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.
Mascio R, Lynch S, Phillips J, Best M.
Objectives: There is a growing need to enhance healthcare providers' spiritual care competence, including for people receiving palliative care. A preceding study of predictors of spiritual care competence in a general group of nurses found that more competent nurses rated significantly higher in spiritual training adequacy, frequency of spiritual care provision, and personal spirituality than other nurses; like the demographic variables of level of education, length of nursing experience, and sex, confidence and comfort in providing spiritual care were not related to spiritual care competence. The current study aimed to replicate these relationships in a sample of palliative care nurses. This sample also allowed the testing of a hypothesis that palliative care nurses will tend to subscribe to more competent understandings of spiritual care.
Methods: Data were collected from a convenience sample of Australian palliative care nurses who completed an anonymous, online survey. The survey provided qualitative data about what spiritual care means for them and quantitative data regarding nurse characteristics. The qualitative data were used to create sub-groups of nurses based on their understanding of spiritual care and the quantitative data were used to construct a profile of nurse characteristics for each sub-group. The replication analysis determined whether a statistical difference in nurse characteristics existed across sub-groups. The hypothesis testing compared levels of spiritual care understanding across the general and palliative care samples of nurses.
Results: While the results of the palliative care sample are largely concordant with those obtained in the general sample, the current study amends "training adequacy" as a predictor of spiritual care competence to "experience (whether on-the-job or training) in caring for the dying." The study hypothesis was supported.
Significance of Results: The results can be used to assess and develop competence in spiritual care for palliative care nurses.
Perera M, Parsonage W, Yates P, Singh GK.
Background: Palliative and supportive care provided in the home for individuals with heart failure and their carers can improve quality of life, reduce symptom burden and hospital admissions. However, how to enable this care in accordance with what matters to individuals living with heart failure and their carers remains elusive. This research aimed to explore the experiences, perspectives and preferences of individuals with heart failure and their carers on home-based palliative and supportive care.
Methods: A qualitative study using semi-structured interviews was conducted with individuals with heart failure and carers, recruited from two tertiary care hospitals in Queensland, Australia.
Results: A total of eleven individuals with heart failure and ten carers participated. Their age ranged between 40– 84 years. Most participants were female (n = 14, 66.7%). The themes derived from thematic analysis centred on: a) diverse strategies for seeking emotional support, b) acknowledging the importance of carers, c) effective information and communication, d) the value of home-visits, e) telehealth enhances care f) a circle of care: health professionals and social services supporting the individual and carer, and g) planning for future care.
Conclusion: Insights into the perspectives, experiences and preferences of individuals with heart failure and their carers are critical to delivering patient and carer centred palliative and supportive care in the home. Providing emotional support to individuals with heart failure, supporting carers, utilising telehealth, and enhancing the circle of care through better communication is required to deliver palliative and supportive care in the home in accordance with what matters to individuals with heart failure and their carer.
Gurgenci T, Olson R, Smith A, Stokes C, Good P. D.
Abstract: This article introduces a framework of contextual effectiveness to reconcile the persistent gap between patients’ positive experiences with treatments and negative clinical trial outcomes in palliative care. Using medicinal cannabis as an illustrative example, we challenge the statistical assumption that averaging patient responses yields a reliable “true effect” for subjective outcomes like quality of life. We argue that treatment effects vary not only between patients but also within the same patient across contexts and time. While averaging approaches remain valid for discrete symptoms (e.g., pain), a patient’s reported improvement in overall well-being in specific situations may reflect genuine contextual effectiveness rather than placebo or misattribution. Highly individualized findings complicate guideline and funding decisions; hence, we propose a dual-pathway model for evidence generation: traditional randomised controlled trials (RCTs) for population-level efficacy, followed by post-trial contextual surveillance studies (CSS) that empower individualized patient-clinician decisions. This framework maintains scientific rigor while enabling more person-centered care. By recognizing that a patient may be both a “responder” and “non-responder” depending on life context, we offer a paradigm shift in how subjective outcomes are understood, evaluated, and applied in palliative care practice.
Ayalew A. A, Poudel A, Johnson K, Thepsourinthone J, Heer S, Redwood L, Mullan J, Bonney A, Morgan D, Yates P, Clark, K Auret K, Clapham S.
Objectives: To assess palliative care utilization, estimate duration of care, and identify predictors of care duration among general practitioner (GP)-referred patients following commencement of specialist palliative care.
Design: Multicenter retrospective cohort study.
Setting and Participants: This study included patients with life-limiting illnesses referred by GPs between July 1, 2019, and June 30, 2024, and who received care from services registered with the Australian Palliative Care Outcomes Collaboration.
Methods: Two outcomes were assessed: (1) palliative care utilization (inpatient vs community) and (2) duration of palliative care, measured in days. Binary logistic regression identified factors associated with inpatient vs community palliative care utilization, and quantile regression identified predictors of palliative care duration from first admission to death.
Results: Of 25,124 GP-referred patients, 92.2% were admitted to community palliative care and 44.4% died during the study period. Most deaths (81.3%) occurred within 3 months of commencing specialist palliative care. Admission to inpatient care was more likely among patients with cancer and those experiencing distress from breathlessness, nausea, or psychological/spiritual problems, and less likely among those with higher functional status, older age, distress from appetite or fatigue, and family/carer problems. Among decedents, shorter duration of palliative care was associated with inpatient care, functional decline, distress from pain, breathlessness, and family/carer problems.
Conclusions and Implications: GP-referred patients were predominantly admitted to community-based palliative care, and most of them received specialist palliative care for a shorter duration than recommended. Future research in primary care, exploring needs-based referral models and referral acceptance, may support timely access and comprehensive care.
Cheung S. C, Lovell M. R, Hilmer S. N.
Objectives: Polypharmacy can increase symptom burden and reduce quality of life in palliative care patients. The Drug Burden Index (DBI) measures patients' exposure to anticholinergic and sedative medications, but has not previously been validated in the palliative care population. This study aimed to quantify the DBI in an older palliative care inpatient population, and examine its associated functional, symptom and delirium outcomes.
Methods: A retrospective cohort study was conducted on patients aged 65 years and older admitted to a specialist palliative care unit in Sydney, Australia, over a 3-month period. Demographic data, admission characteristics, medication exposure and clinical scores were collected via medical record review. Patients' DBI on admission and at 24 hours post-admission were calculated based on regular and pro re nata (PRN) medications.
Results: 79 patients were enrolled, who used a mean of 6.3 (SD 4.4) regular medications on admission, with a corresponding mean DBI of 0.69 (SD 0.55). At 24 hours post-admission, the DBI increased in 37% of patients and the resultant mean DBI was 0.82 (SD 0.58), which increased to 1.01 (SD 0.64) when administered PRN medications were included. There was no significant correlation on univariate analysis between patients' DBI on admission and their functional, symptom or delirium scores or length of hospital stay.
Conclusions: Older palliative care patients are frequently exposed to anticholinergic and sedative medications. The DBI is a practical tool which can prompt medication review and inform safe, individualised prescribing in the palliative care setting in line with patients' goals of care.
Last updated 30 April 2024