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.

 

26 August 2019

Introducing Goals of Patient Care in Residential Aged Care Facilities to Decrease Hospitalization: A Cluster Randomized Controlled Trial.

Martin RS, Hayes BJ, Hutchinson A, Tacey M, Yates P, Lim WK.

OBJECTIVES:
The "Goals of Patient Care" (GOPC) process uses shared decision making to incorporate residents' prior advance care planning (ACP) or preferences into medical treatment orders, guiding health care decisions at a time of clinical deterioration should they be unable to voice their opinions. The objective was to determine whether GOPC medical treatment orders were more effective than ACP alone in preventing emergency department (ED) visits (no hospitalization), ED visits (with hospitalization), and deaths outside the residential aged care facility (RACF).

DESIGN:
The study was a prospective cluster randomized controlled trial, with the intervention being the completion of GOPC process by a geriatrician, following a shared decision-making process, incorporating ACP documents or residents' preferences.

SETTING AND PARTICIPANTS:
The study took place in 6 RACFs in Northern Metropolitan Melbourne, Australia. Eligible participants included all permanent residents in participating RACFs for whom written informed consent could be obtained.

MEASURES:
The primary outcome was the effect on ED visits and hospitalizations at 6 months. Secondary outcomes included a difference in hospitalization rates at 3 and 12 months, total hospital bed-days, and in-RACF and in-hospital mortality rates.

RESULTS:
More than 75% of residents participated, 181 randomized to Intervention and 145 to Control. The intervention did not result in a statistically significant change at 6 months; however, at 12 months, it reached statistical significance with 40% reduction in ED visits and hospitalizations compared with Control, with an incident rate ratio 0.63 [95% confidence interval (CI) 0.41-0.99, P = .044]. Mortality rates show increased likelihood of dying in the RACF, with statistical significance at 6 months at a relative risk ratio of 2.19 (95% CI 1.16-4.14, P = .016).

CONCLUSIONS AND IMPLICATIONS:
In the RACF population, GOPC medical treatment orders were more effective than ACP alone for decreasing hospitalization and likelihood of dying outside the RACF. GOPC should be considered by both RACF staff and health services to decrease hospitalization and in-hospital mortality.

26 August 2019

Interventions available to adolescents and young adults bereaved by familial cancer: a systematic literature review.

Ing V, Patterson P, Szabo M, Allison KR.

OBJECTIVES:
To assess the availability and efficacy of interventions open to adolescents and young adults (AYAs; 15-25 years) bereaved by a parent's or sibling's cancer.

METHODS:
A systematic review of peer-reviewed literature on interventions available to AYAs bereaved by a parent's or sibling's cancer was conducted through searches of six online databases (PsycINFO, Medline, Scopus, Embase, SWAB and Web of Science Core Collection).

RESULTS:
Database and reference searches yielded 2985 articles, 40 of which were included in the review. Twenty-two interventions were identified that were available for bereaved young people. However, only three were specific to young people bereaved by familial cancer, and none were specific to AYAs. Interventions primarily provided opportunities for participants to have fun, share their experiences and/or memorialise the deceased; psychoeducation about bereavement, grief and coping was less common. Only six interventions had been satisfactorily evaluated, and no intervention targeted or analysed data for AYAs separately. Overall, some evidence suggested that interventions (especially those that were theoretically grounded) had positive effects for bereaved young people. However, benefits were inconsistently evidenced in participants' self-reports and often only applied to subgroups of participants (eg, older youths and those with better psychological well-being at baseline).

CONCLUSIONS:
Considering the very limited number of interventions specific to bereavement by familial cancer and the lack of interventions targeting AYAs specifically, it is unclear whether currently available interventions would benefit this population. The population of AYAs bereaved by familial cancer is clearly under-serviced; further development and evaluation of interventions is needed.
 

19 August 2019

A randomised, double-blind, multi-site, pilot placebo-controlled trial of regular, low dose morphine on outcomes of pulmonary rehabilitation in COPD.

