Assess Palliative Care Needs
Palliative care provides high quality health care to people living with a life-limiting illness to live as well as they can by focusing on their physical, psychological, cultural, social and spiritual needs. Palliative care that takes a person-centred approach to care will ensure all resident needs are met.
All residents identified as at the end of life using the SPICTTM tool should have a palliative care needs assessment. The life experiences of a person such as age, culture, religion, ethnicity or experience should be considered.
Re-assessment should occur regularly and at key transition points in the resident’s trajectory, for example:
- if there has been a significant functional or medical decline
- if there is a sudden acute event
- if discussions around goals of care are required particularly around futile treatment
- following hospitalisation
palliAGED offers complete sets of downloadable Practice Tips for Nurses (pdf 1.9MB) and Careworkers (pdf 2.9MB).
The Palliative Care Needs Assessment Guidance
The Palliative Care Needs Assessment Guidance was developed by the National Clinical Programme for Palliative Care and is a framework that considers needs across four domains:
- Domain 1 - Physical Wellbeing
- Domain 2 - Social and Occupational Wellbeing
- Domain 3 - Psychosocial Wellbeing
- Domain 4 - Spiritual Wellbeing
If your service uses electronic notes you may already have these domains within your clinical system. Similarly, your hard copy notes may address these issues. Review your system and see if all the domains are covered. Within each of these domains there are some specific tools or scales that might be useful to understand the needs of the resident and their family. The Assessment Tools section provides information on these domains.
Each resident will have an individual symptom profile and a comprehensive assessment is required.
The Symptom Assessment Scale (SAS) can be used as a self-report tool and provides a report of whether a symptom is present and indication of impact of that symptom. The SAS is based on a rating scale of seven common symptoms and has space to add additional symptoms. The Palliative Care Outcomes Collaboration (PCOC) has a brochure explaining the Symptom Assessment Scale (168kb docx).
Where a symptom has been identified further assessment using valid and reliable tools, if available, should be used to identify the underlying cause of the symptom and further details. The following is a suggested list of tools for common symptoms. You may have some of these in your electronic or hard copy files.
- Pain Assessment
- Modified Resident's Verbal Brief Pain Inventory (M-RVBPI) (112kb pdf): a comprehensive assessment of pain for clients that are able to communicate.
- Abbey Pain Scale (38.2kb pdf): a simple tool that can be used when a client is unable to communicate their pain
- Pain Numeric Rating Scale (87.94kb pdf)
A unidimensional single-item scale that provides an estimate of pain intensity for those individuals who are able to identify by number their pain level.
- Verbal Descriptor Scale (Pain Thermometer) (73.4kb pdf)
A pain scale using words to describe pain. This may be helpful for individuals who may have difficulty with numeral rating, but can identify their pain intensity using verbal descriptors.
Also The Palliative Care Bridge has a video on assessing pain for people unable to communicate.
- 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
- Oral Health Assessment
This domain is based around family support, emotional and social support and practical concerns.
A comprehensive social assessment helps to identify family, emotional and social support. The use of a genogram is helpful, particularly if the resident’s family is large or there are a variety of different individuals that will be providing support. The Residential Aged Care Palliative Approach Toolkit (PA Toolkit) has an example of a genogram in the booklet entitled The Palliative Approach Toolkit: Self-directed learning packages (10MB pdf) on pages 70-73.
The resident’s life biography assists in providing person-centred care, particularly for residents with cognitive impairment or dementia. There are a range of tools that can be used to identify the person’s biography. The Personal Life History Booklet (357kb pdf) is one resource. You may already have this or something similar as part of your admission and assessment process.
Residents at the end-of-life should be assessed for any issues that are worrying them. In particular, awareness of the possibility of psychological concerns such as anxiety, depression or previous mental health issues.
- CareSearch provides an overview of general emotional needs including for anxiety and depression in palliative care. There is information on conducting a psychosocial assessment, which helps in better understanding a person’s holistic needs in their social and cultural context to guide the development of a person-centred care plan.
- The Aged Care Funding Instrument (ACFI) has the modified Cornell Scale for Depression (CSD; ACFI 10), which also covers anxiety and is suitable for residents who cannot be interviewed. This scale is available in the ACFI Assessment Pack (CSD pages 10-13 and pages 27-40; 492kb pdf). More information on how to use the CSD can be found in the ACFI User Guide (439kb pdf). Check how recently a resident has completed a CSD. This may need to be readministered and the results communicated with the residents General Practitioner.