Latest Australian research

Lee CW, Wong AB, Lazarakis S, Lim WK, Darvall J.

Background: Identifying surgical patients at the end of life (EOL) is the first step in integrating palliative and perioperative practices. Palliative prognostic tools (PPTs) are established frameworks from palliative care that assess patients at risk of early death. We conducted a systematic review investigating PPTs in adult surgical populations, their role in surgical decision-making, and their association with perioperative outcomes.

Methods: A prospectively registered systematic review was performed (PROSPERO registration: CRD42023411303). Ovid MEDLINE, Ovid EMBASE, and Cochrane CENTRAL (Wiley) databases were searched for studies investigating PPTs in surgical patients. The primary outcome was the decision to proceed to surgery; secondary outcomes included mortality, quality of life, palliative care consultation, and EOL documentation completion. Abstract screening, full-text review, and study quality appraisal were performed by two authors independently. Results were synthesised narratively owing to study heterogeneity.

Results: Seven studies assessing four different PPTs were included in the review. Studies identified that 12-61% of surgical patients were at the EOL. Patients identified as being at the EOL by a PPT using an illness phase, trajectory approach, or both had an increased in-hospital and 12-month mortality. The impact on decisions to proceed to surgery was uncertain because of conflicting results. Palliative care referral and EOL document completion occurred in <15% of surgical patients at the EOL. No studies described patient-reported outcomes.

Conclusions: Palliative prognostic tools have significant potential for incorporation into preoperative assessment. Future research should focus on preoperative end of life assessments and patient-reported outcomes such as quality of life, decision satisfaction, and disability-free survival.

O'Neill K, Brooks L, Manias E, Bloomer MJ.

Background: Australia is culturally and linguistically diverse. Yet little is known about perceived barriers to the provision of end-of-life care tailored to diverse cultural needs and preferences.

Aims: The aim of this study was to measure critical care nurses' cultural intelligence, comfort, and capabilities in providing end-of-life care and explore the perceived barriers to providing end-of-life care for culturally diverse patients and their families.

Method: An explanatory mixed-method approach was undertaken utilising surveys and interviews. A national survey was distributed in February 2024, collecting data about critical care nurses' capability, comfort, and cultural intelligence when providing end-of-life care. Individual interviews were conducted with nurses between March and April 2024. Quantitative data were analysed using descriptive and inferential statistics, and open-ended survey and interview responses were analysed using inductive content analysis.

Findings: From the sample of 89 survey responses, the median number of years nurses worked in the intensive care unit was 15 (interquartile range = 7.0-21.5). Respondents came from 14 different countries, 20.2% (n = 18) spoke a second language, and 50.6% (n = 45) were affiliated with a religion. One-third had completed end-of-life care training (34.8%, n = 31), whilst 31.5% (n = 28) had completed training in cultural diversity. Respondents who completed end-of-life care training had significantly higher comfort and capability scores regarding end-of-life care provision (Mdn = 91.0) than those with no training (Mdn = 80.5, U = 1301.0, p < 0.001). Interview participants acknowledged some discomfort with diversity, and the importance of prioritising comfort and dignity, and understanding and interpreting cultural preferences. Communication challenges associated with professional interpreter access were also identified.

Conclusion: Critical care nurses' comfort and capabilities with end-of-life care and perceptions of the barriers are critical to understand because end-of-life care is about more than clinical care. Supporting nurses to build their understanding and comfort with providing care that aligns with cultural and religious needs and preferences, and optimising access to professional interpreters, is imperative.

Attia J, Kelly B, Best M.

Abstract: 

In Ancient Greece, when treating patients whose condition was incurable, physicians would sometimes use poisons and other techniques, hastening death in order to relieve suffering. The Hippocratic Oath was revolutionary in its time, going against such practices by swearing to “neither give a deadly drug to anybody if asked for it, nor making a suggestion to this effect.” While this has been a foundational text of western medical ethics for over 2000 years, Voluntary Assisted Dying (VAD) has shaken this foundation.

As physicians in Palliative Care, Psychiatry, and Bioethics, we have noticed that many of our colleagues feel ill-equipped to have discussions with patients surrounding VAD; while the pros of VAD are familiar from popular media, the cons are much less so. We believe that doctors need to understand both sides of the argument in order to have balanced and informed discussions with their patients. In this spirit, we offer a reflection on what we have found to be common assumptions when discussing VAD (see summary in Table 1). By necessity, this means exploring the moral and religious perspectives that underpin our medical practice.

Brooksbank MA.

Abstract: This is a shortened version of the personal reflections of the early developments of palliative care in Adelaide, South Australia delivered as the Rosalie Shaw Oration at the Australia and New Zealand Society of Palliative Medicine conference, Adelaide 6 September 2024: 30 years of palliative medicine: constructing, challenging and transforming.

Cooper AL, Martin-Robins D, Panizza N, Coppock S, Brown JA.

Aim: To gain an understanding of palliative care need and provision in adult medical and surgical inpatients.

Design: An observational point prevalence study was conducted across four study sites in Western Australia.

Methods: All data were collected directly from patient medical records by Registered Nurses. Potential palliative care need was assessed using disease-specific indicators for the 12 conditions outlined in the Gold Standards Framework Proactive Indicator Guidance.

Results: A total of 865 medical and surgical inpatients met study inclusion criteria. Across the four study sites, 38% (n = 331) of adult inpatients reviewed could have potentially benefitted from palliative care. Of the n = 331 patients assessed as having indicators for palliative care, there was evidence that 27% (n = 90) were currently receiving some form of palliative care, while 3% (n = 9) had been referred for specialist palliative care. For the majority of patients (70%, n = 232) there was no evidence of them receiving any form of palliative care or awaiting specialist palliative care.

Conclusion: This study identified high levels of potential palliative care need among adult medical and surgical inpatients. The majority of the patients identified as having indicators for palliative care were not receiving any form of palliative care.

Implications for the profession and/ or patient care: The high prevalence of palliative care need found in this study highlights that recognising and addressing palliative care is essential for high-quality care for medical and surgical inpatients. To address the high level of need identified all nurses require basic palliative care training to provide optimal patient care.

Impact: Knowledge about the level of palliative care need and provision of palliative care in public hospitals was limited. This study identified a high prevalence of potential palliative care need in medical and surgical inpatients. The majority of patients with indicators for palliative care were not receiving any form of palliative care. This research demonstrates that palliative care needs should be considered by all registered nurses and other health professionals caring for medical and surgical inpatients.