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.
Zeng A, Wong AB, Lim SM.
Background: Although the majority of those living in residential aged care facilities (RACFs) prefer to remain in their facility if their health deteriorates, many do not end up achieving this. Hospital-in-the-home (HITH) services have been increasingly used to support RACFs by providing acute, palliative, and supportive care to residents on-site. Understanding the reasons for RACFs engaging HITH services can help identify unmet needs and guide improvements in community-based end-of-life care. This study aimed to characterise the palliative care needs of RACF residents admitted to an Australian HITH service and describe the resources and interventions provided to meet these needs.
Methods: A single-centre retrospective cohort study was conducted at a large metropolitan hospital in Melbourne, Australia. We included RACF residents with palliative care needs admitted to this hospital’s HITH service between July and December 2023. Data were extracted from electronic health records and analysed using descriptive statistics.
Results: There were 142 separate admissions for 135 patients. The patient cohort had a mean age of 88.2 years, were predominantly female (55.6%), frail (median Clinical Frailty Score 7), highly comorbid (median Charlson Comorbidity Index 7), and functionally dependent (median Australia-modified Karnofsky Performance Status 30). Dementia or cognitive impairment was present in 75.6%, and 53.3% had delirium at referral. Most referrals (80.3%) originated from RACFs, with 42.3% occurring after-hours. The most frequent referral reason was for acute deterioration (74.6%). Over a quarter (28.9%) of patients had three or more concurrent symptoms at time of referral. The most common interventions included palliative care discussions (88.0%) and anticipatory medication charting and provision (75.4%). A quarter (25.9%) died in their RACF during admission, which was aligned with their location of choice. Specialist palliative care input was sought in 31.7% of cases, predominantly for care coordination (87.6%). Most (81.5%) of this cohort were deceased within 12 months.
Conclusions: This study highlights key gaps in care delivery for RACF residents with palliative care needs and how HITH can support care in this setting. Flexible and responsive models that integrate palliative care with limited active treatment are required to support goal-aligned care and improve palliative outcomes for this vulnerable population.
Adams S, Clay TD, Turner M, Kueh C, Moes K, Cruickshank T.
Purpose: The present study aimed to gain a deeper understanding of how oncology healthcare professionals' (HCPs) manage sleep disturbances.
Methods: Semi-structured interviews were conducted with 10 oncology HCPs (medical oncologists, oncology nurse practitioners, clinical nurse consultants) working in metropolitan Perth, Western Australia. Reflexive thematic analysis was used to understand oncology HCPs' perspectives on treating sleep disturbances, explore challenges and barriers to their management, as well as opportunities for improvement.
Results: Four main themes were developed: (1) sleep disturbances are underreported and underassessed, (2) poor sleep can be difficult to manage, (3) limited capacity to address sleep issues, and (4) opportunities for the future.
Conclusion: Understanding the current clinical management practices used by oncology HCPs to manage sleep disturbances, along with their perceived opportunities to improve the management of sleep in cancer care is crucial. Efforts to implement these opportunities should focus on co-design with relevant stakeholders at all levels.
Jeon YH, McKenzie H.
Aim: This interpretive qualitative inquiry aimed to explore perspectives of family carers, clinicians and service providers on the issues and challenges of providing quality end-of-life care for people with advanced dementia living at home.
Methods: We conducted in-depth, semi-structured interviews with 33 bereaved and current family carers and focus groups with 20 clinicians and service providers across various care settings. Thematic analysis was used to disclose meaningful insights and patterns of meaning.
Results: Six key themes were identified: Inadequate preparation, guidance and access to appropriate resources; Taboo and misunderstanding: talking about death; Dementia as a terminal illness and the role of palliative care; Key time points, critical events and decisions; Planning ahead not in reality; Family issues and dynamics. From clinicians' and service providers' perspectives, problems related to limited resources, poor consumer access, and skilled workforce shortages all undermined efforts to enable living and dying at home. Family carers found that conversations about death and care home admission were "too confronting" for many, hampering planning in advance. A lack of public, community and health professional awareness led to suboptimal end-of-life planning, signaling the need for all health professionals, especially community and primary care practitioners to be knowledgeable in dementia care.
Conclusions: Addressing unique challenges that people with advanced dementia and their family carers experience requires continuity of care and coordination of multidisciplinary care services. Further research is needed to identify dementia-appropriate policies, for example adaptation of current models of advance care planning to meet the needs of this population.
Lakhani A, Senyel D, Mackenzie-Stewart R, Stuckey R.
Background: Adults aged 18-64 years with life-limiting conditions often fall through gaps in health and disability systems, particularly due to service ineligibility. Although home-based palliative care improves outcomes and cost-effectiveness, structural inequities and fragmented services can prevent younger adults from remaining in the community.
Aim: To identify factors influencing the ability of younger adults with life-limiting conditions to remain in the community and to map how these factors interact - using Australia as an illustrative context - through a systems-thinking approach.
Design: Mixed-methods study combining retrospective case-note analysis and semi-structured interviews. Thematic coding informed a causal loop diagram visualizing system dynamics and leverage points.
Setting/ participants: Sixty-three younger adults connected to a national care-coordination program supporting those at risk of residential aged-care entry due to ineligibility for disability or aged-care funding. Data comprised 48 case notes and 15 interviews across all Australian jurisdictions.
Results: Five interdependent domains influenced community living: informal care, formal care, service navigation, respite access, and condition severity. The causal loop diagram revealed three reinforcing and two balancing loops. Key leverage points included respite access, carer wellbeing, and streamlined navigation and eligibility processes.
Conclusions: Systems thinking clarified how interactions among informal care, formal supports, and symptom severity shape care continuity. Findings highlight the need to position respite, practical carer support and navigation assistance as core components of community-based palliative care, and to align disability, aged-care and palliative-care systems so younger adults are not excluded from essential support due to age or funding rules.
Mitchell RJ, Cai S, George J, Boutros R, Zekry A, Zurynski Y.
Background: Palliative care is essential to manage symptoms and end-of-life (EOL) quality, yet its utilisation in liver cancer remains poorly understood. This study examined sociodemographic and clinical characteristics associated with palliative care admission in the last 5 years of life for people with a death from liver cancer.
Methods: A population-based retrospective cohort study of adults (≥ 18 years) who died from liver cancer between 2013 and 2022 in New South Wales, Australia was conducted. Multivariable logistic regression identified factors associated with palliative care admissions using linked hospital, cancer registry, notifiable conditions and mortality records.
Results: There were 3565 deaths and 55.3% of people had at least one palliative care admission. Females (OR 1.25; 95% CI 1.06-1.49), individuals with anxiety-related disorders (OR 1.63; 95% CI 1.18-2.25), drug-related dependence (OR 1.81; 95% CI 1.29-2.54), who lived in rural locations (OR 1.39; 95% CI 1.18-1.64), who had metastatic cancer at diagnosis (OR 1.23; 95% CI 1.01-1.50), who had ≥ 4 hospital admissions (OR 1.43; 95% CI 1.08-1.90) or who died in hospital (OR 4.64; 95% CI 4.64-6.52) had a higher likelihood of a palliative care admission compared to no palliative care admissions. People admitted to intensive care (OR 0.60; 95% CI 0.47-0.75) or who had mechanical ventilation (OR 0.46; 95% CI 0.29-0.74) in the last 12 months prior to EOL were less likely to have a palliative care admission.
Conclusions: This is the first Australian study to examine palliative care use in liver cancer on a population-level. Findings support earlier integration of palliative care to reduce high-acuity interventions. These insights have implications for service delivery, equity and policy in EOL care planning.
Last updated 30 April 2024