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.
Tan B, Freeman-Spratt G, Kasiri H.
Objectives: Identify the indication, route of administration and dose for phenobarbital continuous subcutaneous infusion (CSCI) in palliative sedation therapy (PST).Assess the dosing and continuation of midazolam and levomepromazine in conjunction with phenobarbital.
Methods: This clinical audit examined inpatient phenobarbital CSCI use for PST from January 2021 to April 2024. Data were retrospectively extracted from electronic medical records (n=23).
Results: The most common indication for phenobarbital CSCI was agitation, followed by sedation for non-invasive ventilation withdrawal. Phenobarbital was administered subcutaneously in all cases without adverse systemic or site reactions.The most common loading dose was 200 mg (50-200 mg), and the most common initiating CSCI dose was 800 mg/24 hours (400-1200 mg/24 hours). The maximum dose was 1800 mg/24 hours. The average time to death following start of phenobarbital was 52 hours (4-123 hours). Most patients (n=22) were described as comfortable at death.Before starting phenobarbital CSCI, all patients were on midazolam CSCI (mean dose 50 mg), which was continued in 14 patients. Seventeen patients received levomepromazine CSCI (mean dose 137 mg), which was continued in 12 patients.
Conclusions: Phenobarbital appears to be an effective medication for PST. However, inconsistencies in dosing, concurrent sedative medication use and standardised protocols highlight areas for improvement in clinical guidelines.
Yang E, Kabir A, Rhee J, O'Callaghan C, Barr M.
Abstract: The ageing population and increasing chronic illness pose significant healthcare challenges, including care late in life. Advance care planning (ACP) is an ongoing process of making decisions regarding future health care for patients. This process can include formal completion of an advance care directive (ACD), which is a legally binding document. ACP can improve patient outcomes and satisfaction, but rates are low across Australia. This study assessed the sociodemographic and clinical predictors of individuals engaging with ACP and ACDs using data from the 45 and Up Study cohort in New South Wales.MethodsA cross-sectional cohort study of 28,626 people responded to ACP-related questions in the wave 2 questionnaire of the Sax Institute's 45 and Up Study. ACP completion was recorded if people responded 'yes' to any of the three ACP questions, and ACD was recorded if they responded 'yes' to the ACD question. Poisson regression modelling was used to estimate the prevalence ratio and the 95%CI.ResultsA total of 28,626 people completed the ACP- and/or ACD-related questions, of whom 17,458 (61%) completed ACP and 3744 (13.1%) completed ACD. The predictors associated with an increased likelihood of ACP and ACD completion included having a will, advancing age, being female, having private health insurance, not currently working, and having one or more self-reported medical conditions. Predictors unique to increased overall ACP completion included having a university degree or higher, being married and having a health care concession card (Health Care Card). Being a carer increased ACD rates, whereas being married or in a de facto relationship decreased ACD completion.ConclusionsThese findings could inform interventions aimed at improving ACP uptake by identifying groups that engage less in ACP and provide a basis for future research.
Last updated 30 April 2024