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.
Gaviola MA, Pedzisi S, Inder KJ, Johnson A.
Introduction: Worldwide in the population of older people, ethnic diversity is prevalent and therefore warrants culturally sensitive advanced care planning. This study aimed to explore advanced care planning documentation related to the cultural needs of residents of Chinese ethnicity in Australian aged care facilities.
Methods: A retrospective review of advanced care plan documentation was undertaken among 31 older Chinese residents with life-limiting illnesses across two residential aged care facilities in New South Wales, Australia. Data were analyzed using descriptive statistics.
Results: 90% of residents had advanced care planning documentation. The presence of the resident and their representative and medical care directives were well documented. Specific details on the provision of palliative care that considers the person's cultural needs and preferences were limited.
Discussion: Findings suggest the need for further research that explores an optimal way of embedding culture-specific information and the development of a culturally sensitive advanced care plan for people of Chinese ethnicity.
Gofton C, Bartolomeo AD, Wijekulasuriya S, Cai S, Boutros R, Stafford-Bell F, et al.
Background: Integration of palliative and supportive care in cancer treatment pathways is becoming standardised. While there has been significant qualitative research in oncology on palliative and supportive care integration into clinical care, there is little evidence that focusses on clinicians who manage hepatocellular carcinoma (HCC) and their perceptions on palliative and supportive care.
Aim: To investigate the attitudes and perceptions regarding palliative and supportive care of healthcare professionals managing patients with HCC.
Design: Qualitative study involving semi-structured individual interviews transcribed verbatim and analysed thematically.
Settings/ participants: A total of 25 healthcare professionals including hepatologists, gastroenterology trainees, hepatology clinical nurse consultants, social workers, and palliative care specialists providing care to patients with HCC recruited at 4 tertiary hospitals via purposive sampling.
Results: The following themes emerged: (1) availability of palliative care services, (2) need for clear referral pathways and processes, (3) patients' limited understanding of palliative care, (4) recognition of benefits of palliative care, and (5) the lack of training in hepatology services for palliative care provision.
Conclusion: Health professionals' perceptions of integration of palliative and supportive care in liver cancer care are hampered by multiple barriers. Opportunities to establish a more cohesive approach to care integration for patients with liver cancer have been identified. TRIAL REGISTRATION: ACTRN12623000010695 (date of registration 9/01/2023). What is already known about the topic? • Integration of palliative and supportive care for cancer can have profound benefits for patients' symptom burden and quality of life. • There is a lack of empirical studies examining the perspectives of health professionals who manage liver cancer on the integration of palliative and supportive care into the treatment pathways for patients. What this paper adds • This study identifies a number of barriers to the implementation of palliative and supportive care into liver cancer treatment algorithms. • The absence of sufficient evidence in clinical guidelines impairs the capacity of health professionals to improve the integration of palliative and supportive care for liver cancer patients. Implications for practice, theory, or policy. • As liver cancer prevalence increases, further effort is required to develop appropriate evidence-based clinical guidelines and referral pathways to support the integration of palliative and supportive care within existing liver cancer services.
Lecuyer K, Weatherburn C, Greenwood M.
Background: The gap between organ availability and the number of people waiting for a transplant remains a major healthcare issue. Most transplanted organs and tissue are received from donors who have died in intensive care units (ICUs). To increase the number of donors, national guidelines and professional bodies in Australia support routine consideration of organ and tissue donation at the end of life. Referral to donation specialists is the first important step to explore a patient's donation wishes and consider the potential for donation, but practice is variable, and not all patients receiving end-of-life care in the ICU are referred.
Objectives: The aim of this study was to investigate health professionals' experiences of making a referral for organ and tissue donation in the intensive care setting and to identify barriers and facilitators that influence practice.
Methods: A qualitative research approach with semistructured interviews and interpretive description analysis methods was used in this study. Doctors and nurses from a single tertiary referral hospital in Australia who had worked in the intensive care setting were invited to participate. Content from interviews was analysed through a process of coding and inductive thematic analysis. Nine health professionals were interviewed.
