Care Plus and early palliative care

Professor Jennifer Philip


Care Plus is an early palliative care implementation project, supported by the Medical Research Future Fund. It has been running for over three years at four health sites in Victoria. The project is a response to the recognition that it is not always easy to gauge the timing of introducing palliative care to patients, and that starting conversations about palliative care can be challenging. The project seeks to remove this burden from clinicians and address these and other barriers to patients accessing early palliative care.


Critical to the success of the project was the understanding that a new service design was required. While there are a number of studies demonstrating the advantages of early palliative care referral, there was limited guidance on how to achieve this in a meaningful way.


It was determined that addressing these barriers would require a new model of care, integrated into patients’ existing care. The process of referral to Care Plus needed to happen automatically, regarded as a routine part of high quality care and, working collaboratively with clinician groups, the timing of this referral was tailored to the needs of each patient group. The Care Plus model involved a minimum of three clinic based consultations to discuss symptoms, support, future planning and decision making with patients. The name ‘Care Plus’ allowed an initial conversation without the stigma of palliative care attached and the introduction of the palliative care team as the best professionals to address these needs with patients.


Initial feedback from patients has been positive. Patients have expressed that preconceptions of palliative care as end of life were changed to seeing palliative care as enabling patients to engage in the activities they wanted to do whilst living with their diagnoses. They also expressed that their cancer treatment teams were excellent at what they did, and also there was insufficient time to have these conversations. Care Plus allowed patients the opportunity to explore what was important to them and what their values were – conversations that take time.


For patients who did not require ongoing palliative care after the three consultations, the early referral meant these patients could return in, for example, one year’s time and ‘pick up the conversation’ with palliative care staff, as well-documented notes of their initial appointments already existed. For patients whose disease was progressing more rapidly, the preliminary work was already done. In both cases, this improved continuity of care.


Embedding Care Plus into the four health sites enhanced collegiate understanding of fields of specialty, as well as processes, pressures and challenges faced by cancer and palliative care clinicians. This enhanced relationships and trust and, in turn, enhanced coordination of patient care. Overall, clinicians have felt it has been useful.


'...it's really good to have that concurrent pathway where we can link patients in from an early point, so that that trajectory is clear and as things progress it makes things much easier when you get further down the line.'


Critical to the success of the project was the understanding that a new service design was required. While there are a number of studies demonstrating the advantages of early palliative care referral, there was limited guidance on how to achieve this in a meaningful way. Using an outpatient model of care delivery was less resource intensive than, for example, community palliative care, and being delivered alongside usual cancer care enabled the ‘early’ integration. Learning from this, a key part of the Care Plus project is the development of an implementation package detailing what was involved, processes and likely costs, as well as cost savings – effectively, a ‘how to’ template.


While there is still health services data to be released on the project, patient, family and clinician qualitative data has been positive, with interest in and commitment to the project.


For clinicians and health services team members interested in learning more about the implementation of the Care Plus project, please contact Jennifer Philip at <jphilip@unimelb.edu.au>.