Latest Australian research

Bartley N, Rodriguez Grieve L, Cooper C, Kirsten L, Wilson C, Sajish B, et al.

Abstract: Bereavement care can facilitate adjustment to death and reduce immediate distress and long-term morbidity, mortality and health service utilisation. This systematic review aimed to identify international models of bereavement care, and barriers and facilitators to implementing such models. A systematic search of MEDLINE, Embase, CINAHL and PsycINFO identified 64 studies for inclusion. The most common forms of bereavement support were bereavement packs, memory-making activities, condolence cards, memorial services, and follow-up contact. Only 14 models included a formal assessment of complex grief, and 17 studies considered culturally and linguistically diverse populations. Barriers included lack of institutional/financial support, staff discomfort delivering care, lack of dedicated staffing, and difficulty collecting/maintaining information. Facilitators were adequate funding/infrastructure, formal protocols/procedures, dedicated staffing, and staff training and support. Future research should address bereavement models of care in settings beyond palliative care, considering culturally and linguistically diverse populations, and should provide implementation data and strategies.

Butler C, Michael N, Kissane D.

Objectives: To explore the potential of incorporating personally meaningful rituals as a spiritual resource for Western secular palliative care settings. Spiritual care is recognized as critical to palliative care; however, comprehensive interventions are lacking. In postmodern societies, the decline of organized religion has left many people identifying as "no religion" or "spiritual but not religious." To assess if ritual could provide appropriate and ethical spiritual care for this growing demographic requires comprehensive understanding of the spiritual state and needs of the secular individual in postmodern society, as well as a theoretical understanding of the elements and mechanisms of ritual. The aim of this paper is to provide a comprehensive and theoretically informed exploration of these elements through a critical engagement with heterogeneous literatures.

Methods: A hermeneutic narrative review, inspired by complexity theory, underpinned by a view of understanding of spiritual needs as a complex mind-body phenomenon embedded in sociohistorical context.

Results: This narrative review highlights a fundamental spiritual need in postmodern post-Christian secularism as need for embodied spiritual experience. The historical attrition of ritual in Western culture parallels loss of embodied spiritual experience. Ritual as a mind-body practice can provide an embodied spiritual resource. The origin of ritual is identified as evolutionary adaptive ritualized behaviors universally observed in animals and humans which develop emotional regulation and conceptual cognition. Innate human behaviors of creativity, play, and communication develop ritual. Mechanisms of ritual allow for connection to others as well as to the sacred and transcendent.

Significance of results: Natural and innate behaviors of humans can be used to create rituals for personally meaningful spiritual resources. Understanding the physical properties and mechanisms of ritual making allows anyone to build their own spiritual resources without need of relying on experts or institutionalized programs. This can provide a self-empowering, client-centered intervention for spiritual care.

Cooper AL, Panizza N, Bartlett R, Martin-Robins D, Brown JA.

Background: Advanced chronic kidney disease is a life-limiting disease that is known to benefit from palliative care. Unmet palliative care need in patients with kidney failure is commonly reported but the level of need among patients receiving haemodialysis is unknown.

Methods: A period prevalence study of adult patients attending two hospital-based dialysis units was conducted. Patient medical records were reviewed using the Gold Standards Framework Proactive Indication Guidance to assess for potential palliative care need.

Results: A total of 128 patient medical records were reviewed, 45% (n = 58) of patients could have potentially benefitted from palliative care. Of the patients with indicators for palliative care, 72% (n = 42) had no evidence of receiving or awaiting any form of palliative care. High levels of palliative care need were found in patients who identified as Aboriginal or Torres Strait Islander and non-Indigenous patients.

Conclusions: This study found high levels of palliative care need among adult patients attending hospital-based dialysis units. The majority of patients with indicators were not receiving any form of palliative care.

FitzGerald G, Cook J, Higgs P, Henderson C, Crawford S, Naren T.

There is a need to improve access to and experiences of palliative care for people who use alcohol and other drugs when faced with terminal medical conditions. Effective harm reduction interventions mean that people who use alcohol and other drugs are living longer, and continue to use substances as older individuals. People who use drugs demonstrate high levels of resilience in the face of a lifetime of structural disadvantage and exclusion, but are still more likely to die at an earlier age than the general population. They also experience accelerated age-related declines in functioning compared with non-drug using persons of similar age, and often have complex care needs due to accumulated health effects from their substance use and a high prevalence of past trauma. The provision of palliative care to people who use drugs can be challenging for clinicians, specifically how to manage pain, anxiety and distress among these individuals. Person-centred care is often obstructed by policies that make generalisations about the risks associated with the use of alcohol and other drugs while receiving medical care. Clinicians and health services looking to improve access to palliative care should integrate the perspectives of people with lived and living experience of drug use into their person-centred care and explore opportunities for the harms of stigma to be minimised.

Haydon HM, Lotfaliany M, Broadbent A, Snoswell CL, Smith AC, Brydon JA, et al.

Background: Telehealth-facilitated models of palliative care are a patient-focused way to deliver specialist care in or closer to home for people with a life-limiting illness. Telehealth can increase access to palliative care and support people experiencing symptoms of advanced disease in their own home, reducing the discomfort of travel. This retrospective cohort study examines the activity and outcomes of a regional telehealth-facilitated palliative care service to (i) describe which patients are most likely to use telehealth; and (ii) explore possible impacts of telehealth on patient outcomes including place of death, timely access to care, responsiveness to urgent needs and pain management.

Methods: Analysis of service activity data (patient demographics, care modality, consultation frequency) and Palliative Care Outcomes Collaborative data registry (place of death, timely access to palliative care, responsiveness to urgent needs as measured by time in unstable phase, pain management) were undertaken. Outcomes were compared between patients who had no videoconsultations (n = 683) and those who had one or more videoconsultations (n = 524).

Results: Compared to people who had no videoconsultations, those who had at least one appointment via video were: more than twice as likely to die at home and spent a shorter amount of time in the unstable phase of palliation. Mixed results were found regarding timely access to palliative care. There was no significant difference in pain management between consultation modes.

Conclusion: Telehealth-facilitated palliative care has multiple benefits, including the increased likelihood of fulfilling someone's wish to die at home, often their preferred place of death.