Latest Australian research

Vayne-Bossert P, Hardy J.

Abstract: Hypnosis has gained popular interest over the last few decades and has become increasingly subject to research study. Evidence of benefit in the palliative care setting is largely lacking, but it has been shown to have a favourable impact on psychological symptoms, especially anxiety, as well as chronic pain conditions. As a personalised approach, hypnotherapy is an excellent example of individual-centred care. Moreover, in the absence of significant adverse effects, it offers great promise as a complementary therapy.

Wong RLY, Han CY, Thomas J, Knowles R.

Objectives: To explore the perceptions and experiences of healthcare professionals (HCPs) caring for older adults with cancer regarding dietary advice provision and dietetic referral.

Methods: Qualitative descriptive study providing rich descriptions of the experiences of multidisciplinary HCPs in providing care to older adults with cancer, excluding dietitians or nutritionists. Purposive and snowball sampling methods were used for recruitment. Semi-structured interviews and a focus group session were conducted. Data was analysed using qualitative content analysis. Inductive codes were generated, and codes representing factors influencing HCPs' referral to dietetics and dietary advice provision were then mapped to domains in the Tailored Implementation of Chronic Diseases (TICD) checklist using a deductive approach.

Results: Twenty HCPs across various Australian healthcare settings participated, with a broad range of working experience (1.5 to 53 years) being interviewed. Most participants perceived their role in the provision of general dietary advice, and there was a consensus that nutrition is important. Key barriers (e.g. lack of time and resources, perceived lack of knowledge, scope of practice), including unique patient-related barriers (e.g. co-morbidities, fatalistic mindset), and key facilitators (e.g. need for education, evidence-based resources, multidisciplinary team approach) to dietary advice provision fell within five TICD domains (intervention, health professional factors, patient factors, professional interactions, incentives and resources). Common barriers (e.g. disconnections in multidisciplinary care, lack of structured referral pathways) and facilitators (e.g. clear referral pathways) to referral fell within four TICD domains (intervention, health professional factors, professional interactions, incentives and resources).

Conclusion: The barriers and facilitators to referral and provision of dietary advice by HCPs suggest the need for system-level changes via a multi-pronged approach. Simple and accessible nutrition resources, stronger nutrition education for HCPs, improved referral pathways and role clarity are required to support a multidisciplinary approach to nutritional care. More qualitative research on patient-level factors involving older adults with cancer is warranted.

McKenzie J, Dunn C, Gard G, Le B, Gibbs P.

Abstract: Previous reports indicated many patients with advanced cancer and limited life expectancy have ongoing preventive medication prescription (PMP) of uncertain benefit and increased risk. Our review of palliative care oncology admissions found high rates of PMP (69%) at time of first palliative care admission, despite high rates of inpatient deprescription (88%) and death at a median of 16 days (interquartile range 10-45) following admission. Rates of PMPs did not vary by time from last systemic treatment (P = 0.29) or by prior palliative care involvement (P = 0.82). Physicians and the wider multidisciplinary care team may be missing deprescription opportunities for terminally ill patients.

Ngezi S, Butler AE, Spelten E.

Objectives: This review aimed to chart existing literature and identify gaps in the evidence base concerning palliative and end-of-life care perspectives and experiences among different generations of African migrants residing outside the continent.

Methods: This review adhered to a predefined protocol, utilizing the Arksey and O'Malley 5-stage framework, as refined by Danielle Levac and colleagues. A systematic search of 5 bibliographic databases (from inception to December 2022) yielded 79 published studies. After title, abstract, and full-text screening using Covidence®, 7 studies met the inclusion criteria. Data extraction was guided by a conceptual framework tailored to the research topic and questions, with results presented in the narrative form.

Results: Cultural and religious beliefs and practices significantly shaped African migrants' perspectives on end-of-life care. A nuanced boundary between palliative and curative care emerged, with the former often stigmatized and stereotypically associated with death and dying. Common barriers to accessing end-of-life care included limited awareness, low literacy, and perceived inadequacy of culturally sensitive care, resulting in disparities in both access and outcomes. Additionally, reluctance to discuss death and dying, along with mistrust of Western healthcare systems, constituted significant obstacles. The studies underscored the necessity of enhancing provider-patient communication by engaging with migrants to raise awareness of services and fostering inclusive healthcare environments for improved care outcomes.

Significance of results: Existing research on racial and ethnic disparities underscores the unequal quality and outcomes of end-of-life care across various racial groups. However, there is still insufficient understanding of these diverse end-of-life care needs, particularly in host countries. Bridging this knowledge gap is crucial for reducing health disparities and enhancing the delivery of culturally sensitive care within Western healthcare systems.

O'Neill K, Bloomer MJ.

Background: Cultural diversity is increasing worldwide. The provision of end-of-life care for people who have culturally diverse rituals, customs and beliefs can present barriers for critical care nurses in delivering high quality end-of-life care.

Aim: To synthesise research evidence about the perceived barriers for critical care nurses providing end-of-life care for patients and their families from diverse cultural backgrounds in ICU.

Research question: What are the perceived barriers for nurses providing end-of-life care for patients and their families from culturally diverse backgrounds in ICU?

Design: Following protocol registration, a structured integrative review was undertaken across Medline, Embase, APA PsycINFO, CINAHL Complete, Cochrane library, Google Scholar and ProQuest Dissertation and Theses Global databases. A total of 823 records were independently assessed against inclusion and exclusion criteria. All included studies were assessed for quality. Narrative synthesis was used to report findings.

Results: Fifteen studies published between 2010 and 2022 were included. Findings are presented according to four themes: (i) Language and communication, (ii) (Dis) Comfort with religion, (iii) Consensus challenges and (iv) Caring at the end of life.

Conclusion: Recognising cultural diversity provides opportunity for critical care nurses to build awareness and understanding of cultural diversity as a way of optimising end-of-life care, through routine cultural assessment, advocating for professional interpreters to enhance communication and demonstrating openness to diverse cultural needs, preferences and practices.

Implications for clinical practice: The obvious first step in countering perceived challenges to end-of-life care is to increase awareness by acknowledging and respecting difference and diversity. Cultural assessments for all patients admitted to critical care would be an ideal first step in addressing challenges associated with cultural diversity. Greater access to professional interpreters to overcome language barriers is also essential to optimising communication and consensus in decision-making at the end of life.