The Palliative Care Gap: Why Too Many Australians Miss Out on Dignified End-of-Life Support
In a poignant reflection on modern healthcare, Australian oncologist Dr Ranjana Srivastava has highlighted a critical systemic failure: despite widespread recognition of its importance, too many Australians are missing out on quality and timely palliative care at the end of their lives. Her insights, drawn from clinical experience and recent data, reveal a troubling gap between medical ideals and on-the-ground reality.
A Personal Story Reveals a Systemic Problem
Dr Srivastava recounts a conversation with a friend whose mother was hospitalised for the seventh time in a single year. Despite clear signs of decline—failing body, faltering cognition, and openly pessimistic doctors—no clear care plan emerged. "Why can't someone tell us the big picture?" her friend lamented. When Dr Srivastava suggested palliative care, it came as an epiphany; her friend had little idea what it involved or that she could request it.
Tragically, the mother died just three days later. Months on, the friend's regret centred not on the death itself, but on the missed opportunity for better end-of-life care. This story, Dr Srivastava notes, is likely to become a more common lament as Australia's population ages.
The Stark Data Behind the Palliative Care Shortfall
Australia's healthcare system is widely admired, but the latest evidence paints a sobering picture of palliative care provision. In 2021-22, there were 132,000 predictable deaths among people aged 65 and over, with a median age of 85. These were expected deaths associated with gradual decline, yet access to palliative care remains uneven:
- While 60% of cancer patients now receive palliative care, this drops to just 28% for those with organ failure.
- For people with dementia and frailty, the figure is a dismal 22%.
- Most vulnerable elders and a significant number of cancer patients go without a service proven to mitigate physical and emotional distress for all involved.
Compounding this, healthcare costs in the last year of life are 14 times higher than usual care, rising to 10 times higher for those over 80. This excludes intangible costs, raising practical questions for a society that prides itself on comprehensive healthcare.
Timing and Access: Critical Issues in End-of-Life Care
Dr Srivastava observes that the first specialist palliative care intervention typically occurs a median of just 12 days before death, far short of the ideal three-to-four-month window needed to assess needs, mobilise resources, and prepare families. This delay contributes to distressing outcomes:
- 68% of dying people experience an unplanned hospital admission in their final year.
- Many die in hospitals or emergency departments, increasingly among those with dementia or organ failure.
Even with advance care directives prioritising quality of life over aggressive measures, nursing home residents are often "bundled into hospital." Relatives may decline keeping loved ones in nursing homes due to fears about end-of-life care quality—fears supported by data showing residential care residents have far less access to specialist palliative care compared to home care users.
Beyond Cancer: The Expanding Need for Palliative Expertise
Historically, palliative care was conflated with giving up, particularly in cancer treatment. Today, it is recognised as complementary to other therapies. However, as more cancer patients live longer, the need extends beyond oncology.
Dementia is now Australia's leading cause of death, and organ failure often follows a slow, irreversible trajectory. Palliative care must adapt to these longer, more complex journeys, requiring compassionate, tailored approaches that differ from cancer models.
A Call for Action: Funding, Awareness, and Advocacy
Dr Srivastava argues that better funding, awareness, and advocacy are urgently needed to include all those currently missing out. Earlier and improved palliative care benefits patients, families, and healthcare professionals alike. If society can achieve this while curbing even a fraction of end-of-life healthcare costs, the gains would be profound.
As Australia grapples with an ageing population, addressing the palliative care gap is not just a medical imperative but a societal one, ensuring dignity and support at life's close.
