Latest Australian research

Yeo NY, Deane AM, Kentish-Barnes N, Saxena M, Williams PJ, Moran JL, et al. 

Abstract: Identifying patient's goals and values at end of life is essential to providing patient-centred care. The purpose of this prospective cohort study was to describe the changes in goals of care and the nature of end-of-life care during admission to two intensive care units in South Australia. Under a quarter of patients had their goals of care documented on admission to the intensive care unit and among those who subsequently survived to hospital discharge, only 32% had their goals of care documented on hospital discharge. Most deaths in the intensive care unit occurred after withdrawal of life-sustaining interventions. Data from 154 family meetings were collected and consensus was achieved among all parties in most meetings. In this study, fewer than one in four patients had goals of care documented on admission to intensive care with marginal increases by ICU discharge. This represent an area of care that could be improved. 

Agarwal A, Le B, Phillip J.

Background: Despite evidence supporting the benefits of Patient-Reported Outcome Measures (PROMs) in palliative care, their widespread implementation remains unrealized. This article aims to provide key insights and recommendations to aid the implementation of PROMs in health care services by addressing the question: What are the attitudes of health care professionals toward PROMs in palliative care, as reported in the qualitative literature?

Methods: We conducted a systematic search with a narrative synthesis of the findings. Systematic searches of Medline, EMBASE, CINAHL, and PsycInfo were undertaken for studies with qualitative evidence, published between June 2013 and January 2025. Included studies were primary studies using qualitative methods to explore health care professionals’ attitudes and experiences with PROMs in adult palliative care settings. Study quality was appraised using the Critical Appraisal Skills Program checklist, and findings were synthesized using thematic analysis informed by a hermeneutic framework.

Results: Nineteen studies met the inclusion criteria and were included for analysis. We identified three central themes regarding the attitudes of health care professionals toward PROMs: (1) the effect of PROMs on the provision of health care, (2) the contribution of PROMs in delivering patient-centered care, and (3) the integration of PROMs into clinical practice.

Conclusions: Given the ongoing challenges in integrating PROMs into routine palliative care, a systematic implementation approach is imperative. Our findings highlight important areas that require detailed consideration to enhance routine PROM implementation in clinical care, by reducing barriers and attending to clinician concerns.

Gutteridge D.S, Javanparast S, Calder A.H, Caughey G.E, Stafford A.C, Peterson G.M, Inacio M.C, Hibbert P.D, Manias E, Hillen J.B, Sluggett J.K.

Aim: This modified Delphi study aimed to achieve expert agreement on quality indicators (QIs) suitable for application at the population level, to evaluate quality use of medications and pharmacist services in long-term care facilities (LTCFs).

Methods: We conducted a two-round modified online Delphi study with a multidisciplinary panel of Australian subject matter experts (n = 25). Experts rated 58 QIs, identified in a recent systematic review, on three criteria (importance, feasibility and amenability to change by an on-site pharmacist) using a 9-point Likert scale. A QI was selected if it reached agreement between expert members (defined as a disagreement index of ≤1) with a high median score (≥7 on the Likert scale) across all three criteria.

Results: Twenty-five experts completed the first Delphi round, and 24 completed the second round. Overall, high scores with agreement were obtained for 45 QIs (78%) for importance, 27 QIs (47%) for feasibility and 25 QIs (43%) for amenability to change. Seventeen of the 58 QIs received high scores in agreement across all three criteria and were selected, covering: multidisciplinary clinical care (n = 7 QIs), clinical governance (n = 5), medication-specific issues (n = 3) and end-of-life care (n = 2).

Conclusion: The identified QIs provide a valuable foundation to capture and monitor the complexity of medication management, including on-site pharmacist services, in LTCFs. Subject to future testing and research, the expert-prioritized QIs could help optimize medication-related quality of care efforts and improve outcomes for residents in LTCFs.

Sikhosana N, Fernandez R, Moxham L.

Background: Individuals facing life-limiting illnesses undergo a profound transformation that encompasses significant physiological changes, in the level of medical care received, and a shift in overall goals of care. This transformation is irreversible and involuntary. However, individuals living with mental health conditions and life-limiting illnesses are not able to go through transformation due to diagnostic overshadowing. Previous research has examined the transformations experienced by caregivers in the context of spinal cord injuries, as well as by professional caregivers in palliative care, highlighting the complexities of their roles and the emotional adjustments they undergo. However, a notable gap in the literature exists regarding the transformation of individuals themselves who are confronting life-limiting illnesses.

Objectives: This study explored the physical and psychological transformations of individuals living with a Life-Limiting Illness, focusing on how they interpret and understand these changes.

Design: To explore this transformation, this study employed an interpretive hermeneutic phenomenological design, guided by an interpretivist-constructionist theoretical framework.

Methods: Fourteen qualitative interviews were conducted both face-to-face and via Zoom.

Results: This study reveals that the illness trajectory of individuals living with a life-limiting condition consists of three stages, which can be metaphorically described as follows: (1) Chrysalis formation: This stage represents the muted voice, where the experiences of individuals with life-limiting illnesses are expressed and supported through the medical interventions provided by healthcare professionals. (2) Breakdown of the chrysalis: This stage is characterised by unsuccessful medical interventions and subsequent physical deterioration of the individual's health. (3) Emerging from the chrysalis: In this final stage, the individual forms a new identity and finds new meaning in life as a result of living with a life-limiting illness.

Conclusion: The voice of persons with life-limiting illness is not stagnant; it undergoes various transformations at each stage of the illness trajectory. An understanding of this transformation process, along with the new identities that emerge at each stage, is crucial for designing and delivering palliative care services that effectively and timeously address the unique physical, emotional, and psychological challenges individuals encounter during each stage of their transformative journey.