Latest Australian research

Lock K, Zhi Yan Lee L, Goh A, Gerber K, Lim WK, Tropea J, et al.

Background: The challenges of implementing evidence-based palliative care in residential aged care are widely acknowledged. Facilitation is often cited as an effective implementation strategy to address these challenges. However, there is limited guidance on how this strategy applies specifically to this context.

Aim: To understand the contextual factors and causal processes (mechanisms) that influence the facilitation of interventions designed to improve palliative care in residential aged care, and to develop a realist programme theory that explains how best to support their implementation.

Design: Realist review guided by the RAMESES standards. Protocol is registered on PROSPERO (CRD42023447043).

Data sources: MEDLINE, CINAHL and PsycINFO databases were searched for studies on palliative care interventions in residential aged care that used facilitation, published between 2000 and 2024. Data extraction and synthesis followed realist principles to identify context-mechanism-outcome configurations.

Results: Twenty-three articles describing 16 palliative care interventions were included in the review. Facilitation was found to be effective when it fostered a shared understanding of the intervention, tailored its components to fit staff workflow and built trust among stakeholders. These processes contributed to normalisation of the intervention and transition of ownership of both the intervention and facilitation process. Proactive support from the facilitator in addition to action learning was most effective at developing learning systems and staff comfort and confidence.

Conclusions: The realist programme theory developed in this study provides a foundation for ongoing testing and refinement, with the aim of accelerating evidence uptake by residential aged care staff and ultimately improving palliative care outcomes for residents.

Schupak I, Chao M, Guerrieri M, Ho H, Udovicich C, Ong WL, et al.

Backgound and purpose: Stereotactic ablative body radiotherapy (SABR) for oligometastatic prostate cancer (omPC) has proven a topic of emerging interest in the paradigm shift from palliative androgen deprivation therapy (ADT) to metastasis-directed therapy. In this study, we aim to evaluate and report on biochemical and clinical outcomes for omPC patients treated with SABR.

Methods and materials: This was a multi-centre, retrospective case series of patients undergoing SABR for omPC from 2015 to 2019 inclusive, staged with PSMA-PET/CT. Concurrent ADT was permitted. Patients with synchronous metastatic disease receiving radiotherapy to primary within 12 months of SABR were excluded. The primary endpoint was biochemical failure-free survival (BCFFS). Secondary endpoints included: PSA response at 6 months, clinical failure-free survival (CFFS), defined by a 2nd course of SABR, commencing ADT, palliative radiotherapy, systemic therapy or changing current line of therapy; ADT-free survival (FS) was calculated in the SABR only cohort.

Results: 213 patients were included for analysis. 41.3 % of SABR was delivered to bone and 49.3 % to nodal metastases, with 28 patients (13.1 %) having SABR together with ADT. Median follow-up was 57.6 months (IQR 45.8-72.6). BCFFS at 12, 24 and 36 months was: 45.6 % (95 %CI: 38.7-52.2 %), 26.2 % (95 %CI: 20.4-32.4 %) and 18.8 % (95 %CI: 13.7-24.5 %), respectively. CFFS at 12, 24 and 36 months was: 71.4 % (95 %CI: 64.7-77.0 %), 50.4 % (95 %CI: 43.4-57.1 %) and 39.2 % (95 %CI: 32.4-45.8 %), respectively.Median ADT-FS was 41.98 months (95 %CI: 32.76-52.90), with 5-year ADT-FS reported at 37.5 % (95 %CI:29.8-45.1 %).

Conclusion: This is the largest cohort of PSMA PET staged patients undergoing SABR for omPC, effective in delaying treatment escalation and ADT exposure beyond 3 years.

Sun V, Coombs S, Armitage N, Dowling M, Jaaniste T.

Abstract: This study aimed to establish the frequency and congruence between preferred and actual locations of expected pediatric deaths and to identify associated factors. A retrospective review of death review forms and medical records was conducted in two pediatric palliative care services in Sydney, Australia, involving 486 patients who died between January 2017 and May 2024). Hospital was the most common LOD (49.8%), then home (28.4%) and hospice (21.0%). At the last documented LOD conversation, 36.2% of families preferred home, 28.6% hospice and 26.4% hospital. Preferred LOD outcomes were achieved for 87.7% of families, although 21% who preferred a home death did not achieve this. Preferred and actual LODs of home were significantly associated with having a community palliative care referral and palliative care home visit. The findings highlight the importance of enabling families to plan for their child's LOD, and ensuring preferences are documented and communicated across health services.

