Latest Australian research

Chow JSF, Maurya N, Jobburn K, Harlum J.

Abstract: Palliative Extended and Care at Home (PEACH) program, implemented in 2013, aimed to support palliative care clients in their last days of life at their own home. Understanding the factors that influence the sustainability of a program was vital to improving the longevity, adaptability, and quality of service delivery models. This study aimed to assess the sustainability of PEACH model of care through analysis of data at different time points where services were delivered by different service providers. Deidentified data were collected retrospectively for all consecutive patients receiving a PEACH package until separation from the package to explore the clinical and sociodemographic determinants of the sustainable PEACH model of care. Additionally, feedback on the services via survey was obtained from the clients' primary carers. The majority of the PEACH package recipients who had a clear preference to die at home when the service was initiated were able to achieve their goal to die at home (77%-84%). Eighty-six percent of the carers were "satisfied" or "very satisfied" with the overall care provided by PEACH. The result shows that PEACH model of care managed to sustain and optimize the patients' outcome despite transitioning to different service providers for partnerships and collaboration.

Ross ML, Iyer R, Williams ML, Boughey M, O'Callaghan C, Hiscock R, et al.

Importance: Psilocybin-assisted psychotherapy may offer a novel approach to treating depression, anxiety, and existential distress in individuals with life threatening illnesses, where current treatments show limited efficacy.

Objective: To evaluate the efficacy and safety of psilocybin-assisted psychotherapy versus active placebo and psychotherapy in adults with life-threatening illnesses.

Design: Double-blind, randomized controlled phase 2b trial (RCT) with an open-label extension and 6-month follow-up (January 2020 - October 2023).

Setting: Single-site study at a tertiary hospital's palliative care department (St. Vincent's Hospital Melbourne affiliated with the University of Melbourne).

Participants: Adults aged 18-80 with a life-threatening illness and clinically significant depression and/or anxiety.

Interventions: Participants were randomized to receive 25 mg psilocybin or 100 mg niacin (active placebo), alongside three preparatory psychotherapy and six post-dose integration psychotherapy sessions. After 6-7 weeks post double blind dose, all participants received 25 mg psilocybin in an open-label extension, enabling a two dose versus one dose group comparator. Participants were followed up to 26 weeks post open label dose.

Main outcomes and measures: Primary outcome was change in depression and anxiety symptoms, assessed using the Hospital Anxiety and Depression Scale (HADS), from baseline to 6-7 weeks post-dose. Key secondary outcomes included the Beck Depression Inventory-II (BDI-II) and the State-Trait Anxiety Inventory - State version (STAI-S), which provided complementary, dimensional measures of depression and anxiety over the same time period. Additional secondary outcomes included Death Attitudes Profile, WHOQOL-BREF, State-Trait Anxiety Inventory (STAI-Trait scale), Mystical Experiences Questionnaire, and Persisting Effects Questionnaire. Exploratory outcomes included spiritual well-being, hopelessness, demoralization, and HADS-Trait scores.

Results: Thirty-five participants (mean age 56.0; 54.3 % female) were randomized (psilocybin: n = 17; placebo: n = 18). At 6-7 weeks, psilocybin produced significantly greater reductions in HADS depression (B = -2.49; P = .02; d = 1.12), BDI-II (B = -7.56; P = .004; d = 2.97), and STAI-State anxiety (B = -12.59; P = .005; d = 4.51) compared to placebo. Benefits were sustained at 26 weeks. Exploratory outcomes demonstrated enhanced spiritual well-being, quality of life, and significant reductions in demoralization, death anxiety and hopelessness. No serious treatment-emergent adverse events occurred. Psilocybin was associated with more mild-to-moderate adverse events. One participant withdrew due to anxiety during dosing.

Conclusions and relevance: Psilocybin-assisted psychotherapy appears safe and may offer durable relief from

Trommer M, Gillett P, Franchini F, Trapani K, Hornby C, Abraham S, et al.

Background: Palliative radiotherapy (PRT) is crucial for improving quality of life in patients with advanced-staged cancer. This large data analysis investigates the travel distances and potential disparities in PRT access especially focusing on the burden of excess travel for palliative cancer patients in Victoria, Australia.

