Latest Australian research

Rasekaba TM, Hodge O, Blackberry I, Rich S, Webb N, Steer CB.

Introduction: Healthcare is increasingly shifting from a paternalistic model to one that prioritises person-centred care (PCC). Despite this trend, implementing PCC in the care of older adults diagnosed with cancer remains challenging. The Age-Friendly Health Systems (AFHS) initiative provides a structured framework - the 4Ms (What Matters, Medication, Mentation, and Mobility) - to promote consistent, evidence-based care for older adults. It has demonstrated benefits in general geriatric care; however, applying the 4Ms principles in oncology is underexplored. This study aimed to assess the feasibility of enhancing geriatric assessment (GA) by integrating two novel person-centred elements: Photovoice (two patient-supplied photographs inspired by "Photovoice" principles but not constituting a full Photovoice methodology) and the "This is Me" (TiM) tool.

Materials and methods: A cross-sectional mixed-methods study evaluated the feasibility of integrating two novel elements (two patient-supplied photographs and the TiM tool) into GA, with the aim of promoting practice based on the AFHS 4Ms framework principles. Twenty consecutive patients (≥70 years, G8 score ≤ 14) from a regional cancer centre completed the assessment (electronic Rapid Fitness Assessment [eRFA]-Photo-TiM, as well as the Mini-Cog and Timed-Up-and-Go). Results were presented at a weekly "enhanced supportive care" (ESC) multidisciplinary team (MDT) meeting. Participants completed post-assessment surveys and interviews.

Results: All patients (n = 20), aged 79 years, 45% female, completed the eRFA, 19 completed the TiM, and 18 provided photographs. The combined assessment was overall acceptable and feasible, user-friendly, captured patients' values and contexts, and facilitated supportive care referrals and advance care planning discussions. ESC-MDT members valued the holistic view for informing supportive care decisions. However, photo submission required substantial assistance for most participants, hence a significant barrier to overcome for implementation. Other barriers included digital literacy and delays in completion, which averaged 2.5 weeks.

Discussion: The eRFA-Photo-TiM approach was feasible and acceptable in a real-world cancer care in a regional cancer centre and may support more person-centred care decision making. Further research should evaluate effect on cancer care outcomes and sustainable implementation.

Smith R, Merlo G, Ezure Y, Love A, Lock C, Broadbent A, et al.

Objectives: Quality palliative and end-of-life care is required to meet the growing need in aged care. The aim of the Specialist Palliative Care in Aged Care (SPACE) service was to enhance equitable access to specialist palliative and end-of-life care for residential aged care residents in Queensland, Australia.

Methods: Local SPACE teams were established in each of 15 adult health services in Queensland. These teams provided services into residential aged care facilities in alignment with the statewide service principles of: (1) comprehensive resident-focused care; (2) streamlined service; and (3) capacity building. The SPACE teams provided advice for managing complex care and built generalist capability through education, training, mentoring and support for care planning. The effectiveness of SPACE was assessed through a repeated cross-sectional design. Data, including postdeath questionnaires, staff knowledge and confidence, organisational change, and resident and family experience measures, were collected in 6-month intervals.

Results: There were significant differences in the response distribution for place of death and for advance care planning across collection periods. Staff knowledge and confidence improved significantly in all areas assessed. There was also a significant change in the proportion of providers who improved palliative care policies, procedures or guidelines. Staff and resident stories attributed avoidance of unnecessary hospital admissions, improved quality of end-of-life care aligned with preferences, and improved coordination and continuity of care to SPACE's involvement.

Conclusions: The SPACE service demonstrated that a principle-based, adaptable model for accessing specialist palliative care can improve staff capability and improve end-of-life outcomes in residential aged care.

Clapham S, Ayalew AA, Redwood L, Yates P, Auret K, Clark K, et al.

Background: Understanding how symptom outcomes vary by care setting helps optimize care.

Aim: To compare trajectories of severe symptom distress in the final week of life across community and hospital settings.

Design: This retrospective consecutive cohort study used point-of-care data from the Australian Palliative Care Outcomes Collaboration, which includes the Symptom Assessment Scale and Palliative Care Problem Severity Score. Mixed-effects logistic regression models were adjusted for clinical, demographic and temporal factors.

Settings/ participants: Australian palliative care services (n = 165) contributed data for people who died between July 1, 2019, and June 30, 2024.

