Latest Australian Research

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.

 

7 December 2020

Prevalence and risk factors of breathlessness across Canada: A national retrospective cohort study in home care and nursing home populations

Seow H, Dutta P, Johnson MJ, McMillan K, Guthrie DM, Costa A, Currow D.

Background:
Breathlessness is a symptom associated with poor clinical outcomes and prognosis. Little is known about its long-term trends and associations with social factors including decline in social activities and caregiver distress.

Objectives:
To describe factors associated with the prevalence of clinician-reported breathlessness across Canada among cohorts receiving home care or nursing home care.

Methods:
A retrospective observational cohort study of cross-sectional intake assessment data from Canadian interRAI Home Care and Nursing Home datasets. In each dataset, we examined covariates associated with the presence of clinician-reported breathlessness using multivariate regression.

Results:
Between 2007-2018, we identified 1,317,117 and 469,709 individuals from the home care and nursing home datasets, respectively. Over two-thirds were aged >75 and over 60% were women. Breathlessness was present at intake in 26.0% of the home care and 8.2% of the nursing home cohorts. Between 2007 to 2018, prevalence of breathlessness increased by 10% for the home care cohort, while remaining relatively constant in nursing homes. Covariates associated with increased odds of having clinician-reported breathlessness at intake in both cohorts were: moderate-severe impairment with activities of daily living, being male, older age, high pain scores, signs of depression, and decline in social activities. In the home care cohort, the presence of breathlessness was associated with a greater odds of caregiver distress (OR=1.19, 95% CI: 1.18-1.20).

Conclusion:
The prevalence of clinician-reported breathlessness is higher in home care than nursing home populations, the former having risen by 10% over the decade. Prevalence of breathlessness is associated with decline in social activities and caregiver distress. Enhanced supports may be required to meet increasing patient need in the community.

7 December 2020

A Randomised Phase III Trial of Palliative Radiotherapy (PRT) versus Concurrent Chemotherapy and PRT (C-PRT)

A Randomised Phase III Trial of Palliative Radiotherapy (PRT) versus Concurrent Chemotherapy and PRT (C-PRT) in Patients with Good Performance Status, Locally Advanced or Metastatic NSCLC with symptoms due to intrathoracic disease who are not suitable for radical Chemo-radiotherapy: Results of the Trans-Tasman Radiation Oncology Group (TROG) 11.03 Trial

Lehman M, Bernard A, See A, King M, Michael M.

Purpose:
We compared intrathoracic symptom response rate, quality of life (QOL) and toxicity in patients with Non-small cell Lung cancer (NSCLC) not suitable for radical chemo-radiotherapy (C-RT), experiencing symptoms from intrathoracic disease, who were randomized to receive palliative radiation therapy (PRT36/12) or concurrent chemotherapy and PRT (C-PRT40/20).

Methods and materials:
We included patients with stage III or IV NSCLC, Eastern Co-operative Oncology Group (ECOG) Performance status 0-1, experiencing at least one of dyspnea, cough, hemoptysis or chest pain. The primary outcome was a change in intrathoracic response rate from baseline to six weeks post completion of therapy using (1) a composite measure, the Intrathoracic Symptom Burden Index (ISBI) and (2) individual symptom scores measured by the EORTC QLQ-C30 and QLQ-LC 13 instruments.

Results:
76 patients were recruited with 68 eligible for analysis. 42.6% and 57.4% had stage III and IV disease respectively. The ISBI was significantly lower at 6 weeks post treatment than at baseline (adjusted mean difference -8.77, SE 2.67, 95%CI [-13.97, -3.58], p<0.01) for the entire cohort with no difference between trial arms (p=0.34). Both treatments provided effective palliation of individual symptoms with no significant difference between trial arms. QOL during treatment was significantly better for patients receiving C-PRT (40/20). There was no difference between arms in overall QOL between baseline and 6 weeks post treatment. There was no difference in toxicity between treatment arms during treatment nor between baseline and 6 weeks post treatment. There was no difference in progression-free survival (PFS). A non-statistically significant 3month improvement in median survival favored C-PRT(40/20).

Conclusion:
PRT(36/12) and C-PRT(40/20) provide effective symptom palliation in patients with stage III NSCLC not suitable for radical C-RT and in patients with Stage IV disease. Chemotherapy added to PRT(40/20) does not provide superior symptomatic relief in this patient cohort .

7 December 2020

Unmet spiritual needs in palliative care: psychometrics of a screening checklist

Michael NG, Bobevski I, Georgousopoulou E, O'Callaghan CC, Clayton JM, Seah D, Kissane D.

Background:
While studies in palliative care use measures of spirituality and religious belief, there have been few validation studies of a screening tool that identifies unmet spiritual needs.

