Latest Australian research

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.

Lee W, Nagla A, Wong ABO, Magann L, Lovell M, Mantle E, et al.

Purpose: Breakthrough cancer pain (BTcP) is an evolving clinical challenge, with limited guideline-specific direction. This study aimed to identify gaps in breakthrough cancer pain (BTcP) diagnosis and management in Australia and propose practical, evidence-informed actions to improve assessment, prescribing and equitable access to effective analgesia.

Methods: A gap analysis was conducted between September 2023 and September 2024, using three hybrid roundtable meetings involving 13 medical and nursing clinicians and researchers. Participants were selected for expertise in BTcP, including rapid-onset opioids (ROOs) policy development, BTcP research and education. A targeted review of the literature and guidelines framed the discussions. Meetings were recorded, transcribed and iteratively member-checked; thematic synthesis identified key gaps and potential solutions.

Results: Five interrelated gaps were identified: (1) inconsistent definitions of BTcP undermining case identification and research comparability; (2) assessment and measurement gaps with uptake of validated tools limited by perceived respondent burden and clinical utility; (3) heterogeneous approach to BTcP with limited comparative evidence guiding ROOs versus immediate-release opioid use and dosing strategies; (4) implementation and systems barriers including workflow, prescribing complexity and clinician training needs; (5) equity in opioid supply and restricted access to vulnerable populations. Recommended actions include Delphi consensus on definition, development and validation of subtype-sensitive assessment tools, pragmatic comparative effectiveness and implementation studies, co-designed prescribing templates and stakeholder engagement to address supply chain and regulatory barriers.

Conclusions: Sequential, coordinated efforts-consensus building, measurement development, targeted research, co-designed implementation supports and supply chain planning-are required to advance equitable, evidence-based BTcP care in Australia.

O'Brien T, Huckvale K, Metcalf O, Chapman W, Ferdous H, Hoda R, et al.

Abstract: Patients forget up to 80% of information conveyed during medical consultations. While clinicians may provide hand-written notes to patients during in-person appointments, such opportunities are limited in telehealth. Palliative care patients with complex information needs may benefit from consultation summaries. We developed a consultation summary application (CSA) to generate patient-facing summaries during video telehealth, in a palliative care context. Traditional research methods fall short in early identification and resolution of socio-technical factors, e.g., workflow compatibility, which impact the adoption of digital health innovations. Drawing on the Service Readiness Level Framework, we adopted a phased approach to generating evidence for the CSA. We conducted clinical simulations with seven clinician-simulated patient dyads involving the metastatic lung cancer scenario to examine and address usability and workflow integration issues prior to real-world implementation. Both clinicians and simulated patients perceived the CSA as a valuable tool to support palliative care patients with information recall and self-management. We recommend clinical simulation to de-risk real-world deployment, and optimise the digital health innovations.

Gerber K, Hjorth L, Bryant C, Lock K, Chong TWH, Engel L, et al.

Objectives: Bereaved older adults often experience health complications, yet receive limited support in primary care settings. This research explored general practice staff's exposure to older patients' grief and identified barriers/enablers to bereavement support.

Methods: We examined 15 in-depth interviews with general practitioners and practice nurses across Australia. Data were analyzed thematically and via poetic narrative analysis, an innovative arts-based method to meaningfully translate participant's lived experience and emotions.

Results: Exposure to older people's grief and bereavement informed primary care staff assumptions about older people's grief, their ability to identify signs of grief, their understanding of how culture, gender, and grief intersected, and how grief could be managed in general practice (e.g. mobilizing nurses to provide support). Barriers/enablers to bereavement support included: Communication, access to support, time to discuss concerns, and knowledge/awareness of grief complications.

Conclusions: Older adults require access to tailored support that addresses their experiences of repeated exposure to grief and loss. Primary care is a key conduit to specialist services but to make such referrals more training is needed on ageism and stigmas surrounding mental health. Arts-based methods can open a dialogue about grief and destigmatize help-seeking among older adults.

Shimoniaba K, Crawford K, Lee DA, Qiu Y, Lalor AF, Jackson KM, et al.

Aims: To examine residential aged care staff's experience of death and grief, and their support needs.

Methods: A mixed-methods sequential explanatory design, using an online cross-sectional survey that included the Texas Revised Inventory of Grief and the Grief Support in Health Care Scale. Followed by semi-structured interviews with direct care workers and managers working in residential aged care homes were conducted.

Results: Over 60% of participants experienced five or more resident deaths in the previous 12 months. Although, different levels of grief were experienced among different roles, the importance of open communication and opportunities for farewells after resident death was highlighted. Participants suggested support and education to normalise grief and promote self-care.

Conclusion: Recognising staff grief following the resident death is important. Providing support and education may help improve staff wellbeing and contribute to the delivery of high-quality care for both residents and their families.