3 phases per closed episode (2.1 in inpatient settings compared with 2.6 in community settings) and 2.9 phases per patient (Table PCOC.1).

The 2022 data on palliative care phases revealed 3 main findings (Figure PCOC.1 and Table PCOC.8):

  • 4 in 10 (42%) were deteriorating phases and 3 in 10 (29%) were stable phases, followed by terminal (17%) and unstable (12%) phases. 
  • Deteriorating and stable phases were more common for those in community settings (46% and 35%, respectively) than in inpatient settings (39% and 24%, respectively), while terminal and unstable phases were more common for those in inpatient settings (24% and 13% compared with around 10% each in community settings, respectively). 
  • The average length of each phase was longer for those in community than inpatient settings, particularly for those in stable and deteriorating phases where duration of the phase was 3.7 and 2.9 times as long for those in community settings than in inpatient settings – 21.7 days vs 5.8 days for stable phase and 14.0 days vs 4.8 days for deteriorating phase, respectively. 

Figure PCOC.1: Overview of patients, episodes of care and phases for services participating in PCOC, 2022

Figure 1.1: The interactive data visualisation shows the number of patients and percentage of Top 10 most frequently diagnoses and cancer diagnoses in patients receiving palliative care from services participating in PCOC in 2022. Cancer was the most frequently diagnosis and lung cancer was the most frequently cancer diagnosis for patient recorded in PCOC.

Figure 1.2: The interactive data visualisation shows the number of episodes and percentage of referral source of episodes by palliative care setting in 2022. Public hospitals accounted for the largest number of referrals both in inpatient and community settings. The second largest number of referrals for inpatient settings was community palliative care services, and for community settings was general practitioners.

Figure 1.3: The interactive data visualisation shows the number of episodes and percentage of elapsed days of closed episodes by palliative care setting in 2022. Most of episodes ended within 30 days both in inpatient and community settings. In general, inpatient episodes were shorter in duration than community episodes.

Figure 1.4: The interactive visualisation shows the number of phases and percentage of each type of phases by palliative care setting in 2022. Deteriorating and stable phases were more common in community settings than in inpatient settings, while terminal and unstable phases were more common in inpatient settings than in community settings.

Palliative care outcome measures

Key measures of quality care are the outcomes that patients, their families, and carers achieve. PCOC is a national program that uses standardised validated clinical assessment tools to benchmark and measure outcomes. 


In 2022, the data on 79,500 palliative care episodes and 176,300 palliative care phases recorded in PCOC revealed the following key findings on palliative care outcomes (Figure PCOC.2 and Table PCOC.9):

  • Over 9 in 10 (94%) episodes commenced on the day the patient was ready for palliative care or the day following – 98% in inpatient settings and 88% in community settings.
  • Almost 9 in 10 (87%) unstable phases lasted for 3 days or less – 90% in inpatient settings and 84% in community settings.
  • Almost 9 in 10 palliative care phases that started with absent/mild symptom/problem remained absent/mild at the end of the palliative care phase – 89% for pain severity and 88% each for distress related to pain, fatigue, or family/carer problems. For distress related to breathing problems a higher proportion remained in the absent/mild phase (94%). 
  • The proportion of phases resolved in the absent/mild symptom outcome range was less likely when the patient had moderate/severe symptoms to begin with, especially for those with fatigue, breathing problems and family/care problems:
    • 3 in 5 palliative care phases that began with moderate or severe patient pain was reduced to absent/mild by the end of the palliative care phase – 61% for pain severity and 58% for distress from pain.
    • 1 in 2 palliative care phases starting with moderate or severe distress from fatigue, breathing problems or family/care problems was reduced to absent/mild at the end of the palliative care phase – 50% for fatigue, 53% for breathing problems and 52% for family/care problem. 


In 2022, the casemix adjusted score was greater than 0 for all 8 outcome measures across all settings and in inpatient settings, indicating an improvement in patient’s outcomes to the reference period. However, in community settings there were 3 outcome measures with a score slightly less than 0 – pain severity, distress from pain and nausea – indicating that outcomes had not improved to the reference period (Figure PCOC.2).

Figure PCOC.2: Palliative care outcome results, 2022  

Figure 2.1: The interactive visualisation shows the outcomes of the PCOC benchmarks by palliative care setting in 2022. The benchmarks have been grouped in four categories including time from date ready for care to episode start (benchmark 1 – 94%), time in unstable phase (benchmark 2 – 87%), absent or mild symptoms/problems (benchmarks 3.1, 3.3, 3.5, 3.7, and 3.9 – 94% for benchmark 3.7, and 88–89% for other benchmarks), and moderate or severe symptoms/problems (benchmarks 3.2, 3.4, 3.6, 3.8 and 3.10 – ranging from 50% to 61%).  

