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.
de Freitas M, Roberts L, Cockroft A, Duke G.
Objective: Evaluate the quality of documentation and delivery of EOLC in the Intensive Care Unit (ICU) during the COVID-19 pandemic and compare with a pre-pandemic audit.
Design: Retrospective clinical audit of medical records of patients who died in ICU during the COVID-19 pandemic, January 2021 to February 2022, using the Documentation and Evaluation of Care of Dying Equation (DECODE) survey tool.
Setting: Three metropolitan adult ICUs in Victoria, Australia.
Main outcomes: DECODE audit score, patient characteristics, demographics, end of life planning, quality of death indicators, management of dying.
Results: There were 194 deaths over a 14-month period. 2 cases were excluded. Patients wishes were documented in 83 (43%) cases. A total of 175 patients (91%) were receiving active treatment 24 h before death. A total of 166 deaths (86%) were expected and occurred a mean of 4.5 (IQR 2-9) days from admission to ICU. A total of 52 (27%) had palliative or symptom control care plans. The median DECODE score was 14 (IQR 12-15) with statistical variation across the three sites (p=0.001). Compared to pre pandemic audits, the DECODE score was higher (p=0.001) despite pandemic restrictions.
Conclusion: EOLC in ICU remains challenging due to diagnostic dilemmas, prognostic uncertainty, and short time-frames. Assessment of quality of EoLC care helps assess and possibly improve provision of care. The DECODE questionnaire provides a semi-objective measure of quality of care provided to the dying patient in ICU.
Guo J, Dai Y, Chen F, Liu C, Jiang S, Hu Y, et al.
Background: Digital health (DH) provides a valuable opportunity for accessible and efficient palliative care delivery. In recent years, an expanding body of systematic reviews and meta-analyses has examined DH-based interventions in palliative care. However, their conclusions regarding effects remain inconsistent, often constrained by methodological limitations and the variable quality of primary studies, making it difficult to form a coherent appraisal.
Objective: This umbrella review aimed to examine, appraise, and synthesize previous systematic reviews and evaluate the role of DH-based services on palliative care, and to identify barriers to using DH-based services in these settings.
Methods: Systematic reviews with or without meta-analysis focusing on DH within palliative care settings were considered eligible. Seven electronic databases, including PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wangfang, and VIP, were searched for eligible studies published from inception to April 2024. The inclusion criteria were identified based on the principles of the PICOS (Population, Intervention, Comparison, Outcomes, and Study Type) framework. Two reviewers independently screened records and extracted data. Eligible studies were appraised for methodological quality using the JBI (Joanna Briggs Institute) Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. A narrative synthesis, supported by tabulated summaries of the results, was used in this umbrella review.
Results: A total of 25 systematic reviews (4 with meta-analyses) published between 2012 and 2024 met our inclusion criteria, most of which were evaluated as moderate quality. Reported outcomes ranged from symptom management effectiveness to psycho-social burden (ie, mood, distress, and emotional well-being), quality of life, caregiver burden, decision-making, cost-effectiveness, communication, self-efficacy and self-management efficacy, resource use, family empowerment, and acceptability. The effect of DH-based interventions for palliative care was basically consistent, with all included reviews reporting either significant improvements or noninferiority of DH-based interventions as compared to usual care. Technical challenges, organizational factors, ethical concerns, resource constraints, nonverbal communication, and perceptions were considered as barriers to the use of DH-based services.
Conclusions: Across included reviews, DH was found to be beneficial or noninferior to standard care, with no reported adverse effects, supporting its safety and feasibility as a mode of service delivery. To ensure successful implementation and long-term sustainability, a multifaceted strategy is needed that integrates technological enhancements and training, organizational commitment, ethical safeguards, infrastructure development, and equitable access.
Lee KKH, Johns A, Lee W, Penm J.
Background: Adjunct methadone has been used previously for cancer-related pain, but evidence on predictors for early response remains limited.