Methods: Using a state-wide linked dataset from the PRedicting the health economic IMPact of new and current Cancer Treatments (PRIMCAT) research program, we analysed the estimated road travel distance (ERTD) and potential excess travel distance (PETD) as well as received radiotherapy fractions for 29,807 PRT patients being treated from 2010-2019. We examined disparities by socioeconomic status (SEIFA) and remoteness (RA) of the residential area of PRT patients, and receiving treatment at a public or private centre.

Results: The average one-way ERTD for all PRT patients was 43 km, with variations based on SEIFA and RA. Patients in the lowest SEIFA quintile and those living in outer regional areas had the longest ERTD. Approximately 50% did not receive treatment at the closest facility, with a mean PETD of 27.9 km for private and 24.3 km for public facility patients. Fractionation patterns showed no significant reduction in the number of fractions with increased travel distance. Patients at private facilities received more fractions on average (8.49) compared to those at public facilities (5.91).

Conclusion: This study highlights potential disparities in PRT access in Victoria, with patients living in socioeconomically disadvantaged and remote regions facing longer travel distances and excess travel. These findings underscore the need for strategic referral practices and further research to optimise equitable access to PRT.

Wan J, Vaughan A, Shepherd E, Coombs S, Trethewie S, Jaaniste T.

Abstract: Paediatric Palliative Care Ambulance Plans ('Plans') are used by New South Wales Ambulance (Australia) to support the care needs of children with life-limiting conditions. We aimed to describe the population of children with Plans and provide details regarding Plan completion, paramedic responses during ambulance callouts, and correspondence between Plan recommendations and paramedic responses. Plans lodged in January 2017-December 2019 were retrospectively coded for demographic information, completeness and care preferences. Associated paramedic callout notes (January 2018-December 2019) were coded for paramedic responses. Of 141 Plans retrieved, 38 (41.3% of those providing suggested medications) suggested medication use outside general paramedic scope of practice. Of 199 associated ambulance callouts, reasons for callout included symptom management, planned transfer, death notification and end-of-life care. Over two-thirds of callouts (n = 135, 67.8%) occurred after-hours. Most paramedic callouts (n = 124, 62.3%), excluding planned transfers, resulted in children being transported. Paramedic interventions corresponded with interventions suggested in Plans. However, only 24 (25.3%) of paramedic callout notes documented Plans being sighted. This study provided detailed information about children with palliative care needs for whom Plans were being used, the nature of these Plans and associated paramedic callouts. However, it is not known how paramedics were influenced by Plans.

Cheng H, Jiang S, Liu T, Li B, Chen S, Li A, et al. 

Background: Understanding policymakers' value judgements in reimbursement decisions is essential for promoting equity and guiding informed healthcare decision-making. This study aimed to estimate and compare Chinese policymakers' willingness-to-pay (WTP) per quality-adjusted life year (QALY) specifically in end-of-life treatment scenarios involving life-threatening common and rare diseases.

Methods: We conducted a contingent valuation study employing single-bounded dichotomous-choice questions among 120 experts formally appointed by China's National Healthcare Security Administration to serve on the National Reimbursement Drug List Expert Committee in recent years. Participants evaluated hypothetical scenarios describing end-of-life treatments providing a one-QALY gain for patients with life-threatening common or rare diseases. Data were collected primarily through face-to-face interviews, supplemented by online responses when in-person meetings were impractical. Statistical analysis was performed using probit regression models, and t-tests were conducted to compare WTP values between scenarios.

Results: A total of 99 policymakers participated. Participants' WTP per QALY for end-of-life treatments in common disease scenarios ranged from CNY 78,031 (0.98 times GDP per capita) to CNY 126,449 (1.58 times GDP per capita). In contrast, WTP was significantly higher for rare diseases, ranging from CNY 183,392 (2.29 times GDP per capita) to CNY 219,691 (2.75 times GDP per capita). Analysis of individual characteristics revealed that female participants and those with expertise in pharmacoeconomics exhibited significantly higher WTP values in common disease scenarios (p < 0.05), though these factors had varied effects in rare disease scenarios.

Conclusion: This study provides novel estimates of Chinese policymakers' WTP per QALY specifically in end-of-life contexts involving common and rare diseases, highlighting the significant impact of disease rarity on reimbursement decisions. These findings offer empirical support for adopting differentiated cost-effectiveness thresholds tailored to end-of-life treatments based on disease rarity in China.