Fitness to travel in palliative care
Many patients with palliative care needs wish to travel to fulfil a long-term dream, to visit family or friends, or to move to where they wish to die. Fitness to travel is a relative term, and careful consideration of the harms and benefits is necessary. As the goal of palliative care is quality of life, healthcare professionals should aim to minimise obstacles to travel. In particular, complicated treatment can make travel impossible and deny a patient the opportunity to complete important tasks.
Most patients have successful and rewarding journeys if carefully planned. If professional help will be needed during their journey or in their new location, arrangements should be made before travel. The Palliative Care Australia national service directory provides an extensive list of palliative care services in Australia.
Patients may not be able to travel alone, and consideration must be given to the demands and practicalities of the journey (eg administration of medications, help with toileting). Some patients require a carer or trained assistant to successfully complete a journey.
The patient should have adequate supplies of drugs and prescriptions. They should also carry a copy of their advance care plan, up-to-date medication list and other relevant documentation to guide healthcare professionals in the event of a sudden deterioration in their condition.
Prescriptions for Schedule 8 medications (eg opioids) may not be valid outside the state or territory of Australia where they were written; further information can be obtained from state or territory health departmentsHua, 2015. Regulations about medications (particularly opioids) also vary between countries; it is essential to investigate and comply with the regulations of any country to be visited.
Some patients with palliative care needs may be at increased risk of developing venous thromboembolism (VTE) when travelling long distances. For considerations when starting VTE prophylaxis for a patient with palliative care needs, see VTE prophylaxis in palliative care. Additional information on VTE prophylaxis for long-distance travel can be found in the Cardiovascular guidelines.
Some patients have medical problems that may preclude commercial air travel:
- Commercial airliners are not fully pressurised to sea level, resulting in reduced partial pressure of inspired oxygen in the cabin1. Even with oxygen supplementation, some patients with cardiac or respiratory conditions can become seriously ill and develop life-threatening hypoxia at altitude (eg cardiac ischaemia, respiratory failure). Severe lung disease with oxygen dependence at sea level can be a contraindication to air travel. For more information about respiratory disease and fitness to fly, see the Respiratory guidelines.
- Reduced cabin pressure in commercial airliners causes expansion of gases by about one-third, which can be important if there is trapped gas in closed body cavities (eg sinuses, middle ear, pleural cavity).
- Patients with unpleasant or offensive lesions may be refused carriage.
Requirements for medical clearance can differ between airlines; airlines produce their own travel clearance guidelines, which are available online. An example of information available online can be found on the Qantas website.If commercial air travel is not possible, escorted medical transfer on a chartered flight may be an option.
Healthcare professionals and patients should be aware of the problems that can arise if a patient becomes more unwell when travelling. Appropriate care may be difficult to access and incur very large costs, particularly overseas, if pre-existing conditions are not covered by health and travel insurance. The charter of an aircraft pressurised to sea level so that a patient can return home can cost tens of thousands of dollars, even within Australia.