Latest Australian research

Chaganti R, Ghasemzadeh M, Wong M, Hanson J.

Objective: Review outcomes for patients undergoing biliary drainage and stenting via percutaneous transhepatic cholangiography, drainage, and stenting (PTCDS) for malignant hilar biliary obstruction secondary to hepatopancreaticobiliary (HPB) tumors versus other tumor types, to identify factors which predict poor outcomes and assist discussions with patients and clinicians.

Methods: Retrospective search electronic medical records for adult patients who underwent PTCDS for malignant hilar obstruction. The primary endpoint was in-hospital bilirubin reduction, with secondary endpoints of progression to further systemic therapy, length of hospital stay, and overall survival from procedure date.

Results: Within the cohort of 50 patients, PTCDS led to a statistically significant reduction in bilirubin (p < 0.0001). The median overall survival was 81.9 days, with a median hospital stay of 11.5 days. Nineteen patients had further systemic therapy. There was no significant difference in bilirubin improvement between different cancer types, and bilirubin improvement was positively correlated with survival and with having further systemic therapy (p = 0.016). There was no significant difference in overall survival between patients with HPB cancers versus other cancers (p = 0.49). Background cirrhosis of the liver (p = 0.03) and the presence of more than one liver lesion (p = 0.02) independently negatively impacted survival. There was no impact of any covariate on the length of hospital stay.

Conclusion: PTCDS for malignant biliary obstruction has a beneficial role in the palliative management of cancer patients, but should only be pursued with very significant caution in those with background liver cirrhosis and in those with a large burden of hepatic disease.

Guo J, McErlean G, Ding J, Jiang S, Dai Y, Johnson CE.

Background: Identifying palliative care needs in older adults is challenging due to variations in the indicator focus, applicability, and sensitivity of existing instruments.

Aim: To systematically review the appropriate instruments for identifying potential palliative care needs in older adults and to assess their clinical performance and effectiveness.

Design: We conducted an umbrella review of systematic reviews that evaluated validated instruments for identifying palliative care needs in older adults across any healthcare setting (PROSPERO registration number: CRD42024616393).

Data sources: PubMed, Web of Science, CINAHL, Cochrane Library, CNKI, WangFang, and VIP databases were used to systematically search for published studies from their inception to October 2024.

Results: Eleven systematic reviews were included in this study and a total of 29 instruments were identified in the literature. Of these, eight provided data on clinical performance. The Surprise Question (SQ), Supportive and Palliative Care Indicators Tool (SPICT), Necesidades Paliativas (Palliative Needs) (NECPAL), and the Palliative Care Rapid Emergency Screening (P-CaRES) were the most frequently identified instruments in older adults. Findings regarding the prognostic capacity of these instruments were inconsistent across the reviews. While three reviews reported the effectiveness of these instruments, evidence on their impact remains limited.

Conclusion: The SPICT and NECPAL instruments have been implemented across diverse healthcare settings, including inpatient, outpatient, and general practice environments, demonstrating good sensitivity in their applications, while the P-CaRES is recommended for identifying palliative care needs in emergency departments. Future research should employ rigorous study designs to validate their effectiveness in enhancing patient-centered outcomes.

McCaffrey N, Engel L, Karnon B, Ratcliffe J, Hoefman R, Rand S, et al.

Objectives: Carer-specific preference-based instruments have been developed to capture outcomes for economic evaluations but the body of evidence has yet to be collated to guide instrument selection and identify knowledge gaps for future research. This scoping review aimed to identify carer-related, preference-based instruments and summarise and assess their performance, valuation and application. Nine databases (ASSIA, CINAHL, Cochrane, DARE, Econlit, EMBASE, iHTA, PsychINFO, Pubmed) were searched until 28^th May 2025 to identify peer-reviewed, English-language articles about the development, validation, valuation and application of preference-based, carer-related instruments. Study characteristics, instrument descriptions, psychometric properties and valuation information were extracted. The body of evidence and reporting quality were assessed using CREATE and the ISOQOL minimum standards for patient-reported outcome measures. In total, 140 included articles reported on five instruments: the ASCOT-Carer; the CarerQol; the CES; the ICECAP-CPM; and the SIDECAR. All carer-specific, preference-based instruments have rigorously developed scoring algorithms, albeit for differing numbers of countries. All of the instruments, except the ICECAP-CPM, have some evidence of psychometric validity in varied populations, though information on responsiveness is limited. Broadly, the CarerQol, the longest established instrument, is the most widely validated, followed by the ASCOT-Carer and CES. The SIDECAR and ICECAP-CPM require further testing. The CarerQol has the most evidence for use in carers of children, the ASCOT-Carer for adult social care settings, the CarerQoL and CES for the palliative care setting, and the ASCOT-Carer, CarerQoL, and CES for mental illness, rheumatoid arthritis, long-term care, and dementia. The CarerQol, CES and ASCOT-Carer represent the most widely used instruments for measuring carer-related outcomes in economic evaluations. The review findings assist with selecting instruments for studies alongside research objectives, population and settings. Future research should explore the responsiveness of these instruments, validate them in different countries and carer populations, and develop country-specific scoring algorithms.