Who is in the palliative care team?

Palliative care is a medical specialty that health professionals receive specific training for. Your palliative care team may be made up of medical, nursing and allied health professionals, who offer a range of services to assist you, your family and carers throughout your illness. This team may include spiritual or pastoral carers and volunteers.

Learn about the people that may be on your palliative care team, and their roles:

• Overview
• General practitioner (GP) or family doctor
• Nurse or nurse practitioner
• Palliative care specialist or physician
• Cancer specialist
• Counsellor, psychologist, clinical psychologist
• Occupational therapist
• Social worker
• Dietitian
• Speech pathologist
• Physiotherapist
• Pharmacist
• Spiritual or pastoral care practitioner
• Cultural adviser or patient care navigator
• Volunteer

Overview

Depending on your needs, your palliative care may be coordinated by your GP, a nurse practitioner or community nurse, or you may be referred to a specialist palliative care service. These services are made up of a multidisciplinary team of doctors, nurses and allied health professionals, such as occupational therapists, physiotherapists and social workers, who are trained to look after people with complex health care issues. Your cancer care team will continue to be involved and work with the palliative care team or your GP at all stages of the illness.

You will have regular appointments or visits with your GP and some of the health professionals in your team so they can monitor your progress and adjust your care. The most common palliative care team members are listed in this chapter. You won’t usually see all these people – some roles overlap and the availability of palliative care specialists varies across Australia. Your GP, nurse, nurse practitioner or palliative care specialist can help you work out the services you’ll need.

If you are at the end of life and have cultural or religious beliefs and practices about dying, death and bereavement, or family customs, let your palliative care team know so that they can provide you with care that respects this.

Possible members of the palliative care team

General practitioner (GP) or family doctor

• coordinates palliative care for many people
• continues to see you for day-to-day health c re issues if you are being cared for at home
• may be able to make home visits
• talks with your nurse or palliative care specialist to coordinate ongoing care and refer you to a palliative care specialist if you have complex needs
• organises your admission to hospital or a palliative care unit (hospice) if your circumstances change
• offers support to you, your family and carers, and gives referrals for counselling and other services

Nurse or nurse practitioner

• may be a nurse, community nurse or specialist palliative care nurse at a hospital, community nursing service, residential aged care facility or palliative care service
• helps you manage pain and other symptoms with medicines, treatments and practical strategies
• visits you if you are being cared for at home and provides after-hours telephone support
• coordinates other health professionals and works out what care you need (e.g. home nursing or personal care)
• refers you to a specialist palliative care unit (hospice)

Palliative care specialist, physician or nurse practitioner

• oversees treatment for symptoms such as pain, nausea, constipation, anxiety, depression, breathlessness
• usually provides care in a palliative care unit (hospice) or hospital (both for inpatients and outpatient clinics), but may be part of a community specialist palliative care service and visit you in your home or in a residential aged care facility
• communicates with and advises the cancer specialist and your GP so your treatment is well coordinated
• may refer you or your family to a counsellor, psychologist or other support person, and assist with decisions about or treatment, including advance care directives

Cancer specialist

• may be a medical oncologist, surgeon, radiation oncologist or haematologist and may manage some of your palliative care
• oversees treatment (e.g. surgery, chemotherapy, immunotherapy, targeted therapy, radiation therapy) aimed at slowing cancer growth and/or managing symptoms of the cancer

Counsellor, psychologist or clinical psychologist

• trained in listening and offering guidance to help you manage your emotional response to diagnosis and treatment
• allows you to talk about any fears, worries or conflicting emotions and about feelings of loss or grief
• helps you and your family talk about relationships or emotions
• may suggest strategies for lessening the distress, anxiety or sadness you and others are feeling or teach meditation or relaxation exercises to help ease physical or emotional pain
• gives grief care and support to your family and carers

Occupational therapist

• helps manage physical aspects of daily activities, such as walking, bathing, getting in and out of bed and chairs. Shows carers the best way to move you or help you sit or stand
• suggests physical aids to help you move around and maintain independence, such as a toilet seat raiser, walking frame or pressure-relieving cushions. Organises equipment hire or home modifications to make it safer and more accessible (e.g. handrails, shower chair)
• helps you prioritise activities to conserve energy for important tasks
• helps manage issues with memory, planning and problem solving

Social worker

• works out what support you, your family and carers need, and identifies ways you can receive this support
• may refer you to legal services, aged and disability services, and housing support or help with completing advance care directives
• helps communicate with family or health professionals (including about care goals) and supporting children or dependants
• may provide counselling or suggest other ways of coping

Dietitian

• helps with issues such as loss of appetite or weight loss
• suggests changes to diet and suitable foods to eat
• may provide nutritional supplements or protein drinks
• tries to resolve digestive issues, nausea or constipation
• may work with a speech pathologist for problems swallowing

Speech pathologist

• helps you eat and drink as safely as possible if you have problems chewing food or with swallowing
• gives advice on consistency of food and helps with good mouth care (e.g. dry mouth, too much saliva)
• helps with communication, such as voice problems and speaking or understanding language
• recommends communication devices and talking boards for patients who have trouble speaking
• may help with memory, planning and problem solving

Physiotherapist

• suggests physical aids to help you move safely and maintain independence, such as a walking frame or walking stick
• helps you improve or maintain your balance when moving
• offers pain relief techniques, such as positioning your body, stimulating nerves in your body and using hot or cold packs
• shows how to safely exercise to reduce pain and stiffness.
• can help clear congestion from your lungs, and teach you breathing exercises to better manage breathlessness
• may work with a massage therapist to relieve stiff and sore muscles or swelling, or a podiatrist for foot-related issues

Pharmacist

• dispenses medicine, gives advice about medicines, doses and possible side effects or interactions with other drugs
• can organise a medicine pack (e.g. Webster-pak) that sets out all the doses that need to be taken throughout the week. Communicates with the prescribing doctor if needed
• can help you keep track of medicines, including costs on the pharmaceutical Benefits Scheme (PBS)

Spiritual or pastoral care practitioner

• may be called a spiritual adviser, pastoral carer, priest, deacon, rabbi, mufti or reverend
• supports you and your family to talk about spiritual matters. Helps you reflect on your life and, if you want, on your search for meaning
• may help you to feel hopeful and develop ways to enjoy your life despite the cancer
• can organise prayer services and religious rituals for you and connect you with other members of your faith
• may discuss emotional issues (many are also counsellors)

Cultural adviser or patient care navigator

• cultural advisers, such as Aboriginal Liaison Officers, help to make sure you feel supported, safe and respected while using health services and help the people looking after you to provide care that is respectful to culture
• patient care navigators work with you, your family and community to help you navigate the health system and avoid any barriers to receiving timely care. Some may organise care plans for you. Some cancer centres may have a patient care navigator who can also help you organise palliative care or book appointments
• residential aged care facility outreach support services can help residents or people having high level support in the home to get care

Volunteer

• offers friendship, support and companionship – their role will vary, depending on the organisation they volunteer with
• may provide practical assistance, such as taking you shopping or to appointments, giving your carer a break, minding children, or doing basic jobs around the house
• you may find a volunteer through a palliative care service (volunteers are screened, trained and supervised) or through a state or territory palliative care organisation
• may be a friend, family member or neighbour. You may not like asking for help, but people usually want to help you

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