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.
Luckett T, Razmovski-Naumovski V, Garcia M, Phillips J, Chye R, Noble B, et al.
Background: Clinical trials are underway of medicinal cannabis for cancer-related anorexia, using various formulations and modes of administration.
Objectives: To explore the benefits and burdens of vaporized medicinal cannabis flower bud for anorexia from the perspectives of trial participants with advanced cancer and their carers.
Design: People with advanced cancer enrolled as inpatients in a Phase I/IIb clinical trial, and their carers participated in face-to-face semi-structured interviews. Analysis used the framework method.
Setting: Inpatient specialist palliative care.
Results: Ten out of 12 trial participants and 6 carers were interviewed. All perceived benefits to eating but, in two cases, this arose from reduced nausea rather than appetite stimulation. Carers sometimes perceive more benefit than patients. Psychoactive effects were well-tolerated and even enjoyed. Burdens included throat irritation and adverse smell and taste, but these were transient.
Conclusion: Vaporized flower bud warrants comparison with other formulations/modes of medicinal cannabis for cancer-related anorexia.
White D, Barham D, McEniery J, Mherekumombe M, Bridge D.
Background: Spiritual pain and distress are commonly unrecognised among patients receiving palliative care, yet engaging with a person's spirituality can allow healing to occur even amid suffering. Palliative care clinicians lack training in assessing and managing spiritual distress among patients.
Objectives: Development of a virtually delivered spirituality workshop to improve clinicians' understanding of their own spirituality and confidence in addressing the spiritual dimension of patients' experience.
Method: 32 palliative care clinicians across Australia and New Zealand attended four 1.5-hour sessions across consecutive weeks, with additional pre-session and post-session written and audiovisual content. Participants completed a pre-post evaluation survey, rating their confidence in knowledge and skills relating to the provision of spiritual care.
Results: All participants completed at least three of the four workshop sessions, and 19 responded to the pre-post evaluation survey. Confidence ratings across all skills significantly improved following the workshop. Most participants reported improved confidence in taking a spiritual history, assessing patients for spiritual issues and managing patients experiencing spiritual pain. All reported that they would recommend the workshop to a colleague, and most (11/19) felt virtual delivery of the workshop was appropriate for the content and activities.
Conclusions: Spirituality training can be safely and effectively delivered through a virtual workshop for palliative care clinicians. The training was highly valued and deepened participants' understanding of their own spirituality. Further exploration of how virtual and face-to-face learning can be combined may identify a flexible and engaging experience for learners.
Grove GL, Lovell MR, Butow P, Hughes I, Best M.
Objectives: This study explored Australian palliative care clinicians' perspectives on the legalization of voluntary assisted dying (VAD), aiming to identify variables associated with clinicians' views and understand challenges of its implementation.
Methods: An online survey exploring support for legalization of VAD was sent to palliative care clinicians in Queensland and New South Wales and followed up with semi-structured interviews. Support was categorized as positive, uncertain, or negative. An ordinal logistic regression model was used to identify variables independently predictive of euthanasia support. Interviews were analyzed using grounded theory to understand key concepts shaping views on VAD.
Results: Of 142 respondents, 53% supported, 10% were uncertain, and 37% opposed legalizing euthanasia for terminal illness with severe symptoms. Support was lower for patients with chronic illness (34%), severe disability (24%), depression (9%), severe dementia (5%), and for any adult with capacity (4%). The model showed lower support among doctors than nurses (38% vs. 69%, p = 0.0001), those in New South Wales compared with Queensland (44% vs. 69%, p = 0.0002), the highly religious versus least religious (24% vs. 79%, p = 0.00002), those politically conservative versus progressive (39% vs. 60%, p = 0.04), and those with more healthcare experience (p = 0.03). Seventeen interviews revealed 2 distinct groups: one focused on the event of death and the need to relieve suffering, providing comfort in the final moments; the second on the journey of dying and the possibility of discovering peace despite suffering. Those in the first group supported legal VAD, while those in the second opposed it. Despite opposing views, compassion was a unifying foundation common to both groups.