Kochovska S, Fazekas B, Hensley M, Wheatley J, Allcroft P, Currow DC.

6 August 2019

Improving community access to terminal phase medicines in Australia: identification of the key considerations for the implementation of a 'core medicines list'.

Tait PA, Cheung WH, Wiese M, Staff K.

During the terminal phase, access to medicines is critical for people wishing to spend their last days of life at home. Yet, access to medicines can be problematic. The aim of this study was to report the perspectives of specialist and generalist health professionals (HPs) on the issues of community access to medicines for this vulnerable group. A qualitative descriptive study design investigated the views of HPs working in palliative care roles in South Australia. Nurses, doctors and pharmacists described their experiences of accessing medicines for management of terminal phase symptoms during semi-structured focus group discussions. Content analysis identified six themes including: 'Medication Supply', 'Education and Training', 'Caregiver Burden', 'Safety', 'Funding' and 'Clinical Governance'. Future projects should aim to address these themes when developing strategies for the management of people wishing to die at home.

6 August 2019

The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomised controlled trials.

Menzies RE, Zuccala M, Sharpe L, Dar-Nimrod I.

Death anxiety has been proposed as a transdiagnostic construct, underlying numerous mental disorders. Although it has been argued that treatments, which reduce death anxiety, are needed, research investigating the impact of interventions on death fears has produced mixed results. As such, the current meta-analysis aimed to examine the effect of psychosocial interventions on death anxiety. Overall, results from 15 randomised controlled trials suggested that psychosocial treatments produced significant reductions in death anxiety, with a small to medium effect size (g = .45). Intervention type (death education vs. therapy) did not significantly moderate the effect of intervention on death anxiety (g = -.47). However, therapy type was a significant moderator of treatment efficacy (g = -1.39). Cognitive Behaviour Therapy was found to be particularly efficacious, producing significant reductions in death anxiety relative to control (g = 1.7), whereas other therapies did not (g = .20). The number of treatment sessions and baseline death anxiety significantly moderated intervention efficacy, whereas the duration of the intervention, training of the interventionist, and clinical nature of the sample did not. Given the small number and generally low quality of the included studies, future research using more rigorous methodology, as well as clinical samples, is needed.

6 August 2019

Physical activity for symptom management in women with metastatic breast cancer: a randomised feasibility trial.

Yee J, Davis GM, Hackett D, Beith JM, Wilcken N, Currow D, Emery J, Phillips J, Martin A, Hui R, Harrison M, Segelov E, Kilbreath SL.

CONTEXT:
Physical activity for women with early-stage breast cancer is well recognised for managing cancer-related symptoms and improving quality of life. Whilst typically excluded from interventions, women with metastatic breast cancer may also benefit from physical activity.

OBJECTIVE:
To i) determine the safety and feasibility of a physical activity program for women with metastatic breast cancer and ii) explore the efficacy of the program.

METHODS:
Fourteen women with metastatic breast cancer were randomised to either a control group or an 8-week home-based physical activity intervention comprising of twice weekly supervised resistance training and an unsupervised walking program.

RESULTS:
The recruitment rate was 93%. Adherence to the resistance and walking components of the program was 100% and 25%, respectively. No adverse events were reported. When mean change scores from baseline to post-intervention were compared, trends in favour of the exercise group over the control group were observed for FACIT-Fatigue score (+5.6 ± 3.2 vs. -1.8 ± 3.9, respectively), VO2max (+1.6ml/kg/min ± 1.8 ml/kg/min vs. -0.2 ml/kg/min ± 0.1 ml/kg/min, respectively) and 6MWT (+40m ± 23m vs. -46m ± 56m, respectively).

CONCLUSION:
A partially supervised home-based physical activity program for women with metastatic breast cancer is feasible and safe. The dose of the resistance training component was well tolerated and achievable in this population. In contrast, adherence and compliance to the walking program were poor. Preliminary data suggest a physical activity program, comprising predominantly resistance training, may lead to improvements in physical capacity and may help women to live well with their disease.

