Latest Australian research

FitzGerald G, Cook J, Higgs P, Henderson C, Crawford S, Naren T.

There is a need to improve access to and experiences of palliative care for people who use alcohol and other drugs when faced with terminal medical conditions. Effective harm reduction interventions mean that people who use alcohol and other drugs are living longer, and continue to use substances as older individuals. People who use drugs demonstrate high levels of resilience in the face of a lifetime of structural disadvantage and exclusion, but are still more likely to die at an earlier age than the general population. They also experience accelerated age-related declines in functioning compared with non-drug using persons of similar age, and often have complex care needs due to accumulated health effects from their substance use and a high prevalence of past trauma. The provision of palliative care to people who use drugs can be challenging for clinicians, specifically how to manage pain, anxiety and distress among these individuals. Person-centred care is often obstructed by policies that make generalisations about the risks associated with the use of alcohol and other drugs while receiving medical care. Clinicians and health services looking to improve access to palliative care should integrate the perspectives of people with lived and living experience of drug use into their person-centred care and explore opportunities for the harms of stigma to be minimised.

Haydon HM, Lotfaliany M, Broadbent A, Snoswell CL, Smith AC, Brydon JA, et al.

Background: Telehealth-facilitated models of palliative care are a patient-focused way to deliver specialist care in or closer to home for people with a life-limiting illness. Telehealth can increase access to palliative care and support people experiencing symptoms of advanced disease in their own home, reducing the discomfort of travel. This retrospective cohort study examines the activity and outcomes of a regional telehealth-facilitated palliative care service to (i) describe which patients are most likely to use telehealth; and (ii) explore possible impacts of telehealth on patient outcomes including place of death, timely access to care, responsiveness to urgent needs and pain management.

Methods: Analysis of service activity data (patient demographics, care modality, consultation frequency) and Palliative Care Outcomes Collaborative data registry (place of death, timely access to palliative care, responsiveness to urgent needs as measured by time in unstable phase, pain management) were undertaken. Outcomes were compared between patients who had no videoconsultations (n = 683) and those who had one or more videoconsultations (n = 524).

Results: Compared to people who had no videoconsultations, those who had at least one appointment via video were: more than twice as likely to die at home and spent a shorter amount of time in the unstable phase of palliation. Mixed results were found regarding timely access to palliative care. There was no significant difference in pain management between consultation modes.

Conclusion: Telehealth-facilitated palliative care has multiple benefits, including the increased likelihood of fulfilling someone's wish to die at home, often their preferred place of death.

White B, Feeney R, Willmott L.

Abstract: This research, undertaken in Queensland, Australia aimed to explore community members' knowledge of voluntary assisted dying (VAD) 17 months after it became a lawful option. Adults living in Queensland (n = 1000) completed an online survey about knowledge of VAD as a legal option and awareness of how to access VAD and information about it. Quotas were set for age, gender and geographical region within Queensland. Only 33% (n = 329) of community members correctly identified that VAD is legal and fewer (26%, n = 257) reported that they would know how to access VAD if they wished to. Most community members (86%, n = 858) reported they would access information on VAD online, typically via search engines, and from health and medical practitioners, primarily doctors. Since lack of awareness and understanding are major barriers to seeking and accessing VAD, proactive measures are needed to increase awareness of VAD in the community and among potentially eligible patients.

Whiteford G, Curley D, Mooney G, Kinsman L, Lower T, Hobbs M.

Objectives: Despite practice development in the area of advanced care planning (ACP) and systems wide changes implemented to support ACP processes, there has been a paucity of research which has addressed the experiences of a key stakeholder group - family and carers - as they navigate their way through these often very challenging processes. The study described in this article focussed on this key group.

Methods: In-depth qualitative interviews were undertaken with family members and carers in a regional area of Australia in order to illuminate their lived experiences of ACP processes.

Results: Thematic analysis of the narrative data yielded 4 key themes: Being overwhelmed on the ACP journey; unifying effects of completing and using an advanced care directive (ACD); experiencing the highlights and lowlights of care; and paying it forward in advice to staff, carers and families.

Significance of results: The ACP journey is unique for each carer/family and can be overwhelming. Whilst he lived experiences of families/carers indicated that the quality of care received was of a high standard, feedback to staff suggested their communications be timelier and more empathic. All participants in this study reported benefitting from engaging in ACP early and appreciated support to do so. All benefitted from the preparation of an ACD and found the outcomes (in terms of concordance) gratifying.

Foster K, Mitchell G, Richard E, Steadman KJ, Senior H, Estafanos R, et al.

Background: Xerostomia is a common and difficult symptom experienced by patients with cancer. Pilocarpine is a cholinergic agent that stimulates salivation.

Aim: To assess the feasibility of conducting a N-of-1 trial to determine the efficacy of pilocarpine orally dissolving tablets in patients with xerostomia.

Design: Double-blind, crossover, placebo-controlled N-of-1 trials of 5 mg pilocarpine tablets vs placebo. Each trial consisted of three 6-day cycles containing pilocarpine (3 days) and placebo (3 days) in random order.

Settings/ participants: Participants with advanced cancer and xerostomia (scoring >3 on an 11-point numerical rating scale) from any cause, were recruited from an inpatient and outpatient palliative care unit in Brisbane, Australia.

Results: Eighteen people were recruited in 17 months. Nine withdrew, seven before or during the first 4 days. Three withdrew due to unacceptable side effects. Two participants met the definition of response (⩾2 point reduction in mean scores active vs placebo cycles). When assessing individual cycles, 15 out of 27 cycles (56%) met the definition of response. More people reported at least one mild episode during pilocarpine than placebo of nausea (6 vs 3), vomiting (3 vs 0) and sweating (3 vs 2). About 48% of adverse event classifications were reported in placebo cycles only.

Conclusions: Recruitment to an N-of-1 trial for xerostomia is feasible but attrition was high (50%). Early dropout may have been due to the trial length, complexity, appropriateness or number of questionnaires. Adverse events were generally mild. Two of 10 participants were considered to have benefited from pilocarpine warranting ongoing treatment.