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.
Vandersman P, Tieman J.
Background: The residential aged care (RAC) sector provides care to a significant number of older people across frail and vulnerable years, all the way through to death. As such, palliative care, and considerations for end-of-life caring, need to be considered as core in aged care practice in Australia.
Aim: To explore how RAC nurses understand, describe, and provide care to people who are in the last months of life.
Methods: A qualitative descriptive research study design based on the secondary analysis of data collected as part of a larger study. Focus groups and semi-structured interviews were conducted with RAC nurses working in Australia using video conferencing software and telephone. Data collected was managed using the NVivo software and analysed using reflexive thematic analysis.
Results: Sixty-four participants from 14 RAC services across three Australian States took part in study. Four themes emerged from the analysis of the data, namely: (1) The last months of life have unique caring needs; (2) Identifying the last months of life is complex (3), Care provision is driven by task orientation, and (4) Good end-of-life care is acknowledged yet limited. Participants highlighted differences in the needs of older people experiencing gradual decline versus those in the terminal stage. Early discussions about death with families and residents were deemed valuable, but resource constraints limited the opportunities of quality one-on-one care.
Conclusions: Nurses see value in recognising early health decline and identifying residents nearing end-of-life, but workflow and resource limitations hinder their ability to engage effectively. Developing and implementing resources and processes to enable nurses to identify early decline and deliver timely, quality end-of-life care is imperative.
Virdun C, Singh GK, Yates P, Phillips JL, Mudge A.
Background: Population ageing and rising levels of non-communicable diseases are increasing the number of people living with and dying from advanced serious illnesses globally. Many of these people are hospitalised more than once in their last year of life. While there is sound evidence on what patients and their families require for safe and high-quality hospital palliative care, enabling this remains a challenge. This study aimed to understand the clinician, team, and organisational-level barriers and enablers to integrating good palliative care into acute care.
Methods: An exploratory-descriptive, qualitative study involving semi-structured interviews and practical thematic analysis was conducted. Medical, nursing and allied health disciplines were recruited from three wards (cancer care, mixed general medicine/renal and mixed general medicine/respiratory) within a large Australian metropolitan hospital.
Results: Eighty-eight interviews (nursing (n = 39); medicine (n = 24); allied health (n = 25)) were undertaken, with a median duration of 25.5 min (range 5 to 55 min). Most participants were female (n = 73, 83%), holding a Bachelor's degree (n = 86, 98%) and ranged from new graduates to participants with over 40 years of post-registration experience. The analysis generated six themes, reflecting the challenges of providing optimal palliative care within acute hospital wards: 1. Understanding when and how to provide palliative care 2. Negotiating shared or changing medical governance in a siloed system 3. Supporting clinicians with the knowledge, skills and confidence to meet palliative care needs 4. Prioritising palliative care amidst the acute care demands of the hospital 5. Optimising the clinical environment to enable private, restful and family-friendly spaces 6. Harnessing organisational support and multidisciplinary clinical leadership
Conclusions: This study reveals complex, multi-level organisational barriers to integrating palliative care within the acute hospital which will need to be addressed for effective and sustained improvement. Harnessing organisational support and multidisciplinary clinical leadership is key to successful change. Improvements with a focus on developing clinician knowledge, skills, and confidence in palliative care need to pay attention to organisational siloes that constrain shared care, cultures of care that prioritise cure and efficiency, clinical uncertainty in the context of advanced serious illness and optimising the environment for quality palliative care.
Winsall M, Devery K, Phelan C.
Aim: To explore the key advice healthcare professionals would give colleagues regarding end-of-life care delivery in hospitals, thereby informing training needs.
Design: Exploratory qualitative study.
Methods: Free-text responses from medical, nursing, and allied health professionals who completed online end-of-life care education modules (n = 597) from August 2022 to September 2023 were analysed using inductive content analysis. Results were explored and separated into two key findings: themes that were shared by all professional groups and themes that were profession specific.
Results: Five themes were consistent across all three professional groups: prioritise patient comfort, proactive communication, collaboration and inclusion, human approach and support and wellbeing, each with their own subthemes. Several profession specific subthemes were also identified.
