Latest Australian research

Gilbertson L, Wilkinson D, Savulescu J.

Abstract: The voluntary stopping of eating and drinking (VSED) is a phenomenon whereby an individual with decision-making capacity chooses to cease eating and drinking with the intention of ending their own life. This is widely acknowledged as a lawful, albeit uncommon, end-of-life decision. It is now generally accepted that patients undertaking VSED should have access to appropriate palliative care, as per any other form of dying. However, it remains unclear whether terminal sedation (TS), the use of sedative drugs to treat intolerable symptoms at the end of life, should form part of this palliative care. In this paper, we explore and defend the use of TS in the management of VSED. We argue that TS is medically appropriate in the management of patients undertaking VSED who develop refractory delirium and have previously consented to TS. We further argue that, given the life expectancy window in cases of VSED, the appropriate use of sedation during this time does not hasten death and fits within the 2-week limit applied to traditional TS. We conclude that TS is medically and ethically appropriate in the management of VSED.

Haining CM, Willmott L, White BP. 

Background: Voluntary assisted dying (VAD) in Victoria, Australia, is governed by a stringent legislative framework, designed and enforced by the state, as well as other forms of regulation. However, there remains limited understanding about how these various forms of regulation operate at the frontline or how clinicians themselves can influence regulation.

Objectives: This article explores how clinicians working at the frontline (clinical coalface) may influence the regulation of VAD in Victoria, and how this contributes to the safe and effective delivery of VAD.

Methods: Reflexive thematic analysis of 30 semistructured interviews with 37 'regulators' (defined as those capable of steering and guiding behaviour with respect to VAD).

Results: Data analysis resulted in the generation of three main themes: (1) coalface regulation extends regulations at the clinical level, ensuring adherence to laws while developing new standards and systems for safe and effective practice; (2) coalface regulation guides day-to-day VAD practice; and (3) coalface regulation plays a critical role in quality monitoring and improvement.

Conclusions: Clinicians play a significant role in VAD regulation in Victoria and fulfil what we define as a 'coalface regulator' role. These coalface regulators are influential in ensuring the safe and effective delivery of VAD. Understanding how coalface regulation intersects with other forms of VAD regulation and how this regulatory influence can be harnessed is critical for optimising VAD regulation, safety and improving service delivery at a local and system level.

Holman T, Macdonald P, Slade D, Goncharov L, Middleton S, Watts GJ, et al.

Background & Aim: Dynamic hospital settings such as cardiology wards face challenges in delivering high-quality end-of-life care due to high patient volumes, urgent clinical demands, variable disease trajectories, and time pressures, often resulting in delayed goals-of-care discussions and suboptimal care. Despite the availability of national End-of-Life Care Standards and associated quality audit tools, evidence describing their use and end-of-life care practices in Australian cardiology wards remains limited. We aimed to examine end-of-life care in cardiology wards within Australian hospitals.

Method: A retrospective medical record audit was conducted using the Australian Commission on Safety and Quality in Health Care’s End-of-Life Audit Tool. The audit included 150 consecutive adult patients who died on cardiology wards across three Australian hospitals between February 2023 and February 2025.

Results: The median age of patients at death was 81 years, with 8.7% (n=13) having a documented Advance Care Directive during the admission. Following admission to cardiology wards, 64.7% of patients were recognised as dying, with the average time between recognition of dying to death being 28 hours. The majority (n=134) of patients had a documented resuscitation plan and 70% were referred to palliative care during their final hospital admission. In their final 48 hours of life, 76% (n=114) of patients received active investigations and/or interventions, whilst 41.7% of those identified as dying more than 48 hours before death also continued to receive active interventions and/or investigations in the last 2 days of life.

Conclusions: This study highlights that whilst some elements of high-quality end-of-life care are being provided in cardiology wards, earlier recognition of dying, improved adherence to evidence-based care and more proactive communication are needed to achieve alignment with the national standards.

Vandersman P, de la Perrelle L, Tieman J.

Objectives: This study describes the perspectives of aged care staff on when and how they communicate with families to plan end-of-life care.

Methods: This qualitative descriptive study sought the perspectives of aged care staff about end-of-life care conversations with families, using interviews, focus groups and inductive thematic analysis.

Results: Interviews were conducted with 64 aged care staff, predominantly females, representing 14 different aged care sites. Participants included registered nurses, enrolled nurses, care managers and support workers. Five key themes were identified: (1) timing as a staged and adaptive process, (2) building expectations over time prepares families for decision-making, (3) clear communication helps manage mismatch in family perceptions of decline, (4) family dynamics and cultural context shape the communication process, and (5) confidence, role clarity and medical endorsement influence communication.

Conclusions: Aged care staff are committed to engaging with families early but often face barriers when talking about end-of-life. When there is no prognosis or families are reluctant to discuss end-of-life plans, staff use various strategies to describe symptoms and changes in an older person's functions, with experienced clinical staff being more direct about deterioration. Findings highlight the need for training to build staff confidence to initiate early and ongoing communication with families. Resources for both staff and families may facilitate discussions and enhance the quality of end-of-life communication and care outcomes in aged care settings.

Xie Z, Dai Y, Mullan J, Ding J, Smith K, Johnson CE.

Background: Community-based palliative care has shown promising results in supporting older adults to remain at home, whilst providing high-quality care. However, how such initiatives are organised and delivered in practice varies widely, and evidence regarding service models and factors influencing delivery for older adults remains fragmented. This scoping review aimed to map and synthesize existing community-based palliative care initiatives for older adults, identifying their key service components, delivery approaches, and determinants of successful implementation.

Methods: A scoping review was conducted using PubMed, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and Scopus for studies published between January 2005 and July 2025. Descriptive analysis was used to summarize the key components of community-based palliative care initiatives for older adults. A narrative synthesis was then undertaken to code implementation strategies using the Expert Recommendations for Implementing Change (ERIC) taxonomy and to integrate determinants influencing implementation, guided by the Consolidated Framework for Implementation Research (CFIR).

Results: Sixteen studies describing 17 community-based palliative care initiatives for older adults were included, encompassing 56,581 older adults with mean ages ranging from 66.1 to 88.0 years. The initiatives predominantly addressed advanced life-limiting illness. Most initiatives were multidisciplinary and employed a home-based service model; all provided symptom management, care coordination, and advance care planning. Common implementation strategies included: ‘Using advisory boards and working groups’, ‘Conducting educational meetings’, ‘Conducting educational outreach visits’, and ‘Revising professional roles.’ Factors influencing delivery operated across multiple levels, including alignment with older adults’ needs, organisational readiness and coordination, workforce capacity, and characteristics of the intervention. Limited integration across care settings and variable provision of staff training were commonly reported challenges.

Conclusions: Community-based palliative care initiatives for older adults are mainly home-based and multidisciplinary, with consistent emphasis on symptom management, coordination, and advance care planning. Successful implementation of initiatives depends on aligning services with older adults’ needs, enhancing organizational readiness and cross-sector coordination, engaging patients and caregivers, and tailoring interventions to local contexts.