The following lists palliative care research primarily conducted by Australian research groups. The list is based on application of the CareSearch search filter for palliative care to identify articles held within the PubMed database and corresponding to the strongest evidence. Articles have been selected based on relevance and new articles are added on a weekly basis.
Whilst not an exhaustive list, the aim is to keep the community informed by providing a snapshot of recent research findings and planned studies in the Australian setting.
Hewitt J, Wilson M, Bloomer MJ, Rennie C, Bonner A.
Objective: Voluntary assisted dying is a contested practice that some end-of-life care providers choose not to offer to patients. In some jurisdictions, this has restricted access. Queensland addressed this with a law designed to ensure that access to voluntary assisted dying was not hindered. The aim of this research was to explore how privately funded health services that provide end-of-life care, prepared for, and identified challenges related to, enabling access to voluntary assisted dying in Queensland.
Methods: An interpretivist exploratory study was undertaken. Health service representatives responsible for developing and implementing organisational voluntary assisted dying policy were invited to participate in semi-structured interviews. Data were analysed thematically.
Results: Fifteen participants participated in an interview. Analysis of the data generated four themes: navigating a spectrum of values and beliefs; knowing and understanding voluntary assisted dying; moderating voluntary assisted dying conversations; and finding space for voluntary assisted dying in end-of-life care. The preparedness of privately funded health services for voluntary assisted dying varied, yet all providers were committed to providing compassionate end-of-life care while meeting their new legal obligations. The need to support staff with a range of values and beliefs about voluntary assisted dying was highlighted.
Conclusions: Using law to balance the rights of individuals to access voluntary assisted dying and those of non-participating organisations obliges all health services to consider patient access, the views of staff, and broader organisational values concerning voluntary assisted dying. Future research will explore whether access to voluntary assisted dying is affected.
Michael N, Liebelt J, Symons X, Kissane D.
Objectives: Caregivers play a significant role in the process of Voluntary Assisted Dying (VAD), reporting stances of support, opposition, or ambivalence. Though caregiver vulnerability is recognized, little is understood about how caregivers adjust when patients seek VAD. We sought to appreciate how bereaved caregivers of patients in organizations that did not participate in VAD processed and adapted to the challenges faced.
Methods: We purposefully recruited caregivers from cases reviewed in a retrospective study exploring how VAD impacted the quality of palliative care. We further expanded sampling to maximize diverse views. We used qualitative interpretative phenomenological analysis to explore unique caregiver perspectives.
Results: Twenty-three caregivers completed interviews. Most were female, Australian-born, retired, identified with no religion, bereaved for 1-3 years, and in a caregiving role for 1-5 years. Caregivers sought accompaniment and non-abandonment across all stages of VAD. Coping was enhanced through framing and reframing thought processes and reconciling values. Caregivers bore responsibility through heightened emotions and experienced isolation and anticipatory grief as they reconciled perceived societal attitudes. Caregivers additionally failed to understand the rationale behind organizational stances and were unable to articulate the moral conflicts that arose. Impartiality from professionals was valued for caregivers to sustain care for the patient.
Significance of results: Despite feelings of vulnerability and isolation, caregivers demonstrated benevolence, courage, and self-compassion, reframing and accommodating their concerns. Professional accompaniment and non-abandonment necessitate solidarity and empowerment, without necessarily enabling VAD. Findings demonstrated the need for individuals and organizations to clearly articulate their willingness to continue to accompany patients, regardless of their position on VAD.
Tassos M, Carey LB, Gjorgioski S, Hodge B, Riley M.
Background: Existing research has long established that direct exposure to patient trauma, such as severe injuries, chronic illnesses and end-of-life care, places clinical healthcare workers at heightened risk of secondary traumatic stress, compassion fatigue and burnout. However, comparatively little attention has been paid to the impact on non-clinical healthcare personnel, such as health information managers (HIMs) who, despite being removed from direct patient care, regularly handle distressing and sensitive patient information.
Objective: This scoping review explores the literature concerning non-clinical healthcare professionals and the potential impact upon their biopsychosocial-spiritual (BPSS) well-being given prolonged exposure to medical and/or patient records.
Method: Arksey and O'Malley's five-stage scoping review strategy was utilised. An initial search of the literature yielded no results specific to HIMs and other non-clinical healthcare professionals. Therefore, the scope of the review was broadened, and a second search of the literature was conducted to explore comparable non-patient/client-facing populations such as transcriptionists.
Results: In total 1226 articles were initially identified and 13 articles revealed either a biological, psychological, social and/or spiritual impact when professionals were exposed to traumatic and/or sensitive data.
