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.

 

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

16 November 2020

Exploring advance care planning awareness, experiences, and preferences of people with cancer and support people: an Australian online cross-sectional study

Rodi H, Detering K, Sellars M, Macleod A, Todd J, Fullerton S, Waller A, Nolte L.

Purpose:
To explore advance care planning (ACP) awareness, experiences, and preferences of people with cancer and support people of someone with cancer, in Australia.

Methods:
Descriptive analysis and independent group t tests were used to examine data from a national, online cross-sectional survey.

Results:
Of 705 respondents (440 people with cancer, 265 support people), 48.5% of participants had heard of ACP prior to the survey and 65% had discussed their values or preferences with someone. Significantly more people aged under 65 years had discussed their preferences than their older counterparts. Most (93%) discussions occurred with family or friends, but only 3.7% occurred with a health professional. A total of 33% had documented their preferences, with support people, women, and people aged under 65 years significantly more likely to have signed a legal document appointing someone to make medical decisions on their behalf. Views varied about the preferred timing of ACP and end-of-life care discussions (38.3% when cancer is incurable compared to 20% at diagnosis). Only 3.0% did not want to discuss ACP at all. Topics discussed were significantly different based on cohort, gender, age group, treatment status, and region.

Conclusion:
Despite increasing community awareness of ACP, understanding remains low amongst cancer patients and support people, who generally rely on discussions with family and friends rather than health professionals. ACP should be introduced early across multiple interactions with health professionals, discuss a broad range of ACP relevant topics, and involve the cancer patient and their support person.

16 November 2020

What Matters? Palliative Care, Ethics, and the COVID-19 Pandemic

Sheahan L, Brennan F. 

As is often the case in clinical ethics, the discourse in COVID-19 has focused primarily on difficult and controversial decision-making junctures such as how to decide who gets access to intensive care resources if demand outstrips supply. However, the lived experience of COVID-19 raises less controversial but arguably more profound moral questions around what it means to look after each other through the course of the pandemic and how this translates in care for the dying. This piece explores the interface between the pandemic, ethics, and the role of palliative care. We argue that the ethical discourse should be broader, and that the principles that underly the discipline of palliative care provide a solid ethical foundation for the care of all patients through the coronavirus pandemic.

9 November 2020

The effect of bereavement on cognitive functioning among elderly people: Evidence from Australia

Atalay K, Staneva A.

This paper explores the effects of experiencing the death of a spouse, relative or close friend on cognitive functioning of Australian elderly. Using rich longitudinal data, we show that experiencing a loss is associated with a modest decline in cognitive function. Our results show that on average the effects are more pronounced for males and the strongest effects are associated with the loss of the spouse or a close friend. These events have significant effects on working memory and speed of information processing. We show that the decrease in cognitive functioning is accompanied by decreases in engagement in cognitive activities and declines in socialization. Our results are suggestive that programmes to support grieving individuals, including support for socialization activities, and extending active aging programmes could be important for promoting successful cognitive aging for the growing population of older adults.

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