The burgeoning incidence of end-stage renal disease in the Indigenous population of the Northern Territory, Australia, being up to 30 times greater than the non-indigenous Australian incidence, has severely stressed existing responses to service delivery. A focus upon institutional haemodialysis within regional centres, rather than offering community base treatment or palliative care options in the remote communities where the majority live, has been the traditional response.

Palliative care services have had to cope with a comparable escalation of ESRD deaths but receiving late referrals of hospitalised patients at the time of cessation or non initiation of haemodialysis. The patient’s dislocation from their community has meant that the capacity to make the journey home, in preparation for their death and related cultural practices, often fails through lack of time, lack of available transport and poorly organised supports.

A public health collaboration between the Northern Territory’s Renal Services, Chronic Disease Programs and Territory Palliative Care is implementing significant changes in the model of care in the decision making processes and care pathways for ESRD management. By engaging patients and communities earlier, offering advanced care planning and presenting palliative care as one of a number of management options it is hoped that decision making and cultural practices will be respected and that the changes will make a meaningful difference to the lives of patients, their families and communities.

This presentation will detail the elements of the collaboration model and changes between the services and present the preliminary data and evaluation of their impact.