Findings: A local protocol was in place to support multidisciplinary referral for organ and tissue donation; however, there were organisational barriers and referral misconceptions that discouraged clinicians to make a referral. Nurses felt disempowered to refer and had limited knowledge of what was required. Doctors supported nurses making referrals, acknowledging that the responsibility should be shared to minimise the chance that a referral will be missed. Donation specialist nurses provided valuable support for health professionals navigating the organ and tissue donation process.
Conclusions: Research outcomes suggest the need for greater interprofessional collaboration to support a more inclusive referral culture in the ICU to optimise opportunities for organ and tissue donation.
Lovell T, Mitchell M, Powell M, Strube P, Tonge A, O'Neill K, et al.
Background: The provision of end-of-life care (EOLC) is an ongoing component of practice in intensive care units (ICUs). Interdisciplinary, multicomponent interventions may enhance the quality of EOLC for patients and the experience of family members and ICU clinicians during this period.
Objectives: This study aimed to assess the impact of a multicomponent intervention on EOLC practices in the ICU and family members' and clinicians' perceptions of EOLC.
Methods: A before-and-after interventional study design was used. Interventions comprising of EOLC guidelines, environmental and memory-making resources, EOLC education day for nurses, web-based resources, and changes to EOLC documentation processes were implemented in a 30-bed adult tertiary ICU from September 2020 onwards. Data collection included electronic health record audits of care provided post initiation of EOLC and family and clinician surveys. Open-ended survey questions were analysed using content analysis. Data from before and after the intervention were compared using the Chi-squared test for categorical variables, unpaired two-sample t-tests for normally distributed continuous measurements, and Mann-Whitney U tests for non-normally distributed data.
Findings: A reduction in documented observations and medications and an increased removal of invasive devices unrelated to EOLC were observed post the intervention. The mean overall satisfaction of family members improved from 4.5 to 5 (out of 5); however, this was not statistically significant. Statistically significant improvements in clinicians' perception of overall quality of EOLC (mean difference = 0.28, 95% confidence interval: 0.18, 0.37; t282 = 5.8, P < 0.01) were found. Although statistically significant improvements were evident in all subscales measured, clinicians' work stress related to EOLC and support for staff, patients, and their families were identified as needing further improvement.
Conclusions: The development and implementation of a multicomponent interdisciplinary intervention successfully improved EOLC quality, as measured by chart audit and family and clinician perceptions. Continuing interdisciplinary collaboration is needed to drive further change to continue to support high-quality EOLC for patients, families, and clinicians in the ICU.
Gooley M, Delardes B, Hopkins S, Oswald J, Cameron C, Nehme E.
Background: Paramedics are increasingly involved in palliative care and often support community-based palliative care service delivery to facilitate integrated practice. However, the impact of specific palliative care guidelines on clinical practice remains unknown.
Aim: To determine the impact of an ambulance service palliative care guideline on rates of supportive medication administration and non-transport.
Design: A retrospective cohort study of electronic patient care records from January 2014 to June 2023. Baseline characteristics were compared pre- and post-guideline introduction. Interrupted time series analysis was performed to examine guideline efficacy.
Seting/ participants: Patients of all ages receiving palliative care who were attended by paramedics in Victoria, Australia.
Results: A total of 31,579 patients were included. The median age was 75 years (IQR = 64-84 years), and 56.4% were men. Overall, 25.8% of patients were not transported to hospital. Following guideline introduction, there were no significant trend changes in administration of supportive medications. However, the non-transport rate increased significantly per month (0.2%, p = 0.007), amounting to a 9.9% (p = 0.020) total increase by the end of the study period compared to a scenario in which the guideline had not been introduced. Subgroup analysis of patients diagnosed with 'pain' or attended after-hours also showed significant increases in non-transport (monthly increase: pain 0.3%, p = 0.003; after-hours 0.3%, p < 0.001; total increase: pain 29.7%, p < 0.001, after-hours 22.6%, p = 0.001).
Conclusions: Introduction of a palliative care guideline was associated with a decrease in ambulance transport to emergency departments, allowing more patients continuity of care in the community.
Last updated 30 April 2024