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.
Lizzio-Wilson M, Thomas EF, Louis WR, Crane MF, Kho M, Molenberghs P, et al.
Abstract: Prior work has documented considerable diversity among health practitioners regarding their support for voluntary assisted dying (VAD). We examined whether their attitudes are characterised by different combinations of personal support, normative support by other health practitioners, and whether they are predisposed to vicariously experience others' emotions (i.e., empathy). We also examined whether these profiles experienced different mental health outcomes (i.e., burnout and posttraumatic stress) in relation to VAD. To test this, 104 Australian health practitioners were surveyed after VAD was legalised in Victoria, Australia in 2019. Results indicated that practitioners' attitudes were characterised by three profiles: 1) strong personal and normative support (strong VAD supporters), 2) moderate personal and normative support (moderate VAD supporters), and 3) lower personal and normative support (apprehensive practitioners). However, each profile reported similar mental health outcomes. Findings suggest that the normative environments in which health practitioners operate may explain their diverse attitudes on VAD.
Meehan E, Parker C, Ayton D, Katz N, Gold M, Wang Y, et al.
Background: Current research has shown that inpatient palliative care (PC) services are under-utilized, poorly integrated, and frequently introduced too late during inpatient hospital stays. The aim of this study was to identify a comprehensive list of multi-disciplinary facilitators and barriers to inpatient PC in Australian hospitals through a scoping literature review.
Methods: This review identified articles published since 2000 from 3 electronic databases (CINAHL Plus, MEDLINE and Embase), which included discussion of collaboration among non-palliative care clinicians and palliative care professionals in Australian hospitals. We used an inductive approach to identifying key domains of barriers and facilitators.
Results: Thirty-four articles met inclusion criteria following full text review. Barriers and facilitators were categorized in 7 domains: (1) Patient concerns, (2) Family concerns, (3) Clinician knowledge, education, and experience in palliative care, (4) Recognition and acceptance of prognosis when a patient was dying or needing end of life treatment, (5) Reconciliation of individual and professional values around PC, (6) Clinician access to resources for PC in the hospital, and (7) Communication between the PC team and ward clinicians. Each domain included potentially substantial barriers to PC delivery and practice. However, given the small sample sizes and specialized settings of many included studies, it was difficult to draw conclusions on the relative significance of different barriers across hospitals.
Conclusion: This review identified a number of barriers and facilitators across studies. Subsequent research needs to more comprehensively compare factors impacting PC use in order to improve implementation of PC across hospital settings.
Vandersman P, Tieman J.
Background: The residential aged care (RAC) sector provides care to a significant number of older people across frail and vulnerable years, all the way through to death. As such, palliative care, and considerations for end-of-life caring, need to be considered as core in aged care practice in Australia.
Aim: To explore how RAC nurses understand, describe, and provide care to people who are in the last months of life.
Methods: A qualitative descriptive research study design based on the secondary analysis of data collected as part of a larger study. Focus groups and semi-structured interviews were conducted with RAC nurses working in Australia using video conferencing software and telephone. Data collected was managed using the NVivo software and analysed using reflexive thematic analysis.
Results: Sixty-four participants from 14 RAC services across three Australian States took part in study. Four themes emerged from the analysis of the data, namely: (1) The last months of life have unique caring needs; (2) Identifying the last months of life is complex (3), Care provision is driven by task orientation, and (4) Good end-of-life care is acknowledged yet limited. Participants highlighted differences in the needs of older people experiencing gradual decline versus those in the terminal stage. Early discussions about death with families and residents were deemed valuable, but resource constraints limited the opportunities of quality one-on-one care.
Conclusions: Nurses see value in recognising early health decline and identifying residents nearing end-of-life, but workflow and resource limitations hinder their ability to engage effectively. Developing and implementing resources and processes to enable nurses to identify early decline and deliver timely, quality end-of-life care is imperative.
Virdun C, Singh GK, Yates P, Phillips JL, Mudge A.
Background: Population ageing and rising levels of non-communicable diseases are increasing the number of people living with and dying from advanced serious illnesses globally. Many of these people are hospitalised more than once in their last year of life. While there is sound evidence on what patients and their families require for safe and high-quality hospital palliative care, enabling this remains a challenge. This study aimed to understand the clinician, team, and organisational-level barriers and enablers to integrating good palliative care into acute care.
Methods: An exploratory-descriptive, qualitative study involving semi-structured interviews and practical thematic analysis was conducted. Medical, nursing and allied health disciplines were recruited from three wards (cancer care, mixed general medicine/renal and mixed general medicine/respiratory) within a large Australian metropolitan hospital.
Results: Eighty-eight interviews (nursing (n = 39); medicine (n = 24); allied health (n = 25)) were undertaken, with a median duration of 25.5 min (range 5 to 55 min). Most participants were female (n = 73, 83%), holding a Bachelor's degree (n = 86, 98%) and ranged from new graduates to participants with over 40 years of post-registration experience. The analysis generated six themes, reflecting the challenges of providing optimal palliative care within acute hospital wards: 1. Understanding when and how to provide palliative care 2. Negotiating shared or changing medical governance in a siloed system 3. Supporting clinicians with the knowledge, skills and confidence to meet palliative care needs 4. Prioritising palliative care amidst the acute care demands of the hospital 5. Optimising the clinical environment to enable private, restful and family-friendly spaces 6. Harnessing organisational support and multidisciplinary clinical leadership
Conclusions: This study reveals complex, multi-level organisational barriers to integrating palliative care within the acute hospital which will need to be addressed for effective and sustained improvement. Harnessing organisational support and multidisciplinary clinical leadership is key to successful change. Improvements with a focus on developing clinician knowledge, skills, and confidence in palliative care need to pay attention to organisational siloes that constrain shared care, cultures of care that prioritise cure and efficiency, clinical uncertainty in the context of advanced serious illness and optimising the environment for quality palliative care.
Winsall M, Devery K, Phelan C.
Aim: To explore the key advice healthcare professionals would give colleagues regarding end-of-life care delivery in hospitals, thereby informing training needs.
Design: Exploratory qualitative study.
Methods: Free-text responses from medical, nursing, and allied health professionals who completed online end-of-life care education modules (n = 597) from August 2022 to September 2023 were analysed using inductive content analysis. Results were explored and separated into two key findings: themes that were shared by all professional groups and themes that were profession specific.
Results: Five themes were consistent across all three professional groups: prioritise patient comfort, proactive communication, collaboration and inclusion, human approach and support and wellbeing, each with their own subthemes. Several profession specific subthemes were also identified.
Conclusion: The identification of common themes across healthcare professions helps to support the development of interprofessional training initiatives.
Implications for profession and/ or patient care: This research contributes valuable insights for developing targeted end-of-life care education programs. Results also underscore the potential of online learning platforms in providing accessible, evidence-based, continuing professional development in end-of-life care.
Impact: In Australia, most deaths occur in acute hospital settings. To inform and shape future training, this study collected the key advice healthcare professionals would give colleagues regarding end-of-life care delivery. The themes generated covered a range of potential training topics shared across all professionals, including prioritise patient comfort, proactive communication, collaboration and inclusion, human approach and support and wellbeing. Several profession-specific subthemes were also identified, providing additional insights for designing training for professional groups. Results underscore the potential of online learning platforms in providing accessible, evidence-based, continuing professional development in end-of-life care.
Last updated 30 April 2024