Find out what Australian researchers are publishing in palliative care 

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.

19 February 2024

'Can a relative override a patient's Advance Care Directive?': End-of-life legal worries of general practitioners and nurses working in aged care.

White B, Feeney R, Sellars M, Neller P, Yates P, Willmott L.

Abstract

Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting.

Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken.

Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death.

Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce.

19 February 2024

Heart failure and the cost of dying: Must the ferryman always be paid?

Sivanathan V, Smallwood N, Ong J, Wee E, Zentner D.

Abstract

Background: Provision of palliative care in chronic heart failure (CHF) can support complex decision-making, significantly improve quality of life and may lower healthcare costs.

Aims: To examine whether healthcare costs differed in terminal admissions according to the adoption of a palliative approach.

Design: Retrospective review of medical records and costing data for all admissions resulting in death from CHF (July 2011 to December 2019), analysed as two groups (2011-2016 and 2016-2019) because of background changes in costings.

Setting: Admissions with CHF resulting in death in an Australian tertiary referral centre.

Results: The cohort (n = 439) were elderly (median age 83.7 years, interquartile range (IQR) = 77.6-88.7 years) and mostly men (54.9%). Half (230, 52.4%) were referred to a specialist palliative care team, whereas over a third (172, 39.2%) received a palliative approach. Receiving a palliative approach was associated with a nonstatistically significant lower admission cost (AU$12 710 vs AU$15 978; P = 0.19) between 2011 and 2016 (n = 101, 38.8%) and a significantly lower cost (AU$11 319 vs AU$15 978; P < 0.01) between 2016 and 2019 (n = 71, 39.7%). Intensive care admission resulted in the single greatest additional cost at AU$14 624 (IQR = AU$4130-AU$44 197) (n = 48, 2011-2016). Median terminal admission cost was lower for patients with comfort goals of care (P < 0.01), without life-sustaining interventions (P < 0.01) or who received a palliative approach (P < 0.01). Referral to inpatient specialist palliative care or receiving a palliative approach resulted in comparable admission costings (AU$11 621 [IQR = AU$4705-AU$32 457] and AU$11 466 [IQR = AU$4973-AU$25 614]).

Conclusion: A palliative approach in terminal CHF admission may improve quality at the end of life and decrease costs associated with care.

© 2024 Royal Australasian College of Physicians.

19 February 2024

Palliative approach remains lacking in terminal hospital admissions for chronic disease across rural settings: Multisite retrospective medical record audit.

Disler APR, Pascoe DA, Chen DXE, Lawson E, Cahyadi M, Paalendra A, Hickson DH, Wright PJ, Phillips B, Subramaniam DS, Glenister DK, Philip PJ, Donesky PD, Smallwood APN.

Abstract

Introduction/aim: Despite clear benefit from palliative care in end-stage chronic diseases, access is often limited, and rural access largely undescribed. This study sought to determine if a palliative approach is provided to people with chronic disease in their terminal hospital admission.

Methods: Multisite, retrospective medical record audit, of decedents with a primary diagnosis of chronic lung, heart or renal failure, or multimorbidity of these conditions over 2019.

Results: Of 241 decedents, across five clinical sites, 143 (59.3%) were men, with mean age 80.47 years (SD 11.509), and diagnoses of chronic lung (n=56, 23.2%), heart (n=56, 23.2%), renal (n=24, 10.0%) or multimorbidity disease (n=105, 43.6%), and had 2.88 (3.04SD) admissions within 12 months. Outpatient chronic disease care was evident (n=171, 73.7%), however, contact with a private physician (n=91, 37.8%), chronic disease program (n=61, 25.3%), or specialist nurse (n=17, 7.1%) were less apparent. "Not-for-resuscitation" orders were common (n=139, 57.7%), however, advance care planning (n=71, 29.5%), preferred place of death (n=18, 7.9%), and spiritual support (n=18, 7.5%) were rarely documented. Referral to and input from palliative services were low (n=74, 30.7% and n=49, 20.3%), as was review of non-essential medications or blood tests (n=86, 35.7%, and n=78, 32.4%). Opioids were prescribed in 45.2% (n=109). Hospital site and diagnosis were significantly associated with outpatient care and palliative approach (p<0.001).

Conclusions: End-of-life planning and specialist palliative care involvement occurred infrequently for people with chronic disease who died in rural hospitals. Targeted strategies are necessary to improve care for these prevalent and high needs rural populations.

Copyright © 2024. Published by Elsevier Inc.

13 February 2024

Blogging at the end-of-life: Anticipatory grief, losses, and positive experiences in facing terminal illness.

Worrell S, Hemer SR.

Abstract

This paper explores the experiences of people who blog about their own terminal illness and dying through the lens of anticipatory grief. Anticipatory grief is a concept which is frequently applied to those people who will be bereaved by death, rather than those who are themselves dying. Ethnographic content analysis of terminal illness blogs of two Australian women clearly narrate experiences of loss and grief which can be understood through the frame of anticipatory grief. Yet they also document positive experiences of growth and connection which can be conceptualized as resilience rather than a demonstration of denial of death.

13 February 2024

What are the cost and resource implications of voluntary assisted dying and euthanasia?

Hudson P, Marco D, De Abreu Lourenco R, Philip J.

Abstract

ObjectivesVoluntary assisted dying (VAD) legislation has now been passed in all Australian states. Although VAD has been operating in many settings worldwide for a considerable time, the specific costs associated with VAD seem unclear. The aim of this study was therefore to outline the common resource implications associated with VAD.MethodsA rapid literature review and grey literature search were undertaken.ResultsWe found a paucity of empirically informed detail regarding the actual costs required to implement VAD. Hence, we tabulated a list of potential costs that could be used for subsequent evaluation and a future research agenda.ConclusionsThere is a lack of publicly available information related to the costs associated with implementing VAD. Given that this is a significant change in policy and many multidisciplinary practitioners may be directly or indirectly involved in VAD it is important that associated costs are clearly outlined so that appropriate resources can be allocated.

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Last updated 16 January 2024