Latest Australian research

Mogg D, Levy MH.

Abstract: New South Wales was the last Australian state to pass voluntary assisted dying (VAD) legislation, effective on 28 November 2023. The Justice Health and Forensic Mental Health Network (JHNSW) is responsible for the health care of people in contact with the criminal justice system in NSW (www.nsw.gov.au/health/justicehealth/) and was tasked with implementing a VAD pathway for prisoners. A steering committee was formed with the Corrective Services NSW (CSNSW; https://correctiveservices.dcj.nsw.gov.au/), the local health district, the CSNSW Inmate Consumer Referent Group, the Mental Health Review Tribunal (https://mhrt.nsw.gov.au/the‐tribunal/), the JHNSW Clinical Ethics Committee, the Victims Support Scheme and the Aboriginal Health and Medical Research Council of NSW (www.ahmrc.org.au) to create dignified and culturally safe pathways for prisoners to access VAD. The ethical and legal challenges of integrating VAD into the NSW correctional settings are highlighted below, with a hypothetical patient journey demonstrating the pathway.

Rowe A, Loi SM, Cheung G. 

Objective: Voluntary assisted dying (VAD) in Australia and New Zealand is reserved for terminally ill individuals experiencing unbearable suffering. This study investigated the knowledge and views of Australian and New Zealand psychiatrists and trainees on VAD, including for mental illnesses, and whether these knowledge and views differ between psychiatrists and trainees.

Methods: Participants completed an online survey consisting of 18 questions between March and June 2024. The survey was distributed via various Royal Australian and New Zealand College of Psychiatrists newsletters and through snowballing.

Results: One hundred and sixty-four psychiatrists and sixty-five trainees were included. Psychiatrists tended to be more confident in their knowledge of VAD, less willing to be involved with VAD and more conservative in their views of VAD than trainees: 26.8% of psychiatrists and 10.8% of trainees strongly agreed that the criteria for VAD will progressively broaden (p < .047).

Conclusion: Differences in experience may explain some of these distinctions; however, other factors are likely to have been influential in explaining these differences. Given the increasingly liberalised and autonomous social landscape, Australian and New Zealand psychiatry should prepare themselves for the ethical question of VAD for mental illnesses that will inevitably arise.

Fernandes BR, Newton JA, Betts K, Sheehan C.

Background: Patients with end-stage heart failure experience a significant symptom burden that is often poorly controlled. Although palliative care can improve symptom management and reduce hospital admissions, many patients still die in acute care settings. The unpredictable course of end-stage heart failure complicates the identification of patients who would benefit from early palliative care referral. To address this challenge, an integrated cardiac supportive care service was developed to engage these patients early, optimise symptom control, and ensure timely access to palliative care.

Aim: The aim of this study is to document the symptom burden, using Patient-Reported Outcome Measures, for patients with end-stage heart failure on admission to the cardiac supportive care service.

Method: A prospective observational study was undertaken in a tertiary hospital service in Sydney, Australia between January 2020 and July 2022. Patients were included if they had a recent admission for heart failure or had heart failure with breathlessness or chest pain at rest or on minimal effort. The cardiac supportive care service, consisting of initial home visits and follow-up reviews conducted by a palliative care physician and cardiac nurse practitioner, collected information using the Dyspnoea-12 (D-12) Questionnaire and the Integrated Palliative Care Outcome Scale (IPOS). Symptom scores from these tools were analysed in relation to patient mortality, with Kaplan-Meier survival curves and Cox regression used to assess the association between symptom burden and time to death.

Results: A total of 114 patients were included in this study. Both the IPOS and D-12 scores indicated a substantial and clinically relevant symptom burden for this cohort of patients. High mean scores on the IPOS were observed for weakness (2.6, standard deviation [SD] 1.2), shortness of breath (2.6, SD 1.2), and sore/dry mouth (2.5, SD 1.3). Sore/dry mouth was the most frequent severe or overwhelming symptom (59%). The D-12 showed that descriptors of breathlessness most commonly rated as severe were "My breathing is exhausting" (40%), "My breathing is distressing" (39%), and "I feel short of breath" (38%). Patients with an IPOS score in the highest quartile had an elevated mortality risk. The survival of patients in this cohort was 17.1 months.

Conclusions: Patients with end-stage heart failure experience a substantial and frequently severe symptom burden, including breathlessness, dry mouth, and weakness. This study demonstrates the significant unmet need in this patient population and highlights the opportunity for integrated and proactive palliative care, delivered through a cardiac supportive care service. This model of care can optimise symptom management, facilitate advance care planning, and ensure timely referral to palliative care.

Lewis S, Franklin M, Newton G, Kenny K, Boyle F, Smith A.

Abstract: Understandings of living well with incurable, life-limiting disease are limited. This article examines how living with a 'contracted future', albeit of uncertain duration, affects how one spends time (wisely) in the present and plans future time. Mobilising the concept of timescapes and interviews with women with metastatic breast cancer, we examined how an incurable prognosis shaped how women experienced time, what meanings they ascribed to time and at what cost. Thematic analysis derived five themes: 'quality time'-the imperative to spend time well; 'out-of-sync timing'-experiencing temporal disconnect with others; 'making time'-motivation to extend their time through treatments; 'time mis/calculations'-planning amid uncertain certainty; and 'the tempo of living beyond prognosis'-responding to initial contraction and subsequent expansion of temporal horizons. Our analyses reveal how pressures to live well, die well and be remembered well complicated women's experiences of how to be in the present and future, incurring substantial social and economic costs. We illuminate how the quest for improved quality of life and extended longevity can result in emotional and financial precarity, experienced most profoundly by those with limited economic resources, revealing the economic and social factors that shape how time is spent well by those with metastatic disease.

Cole E, Reymond L, Stroil-Salama E, Phelan C.

Objective: Queensland implemented a centralised voluntary assisted dying (VAD) pharmacy model to promote safety, consistency and equitable access to VAD substances. In a geographically dispersed state, such as Queensland, a potential concern is whether centralisation affects time-to-delivery (TTD) for patients in regional and rural areas. This audit examined whether differences exist in TTD between South East Queensland (SEQ; metropolitan) and non-SEQ (non-metropolitan) patients, and explored reasons for prescription and visit cancellations to determine whether geographic factors, particularly remoteness, influenced service reliability.

Methods: All VAD substance deliveries between 1 January 2023 and 31 January 2024 were analysed. TTD was defined as the difference between the patient's preferred and actual supply dates. Comparisons were made across region (SEQ vs non-SEQ), hospital and health service districts, and Modified Monash Model categories. Reasons for prescription and visit cancellations were also explored, as these cases were not captured in the TTD dataset if a delivery did not proceed, and may reveal potential geographic barriers for timely access.

Results: Of 911 patients, 723 (83%) received the VAD substance on their preferred date. No statistically significant differences in TTD were observed across region, hospital and health service districts or Modified Monash Model classifications, demonstrating consistent and reliable statewide delivery - an indicator of safety and standardised practice. Cancellations (prescriptions n = 58, visits n = 56) were geographically uniform and most commonly due to patient death.

Conclusions: Queensland's centralised VAD pharmacy enables equity of access and safe delivery of VAD substances regardless of geography, supporting standardised practice and mitigating operational risks through centralised oversight.