Palliative care training gaps remain in chronic disease management post-COVID-19.

Abstract

Background: The COVID-19 pandemic added to demand and diversification in specialist palliative care, including unprecedented need to deliver supportive respiratory therapies.

Aim: To understand training needs and ongoing models of care, including delivery of chronic disease management and supportive respiratory therapies, post-pandemic for palliative care clinicians.

Methods: Mixed-methods study of specialist palliative care physicians and nurses, recruited through Australian palliative care organisations and snowballing sampling between Nov 2022 - March 2023. Online survey captured training required and acquired in chronic disease management, respiratory therapies, and ongoing barriers to quality care delivery. Structured follow-up interviews explored adjustments in models of care and key areas of need. Quantitative data were described, free-text and interview data analysed through content and thematic analyses respectively.

Results: Of 71 palliative care responding clinicians (47 physicians, 23 nurses), most were female (79%) and many were rurally-based (38%). Completion of any chronic disease-specific training was infrequent (21% physicians, 30% nurses), compared with informal organ-specific training (61-83%) and age-related decline training (44-60%) through generalised palliative care qualifications. Respondents commonly managed chronic breathlessness (55%) and respiratory therapies (24-42%), yet targeted training was atypical. Content analysis (n=64) confirmed ongoing training gaps broadly in coping with daily operational demands and workforce fluctuations and specifically in respiratory skills. Interviews (n=7) reported challenges in care delivery post-pandemic; absence of pathways and policies for chronic disease management; and patient misconceptions about palliative care.

Conclusions: Clinicians are frequently required to support varied chronic conditions, including the use of respiratory therapies and breathlessness management, but report lack of specific training. Future endeavours should address workforce training and models of care to support increased demand.

Funding: Associate Professor Disler is the recipient of an Australian Research Council Australian Discovery Early Career Award Fellowship (DE200100343) funded by the Australian Government.