Sundararajan K, Aziz S, Anderson N, Damarell RA, Raith E, Phelan C, et al.

Background: Patients and families from culturally and linguistically diverse (CALD) backgrounds face distinct challenges during end-of-life care (EOLC) in intensive care unit (ICU) settings, where communication, cultural expectations and decision-making may conflict with clinical norms. These complexities have important implications for intensive and palliative care teams.

Objectives: To map literature on clinician, patient and family perspectives on end-of-life communication with CALD populations in ICUs, and identify barriers and facilitators to culturally responsive care.

Design: This scoping review followed Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The protocol was registered with the Open Science Framework and published in BMJ Open. Screening, review and data extraction were conducted by multiple reviewers using Covidence and the Joanna Briggs Institute tool, with findings synthesised through inductive thematic analysis.

Primary and secondary outcome measures: The primary outcome was to identify barriers and facilitators to communication between clinicians, patients and families from CALD backgrounds during EOLC. Secondary outcomes were to map the scope of evidence, describe study characteristics and participant demographics, and summarise themes on cultural sensitivity, clinician awareness, family involvement, decision-making and integration of support services.

Results: Thirty of 766 screened studies were included. Three themes emerged: communication challenges; cultural sensitivity and humility and decision-making and support. Barriers included limited access to palliative care, language discordance, underuse of interpreters, clinician discomfort and conflicting care expectations. Facilitators included structured meetings, inclusive practices and interdisciplinary collaboration.

Conclusions: Structural, communicative and cultural barriers undermine equitable EOLC for CALD patients. Embedding palliative care principles, cultural responsiveness and shared decision-making into ICU practice requires coordinated input from a multidisciplinary team involving physicians, nurses, social workers, spiritual care, psychologists and interpreters. System-level reforms in training, service delivery and research are needed to ensure person-centred care.

Carey M, Mason K, Fox L, Moeke-Maxwell T, Gott M.

Background: Māori people in Aotearoa New Zealand and Australia experience significant healthcare inequity as they age and towards the end of their lives. Compassionate community approaches to ageing and end-of-life care are increasing in popularity throughout the world. However, this approach has arisen from Eurocentric knowledge systems and not from First Nations people and their communities.

Objectives: This research aimed to gain insight into what the Compassionate Communities approach means for First Nations people and identify implications for Māori in Aotearoa New Zealand and Australia. A systematic literature review explored the intersection of Compassionate Communities and First Nations peoples' perspectives and needs. Addressing the overarching question of: What does the Compassionate Communities approach mean for older First Nations people?

Design: A Kaupapa Māori approach was used to answer the research question and to explore the literature retrieved.

Methods: The main literature search was conducted during 2020-2022, with subsequent searches in 2023 and a final search in 2025. The review was conducted in Covidence systematic review software following the PRISMA process. Screening was completed by two reviewers and assessed against the inclusion and exclusion criteria. Kaupapa Māori theoretical questions were applied to each full-text article, with a rating of positive, neutral or negative allocated to establish conceptual alignment. NVivo thematic analysis software was utilised to code and explore themes.

Results: Fifty papers were imported into Covidence, with 22 studies included in the final review.

Conclusion: The review found minimal discussion about how Compassionate Communities approaches are implemented in a way that includes First Nations knowledges of ageing and end of life. There is a greater need to understand the contribution First Nations peoples' wellness philosophies make to the Compassionate Communities approach. Evaluations of Compassionate Community initiatives need to be more inclusive of First Nation peoples and their knowledges. In Aotearoa New Zealand and Australia, more research is needed to understand pathways to well-being for older Māori people based upon existing community strengths to ensure flourishing futures. Addressing these knowledge deficits will support efforts to address the inequities experienced by First Nations people as they age and at the end of life.