Primary Care - Clinical Action - Assess Palliative Care Needs
X

Assess Palliative Care Needs

What are palliative care needs?

End-of-life care needs are person-dependent, often complex, and may change quickly. They include social, psychological, and spiritual needs as well as clinical or physical health needs.

You can read more about what palliative care needs to assess in the Assess Palliative Care Needs page of the ELDAC Care Model.

What is my role as a primary care professional in assessing palliative care needs?

Assessing palliative care needs can help to appropriately plan the care and services needed to support the older person to provide best quality of life.

Assessment of needs should consider the life experiences of the older person, such as their age, culture, religion, ethnicity or experience, and also of the local health services available to support the care they need. As palliative care is delivered over time (from days to years), it is important to also identify when to reassess palliative care needs. You can read more about when to reassess on the Assess Palliative Care Needs page of the ELDAC Care Model.

Primary care professionals, with their pre-established relationships with the older person, have a good understanding of previous health needs and what may be considered important to the older person in their care planning.

We want you to be equipped to:

  • Understand what your roles and responsibilities are when assessing palliative care needs, including for carer needs.
  • Be confident in assessing palliative care needs holistically, considering those beyond clinical or physical.
  • Consider and prepare for the different needs of older people within diverse population groups. This includes older persons who may be unable to communicate, such as those with dementia.
  • Be familiar with local services to support referral pathways and easy health system navigation for the older person and their families.

Needs Assessment Tool for Carers (NAT-CC - Caring for you) (149kb pdf)

University of Queensland

The NAT-CC is a self-reported tool for carers supporting someone with a chronic illness. The tool identifies the care needs of someone living with a chronic condition, and the level of concern this causes the carer. This provides prompts for the carer and/or the health professional to discuss these issues.

Common ELDAC Clinical Tools

ELDAC

ELDAC has developed a resource of commonly utilised tools for support in care delivery, including tools for screening, risk prediction, cognitive, symptom, and psychological assessment.

Palliative Care Needs Assessment Guidance

Health Service Executive: National Clinical Programme for Palliative Care

The Guidance was developed as a framework to consider palliative care needs across four domains of care, as below. 
Under each of these domains, a series of tools and prompts have been provided to support you in the assessment of palliative care needs.

  • Physical Wellbeing
  • Social and Occupational Wellbeing
  • Psychosocial Wellbeing
  • Spiritual Wellbeing

Older persons with life-limiting conditions often have multiple palliative care needs. While some may be self-reported, others may require prompting and investigation. Symptoms are diverse and complex, and while this list provides common symptom assessment tools, it is non-exhaustive. Assessment of physical symptoms should consider clinical history.

General Symptoms

  • Symptom Assessment Scale
    Palliative Care Outcomes Collaborative (PCOC)
    The SAS is based on a rating scale of seven common symptoms, and has space to include additional symptoms. This scale can be used as a self-report tool for older persons on their experience and impact of symptoms. There is also a SAS Guide for clinicians (577kb pdf).
  • Needs Assessment Tool for Progressive Disease (NAT:PD) (99kb pdf)
    University of Newcastle
    This tool can help to identify the level of complexity in palliative care needs for progressive chronic diseases to best align care. In a primary care setting, this tool can be used to help identify what needs you can meet within your scope, and which needs may be better managed by specialists and require a referral.

Pain Assessment

Dyspnoea (shortness of breath) Assessment

  • The Modified Borg Scale (mBORG) (181kb pdf)
    Lung Foundation Australia
    The Modified Borg Dyspnoea Scale (mBORG) is used to measure the self-reported intensity of the sensation of breathlessness for individuals who may have difficulty with a numeral rating, but can identify their dyspnoea level using verbal descriptors. The mBORG rates dyspnoea on a scale of 0-10 to quantify the intensity of dyspnoea during activity.

Delirium Assessment

Nutrition Assessment

  • The Mini-Nutritional Assessment (MNA®-SF)
    Nestlé Nutrition Institute
    The MNA is a screening tool used to identify adults over 65 years of age who are malnourished or at risk of malnutrition. The link provides more information on the tool, and where to download the form from.

