Latest Australian research

Bloomer MJ, Bonner A, O'Connor M, Berquier I, Carlini J, Hewitt J.

Background: Voluntary assisted dying (VAD) is legal in most of Australia. Despite growing societal acceptance, clinicians’ views remain mixed, particularly in critical care.

Aim: The aim of this study was to identify and describe factors influencing critical care nurses’ support for and willingness to participate in VAD.

Methods: Convergent mixed-method study was undertaken involving (i) an online survey; (ii) individual interviews; and (iii) integration. Critical care nurses were recruited through multiple Australian nursing organisations.

Results: Forty-two critical care nurses completed the survey. Over half (57.1%, n = 21) provided end-of-life care at least monthly, 76.2% (n = 32) had at least some knowledge of VAD, and 92.9% (n = 39) were supportive of VAD. Almost all (97.6%, n = 40) were willing to participate in VAD by providing care, advice, or support to a person requesting VAD (97.6%, n = 40), even if family members did not agree (92.7%, n = 38), to care for a person after taking the VAD substance (92.7%, n = 38), and to be present at death (92.7%, n = 38). Willingness reflected respondents’ support for patient choice, autonomy, and alignment with professional obligations and personal values. Critical care nurses’ cultural beliefs, religion/spirituality, and workload concerns were less important. Eight critical care nurses were interviewed, providing greater detail about VAD in the intensive care unit (ICU) with three themes identified: (i) the complex context, describing tensions with the momentum of ICU care; (ii) if it’s the person’s wishes, upholding patient autonomy and choice; and (iii) VAD fit and function, reflecting scope of practice and legal concerns and the essential skills for participation. Nurse practitioners were universally regarded as possessing the skills and relational qualities necessary for VAD participation.

Conclusions: Critical care nurses showed strong support for VAD, and a willingness to provide VAD-related care, grounded in professional values and commitment to patient autonomy. Policy and practice frameworks formally recognising critical care nurses’ role in VAD in the ICU are essential.

Dadich A, Rowley G, Ooi C, Eliott J, Laurence C.

Objective: The objective of this scoping review is to describe models of palliative care for under-served populations in high-income countries, defined as adults of culturally and linguistically diverse communities, low socioeconomic status, and/or residing in rural areas.

Introduction: Models of palliative care are processual, referring to the way palliative care services are delivered as people experience a condition, injury, or event. The aim of these models is to ensure people get the right care, at the right time, by the right team, in the right place. Evidence suggests there is a wide variety of models of palliative care, but what is not known is how these models can vary to meet the needs of under-served populations.

Inclusion criteria: This scoping review will consider articles that focus on models of palliative care for under-served populations, irrespective of sex, age, or primary diagnosis.

Methods: MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), Emcare (Ovid), CINAHL (EBSCOhost), and Scopus will be searched for articles, irrespective of language, published from 2014. Two independent reviewers will screen titles and abstracts, followed by a full-text review of potentially relevant articles. Discrepancies will be reconciled with another reviewer. Two independent reviewers will extract data from included articles using a data extraction tool developed for this review. Results will be tabulated and/or presented diagrammatically, as well as summarized to explicitly address the objective of the review.

Review registration: Open Science Framework osf.io/x4ky3.

Edwards CE, Mao L, Rhee J, Sinclair C.

Objectives:  Examine how older adults with life-limiting conditions engage in meaning-making for coping and growth, and how individual needs and attributes shape these processes.

Method: An integrative review across health and psychosocial disciplines was conducted, incorporating qualitative, quantitative, mixed-method, and theoretical literature. Fifty-eight peer-reviewed records were analysed using reflexive thematic analysis.

