Latest Australian Research

Patients with cancer frequently have unmet palliative care needs yet timely integration of palliative care in oncology remains limited. Screening tools could support early identification of patients who would benefit from palliative care, but their usability and practical integration within cancer care remain inadequately delineated. This scoping review aims to synthesise and compare available screening tools identifying unmet palliative care needs in cancer populations.

Four English databases (Web of Science, PubMed, Embase and CINAHL) and four Chinese databases (CNKI, Wanfang, CMB and VIP) were searched from inception to November 2025. Descriptive analysis and narrative synthesis were used to summarise the key findings.

Thirty-seven studies reporting 19 screening tools were included. The tools could be grouped into universal tools (eg, the Needs at the End-of-Life Screening Tool), tools with cancer-specific modules (eg, the NECesidades PALiativas (NECPAL) CCOMS-ICO Tool) and tools developed specifically for cancer populations (eg, Palliative Care Screening Checklist for Patients with Advanced Cancer). Considerable heterogeneity was observed in domains, item numbers, users, formats and clinical settings. Only a minority of tools provided psychometric evaluation in cancer populations and evidence on real-world implementation.

This review provides an overview of available screening tools used to identify palliative care needs in cancer populations and highlights substantial variability in their characteristics, validation and clinical use. Strengthening psychometric evidence and application research is needed to support timely and appropriate integration of palliative care into oncology practice.

Pain is common in advanced cancer, and many people require opioid switching to achieve adequate analgesia. However, longitudinal patterns of switching across the complete illness trajectory remain poorly characterized. This study describes the incidence, indications, dose thresholds, and prescribing patterns of opioid switching from advanced cancer diagnosis to death.

 This retrospective cohort study analyzed opioid prescribing data for 200 adults with advanced cancer from diagnosis to death. Prescribing data were converted to standardized oral morphine equivalent daily dose (oMEDD). Switching frequency, dose thresholds, duration of opioid use, documented indications, and prescriber patterns were analyzed using descriptive statistics.

 Opioid switching occurred in 58% of patients (n = 116), with some requiring up to four switches. Each successive switch occurred after substantial dose escalation during treatment on a given opioid, where starting doses of each successive switch approximately doubled: 20 mg oMEDD for the first opioid, 30 mg at first switch, 60 mg at second, and 180 mg at third switch. Median duration on each opioid progressively shortened with each switch: 39 days interquartile range (IQR 9-98), 25 days (IQR 6-103), and 18 days (IQR 5-53) for the first, second, and third switches, respectively. Inadequate analgesia was the predominant indication (58% of switches). Palliative care clinicians initiated an increasing proportion of switches (31% of first opioids; 89% of third).

Opioid switching is common across the advanced cancer trajectory, characterized by progressive dose escalation and shortening duration of use with each successive switch. These findings highlight the importance of access to multiple opioid options and timely specialist palliative care involvement.

Aging populations require physicians skilled in competencies essential for the care of older adults. The extent to which such geriatric competencies are included in non-geriatric postgraduate medical training programs is not known. Therefore this study examined the inclusion of 13 geriatric competencies in postgraduate training programs in Australia and New Zealand, the United Kingdom, and the United States.

Thirteen core geriatric competencies were identified and defined: aging physiology; health equity and sociodemography in aging; geriatric assessment and management; individualized care and decision-making; multidisciplinary team collaboration; effective communication; cognition and mental health; common geriatric syndromes and presentations; medication prescribing and pharmacology; ethical and legal issues; coordination of care; end-of-life care and advance care planning; and older adults in research. Curricula of programs accredited by the Australian Medical Council, General Medical Council, and Accreditation Council for Graduate Medical Education were reviewed for inclusion of these competencies. Subspecialty programs pursued after initial training, and specialties without direct clinical care of older adults were excluded.

Twenty-four of 52 programs (46%) included no core geriatric competencies. Among curricula that did include them, coverage ranged from 1 to 12 competencies. The most frequently included were ethical and legal issues (18 programs [35%]), cognition and mental health (15 programs [29%]), and geriatric syndromes (14 programs [27%]).

