Participants continue to report that PEPA is positively impacting their knowledge and skills, resulting in the enhanced provision of care for their patients/clients with life-limiting illnesses. Many participants mentioned specific areas in which their PEPA placement has impacted on their workplace, including through a better understanding of the palliative approach and changes in patient/client management. Some of the main areas are listed below with quotes from the post-placement surveys (S), longitudinal interviews (IP) and longitudinal surveys (LES).

Improved symptom management 

“I am able to talk to our G.P. about the need for medication.” (S: Aboriginal and Torres Strait Islander health worker)

Improved psychosocial support 

“Given me time to listen to each individual’s needs and listening to family members; confidence in communicating and delivering quality service to our clients.” (S: Aboriginal and Torres Strait Islander health worker)  

Improved networks

“It will help with Palliative care in the remote community, PEPA placement was very helpful. Know who to ring a palliative care, for information about palliative care clients.” (S: Aboriginal and Torres Strait Islander health worker)  

Improved confidence and care

“I think of the palliative approach sooner. I have a much better knowledge base and considerably improved confidence. My skills have improved and this is better for my patients & their kin.” (S: GP)

“The huge increase of confidence in dealing with the terminally ill patients and their relatives. Increased my knowledge regarding PROPER use of medications in dealing with such patients. I think it is an excellent teaching programme esp. for overseas medical graduates.” (LES: GP)

“You just get so much better impression of the problems involved and some of the simple solutions. Areas that are scary don’t turn out to be that scary after all… and for me to know who it is that I’m referring my patients to, I can say, “Look, I know the nurse in this area, I’ve met her, I’ve met the chaplain or the whoever and they’re good people”, is really helpful.” (IP: GP, Metropolitan practice)

Improved symptom management

“Better understanding of palliative care guidelines especially the use of analgesics and antiemetic has meant better patient satisfaction and improved practice.” (S: GP)

“(It’s) one thing to read in the palliative care therapeutic guidelines about using xxx (unclear) and haloperidol, and I’d seen that used down there a bit when it was appropriate with people who had some delirium symptoms associated with the terminal stages, and the use of the haloperidol for the delirium as well as their nausea.. Seeing someone actually doing it meant that when I came back here, and I have had two people since then that I have been able to use that and felt confident that it’s the appropriate drug and the appropriate way to use it.” (IP: GP, Rural practice)

Improved networks

“More proactive in our care of these patients; more collaboration between the GPs; more vigilant in informing the on call doctor of palliative care patients during after hours.” (S: GP)

“The personal face to face contact with the specialist palliative care doctors in the clinical placement has made me feel freer to consult with them by phone if I have concern about patients.” (LES: GP)

“So it made me more comfortable to be able to deal directly with the guys at XXX who are our referral consultants. I’ve got a face, they know me, and it’s certainly improved that network there.” (IP: GP, Rural practice) 

Increased use of palliative care resources

“Our practice has a greater awareness of available resources which we can access to help patients and their families. We had little to do with Advanced Care Directives prior to my PEPA placement but now routinely discuss them with appropriate patients.” (S: GP)

“The other thing I did was make up a resource folder so that … any of the referral services you could refer to, the help lines, and the other thing that’s part of that file is a whole list of drugs, especially chemotherapy agents, which I’m not very familiar with, and their effects and side effects.” (IP: GP, Metropolitan practice) 

Greater involvement promoting palliative care locally

“I have been able to discuss the lessons I learnt with other health professionals in my clinic to achieve a more coordinated approach to care of the dying.” (S: GP)

“Became part of a regional palliative care committee. Been more pro-active in defining patients as “palliative” and mobilising palliative support. Encouraged other doctors to do PEPA. Educated nursing staff about palliative management.” (S: GP)

Better understanding of the palliative approach to care

“I found my PEPA placement to be inspiring and radically improved my treatment and care of dying patients.” (LES: GP)

