Latest Australian research

Luitingh TL, Prentice TM, Rowe J, Rotin L, Heywood M, Vemuri S.

Background: Grief experienced by parents following the death of their child is profound and places them at a higher risk of adverse health outcomes. Memory making practices intend to provide families the tools to meaningfully adjust and make sense of a child's death. Although memory making practices are established in end-of-life care, it remains uncertain how memory making interventions are experienced by families during bereavement.

Aim: This study aims to provide evidence-based insights into the memory making experiences of parents during neonatal and paediatric bereavement care.

Design: This is an exploratory descriptive mixed-methodology study using a Melbourne-based cross-sectional electronic-survey.

Setting/ participants: Thirty-three bereaved parents participated in this study. All families were known to the Neonatal Intensive Care Unit and/or the Victorian Paediatric Palliative Care Program at The Royal Children's Hospital. This study captures the experiences of bereaved parents whose children died between 1 January 2018 and 31 December 2020.

Results: The majority of parents who took part in memory making activities had a positive experience. Parent responses came together across four themes: (1) Experiential memory making is emotionally challenging but rewarding, (2) Physical memory making keeps the child real and part of the family, (3) Regret over missed opportunities and (4) Catering to individual needs.

Conclusion: Personalised provisions of love and care were dignities parents could warmly reflect back on during their bereavement. Importantly, tailoring memory making practices to the unique needs of the family and the dying child ensures both have their needs acknowledged and met.

Lussier S, Jones C, Thornhill S, Serpa Neto A, Jones D.

Abstract: Little is known about the characteristics of potentially inappropriate or unnecessarily prolonged intensive care unit (ICU) admissions in Australia, nor the exposure rate of non-ICU clinicians to dying ICU patients. We conducted a single-centre retrospective cohort study at a university-affiliated hospital in Victoria, Australia, of patients admitted to the ICU between January 2022 and June 2023, who transitioned to end-of-life care during their ICU admission. Decisions regarding appropriateness were adjudicated during a bi-weekly morbidity and mortality meeting. Out of 287 patients 279 were included in the final analysis. One hundred and eight (39%) patients were deemed to have had a potentially inappropriate admission, and 37 (13%) were deemed to have had a potentially inappropriately prolonged admission. Significantly higher proportions of patients were admitted from either the ward (32.4% versus 22.4%, P=0.02) or another hospital (15.7% versus 6.4%, P=0.02) if they were deemed to have had a potentially inappropriate admission. Significantly higher proportions of patients deemed to have had a potentially inappropriately prolonged admission had treatment limitations (16.2% versus 40.5%, P=0.006), lower Australian and New Zealand Risk of Death scores (median score 27.2 versus 45.5, P=0.006) and a clinical frailty score of 5 or more (63.9% versus 45.1%, P=0.048). They also had a significantly longer median ICU length of stay (median length of stay 13.4 days versus 2.6 days, P <0.001) and received significantly higher rates of invasive supports such as tracheostomy (16.2% versus 1.2%, P <0.001). The four major themes linked to these admissions were 1) lack of planning/appropriate treatment limitations, 2) lack of recognition of dying, 3) issues with communication/consensus and 4) provision of highly invasive treatments. The median rate of exposure of individual ward-based clinicians was 1 dying ICU patient per 18 months. Early framing of goals of care, reassessment of treatment goals during an ICU admission, dedicated communication skills training, and embedded frailty assessments might reduce non-beneficial and prolonged ICU admissions.

Seah DSE, Lujic S, Chang S, Currow DC, Eagar K.

Background: Community Palliative Care Services, a limited resource, helps patients spend as much time at home as possible by managing their symptoms and supporting caregivers in the community.

Aim: To describe the characteristics of patients discharged alive from the Community Palliative Care Services and to determine the outcomes of those discharged alive, including overall survival, subsequent place of death, and health service use.Design, setting/participants:Linked administrative clinical data were analysed for all adults discharged from an Australian metropolitan Community Palliative Care Services in Sydney between July 2010 and September 2018. That data comprised death records, ambulance, emergency, and hospital admissions. Factors associated with 30-day re-presentation to these services after discharge from the Community Palliative Care Services were examined using logistic regression.

