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.
Allcroft P, De Pasquale CG, Lim D, Amgarth-Duff I, Agar MR.
Abstract: People with advanced heart failure experience significant biopsychosocial needs and have a poor prognosis. International guidelines have called for integrating palliative care in heart failure management. This review explores the elements of effective palliative care interventions in advanced heart failure. PubMed, Embase, CINAHL and Cochrane Reviews were searched following an a priori review protocol for clinical trials of advanced heart failure and palliative care. The risk of bias was assessed using Risk of Bias 2 (RoB2). A qualitative, emergent approach was used to synthesize context + mechanism = outcome. Twenty-one papers from 18 studies were the data source. The efficacy of palliative care in advanced heart failure was mixed. Five studies reported significant improvement in health outcomes compared with the usual care control group. Timing may be necessary in accounting for improvement in quality of life (occurring on or about 3 months) and functional and symptomatic improvements (occurring on or about 6 months or longer). Effective models of secondary palliative care in advanced heart failure include interdisciplinary teams comprising primary care, cardiology and palliative care, routine check-ins, personalized care plans that explore goals, evidence-based symptom management and counselling. Integrating palliative care with heart failure management could improve patient outcomes. Future research and policy development may wish to consider when, how and what palliative care modalities are to be incorporated into the care of patients with advanced heart failure.
Auret K, Pikora TJ, Briand BC.
Background: Voluntary assisted dying has become available as an end-of-life choice in many countries, including Australia. There is evidence on the mixed impact of voluntary assisted dying legislation on palliative care healthcare professionals, however, less is known about the interface between palliative care and voluntary assisted dying in smaller rural settings. This study explored the experiences of staff at a hospice in rural Western Australia in the two years following the implementation of voluntary assisted dying legislation.
Methods: A mixed-methods research methodology was used, with data collected via a brief anonymous survey and semi-structured interviews conducted with hospice staff in one rural location in Western Australia. Survey data was exported into SPSS and descriptive statistics were performed. Interviews were audio recorded and after deidentification, the transcripts were analysed thematically.
Results: A total of 30 participants took part in the survey and 10 were interviewed. The majority (n = 19) of survey respondents had been involved in voluntary assisted dying, yet only seven reported that their day-to-day role had changed. Supporting patient choice and autonomy were the most cited benefits of the introduction of voluntary assisted dying. Analysis of the qualitative data yielded three main themes: everyone is involved with patients accessing VAD; nothing changes but everything changes; and perceived support, education and training needs.
Conclusions: This study has described day-to-day work and experiences of those working in a small rural hospice which has integrated VAD into the care offered within the facility, observing there are subtle changes in the organisational atmosphere when VAD occurs. The education and support activities in place and the noted gaps may be a useful checklist for other hospices in the early phases of integrating VAD into their facility. Recommendations for future research are made.
Brown MA, Hole BD, Brennan F, Vallath N, Davison SN.
Abstract:
The concept of kidney supportive care (KSC) grew from an increasingly recognized need to provide treatment directed at the quality as well as the quantity of life of people living with chronic kidney disease (CKD). KSC attends to the lowered well-being and multiple—often severe—symptoms associated with CKD, which can be overlooked and stay unaddressed with disease-focused care in busy clinical settings.
We represent an international group, heavily involved in the development of contemporary KSC. We reflect on the available evidence and our experiences of researching, establishing, developing, and quality assuring KSC services across geographic and resource settings. Different nephrologists are at different stages of accepting and learning about what KSC and conservative kidney management (CKM) entail. We acknowledge and applaud those who provide most components of KSC most of the time. Meanwhile, we believe that KSC has yet to become part of mainstream nephrology. A recent Global Kidney Health Atlas survey found extensive variation in how CKM and KSC were defined, and what and how much care was provided.1 A separate survey of 114 kidney services across Australia, New Zealand, and the United Kingdom showed that a third do not provide KSC services, and even where a service is available, this often does not involve a nephrologist.2 It is our opinion that (i) KSC must be considered an essential part of nephrology services, universally accessible to all people under our care; (ii) clinical skills in KSC should become mandated core competencies of all nephrology training programs; and (iii) optimum and proportionate care will ensue with KSC services integrated across the CKD trajectory. We advocate for acceptance and awareness of KSC in general, and CKM in particular. We promote recent guidelines and educational opportunities in this field, particularly the International Society of Nephrology (ISN) curriculum (https://academy.theisn.org/products/kidney-supportive-care-and-conservative-kidney-management-curriculum).
Eu D, Fischer A, Griffin A, Lancaster M, Good P.
Background: Despite preferring end-of-life care at home, only a small percentage of deaths in Australia occur in private homes.
Aim: This study evaluates a private health insurance-funded support programme (provided in addition to the standard level of community palliative care), the rates of home death, the percentage of patients who died in their preferred location and the satisfaction with the care provided.
Methods: This prospective study enrolled patients in two cohorts: the Medibank cohort (with private health insurance, a prognosis of less than 3 months, a preference for home death) and the standard cohort (publicly funded patients, with no limitation to prognosis or preferred place of death). Demographics and preferences for place of death were collected.
Results: The first 12 months of the study are reported here with 132 patients (Medibank cohort, n = 67; standard cohort, n = 65). Medibank patients that died had significantly shorter contact with the service compared with the standard cohort (median 13.5 days vs 39 days), a higher home death rate (79% vs 44%) and a higher rate of preference for a home death (97% vs 59%). The proportion of deaths in the patients' preferred location was similar for both groups.
Conclusions: The high home death rate observed in the Medibank cohort highlights the potential benefit of enhanced palliative care support at the end of life. This support should be dedicated, accessible and resourced with in-home nursing assistance and allied health interventions.
Keon-Cohen Z, Loane H, Romero L, Jones D, Banaszak-Holl J.
Background: Advance care planning is well established in general medical wards, but its implementation in anaesthesia and perioperative care presents unique challenges. Effective communication and shared decision-making regarding treatment limitations are essential to clarify care goals and provide timely, high-quality end-of-life care. Terminally ill patients with complex care needs can experience a higher risk of postoperative mortality during anaesthesia.
Methods: This scoping review examines the literature describing when and how advance care planning has been studied in perioperative care, focusing on patient characteristics, the content of advance care planning discussions, and impact on patient outcomes. The study follows PRISMA-ScR guidelines. Articles were collected from MEDLINE, CENTRAL, and CINAHL databases, using search terms from MeSH and synonyms for anaesthesia, surgery and perioperative care, advance care planning, living wills or advance directives, goals of care and terminal care, resuscitation orders, shared decision-making, and palliative care discussions.
Results: Advance care planning documentation varies across surgical specialties and settings, with higher rates in emergency and palliative surgery. Patient factors, such as age and comorbidities, impact completion of advance care planning. Structurally, the presence of interdisciplinary teams, increased decision-making aids, and structured discussions improve implementation. Barriers included a lack of consistency in terminology, poor timing of needed conversations, a lack of cultural sensitivities, and patient fears of abandonment and palliative care.
Conclusions: Further research is required to determine the most appropriate and beneficial methods and outcomes for implementing advance care planning into perioperative and end-of-life care, ensuring appropriate, timely, and patient-oriented care delivery.
Last updated 30 April 2024