Latest Australian research

Gerber K, Hjorth L, Bryant C, Lock K, Chong TWH, Engel L, et al.

Objectives: Bereaved older adults often experience health complications, yet receive limited support in primary care settings. This research explored general practice staff's exposure to older patients' grief and identified barriers/enablers to bereavement support.

Methods: We examined 15 in-depth interviews with general practitioners and practice nurses across Australia. Data were analyzed thematically and via poetic narrative analysis, an innovative arts-based method to meaningfully translate participant's lived experience and emotions.

Results: Exposure to older people's grief and bereavement informed primary care staff assumptions about older people's grief, their ability to identify signs of grief, their understanding of how culture, gender, and grief intersected, and how grief could be managed in general practice (e.g. mobilizing nurses to provide support). Barriers/enablers to bereavement support included: Communication, access to support, time to discuss concerns, and knowledge/awareness of grief complications.

Conclusions: Older adults require access to tailored support that addresses their experiences of repeated exposure to grief and loss. Primary care is a key conduit to specialist services but to make such referrals more training is needed on ageism and stigmas surrounding mental health. Arts-based methods can open a dialogue about grief and destigmatize help-seeking among older adults.

Shimoniaba K, Crawford K, Lee DA, Qiu Y, Lalor AF, Jackson KM, et al.

Aims: To examine residential aged care staff's experience of death and grief, and their support needs.

Methods: A mixed-methods sequential explanatory design, using an online cross-sectional survey that included the Texas Revised Inventory of Grief and the Grief Support in Health Care Scale. Followed by semi-structured interviews with direct care workers and managers working in residential aged care homes were conducted.

Results: Over 60% of participants experienced five or more resident deaths in the previous 12 months. Although, different levels of grief were experienced among different roles, the importance of open communication and opportunities for farewells after resident death was highlighted. Participants suggested support and education to normalise grief and promote self-care.

Conclusion: Recognising staff grief following the resident death is important. Providing support and education may help improve staff wellbeing and contribute to the delivery of high-quality care for both residents and their families.

Zeng A, Wong AB, Lim SM.

Background: Although the majority of those living in residential aged care facilities (RACFs) prefer to remain in their facility if their health deteriorates, many do not end up achieving this. Hospital-in-the-home (HITH) services have been increasingly used to support RACFs by providing acute, palliative, and supportive care to residents on-site. Understanding the reasons for RACFs engaging HITH services can help identify unmet needs and guide improvements in community-based end-of-life care. This study aimed to characterise the palliative care needs of RACF residents admitted to an Australian HITH service and describe the resources and interventions provided to meet these needs.

Methods: A single-centre retrospective cohort study was conducted at a large metropolitan hospital in Melbourne, Australia. We included RACF residents with palliative care needs admitted to this hospital’s HITH service between July and December 2023. Data were extracted from electronic health records and analysed using descriptive statistics.

Results: There were 142 separate admissions for 135 patients. The patient cohort had a mean age of 88.2 years, were predominantly female (55.6%), frail (median Clinical Frailty Score 7), highly comorbid (median Charlson Comorbidity Index 7), and functionally dependent (median Australia-modified Karnofsky Performance Status 30). Dementia or cognitive impairment was present in 75.6%, and 53.3% had delirium at referral. Most referrals (80.3%) originated from RACFs, with 42.3% occurring after-hours. The most frequent referral reason was for acute deterioration (74.6%). Over a quarter (28.9%) of patients had three or more concurrent symptoms at time of referral. The most common interventions included palliative care discussions (88.0%) and anticipatory medication charting and provision (75.4%). A quarter (25.9%) died in their RACF during admission, which was aligned with their location of choice. Specialist palliative care input was sought in 31.7% of cases, predominantly for care coordination (87.6%). Most (81.5%) of this cohort were deceased within 12 months.

Conclusions: This study highlights key gaps in care delivery for RACF residents with palliative care needs and how HITH can support care in this setting. Flexible and responsive models that integrate palliative care with limited active treatment are required to support goal-aligned care and improve palliative outcomes for this vulnerable population.

Adams S, Clay TD, Turner M, Kueh C, Moes K, Cruickshank T.

Purpose: The present study aimed to gain a deeper understanding of how oncology healthcare professionals' (HCPs) manage sleep disturbances.

Methods: Semi-structured interviews were conducted with 10 oncology HCPs (medical oncologists, oncology nurse practitioners, clinical nurse consultants) working in metropolitan Perth, Western Australia. Reflexive thematic analysis was used to understand oncology HCPs' perspectives on treating sleep disturbances, explore challenges and barriers to their management, as well as opportunities for improvement.

Results: Four main themes were developed: (1) sleep disturbances are underreported and underassessed, (2) poor sleep can be difficult to manage, (3) limited capacity to address sleep issues, and (4) opportunities for the future.

Conclusion: Understanding the current clinical management practices used by oncology HCPs to manage sleep disturbances, along with their perceived opportunities to improve the management of sleep in cancer care is crucial. Efforts to implement these opportunities should focus on co-design with relevant stakeholders at all levels.

Jeon YH, McKenzie H.

Aim: This interpretive qualitative inquiry aimed to explore perspectives of family carers, clinicians and service providers on the issues and challenges of providing quality end-of-life care for people with advanced dementia living at home.

Methods: We conducted in-depth, semi-structured interviews with 33 bereaved and current family carers and focus groups with 20 clinicians and service providers across various care settings. Thematic analysis was used to disclose meaningful insights and patterns of meaning.

Results: Six key themes were identified: Inadequate preparation, guidance and access to appropriate resources; Taboo and misunderstanding: talking about death; Dementia as a terminal illness and the role of palliative care; Key time points, critical events and decisions; Planning ahead not in reality; Family issues and dynamics. From clinicians' and service providers' perspectives, problems related to limited resources, poor consumer access, and skilled workforce shortages all undermined efforts to enable living and dying at home. Family carers found that conversations about death and care home admission were "too confronting" for many, hampering planning in advance. A lack of public, community and health professional awareness led to suboptimal end-of-life planning, signaling the need for all health professionals, especially community and primary care practitioners to be knowledgeable in dementia care.

Conclusions: Addressing unique challenges that people with advanced dementia and their family carers experience requires continuity of care and coordination of multidisciplinary care services. Further research is needed to identify dementia-appropriate policies, for example adaptation of current models of advance care planning to meet the needs of this population.