From Local Realities to System Reform: Lessons from the Katherine Palliative Care Review

Amy Ward¹, Rebecca Garner²

¹Remote Generalist Speech Pathologist, ²Complex and Palliative Care Clinical Nurse Consultant

Abstract:

Background:
Palliative care is an essential component of health service delivery, with potential to drive innovation focusing on holistic care and community empowerment. Similarly, delivery of remote healthcare is also reliant on interpersonal and interagency relationship, to the extent that relationship often replaces infrastructure. In Katherine in the Northern Territory (NT), palliative care resourcing is limited, however despite these structural limitations clinicians continue to deliver high stakes care in a medically, socially, geographically and ethically complex environment.

Aims:
As part of a broader development project, we aimed to understand the strengths and gaps found in the existing Katherine palliative care services. This would serve to better inform current practice, education and onboarding, equitable distribution of resourcing and projected models of care.

Methods:
The project combined quantitative and qualitative data analysis through health service data, survey of healthcare workers, patient stories, and community yarning. Relationship-based care was used as both a principle of the project and tool of the methodology.

Results:
The project is currently in process, however preliminary reviews demonstrate:

• Multidimensional complexity in the remote setting, including clinical, social, cultural and structural complexity
• Relationship-based healthcare as a strength and foundation of remote palliative care, often challenging conventional medical models
• Sustainable care requires structural supports, including governance, partnerships and accountability

Conclusions:
Preliminary conclusions suggest that structural and systemic support that guarantees relationship-based care is required for a sustainable, equitable and community-affirmed palliative care service in Katherine. This is also applicable to all settings, regardless of remoteness or clinical domain, because “if we get remote palliative healthcare right, we get all palliative healthcare right”.