Latest Australian Research

Polypharmacy is prevalent in palliative care and may increase medication burden, adverse drug events, and clinically significant drug-drug interactions as goals of care shift.

To identify factors associated with polypharmacy and describe longitudinal medication use and discontinuation patterns in an Australian metropolitan palliative care unit (PCU).

This retrospective cohort study included adults admitted to the PCU in 2023. Medications were assessed at five timepoints: preadmission (T1), admission (T2), day five (T3), final palliative care phase (P1), and discharge/death (T4). Factors associated with polypharmacy were evaluated using multilevel multivariable logistic regression. Medication discontinuation patterns were categorized with reference to OncPal and Hedman et al. criteria.

Among 386 patients, median age was 78 years (interquartile range 69-87). Polypharmacy was associated with admission for symptom management (adjusted Odds ratio [aOR] 4.07; 95% confidence interval [CI] 2.51-6.59) and endocrine comorbidity (aOR 1.73; 95% CI 1.10-2.72), while terminal phase (aOR 0.06; 95% CI 0.03-0.11) and age ≥80 years (aOR 0.34; 95% CI 0.18-0.66) were associated with lower odds. Preventive medications were frequently discontinued. Medications for which tapering is generally recommended, including proton pump inhibitors, beta-blockers, and antidepressants, were often ceased without an observed preceding dose reduction. Symptom-directed medications increased over time.

Polypharmacy was more common among younger patients, those admitted for symptom management, and those with endocrine comorbidity. Medication burden changed throughout admission, with preventive therapies frequently discontinued and symptom-directed therapies maintained or increased. These findings highlight opportunities for medication review and deprescribing throughout the palliative care trajectory.

Goal-concordant care is critical to supporting patients at the end of life (EOL), and palliative care is a key facet of this. The study aims to (1) synthesize the evidence available on the EOL and palliative care (PC) needs and preferences of people with cancer from culturally and linguistically diverse (CALD) backgrounds and (2) explore what elements of service provision are facilitators or barriers to service engagement and goal-concordant care.

A systematic review was conducted. The search strategy was applied to five electronic databases to identify relevant articles published between January 2003 and September 2025. Quality assessment was performed using the Quality Assessment for Diverse Studies (QuADS) tool. A narrative synthesis was led by one reviewer with the support of a wider team.

A total of 6017 titles were identified. After duplicate removal and screening, 20 studies were included in the review. Fourteen studies reported EOL care and six reported PC encounters. People from CALD backgrounds identified the following needs: (1) maintaining positivity, (2) maintaining decision-making autonomy, (3) involving family/caregivers in decision-making, and (4) trust in the provider-patient relationship. Factors which influenced patient engagement and care preferences were (1) family involvement, (2) faith/spirituality, and (3) understanding of services.

This review illustrates the distinct care complexities for patients from CALD backgrounds. These findings underscore the importance of avoiding cultural generalizations and involving consumers in system planning. System-level changes, including community consultation, and improved access to culturally/linguistically appropriate resources are needed to support service engagement.

Efforts to reduce hospital transfers from nursing homes at the end of life have received considerable attention. However, less is known about how hospitals are understood and experienced as places of death for nursing home residents.

To synthesize qualitative evidence exploring stakeholder perceptions of hospital as a place of death for older adults living in nursing homes.

A meta-ethnography of qualitative evidence following the Meta-ethnography Reporting Guidelines (eMERGe). Four bibliographic databases (MEDLINE, CINAHL, PsychINFO and Scopus) were systematically searched to identify all studies published from January 2012 to March 2024.

Studies were included if they reported qualitative findings on nursing home residents dying in hospital. Following quality appraisal, first- and second-order constructs were extracted and translated across studies using reciprocal and refutational analysis to develop third-order interpretations.

Two overarching interpretive themes were generated: (1) Controlling Symptoms of Dying: Comfort and Discomfort; and (2) Acceptance of Death After All Efforts to Save Life Have Been Exhausted. Hospitals were perceived as both impersonal environments and medically resource-rich settings that legitimize death through medical authority.

Hospitals occupy a paradoxical position in end-of-life care for nursing home residents. While often viewed as clinically oriented and less personal, they are also perceived to provide symptom control and reassurance that ‘everything possible’ has been done. Addressing these perceptions-alongside strengthening palliative capacity within nursing homes-is essential to supporting residents’ preferences and enabling high-quality end-of-life care across settings.

Nurses can support more person-centred end-of-life care by strengthening palliative symptom management in nursing homes, engaging residents and families in early advance care planning, and improving communication about dying and hospital treatment. These practices may help reduce avoidable hospital transfers and support residents to die in their preferred place.

