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.
Chauhan A, Sansom-Daly UM, Manias E, Van Poucke M, Sarwar M, Tieu NT, et al.
Purpose: Despite the availability of resources to support advance care planning (ACP) among people from ethnic minority backgrounds, its uptake remains low among these communities presenting an ACP implementation gap. This study was conducted to understand barriers and facilitators in service delivery experienced by healthcare staff and interpreters involved in implementing ACP with people from ethnic minority backgrounds with cancer.
Methods: A qualitative study using focus groups and semi-structured interviews was conducted with eligible healthcare staff and interpreters. Data was analysed employing the Framework Method using the Theoretical Domains Framework to understand ACP implementation factors.
Results: Eight focus groups comprising 28 participants and three individual semi-structured interviews were conducted. Four themes were developed, along with an underpinning theme of interprofessional collaboration between clinicians and interpreters in ACP. The four themes were as follows: (1) skills of the healthcare clinicians and interpreters; (2) knowledge of cultural factors that impact ACP; (3) the care setting and the physical environment for ACP; and (4) availability of resources to support ACP. Opportunities to foster interprofessional collaboration between clinicians and interpreters, such as training in working with each other and briefing and debriefing, were not available.
Conclusions: Shared understanding between interpreters and cancer clinicians about their communication approach and terminologies to use when no direct translation is available may contribute towards increased uptake of ACP. Identification and necessary adaptations of mechanisms that foster interprofessional collaboration in cancer care between clinicians and interpreters in ACP communication with ethnic minority communities will enhance ACP uptake and person-centred care.
Clapham S, Clark K, Draper K, Mastroianni F, Rand J, Redwood L, et al.
Background: The Palliative Care Outcomes Collaboration (PCOC), established in 2005 and funded by the Australian Government, is a national quality improvement initiative that integrates patient outcome measures into routine clinical practice. While PCOC supports services to improve patient care, implementation across diverse clinical settings presents challenges, with variation observed between similarly resourced services. Engaging services in continuous quality improvement proves difficult as the program grows.
Objectives: To identify factors associated with high-performing palliative care services and develop and evaluate an implementation framework and education program that supports continuous quality improvement.
Methods: Patient outcome data and case studies from established PCOC-participating services were analyzed to identify high-performing services and the factors enabling successful integration of outcome measures. Based on the findings, an implementation framework was developed. Improvement trends were assessed in 20 services participating pre-intervention (2016–2018) and 11 services participating post-intervention (2022–2024).
Results: Five key strategies and 25 enabling factors for successful integration were identified including, leadership and governance; education to improve data literacy; infrastructure for the meaningful management of data; and uptake of PCOC in quality systems. The post-intervention services started with higher benchmark performance and showed improvements within 6 months of implementation. Addressing patient’s psychological/spiritual needs continues to be challenging.
Conclusions: Quality improvement involving outcome measurement and benchmarking in palliative care requires education and structured implementation with ongoing feedback. The PCOC initiative demonstrates that improving patient outcomes involves more than collecting and analyzing outcome measures and benchmarking—it requires integrated assessment models, education, and resources to support information-driven quality improvement.
Gebresillassie BM, Attia J, Cavenagh D, Harris ML.
Background and objective: Proactive palliative interventions can improve symptom control and quality of life in individuals with chronic obstructive pulmonary disease (COPD); however, they are often underutilised. This study aimed to develop and validate a prediction model to identify women with COPD in their last year of life to facilitate timely palliative care referrals and interventions.
Methods: Data from 1236 women diagnosed with COPD from the 1921-1926 Australian Longitudinal Study on Women's Health cohort, linked to administrative health records, were analysed. We employed Lasso regression and multivariable logistic regression to select predictors. To assess the predictive performance of the model, we used the area under the receiver operating characteristic (AUROC) curve, calibration plot, and calibration metrics. The Youden index was used to establish the optimal cutoff point for risk classification. The clinical utility of the model was evaluated using decision curve analysis (DCA).
