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.
Yeo ZWE, Tieman J, George S, Farrer O.
Objective: Palliative and end-of-life care should be considered core business for aged care and healthcare teams in these settings. With a growing ageing population, the primary care workforce faces growing demand to deliver palliative care. This study aimed to explore the experiences of allied health clinicians and tertiary educators working in, and teaching, palliative care with an ageing focus in Australia.
Methods: We undertook a qualitative study using semi-structured interviews with clinicians experienced in aged and palliative care and tertiary educators delivering aged and palliative care curriculum content from four allied health disciplines (dietetics, occupational therapy, physiotherapy, speech pathology). Guided by critical realism ontology and a constructivist epistemology, reflexive thematic analysis was used for data analysis.
Results: Eleven participants were interviewed. Thematic analysis yielded two key themes and five subthemes. The two key themes were: (i) Barriers to best practice (n=4 subthemes) and (ii) Enablers of palliative care best practice (n=2 subthemes). Key barriers were that curriculum content is lacking and the medical model limits the volume and quality of care delivered. Enablers to quality care were self-directed learning and clinical experience.
Conclusion: Palliative and end-of-life care in aged care should foster reablement to support continuing agency and dignity through person-centred care. Allied health professionals are well-positioned to support this approach. However, facilitating allied health best practice will require addressing the reported barriers, including clinician preparedness and funding sufficient to meet demand and need.
Zhou M, Dray J, Parkinson A, Richardson A, Clynes L, Desborough J.
Background: Despite growing recognition of the importance of consumer engagement in advancing consumer-oriented and relevant research, many researchers experience challenges in appropriately acknowledging consumers' contributions to the research process. A pivotal aspect of this challenge relates to the financial remuneration offered to consumers in recognition of their contributions to research in terms of time, skills and expertise. This may be due to a lack and inconsistency of reported practice and guidance regarding remuneration. We sought to explore current practices for recognising consumers' contribution to health research and to understand health organisations' experiences and perspectives regarding this.
Methods: A working group convened by Research Australia comprised of two academics, one PhD candidate and eight health research organisation representatives, including consumer-led organisations, was established to develop a survey to elucidate current consumer remuneration practices in Australia. Drawing on existing consumer engagement literature, the draft survey questions were constructed and finalised following review, discussion and reaching consensus among the working group. The survey was distributed online to 503 research organisation participants across Australia from December 2023 to February 2024. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed using content analysis methods.
Results/ findings: 124 completed surveys were returned (25% response rate). 92% of participants supported recognition of consumer contributions to health research. Of this, 56% provided financial remuneration, while 36% provided non-financial forms of recognition, such as training and acknowledgement of academic outputs. However, recognition methods used in practice differed, and rates of financial remuneration varied across different levels of engagement. The need for national guidelines in consumer remuneration practice was expressed by 93% of participants.
Implications/ key mesage: These survey findings support an imperative to establish national recommendations for consumer remuneration, tailored to the needs of different organisations and contexts in Australia.
Patient and public contribution: A working group formed with eight member organisations from Research Australia, including consumer-led organisations, contributed to the survey development and interpretation of the qualitative findings by reflecting on the themes developed.
Alan JJ, Laging B, Cameron P, Laging R, Boyd J, Porock D, et al.
Objective: To explore emergency hospitalisations from Victorian residential aged care facilities (RACFs).
Methods: Retrospective descriptive study of Victorian RACFs transfers to ED from 2015/16 to 2022/23.
Main outcome measures: (1) ED event rate per 100 RACF beds; (2) Number of ED events, day/time, triage category, reason, comorbidity profile, length of stay, death within 12 months of ED presentation and costs; (3) Relationship between resident characteristics and total ED events; (4) Number of inpatient events, comorbidity profile, length of stay, intensive care use, preventable hospitalisations, diagnosis-related group, deaths and costs.
Results: The rate of ED presentations from Victorian RACFs from 2015/16 to 2022/23 ranged from 77 to 91 ED events per 100 RACF beds. Associated costs for ED and inpatient stay were over $2.8B. An advance care directive or substitute decision maker was unavailable for 84% of ED events. Eighty-seven per cent of residents presenting to ED were admitted; 90% for medical DRGs. Sixteen per cent of inpatient stays were potentially preventable under the national definition.
Conclusion: Victorian RACF residents make substantial use of hospitals. This study highlights a significant gap in advance care planning (ACP), with causes potentially linked to inadequate planning, poor document quality or lack of accessibility. To enhance hospital-RACF interactions, it is essential to identify and address unmet palliative care needs at policy, planning, and practice levels, ensuring person-centred care for residents in their final years.
Bartley N, Rodriguez Grieve L, Kirsten L, Wilson C, Sajish B, Shaw J.
Abstract: This research explored current practices, gaps in services and resources, and identified barriers and facilitators to implementing a bereavement model of care in an Australian health setting. We conducted 34 interviews with staff/volunteers who provide bereavement care to explore their practice and perceptions of care delivery. Five themes were identified through thematic and framework analysis: 1. Conceptualisation of bereavement was setting dependent; 2. Formal versus informal delivery of care; 3. Current bereavement care, referral pathways, and evaluation; 4. Barriers and Facilitators to accessing and providing care; 5. An ideal bereavement model of care. This research highlighted gaps in services and suggests a disconnect between current practice and ideal bereavement care delivery. We present an evidence-based bereaved-centred model of care, that can be tailored to fit specific health context and settings. Identified barriers and facilitators to implementing this model of care should inform strategies that underpin implementation of the model.
Collins MP, Steele P, Hackenberger L, MacIsaac C, Presneill J.
Abstract: This study aimed to characterise specialist palliative care service involvement within the intensive care unit (ICU) and subsequently in post-ICU hospital wards, and compare current ICU referral practices with those suggested by an internationally utilised ICU palliative care referral tool. This was a retrospective cohort study, carried out at a large university-associated ICU in Melbourne, Australia, and was conducted on adult patients aged at least 18 years admitted to ICU between July 2019 and July 2023. The study included 11,449 ICU admission episodes relating to 10,171 patients. The overall ICU mortality for all patients was 9% in ICU with a further 4.3% post-ICU. Within non-survivors, specialist palliative care involvement was uncommon for patients who died in ICU (78/1035, 7.5%), but substantial (287/488, 59%) for those ICU patients who died on a hospital ward after ICU discharge. Compared with ICU patients who did not have an identified palliative care referral, ICU patients with palliative care input averaged longer ICU stays with shorter hospital stays post-ICU discharge. The referral tool showed low sensitivity (39%) when compared with observed current ICU palliative care referral practice. Clinical staff within the ICU provided the majority of palliative care for ICU patients, with a palliative care consultative service taking a proportionally much greater role in post-ICU hospital wards. The selected criteria appeared inadequate for use as an effective referral tool. Future research may explore the quality of palliative care provided by ICU staff and specialist palliative care staff, and the role of decision support tools, so as to provide optimal care for critically ill patients approaching the end of life.
Last updated 30 April 2024