5 August 2019

How and how much is spirituality discussed in palliative care consultations for advanced cancer patients with and without a question prompt list?

Best M, McArdle MB, Huang YJ, Clayton J, Butow P.

OBJECTIVE:
Patients want to discuss spirituality more with their doctors but feel disempowered. Question prompt lists (QPLs) assist conversations. This study assessed the impact of a QPL on spirituality discussions in Palliative Care (PC).

METHODS:
This was a sub-study of a trial in which PC patients were randomised to either receive a QPL prior to a consultation or not, to see whether its provision influenced advanced cancer patients'/caregivers' questions and discussion of topics relevant to end-of-life care during consultations with a PC physician. Consultations were recorded and transcribed. Transcriptions were analysed to examine the frequency and content of spirituality discussions. We conducted logistic regression to investigate the impact of the QPL and other predictors.

RESULTS:
174 patients participated. Spirituality was discussed in half the consultations. Patients receiving a QPL discussed spirituality 1.38 times more than controls. This finding did not reach statistical significance. First PC consultation and being asked about their concerns by the doctor were significant predictors of a spiritual discussion.

CONCLUSION:
Patients are more likely to discuss spirituality in their first PC consultation, and when their doctor asks them about their concerns.

PRACTICE IMPLICATIONS:
Doctors caring for patients at the end of life should routinely raise spiritual issues.

29 July 2019

An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities.

Karacsony S, Good A, Chang E, Johnson A, Edenborough M.

BACKGROUND:
Providing quality palliative care in residential aged care facilities (RACFs) (aged care homes) is a high priority for ageing populations worldwide. Older people admitted to these facilities have palliative care needs. Nursing assistants (however termed) are the least qualified staff and provide most of the direct care. They have an important role at the frontline of care spending more time with residents than any other care provider but have been found to lack the necessary knowledge and skills to provide palliative care. The level of competence of this workforce to provide palliative care requires evaluation using a valid and reliable instrument designed for nursing assistants' level of education and the responsibilities and practices of their role.

METHOD:
The overall study purpose was to develop and test an instrument capable of evaluating the knowledge, skills and attitudes of nursing assistants within a palliative approach in RACFs. Development consisted of a four-phase mixed-methods sequential design. In this paper, the results and key findings following psychometric testing of the instrument in Phase 4 is reported using data collected from a random sample of 17 RACFs and 348 nursing assistants in the Greater Sydney region. Study hypotheses were tested to confirm discriminative validity and establish the utility of the instrument in both research and training assessment.

RESULTS:
Individual item properties were analysed for difficulty, discrimination and item-total correlations. Discriminative and structural validity, and internal consistency and test-retest reliability were demonstrated. Three separate questionnaires comprising 40 items were finalised: The Palliative Approach for Nursing Assistants (PANA)_Knowledge Questionnaire (17 items), the PANA_Skills Questionnaire (13 items) and the PANA_Attitudes Questionnaire (10 items).

CONCLUSIONS:
This study provides preliminary evidence for the validity and reliability of three new questionnaires that demonstrate sensitivity for nursing assistants' level of education and required knowledge, skills and attitudes for providing a palliative approach. Implications for practice include the development of palliative care competencies through structured education and training across this workforce, and ongoing professional development opportunities for nursing assistants, especially for those with the longest tenure.

22 July 2019

Teaching Palliative Care to Health Professional Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Donne J, Odrowaz T, Pike S, Youl B, Lo K.

BACKGROUND:
End-of-life care is challenging on health professionals' mental and emotional state. Palliative care education can support health professional students' transition, helping them to cope with the challenges of working in this complex setting. Students feel that they need more preparation in this area.

PURPOSE:
To collate the relevant information regarding how to teach health professional students about palliative care.

