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.
McIlveen J, MacPhail C, Fox M, Noonan K.
Background: Global health systems are currently socially and economically burdened. Public health palliative care is an approach to caring toward end of life that can create the innovative change needed to address this inequity. Guided by the Ottawa Charter for Health Promotion (1986), public health palliative care promotes collaboration among palliative care services, civic institutions, and communities to build capacity in all aspects of death, dying, caregiving, and bereavement. Despite growing evidence for the public health approach to palliative care, little is known about how acute hospitals and communities can work together to provide care toward end of life.
Aim: To explore how acute hospitals and communities work together to provide care toward end of life.
Design: Scoping review guided by Arskey and O'Malley framework.
Data Sources: Scopus, Pubmed, CINAHL, and Informit as well as gray literature were searched. Citations were independently assessed against inclusion and exclusion criteria.
Results: Of the six included studies and reports, a priori themes of creating supportive environments; strengthening community action; reorienting health services; developing personal skills and building healthy public policy from the Charter were well represented. Additional themes of communication and language, culture and risk were also identified. Educational, arts health, community engagement initiatives were explored as well as clinical tools, psychosocial interventions, and the No One Dies Alone (NODA) program.
Conclusions: This review offers policymakers, hospitals, and practitioners a framework for implementing hospital-community partnerships toward end-of-life. Despite challenges in acute settings, these initiatives can enhance end-of-life experiences for patients and families.
Patterson P, McDonald FEJ, Tindle R, Bibby K.
Objective: A preliminary examination of the psychosocial wellbeing of young people impacted by a family member's cancer, and changes after engaging with a community cancer support organization.
Methods: Five-hundred-and-sixty young people attending a community cancer support organization self-reported distress and unmet needs at baseline and 6-month follow-up. This included young people who: had a brother or sister living with cancer ("siblings"); had a parent living with cancer ("offspring"); had lost a brother or sister to cancer ("bereaved siblings"); or had lost a parent to cancer ("bereaved offspring").
Results: Between 36.1% (siblings) and 57.6% (bereaved offspring) reported high distress; 61.6% (siblings) to 88.1% (bereaved offspring) endorsed 10+ needs. Distress decreased significantly for offspring and bereaved offspring, and unmet needs decreased significantly for siblings, offspring and bereaved offspring. Between 50.0% (siblings) and 63.6% (bereaved siblings) showed significant improvement in distress, unmet needs, or both.
Conclusions: Many young people impacted by family cancer have elevated distress and unmet needs. Engagement with a community cancer support organization may improve their psychosocial wellbeing.
Van Dinther K, Noonan K, Leonard R, Javanparast S.
Abstract: Unpaid carers of palliative patients make a significant contribution to the health economy but are particularly vulnerable to burdens due to facing the prospect of death. Caring for a loved one at the end-of-life requires knowledge of the death system in which they operate to access both practical support networks and services and emotional support for themselves. We combined qualitative data from interviews and focus groups with survey data designed using the Death Literacy Index (DLI) for 18 unpaid carers of palliative patients in South Australia. Comparing the DLI with the lived experience of carers revealed factors affecting the manner in which carers talk, learn and share knowledge about death and dying. A compassionate communities' model is proposed to capitalise on the strengths and rectify the deficits which pose barriers to unpaid carers networks of support.
Hardy JR, Good P.
Following sustained public pressure and despite a paucity of evidence to support medical benefit, medicinal cannabis (MC) was legalised in Australia in 2016 for use in resistant childhood epilepsy, chemotherapy-induced nausea and vomiting (CINV), spasticity associated with multiple sclerosis, chronic non-cancer pain and ‘palliative care’. Over subsequent years, there has been an exponential rise in the number of prescriptions approved and an associated ‘indication creep’. Most common Special Access Scheme applications to the Therapeutic Goods Administration are for pain, anxiety, sleep disorders and cancer symptoms. Popular brands include those with tetrahydrocannabinol (THC), the most common psychoactive cannabinoid. This is despite the fact that THC is associated with significant side effects, and it is illegal to drive while taking THC in most states.
Cannabis remains popular amongst cancer patients. A recent review reports that one-quarter of adults receiving cancer treatment at a cancer clinic in the United States had used cannabis in the past 30 days in an attempt to fight cancer or ameliorate the symptoms related to the disease or its treatment. The most common reasons given by over 1000 cancer patients and survivors in South Carolina were difficulty in sleeping, stress/anxiety/depression and pain. The ongoing interest is not surprising when uncontrolled trials continually report significant benefits, supported by strong media bias towards positive results. A fake news story claiming that cannabis cured cancer received 100-fold more media attention than the evidence-based story debunking the theory.
Over recent years, much research has been undertaken to answer many of the unknowns around cannabis (e.g. what combination of cannabinoids is best, at what dose and by what schedule) and to explore where it might be most effective. Uncontrolled studies and case reports continue to report benefit for a range of conditions. Randomised controlled trials (RCTs) do not. So, what is the hard evidence to date in oncology/palliative care?
Schuler T, Roderick S, Wong S, Kejda A, Grimberg K, Lowe T, et al.
Abstract: The feasibility of simulation-free radiation therapy (SFRT) has been demonstrated but information regarding its routine care impact and scalability is lacking.
Methods and materials: In this single-institution, retrospective cohort study, all patients receiving palliative radiation therapy at an Australian tertiary cancer center were eligible for consideration of SFRT unless mask immobilization, a stereotactic technique, or a definitive dose was indicated. Coprimary endpoints were SFRT utilization, impact on consultation-to-RT time, and on-couch treatment duration. Timing metrics were compared with a contemporary local cohort that received simulation-based palliative radiation therapy using unadjusted Wilcoxon rank-sum tests and a propensity score-matched regression. Electronic patient-reported outcomes captured 2-week toxicity and pain response.
Results: Between April 2018 and February 2024, 2849 palliative radiation courses were delivered, of which 1904 were eligible. Of the 1904 courses, 1000 (52.5% SFRT utilization) received SFRT, including 668 using intensity-modulated radiation therapy/volumetric-modulated arc therapy. A total of 788 individual patients received SFRT and the median age was 71 years (IQR, 61-80) with 59% being male and 42% being Eastern Collaborative Oncology Group 2-4. SFRT utilization increased from 41% to 54% between years 2018-2019 and 2022-2024. SFRT reduced median consultation-to-RT time from 7.0 to 5.1 days (P < .0001) corresponding to an adjusted average treatment effect in the treated of -2.1 days (95% CI, -2.8 to -1.3). SFRT increased median on-couch treatment duration from 17.8 to 20.5 minutes (P < .0001; adjusted average treatment effect in the treated 2.6 minutes, 95% CI, 1.3-3.9). Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events grade 3 acute toxicity was 9% and at 4 weeks after RT, patients with moderate/severe pain at baseline (≥5/10) had a mean pain reduction of 3.5 points (7.1-3.6; P < .0001).
Conclusions: Using widely available technologies, the SFRT-1000 cohort demonstrates routine care scalability with patient-centered and workflow benefits. SFRT is an attractive new paradigm implementable in most settings following adaptation to local requirements. Thus, SFRT opens new avenues to potentially improve access to palliative RT, which remains a global area of need.
Last updated 30 April 2024