“The most significant thing was really just seeing the palliative approach, and that was the first thing that they went through when we did our little two-day workshop and then obviously, when you do the placement, the placement’s not, “Sit down, I’m going to tell you all about palliative care”, it’s “You come along and work with us and see what happens”, and by the end of the week you go, “Okay, that first thing they talked about on the palliative care weekend isn’t just something they talk about, that’s what they actually do”, and I think perhaps that’s the most significant thing. You go away with a real feeling for what that actually means and how it applies.” (IP: GP, Rural practice)

Important professional development opportunity

“As an ACRRM (Australian College of Rural and Remote Medicine) registrar, this was invaluable. In the same way EMST (Emergency Management of Severe Trauma), etc are compulsory parts of the ACRRM curriculum, consideration should be given to making this 4 days compulsory for at least all rural registrars, and probably all GP registrars.” (LES: Rural and remote medical practitioner)

“This programme is essential for increasing knowledge and confidence plus links with the local palliative care service to enable general practitioners to feel very supported in their ability to manage patients with life-limiting illness. I have also worked with RNs, ENs, ECAs, etc, doing their placements with PEPA and it is critical they also have access to this programme. Funding must continue in the same manner via the PEPA programme in the future. It is excellent.” (LES: GP)

“The huge increase of confidence in dealing with the terminally ill patients and their relatives. Increased my knowledge regarding PROPER use of medications in dealing with such patients. I think it is an excellent teaching programme esp. for overseas medical graduates.” (LES: GP)

Improved understanding of the palliative approach

“My PEPA experience has given me a broader view of the palliative approach, especially the inclusion of a multi-disciplinary team approach.” (S: Nurse)

“I know by implementing a palliative approach that the resident and family have an active approach in the role of dying. I am more confident now to discuss with my peers, talk with family and ensure the resident has the best care. I would strongly recommend my colleagues to participate in PEPA. This has given me so much more knowledge and understanding towards the dying and their family. I don’t just ‘think’ I am doing my best, I KNOW I am. The staff I worked with on PEPA have been an endless source of knowledge and I learned so much from them.” (LES: Nurse)

“Well I didn’t have that much really understanding of palliative care before I started this programme.  I was more or less under the impression that one sort of does very little care and manages the pain.  I think that’s a lot of people’s understanding, whereas I learnt quite the opposite, that it’s quite a lot of management, there are a lot of symptoms involved in palliative care, the goal being to make the patient as comfortable as possible.” (IP: Pharmacist, RACF consultant)

Improved confidence to implement the palliative approach

“I feel more comfortable talking and working with patients that are terminal and not unsure anymore about care. (S: AIN/carer)

I feel more confident that I could help with their distress… Well that’s what it is, it was for a confidence thing. I’ve been doing this (nursing) for years and I just feel more confident now.” (IP: RN, Rural RACF)

Improved symptom management

“Being able to do better pain assessments, looking at pain as a bigger picture, focusing on what the resident is saying regarding their pain, asking more relevant questions about pain – therefore being better able to advocate for them with their GPs.” (S: Nurse)

“The XXX (host site) had set up a whole bag of information about symptom management, about assessment processes, about delirium and bowel obstruction and respiratory shut down and a whole lot of stuff that they’ve actually put together, and best practice management of those things and they were already together summarised.  And we’ve now put them on our workstation web so that we can access them too because sometimes a doctor would say to us…, “Well, I don’t know what medications to use, I don’t know what to put in the syringe driver”, and we say, “Let’s have a look, this is what we’ve got on our workstation here”, as where we start, what sort of issues we can look at and how we can put a syringe driver together. So that’s been invaluable.” (IP: RN)

Improved psychosocial support

“End of life issues – Currently working as Respiratory Specialist Nurse. Valuable to be able to confidently talk about end of life.” (S: Nurse)