Methods:
A multidisciplinary research team developed and examined the usefulness, reliability and validity of a 17-item Spiritual Concerns Checklist (SCC) as a screening tool for unmet spiritual needs. A cohort of patients recruited from three palliative care services in Sydney and Melbourne, Australia completed anonymous questionnaires. Factor structure and item response theory were used to examine its properties; concurrent validity employed the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12).

Results:
Among 261 patients, while only 15% directly sought spiritual care, nearly 62% identified at least one spiritual concern. Existential needs (fear of the dying process 32%; loss of control 31%), regret (20%), need for forgiveness (17%), guilt (13%), loss of hope (13%) and meaning (15%) were prominent concerns. Eleven concerns were present for more than 10% of the participants and 25% of religiously orientated participants expressed >4 concerns. The 17-item SCC was unidimensional, with satisfactory reliability. Concurrent validity was evident in the reduced sense of meaning and peace on the FACIT-Sp-12.

Conclusion:
This preliminary Rasch analysis of the newly developed SCC has demonstrated its usefulness, reliability and validity. Our findings encourage refinement and ongoing development of the SCC with further investigation of its psychometric properties in varying populations.

30 November 2020

Unsettling Place(s) at the end of life

Collier A, Broom A.

Critical considerations of space and place at the end of life have been limited in the social science literature. To address this gap, we draw on empirical data from two interrelated but separate qualitative Australian data sets to critically examine dying in relation to considerations of space, place and affect. These studies share the primary aim to better understand and articulate end-of-life experiences, with one using video reflexive ethnography and the other semi-structured interviews with patients. Challenging the broader valorisation of particular places of dying and death (e.g. home, hospice, hospital), we critically explore the meanings and affects of space and place and how they are rooted in normative expectations. Drawing on participant accounts we interrogate simplistic concepts of home versus hospice, or hospital versus community, developing a critical social science of the intersections of space and place at the end of life.

30 November 2020

Healthcare Professionals' Views of Working with Medical Interpreters in a Cancer Setting: an Exploratory Study

Martin FC, Philip J, McLachlan SA.

Australia, like many other nations, continues to become more culturally and linguistically diverse. Medical interpreters play a key role in bridging the linguistic gap between healthcare professionals (HCPs) and patients. Little research exists from the HCP's perspective about working with interpreters. This study aimed to explore the views of HCPs regarding working with interpreters in a cancer setting. This exploratory study utilised a cross-sectional, qualitative design, involving focus groups and semi-structured interviews. HCPs from the Oncology and Palliative Care units were invited to participate and were asked about their experiences of working with interpreters in a cancer setting. Interviews were audio-recorded and transcribed. An inductive thematic analysis of qualitative data derived an understanding of attitudes and beliefs which may affect the way in which HCPs interact with interpreters and patients. Twenty-five participants were recruited. Five key themes emerged from the data: (1) communication practices and preferences, (2) training and supports, (3) alternative methods for translation, (4) challenges faced by HCPs and interpreters, and (5) limitations of translation. Communication with non-English-speaking patients using interpreters could be significantly improved with further training and support for both HCPs and interpreters, and a greater appreciation for the challenges each party faces.

30 November 2020

Enhanced toxicity with CDK 4/6 inhibitors and palliative radiotherapy: Non-consecutive case series and review of the literature

David S, Ho G, Day D, Harris M, Tan J, Goel S, Hanna GG, Srivastava R, Kruss G, McDowell L, White M.

Current first-line systemic treatment in most patients with metastatic hormone receptor-positive, HER-2 negative breast cancer is an aromatase inhibitor in combination with a cyclin dependant kinase (CDK) 4/6 inhibitor. Frequently, these patients require palliative radiotherapy (RT) for symptomatic disease management. There is a paucity of data on the safety of combining a CDK 4/6 inhibitor with palliative RT, with conflicting case reports in the literature. We report on 5 cases at our institution where enhanced radiotherapy toxicity was observed when palliative doses of RT was delivered during or prior to treatment with a CDK 4/6 inhibitor. After review of pre-clinical and mechanistic data, we hypothesise that the effects of CDK4/6 inhibition on normal tissue and the tumour microenvironment may impede tissue recovery and exacerbate acute radiation and radiation recall toxicities. Further studies are required to clarify the potential toxicities of this combination. Clinicians should consider the potential risks when combining CDK 4/6 inhibitors with palliative RT and individualise patient management accordingly.

23 November 2020

Inequalities in end-of-life palliative care by country of birth in New South Wales, Australia: a cohort study

Möller H, Assareh H, Stubbs JM, Jalaludin B, Achat HM.

Objective:
This study investigated variation in in-hospital palliative care according to the decedent's country of birth.

