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.
Luc I, Dadich A, Laurence C.
Background: As in many countries, Australians are living longer and experience greater rates of chronic conditions. This can require greater use of palliative care services. However, there is limited research on how many people would benefit from palliative care. The aim of this study is to estimate the current and future need for palliative care services in Australia and within geographical regions.
Methods: Using national mortality data and population projections, the study used two methods to estimate the observed (2011 to 2022) palliative care need in Australia by age, sex, and geographical area. These were: 75% of all deaths would require palliative care; and a diagnostic based approach on main underlying cause of death. These methods were used to estimate the future need for palliative care, applying the proportion of palliative deaths to the Australian Bureau of Statistics projected deaths to 2042 using 75%, the 2022 proportion of diagnostic-based deaths, and the mean annual change in proportion of these deaths from 2011 to 2022. Analyses were also performed across sex, age group, geographical areas and disease group to identify areas of increasing palliative care need.
Results: The two methods demonstrated a growing need for palliative care in the observed and projected period. From 2011 to 2022, there was an 18 to 30% increase in the number of people who needed palliative care. From 2023 to 2042, there will be an increase of 37 to 65% in the number of people needing palliative care. People aged over 85 years, as well as people living with cancer and dementia are expected to drive the future need for palliative care. The need for palliative care in regional and remote areas is greater than that in the major cities.
Conclusion: Current workforce trends in Australia are unlikely to meet the growing need for palliative care. Future palliative care services must be developed in line with these findings and further research is required ensure an adequate supply of palliative care to match the expected demand.
Riggs DW, Patlamazoglou L, Simmonds JG, Snell T.
Abstract: All too often, humans who experience the death of a partner are directed towards other humans for support, ignoring the important role that animal companions play in the lives of many humans. For lesbians and gay men specifically - whose grief may be disenfranchised - animal companions may play a particularly important role. This paper reports on a secondary analysis of interviews with 10 Australian lesbians or gay men who had lost a partner due to non-HIV related issues. Six of the participants spoke impromptu about the importance of animal companions following the death of a partner. Thematic analysis resulted in the development of three themes: (1) animals provide comfort and company, (2) animals serve as a reminder of partners, and (3) animals give people a reason to go on. The paper concludes by considering the importance of speaking about animals in the context of research and practice related to human bereavement.
Button E, Virdun C, Mudge A, Donovan T, Singh GK, Yates P, et al.
Background: Acute inpatient care does not always align with the known palliative care needs and preferences of people with deteriorating health. The LEAHP (Listen, Empower and Act to improve Hospital Palliative care) bundle is a novel intervention combining collection and feedback of patient reported experience measures (PREMs), an understanding of context, co-design of a shared vision and facilitated clinician-led improvements in quality of care, for inpatients with palliative care needs. We describe the resource requirements for pilot implementation of the LEAHP bundle, and potential cost considerations for sustaining and spreading this initiative.
Methods: A prospective costing analysis was conducted alongside a pre-post implementation study between May 2022 and Nov 2023 across three wards in a large hospital in Australia. A health service perspective was taken, with costs collected during the study period and valued in 2023 Australian dollars. Costs included Project Team and Clinical Team labour, as well as non-labour resources. Time-driven, activity-based costing methods were adopted, with implementation activities categorised using a modified Expert Recommendations for Implementing Change (ERIC) Framework headings. A scenario analysis explored cost reductions that would support sustaining and spreading of the initiative.
Results: The total average cost of implementing the LEAHP bundle for each ward over approximately 12 months was $37,019; consisting of $26,289 (71%) Project Team, $8,870 (24%) Clinical Team, and $2,053 (5%) non-labour average costs. The greatest percentage of costs was attributed to the Facilitator (average $13,488 per ward, 36% overall) and the Research Nurse (average of $10,868 per ward, 29%). In a scenario analysis testing sustainment and spread, the total average cost of implementing the LEAHP bundle was an average of $25,251 per ward ($15,212 [60%] Project Team, $8,373 [33%] Clinical Team, and $1,667 [7%] non-labour costs) – 32% less than the base case.
