Latest Australian research

Ayalew AA, Clapham S, Clark K, Hodiamont F, Redwood L, Currow D.

Background: Periodic evaluation of the psychometric properties of palliative care outcome measures is essential to ensure accurate assessment of patient outcomes and to support ongoing improvements in care quality. This study aimed to assess the psychometric properties of three tools: the Integrated Palliative Care Outcome Scale (IPOS), the Symptom Assessment Scale (SAS), and the Palliative Care Problem Severity Score (PCPSS).

Methods: We conducted a multicentre study using de-identified data collected from 378 participants. Internal consistency was assessed using Cronbach’s alpha for all tools, and confirmatory factor analysis was performed for the IPOS. Convergence and discriminant validity were examined for the SAS and PCPSS by analysing the correlations between similar and dissimilar items, respectively. Lastly, known-groups comparison validity was assessed.

Results: Of the 378 participants, 54.5% were male, and most (77.5%) had cancer. Internal consistency was good for the IPOS total (α = 0.81), acceptable for the SAS (α = 0.70), and marginal for the PCPSS (α = 0.65). A strong correlation was observed between the pain construct of SAS and PCPSS (r = 0.74). Both the PCPSS and SAS effectively discriminated symptoms between palliative care phases and settings of care in known-group comparisons. The physical domain of the IPOS demonstrated good discriminative ability in differentiating symptoms between cancer and non-cancer patients. Our data confirmed the three theoretical domains of the IPOS—physical, emotional, and informational.

Conclusions: The IPOS demonstrated higher reliability using internal consistency, whereas SAS and PCPSS showed good validity in known group comparisons. These findings may inform the selection of context-appropriate palliative care outcome measures.

Bedrikovetski S, Murshed I, Oehler MK, Cho J, Wagstaff M, Vather R, et al. 

Background: Pelvic exenteration (PE) is a major procedure typically performed for patients with locally advanced or recurrent pelvic malignancy. Appropriate patient selection is crucial to achieving good outcomes and obviating futile resections. The objective of this study was to establish the incidence and predictors of futile PE in patients with locally advanced or recurrent pelvic malignancy.

Methods: A retrospective analysis of a prospective database of patients undergoing PE for advanced or recurrent pelvic malignancy between 2008 and 2025 was performed. Patients with benign disease or less than 6 months' follow-up were excluded, except those who died or recurred within 6 months, who were classified as futile PE. Futility in planned R0 (curative) resections was defined as death from any cause or recurrence (local or distant) within 6 months. Futility in planned R1/R2 (palliative) resections was defined as death from any cause within 6 months. Multivariable logistic regression was performed to identify predictors of futile PE.

Results: Of 224 patients identified, 172 were eligible for inclusion in the study and 25 (14.5 %) patients had a futile resection criteria. Multivariable analysis demonstrated Systemic Inflammation Response Index (SIRI ≥1.92) (OR, 7.06; 95 % CI, 1.58-31.57; P = 0.011) and cancer site (non-colorectal cancer) (OR, 4.68; 95 % CI, 1.81-12.10; P = 0.001) as independent risk factors for futile surgery.

Conclusion: Futile PE was observed in 14.5 % of patients. Key predictors of futility included non-colorectal cancers and elevated preoperative SIRI levels.

Marshall C, Virdun C, Phillips JL. 

Background: Almost 45% of the world's population resides in rural locations. Despite this, access to best evidence-based palliative care is variable. Reforming and optimising rural palliative care is dependent upon positive public policy.

Aim: To map country- and jurisdiction- level policy against the elements of care required to optimise rural palliative care provision in high-income countries.

Design and data sources: An environmental scan of policies denoting actions informing rural palliative care access and delivery in high-income countries, performed using a modified version of Khalil and colleagues' five-stage scoping review methodology. Grey literature was searched in November 2024 across Australia, Canada, Ireland, Japan, New Zealand, Norway, Finland, United Kingdom, and the United States of America. Rural specific policy actions were mapped against the World Health Organization's Innovative Care for Chronic Conditions Framework (ICCCF).

Results: Of 3809 records screened, eight country-level and eight jurisdiction-level palliative care policies denoting 113 rural palliative care specific actions across 13 of 18 WHO ICCCF elements of care were identified. Over 90% of actions addressed macro-(n = 52, 47%) or meso- level (n = 50; 44%) elements, and two-thirds addressed five sub-categories: 1) Build workforce capacity; 2) Develop rural specific teams, committees and positions; 3) Identify, maintain, and scale up new and/or existing rural palliative care models; 4) Increase access to integrated, seamless rural palliative care; and 5) Identify gaps in rural service provision and service planning.

Conclusions: While there is a wide spread of actions across macro- and meso- level WHO ICCCF elements, there is limited focus on micro- level elements, and a lack of complementary actions within documents across the three layers of care. Country-level policies are pivotal to setting the tone, while jurisdiction-level policies can further target the specific needs of rural communities within each area's unique constraints. Findings support a growing need to devise methodologies informing development and measurement of healthcare policy. Optimising rural palliative care policy demands cross-sector participation and the involvement of consumers, to co-design actions which accurately reflect the unique and nuanced rural environment and its citizens, and be capable of bridging disparities.

Stokes C, Khagram A, Metselaar B, Gurgenci T, Good P.

Abstract: Patients with life-limiting illnesses often experience profound emotional and spiritual challenges that conventional palliative care treatments may not fully alleviate. Psychedelics, with their potential to facilitate deep psychological insight, offer a promising approach to enhancing end-of-life care. Despite growing interest and emerging psychiatric applications, their use in palliative settings remains poorly understood, with existing studies limited by small sample sizes and low methodological quality. This article outlines a research agenda that prioritises adequately powered randomised controlled trials with patient-centred outcome measures, with an aim to inform policy and practice change.

Das A, Kondasinghe JS.

Background: Managing pain in patients with incurable intestinal failure requires a multidisciplinary approach that addresses complex pharmacological and systemic challenges while navigating prognostic uncertainties.

Case presentation: This case report of gastrointestinal hypoganglionosis demonstrates the use of subcutaneous ketamine when conventional opioids fail due to intestinal malabsorption and dysmotility. Effective care required interdisciplinary collaboration, yet persistent discordance between the patient’s curative expectations and her life-limiting prognosis hindered timely advance care planning and community support transitions.

Conclusions: Prognostic uncertainty, compounded by the condition’s rarity, highlights the need for early palliative care integration in non-malignant conditions, to ensure that care goals align with patient and family priorities. The case report advocates for adaptable care models that bridge inpatient and community services, even amid prognostic ambiguity, to prevent fragmented care during critical transitions.