Methods:
A retrospective cohort study was performed of 73469 patients who died in a New South Wales public hospital between July 2010 and June 2015 and were diagnosed with a palliative care-amenable condition. Differences in receipt of palliative care by country of birth were examined using multilevel logistic regression models adjusted for confounding.

Results:
In this cohort, 26444 decedents received palliative care during their last hospital stay. In the adjusted analysis, 40% rate differences (median odds ratio 1.39; 95% confidence interval 1.31-1.51) were observed in receipt of palliative care between country of birth groups.

Conclusions:
There are differences in in-hospital palliative care at the end of life between population groups born in different countries living in Australia. The implementation of culturally sensitive palliative care programs may help reduce these inequalities. Further studies are needed to identify the determinants of the differences observed in this study and to investigate whether these differences persist in the community setting.

What is known about the topic?
International studies have reported inequities in access to palliative care between ethnic groups.

What does this paper add?
We observed differences in in-hospital palliative care between decedents from different countries of birth in New South Wales, Australia. These differences remained after adjusting for individual, area and hospital characteristics.

What are the implications for practitioners?
Implementation of culturally sensitive palliative care services and targeting groups with low rates of palliative care can reduce these inequalities and improve a patient's quality of life.

23 November 2020

Management of melanoma brain metastases: Evidence-based clinical practice guidelines by Cancer Council Australia

Hong AM, Waldstein C, Shivalingam B, Carlino MS, Atkinson V, Kefford RF, McArthur GA, Menzies AM, Thompson JF, Long GV.

Introduction:
The brain is a common site of metastatic disease for patients with advanced melanoma. Brain metastasis portends a poor prognosis, often causing deterioration in neurological function and quality of life, and leading to neurological death. Treatment approaches including surgery, radiotherapy and systemic therapy can lead to better control of this problem. Therefore, appropriate guidelines for the management of melanoma brain metastases need to be established, with regular updating when new treatment options become available.

Methods:
A multidisciplinary working party established by Cancer Council Australia has produced up-to-date, evidence-based clinical practice guidelines for the management of melanoma. After selecting key clinical questions, a comprehensive literature search for relevant studies was conducted, followed by systematic review of those studies. Data were summarised and the evidence was assessed, leading to the development of recommendations.

Main recommendations:
Symptomatic lesions are best treated with surgery, when possible; this provides safe and effective local control. For patients with single or a small number of asymptomatic brain metastases, stereotactic radiotherapy is recommended, but in asymptomatic patients who have not previously received systemic treatment, drug therapy can be considered as a first-line treatment option. Whole brain radiotherapy may provide palliative benefits in patients with multiple brain metastases. Whenever possible, melanoma patients with brain metastases should be managed by a multidisciplinary team of melanoma specialists that considers the optimal combination and sequencing of surgery, radiotherapy and systemic therapy.

23 November 2020

Nurses' intentions to respond to requests for legal assisted-dying: A Q-methodological study

Wilson MR, Wiechula R, Cusack L, Wilson M.

Aims:
To explore the intentions of nurses to respond to requests for legal assisted-dying.

Background:
As more Western nations legalize assisted-dying, requests for access will increase across clinical domains. Understanding the intentions of nurses to respond to such requests is important for the construction of relevant policy and practice guidelines.

Design:
Mixed-methods.

Data sources:
A total of 45 Australian nurses from aged, palliative, intensive, or cancer care settings surveyed in November 2018.

Method:
Q-methodology studying nurses' evaluations of 49 possible responses to a request for a hastened death. Data consisted of rank-ordered statements analysed by factor analysis with varimax rotation.

Findings:
Four distinct types of intentions to respond to requests for assisted-dying: a) refer and support; b) object to or deflect the request; c) engage and explore the request; or d) assess needs and provide information.

Conclusion:
The findings underscore the complexity of intentionality in assisted-dying nursing practice and differences from other forms of end-of-life care, particularly regarding patient advocacy and conscientious objection. This study enables further research to explore determinants of these intentions. It can also assist the development of professional guidance by linking policy and clinical intentions.

Impact:
Identified a basic range of nurses' intentions to respond to requests for assisted-dying, as there was no evidence at present. Developed a fourfold typology of intentions to respond with most nurses intending to engage in practices that support the requestor and sometimes the request itself. A minority would object to discussing the request. The relatively low level of advocacy within the intended responses selected also is distinctly different from other end-of-life care research findings. This research could assist nursing associations in jurisdictions transitioning to legal assisted-dying to develop guidance ways nurses can frame their responses to requests.

23 November 2020

The participation of people with dementia in the planning of their care and support: An integrative literature review

Read ST, Toye C, Wynaden D.

No abstract available

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