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.
Mitchell RJ, Cai S, George J, Boutros R, Zekry A, Zurynski Y.
Background: Palliative care is essential to manage symptoms and end-of-life (EOL) quality, yet its utilisation in liver cancer remains poorly understood. This study examined sociodemographic and clinical characteristics associated with palliative care admission in the last 5 years of life for people with a death from liver cancer.
Methods: A population-based retrospective cohort study of adults (≥ 18 years) who died from liver cancer between 2013 and 2022 in New South Wales, Australia was conducted. Multivariable logistic regression identified factors associated with palliative care admissions using linked hospital, cancer registry, notifiable conditions and mortality records.
Results: There were 3565 deaths and 55.3% of people had at least one palliative care admission. Females (OR 1.25; 95% CI 1.06-1.49), individuals with anxiety-related disorders (OR 1.63; 95% CI 1.18-2.25), drug-related dependence (OR 1.81; 95% CI 1.29-2.54), who lived in rural locations (OR 1.39; 95% CI 1.18-1.64), who had metastatic cancer at diagnosis (OR 1.23; 95% CI 1.01-1.50), who had ≥ 4 hospital admissions (OR 1.43; 95% CI 1.08-1.90) or who died in hospital (OR 4.64; 95% CI 4.64-6.52) had a higher likelihood of a palliative care admission compared to no palliative care admissions. People admitted to intensive care (OR 0.60; 95% CI 0.47-0.75) or who had mechanical ventilation (OR 0.46; 95% CI 0.29-0.74) in the last 12 months prior to EOL were less likely to have a palliative care admission.
Conclusions: This is the first Australian study to examine palliative care use in liver cancer on a population-level. Findings support earlier integration of palliative care to reduce high-acuity interventions. These insights have implications for service delivery, equity and policy in EOL care planning.
Pullen S, Majeed T, Russo S, Dieckmann MA, Oldmeadow C, Wynne O, et al.
Objectives: Patients with advanced liver disease (ALD) may benefit from the early integration of supportive care toward the end of life. Engagement with supportive and palliative care could decrease disease-related distress and alleviate pressure on the health system. This trial evaluated whether a transdisciplinary supportive care model, aligned with standard care and guided by patient- and carer-identified needs, could optimize health service utilization and outcomes for patients and carers living with ALD.
Methods: A 90-day multicenter, mixed-methods pilot randomized controlled trial, "Liver Life," was conducted at 1 regional tertiary and 1 rural referral hospital in NSW, Australia. The intervention group received patient- and carer-centered supportive care interventions during 5 scheduled allied health-led outpatient visits, alongside ongoing standard care. This paper reports health service utilization and associated costs, and participant-reported measures.
Results: Over 90 days, emergency department presentations were reduced by 66% (incidence rate ratio: 0.34 [0.13-0.80]), and hospital admissions by 64% (incidence rate ratio: 0.36 [0.12-0.98]). Intervention patients were 5 times more likely to have more days "alive and out of hospital" than those receiving standard care alone (odds ratio: 5.34 [1.43-22.1]). As a result, the overall cost of health service use per intervention patient was less than half that of standard care alone.
Significance of results: The Liver Life trial demonstrated the feasibility, acceptability, efficacy, and potential cost savings of a transdisciplinary supportive care model for ALD patients and their caregivers. Future research should investigate the sustainability and transferability of this approach to other populations and other chronic diseases.
Ross L, McDonald J, Volkmann ER.
Purpose of review: Respiratory disease is a major cause of morbidity and mortality for patients with systemic autoimmune diseases. Chronic exertional fatigue, breathlessness, and cough all cause significant impairment of quality of life. In this review, we summarize the major respiratory complications of systemic autoimmune diseases and consider the evidence supporting the role that palliative care can play in the management of systemic autoimmune disease.
Recent findings: The symptom burden suffered by patients with systemic autoimmune diseases is equivalent to that of patients with active malignancy. Recent studies have explored how palliative care could be integrated with rheumatology care to improve symptom control and address the high psychosocial burden associated with living with a systemic autoimmune disease. Both rheumatologists and palliative care providers are uncertain as to the role of palliative care in the management of systemic autoimmune diseases, with the optimal model of integrated palliative care yet to be defined.
Summary: Emerging evidence supports the acceptability and value of palliative care to patients living with a systemic autoimmune disease and their caregivers. However, there are both patient and physician associated barriers to the integration of palliative care with rheumatology care. Studies are required to demonstrate the efficacy of palliative care in the management of systemic autoimmune diseases.
Bryant RA, Breukelaar IA, Korgaonkar M.
Abstract: Prolonged grief disorder (PGD) is a psychiatric condition that describes individuals who experience persistent grief reactions characterized by preoccupation with the loss. This review provides an overview of the evidence on neurobiological processes associated with PGD. We propose that, although the neurobiological circuitry of PGD overlaps with that of anxiety and depression, it also involves neural responses that reflect the distinct symptom profiles of people with PGD. Specifically, while recruitment of cognitive control and salience networks is observed across common mental disorders, there is evidence that aberrant neural processes implicated in reward processes and appetitive functions are somewhat distinctive to PGD. We emphasize that methodological limitations suggest caution is needed in interpreting current evidence, and more rigorous research is required to delineate key distinct neurobiological processes of PGD.
Stevens SX, Addo IY, El-Katateny E, Rollins B, Lourenço RA, Booth CM, et al.
Background: People with advanced cancer often invest substantial amounts of time to receive palliative treatments. This has been labelled the 'time toxicity' of cancer treatment. However, stakeholder views on time toxicity are still being established. This study used mixed methods to explore Australian oncologists' perspectives on the time burdens of palliative systemic cancer treatments.
Methods: Semi-structured qualitative interviews were conducted with a convenience sample of gastrointestinal oncologists recruited from one metropolitan and one regional centre, supplemented by online advertising through the Australian Gastrointestinal Trials Group. Themes emerging from initial interviews (n = 8) informed the development of an online survey disseminated to Australian oncologists via professional groups. Qualitative data were analysed using an inductive approach. Survey data were summarised descriptively.
Results: Fifteen oncologists were interviewed, 60% of whom were primarily based in major metropolitan areas. One overarching theme: the value of time, unified four subthemes: (1) contributors to 'time 'toxicity', (2) benefits and uncertainties, (3) time as a decision-modifier, and (4) proposed solutions. Surveyed oncologists (n = 108) expressed broad agreement with the thematic framework in interviews, affirming the importance of time for patients with advanced cancer and supporting strategies to reduce time burdens. However, responses acknowledged the subjectivity of time 'toxicity' to individual patients.
Conclusions: This mixed-methods study establishes Australian oncologists' perspectives on the time toxicity of palliative systemic cancer treatments, identifying potential barriers and opportunities for including discussions of healthcare time into shared decision-making, and systems-level strategies for addressing unwanted healthcare contact time.
Last updated 30 April 2024