Results: Of 141,691 patients,73.6% were inpatients; 61.0% had a cancer diagnosis. Severe symptom prevalence was generally low (<5%). After adjusting important factors, inpatients had higher relative odds of severe pain-related (aOR: 1.20, 95% CI: 1.10, 1.30) and breathing-related distress (aOR: 1.55, 95% CI: 1.40, 1.70) compared with community patients; the corresponding absolute risk differences (ARDs) were minimal (pain: +0.36 percentage points; breathing: +0.79 percentage points). Conversely, inpatients had lower relative odds of severe fatigue (aOR: 0.86, 95% CI: 0.79, 0.94) and insomnia (aOR: 0.74, 95% CI: 0.66, 0.84), with small ARDs (fatigue: -0.32; insomnia: -0.26). Over time, severe breathing-related distress increased significantly as death approached, while pain-related distress increased slightly. Inpatients were also less likely to experience family/carer issues (aOR: 0.78, 95% CI: 0.72-0.84), or other symptoms (aOR: 0.57, 95% CI: 0.53-0.61), with small ARDs (family/carer: -0.56; other symptoms: -0.26).

Conclusions: While some relative differences were noted between settings, absolute differences were minimal, suggesting clinically comparable outcomes. These national data show that severity of symptoms in the two care settings are similar, reassuring patients, families, and health care professionals.

Grose D, Corbett C, Walker A, Lim WK, Smallwood N, Zentner D. 

Aim: More older adults are living with an implantable cardioverter defibrillator (ICD). Deactivation rates for those approaching end-of-life are low, risking undue distress and an undignified death. This scoping review aimed to determine the availability and content of hospital guidance documents regarding ICD deactivation towards end-of-life.

Method: Guidelines' databases from two Australian states (Victoria and South Australia) were systematically searched between September 2022 to February 2023, to identify all documents that specified guidance for ICD deactivation at end-of-life. Relevant documents were analysed using a pre-specified data extraction tool.

Results: Following screening of 59,662 documents from 94 health services providing acute, aged or palliative care, 11 were included. Most were from public (10, 91%), metropolitan (eight, 73%) health services. Guidance on timing of ICD deactivation discussions was limited; only two (18%) documents advised discussion at time of insertion, one (9%) at generator change and six (55%) during advance care planning discussions. Recommended criteria for ICD deactivation varied: people with a terminal illness (two, 18%), with an active do not resuscitate order (five, 45%), receiving end-of-life care (11, 100%), or at the person's request (seven, 64%). Nine (82%) recommended consent dialogue that deactivation does not cause/hasten death (eight, 73%) or deactivate pacing (eight, 73%), aims to promote a peaceful death (eight, 73%) and that reactivation is possible (eight, 73%).

Conclusions: There is a paucity of local health service guidance to support clinicians navigating ICD deactivation at end-of-life.

Kim B, Boustany C, Fethney J, Simpson JM, White K.

Purpose: This study aimed to report the incidence, common reasons, and associated risk factors for unplanned hospital presentations during chemotherapy treatment.

Methods: A secondary analysis using data from a randomized controlled trial containing hospital data for the first three cycles of chemotherapy of adult oncology patients in two tertiary hospitals in Australia. Descriptive statistics were used to report hospital utilization patterns. Poisson regression explored risk factors for unplanned presentations.

Results: Analyses included data from 346 patients; 115 patients (33%) made one/or more presentations during the first three cycles of chemotherapy. Of 144 unplanned presentations, 74 (51%) were made during cycle 1. Predominant reasons were fever with/without neutropenia (n = 50, 35%) and nausea/vomiting (n = 30, 21%). Fifty-two percent (n = 75) of unplanned presentations did not result in hospital admission. Of 346 patients, 70 (20%) had hospital admissions with a median length of stay of 3 days (IQR 2-7). Multivariable analysis identified the following as predictors for unplanned presentations: cancer stage (stage 1 vs stage 4: IRR 2.50, 95% CI, 1.28-4.89; P = 0.01) and cancer type (lung cancer vs breast cancer: IRR 2.25, CI, 1.26-4.01; P = 0.01).

Conclusion: Nausea/vomiting management support may be one area warranting improvement, a frequent reason for unplanned presentations that are potentially preventable. Such support will be most beneficial during the first treatment cycle, when most unplanned presentations occurred. A high proportion of unplanned presentations did not result in hospital admission, indicating an opportunity to manage some of the side effects within primary care or outpatient settings, rather than utilizing emergency department services.