“I guess because I’m more confident about the questions that they (patients/clients) may ask and I now have the skills to know what to say and return it, it does make it better for the patients.  I guess before, if I got any tricky questions I’d have to say “Oh, I’ll refer you onto our psychologist, social worker” that sort of thing.  Whereas now I still will do that if it’s necessary but sometimes it’s just the patient wants a bit of reassurance and I feel much more confident to be able to do that.” (IP: Physiotherapist)

Improved networks

“I have confidently contacted and arranged a visit by the community palliative care team to assist with life improvement for a palliative care client and his family.” (S: Nurse)

“I actually know the people that I’m referring to… I’ve made many more phone calls and said, “Look, I’ve got this person on the ward, I don’t know whether you know them. Before I do a referral, even just symptom management, have you got some advice?”  So that sort of informal contact.  I wouldn’t have had the courage, I wouldn’t have known the language and what I was talking about (prior to the PEPA placement). I didn’t know some of the services that connected in with palliative care, I didn’t know about the volunteer group, that I’ve rung. Some of the clergy that I’ve met in terms of speaking about death and dying, and involving them.  Who else have I involved?  Probably the community nurses.  I didn’t realise how much a backbone of the service they were in terms of providing a lot of the hands on care.  Occupational therapists, physiotherapists, housing services I’ve contacted.” (IP: RN)

Increased palliative care resource use

“I’ve developed a detailed resource folder including information for both staff and patients/families and referral process.” (S: Nurse)

“I did it with three other girls in a different ward and we spent several days just setting up a major resource folder with everything in it and all the (contact) numbers… and it’s updated regularly… We do it as a group but its hospital wide so we’ve got resource folders in every ward.” (IP: RN)

Incorporating the palliative approach in the workplace

“Have been trialling a Palliative Care assessment tool for past 2 months which has facilitated a holistic and consistent approach to palliative care in our facility.” (S: Nurse)

“The ICU unit has changed the way we do end-of-life-care. We now routinely take hand-prints and take locks of hair.  We no longer monitor dying patients, or do vital signs. ‘Comfort care’ as THE criteria for determining care is being taken on board.  I have written a book for the children of a dying mum.  (We) Use the information on ‘grief’ from the handout in XXX (hospice) when the social worker is not available.  (We now) Use the reference material, ‘Therapeutic Guidelines to Palliative Care’.” (S: Nurse)

“Quite often some of our experienced senior doctors will say, “Well, how do we see palliation, what can we do and, before we have a family meeting which we’d like you to be involved in, what do you think about how we’re going to define palliation?”.  So that’s been good.” (IP: RN) 

“Good value” for the workplace

“It has been an ideal way of gaining much exposure and experience in a short time, that in our rural setting, would have taken at least a year to gain.” (LES: Allied health) 

“The PEPA experience is extremely important for every health professional to broaden and to develop their personal and professional development. It sets up networks and exposes applicants to a myriad of differing opinions. I encourage everyone I come into contact to become actively involved in the PEPA program.” (LES: Nurse)

Important professional development opportunity

“My workplace (hospital ward) has many palliative patients. They are entitled to receive the best nursing care possible. To enable such, staff need to be educated, made aware and encouraged to utilise current resources and encouraged to reflect on what we do and how we could better develop practices and protocols in managing and maximising positive outcomes with palliative patients and their families. We also have a role in educating other professional staff (including the medical officers) as to palliative principles and better symptom management. We have a role in developing resources and advocating for patients and their families and, to do this, we need the networking and education provided through the PEPA program.” (LES: Nurse)

“I have just completed my last clinical placement for my RN training. Looking back, I highly recommend ALL health professionals to do the PEPA programme. I learnt so much in two weeks and I have to honestly say my PEPA placement was one of the BEST placements I have done over the last 3 years. I suggest that this is such an important area of nursing and I have noticed, especially in aged care, nurses and carers are not equipped with the education on palliative care, which I find scary. Every registered nurse in Australia should do the PEPA placement. Thank you so much for giving me the opportunity.” (LES: AIN/carer)

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