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.
Gillan PC, Parker C.
Abstract: Pressure injuries are a major problem in all health care settings. The incidence of pressure injuries at the end of life is as high as 58% in some facilities, and there is little consensus on how pressure injuries are managed at the end of life. A scoping review was conducted, to investigate what is known of the factors associated with the management of pressure injuries at the end of life. Literature was sourced from several databases. A total of 1760 potential sources were identified; after applying the Population Concept Context inclusion and exclusion criteria, 16 empirical research articles were sourced: 10 were quantitative, 5 were qualitative, and 1 was mixed methods. Studies were published between 2003 and 2021 and originated from Italy, the United States, Australia, Sweden, Brazil, Taiwan, Turkey, and Canada. Key interventions included regular second hourly turning, wound debridement, wound assessment, and application of various wound coverings. The most widely discussed management strategy, regular second hourly turning, proved controversial and inconsistent in practice. There were also inconsistencies with wound assessment, with practice not always following best evidence-based assessment guidelines. Research findings also highlighted issues with prognostication and identification of the end-of-life phase with no consistent tool applied to assist end-of-life pressure injury management decision-making.
Jahan S, Lindsay D, Diaz A, Li M, Griffiths K, Olver I, et al.
Purpose: Cancer significantly impacts First Nations Australians, with higher incidence and lower survival rates. However, understanding of end-of-life (EOL) service use and costs in this population is limited. We aimed to assess EOL healthcare utilisation and costs for First Nations cancer patients in Queensland, Australia.
Methods: Retrospective data from CancerCostMod, a linked administrative dataset of all cancer diagnoses in Queensland, were used. This dataset includes records from the Queensland Cancer Registry (QCR) from July 1, 2011, to June 30, 2015, linked to Queensland Health Admitted Patient Data Collection (QHAPDC), Emergency Department (ED) Information Systems, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data from July 2011 to June 30, 2018. All diagnosed cancer patients who had died during the study period (N = 467) were included. Health service usage and costs during the last 6 months of life were described and compared across care type, comorbidity status, age group, and residential remoteness using Mann-Whitney and Kruskal-Wallis tests.
Results: Individuals had at least one hospital episode (100%), ED visit (83%), MBS claim (96%), and PBS claim (96%). The median overall cost per person for hospital episodes was AUD$40,996, with higher costs for those receiving palliative care (AUD$43,521) and chemotherapy (AUD$50,437) compared to those who did not receive these services (palliative: AUD$34,208, chemotherapy: AUD$38,557). Having comorbidities and living in regional and remote areas were associated with higher hospital costs.
Conclusion: The study findings may guide the re-design and delivery of optimal and culturally appropriate EOL care for First Nations Australians diagnosed with cancer.
Kenny P, Street DJ, Hall J.
Introduction: Societal preferences over different health states are used to guide service planning, but there has been little investigation of treatment preferences at the end of life. This study aimed to examine population preferences for active treatment or palliation for cancer patients when life expectancy is limited and the relative importance of time spent in hospital or with functional limitation.
Methods: We used a discrete choice experiment that presented respondents with a series of hypothetical patients who had died, describing their last few months of life. Respondents selected the end-of-life alternative they thought best. Data were collected from 1,502 Australian adults participating in an online survey panel. Latent class analysis was used to identify groups with different preference patterns.
Results: Four preference groups were identified along with an additional group that we termed inattentive, as they appeared to respond at random. Among the 1,070 respondents assigned to 1 of the 4 preference groups, 33.5% favored longer overall survival regardless of how that time was spent; 26.1% were willing to accept a shorter survival time for less time in the hospital or completely incapacitated at home, and they had a stronger preference for palliative care in older patients; 22.5% strongly supported the use of palliative care regardless of the age of the patients, preferring less time in the hospital or time at home with any functional limitations; and 17.9% had a strong preference to not use palliative care.
