End of life care at Ballarat Health Services

The resources in this section support the Ballarat Health Services End-of-Life (EoL) framework.

The Ballarat Health Services (BHS) End-of-Life (EoL) framework has been developed to guide and direct staff of BHS to deliver the best possible End-of-Life Care every time. We recognise that people approaching the end of life, and their loved ones, need us to provide safe and high-quality care. This framework offers an integrated approach to managing End-of-Life Care in the Community, Acute, Subacute, Mental Health & Residential Aged Care settings.

Let's talk about dying - Peter Saul (TED talk)

The Dying Patient - Decision Asist

Goals of Care: A clinical framework for limitation of medical treatment - Clinical Focus

Goals of Care Inclusion Criteria & Supportive and Palliative Care Indicator Tools

The scope of the EoLFramework is from when a person is well and chooses to discuss and document their wishes for future health care in an Advance Care Plan (ACP). At BHS, we promote the completion of an ACP in the Primary care and Community programs setting.  The role of medical staff in the acute and subacute setting is to establish if a person has an ACP. If there is an ACP and the person has lost capacity, the ACP is used to inform the medical goals of care. This would be done in collaboration with the legal Substitute Decision Maker (SDM).

Can your Adult Patient Consent?

When the person is diagnosed with a life limiting illness or is at risk of deteriorating or dying – they meet the criteria of the Supportive and Palliative Indicators Tool™ they should have a meaningful and open discussion about their Goals of Medical Treatment. This discussion with the patient occurs after the treating team has made decisions about the benefit or otherwise of resuscitation measures such as CPR. The Goals of Care Summary form is completed by either a senior medical trainee (Registrar) or a Consultant. However it is important for junior medical staff to have an opportunity to see this conversation in action.

Advance Care Planning Conversations - Health.vic

Advance care PLanning: Have the conversation - AMA Vic

Example form - Goals of care: how to complete

Advanced CRP decision making - Video

Clinical model for ethical CPR decision-making - Hayes.B 2013 (Internal Medicine Journal)

Trust and Distrust in CRP Decision Making - Hayes.B 2010  (Internal Medicine Journal)

Ballarat Health Services recognises that these difficult conversations do not come easily to most health care providers and that these communication skills can be taught. We offer an evidence-based communication skills workshop on a regular basis but we also have resources on this site that offer advice and guidance on having a difficult conversation. 

The 5 Step ACP Conversation Guide

Recommended language for communicating end-of-life concepts - ANZICS

Clinical practive guidelines for communication in end of life issues - MJA 2007

Discussing Goals of Care: Evidence based communication skills in action - BHS 2015

A resource for you to suggest to your patient: MyValues - Online set of specially constructed statements designed to help a person identify, consider and communicate their wishes about the medical treatment they would want in the later stages of life. Developed by Barwon Health.

Finally,  a note on bereavement

A Time to be Careful: a reflection on End of Life Care at BHS - David Brumley 2013