Significance of results: There are 2 fundamentally different orientations toward VAD among palliative care clinicians, which will likely contribute to tensions within teams. Acknowledging that both perspectives are rooted in compassion may provide a constructive basis for navigating disagreements and supporting team cohesion.
Jahan S, Lindsay D, Diaz A, Li M, Cunningham J, Garvey G.
Objective: To quantify costs incurred by the health system for hospital episodes and emergency department (ED) presentations for pancreatic cancer patients within the first three years after diagnosis in Queensland, Australia.
Study settings and design: Using a linked administrative dataset, CancerCostMod, which includes cancer diagnoses from the Queensland Cancer Registry (1st July 2011-30th June 2015) and linked Queensland Health Admitted Patient Data Collection and ED Information Systems records (1st July 2011-30th June 2018), we assessed costs for adults diagnosed with primary pancreatic cancer (International Classification of Diseases, 10th Revision: C25). Costs (in Australian dollars) were assigned using national public costs and private hospital charge datasets for the relevant year. Descriptive analyses were conducted to evaluate hospital and ED utilization and costs. Cost variations across sociodemographic and clinical characteristics were assessed using Kruskal-Wallis or Mann-Whitney U tests.
Principal findings: Among 2082 individuals diagnosed with pancreatic cancer, hospital episodes (n = 26,405) in the first three years after diagnosis cost a total of $100.7 million; median cost per patient was $36,832. For ED presentations (n = 4228), corresponding figures were $3.6 million (total) and $963 (median per patient). Most of the total hospital (81%) and ED (79%) costs occurred in the first year after diagnosis. Patients who survived ≤ 6 months had the lowest median cost per patient but accounted for 38% of total hospital costs. Median cost per patient varied substantially by socio-demographic (i.e., Age groups, Indigenous status, socio-economic disadvantages) and clinical characteristics (i.e., comorbidity, cancer morphology, location of tumor, tumor resection, palliative care).
Conclusions: Our findings highlight the significant economic burden of pancreatic cancer on the healthcare system, especially within the first year. Targeted strategies are essential to optimize healthcare delivery, ensure equitable access, and improve outcomes.
Marston C, L'Etang M, Philip J, Morgan DD, Edbrooke L, Chang S, et al.
Objectives: Carers are critical to support discharge home from hospital at end of life yet remain under-represented in health service initiatives to assist this transition. A carer-focused intervention embedded into practice may facilitate hospital discharge. This open-labeled, single-arm phase 2 study aimed to determine the feasibility of (1) delivering a multi-staged intervention (CARENET) to carers of advanced cancer patients in a hospital setting and (2) the study design to inform a phase 3 trial.
Methods: CARENET, delivered before and after discharge to address carer support needs, was tested in an Australian specialist cancer hospital. Eligible participants included carers of advanced cancer inpatients with planned discharge home. The primary outcome was intervention and trial feasibility (recruitment and adherence). Secondary outcomes were eligibility and effects of intervention on outcomes including carer preparedness.
Results: Of the 382 potential patient-carer dyads, 25 were recruited within required time frames. The intervention adherence outcome feasibility threshold of 80% of carer participants completing all 3 core components of CARENET was not achieved (60% completion). Trends in improvement in overall carer levels of preparedness were observed from baseline to discharge home (n = 12; mean [95% CI]) 0.5 [-0.0007, 1.007]). However, a downward trend in preparedness to provide emotional care after discharge was observed (n = 12; mean [95% CI] 0.25 [-0.30, 0.80]).
Significance of results: Delivering all elements of the CARENET intervention to address carers' needs in the discharge planning context was not feasible. However, some elements were feasible, including identifying and responding to carer need, whilst completing elements after discharge were less feasible. Findings can be explained by problems with adherence, eligibility, and clinician barriers to fitting a multi-staged carer intervention into an acute healthcare setting. Future research should test a more adaptable intervention and delivery model that is accessible to all carers across and compatible with acute care settings.
Last updated 30 April 2024