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.
Bloomer MJ, Brooks LA, Coventry A, Ranse K, Rowe J, Thomas S.
Background: The death of a child can have a profound impact on critical care nurses, shaping their professional practice and personal lives in diverse, enduring ways. Whilst end-of-life care is recognised as a core component of critical care nursing practice and a research priority, evidence about nurses’ experiences after death in neonatal and paediatric intensive care is poorly understood.
Research question: What is the experience of the nurse after death of a patient in neonatal and/or paediatric intensive care?
Method: Following registration with Open Science Framework, an integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings was used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Medline, APA PsycInfo, Scopus, and Embase databases. Records were independently assessed against inclusion and exclusion criteria. All included papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.
Findings: From 13,018 records screened, 32 papers reporting primary research, representing more than 1850 nurses from 15 countries, were included. Three themes were identified: (i) postmortem care; (ii) caring for bereaved families; and (iii) nurses’ emotional response, which includes support for nurses. Nurses simultaneously cared for the deceased child and family, honouring the child and child–family relationship. Nurses were expected to provide immediate grief and bereavement support to families. In response to their own emotions and grief, nurses described a range of strategies and supports to aid coping.
Conclusion: Recognising neonatal and paediatric critical care nurses' experience after death is key to comprehensively understanding the professional and personal impacts, including the shared grief of a young life lost. Enabling nurses to acknowledge and reflect upon their experiences of death and seek their preferred supports is critically important. Thus, ensuring organisational and system processes similarly align with nurses’ preferences is key.
Dharmagunawardene D, Kularatna S, Halahakone U, Purtell L, Bonner A, Healy HG, et al.
Introduction: Kidney failure can be managed either conservatively or via kidney replacement therapy. Kidney supportive care combines the expertise of nephrology with palliative care in a multidisciplinary team with a focus on improving quality of life.
Objective: To identify and appraise evidence-based health system kidney supportive care interventions DESIGN: Systematic review (PROSPERO Registration - CRD42022333650).
Participants: Adults with chronic kidney failure.
Measurements: Six databases were searched, using terms "palliative care" and "chronic kidney disease" for publications between January 2010 and March 2024. The Cochrane "Effective Practice and Organisation of Care" and "Clinical Practice Guidelines for Quality Palliative Care" domains informed data extraction.
Results: Of the 60 studies included, one-third were randomised controlled trials. The most common "Effective Practice and Organisation of Care" domain described was care delivery (58/60). End-of-life care (33/60), and physical aspects of care (19/60), were commonly described "Clinical Practice Guidelines for Quality Palliative Care" domains. Multidisciplinary shared care was highlighted in 26 studies. Least described domains were cultural (0/60) and ethical aspects (3/60). Almost 2/3 (39/60) of studies compared the outcomes of kidney supportive care interventions, and the most common outcome assessed was advance care planning (18/39). Key findings reported integrated palliative care reduced hospital admissions and costs, facilitated better patient-clinician communication, and improved symptom management. Gaps were identified in cultural and ethical/legal aspects of care.
Conclusions: The studies highlighted the effectiveness of kidney-supportive care interventions in improving patient outcomes, especially in end-of-life care and symptom management. However, significant existing gaps identified necessitate further research.
Hardy JR.
Background: Over recent years, there has been great interest amongst both health professionals and lay people in the use of cannabis for a range of indications. This has been supported by multiple reports of benefit, especially via social media and anecdotal reports from the community. This has led to the legalisation of cannabis for medical use in many countries despite a lack of evidence of benefit in most cases.
The most common reasons given by cancer patients for the non-recreational use of cannabinoids are sleep quality, pain, mood changes, lack of appetite and digestive problems.1
The indications for which cannabis has been approved for medicinal use in Australia include childhood epilepsy in two rare neurological conditions, muscle spasms from multiple sclerosis (MS), chemotherapy-induced nausea and vomiting (CINV), chronic non-cancer pain and palliative care.2 The laws dictating medicinal cannabis use in the United States vary from state to state but common indications in addition to the above include post-traumatic stress disorder, inflammatory bowel disease, glaucoma and symptoms related to HIV/AIDS. The regulatory systems in place across a range of countries including Israel and Canada have been discussed in relation to the UK experience.3
The challenge for researchers has been to obtain evidence to support use in a medical context and to define therapeutic indications.
Michael N, Moore G, Appleton J, Kissane D.
Objectives: To explore 1) perspectives of feasibility, acceptability, integration and sustainability of the Psycho-existential Symptom Assessment Scale (PeSAS); 2) barriers and benefits of PeSAS in its real-world performance; and 3) clinician confidence and perceived competency in using PeSAS.
Methods: Thirty-one key stakeholders from nine palliative care services who participated in the implementation of the PeSAS were purposefully sampled and participated in semi-structured interviews. Data was managed using the Determinants Framework.
Results: Benefits of PeSAS were a common language enhancing communication, identifying symptoms of psycho-existential distress, initiating referral, providing acknowledgement for previously unrecognised distress and enhancing patient agency. Key barriers were the availability of skilled clinicians, patient characteristics such as delirium and phase of illness, avoidance of confronting end-of-life conversations, information technology resourcing, and reduced engagement due to language, culture and health literacy.
Conclusion: Screening using the PeSAS is feasible and acceptable once clinicians are adequately trained to administer it. Our study highlights the benefits of qualitative enquiry in developing and implementing new interventions.
Practice Implications: The identification and management of psycho-existential symptoms should be part of routine practice in palliative care. However, adequate staff training, resourcing, referral pathways and implementation process and outcome assessments are important to ensure sustainability.
Omoya O, Njoroge T, De Bellis A.
Background: Since 2011, extended care paramedics in South Australia have collaborated with palliative care services to deliver successful palliative and end of life care. However, a gap in paramedic training was identified with a growing number of patients opting for home palliation, prompting the development of a 2021 education program by the South Australian Ambulance Service in partnership with Program of Experience in the Palliative Approach, to equip paramedics with enhanced skills and resources for effective palliative care in the community.
Aim: To qualitatively evaluate the effectiveness of the education program provided to paramedics by exploring their subjective experience in providing palliative care within the community following the education program.
Method: The study was guided by an interpretative phenomenological approach to understand the impact an education training in palliative care has had on the practices of paramedics in South Australia.
Setting/ Participants: A purposive sample of nine South Australian paramedics from rural and metropolitan areas participated.
Results: Four major themes were identified including: (1) benefits of the education program; (2) gaps in the education program; (3) responsibility for the education provision; and (4) suggestions for the improvement of the education program.
Conclusions: Paramedics were integral to avoiding the transfer of palliative care patients to emergency departments. This was crucial for complying with a patient's wishes of not wanting to leave their own familiar surrounding at the end of their life. Palliative care education was shown to improve paramedic knowledge and skills. Specific knowledge gaps were highlighted by the participants to better manage palliative care patients in the community.
Last updated 30 April 2024