A comprehensive social assessment helps to identify the older person’s concerns or considerations in relation to their home, family and community, and in their autonomy and practical support. This will support appropriate care planning, and ensure care is person-centred.

  • Palliative Care Needs Assessment Poster (184kb pdf)
    Health Service Executive: National Clinical Programme for Palliative Care
    This one-page poster considers key actions and information across all 4 domains in assessing palliative care needs. Under Domain 2: Social and Occupational Wellbeing, it provides a series of prompts for assessing the older person’s social needs and mapping their family and community support systems.
  • Social support
    CareSearch
    This webpage provides a summary of clinical evidence on social support in palliative care, and recognises the how equity and access, and diverse care settings can influence care decisions.

Older persons approaching end of life often have significant psychosocial needs, which may include mental conditions like anxiety and depression to manage. Being proactive to identify these needs is an important component of palliative care needs assessment.

  • Psychosocial complexity
    CareSearch
    This webpage explores the range of factors to consider when assessing psychosocial concerns.
  • Assessing distress
    CareSearch
    This webpage provides key points to consider when identifying symptoms of distress.
  • Kessler Psychological Distress Scale (K10) (64kb pdf)
    Black Dog Institute
    The K10 is a simple measure of psychological distress as a measure of outcomes following treatment for common mental health disorders. The K10 asks 10 self-reported questions with a 5-value scale. The maximum score is 50 indicating severe distress and the minimum score is 10 indicating no distress.

Assessment of spiritual wellbeing can help to ensure person-centred care that is meaningful to the beliefs of the older person and aligns with their goals of care.

It is important to note that the meaning of spiritual differs between people, and may encompass beliefs in religion or faith, culture, traditions, and/or philosophy.

  • Spiritual Care
    palliAGED
    This webpage provides an evidence-based summary of spiritual care, and provides practical tips and educational links and resources to support you and your organisation’s capacity to provide spiritual care.
  • National Guidelines for Spiritual Care in Aged Care Meaningful (831kb pdf)
    Ageing Australia
    This resource provides an overview of some common spiritual needs of older people, and identifies 5 domains for spiritual care.

 

Non-verbal pain assessment (video)

NSW Agency for Clinical Innovation

In this video, Peter Cleasby and Leigh Hatcher discuss non-verbal pain assessment, introducing common tools to support assessment and considerations to ensure quality care.

Abbey Pain Scale (APS) (38kb pdf)

The Australian Pain Society

A tool to assess the experience of pain in people who cannot verbalise their needs, including those with dementia, cognition, or communication issues. This resource also provides a follow-on form to enable comparisons across time.

Aboriginal and Torres Strait Islander care

CareSearch

This webpage providing information and resources for healthcare providers and carers in providing palliative care for Aboriginal and Torres Strait Islander peoples.

Diverse Population Groups 

ELDAC

ELDAC has compiled a series of information for diversity considerations in palliative care across population groups, including Aboriginal and Torres Strait Islander peoples, Care Leavers, Carers, Culturally and Linguistically Diverse, Financially or Socially Disadvantaged, Homeless, LGBTI+, Rural and Remote, Spirituality and Faith, and Veterans.

Caring for Diverse Populations 

ELDAC Primary Care Toolkit

The Older Person, Family and Carer Support section provides additional resources, further education and information on how to identify HealthPathways for diverse populations to support appropriate care.

Lesbian, gay, bisexual, transgender, and intersex

CareSearch

This webpage considers the importance of, and barriers to, palliative care for LGBTIQ+ populations.

Digital Tools

ELDAC Primary Care Toolkit

This section of the Toolkit provides an overview of the digital tools available to support care delivery, and includes a summary of HealthPathways as a decision-making support resource and local referral guide. 

Older Person, Family and Carer Support

ELDAC Primary Care Toolkit

This section of the Toolkit provides a summary of resources on palliative and end-of-life care to provide to the older person, their family and carer(s) to support them. It also provides information on how to develop feedback mechanisms for ongoing improvement and providing care to diverse populations.