Latest Australian research

Khor YH, Ekström M.

Introduction: Home oxygen therapy is one of the few interventions that can improve survival in patients with chronic obstructive pulmonary disease (COPD) when administered appropriately, although it may cause side effects and be an unnecessary burden for some patients. 

Areas covered: This narrative review summarizes current literature on assessment of hypoxemia, different types of home oxygen therapy, potential beneficial and adverse effects, and emerging research of home oxygen therapy in COPD. A literature search was performed using MEDLINE and EMBASE up to January 2024, with additional articles being identified through clinical guidelines.  

Expert opinion: Hypoxemia is common in patients with more severe COPD. Long-term oxygen therapy is established to prolong survival in patients with chronic severe resting hypoxemia. Conversely, in the absence of chronic severe resting hypoxemia, home oxygen therapy has an unclear or conflicting evidence base, including for palliation of breathlessness, and is generally not recommended. However, beneficial effects in some patients cannot be precluded. Evidence is emerging on optimal daily duration of oxygen use, role of high-flow and auto-titrated oxygen therapy, improved informed decision-making, and telemonitoring. Further research is needed to validate novel oxygen delivery systems and monitoring tools, and establish longer-term effects of ambulatory oxygen therapy in COPD. 

Sulistio M, Gorelik A, Tee HJ, Wojnar R, Kissane D, Michael N.

Purpose: Refractory cancer-induced bone pain (CIBP) affects a patient's functional capacity and quality of life, but there is limited evidence to guide opioid choice. We assessed the feasibility, tolerability and possible efficacy of methadone rotation (MR) compared to other opioid rotations (OOR) in this cohort. 

Methods: Adults with CIBP and worst pain intensity ≥ 4/10 and/or opioid toxicity graded ≥ 2 on the Common Terminology Criteria for Adverse Events were randomised 1:1 to methadone or another opioid rotation. Standardised assessment tools were used at pre-defined study time points up to 14 days. 

Results: Of 51 eligible participants, 38 (74.5%) consented, and 29 (76.3%, MR: 14, OOR: 15) completed the fourteen days follow-up post-opioid rotation. Both groups displayed significant reduction in average (MR: d = - 1.2, p = 0.003, OOR: d = - 0.8, p = 0.015) and worst pain (MR: d = - 0.9, p = 0.042, OOR: d = - 0.6, p = 0.048) and total pain interference score (MR: d = - 1.1, p = 0.042, OOR: d = - 0.7, p = 0.007). Oral morphine equivalent daily dose was reduced significantly in MR compared to the OOR group (d = - 0.8, p = 0.05). The incidence of opioid-related adverse events following MR was unchanged but lower in the OOR group (d = 0.9, 95% CI 0.1,1.7, p = 0.022). There were no within-group or between-group differences in satisfaction with analgesia at the end of the study.

Conclusion: This pilot study demonstrated that MR and OOR in patients with refractory CIBP are feasible, safe and acceptable to patients. Appropriately powered multi-centre randomised controlled studies are needed to confirm the efficacy of MR and OOR in this cohort. 

© 2024. The Author(s).

Martin C, Pakenham K.

Abstract: This pilot study evaluates the feasibility and efficacy of a brief (four-week) predominantly self-help acceptance and commitment therapy (ACT) intervention (“Full Palliative Living”) in improving palliative patient primary outcomes (death attitudes, distress, pain, and quality of life) and a secondary outcome psychological flexibility (PF) within a palliative care (PC) setting. A quasi-experimental non-equivalent group design was used with pre- and post-intervention assessments with two groups: intervention (n = 52) and comparison (n = 54). Across three sets of analyses (mixed within/between ANCOVAs, intervention group t-tests and reliable change index), results demonstrated beneficial intervention effects for distress and PF at post-intervention. Mediation analyses showed that increases in PF mediated improvements in distress. Feasibility of delivering the intervention in a frontline PC service was supported by intervention acceptability and adherence ratings, intervention engagement, and participants’ perceptions of intervention helpfulness. The intervention effects on distress are noteworthy given the high prevalence of distress and the self-reported prioritisation of help-seeking for distress among PC patients. The Full Palliative Living program has the potential to make a significant contribution to a holistic approach to PC.

Reeves NE, O'Shea M-C, Ash K, Rego J.

Introduction: There is a growing need to prepare the health workforce to work collaboratively to meet the needs of people affected by life-limiting illness. Despite the call from industry for the inclusion of palliative care in undergraduate curriculum, there are few established methods to deliver this education for interprofessional student cohorts. Where clinical experience options are limited, the simulation-based learning experience (SBLE) offers a valuable experiential learning opportunity in the preparation of students to care for dying patients and their families. This research aims to examine the impact of SBLE on the level of allied health students' confidence in delivering palliative care. 

Methods: A quasi-experimental, pre-test/post-test design was used with 11-point rating scales to measure the change in levels of self-reported confidence in knowledge, providing care, preparedness, management and assessment of need, and professional and ethical practice among allied health students who participated in either a face-to-face or an online palliative care SBLE. 

Results: A total of 130 students participated in the SBLE in 2019 and 2020. A paired-sample t-test showed improvement post simulation, with mean differences ranging from 2.87 [95% CI 2.45–3.29] for knowledge to 3.2 [95% CI 2.79–3.60] for confidence. All categories were statistically significant (p < .05). Analysis of opened-ended questions indicated that after the simulation, students recognised the importance of a holistic focus and patient-centred care model. 

Conclusions: The SBLE improved levels of student perceived confidence for the delivery of palliative care. Educators are encouraged to use SBLE to support the development of graduate capabilities in palliative care in allied health students. 

Rosenberg J, Flynn T, Merollini K, Linn J, Nabukalu D, Davis C.

Background: Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. Its goals are to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services and is grounded in equal partnerships between civic life, community members, patients and carers, and service providers. This takes many forms, including what we have termed the ‘citizen organization’.

Objectives: This paper reports on an evaluation of Little Haven’s model of care and explores the organization’s place as a ‘citizen’ of the community it services.

Design: A co-designed evaluation approach utilizing mixed-method design is used.

Methods: Multiple data sources obtained a broad perspective of the model of care including primary qualitative data from current patients, current carers, staff, volunteers and organizational stakeholders (interviews and focus groups); and secondary quantitative survey data from bereaved carers. Thematic analysis and descriptive statistics were generated.  

Results: This model of care demonstrates common service elements including early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users, with strong community engagement. These elements enable high-quality care for patients and carers who describe the support as ‘over and above’, enabling good quality of life and care at home. Staff and volunteers perceive the built-in flexibility of the model as critical to its outcomes; the interface between the service and the community is similarly stressed as a key service element. Organizational stakeholders observed the model as a product of local activism and accountability to the community.  

Conclusions: All participant groups agree the service model enables the delivery of excellent care. The construction of a community palliative care service as a citizen organization emerged as a new concept.

© The Author(s), 2024. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).