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.
Broom A, Kenny K, Ehlers N, Byrne H, Good P.
Abstract: Perhaps the most valuable asset in our cultural imaginary is time. Yet, this notion of time-as-asset intensifies, is contested, and is often derailed at the end of life. When faced with death, time can become many things, including both personal and interpersonal asset and liability. Bringing the concept of time and dying into focus, this paper draws on qualitative interviews with 15 people nearing death in an Australian specialist palliative care unit. We examine the normative expectations of time and its unravellings in their lived experiences, findings which are critical given time near death has not been extensively studied. We consider five key themes, 'agency and physical decline across time', 'negotiating the time of death', 'the relational affordances of waiting', 'resisting prognostic time', and 'the cost of waiting', all relations to and in time, that were variously woven through people's accounts of the end of life. These themes highlight connections between time and agency, juxtapositions of swiftness and sometimes interminable slowness, and how busyness and paralysis play crucial roles in the practices of dying. Sitting in stark contrast to the rather typical representation of time as a 'good' to be protected or used 'well', especially close to death, more nuanced accounts of dying-in-time emerge, highlighting tensions, troubles, and vitalities as we all collectively confront the end (of life/time).
Cameron J, Stewart C, Savulescu J.
Abstract: This column discusses the New South Wales Supreme Court decision in H v OL [2024] NSWSC 271. That decision raises a number of issues about how the "best interests" principle is employed in cases where disputes arise about whether life-sustaining treatments should be withheld or withdrawn from children. The column argues that these cases would be better served by adopting the "balance sheet" approach that is employed in England and Wales.
Feeney R, Willmott L, White B.
Abstract: The law plays an important role in governing end-of-life decision-making in paramedic practice. A scoping review was undertaken to identify and examine the extent, range and nature of literature on the legal issues relevant to end-of-life clinical practice for Australian paramedics. Documents (scholarly works and/or policies) were identified by searching electronic databases, Google Scholar, professional organisation and State/Territory health department websites, scanning reference lists and drawing on authors' existing knowledge. Sixteen of the 22 documents identified were policies, including clinical practice guidelines or similar documents from the various State/Territory Ambulance services, and policies from State/Territory Health Departments or resuscitation organisations. Common legal issues were consent to treatment, decision-making capacity, withholding and withdrawing life-sustaining treatment, advance care planning, substitute decision-making, emergency treatment and children and end-of-life decision-making. Gaps included documents focusing on paediatric clinical practice and broad practice guidelines on end-of-life care for paramedics working in some jurisdictions.
Grove GL, Lovell MR, Hughes I, Maehler E, Best M.
Background: Discussions about euthanasia and physician-assisted suicide (EAS) involve various stakeholders, including patients, healthcare professionals and the general public. This review examines perspectives across different population subgroups to contribute to a broader understanding of EAS attitudes.
Methods: A systematic review of literature published prior to July 2023 with quantitative data about EAS views was undertaken. Details extracted from eligible papers included data year, geography, demographic features of population subgroups and levels of support for EAS under various circumstances. Proportions in support for EAS were calculated based on these factors. Meta-analyses were conducted to estimate changes in the proportion of support for euthanasia dependent on the presence or absence of pain or terminal illness in patients.
Results: The search identified 521 relevant studies. There were 1863 relevant survey questions with 1 945 945 individual responses, spanning years 1936 to 2023.478 studies explored whether EAS should be allowed, 134 examined clinician willingness to practise EAS and 78 investigated which persons might seek EAS. Clinician views were surveyed in 266 studies, public opinion in 139 and patient beliefs in 54.Support for EAS across studies and subpopulations varied widely. Mean support for EAS was lower in doctors than in the general public (25% compared with 55%). Support varied depending on access criteria to EAS with 54% support for patients in pain vs 36% for those without and 53% for terminally ill patients vs 29% for those without a terminal illness. Public support for EAS was lower in religious people, females, older people and African Americans.
Conclusions: Support for EAS varies widely across studies, with numerous demographic and situational factors associated with differing levels of support. This indicates a complex interplay of elements is involved in the formation of EAS beliefs. Understanding these factors is valuable for facilitating meaningful discussions among clinicians and the community and informing policy debates and decisions.
Russell L, Howard R, Street M, Johnson CE, Berry D, Flemming-Judge E, et al.
Objective: International standards of end-of-life care (EOLC) intend to guide the delivery of safe and high-quality EOLC. Adequately documented care is conducive to higher quality of care, but the extent to which EOLC standards are documented in hospital medical records is unknown. Assessing which EOLC standards are documented in patients' medical records can help identify areas that are performed well and areas where improvements are needed. This study assessed cancer decedents' EOLC documentation in hospital settings.
Methods: Medical records of 240 cancer decedents were retrospectively evaluated. Data were collected across six Australian hospitals between 1/01/2019 and 31/12/2019. EOLC documentation related to Advance Care Planning (ACP), resuscitation planning, care of the dying person, and grief and bereavement care was reviewed. Chi-square tests assessed associations between EOLC documentation and patient characteristics, and hospital settings (specialist palliative care unit, sub-acute/rehabilitation care settings, acute care wards, and intensive care units).
Results: Decedents' mean age was 75.3 years (SD 11.8), 52.0% (n = 125) were female, and 73.7% lived with other adults or carers. All patients (n = 240; 100%) had documentation for resuscitation planning, 97.6% (n = 235) for Care for the Dying Person, 40.0% for grief and bereavement care (n = 96), and 30.4% (n = 73) for ACP. Patients living with other adults or carers were less likely to have a documented ACP than those living alone or with dependents (OR 0.48; 95% CI 0.26-0.89). EOLC documentation was significantly greater in specialist palliative care settings than that in other hospital settings (P < .001).
Conclusion: The process of dying is well documented among inpatients diagnosed with cancer. ACP and grief and bereavement support are not documented enough. Organizational endorsement of a clear practice framework and increased training could improve documentation of these aspects of EOLC.
Last updated 30 April 2024