Globally, people in prison are increasingly older, more culturally diverse and have a growing need for palliative and end-of-life care. Yet, they have limited access to equitable primary and specialist healthcare or culturally safe care. Strengthening prisons capacity to deliver palliative care is critical to improving care for this underserved population.

To understand correctional and justice health professionals’ and specialist palliative care clinicians’ perceptions of the actions required to strengthen palliative care for people in prison.

A descriptive qualitative study underpinned by a constructivist paradigm. The semi-structured interview data were analysed using a hybrid inductive-deductive reflexive thematic analysis approach informed by the WHO Capacity-Building Framework.

Purposive and snowballing sampling were used to recruit participants from Australian prisons. Eligible participants included correctional staff (e.g. prison executives, managers and officers), prison volunteers, justice health professionals (e.g. nurses, doctors and allied health) and specialist palliative care clinicians providing palliative care to people in prison.

Seventeen (n = 17) participants were interviewed. Five themes describing the capacity-building actions required at the individual, organisational and systems levels were identified, including: (3) Embedding culturally safe palliative care for Aboriginal and Torres Strait Islander people in prison requires intentional capacity-building. (5) Building the prison workforce’s palliative care capabilities is challenging but is required to build confidence.

Strategic capacity-building action focussed on prison governance, formalising internal and external partnerships, cultural leadership and tailored workforce development is required to support the delivery of equitable palliative care for people in prison that is evidence-based and culturally safe.

Problem description Measuring quality of care, represented by quality indicators (QIs), in long term care (LTC) residents is a key imperative for care systems globally. To measure at scale, algorithms can be developed to automatically extract QIs from residents’ records. However, much information documented in residents’ care records is free-text, making the automated extraction of QIs challenging.

To analyse the proportion of QIs that are extracted from structured data fields in LTC residents’ care records and therefore are amenable to automated extraction.

A total of 236 QIs were developed for 16 conditions, e.g., Cognitive impairment, End of life care. Trained LTC nurses then undertook a manual care record review to assess the percentage of CareTrack Aged QIs that were collected and stored in structured data fields in the care record.

The underlying QI data field type was extracted from six electronic care record systems across 8,333 QI assessments (encounters of care) for 118 residents in 42 facilities. To determine QI eligibility, 17 % (n = 1425/8333) of QIs used structured data fields, with 39 % hybrid (structured and free-text) and 44 % free-text. QI eligibility assessment using structured data fields varied across the care record systems (Range 11-26 %). To determine QI adherence, 5 % (n = 251/4930) of QIs used structured data fields, with 60 % hybrid and 35 % free-text. QI adherence assessment using structured data fields varied across the care record systems (Range 1-12 %). Combining QI eligibility and adherence, 13 % (n = 1676/13263) of indicator question information used structured data fields.

This study challenges the assumption that QIs that are representative of care delivered in LTCs can be largely algorithmically electronically extracted from structured data fields. QI assessments for evidence-based care were extracted predominantly from free-text and hybrid data fields in LTC residents’ records.

Digital health technologies are increasingly used across cancer care, yet evidence specific to community-based end-of-life (EoL) cancer care is less clearly synthesised. Understanding available technologies alongside barriers and enablers to implementation is essential for guiding feasible and clinically meaningful deployment in community settings. The purpose of this systematic review was to synthesise peer-reviewed research on digital health interventions that support the provision of EoL care to people with cancer living in the community.

We conducted a mixed-methods systematic review with narrative synthesis, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered on PROSPERO (CRD42021241447). MEDLINE (Ovid), Cochrane (CENTRAL), Embase (Ovid), Emcare (Ovid), PsycInfo (Ovid), CINAHL Complete (EBSCOhost) and Web of Science were searched from 2010 to May 2025. Peer-reviewed, English-language studies evaluating digital health interventions supporting EoL care for people with cancer in home or community settings were included.

24 publications reported on 23 unique studies on digital health interventions for EoL care in the community. Interventions included mobile applications, tele/videoconferencing, wearables, electronic health record–integrated tools and web-based platforms. We noted four main goals: (1) remote symptom monitoring/management; (2) care coordination/communication; (3) prognostic and clinical decision support and (4) psychosocial/educational support. Interventions were generally feasible and acceptable to patients, caregivers and clinicians.

Digital health interventions in this context are diverse, generally feasible and acceptable, but the evidence remains heterogeneous and in its early stages. Future research should prioritise pragmatic evaluation, workflow integration and digital inclusion to support equitable access at the EoL.