Conclusion: The identification of common themes across healthcare professions helps to support the development of interprofessional training initiatives.
Implications for profession and/ or patient care: This research contributes valuable insights for developing targeted end-of-life care education programs. Results also underscore the potential of online learning platforms in providing accessible, evidence-based, continuing professional development in end-of-life care.
Impact: In Australia, most deaths occur in acute hospital settings. To inform and shape future training, this study collected the key advice healthcare professionals would give colleagues regarding end-of-life care delivery. The themes generated covered a range of potential training topics shared across all professionals, including prioritise patient comfort, proactive communication, collaboration and inclusion, human approach and support and wellbeing. Several profession-specific subthemes were also identified, providing additional insights for designing training for professional groups. Results underscore the potential of online learning platforms in providing accessible, evidence-based, continuing professional development in end-of-life care.
Yeo ZWE, Tieman J, George S, Farrer O.
Objective: Palliative and end-of-life care should be considered core business for aged care and healthcare teams in these settings. With a growing ageing population, the primary care workforce faces growing demand to deliver palliative care. This study aimed to explore the experiences of allied health clinicians and tertiary educators working in, and teaching, palliative care with an ageing focus in Australia.
Methods: We undertook a qualitative study using semi-structured interviews with clinicians experienced in aged and palliative care and tertiary educators delivering aged and palliative care curriculum content from four allied health disciplines (dietetics, occupational therapy, physiotherapy, speech pathology). Guided by critical realism ontology and a constructivist epistemology, reflexive thematic analysis was used for data analysis.
Results: Eleven participants were interviewed. Thematic analysis yielded two key themes and five subthemes. The two key themes were: (i) Barriers to best practice (n=4 subthemes) and (ii) Enablers of palliative care best practice (n=2 subthemes). Key barriers were that curriculum content is lacking and the medical model limits the volume and quality of care delivered. Enablers to quality care were self-directed learning and clinical experience.
Conclusion: Palliative and end-of-life care in aged care should foster reablement to support continuing agency and dignity through person-centred care. Allied health professionals are well-positioned to support this approach. However, facilitating allied health best practice will require addressing the reported barriers, including clinician preparedness and funding sufficient to meet demand and need.
Zhou M, Dray J, Parkinson A, Richardson A, Clynes L, Desborough J.
Background: Despite growing recognition of the importance of consumer engagement in advancing consumer-oriented and relevant research, many researchers experience challenges in appropriately acknowledging consumers' contributions to the research process. A pivotal aspect of this challenge relates to the financial remuneration offered to consumers in recognition of their contributions to research in terms of time, skills and expertise. This may be due to a lack and inconsistency of reported practice and guidance regarding remuneration. We sought to explore current practices for recognising consumers' contribution to health research and to understand health organisations' experiences and perspectives regarding this.
Methods: A working group convened by Research Australia comprised of two academics, one PhD candidate and eight health research organisation representatives, including consumer-led organisations, was established to develop a survey to elucidate current consumer remuneration practices in Australia. Drawing on existing consumer engagement literature, the draft survey questions were constructed and finalised following review, discussion and reaching consensus among the working group. The survey was distributed online to 503 research organisation participants across Australia from December 2023 to February 2024. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed using content analysis methods.
Results/ findings: 124 completed surveys were returned (25% response rate). 92% of participants supported recognition of consumer contributions to health research. Of this, 56% provided financial remuneration, while 36% provided non-financial forms of recognition, such as training and acknowledgement of academic outputs. However, recognition methods used in practice differed, and rates of financial remuneration varied across different levels of engagement. The need for national guidelines in consumer remuneration practice was expressed by 93% of participants.
Implications/ key mesage: These survey findings support an imperative to establish national recommendations for consumer remuneration, tailored to the needs of different organisations and contexts in Australia.
Patient and public contribution: A working group formed with eight member organisations from Research Australia, including consumer-led organisations, contributed to the survey development and interpretation of the qualitative findings by reflecting on the themes developed.
Last updated 30 April 2024