Objective: Identify the prevalence and predictors of early adjunct methadone response in palliative care patients.
Design: Retrospective cohort study.
Settings/ Subjects: Patients who initiated adjunct methadone from 2022 to 2024.
Measurement: Univariate and multivariate Poisson regression identified prevalence and predictors of early response.
Results: Among 42 patients, 28 (67%) achieved early response. They had higher baseline oral morphine equivalents, higher starting methadone doses, and shorter days to first titration (p < 0.05). Predictors included metastatic cancer (RR 3.30, p = 0.005), higher performance status (RR 2.58, p = 0.033), methadone daily dose >5 mg (RR 3.91, p = 0.013), lower baseline pain scores (RR 0.78, p = 0.025), and preserved liver function (RR 4.32, p = 0.009).
Conclusions: Metastatic cancer patients with high performance status without liver damage may benefit from a higher, proactively titrated starting dose of adjunct methadone.
Peters G, Milnes S, Simpson N, Gedye O, Kakho N, Corke C, et al.
Objective: Describe the association between the implementation of a shared decision-making (SDM) program and documentation of goals of care for critically ill patients with life-limiting illness (LLI).
Methods: A prospective longitudinal cohort study was conducted from 1st January 2015 to 30th September 2020 in an Australian tertiary teaching hospital. Adult patients with LLI admitted to the intensive care unit (ICU) were included. A SDM program consisting of communication training, a new goals of care form, and clinical support was implemented. The primary outcome was the proportion of patients with a documented SDM discussion. Secondary outcomes included patient treatment preferences and hospital utilisation parameters.
Results: A total of 1178 patients with LLI were admitted to the ICU during the study period and included in the study. Following the introduction of an SDM program, the proportion of patients with a documented SDM discussion increased from 22 % at baseline to a peak of 68 % at year five, then 60 % in year six of the study (adjusted odds ratio: 1.49, 95 % confidence interval: 1.38-1.60; p < 0.0001). Patients who had documented SDM were more likely to be older, female, frail, and have a prior advance care plan. SDM discussions resulted in higher rates of documented deterioration treatment preference plan (p < 0.0001), an increased ICU length of stay (3 vs. 2 days, p < 0.0001), referrals to palliative care services (p = 0.002), and a higher mortality rate. Time to death was significantly shorter in decedents with documented SDM compared to those without it (12 vs. 49 days, p < 0.0001).
Conclusion: The implementation of a comprehensive clinical communication training program was associated with increased documentation of shared decision-making discussions for patients in ICU with LLI, which corresponded with changes in patient treatment preferences and healthcare utilisation by decedents. Further research is required to understand the impact of these conversations from the perspective of patients and their families.
Podbury B, Gurgenci T, Huggett G, Greer R, Hardy J, Good P.
Objectives: Patients with advanced cancer experience varying physical and psychological symptoms throughout the course of their illness. Depression, anxiety and stress affect overall well-being. This study investigates the correlation between emotional distress and physical symptoms in a cohort of patients with advanced cancer.
Methods: There were 238 patients included in this study. Data from participants in two medicinal cannabis randomised controlled trials were analysed. Patients were aged over 18 years and had advanced cancer. Edmonton Symptom Assessment System, and Depression, Anxiety and Stress Scale (DASS-21) were assessed for all patients at baseline.
Results: Moderate-severe depression was reported in 29.8% and moderate-severe anxiety was reported in 47.9% of patients. The emotional subscales of DASS-21 (depression, anxiety, stress) correlated with total symptom distress score (p<0.001) and overall well-being (p<0.001). Depression was correlated with physical symptoms of fatigue, nausea, poor appetite and dyspnoea. Anxiety was correlated with fatigue and dyspnoea. Stress was correlated with fatigue, nausea and dyspnoea.
Conclusions: Depression, anxiety and stress were common in this population. The relationship between physical and psychological well-being is complex. A holistic approach to symptom management is required to improve quality of life in patients with advanced cancer.
Last updated 30 April 2024