"Inadequate coordination of care"

My parent-in-law was diagnosed with metastatic prostate cancer (grade IV, spread to bones) almost a couple of years ago. They were involved in a clinical trial for a little over 12 months until the treatment stopped working. They saw their oncology specialist who recommended they commence chemotherapy to enhance their quality of life early this year.

I believe it was made very clear this is a terminal diagnosis and treatment is not curative. I felt discussions and referral to palliative care were not made early in the diagnosis.

Sometime into the chemotherapy, my parent-in-law began losing weight. I recommended they speak with their doctors (at FSH and their regular GP) about this and to request a dietician referral/nutritional supplements to manage this. At that stage, I believe they had lost around 6kg and as I understand it, was told the referral wasn't necessary because weight loss was a side effect of their treatment.

They have now lost around 16kg. They were referred to a dietitian and prescribed nutritional supplements a couple of months ago. Unfortunately, my parent-in-law has now lost appetite, enjoyment and a desire to eat so I feel these have been mostly ineffective.

My parent-in-law was recently admitted to FSH to manage dehydration, constipation, pain and a general inability to manage symptoms at home (they have medications at home but is refusing to take them as directed). My parent-in-law’s spouse requested a referral to palliative care around a couple days ago at the start of this admission. The team are now talking about discharging my parent-in-law home, but they are yet to meet the palliative care team. I believe that no doctor has discussed goals of care with them (both at FSH and regular GP). I feel that no advanced health directive is in place.

My parent-in-law’s treating team has provided great care toward individual aspects of their care. I am certain that if there was a referral to palliative care earlier, their overall care would be better coordinated. I believe these symptoms would be far better managed at home and unnecessary stress/trauma and ED presentations/hospital admissions could be avoided.

Particularly in this instance (I'm sure there are others in the same situation) where the patient/family does not understand what is happening and perhaps in denial about what is happening/refused to speak about end of life care.