Development and Implementation of the Palliative Care Assessment Toolkit for Rural Aged Care Facilities in Australia.

Background: Palliative care (PC) in rural aged care facilities faces significant challenges, including late referrals and insufficient staff training, leading to a risk of suboptimal end-of-life care. Objectives: The aim of the project was to develop and implement an evidence-based Palliative Care Assessment Toolkit (PCAT) to improve PC in rural aged care facilities and evaluate its impact on care delivery and staff practices. Design: The study employed a mixed-methods design across three phases: codesign of the toolkit, implementation, and evaluation (using pre- and post-data). Baseline data were collected through an audit of decedents records and interviews with clinical staff. The toolkit was developed based on these findings and included resources in four domains: anticipatory care; advanced care planning, end-of-life care management, and staff training. Post-implementation, the toolkit's impact was assessed through repeat audit of resident records. Results: The baseline audit revealed issues around advanced care directives, regular reviews, and end-of-life care management. Five to seven months post-implementation of the PCAT toolkit, there were improvements in key areas, the commencement of end-of-life care planning (54% vs. 88%, p = 0.03), availability of medications (55% vs. 100%, p = 0.0016), provision of psychological (59% vs. 82%, p = 0.17), and spiritual support (14% vs. 44%, p = 0.05). Staff feedback indicated increased confidence in delivering PC. Conclusions: The PCAT improved the delivery of PC in rural aged care settings, enhancing both resident outcomes and staff practices. Further research is recommended to validate these findings across various settings and to explore the long-term sustainability and cost-effectiveness of such interventions.