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.
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.
Ong XW, Le Couteur DG, Waite LM, Thillainadesan J.
Background: As the aging population grows, the care provided to patients with dementia at the end of life represents a critical area of geriatric and palliative care. This study aimed to describe the care provided to hospitalized patients with dementia who died during their hospital stay.
Methods: A retrospective cohort study was conducted at a teaching hospital in Sydney, Australia. The study included patients with dementia who died during hospitalization. Data were collected on demographic characteristics, clinical management, and documentation of key care processes, including advance care planning, resuscitation orders, and discussions about oral nutrition and hydration.
Results: The study cohort comprised patients with a mean age of 87.2 ± 7.2 years (n = 100), 63% of whom had lived in nursing homes. Geriatric medicine teams cared for a large proportion of patients (63%), and their patients were more likely to be older, from a nursing home, and to die from pneumonia compared to those admitted in palliative care teams. Recommended care processes were implemented in the majority of patients with advance care planning and resuscitation orders being the most frequently documented, and discussions about oral nutrition and hydration the least frequent.
Conclusions: This study highlights the integral role of geriatrics services in providing end-of-life care for hospitalized patients with dementia, and underscore opportunities to enhance the quality and consistency of care for this population.
Davidson PM, Currow DC, Pantilat SZ, Hillman K.
Introduction: Globally health systems are in crisis struggling with upward pressure on demands and without concomitant increases in resources. In high income countries the addition of expensive new technologies is yielding fewer health benefits for every unit of cost and in mid- and lower- income countries the increasing availability of technologies and treatments adds to the upward cost pressures. Many of these stressors are driven by increases in population numbers and the higher proportion of older persons (Beard et al., 2016). Despite the rhetoric of the importance of prevention, almost all expenditure in healthcare is in the acute care sector and most people spending some time in hospital in their last year of life. In the United Kingdom, four fifths of the money spent on healthcare in people’s last year of life was spent on hospital care (Iacobucci, 2025). This also raises the question of the influence of acute care interventions and the role of prevention in older people. The United States (U.S.) spends the most globally on healthcare and in 2023 this was 16. 5 % of its gross domestic product (GDP). Yet the US scored lowest on health outcomes (assessed by access to care, care process, administrative efficiency and equity) compared with Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom (Blumenthal et al., 2024). In contrast, Australia scoring number one in this analysis spent 9.8 % of its GDP on healthcare during this same period. This means that how and where money is spent is critical to achieve the best possible outcomes. The financial and resource pressures on health systems are well documented, and we need to acknowledge that health resources are finite (Page et al., 2024). Health systems cannot keep endlessly spending without calibrating to needs and implementing methods for allocating resources ethically and appropriately. The care of the older person at the end-of-life is an important focus for consideration not only in improving health outcomes but reducing costs and promoting the viability of the whole healthcare system. Low value services are those that are ineffective, harmful or provide negligible benefit (Teisberg et al., 2020). It is estimated that 60 % of healthcare is provided in accordance with evidence-based guidelines, 30 % is wasteful or low value, and 10 % inflicts harm. Braithwaite and colleagues have highlighted the need for addressing this 60-30-10 challenge through shifting to learning health systems (Braithwaite et al., 2020). This requires close analyses of current structures, processes and outcomes from a range of stakeholder perspectives and challenging the status quo.
Hardy JR, Greer RM, Pelecanos AM, Huggett GE, Kearney AM, Gurgenci TH, et al.
Purpose: Patients with cancer commonly access cannabis hoping to relieve their symptoms. This study assessed whether a 1:1 10 mg/ml THC:CBD combination oil could improve total symptom burden in patients with advanced cancer over that provided by palliative care alone.
Methods: Participants were randomised to medicinal cannabis (MC) or placebo oil; dose escalated over 14 days according to tolerance and efficacy and continued to day 28. Symptoms assessed using the Edmonton Symptom Assessment Scale (ESAS) were summated to give a total symptom distress score (TSDS). The primary outcome measure was the change from baseline in TSDS at day 14. Secondary outcomes included individual symptom scores, opioid use, participant-selected dose, QoL, psychological symptoms, global impression of change (GIC), and adverse effects.
Results: The pre-planned sample size of 120 at day 14 was reached following the randomisation of 144 patients. Mean (SD) TSDS improved over time in both arms (- 6.30 (12.3) MC, - 6.98 (12.56) placebo, p = 0.76) to day 14 with no difference between arms. A statistically significant improvement in ESAS pain scores in the MC arm (mean (SD) - 1.42 (2.15) MC and - 0.46 (2.83) placebo, p = 0.04) was at the expense of greater psychomimetic toxicity. Improvement in general well-being was greater for the placebo. GIC and the pain component of QoL both favoured MC.
Conclusions: Patients can be informed that a 1:1 THC:CBD combination cannabis oil was no better than palliative care alone in palliating symptoms in patients with advanced cancer. A small benefit in pain control was associated with greater toxicity.
Jaaniste T, Helyar M, Eamens M, Smeal T, Coombs S, Mherekumombe M.
Objectives: Pediatric end-of-life (EOL) care at home is often provided by community palliative care (CPC) nurses who are not specialist pediatric service providers. This study explores the challenges, benefits, and future directions of home-based EOL care as perceived by CPC nurses in New South Wales (NSW), Australia.
Methods: Eleven CPC nurses participated in a semi-structured interview to elicit information about their attitudes and experiences regarding their work in providing community-based EOL care to children. Reflexive thematic analysis was used to explore themes regarding the benefits, challenges and their thoughts on future directions regarding home-based EOL care.
Results: Challenges identified by CPC nurses included resource access, complexity of pediatric, models of care, and family psychological factors. Benefits included patient and family autonomy, home comforts and the nurses' sense of satisfaction. CPC nurses suggested the need for increased education, support and collaboration.
Conclusions: Areas of possible clinical and organizational improvements are discussed, including more pediatric training and experience for CPC nurses.
Last updated 30 April 2024