Results: Of 5270 community patients, 20% (n = 1095) were alive at discharge. The median follow-up after the first discharge was 259 (95% CI 214-287) days, with 40% (n = 454) of these having a subsequent community palliative care referral. Six hundred and sixty-four (61%) died within a year of discharge, and 45% (n = 495) died in the community. Patients who lived in private residences and who had a malignant disease had higher odds of 30-day hospital re-presentation.

Conclusion: As the demand for Community Palliative Care Services increases, delivering equitable and efficient services to patients with palliative care needs becomes challenging with limited resources. Factors associated with hospital readmission shortly after discharge from the Community Palliative Care Services should be further explored to determine interventions that may support patients and families in their illness trajectory.

Summers I, Reymond E, Haydon HM.

Objective: This study aimed to identify how telehealth supports access to Voluntary Assisted Dying (VAD) globally and explore potential risks and benefits of telehealth for VAD consultations.

Methods: A systematic review of peer-reviewed articles on telehealth and VAD examining global use of telehealth to support access to VAD, global restrictions to telehealth-enabled VAD, and practical and clinical implications of using telehealth in supporting VAD was performed. PubMed, Embase (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and Scopus were searched and supplemented by handsearching relevant articles. Study quality was assessed using the SQUIRE (The Standard for Quality Improvement Reporting Excellence) guidelines.

Results: Two hundred and thirty articles were identified and then screened by two reviewers. Data were extracted from 26 included articles. Guided by Braun and Clarke's thematic analysis methodology, manual open coding was undertaken, and peer debriefing meetings resulted in the final key themes. Overall, findings indicate that telehealth can facilitate VAD services, enhance patient and provider experiences, and mitigate access inequities. The analysis highlighted that telehealth could further improve VAD access, especially in rural and remote areas. Until then, there are ongoing legal ambiguities for providers in Australia.

Conclusions: Telehealth can improve access to VAD, particularly in remote areas, reducing travel burdens for terminally ill patients. Global evidence from VAD and other sensitive medical fields supports the conclusion that telehealth's benefits outweigh its risks. Legislative clarity in Australia is necessary to resolve conflicts between federal and state laws and to provide clarity for healthcare providers and improve access for eligible patients. Future research should include more robust measures of the efficacy of telehealth.

Button E, McCaffrey N, LeBlanc TW, Carter H.

Aim: To investigate whether early referral to specialist palliative care (SPC) is cost-effective compared to standard care for people ≥ 60 years of age with newly diagnosed acute myeloid leukaemia (AML).

Methods: A modelled cost-utility analysis, from an Australian public healthcare system perspective, over a 5-year time horizon. A systematic review of studies reporting health state utility values (HSUVs), or convertible health-related quality of life measures, provided values for the decision tree model. Cost and effectiveness data were sourced from a broad review of the literature. All costs were estimated using 2022 Australian prices. Scenario analyses and sensitivity analyses explored the impact of varying key assumptions on the results. To account for uncertainty in the model, the mean of Monte Carlo simulation with 10,000 iterations, and 95% uncertainty intervals were reported for base case and scenario analyses results.

Results: For the deterministic base case, SPC was associated with mean incremental cost-saving (AUD -$2805) and greater mean incremental quality-adjusted life years (QALYs [0.05]). In probabilistic sensitivity analysis, the probability of SPC being cost-effective or dominant was 57.3%. In scenario analyses, SPC dominated standard care in all eight scenarios. In one-way sensitivity analysis, results were sensitive to utility values in treatment-related health states.

Conclusions: Findings indicate early SPC is likely to be cost-saving and more effective than standard care. Results must be interpreted cautiously given the reliance on assumptions and uncertainty of inputs in the model. However, findings are promising and warrant further research.