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.
Omoya O, Njoroge T, De Bellis A.
Background: Since 2011, extended care paramedics in South Australia have collaborated with palliative care services to deliver successful palliative and end of life care. However, a gap in paramedic training was identified with a growing number of patients opting for home palliation, prompting the development of a 2021 education program by the South Australian Ambulance Service in partnership with Program of Experience in the Palliative Approach, to equip paramedics with enhanced skills and resources for effective palliative care in the community.
Aim: To qualitatively evaluate the effectiveness of the education program provided to paramedics by exploring their subjective experience in providing palliative care within the community following the education program.
Method: The study was guided by an interpretative phenomenological approach to understand the impact an education training in palliative care has had on the practices of paramedics in South Australia.
Setting/ Participants: A purposive sample of nine South Australian paramedics from rural and metropolitan areas participated.
Results: Four major themes were identified including: (1) benefits of the education program; (2) gaps in the education program; (3) responsibility for the education provision; and (4) suggestions for the improvement of the education program.
Conclusions: Paramedics were integral to avoiding the transfer of palliative care patients to emergency departments. This was crucial for complying with a patient's wishes of not wanting to leave their own familiar surrounding at the end of their life. Palliative care education was shown to improve paramedic knowledge and skills. Specific knowledge gaps were highlighted by the participants to better manage palliative care patients in the community.
Ley Greaves L, Willmott L, Feeney R, White BP.
Objectives: As more countries legalise assisted dying, it is of increasing significance for policy-makers and the medical profession. Doctors are needed for patients to access this choice; however, there is currently limited participation. Few studies identify what factors, if any, facilitate participation in assisted dying and how the inter-relationship of multiple factors may also influence participation. This study investigates factors influencing potential participation of doctors who have no in-principle objection to assisted dying in Queensland, Australia.
Method: A qualitative interview study with 31 doctors who have no in-principle objection to assisted dying. Interviews were conducted between March 2022 and January 2023 during the implementation period, when the assisted dying law had passed but was not yet in effect.
Results: Participants identified four categories of barriers to participation: personal burdens; professional ramifications; external constraints and the difference from the traditional role of a doctor. Facilitators to participation were: continuation of care; philosophical support for assisted dying; providing a good death and scope of provision. The interplay between barriers and facilitators influenced the degree of expected participation, if any. Three key decision points determining participation were also identified: providing for all patients or only their own patients; participation as the co-ordinating or consulting practitioner and whether to participate in practitioner administration.
Conclusion: Participation in assisted dying may be shaped by whether or not an individual doctor's philosophical support for this choice is outweighed by barriers to participation. Removing barriers could positively affect the future sustainability of an assisted dying workforce.
Williams O, Chur-Hansen A, Crawford GB.
Abstract: End-of-life care options in Australia, recently including Voluntary Assisted Dying (VAD), are available to people in prison. Little is known about how the public perceives this right. We aimed to identify the attitudes of the public by conducting a qualitative content analysis of comments across four Australian online news media outlets discussing the first case of a person in prison being granted VAD (a sexual offender). From 434 comments, we identified four overarching categories: not punished enough; unsupportive of VAD; approving of VAD; and negative characteristics of VAD recipient and other stakeholders involved. Most comments were punitive, highlighting the opinion that VAD was escaping punishment and reflected a tension between the rights of the individual versus the perceived rights of the community. We highlight the risks these attitudes can pose in terms of providing end-of-life care to people in prisons.
Chen X, Zhou W, Hoda R, Li A, Bain C, Poon P.
Introduction: Recent developments in the field of large language models have showcased impressive achievements in their ability to perform natural language processing tasks, opening up possibilities for use in critical domains like telehealth. We conducted a pilot study on the opportunities of utilizing large language models, specifically GPT-3.5, GPT-4, and LLaMA 2, in the context of zero-shot summarization of doctor-patient conversation during a palliative care teleconsultation.
Methods: We created a bespoke doctor-patient conversation to evaluate the quality of medical conversation summarization, employing established automatic metrics such as BLEU, ROUGE-L, METEOR, and BERTScore for quality assessment, and using the Flesch-Kincaid grade Level for readability to understand the efficacy and suitability of these models in the medical domain.
Results: For automatic metrics, LLaMA2-7B scored the highest in BLEU, indicating strong n-gram precision, while GPT-4 excelled in both ROUGE-L and METEOR, demonstrating its capability to capture longer sequences and semantic accuracy. GPT-4 also led in BERTScore, suggesting better semantic similarity at the token level compared to others. For readability, LLaMA 7B and LLaMA 13B produced summaries with Flesch-Kincaid grade levels of 11.9 and 12.6, respectively, which are somewhat more complex than the reference value of 10.6. LLaMA 70B generated summaries closest to the reference in simplicity, with a score of 10.7. GPT-3.5's summaries were the most complex at a grade level of 15.2, while GPT-4's summaries had a grade level of 13.1, making them moderately accessible.
Conclusion: Our findings indicate that all the models have similar performance for the palliative care consultation, with GPT-4 being slightly better at balancing understanding content and maintaining structural similarity to the source, which makes it a potentially better choice for creating patient-friendly medical summaries. Threats and limitations of such approaches are also embedded in our analysis.
Griffin CP, Carlson MA, Walker MM, Lynam J, Paul CL.
Background: Brain cancer is a devastating and incurable disease that places a high burden of care on next of kin (NOK). NOK can play a core role in supporting end-of-life planning, including the decision to donate one's brain after death. Postmortem brain donation is crucial to research. As postmortem programs develop it is important to understand the experiences of NOK as they support a loved one in the donation decision.
Methods: Thirteen qualitative interviews were completed with NOK of people who had consented to donate their brains to the Mark Hughes Foundation (MHF) Biobank. A thematic analysis was carried out on the transcribed interviews.
Results: Four central themes were identified: (i) The carer role has additional responsibilities and psychological benefits when brain donation is being considered; (ii) Supporting a loved one to donate requires mutual trust, understanding, and a commitment to honor agency; (iii) Increasing awareness of brain donation is a priority for NOK, and (iv) Brain donation is seen as a natural continuation of the donor's altruistic values.
Conclusion: When a person with brain cancer decides to donate their brain to research, their NOK can experience additional burdens and benefits as the NOK-patient relationship evolves. Understanding this evolution and recognizing the importance of trust, advocacy, and altruism provides a guide for the integration of brain donation programs into clinical pathways and a basis for normalizing brain donation as an extension of organ donation frameworks.
Last updated 30 April 2024