Latest Australian research

Bryant RA, Azevedo S, Yadav S, Cahill C, Kenny L, Maccallum F, et al.

Importance: Although grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy.

Objective: To examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity.

Design, setting, and participants: A single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief-13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months.

Interventions: Both groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress.

Main outcomes and measures: The primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life.

Results: The trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events.

Conclusions and relevance: In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be consi

Clarke Z.

Abstract

The Western New South Wales Local Health District (WNSWLHD) has a significant footprint within the state of New South Wales (NSW). Due to the significant size of the WNSWLHD, patients residing in the local health district face many barriers to receiving Radiation Therapy. The inter-professional collaboration behind the successful implementation and evaluation of a simulation free pathway for palliative Radiation Therapy in WNSWLHD will be explored within this narrative. The process known in WNSWLHD as Medical Imaging Simulated Radiation Therapy (MISRT) removes the need for a computed tomography (CT) simulation and allows for palliative Radiation Therapy to be planned on previously acquired diagnostic CT imaging. The implementation of MISRT has required significant inter-professional collaboration. This also extends to inter-centre partnership, intra-district cooperation with Medical Imaging and inter-discipline teamwork amongst Radiation Oncologists, Radiation Oncology Medical Physicists, Radiation Oncology Nursing and Radiation Therapists. The impact and involvement of the inter-disciplinary teamwork will be explored. The methods of implementing MISRT will be outlined covering changes to standard workflow, educational requirements and inclusion criteria. The evaluation of the implementation will also be covered with two evaluation surveys being conducted. Inter-professional communication, education, teamwork and collaboration is highlighted to demonstrate improving access to quality care in a rural and regional healthcare setting whilst reducing known barriers to accessing Radiation Oncology.

Copyright © 2024. Published by Elsevier Inc.

O'Connor T, Liu WM, Samara J, Lewis J, Paterson C.

Background: Predicting length of time to death once the person is unresponsive and deemed to be dying remains uncertain. Knowing approximately how many hours or days dying loved ones have left is crucial for families and clinicians to guide decision-making and plan end-of-life care.

Aim: To determine the length of time between becoming unresponsive and death, and whether age, gender, diagnosis or location-of-care predicted length of time to death.

Design: Retrospective cohort study. Time from allocation of an Australia-modified Karnofsky Performance Status (AKPS) 10 to death was analysed using descriptive narrative. Interval-censored survival analysis was used to determine the duration of patient's final phase of life, taking into account variation across age, gender, diagnosis and location of death.

Setting/participants: A total of 786 patients, 18 years of age or over, who received specialist palliative care: as hospice in-patients, in the community and in aged care homes, between January 1st and October 31st, 2022.

Results: The time to death after a change to AKPS 10 is 2 days (n = 382; mean = 2.1; median = 1). Having adjusted for age, cancer, gender, the standard deviation of AKPS for the 7-day period prior to death, the likelihood of death within 2 days is 47%, with 84% of patients dying within 4 days.

Conclusion: This study provides valuable new knowledge to support clinicians' confidence when responding to the 'how long' question and can inform decision-making at end-of-life. Further research using the AKPS could provide greater certainty for answering 'how long' questions across the illness trajectory.

Yu KK, Yeo A, Ngan S, Chu J, Chang D, Siva S, et al.

Background: Locally advanced, bulky, unresectable sarcomas cause significant tumour mass effects, leading to burdensome symptoms. We have developed a novel Partially Ablative Body Radiotherapy (PABR) technique that delivers a high, ablative dose to the tumour core and a low, palliative dose to its periphery aiming to increase overall tumour response without significantly increasing treatment toxicity.

Aim: This study aims to report the safety and oncologic outcomes of PABR in patients with bulky, unresectable sarcomas.

Methods and materials: A total of 18 patients with histologically proven sarcoma treated with PABR from January 2020 to October 2023 were retrospectively reviewed. The primary endpoints were symptomatic and structural response rates. Secondary endpoints were overall survival, freedom from local progression, freedom from distant progression, and acute and late toxicity rates.

Results: All patients had tumours ≥5 cm with a median tumour volume of 985 cc, and the most common symptom was pain. The median age is 72.5 years and 44.5 % were ECOG 2-3. The most common regimen used was 20 Gy in 5 fractions with an intratumoral boost dose of 50 Gy (83.3 %). After a median follow-up of 11 months, 88.9 % of patients exhibited a partial response with a mean absolute tumour volume reduction of 49.5 %. All symptomatic patients experienced symptom improvement. One-year OS, FFLP and FFDP were 61 %, 83.3 % and 34.8 %, respectively. There were no grade 3 or higher toxicities.

Conclusion: PABR for bulky, unresectable sarcomas appears to be safe and may provide good symptomatic response, tumour debulking, and local control. Further study is underway.

Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.

Arena AFA, MacCann C, Moreton SG, Menzies RE, Tiliopoulos N.

Abstract: Despite research demonstrating positive outcomes of conscious death reflection, very little research directly examines a core proposition of existential psychologists-that death reflection provides an opportunity for more authentic living. The current study compared individuals chronically exposed to genuine mortality cues (funeral/cemetery workers, n = 107) to a matched control sample (n = 121) on autonomous motivation. It also assessed the moderating role of six constructs implicated in growth-oriented processing of death reflection: psychological flexibility, curiosity, neutral death acceptance, death anxiety, approach-oriented coping, and avoidant coping. Funeral/cemetery workers were significantly higher on autonomous motivation, and death-related work was found to have a more positive association with autonomous motivation for those higher on flexibility and lower on death anxiety. This has implications for both understanding which individuals are most likely to experience growth motivations when confronting death, and potential avenues for facilitating these motivations to enhance well-being.