Innovations in Community-Based and Digital Palliative Care

By IAHPC Member Audrey Lelekufa
Port Moresby General Hospital, Papua New Guinea

At the Oceanic Palliative Care Conference in September, I was struck by the rapid evolution in community-based and digital care. Digital care is not about replacing the essential human element of our work, but enhancing our ability to deliver it effectively and compassionately.

Audrey Lelekufa at the 2025 Oceanic Palliative Care Conference. Photo used with permission.

Several members have asked me for details about specific innovations: here are some key ones that I believe have a practical application for our team.

Community-based innovations: Shifting the centre of gravity

The conference emphasized a "home-first" model, supported by new roles and systems that enhance community-based care.

Specialist Community Paramedicine. This was a standout model that deploys specially trained paramedics to support palliative care patients in their homes. They can manage symptoms such as pain or breathlessness, perform urgent catheter or syringe driver maintenance, and provide a rapid response that prevents unnecessary and distressing transfers to the emergency department. It bridges a critical gap in after-hours care.

Integrated Palliative Care Hubs. Instead of relying on a single GP or community nurse, these "hubs" house palliative care specialists, social workers, pharmacists, and volunteers. The hub is a central coordination point that provides rapid advice and support to both patients at home and the primary care team. This model reduces fragmentation and ensures a consistent, multidisciplinary approach.

Palliative Care Pharmacist in the Community. The role of the pharmacist goes far beyond dispensing. Palliative care pharmacists now routinely take part in community nursing visits. They conduct medication reviews in the patient's home, reconcile complex drug regimens, advise on the use of non-standard medications, and educate families on how to safely and properly administer the prescribed medicines, significantly improving efficacy.

Digital innovations: The connected care ecosystem

Technology is becoming an invisible backbone that can support patients at home and connect the care team.

Symptom Tracking & Predictive Analytics. Patients and families use simple apps on a tablet or phone to report symptoms daily (e.g., pain score, nausea, mood). This data feeds into a dashboard that alerts the clinical team to concerning trends before a crisis occurs. This moves us from reactive to proactive care, permitting early intervention.

Virtual Health Consults & Telemedicine. While not new, these services have broadened their reach. They are being used for urgent clinical reviews, family meetings that include relatives in different cities or countries, and real-time consultations with distant specialists. This improves access and reduces the burden of travel for very unwell patients.

Innovations I am keen to explore for our practice

Based on what I learned, I believe that our patients and health care team could greatly benefit by two innovations:

Pilot a Digital Symptom Tracker. I propose that we identify a small cohort of patients who would be willing to trial a simple symptom-monitoring app for three months. The goal would be to see if it reduces our emergency call-outs and improves our ability to stabilize symptoms at home. The conference provided strong evidence for its efficacy.

Formalize a Partnership with Local Paramedic Services. We will initiate a conversation with our local ambulance service to explore its interest in developing a community paramedicine pilot project for palliative patients. Even an educational session on our model of care could be a valuable first step.

The overarching message from the conference was clear: by thoughtfully integrating proven community-based care and digital tools, we can create a more resilient, responsive, and patient-centred system that truly allows people to live well in their place of choice until the very end.