Latest Australian research

Chen J, Cohen MS, Louis W, Decety J, Thomas EF, Crane M, et al.

Abstract: Medical assistance in dying (MAiD) is gaining legal and social acceptance; yet it remains ethically controversial and challenging for healthcare professionals. This functional MRI study examines how social norms and empathy influence MAiD decisions in 59 Australian medical students while evaluating hypothetical assisted-dying scenarios. Participants’ decisions generally aligned with the legal framework. MAiD was approved when eligibility criteria were met (normative cases) and denied when they were not (nonnormative cases). Nonnormative scenarios elicited greater activation in frontoparietal brain regions involved in response selection and inhibition, consistent with increased decision difficulty. These scenarios elicited heightened activity in the precuneus, temporoparietal junction, and angular gyrus, along with stronger functional connectivity between the anterior hippocampus and the precuneus, suggesting greater reliance on memory retrieval and mentalizing. Normative scenarios were associated with increased amygdala activity, particularly among less religious participants, suggesting a role for negative affective salience. Greater activity in the ventromedial prefrontal cortex, and connectivity between the anterior cingulate cortex and this region, suggest positive feelings related to compassion when a clinician can legally approve an assisted dying request. Normative scenarios were also associated with reduced connectivity between the anterior cingulate cortex and the anterior insula, particularly in those with higher trait affective empathy, suggesting that doctors might feel a reduction in their patients’ pain. The findings provide the first empirical evidence of the neural mechanisms underlying decision-making in bioethical cases involving death as the outcome, highlighting distinct contributions and potential risk factors for medical practitioners in normative and nonnormative MAiD clinical situations.

Lee J, Evans H, Wakefield CE, Anazodo A, Cohn RJ, McGill BC, et al.

Abstract: End‐of‐life conversations with adolescents and young adults (AYAs) with cancer rarely occur without the guidance of healthcare professionals. As a part of the ‘Difficult Discussions’ study, focused on palliative care and advance care planning discussions with AYAs with cancer, we investigated the factors that healthcare professionals identify as barriers and facilitators to end‐of‐life conversations. Twenty‐eight multidisciplinary healthcare professionals participated in semi‐structured interviews exploring conversations focused on end‐of‐life care (29% oncologists/haematologists, 39% nurses and 32% allied health professionals). Data were analysed through qualitative content analysis using an inductive approach. The conversations were shaped by factors at the healthcare professionals’ personal, interpersonal, teams and hospital system levels, as well as being influenced by cultural and societal influences. Barriers at each level included patients’ and caregivers’ emotional needs; patients’ maturity levels; lack of relational trust between patient, caregiver and healthcare professional; and the social taboo of speaking about death with young people. Conversely, good communication between members of the multidisciplinary team was identified as a facilitator, as working effectively in a team was found to mitigate some of the emotional burden and logistical constraints of conducting end‐of‐life conversations. The results of this study offer new insights into how the interplay of these factors acts as facilitators and barriers to communication. Further research could explore the communication processes that facilitate trust between the AYA and healthcare team, factors associated with AYAs’ readiness and the optimal time to conduct end‐of‐life conversations.

Shanmugasundaram DS. 

Abstract: "Caring outside the box" refers to holistic, personalised, and innovative support approaches that move beyone traditional, standardised care models, particularly in disability, education, and health services. It emphasizes tailored solutions, such as creative therapy, community engagement, and proactive, flexible support systems that address an individual's unique needs.

Banks S, Lee B, Ayres N, Schrader S, Thomson B, Loveday BPT, et al.

Introduction: Optimal care pathways (OCP) were developed in Australia as a framework to define quality and timeliness targets. The 2022 National Pancreatic Cancer Roadmap highlighted a paucity of population-level data on pancreatic cancer management in Australia, such that compliance with OCP targets is uncertain. This study used real-world data to compare pancreatic cancer care in Victoria, Australia, against OCP targets.

Methods: Data collected on pancreatic cancer patients between January 2016 and July 2025 were extracted from the PURPLE registry for five Victorian tertiary hospitals. Care processes and timeliness outcomes were compared with OCP benchmarks.

Results: 1878 patients were identified, with a median age of 70 years. At diagnosis, 41% had metastatic disease and 69% were ECOG performance status 0-1. Median interval from diagnosis to surgery was 20 days (OCP benchmark ≤ 28 days) with 60% of patients operated on within the timeframe, and to adjuvant therapy 55 days with 88% of patients receiving chemotherapy within the OCP benchmark of ≤ 84 days. However, just 33% received neoadjuvant chemotherapy, and 38% received palliative chemotherapy within the 28-day timeframe for commencing systemic treatment. Palliative care referral occurred in 65% of patients with advanced disease and 61% were discussed at a multidisciplinary meeting. Marked inter-site variation was evident across metrics.

Conclusion: In Victoria, Australia, pancreatic cancer care variably met OCP targets. Real-world registry data can identify domains of care where performance is strong and highlight opportunities for process improvement and resource optimisation. Where OCP targets are rarely achieved, these findings support review of their real-world feasibility.

Dhanapriyanka M, Pritchard L, Zamora A, Torwane N, Schuch HS, Ha DH, et al.

Introduction: The global rise in population ageing challenges health systems, including oral health, which is integral to overall health and quality of life. Although the World Health Organization advocates integrated care for older adults, evidence on national models integrating oral health into broader health strategies remains limited.

Aim: This review aimed to synthesise evidence on approaches that integrate oral health into general health national policy frameworks, focusing on older adults.

Methods: A scoping review was conducted using electronic searches of government domains via Google and Google Advanced in English- speaking countries, supplemented by searches of the Analysis and Policy Observatory database. Inclusion criteria were based on Population: older adults; Context: national- level health policy frameworks; Concept: integration of oral health.

Results: Of the 2616 documents retrieved from 52 countries, 1964 were screened, and 28 documents with oral health incorporated were included. The focus areas of the included documents were palliative care, mental health, disease prevention, chronic diseases, nutrition, and healthy ageing. Across the 28 included documents, oral health was mentioned in the context of 24, with nine of these referring to it only in the policy context. Oral health appeared under an objective or strategy in five documents, as an activity in three, as an indicator in two, and as a recommendation in nine documents. Oral health stakeholder representation was limited.

Conclusion: This rev iew identified th at the integration of oral health within broader nat ional health policies targeting older adults remains largely superficial, underscoring the need for deeper and more meaningful integration and intersectoral collaboration.