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.
Gallop M, Ford J, Bowman A, Mullen A, Schwebel D, Johnson A, et al.
Aim: To explore current evidence regarding the provision of palliative care for individuals with very severe to extreme behavioural and psychological symptoms of dementia (BPSD) in a hospital setting.
Design: Scoping review.
Reporting method: The PRISMA-ScR reporting guideline.
Methods: The JBI guidelines for scoping reviews were followed. A data extraction form assisted in the identification of key findings via a process of content analysis.
Data sources: Studies were obtained from bibliographic databases of PubMed, CINAHL, and PsycINFO.
Results: This review included six articles, and nine categories emerged from the findings. Symptom assessment and management, pain assessment challenges, atypical presentation of end-stage dementia, complex prescribing and treatment practices, principles of person-centred care, collaboration; training for health care professionals; emotional impact on staff; and family and caregivers.
Conclusions: This scoping review highlighted a significant gap in the literature regarding palliative care for people living with very severe to extreme BPSD in hospital settings. This review highlighted key differences in the presentation of people with BPSD needing palliative care. There is a need for tailored models of care, specialised training and education for health professionals, families, and carers, and recognition of dementia as a terminal illness.
Gebresillassie BM, Attia J, Cavenagh D, Harris ML.
Background: Accurately estimating one-year mortality risk in older women with dementia can inform clinical decision-making, facilitate timely advanced care planning, and optimise palliative care delivery. This study aimed to develop, validate, and assess the clinical utility of a prediction model for one-year all-cause mortality in this population using a nationally representative Australian cohort.
Methods: This prognostic study utilised data from the 1921-26 cohort of the nationally representative, population-based Australian Longitudinal Study on Women's Health (ALSWH) and linked national and state-based administrative health records. Candidate predictors were identified through a systematic review and expert consultation, then refined using a data-driven statistical approach. A multivariable binary logistic regression model was developed and validated to predict one-year all-cause mortality.
Results: The analysis included 1576 older women with dementia (mean age, 72.6 ± 1.5 years). The model demonstrated good discrimination (AUC: 75.1 %, 95 % CI: 72.7 %-77.5 %) and excellent calibration (slope = 1.00, 95 % CI: 0.87-1.13; intercept = 0.00, 95 % CI: 0.11 - 0.11). Model validation using both 10-fold cross-validation and 1000 bootstrap iterations showed minimal optimism in its predictive performance, with AUC optimism of 0.0047 and 0.0042, respectively. Decision curve analysis indicated a net benefit across probability thresholds from 0.24 to 0.88, supporting the model's clinical utility for guiding palliative care decisions.
Conclusion: This prediction model, incorporating readily available predictors, demonstrated compelling performance and clinical utility for identifying older women with dementia at high risk of one-year mortality. The model has the potential to facilitate timely palliative care interventions and is publicly accessible via a web-based calculator. Further external validation in diverse populations and healthcare settings is warranted to confirm its generalisability.
Hungerford C.
Abstract: Grief is a highly personal, idiosyncratic experience involving deep sorrow and emotional distress in response to significant loss. Family carers of people with dementia report high levels of grief after diagnosis, during the progressive deterioration in the person’s cognition, and after the person’s death, with many family carers experiencing complicated grief. Factors contributing to the complexity of a family carer’s grief journey include the protracted and evolving nature of the loss, together with the burden of care carried by family carers as the dementia progresses.
This column explores the grief journey of family carers of people with dementia and identifies how health professionals, including mental health nurses, can better support them to process their grief. Such support includes helping to reduce the burden of care, listening to the carer express their grief, enhancing their problem-solving skills, and addressing their personal needs. Family carers assisted in this way are less likely to develop mental health issues, such as anxiety, depression, or complicated grief.
Adi Pranoto E, Wong ABO.
Abstract:
Delirium occurs frequently near the end of life and is highly prevalent in palliative care settings. This case report describes how purposeful examination supported a diagnosis of serotonin syndrome (SS) as a contributor to the patient's delirium and how deliberate interventions resulted in the resolution of symptoms and delirium. Given its impact on prognostication and management, we strive to raise awareness about SS in palliative care.
Bloomer MJ, Brooks LA, Coventry A, Ranse K, Rowe J, Thomas S.
Background: The death of a child can have a profound impact on critical care nurses, shaping their professional practice and personal lives in diverse, enduring ways. Whilst end-of-life care is recognised as a core component of critical care nursing practice and a research priority, evidence about nurses' experiences after death in neonatal and paediatric intensive care is poorly understood.
Research question: What is the experience of the nurse after death of a patient in neonatal and/or paediatric intensive care?
Method: Following registration with Open Science Framework, an integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings was used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Medline, APA PsycInfo, Scopus, and Embase databases. Records were independently assessed against inclusion and exclusion criteria. All included papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.
Findings: From 13,018 records screened, 32 papers reporting primary research, representing more than 1850 nurses from 15 countries, were included. Three themes were identified: (i) postmortem care; (ii) caring for bereaved families; and (iii) nurses' emotional response, which includes support for nurses. Nurses simultaneously cared for the deceased child and family, honouring the child and child-family relationship. Nurses were expected to provide immediate grief and bereavement support to families. In response to their own emotions and grief, nurses described a range of strategies and supports to aid coping.
Conclusion: Recognising neonatal and paediatric critical care nurses' experience after death is key to comprehensively understanding the professional and personal impacts, including the shared grief of a young life lost. Enabling nurses to acknowledge and reflect upon their experiences of death and seek their preferred supports is critically important. Thus, ensuring organisational and system processes similarly align with nurses' preferences is key.
Last updated 30 April 2024