The end of life population is not a homogeneous population group – it is time to define the population more precisely.
For the purposes of population based service planning, it is proposed that all people at the end of life (including their family, caregiver/s and community) be conceptualized as falling within three broad sub-groups.
The population represented in the conceptual model is 100,000.
The largest sub-group A
are those patients who do not require access to specialist care as their needs are met either through their own resources or with the support of primary care providers (for example generalist medical and nursing services as well as other specialist staff – oncologists, cardiac services, geriatricians and so on).
Currently, almost two-thirds of all people whose death is expected fall within sub-group A
and are not seen by a specialist palliative care service prior to their death. Fewer than a third of patients represented in the model are currently seen by palliative care services.
These patients are distributed between sub-groups B
(those patients requiring consultation care) and C
(those requiring ongoing specialist care). It is not known how they are proportionally distributed between sub-groups B
In sub-group B
, patients may have sporadic exacerbations of pain or other physical symptoms or may experience social or emotional distress. This temporary increase in their level of need may require access to specialist palliative care services for consultation and advice. They will continue to receive care from their primary care provider.
are those palliative care patients who have been identified as having complex physical, social, psychological and/or spiritual needs that do not respond to simple or established protocols of care. They usually require highly individualized care plans developed, implemented and evaluated by knowledgeable and skilled specialist practitioners, in partnership with primary care providers. This sub-group is likely to be the smallest of the three sub-groups of the population.
See reference for the diagram / model of the level of need within the population of individuals with a life-limiting illness.
Palliative Care Australia. PCC4U. Who need palliative care? Internet. Accessed on February 21, 2016.