Timely Referral to Outpatient Palliative Care Services in Regional Victoria (TROPICAL-VIC) is a 3-year Victorian Cancer Agency funded project aimed at bringing best practice palliative care to people diagnosed with advanced cancer in the regions.
People with advanced cancer have considerable physical and psychological needs. Studies of Victorian patients who died with cancer reveal an average of three multiday hospital admissions and 29 days in hospital following a diagnosis of incurable disease. Most will die in hospital (68%) and 62% will have two or more acute hospital admissions in the last 30 days of life. For many, this acute hospital care at the end of life does not reflect their preferences and the high levels of healthcare usage experienced have significant cost implications. There is now a mature evidence base demonstrating the effectiveness of early referral to palliative care for patients with cancer including: improved quality of life, improved mood, improved survival outcomes, reduction in emergency presentations fewer emergency presentations and hospital admissions at the end of life, increased likelihood of death at home (the preferred option of most), and savings of palliative care of up to 25% of total healthcare expenditure (compared to usual care). Despite these benefits, many patients do not access palliative care until very late, if at all. To reduce existing variation in care, and facilitate access to early palliative care, new models and demonstration projects are required. Data on the success or otherwise of early referral to palliative care in rural and regional areas is particularly scant. Rurality lends another layer to the complexity of palliative care provision, given shortages of allied health and psychological services, geographical isolation and the fragmentation of palliative care services across service areas and borders.
The TROPICAL-Vic project aims to enhance the current offerings of palliative care in the region, and to contribute to the evidence base by describing the process of co-designing the implementation of an adapted model of early referral to palliative care in a regional setting.