Results: Four interrelated themes were identified: (1) adjusting global meaning (e.g. core beliefs and purpose) helped buffer distress by aligning it with situational meaning. (2) Disrupted life trajectories compressed time for meaning-making; distress, rumination, and cognitive rigidity impeded integration, while social comparison and reminiscence supported adaptation. (3) Reminiscence, motivated by awareness of life’s finitude, supported identity continuity and psychological conflict resolution, though unresolved regrets could evoke existential distress. (4) Meaning-making was temporally integrative, connecting past experiences, present awareness, and anticipated futures; strategies such as positive reframing, acceptance, and legacy-making fostered coherence and hope.

Conclusion: Meaning-making in older adults with life-limiting conditions is a dynamic, temporally integrative process shaped by cognitive flexibility and adaptive strategies. Significant gaps remain, including limited research on cognitive decline, theoretical inconsistency, and poorly understood intervention mechanisms, which must be addressed to support quality of life, meaning-in-life, and dignity in later life.

Johnson K, Poudel A, Ayalew AA, Thepsourinthone J, Heer S, Morgan D, et al.

Context: Early identification of palliative care needs in primary care is increasingly recognized as essential, yet the implementation of screening tools remains inconsistent and challenging.

Objectives: To identify the implementation of screening tool protocols in primary care for early identification of patients with palliative care needs, and to describe enablers or barriers influencing their uptake and integration into routine practice. This review also sought to map the methodologies, theoretical frameworks, and screening measures employed.

Methods: This scoping review was guided by the Arksey and O'Malley framework. Literature was retrieved from the MEDLINE, CINAHL, Scopus, and Cochrane databases, focusing on screening tools for early identification of palliative care needs in primary care. Articles published in English between January 2015 and March 2025 were included. The Consolidated Framework for Implementation Research (CIFR) was used as an overarching categorizing structure for synthesizing the identified barriers and facilitators.

Results: A total of 3,140 articles were identified, and 174 were included for full-text screening. In total, 25 studies were included in the review. The implemented tools varied in their application and integration within primary care settings. Key barriers to implementing palliative care screening protocols in primary care included time constraints, doubts about the tool's value, limited resources, poor communication, unfavorable funding models, and sociocultural attitudes toward palliative care. Facilitators included integration with electronic health records, the presence of clinical champions, early reframing of palliative care, clearly defined roles, and tailored training initiatives.

Conclusion: Implementation of screening tools in primary care remains challenging due to contextual, organizational, and individual-level factors. Successfully embedding these tools into practice requires tailored context-sensitive strategies that are co-designed with interprofessional communication and informed by the principles of implementation science.

Aakataa M, Khalil H.

Background: Palliative care requires timely and accurate assessment to support patient-centred outcomes. However, existing tools vary widely in purpose, design, and implementation. Understanding the current landscape of available tools is essential to guide future innovation. This review aimed to systematically identify and map published literature on palliative care assessment tools, focusing on their purpose and domains assessed, with consideration of reported validation, usability, and implementation characteristics.

Methods: Scoping review conducted using the Joanna Briggs Institute (JBI) methodology and reported according to the PRISMA-ScR checklist. Ovid MEDLINE, CINAHL, and the Cochrane Library were searched for peer-reviewed studies published in English from 2005 to 2024. Studies were included if they assessed tools used in palliative care populations for symptom assessment, quality of life, early identification, psychosocial evaluation, or caregiver support. Study screening, data extraction, and synthesis were completed in Covidence.

Results: A total of 299 studies from over 40 countries were included, representing 813,819 participants. The Edmonton Symptom Assessment System (52.1%) was the most frequently used tool. Most tools focused on symptom assessment (27%) and quality of life (22%), with limited attention to caregiver burden (4%), spiritual wellbeing (4%), or social support (4%). Ninety-four studies (31%) reported positive perceptions of tool utility, and one reported a negative outcome. Key gaps included cultural adaptation, digital integration, multi-user access, and holistic scope.

Conclusion: Although many tools support clinical assessment, few address the complexity of holistic, person-centred care. There is an urgent need for co-designed, culturally sensitive, and digitally enabled tools to support equitable palliative care delivery.