Latest Australian research

Ly L, Cservid V, Qazi U, Buchan C, Pascoe A, Goh N, et al.

Introduction/ aim: Distressing symptoms such as cough, fatigue and chronic breathlessness are highly prevalent among people with interstitial lung disease (ILD). Despite high symptom burden, treatment options are limited and access to palliative care is suboptimal. We aimed to explore the knowledge and beliefs of people with ILD and their carers regarding symptom management, and understand the barriers and facilitators to accessing supportive and palliative care.

Methods: Qualitative interviews with people with ILD and carers recruited from Australian public and private respiratory clinics were conducted. Transcripts were analysed thematically.

Results: Four themes emerged from 15 people with ILD and 2 carer interviews: (1) symptom burden and management; (2) beliefs and perceptions regarding opioids and supportive and palliative care; (3) informational needs; and (4) access to care and trust through continuity of care. Participants described managing frightening breathlessness, challenging symptoms and treatment side effects as overwhelming. Relentless functional decline and variable self-management adherence were reported. Opioids and palliative care were associated with end-of-life care. Participants indicated greater acceptance of supportive care if more reliable information and educational resources regarding disease and symptom management were available. Participants noted that healthcare access requires multimodal delivery, digital literacy, the establishment of trust, continuity of care and multidisciplinary collaboration.

Conclusion: People with ILD had high symptom burden but limited knowledge regarding symptom management and palliative care, with misperceptions influencing acceptance. Early integration of palliative care within multidisciplinary specialist ILD clinics, together with educational resources, is needed to facilitate holistic care.

Osborne TR, Triandafilidis Z, Jeong SY, Szwec S, Leigh L, Goodwin N.

Objective: To examine patterns of emergency department (ED) presentation and emergency hospital admission in the last 90 days of life for residents of New South Wales, Australia.

Methods: A retrospective audit of electronic clinical records. Descriptive statistics report patterns of ED presentation and emergency hospital admission in the last 90 days of life, and symptom drivers of ED presentation. Logistic regression identifies factors associated with low versus high rates of ED presentation and emergency admission.

Results: 2869 ED presentations are included across 1730 decedents. 80% of ED visits led to admission. 92% of people had at least 1 ED presentation in the final 90 days of life, with 18% having 3 or more. 86% of people had at least 1 emergency admission, with 9.5% having 3 or more. Odds of high ED use and high admissions were increased for people with cancer and those under 70 years. ED visits were long and often involved multiple investigations, but a small number of patients required no investigations. Common symptom drivers of ED attendance were pain, breathlessness, and confusion/delirium.

Conclusions: ED presentations in the final months of life are common, and investigations are often required to assess for potentially reversible problems. Some people approaching end of life require admission to hospital via ED without the need for investigations, so may be seeking help for escalating nursing needs. Alternative models of care are needed to support escalating nursing needs at home, and funding for palliative services must keep pace with the rising demand.

Staniland L, Too C, Butshiire L, Skinner S, Breen LJ.

Abstract: Telephone bereavement support is recommended in bereavement care policy and practice; however, little is known about what constitutes best practice. To explore how best practice in telephone bereavement support is conceptualized by those who provide the service, 26 healthcare professionals working in Australian hospitals, hospices, and other palliative care settings were interviewed. Thematic analysis was used to construct seven themes: A Valuable Service with Limited Resources, The First Call, The Dance of Rapport, A Space to Share, Identifying and Responding to Risk, Maintaining Contact, and Training and Development Needs. Participants viewed telephone bereavement support as an effective and accessible tool in supporting individuals' processing of and adaptation to loss; however, concerns remain regarding the quality and consistency of care provided. Greater resourcing of bereavement care is required, and telephone bereavement care providers' perspectives offer a foundation to ensure the service is evidence-based, pragmatic, and supported by quality training.

Stubbs M, Gaviola M, Sunner C, Reis J.

Abstract: Grief and bereavement are profound yet underexplored aspects of nursing practice within residential aged care facilities. Registered nurses who work in these settings often form close emotional bonds with residents, making repeated exposure to death deeply impactful. This study aimed to depict the grief, loss, and bereavement experiences of registered nurses in aged care through an arts-based qualitative approach. Nine nurses participated in a one-hour creative session involving drawing or painting to express their experiences of grief and loss. The artworks and accompanying narratives were analysed using a combined deductive and inductive approach guided by Guillemin's adaptation of Rose's critical visual methodology framework. Three key themes emerged: (i) symbolic use of colour, where colours conveyed emotions such as grief, peace, and transformation; (ii) elements of transformation, with imagery evolving from depictions of death and turmoil to representations of acceptance and renewal; and (iii) meaningful motifs, where symbols such as butterflies, birds, and domes represented peace, connection, and spirituality. Collectively, the artworks illustrated how grief, while painful, can evolve into acceptance and peace through creative expression. This study demonstrates the capacity of arts-based methods to reveal the emotional complexity of grief among aged care nurses, highlighting symbolism and colour as powerful tools for emotional understanding. Integrating creative approaches into professional development and emotional support initiatives may enhance wellbeing, reduce burnout, and improve retention. Further research should explore the long-term emotional effects of grief and the therapeutic potential of structured creative interventions in nursing practice.

Tiansaard J, Bloomer MJ, Purtell L, Bonner A.

Background: Advance care planning enables adults to express their goals and preferences for future care. Advance care planning has been widely recognised in oncology and palliative care for decades, but its use in kidney care is variable.

Objectives: To examine interventions that promote advance care planning among adults with chronic kidney disease, including those receiving kidney replacement therapy.

Design: Systematic review.

Methods: A comprehensive search was conducted in six databases: PubMed, MEDLINE, CINAHL, PsycINFO, Scopus, and Embase. Studies published from databases inception to September 2024 were included. Two independent reviewers identified studies for full-text review and data extraction. Methodological quality was assessed using the Mixed Methods Appraisal Tool. The review protocol was registered in PROSPERO (CRD42024589958).

Results: Twenty-seven studies were included: 22 were quantitative (10 randomised and 12 non-randomised), three were qualitative, and two were mixed-methods designs. Most studies were conducted in the United States of America. Five main strategies to promote advance care planning uptake and improve outcomes were educating and training kidney healthcare professionals; implementing advance care planning conversations; providing educational resources; offering peer facilitators; and integrating palliative care teams. The synthesis of qualitative findings indicated that advance care planning discussions instilled hopefulness about the future and did not induce anxiety.

Conclusion: Advance care planning conversations combined with educational resources and peer support facilitators are likely to improve rates of advance care planning completions in this population, although further evidence is needed. Kidney healthcare professionals should be trained to initiate these conversations with all patients.