Results: The final model to predict 1-year all-cause mortality included six predictors: smoking status, body mass index, needing regular assistance with daily activities, number of supplied medications, duration of illness, and number of hospital admissions. The model performed well, with AUROC of 0.82 (95% CI: 0.80-0.85) and showed excellent calibration. Using a cutoff of 56.6% predicted risk, the model achieved a sensitivity of 72.3%, specificity of 77.7%, and accuracy of 75.0%. The DCA indicated that the model provided a greater net benefit for clinical decision-making.
Conclusions: Our prediction model for identifying women with COPD who may benefit from palliative care has shown robust predictive performance and can be easily applied, but requires external validation.
Goh AMY, Gerber K, Lock K, Gaffy E, Hwang K, Lane A, et al.
Background: The quality of palliative and end-of-life care (EOLC) in residential aged care (RACFs) is variable, and often suboptimal. The aim of IMPART is to improve palliative care in RACFs. IMPART provides online training and telehealth palliative-geriatric support to aged care staff and family physicians/general practitioners (GPs) to enable timely EOLC discussions, clinical support, and improve documentation of care preferences. This may lead to preference-based care, reduction of unplanned hospitalization, and improved quality of life and EOLC. This protocol describes a study to evaluate the effectiveness, cost, and implementation process of the IMPART intervention.
Methods: This study is a pragmatic, stepped-wedge, cluster randomized controlled trial across 10 RACFs to evaluate the IMPART intervention. Clusters are randomly assigned to intervention or control groups. The IMPART intervention group 1) receives timely end-of-life support from specialist In-Reach teams using telehealth; 2) engages RACF staff and GPs in a Planning Ahead Team to reflect on current practices and co-design an Action Plan to improve EOLC planning and processes; 3) receives an online interactive, needs-based EOLC education program for staff and GPs working in RACFs. The control groups receive the IMPART intervention in subsequent waves. The primary outcome measure is reduction of unplanned hospital admissions and avoidable hospital transfers for residents at end-of-life when appropriate care in their RACF is possible and consistent with residents' wishes. Secondary outcomes include reduction of emergency department presentations and length of stay of unplanned hospital admissions, and improvement in residents' quality of life, comfort, satisfaction, and quality of EOLC.
Discussion: RACFs are high-mortality settings, yet the quality of palliative and EOLC varies across facilities. There is an urgent need for timely and integrated high-quality palliative care delivered in this context. Implementing IMPART, as a novel telehealth intervention, aims to address this need. This large multisite trial will provide robust evidence about the impact of the intervention (efficacy, cost-effectiveness, and process evaluation), to inform future roll-out and scale-up into the residential aged care sector.
Hewitt J, May K, Alsaba N, Denny K, Cartwright C, Willmott L, et al.
Background: All health care is underpinned by legal frameworks, including those that regulate who is responsible for healthcare decisions at the end of life. How these frameworks support decision-making in emergency departments (EDs) and intensive care units (ICUs) is underexplored.
Objective: The objective of this study was to identify factors that help or hinder healthcare professionals' understanding and application of the law that applies to end-of-life decision-making in the EDs and ICUs in Queensland, Australia.
Methods: A descriptive qualitative study based on naturalistic inquiry was undertaken. Participants were healthcare professionals working in the ICUs or EDs of one South East Queensland Hospital and Health Service, responsible for the care of adult patients who had died.
Results: Thirteen medical practitioners, 19 registered nurses, and three social workers participated in semistructured interviews. Three themes and eight subthemes were identified in the data. First, the theme the complexity of communication is laid bare at the end of life described the challenges associated with talking about death and dying and the need to reframe conversations where death is inevitable. Next, the theme decision-making has layers highlighted family inclusion in decisions, navigating different perspectives to share decision-making and acknowledging that decision-making is emotionally burdensome. Finally, the theme how the law should apply is uncertain described the difficulties in deciding who should decide, knowing when Advance Health Directives can be relied on, and the need to reduce legal risk.
Conclusions: Decision-making at the end of life is complex and challenging. Healthcare professionals charged with leading conversations find them challenging and are mindful of the burdens associated with such decisions. The need to work within the legal framework is acknowledged, but applying the law can be difficult.
Last updated 30 April 2024