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.
Lambert E, Strickland K, Gibson J.
Purpose/ aim: To establish cultural considerations for people from culturally or linguistically diverse backgrounds at the end-of-life in Australia.
Background: Globally, there is a rapidly increasing proportion of the ageing population, and high levels of migration to Australia, the Australian healthcare community must recognise individualised and cultural needs when approaching death and end-of-life care. Many people from culturally and linguistically diverse backgrounds do not traditionally practice the palliative care approaches that have been developed and practised in Australia.
Design: A Critical Interpretive Synthesis.
Methods: A review protocol was established using PRISMA 2020 guidelines and the literature searched using CINAHL, PubMed, Psych INFO and Medline from January 2011 to 27th February 2021. This search protocol results in 19 peer-reviewed results for inclusion in critical analysis.
Results: Included studies were qualitative (14), quantitative (4) and mixed methods (1). Four themes were identified from the literature: (i) communication and health literacy; (ii) access to end-of-life care services; (iii) cultural norms, traditions and rituals; and (iv) cultural competence of healthcare workers.
Conclusions: Healthcare workers have an essential role in providing care to people with life-limiting illnesses. Cultural considerations during end-of-life care are imperative for the advancement of nursing practice. To achieve effective care for people of culturally and linguistically diverse backgrounds during end-of-life care, healthcare workers need to increase their education and cultural competency. There is inadequate research conducted within specific cultural groups, rural and remote Australian communities and individual cultural competence of healthcare workers.
Implications for practice: Continuing advancement within nursing practice relies on health professionals adopting a person-centred and culturally appropriate approach to care. To ensure individualised person-centred care is provided in a culturally appropriate way, healthcare workers must learn to reflect on their practice and actively advocate for people with culturally and linguistically diverse backgrounds during end-of-life care.
Pearce R, Steele P, Poon P.
Background: Palliative care patients undergoing transitions between hospital and home settings encounter significant challenges, necessitating specialised support services. The Rapid Palliative Care Inreach Division (RAPID) program was implemented to facilitate this transition utilising telehealth services.
Objectives: This study aimed to evaluate the use of telehealth modalities and their association with consultation interventions within the RAPID program.
Design: A retrospective clinical audit was conducted using electronic medical record data from patients seen by the RAPID palliative care service.
Setting/ subjects: The study took place in Australia, across a metropolitan health service. Data were collected from all patients referred to the RAPID program between October 2020 and March 2022, including those discharged home from inpatient palliative care or admitted under Hospital in the Home (HITH).
Measurements: Data included patient demographics, Palliative Care Outcomes Collaboration (PCOC) phase at each consultation, consultation modality (telephone, video, or in person), and intervention type (e.g. medication changes, education, referrals).
Results: A total of 201 patients received 722 consultations: 76.18% by telephone, 18.56% by video, and 5.26% in person. Patients from non-English speaking backgrounds more frequently received video and in-person reviews. Video consultations were associated with higher intervention rates, particularly in Stable and Deteriorating phases. Patients under HITH had longer service involvement and more interventions than community-discharged patients.
Conclusions: The RAPID program highlights the role of tailored telehealth in transitional palliative care. Video consultations were linked to more frequent interventions, suggesting a potential clinical benefit that warrants further research into patient-centred outcomes and optimal modality use.
Stevens SX, El-Katateny E, Addo IY, Street D, Booth C, Shaw J, et al.
Background: People receiving treatment for advanced cancer invest substantial portions of their survival time receiving healthcare, labelled the 'time toxicity' of treatment. Although qualitative research has examined the impact of time burden on patients and their caregivers, its influence on treatment decision-making is unclear.
Objective: Our objective was to explore treatment decision-making with patients with advanced gastrointestinal cancer, their caregivers, and oncologists, and unmask the role of time burden in those decisions. The objective was to inform the design of a subsequent discrete-choice experiment (DCE) investigating the importance of time burden in treatment decision-making.
Methods: A two-step process was used. Factors relevant to treatment decision-making were discussed as part of semi-structured interviews. Responses were analysed using thematic analysis with a focus on measurable themes relevant to the development of candidate attributes for a DCE. Second, we reviewed stated-preferences studies in the field of treatment decision-making in cancer and compared the results with the candidate attributes identified from interviews.
Results: Interviews with 45 participants (20 patients, 10 caregivers,15 gastrointestinal oncologists; 53% metropolitan) revealed 4 themes and 6 candidate attributes: expected survival benefit of treatment, impact of physical side effects, effect on day-to-day functioning, route of administration, healthcare contact days, and planned length of the treatment course. Review of 45 published studies yielded no additional attributes.
Conclusions: This study identified six candidate attributes for a forthcoming DCE on time burden in advanced cancer care. These findings support growing efforts to quantify and address time toxicity in cancer treatment decision-making.
Yeo NY, Deane AM, Kentish-Barnes N, Wong HZ, Sundararajan K, Reddi BAJ.
Abstract: Identifying patient's goals and values at end of life is essential to providing patient-centred care. The purpose of this prospective cohort study was to describe the changes in goals of care and the nature of end-of-life care during admission to two intensive care units in South Australia. Under a quarter of patients had their goals of care documented on admission to the intensive care unit and among those who subsequently survived to hospital discharge, only 32% had their goals of care documented on hospital discharge. Most deaths in the intensive care unit occurred after withdrawal of life-sustaining interventions. Data from 154 family meetings were collected and consensus was achieved among all parties in most meetings. In this study, fewer than one in four patients had goals of care documented on admission to intensive care with marginal increases by ICU discharge. This represent an area of care that could be improved.
Bennett G, Bates F, Duncanson K, Heslop I, Schneider J, Dineen-Griffin S.
Objectives: Palliative care enhances life, but rural Australia faces significant inequities, and psychosocial distress, an important yet often overlooked aspect, is under-recognized in these settings. This study examines how psychosocial distress evolves in rural palliative patients using the Death and Dying Distress Scale (DADDS).
Methods: A longitudinal study was conducted with palliative care patients in rural hospitals on Australia's east coast. Distress levels were measured using DADDS at multiple timepoints. Mixed-effects models assessed distress trajectories, while survival analyses (Weibull model) examined whether average distress changes predicted survival duration. For comparability, DADDS scores in mixed-effects models were standardized (0-100%), whereas survival analyses used raw total score changes.
Results: Adjusted mean total DADDS was 37.14 ± 22.67, with highest distress in fear of suffering and pain (49.95 ± 26.56) and lowest in fear of sudden death (30.26 ± 30.24). Distress followed a U-shaped trajectory: peaking early (52.68), declining mid (29.85) and late stages (28.26), then rising near death (53.05) (EMMs). Statistically significant changes included declines from early to mid-stage (β = -22.84, p = 0.007) and increases from late to near-death (β = 24.79, p = 0.003). Distress increased most from late to near-death in fear of suffering and death (β = 27.38, p = 0.006) and declined most from early to mid-stage in fear of dying (β = 28.01, p = 0.007). Higher distress correlated with shorter survival; each one-point increase in distress linked to a 6.97% survival reduction (time ratio = 0.930, β = -0.070, p < 0.001).
Significance of results: Psychosocial distress peaks in early palliative care and near death and is associated with reduced survival. Support should prioritize fears of suffering and pain during these stages, address fear of the dying process earlier, and remain attentive to persistent concerns such as loss of time and opportunity.
Last updated 30 April 2024