A pioneering new toolkit and training package has been designed to equip the nation’s 4000 general practice nurses with the skills to initiate advance care planning and palliative care planning as part of their every-day practice.

The free Advance toolkit of screening and assessment tools coupled with a training package has been specifically designed to support general practice nurses to broach the conversations with patients and their families.

The project, led by HammondCare and funded by the Australian Government Department of Health, aims to deliver the appropriate training and education to break down barriers to advance care planning with patients aged 75 and over or chronically ill patients, and to identify patients who may be at risk of deteriorating and dying.

It will also help nurses to assess and address both the supportive care needs of patients and carers while working to identify patients who may benefit from early referral to specialist palliative care services.

Advance project director Dr Josephine Clayton, a HammondCare palliative medicine physician and Associate Professor of Palliative Care at the University of Sydney, says general practice nurses come into contact with a large number of patients with chronic, debilitating diseases, malignant and non-malignant conditions, and play a key role in patient management.

“It’s so much easier for people and their families for these conversations to start much earlier outside of a crisis situation, so when people are relatively well and with people that they trust,” she says.

“GPs themselves are incredibly busy and there’s huge demands on their time and nurses can work very well and very effectively with GPs to enable advance care planning to happen in other settings, and so we think that general practice nurses are ideally placed to be able to start these conversations.

“They are not currently very involved in this area. It's certainly under-utilised these advance care planning discussions and I think there’s room for nurses to get much more involved in collaboration with the GP.”

Dr Clayton says often the initial hurdle for health practitioners is knowing how to start the discussion.

She says the toolkit provides education and a structured approach to guide nurses in their conversations on advance care planning and palliative care planning.

Dr Clayton says one example where nurses can initiate the discussion is with a patient, aged 75 or above, coming in for their annual flu shot.

“The nurse might say - ‘in the next five to 10 minutes could I ask you a few questions about your future health wishes?’

“It’s just phrasing it in a simple way like that. The tool that we’ve developed then gives a list of questions that the nurses can ask. They don’t have to remember it - it’s there for them in the tool.

“I think it’s just a way to get started. Once they’ve done it several times, they will probably develop their own way of phrasing the questions.”

The Advance toolkit, which has been designed for registered and enrolled nurses working in Australian general practice, features six screening and assessment tools and a guide, which details how to implement the screening tools in a systematic way in general practice.

It was designed following a literature review of the best available evidence and received input from an expert advisory group and feedback from general practice nurses, GPs and Carers Australia.

The online training, which counts towards CPD requirements for general practice nurses, is delivered free online, and includes three modules which will take about two hours to complete.

The online training has been endorsed by the Australian Primary Health Care Nurses Association (APNA) while the Royal Australasian College of General Practitioners (RACGP) has recognised the toolkit as an accepted clinical resource.

Free practical three-hour workshops will be held on weekday evenings in every capital city across the nation. Scholarships will also be available for general practice nurses in rural and remote settings to help cover the costs to attend the workshops.

Nurses will also be able to tap into free one-to-one tele-mentoring from an experienced palliative care nurse.

The Advance project, which Dr Clayton is presenting this week at the Advance Care Planning 2016 national two-day conference in Melbourne, is designed to transform the nation’s advance care and palliative care planning.

Dr Clayton says having these discussions earlier and increasing uptake can make an incredible difference to patients and their families.

“As a specialist doctor in palliative care, I look after people in acute hospitals and also in palliative care hospitals, and it is so much easier if people have started these conversations with their GP or with their nurse in their practice,” she says.

“If they were ever in a situation where they were too unwell to say what they wanted, their loved ones, who are called upon in a crisis situation, have to make what can be very difficult decisions on behalf of the patient.

“This program makes it easier for people at the frontline of care to be able to start these conversations and it makes it easier for patients and families.”