Conclusions: Our results show distinct heterogeneity in population preferences for end-of-life care. Policy goals and service planning should acknowledge this heterogeneity and provide end-of-life support services that offer the flexibility to enhance patient choice. Many current funding approaches are not consistent with the philosophy of patient-centered care. Policy makers can and should be exploring innovative approaches to improve efficiency and equity.
Highlights: Social preferences, based on a general population survey, vary across palliative and active care approaches.Preferences for palliative care and willingness to tolerate time in hospital and time at home with activity limitations varied within the groups willing to trade quality and quantity of life.Policy, resource allocation, and funding methods should accommodate this variability.
Kinton W, Roberts T, Mitchell M, Smoll N, Giuseppin M.
Background:Patients with palliative care needs often rely on emergency departments for management of acute symptoms due to limited access to timely and appropriate outpatient care, however they can be poorly equipped to meet patients' complex needs. Rapid access clinics exist for addressing health issues such as chest pain but are not routinely established for palliative care. In 2020, the Sunshine Coast Health Palliative Care Service introduced a rapid access clinic to address patients' unmet acute care needs. This research aimed to understand the impact on clinical outcomes.
Methods: A retrospective observational analysis of patient health records was undertaken for 283 admissions for 172 patients who attended the clinic between 1 January 2020 and 31 December 2022, and included demographic and diagnostic information, reason for admission and date of death. Statistical analysis of differences using the chi squared test was conducted for age (< 70 years vs. ≥ 70 years), gender and mortality at 30 days after discharge from the clinic. Fisher's exact test was used to assess associations between the type of admission and the likelihood of preventing an emergency department visit. Confidence interval was set at 95%.
Results: Attendance at the rapid access clinic was judged to likely result in avoidance of an emergency department visit for 11.7% of admissions. A potentially avoided emergency department visit was associated with mortality within 30 days (22.9%), X2 (1)= 9.82, p =.002, and urgent admission to the rapid access clinic (31.5%), p <.001, OR = 22.6 (95% CI: 7.63, 66.87). There were more planned (67.5%) than urgent admissions. Mortality within 30 days of presentation to the clinic was 24.6%, and significantly associated with male gender (31.3%), X2 (1) = 6.02, p =.014 and urgent admission (34.8%), X2 (1) = 6.7, p =.008.
Conclusions: A newly established palliative care rapid access clinic addressed acute symptoms in a timely manner and may offer a valuable alternative to emergency department care, particularly for patients nearing the end of life. Further prospective research using control groups and validated patient outcome measures would provide more robust evidence about the clinic's effectiveness in optimising end-of-life care and reducing the burden on our emergency departments.
Lee YC, Zhao E, Lee KKH, Lee W, Dumitrescu A, Loadsman J, et al.
Abstract: This pilot study aimed to determine feasibility of a larger definitive study evaluating sublingual ketamine efficacy as first-line breakthrough analgesia for moderate-to-severe pain in advanced cancer. This prospective, double-blind, randomized, placebo-controlled, repeated cross-over trial included patients (≥18 years) with moderate-to-severe pain from advanced cancer requiring opioid analgesia, randomized to weekly-alternating treatment sequences (APAPAP, APAPPA, APPAAP, APPAPA, PAAPAP, PAAPPA, PAPAAP, PAPAPA; A = sublingual ketamine, P = placebo). The primary outcome was attrition rate, measured by completion of two treatment cycles over 12-months. Of 64 patients referred, 29 were randomized, 11 received intervention. The pre-determined criterion of 24 patients completing 2-cycles over 12-months was not met. Most patients perceived receiving active drugs in placebo (0.71) and active (0.67) periods. Ketamine scored higher than placebo for pain reduction, perceived to be more efficacious than usual breakthrough analgesia, and increased quality-of-life scores. This study design will be infeasible for a larger trial due to a high attrition rate. The patients' inability to discriminate between the placebo versus active medication and the minimal adverse effects suggested that the chosen dose was possibly too low. The potential issue of disease progression over the study period suggests that further target population refinement should be considered.
Last updated 30 April 2024