Significant gaps exist in the integration of geriatric competencies across postgraduate medical training programs. Coordinated efforts are needed to integrate and assess these competencies to prepare physicians to care for aging populations.

Unpaid caregivers play a crucial role in providing care for people with life-limiting illnesses such as cancer, yet their economic contributions are rarely recognised in economic evaluations, leaving caregivers to shoulder significant direct and indirect costs.

To explore the direct and indirect costs experienced by unpaid caregivers of people with cancer receiving palliative care.

A qualitative study underpinned by a social constructivist framework, reported in line with COREQ and RTARG guidelines. Semi-structured interviews were conducted with unpaid caregivers to capture their lived experiences of caregiving costs. Thematic analysis was employed.

The study was conducted at a single tertiary hospital in Melbourne, Australia. Eleven caregivers (43-87 years; mean 64 years) participated, including spouses, children, and parents of cancer patients who had accessed palliative care.

Caregivers reported a wide range of direct costs, including food, equipment, medications, transportation, insurance, and home modifications. Indirect costs emerged as equally burdensome, including time spent on personal care, care-coordination, employment disruption, and loss of leisure. These burdens frequently extended beyond the caregiving period, undermining economic security and long-term wellbeing.

Caregiving imposes substantial and enduring direct and indirect costs that are rarely measured or recognised in decisions made around health systems. Findings highlight the need for a validated tool to capture the full cost of caregiving, to guide equitable comprehensive economic evaluation.

This study explores the integration of home-like design elements in paediatric/adolescent palliative care inpatient units, drawing on perspectives from both medical and architectural professionals. Recognising the unique developmental and psychosocial needs of young patients, this research explores how the spatial and emotional qualities associated with ‘home’ are interpreted and operationalised in palliative care environments.

A multimethod approach was employed, including a targeted literature review, analysis of seven international paediatric hospice design and semistructured interviews with 22 experts from the medical and architectural fields.

The findings identify two central themes in the design of supportive palliative care settings: (1) Supporting Moments of Normalcy, which highlights the importance of daily routines, social connections and familiar activities in fostering emotional well-being, and (2) Architectural Features of Home, which addresses spatial layout, materiality and aesthetic elements that evoke comfort and familiarity of home. A key divergence was observed between the disciplines: medical professionals emphasised the emotional and social aspects of care, while architects prioritised spatial configuration and material considerations. Additionally, the study discusses how design approaches may vary between younger children and adolescents in creating home-like environments.

The contrast points to the need for more integrated design strategies that balance clinical functionality with emotional and social well-being. Limitations include the lack of direct input from young patients and families, as well as a limited exploration of cultural interpretations of ‘home’. Future research should address these gaps to inform more inclusive and holistic design approaches in paediatric palliative care.

Massage therapy (MT) is an emergent health care discipline increasingly recognized and recommended as an effective non-pharmacological and holistic intervention for pain relief and well-being promotion for palliative patients. However, it is not clear how it is being operationalized in palliative care (PC) settings.

To identify and describe the available evidence on the characteristics of massage service provision in specialist PC settings.

A scoping review applying the Johanna Briggs Institute methodology was conducted, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Searches of five electronic databases (Medline, EMBASE, CINAHL, PsycINFO, and AMED) were undertaken, limited to studies in English published between 2013 and November 2024, with the addition of searches of PC websites for gray literature. Major search terms related to the concept of MT for participants receiving PC in the context of PC settings (hospice, hospital, or community-based). The Donabedian framework was employed to categorize the extracted data, and a deductive approach was applied to the results.

Our review identified 25 published studies of diverse designs and 6 gray literature reports and policy documents addressing the review objectives. Major findings confirmed increasing recognition of the value of MT for palliative patients and revealed the prevalence of professional, trained massage therapists as providers in established programs. Evidence of a widening scope of practice and participation of massage therapists in interdisciplinary models of care was significant; however, barriers to MT integration, such as governance issues and poor health professional knowledge, were identified.

This review described a reconceptualization of MT and its role in PC, with implications for future employment, education, and training of therapists. Further research is needed to develop implementation and integration models to facilitate access to MT in PC settings.