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.
Lin RZ, Evans S, Lau DH.
Abstract: Modern advances in cardiovascular care emphasize early intervention and guideline-directed therapies, which have significantly improved survival and longevity. Over the last decades, landmark trials have defined the role for implantable cardioverter-defibrillator (ICD) in at-risk populations to prevent sudden cardiac death, which remains a leading cause of mortality from cardiovascular disease worldwide. However, competing and non-cardiac causes of death begin to increase with senescence. With aging, the goals of care may change, and in those with an ICD, this requires a proactive, multi-disciplinary and patient-centered approach as part of holistic care. A critical aspect of care is the option to deactivate ICD therapies to prevent unwanted, futile and distressing defibrillation attempts. Although this approach is endorsed by major professional societies, the process for deactivation of an ICD in those requiring end-of-life care may prove to be challenging in the real-world scenario, with many devices remaining active even in those with a do-not-resuscitate order in place. This highlights the need for urgent education and reform to improve our care in those with an ICD and requiring end-of-life care. It is in this context that the thoughtful review by Mugnai et al. in the current issue of the Journal is particularly welcomed, as they explore the many challenges and propose practical solutions towards integrated patient-centered care in this patient population.
Stokes C, Gurgenci T, Herbert A, Huggett G, Poxton M, Good P.
Abstract: Over a quarter of Australians reside in rural and remote areas, where access to clinical trials is limited. This disparity affects the generalisability of trial results and may contribute to poorer health outcomes for rural and remote patients. Teletrials - where regional, rural, or remote research sites are connected to primary research sites via telehealth - can overcome geographic barriers and improve access to clinical trials. In April 2024, Queensland launched a palliative care teletrial cluster recruiting to a clinical trial investigating medicinal cannabis for advanced cancer symptoms. This innovative model differs from other teletrial models in that it utilises existing health jurisdictions to create a statewide research cluster. This approach has the potential to expand clinical trial access throughout Australia. However, procedural delays in setting up satellite sites and high setup costs underscore the need to reform trial management processes and prompt discussion about optimal decentralised trial models to achieve universal access to clinical trials.
Lee SF, Choong ES, Leung J, Lim T, Ramani S, Joon DL, et al.
Background: Bone metastases cause significant pain and functional limitation. Conventional external beam radiotherapy (EBRT) provides effective symptom relief, but local progression remains frequent. Stereotactic body radiotherapy (SBRT) offers improved local control but is often resource-intensive and associated with higher vertebral compression fracture (VCF) rates. Integrating a simultaneous gross tumour volume (GTV) boost within a conventional EBRT regimen may provide a feasible and safe alternative.
Methods: This is a prospective, multicentre, multinational, single-arm study enrolling 100 adults with painful bone metastases from solid tumours. Eligible patients receive 20 Gy in 5 fractions with a 5 Gy "stereotactic-lite" GTV boost (total 25 Gy) or 30 Gy in 10 fractions with a 6 Gy boost (total 36 Gy), delivered using intensity modulated radiotherapy or volumetric modulated arc therapy. The primary endpoints are feasibility (commencement of radiotherapy within 10 working days of computed tomography simulation in at least 80% of patients) and safety (incidence of Common Terminology Criteria for Adverse Events version 5.0 grade ≥ 2 acute toxicity within 3 months). Secondary endpoints include pain response, radiation site-specific progression-free survival, rates of VCF and long bone fracture, skeletal-related events, quality of life changes via EORTC QLQ-C30 and BM22, and overall survival.
Discussion: This protocol evaluates a hybrid EBRT approach with a simultaneous integrated boost as a practical strategy to enhance local tumour control and symptom relief without delaying palliation. If feasible and safe, this approach may bridge the gap between conventional EBRT and SBRT.
Nourmusavi Nasab S, McLaughlan R, Smith CL.
Abstract: This study explores the integration of home-like design elements in paediatric/adolescent palliative care inpatient units, drawing on perspectives from both medical and architectural professionals. Recognising the unique developmental and psychosocial needs of young patients, this research explores how the spatial and emotional qualities associated with 'home' are interpreted and operationalised in palliative care environments. A multimethod approach was employed, including a targeted literature review, analysis of seven international paediatric hospice design and semistructured interviews with 22 experts from the medical and architectural fields.The findings identify two central themes in the design of supportive palliative care settings: (1) Supporting Moments of Normalcy, which highlights the importance of daily routines, social connections and familiar activities in fostering emotional well-being, and (2) Architectural Features of Home, which addresses spatial layout, materiality and aesthetic elements that evoke comfort and familiarity of home.A key divergence was observed between the disciplines: medical professionals emphasised the emotional and social aspects of care, while architects prioritised spatial configuration and material considerations. Additionally, the study discusses how design approaches may vary between younger children and adolescents in creating home-like environments. The contrast points to the need for more integrated design strategies that balance clinical functionality with emotional and social well-being. Limitations include the lack of direct input from young patients and families, as well as a limited exploration of cultural interpretations of 'home'. Future research should address these gaps to inform more inclusive and holistic design approaches in paediatric palliative care.
O'Callaghan C, Brooker J, Tissera S, Samankula D, Healy B, Healy K, et al.
Context: Mesothelioma is a rare, incurable, and aggressive cancer and "patient-reported outcome" (PRO) data from people living with mesothelioma (PLM) are lacking.
Objectives: To examine PLM's views about, and cognitive processes whilst answering, a draft quality of life and care survey, to inform survey refinements and implementation into the Victorian Mesothelioma Outcome Registry (VMOR), Australia.
Methods: Constructivist (qualitative) and co-designed study. An expert-developed draft PRO survey comprised the: EORTC QLQ-C30 health-related quality of life question-set, Australian Hospital Patient Experience Question Set (AHPEQS), and demographic / mesothelioma background questions. Telephone semi-structured and "think aloud" interviews examined PLM's survey views and cognitive processes during responses. Concurrent inductive thematic analysis (survey views) and deductive content analysis (cognitive processes) proceeded.
Results: PLM believed that the survey would produce information important for improving PLM healthcare but made many content and layout suggestions to reduce respondent confusion, inappropriate answers, and burden. Free-text response options were strongly recommended. Survey content was generally nondistressing but could elicit challenging memories and need for support. Several PLM displayed challenges in executing cognitive processes during survey responses, notably on whether EORTC-QL30 referred to general or mesothelioma-only related health and which hospital care experience the AHPEQS referred to.
Conclusion: A refined co-designed VMOR PRO survey should yield patient-meaningful qualitative and quantitative evidence to guide the Registry's leadership in what issues are important to patients and their clinical team. While co-designed "viewpoint seeking" and cognitive interviewing studies can improve valid survey outcomes, PRO responses may also be affected by extraneous circumstances, including comorbidities.
Last updated 30 April 2024