Latest Australian research

Crosbie D, McCarthy M, Ghosh A, Hayes B, Suleiman M, Jones D.

Background: A considerable proportion of medical emergency team (MET) calls involves dying patients. Little is known regarding the quality of care for these patients and whether MET involvement in a dying patient is preventable.

Aims: To analyse a cohort of patient deaths at a metropolitan teaching hospital and compare the characteristics of those patients who received a MET review during their last admission with those who did not.

Methods: A retrospective analysis was conducted of all deaths occurring on general wards during 2022. Patients admitted for palliative care or those cared for solely in the intensive care unit or emergency departments were excluded. Demographics, comorbidities, frailty scores and resuscitation status were ascertained. For the patients who had a MET call during their last admission the number and aetiology of calls, intensive care unit (ICU) admission and time between last MET review and death were also recorded.

Results: Of 605 deaths, 567 (93.7%) fulfilled the inclusion criteria, of which 320 patients (56.3%) had a MET call. Patients receiving a MET call were less likely to have prior treatment limitations documented, and few were admitted to the ICU. Patients who received a MET call had a shorter time between treatment limitation and death.

Conclusions: Over half the patients who died on general wards had a MET call. These patients often had multiple reviews, and were less likely to have prior treatment limitations. Our study suggests that early review of treatment goals on admitted patients is warranted.

Hall K, McKeever S, Ojabo M, Simonda I, Tighe J, Shaw J.

Background: Generative Artificial Intelligence (Gen AI) enables nursing students to practice complex, sensitive end-of-life care discussions in a simulated environment. This approach provides opportunities to develop person-centred communication and feedback with students without involving real patients, supporting preparation for clinical practice.

Purpose: To explore Australian undergraduate nursing students' satisfaction and competence in conducting end-of-life (EOL) conversations after interacting with AI-generated characters representing diverse backgrounds.

Methods: An exploratory pre- and post-test survey design incorporating both quantitative and qualitative data. Third-year undergraduate nursing students from one Australian university participated. Pre-test surveys assessed self-reported competence in sensitive EOL conversations. Post-test surveys measured self-reports of competence in EOL conversations, confidence, and satisfaction with the learning experience. A total of 109 students completed the pre-test, and 82 completed the post-test. Data were analysed using descriptive statistics and thematic analysis.

Discussion: The intervention positively impacted students' confidence and competence in EOL conversations (respondents who stated, 'Strongly Agree' or 'Agree' increased by 15% to 34%). The identified qualitative themes included content-specific learning, as well as the development of knowledge, skills, and attributes. It was perceived as a safe learning environment that offered interactivity and engagement, realism, but also had challenges and emotional limitations.

Conclusion: Gen AI simulations enhanced students' competence and engagement in EOL discussions. While some participants noted a lack of emotional depth in AI responses, the overall experience was found to be safe, informative, and promising for nursing education.

Hardy J, Greer R, Foster K, Oliveira N, Good P, Vayne-Bossert P, et al.

Objectives: Men with castrate-resistant prostate cancer (CRPC) suffer from symptoms related to both their disease and its treatment with marked variation between individuals with respect to symptom expression. This study aimed to determine whether genetic variation in cytokine expression is associated with symptom severity.

Methods: An exploratory prospective, longitudinal consecutive patient cohort study was undertaken across two Queensland sites. Patient characteristics including tumour burden and current treatment were collected at baseline. Symptom severity was assessed 3-4 weekly for up to 6 assessments, with blood taken for genetic analysis once only during the study. Cytokine gene variants of each participant were assessed using a panel of single nucleotide polymorphisms (SNPs) most described in the literature.

Results: Of the 66 participants, 27/66 (41%) had a low, and 39/66 (59%) a high tumour burden. Symptom severity was not related to tumour burden or patient characteristics. Of the 142 SNPs analysed from 62 participants, 15 SNPs from 7 genes were significantly associated with symptom severity. After Benjamini-Hochberg adjustment, SNPs rs2069772 from Interleukin-2 (IL2) and rs230494 from Nuclear Factor kappa-light-chain-enhancer of activated B cells (NFKb) remained significant.

Conclusion: Although multiple factors can influence symptom severity, genetic variation may play a part. The early identification of men likely to develop severe symptoms during the course of their prostate cancer could theoretically enable symptoms to be managed more aggressively from an early stage. These preliminary findings need to be replicated in a larger cohort of men with CRPC.

Mogg D, Levy MH.

Abstract: New South Wales was the last Australian state to pass voluntary assisted dying (VAD) legislation, effective on 28 November 2023. The Justice Health and Forensic Mental Health Network (JHNSW) is responsible for the health care of people in contact with the criminal justice system in NSW (www.nsw.gov.au/health/justicehealth/) and was tasked with implementing a VAD pathway for prisoners. A steering committee was formed with the Corrective Services NSW (CSNSW; https://correctiveservices.dcj.nsw.gov.au/), the local health district, the CSNSW Inmate Consumer Referent Group, the Mental Health Review Tribunal (https://mhrt.nsw.gov.au/the‐tribunal/), the JHNSW Clinical Ethics Committee, the Victims Support Scheme and the Aboriginal Health and Medical Research Council of NSW (www.ahmrc.org.au) to create dignified and culturally safe pathways for prisoners to access VAD. The ethical and legal challenges of integrating VAD into the NSW correctional settings are highlighted below, with a hypothetical patient journey demonstrating the pathway.

Rowe A, Loi SM, Cheung G. 

Objective: Voluntary assisted dying (VAD) in Australia and New Zealand is reserved for terminally ill individuals experiencing unbearable suffering. This study investigated the knowledge and views of Australian and New Zealand psychiatrists and trainees on VAD, including for mental illnesses, and whether these knowledge and views differ between psychiatrists and trainees.

Methods: Participants completed an online survey consisting of 18 questions between March and June 2024. The survey was distributed via various Royal Australian and New Zealand College of Psychiatrists newsletters and through snowballing.

Results: One hundred and sixty-four psychiatrists and sixty-five trainees were included. Psychiatrists tended to be more confident in their knowledge of VAD, less willing to be involved with VAD and more conservative in their views of VAD than trainees: 26.8% of psychiatrists and 10.8% of trainees strongly agreed that the criteria for VAD will progressively broaden (p < .047).

Conclusion: Differences in experience may explain some of these distinctions; however, other factors are likely to have been influential in explaining these differences. Given the increasingly liberalised and autonomous social landscape, Australian and New Zealand psychiatry should prepare themselves for the ethical question of VAD for mental illnesses that will inevitably arise.