Latest Australian research

Aakataa M, Khalil H.

Background: Palliative care requires timely and accurate assessment to support patient-centred outcomes. However, existing tools vary widely in purpose, design, and implementation. Understanding the current landscape of available tools is essential to guide future innovation. This review aimed to systematically identify and map published literature on palliative care assessment tools, focusing on their purpose and domains assessed, with consideration of reported validation, usability, and implementation characteristics.

Methods: Scoping review conducted using the Joanna Briggs Institute (JBI) methodology and reported according to the PRISMA-ScR checklist. Ovid MEDLINE, CINAHL, and the Cochrane Library were searched for peer-reviewed studies published in English from 2005 to 2024. Studies were included if they assessed tools used in palliative care populations for symptom assessment, quality of life, early identification, psychosocial evaluation, or caregiver support. Study screening, data extraction, and synthesis were completed in Covidence.

Results: A total of 299 studies from over 40 countries were included, representing 813,819 participants. The Edmonton Symptom Assessment System (52.1%) was the most frequently used tool. Most tools focused on symptom assessment (27%) and quality of life (22%), with limited attention to caregiver burden (4%), spiritual wellbeing (4%), or social support (4%). Ninety-four studies (31%) reported positive perceptions of tool utility, and one reported a negative outcome. Key gaps included cultural adaptation, digital integration, multi-user access, and holistic scope.

Conclusion: Although many tools support clinical assessment, few address the complexity of holistic, person-centred care. There is an urgent need for co-designed, culturally sensitive, and digitally enabled tools to support equitable palliative care delivery.

Chen J, Cohen MS, Louis W, Decety J, Thomas EF, Crane M, et al.

Abstract: Medical assistance in dying (MAiD) is gaining legal and social acceptance; yet it remains ethically controversial and challenging for healthcare professionals. This functional MRI study examines how social norms and empathy influence MAiD decisions in 59 Australian medical students while evaluating hypothetical assisted-dying scenarios. Participants’ decisions generally aligned with the legal framework. MAiD was approved when eligibility criteria were met (normative cases) and denied when they were not (nonnormative cases). Nonnormative scenarios elicited greater activation in frontoparietal brain regions involved in response selection and inhibition, consistent with increased decision difficulty. These scenarios elicited heightened activity in the precuneus, temporoparietal junction, and angular gyrus, along with stronger functional connectivity between the anterior hippocampus and the precuneus, suggesting greater reliance on memory retrieval and mentalizing. Normative scenarios were associated with increased amygdala activity, particularly among less religious participants, suggesting a role for negative affective salience. Greater activity in the ventromedial prefrontal cortex, and connectivity between the anterior cingulate cortex and this region, suggest positive feelings related to compassion when a clinician can legally approve an assisted dying request. Normative scenarios were also associated with reduced connectivity between the anterior cingulate cortex and the anterior insula, particularly in those with higher trait affective empathy, suggesting that doctors might feel a reduction in their patients’ pain. The findings provide the first empirical evidence of the neural mechanisms underlying decision-making in bioethical cases involving death as the outcome, highlighting distinct contributions and potential risk factors for medical practitioners in normative and nonnormative MAiD clinical situations.

Lee J, Evans H, Wakefield CE, Anazodo A, Cohn RJ, McGill BC, et al.

Abstract: End‐of‐life conversations with adolescents and young adults (AYAs) with cancer rarely occur without the guidance of healthcare professionals. As a part of the ‘Difficult Discussions’ study, focused on palliative care and advance care planning discussions with AYAs with cancer, we investigated the factors that healthcare professionals identify as barriers and facilitators to end‐of‐life conversations. Twenty‐eight multidisciplinary healthcare professionals participated in semi‐structured interviews exploring conversations focused on end‐of‐life care (29% oncologists/haematologists, 39% nurses and 32% allied health professionals). Data were analysed through qualitative content analysis using an inductive approach. The conversations were shaped by factors at the healthcare professionals’ personal, interpersonal, teams and hospital system levels, as well as being influenced by cultural and societal influences. Barriers at each level included patients’ and caregivers’ emotional needs; patients’ maturity levels; lack of relational trust between patient, caregiver and healthcare professional; and the social taboo of speaking about death with young people. Conversely, good communication between members of the multidisciplinary team was identified as a facilitator, as working effectively in a team was found to mitigate some of the emotional burden and logistical constraints of conducting end‐of‐life conversations. The results of this study offer new insights into how the interplay of these factors acts as facilitators and barriers to communication. Further research could explore the communication processes that facilitate trust between the AYA and healthcare team, factors associated with AYAs’ readiness and the optimal time to conduct end‐of‐life conversations.

Shanmugasundaram DS. 

Abstract: "Caring outside the box" refers to holistic, personalised, and innovative support approaches that move beyone traditional, standardised care models, particularly in disability, education, and health services. It emphasizes tailored solutions, such as creative therapy, community engagement, and proactive, flexible support systems that address an individual's unique needs.

Banks S, Lee B, Ayres N, Schrader S, Thomson B, Loveday BPT, et al.

Introduction: Optimal care pathways (OCP) were developed in Australia as a framework to define quality and timeliness targets. The 2022 National Pancreatic Cancer Roadmap highlighted a paucity of population-level data on pancreatic cancer management in Australia, such that compliance with OCP targets is uncertain. This study used real-world data to compare pancreatic cancer care in Victoria, Australia, against OCP targets.

Methods: Data collected on pancreatic cancer patients between January 2016 and July 2025 were extracted from the PURPLE registry for five Victorian tertiary hospitals. Care processes and timeliness outcomes were compared with OCP benchmarks.

Results: 1878 patients were identified, with a median age of 70 years. At diagnosis, 41% had metastatic disease and 69% were ECOG performance status 0-1. Median interval from diagnosis to surgery was 20 days (OCP benchmark ≤ 28 days) with 60% of patients operated on within the timeframe, and to adjuvant therapy 55 days with 88% of patients receiving chemotherapy within the OCP benchmark of ≤ 84 days. However, just 33% received neoadjuvant chemotherapy, and 38% received palliative chemotherapy within the 28-day timeframe for commencing systemic treatment. Palliative care referral occurred in 65% of patients with advanced disease and 61% were discussed at a multidisciplinary meeting. Marked inter-site variation was evident across metrics.

Conclusion: In Victoria, Australia, pancreatic cancer care variably met OCP targets. Real-world registry data can identify domains of care where performance is strong and highlight opportunities for process improvement and resource optimisation. Where OCP targets are rarely achieved, these findings support review of their real-world feasibility.