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.
Gebresillassie BM, Attia J, Cavenagh D, Harris ML.
Background and objective: Proactive palliative interventions can improve symptom control and quality of life in individuals with chronic obstructive pulmonary disease (COPD); however, they are often underutilised. This study aimed to develop and validate a prediction model to identify women with COPD in their last year of life to facilitate timely palliative care referrals and interventions.
Methods: Data from 1236 women diagnosed with COPD from the 1921-1926 Australian Longitudinal Study on Women's Health cohort, linked to administrative health records, were analysed. We employed Lasso regression and multivariable logistic regression to select predictors. To assess the predictive performance of the model, we used the area under the receiver operating characteristic (AUROC) curve, calibration plot, and calibration metrics. The Youden index was used to establish the optimal cutoff point for risk classification. The clinical utility of the model was evaluated using decision curve analysis (DCA).
Results: The final model to predict 1-year all-cause mortality included six predictors: smoking status, body mass index, needing regular assistance with daily activities, number of supplied medications, duration of illness, and number of hospital admissions. The model performed well, with AUROC of 0.82 (95% CI: 0.80-0.85) and showed excellent calibration. Using a cutoff of 56.6% predicted risk, the model achieved a sensitivity of 72.3%, specificity of 77.7%, and accuracy of 75.0%. The DCA indicated that the model provided a greater net benefit for clinical decision-making.
Conclusions: Our prediction model for identifying women with COPD who may benefit from palliative care has shown robust predictive performance and can be easily applied, but requires external validation.
Goh AMY, Gerber K, Lock K, Gaffy E, Hwang K, Lane A, et al.
Background: The quality of palliative and end-of-life care (EOLC) in residential aged care (RACFs) is variable, and often suboptimal. The aim of IMPART is to improve palliative care in RACFs. IMPART provides online training and telehealth palliative-geriatric support to aged care staff and family physicians/general practitioners (GPs) to enable timely EOLC discussions, clinical support, and improve documentation of care preferences. This may lead to preference-based care, reduction of unplanned hospitalization, and improved quality of life and EOLC. This protocol describes a study to evaluate the effectiveness, cost, and implementation process of the IMPART intervention.
Methods: This study is a pragmatic, stepped-wedge, cluster randomized controlled trial across 10 RACFs to evaluate the IMPART intervention. Clusters are randomly assigned to intervention or control groups. The IMPART intervention group 1) receives timely end-of-life support from specialist In-Reach teams using telehealth; 2) engages RACF staff and GPs in a Planning Ahead Team to reflect on current practices and co-design an Action Plan to improve EOLC planning and processes; 3) receives an online interactive, needs-based EOLC education program for staff and GPs working in RACFs. The control groups receive the IMPART intervention in subsequent waves. The primary outcome measure is reduction of unplanned hospital admissions and avoidable hospital transfers for residents at end-of-life when appropriate care in their RACF is possible and consistent with residents' wishes. Secondary outcomes include reduction of emergency department presentations and length of stay of unplanned hospital admissions, and improvement in residents' quality of life, comfort, satisfaction, and quality of EOLC.
Discussion: RACFs are high-mortality settings, yet the quality of palliative and EOLC varies across facilities. There is an urgent need for timely and integrated high-quality palliative care delivered in this context. Implementing IMPART, as a novel telehealth intervention, aims to address this need. This large multisite trial will provide robust evidence about the impact of the intervention (efficacy, cost-effectiveness, and process evaluation), to inform future roll-out and scale-up into the residential aged care sector.
Hewitt J, May K, Alsaba N, Denny K, Cartwright C, Willmott L, et al.
Background: All health care is underpinned by legal frameworks, including those that regulate who is responsible for healthcare decisions at the end of life. How these frameworks support decision-making in emergency departments (EDs) and intensive care units (ICUs) is underexplored.
Objective: The objective of this study was to identify factors that help or hinder healthcare professionals' understanding and application of the law that applies to end-of-life decision-making in the EDs and ICUs in Queensland, Australia.
Methods: A descriptive qualitative study based on naturalistic inquiry was undertaken. Participants were healthcare professionals working in the ICUs or EDs of one South East Queensland Hospital and Health Service, responsible for the care of adult patients who had died.
Results: Thirteen medical practitioners, 19 registered nurses, and three social workers participated in semistructured interviews. Three themes and eight subthemes were identified in the data. First, the theme the complexity of communication is laid bare at the end of life described the challenges associated with talking about death and dying and the need to reframe conversations where death is inevitable. Next, the theme decision-making has layers highlighted family inclusion in decisions, navigating different perspectives to share decision-making and acknowledging that decision-making is emotionally burdensome. Finally, the theme how the law should apply is uncertain described the difficulties in deciding who should decide, knowing when Advance Health Directives can be relied on, and the need to reduce legal risk.
Conclusions: Decision-making at the end of life is complex and challenging. Healthcare professionals charged with leading conversations find them challenging and are mindful of the burdens associated with such decisions. The need to work within the legal framework is acknowledged, but applying the law can be difficult.
Lai D, Ling RR, Michel C, Hwang D, Parikh T, Planche Y, et al.
Objectives: Timely documentation of patient-concordant goals of care (GOC) in the ICU aims to promote patient autonomy and patient-centered care where the harms of interventions outweigh the potential benefits. This study examined the prevalence, timing, and predictors of ICU patients undergoing new and updated GOC documentation events while in the ICU.
Design: Multicenter retrospective study.
Settings and patients: All adults admitted to four ICUs from July 1, 2023, to December 31, 2023.
Interventions: None
Main outcomes: The primary outcome was to determine the prevalence, timing, and predictors of new-GOC and updated-GOC documentation events following ICU admission.
Measurements and main results: We used multivariable logistic regression to identify predictors for new-GOC or updated-GOC documentation events using a backward stepwise elimination. Of the 2130 patients included, 13.3% ( n = 284) had a new-GOC documentation event, and 16.3% ( n = 346) had an updated-GOC documentation event. New-GOC events occurred sooner than updated-GOC events (median [interquartile range]: 18.3 [7.8-70.5] vs 73.7 [22.7-157.8] hr). Factors associated with GOC documentation events included age (odds ratio [OR] = 1.02, 95% CI, 1.01-1.03), frailty (OR = 1.30; 95% CI, 1.16-1.46), Sequential Organ Failure Assessment (SOFA) (OR = 1.23, 95% CI, 1.17-1.29), metastatic cancer (OR = 3.69, 95% CI, 2.17-6.26), ICU admission post medical emergency team review (OR = 1.94, 95% CI, 1.40-2.69), and cardiac arrest (OR = 2.23, 95% CI, 1.22-4.06) and if pre-ICU GOC had established treatment limitations, namely selective treatment goals (OR = 4.33, 95% CI, 3.18-5.90) or comfort-based treatment goals (OR = 7.66, 95% CI, 2.72-21.61). Apart from SOFA, all other factors remained significantly associated with GOC documentation events, even after accounting for ICU mortality as a competing outcome.
Conclusions: Almost 30% of patients had new- or updated-GOC documentation events while in ICU. Increasing age, higher SOFA scores, metastatic cancer, frailty, cardiac arrest, and ICU admission post-MET review predicted GOC changes while in ICU.
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.
Last updated 30 April 2024