Figure 2.2: The interactive visualisation shows the casemix adjusted outcomes of the PCOC benchmarks by palliative care setting in 2022. The benchmarks have been grouped in two categories including clinician reported problem severity (benchmark 4.1–4.4) and patient reported symptom distress (benchmarks 4.5–4.8).  In 2022, the casemix adjusted score was greater than 0 for all 8 outcome measures across all settings and in inpatient settings. However, in community settings there were 3 outcome measures with a score slightly less than 0 – benchmark 4.1, 4.5 and 4.6.

Trends 

Services, patients and episodes of care

Between 2018 and 2022, the number of services participating in PCOC increased each year, from 133 to 180 services or a 35% increase over this period. The rate of increase was steeper between 2018 and 2020 (11% increase from 2018 to 2019 and 15% increase from 2019 to 2020), and then slowed considerably between 2020 and 2022 (4.1% increase from 2020 to 2021 and 1.7% increase from 2021 to 2022). 

This pattern was also observed for palliative care episodes over the same period – episodes increased by 12–13% between 2018 and 2020 and slowed to 7.1% and 2.5% increase in the next 2 years to 2022. However, this trend differed somewhat by palliative care setting. For inpatient palliative care episodes, the increase was steeper from 2018 to 2019 (14%) and 2020 to 2021 (12%) than other years (6.4% increase from 2019 to 2020 and 3.5% from 2021 to 2022). While, for community-based episodes, the increase was steepest (19%) between 2019 and 2020 and then slowed considerably in the 2 years to 2022 (2.2% and 1.6%, respectively). 

Interestingly, the number of patients steadily increased each year between 2018 and 2021 (10–13% annual increase), before slowing to 4% increase in the 12 months to 2022 (Figure PCOC.3). 

Figure PCOC.3: Trends in number of palliative care services, patients, episodes of care and phases for services participating in PCOC, 2018 to 2022

Figure 3.1: This line graph shows the trend of number of services participating in PCOC from 2018 to 2022. The number of services increased every year over this period; however, the rate of increase was steeper between 2018 and 2020 (11–15% annual increase), and then slowed considerably between 2020 and 2022 (2–4% annual increase).

Figure 3.2: This line graph shows the trend of number of patients receiving palliative care from services participating in PCOC from 2018 to 2022. The number of patients steadily increased each year between 2018 and 2021 (10–13% annual increase), before slowing to 4% increase in the 12 months to 2022.

Figure 3.3: This line graph shows the trend of number of episodes for patients receiving palliative care from services participating in PCOC by palliative care setting from 2018 to 2022. The number of episodes increased every year in this period; however, the rate of increase was steeper between 2018 and 2020 and slowed considerably between 2020 and 2022.  

Figure 3.4: This line graph shows the trend of number closed episodes for patients receiving palliative care from services participating in PCOC by palliative care setting from 2018 to 2022. The number of closed episodes increased every year in this period; however, the rate of increase was steeper between 2018 and 2020 and then began to slow between 2020 and 2022.

Figure 3.5: This line graph shows the trend of number of phases for patients receiving palliative care from services participating in PCOC by palliative care setting from 2018 to 2022. The number of phases increased every year in this period; however, the rate of increase was steeper between 2018 and 2020 and then began to slow between 2020 and 2022.

Palliative care outcome measures

Of particular interest is whether there have been changes in the proportion of patients achieving a positive outcome. Between 2018 and 2022, most outcome measures have remained relatively stable. However, there have been some measures where more notable movements have been observed over this time period (Figure PCOC.4):

  • notable drop in 2021 in those assessed as ready for care and receiving it within 2 days (86% in 2021 compared with relatively stable proportions of around 93–94% for all other years (between 2018 and 2020, and 2022; benchmark 1). Note that this drop occurred at a time where there were restrictions and subsequent pressures on the health care system due to COVID-19 pandemic which may have impacted on how people were accessing and receiving palliative care services, and their outcomes during this period.
  • slight increase in those remaining with absent/mild distress from fatigue at the end of the palliative care phase (from 85% to 88%; benchmark 3.5) 
  • increase in those moving from moderate/severe to absent/mild symptoms at the end of the phase for distress from fatigue (from 44% to 50%; benchmark 3.6) and for breathing problems (from 46% to 53%; benchmark 3.8).

Note that comparisons of outcome measures over time should be interpreted with caution, as these outcomes measures may be affected by compositional changes in the population, given that the number of services participating in PCOC is changing.

Figure PCOC.4: Trends in palliative care outcome results, 2018–2022

Figure 4.1: This interactive visualisation shows the trend of outcomes of the PCOC benchmarks by palliative care setting between 2018 and 2022. Between 2018 and 2022, most outcome measures have remained relatively stable. However, there have been some measures where more notable movements have been observed over this period, including benchmark 1, benchmark 3.5, 3.6 and 3.8.

Figure 4.2: This interactive visualisation shows the trend of casemix adjusted outcomes of the PCOC benchmarks by palliative care setting between 2018 and 2022. Between 2018 and 2022, the casemix adjusted score was greater than 0 for all 8 outcome measures across all settings and in inpatient settings. However, in community settings there were 3 outcome measures with a score slightly less than 0 – benchmark 4.1, 4.5 and 4.6.