Conclusion: Exploring the roles of comparable non-patient/client-facing populations provides insight into the potential impact that exposure to traumatic and/or sensitive information may have on the health and well-being of HIMs and other non-clinical health professionals.Implications for health information management practice:Further research is recommended to explore the potential BPSS impact that HIMs and other non-clinical health professionals experience due to the exposure of traumatic and/or sensitive information.
Ven S, Steele M, Burston A, Fulbrook P, Lovegrove J, Miles S, et al.
Aim: To describe the cumulative incidence and characteristics of hospital-acquired pressure injury in acute palliative patients.
Design: Secondary data analysis of hospital-acquired pressure injuries during 2019-2022.
Methods: The setting was a palliative care unit at a tertiary hospital in Queensland, Australia, including adult (≥ 18 years) acute-phase palliative inpatients. Retrospective data from four databases were used to identify and analyse hospital-acquired pressure injury cases from 2019 to 2022. Clinical characteristics of patients with and without hospital-acquired pressure injury were compared.
Results: The incidence of hospital-acquired pressure injury in acute palliative care patients was 3.9% over the 4 years. These patients were predominantly male, with an average age of 74 years, with 66 of 78 cases developing in the deteriorating palliative care phase. Using the Waterlow Score, 51.3% of patients were assessed as at very high risk of pressure injury. Ninety-five hospital-acquired pressure injuries were reported in 78 patients; 16.8% were medical device-related, 40% were Stage 1 injuries, and the most common injury sites were the sacrum, heels and genitals. Patients with hospital-acquired pressure injury had significantly higher (worse) scores on both the palliative care Resource Utilisation Group-Activities of Daily Living and Problem Severity Scores. Regression analysis identified a high Problem Severity Score on admission as a significant predictor for hospital-acquired pressure injury development.
Conclusion: The incidence of hospital-acquired pressure injury in acute palliative patients is lower than in previous studies. However, many injuries occurred in those in the deteriorating phase, with higher scores for severity of symptoms. These findings suggest that acute palliative patients do require nursing care for pressure injury prevention, as well as for symptom management and activities-of-daily-living. Overall, this research contributes to a deeper understanding of pressure injury incidence and characteristics for acute palliative care patients. Future research should focus on population-specific pressure injury risk assessment to explore risk factors in greater detail.
Implications for the profession and/ or patient care: Current pressure injury risk assessment tools, like the Waterlow Score, may not provide the comprehensive evaluation needed for the acute palliative care cohort. To better address the unique needs of this cohort, it may be necessary to refine existing tools or develop new instruments that integrate palliative-specific assessments, such as the Resource Utilisation Group-Activities-of-Daily-Living (RUG-ADL) and Problem (symptom) Severity Score (PSS). These adaptations could help improve pressure injury prevention care planning and enhance outcomes for patients in this setting.
Impact: This study separated acute palliative care patients from those at end-of-life and found a 3.9% cumulative incidence of pressure injuries. There were no significant differences in age, gender, or cancer diagnosis
Wojnar R, Sulistio M, Gorelik A, Michael N.
Background: Therapeutic drug monitoring of methadone for opioid replacement therapy in the management of opioid dependence is well-described. However, only a few studies have described the correlation between serum methadone concentration and cancer pain during palliative care.
Methods: Patients were recruited from an exploratory randomized controlled trial (RCT) comparing methadone rotation with other opioid rotations for refractory cancer-induced bone pain. Serum methadone trough levels and 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) levels on day 14 of the rotation were analyzed using validated liquid chromatography-mass spectrometry. The average and worst pain intensities were rated at baseline and on day 14, preceding the recorded methadone levels. The Common Terminology Criteria for Adverse Events composite score was used to determine the adverse effects of methadone. The Spearman ρ was used to examine the correlation between methadone trough levels and pain reduction.
Results: Among the 20 patients who were randomized to receive methadone in the RCT, eight consented to this substudy. The mean (SD) steady-state 24-hour methadone dose was 11.6 (2.6) mg, whereas the mean (SD) serum methadone trough concentration was 93.7 (45.6) ng/mL with an acceptable adverse effect profile. All patients had an EDDP concentration of <0.01 mg/L, suggesting good metabolite clearance.
Conclusion: The reported methadone concentration required for therapeutic benefit was significantly lower than that reported previously. The study highlights that further appropriately powered studies are required to establish the role of routine trough methadone monitoring in patients newly rotated for the management of refractory cancer pain.
Last updated 30 April 2024