METHOD:
The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC, and EMBASE via Elsevier were searched until April 7, 2019. Inclusion criteria were randomized controlled trials of group interventions that aimed to increase health professional students' knowledge, skills, or attitudes in palliative care. Studies were appraised using the PEDro scale. Data were synthesized using meta-analysis.

RESULTS:
The results favored the intervention and were statistically significant for knowledge and attitudes but not for skills. A 2-hour seminar accompanied by readings seems sufficient to improve both knowledge and attitudes. Quality assessment scores ranged from 1/10 to 7/10 (mean 5, standard deviation 1.73). When studies at high risk of bias were excluded, then only knowledge improved significantly. Key areas where rigor was lacking were in concealing the randomization, omitting intention-to-treat analysis and not blinding of participants, therapists, or assessors.

CONCLUSIONS:
Palliative care education is effective in improving health professional students' knowledge and attitudes toward palliative care. More research is required into skill development. This review highlights the need for more high-quality trials in both the short and long-term to determine the most effective mode of palliative care education.

15 July 2019

Systematic review and meta-analysis of cannabinoids in palliative medicine.

Mücke M, Weier M, Carter C, Copeland J, Degenhardt L, Cuhls H, Radbruch L, Häuser W, Conrad R.

We provide a systematic review and meta-analysis on the efficacy, tolerability, and safety of cannabinoids in palliative medicine. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, PubMed, Scopus, and http://clinicaltrials.gov, and a selection of cancer journals were searched up until 15th of March 2017. Of the 108 screened studies, nine studies with a total of 1561 participants were included. Overall, the nine studies were at moderate risk of bias. The quality of evidence comparing cannabinoids with placebo was rated according to Grading of Recommendations Assessment, Development, and Evaluation as low or very low because of indirectness, imprecision, and potential reporting bias. In cancer patients, there were no significant differences between cannabinoids and placebo for improving caloric intake (standardized mean differences [SMD]: 0.2 95% confidence interval [CI]: [-0.66, 1.06] P = 0.65), appetite (SMD: 0.81 95% CI: [-1.14, 2.75]; P = 0.42), nausea/vomiting (SMD: 0.21 [-0.10, 0.52] P = 0.19), >30% decrease in pain (risk differences [RD]: 0.07 95% CI: [-0.01, 0.16]; P = 0.07), or sleep problems (SMD: -0.09 95% CI: [-0.62, 0.43] P = 0.72). In human immunodeficiency virus (HIV) patients, cannabinoids were superior to placebo for weight gain (SMD: 0.57 [0.22; 0.92]; P = 0.001) and appetite (SMD: 0.57 [0.11; 1.03]; P = 0.02) but not for nausea/vomiting (SMD: 0.20 [-0.15, 0.54]; P = 0.26). Regarding side effects in cancer patients, there were no differences between cannabinoids and placebo in symptoms of dizziness (RD: 0.03 [-0.02; 0.08]; P = 0.23) or poor mental health (RD: -0.01 [-0.04; 0.03]; P = 0.69), whereas in HIV patients, there was a significant increase in mental health symptoms (RD: 0.05 [0.00; 0.11]; P = 0.05). Tolerability (measured by the number of withdrawals because of adverse events) did not differ significantly in cancer (RD: 1.15 [0.80; 1.66]; P = 0.46) and HIV patients (RD: 1.87 [0.60; 5.84]; P = 0.28). Safety did not differ in cancer (RD: 1.12 [0.86; 1.46]; P = 0.39) or HIV patients (4.51 [0.54; 37.45]; P = 0.32) although there was large uncertainty about the latter reflected in the width of the CI. In one moderate quality study of 469 cancer patients with cancer-associated anorexia, megestrol was superior to cannabinoids in improving appetite, producing >10% weight gain and tolerability. In another study comparing megestrol to dronabinol in HIV patients, megestrol treatment led to higher weight gain without any differences in tolerability and safety. We found no convincing, unbiased, high quality evidence suggesting that cannabinoids are of value for anorexia or cachexia in cancer or HIV patients.

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