Conclusions: Pilot implementation of the LEAHP bundle required investment from both the Project Team and Clinical Team to enable facilitation, collection of PREMs, an understanding of context, and engagement of clinicians to implement improvements for inpatients with palliative care needs. Sustainment would be contingent on the resources required for facilitation in a changing clinical context and on mechanisms for collecting and processing the PREM data. Future research is warranted to explore sustainable and widescale implementation of this promising intervention.
Rasekaba TM, Hodge O, Blackberry I, Rich S, Webb N, Steer CB.
Introduction: Healthcare is increasingly shifting from a paternalistic model to one that prioritises person-centred care (PCC). Despite this trend, implementing PCC in the care of older adults diagnosed with cancer remains challenging. The Age-Friendly Health Systems (AFHS) initiative provides a structured framework - the 4Ms (What Matters, Medication, Mentation, and Mobility) - to promote consistent, evidence-based care for older adults. It has demonstrated benefits in general geriatric care; however, applying the 4Ms principles in oncology is underexplored. This study aimed to assess the feasibility of enhancing geriatric assessment (GA) by integrating two novel person-centred elements: Photovoice (two patient-supplied photographs inspired by "Photovoice" principles but not constituting a full Photovoice methodology) and the "This is Me" (TiM) tool.
Materials and methods: A cross-sectional mixed-methods study evaluated the feasibility of integrating two novel elements (two patient-supplied photographs and the TiM tool) into GA, with the aim of promoting practice based on the AFHS 4Ms framework principles. Twenty consecutive patients (≥70 years, G8 score ≤ 14) from a regional cancer centre completed the assessment (electronic Rapid Fitness Assessment [eRFA]-Photo-TiM, as well as the Mini-Cog and Timed-Up-and-Go). Results were presented at a weekly "enhanced supportive care" (ESC) multidisciplinary team (MDT) meeting. Participants completed post-assessment surveys and interviews.
Results: All patients (n = 20), aged 79 years, 45% female, completed the eRFA, 19 completed the TiM, and 18 provided photographs. The combined assessment was overall acceptable and feasible, user-friendly, captured patients' values and contexts, and facilitated supportive care referrals and advance care planning discussions. ESC-MDT members valued the holistic view for informing supportive care decisions. However, photo submission required substantial assistance for most participants, hence a significant barrier to overcome for implementation. Other barriers included digital literacy and delays in completion, which averaged 2.5 weeks.
Discussion: The eRFA-Photo-TiM approach was feasible and acceptable in a real-world cancer care in a regional cancer centre and may support more person-centred care decision making. Further research should evaluate effect on cancer care outcomes and sustainable implementation.
Smith R, Merlo G, Ezure Y, Love A, Lock C, Broadbent A, et al.
Objectives: Quality palliative and end-of-life care is required to meet the growing need in aged care. The aim of the Specialist Palliative Care in Aged Care (SPACE) service was to enhance equitable access to specialist palliative and end-of-life care for residential aged care residents in Queensland, Australia.
Methods: Local SPACE teams were established in each of 15 adult health services in Queensland. These teams provided services into residential aged care facilities in alignment with the statewide service principles of: (1) comprehensive resident-focused care; (2) streamlined service; and (3) capacity building. The SPACE teams provided advice for managing complex care and built generalist capability through education, training, mentoring and support for care planning. The effectiveness of SPACE was assessed through a repeated cross-sectional design. Data, including postdeath questionnaires, staff knowledge and confidence, organisational change, and resident and family experience measures, were collected in 6-month intervals.
Results: There were significant differences in the response distribution for place of death and for advance care planning across collection periods. Staff knowledge and confidence improved significantly in all areas assessed. There was also a significant change in the proportion of providers who improved palliative care policies, procedures or guidelines. Staff and resident stories attributed avoidance of unnecessary hospital admissions, improved quality of end-of-life care aligned with preferences, and improved coordination and continuity of care to SPACE's involvement.
Conclusions: The SPACE service demonstrated that a principle-based, adaptable model for accessing specialist palliative care can improve staff capability and improve end-of-life outcomes in residential aged care.
Last updated 30 April 2024