Latest Australian research

Butler C, Kissane D, Michael N.

Background: Rituals are a universal phenomenon in human culture, which act to support and process transitions and challenges. The objective of this integrative review was to synthesise the evidence for the types of rituals, whether traditional, religious or idiosyncratic, that are used by people witnessing or experiencing the dying process, as well as the specific elements and impacts of such activities.

Methods: This review used methodology proposed by Whittemore and Knafl⁹ and searched the following databases: Web of Science, Medline, PubMed, CINAHL and EMBASE. Articles were limited to qualitative and quantitative studies in English with keywords in the title or abstract and no limits on year of publication. Of the 482 studies identified, 34 were included and categorised as rituals conducted for patients, staff or patients and staff together. Data analysis involved deductive content analysis and a narrative approach to summarise the synthesised results.

Results: Two distinct ritual patterns that differed in purpose and impacts were identified: rituals within coherent religious or cultural frameworks and personally-derived idiosyncratic rituals. Traditional religious and cultural rituals supported passage from life to death and affirmed identity and belonging, while idiosyncratic rituals affirmed individuality and provided psychosocial and physiological support.

Conclusion: Rituals continue to be defined ambiguously and evolve organically to signify the significance of death. Rituals support a 'good death' as unification with a divine force or through honouring values of individualism, humanism and existentialism. The level of impact of rituals depends on conscious use of collectively understood symbolism for context and participants.

Cairns N, Hayden T, Lacey J, Sweeney E, Finucane O, Attia JR.

Objectives: To investigate why residents of residential aged care homes (RACH) are transferred to hospital for end-of-life care (EoLC).

Methods: We audited electronic health records at one tertiary referral centre hospital (New South Wales, Australia) from 1 June 2021 to 30 May 2023.

Results: Over a 2 year period, there were 2535 presentations to the emergency department (ED) from RACH, of which 45% were transferred back to RACH, 9% died in ED and 46% were admitted to hospital. Only 17% of those admitted were referred to palliative care, with an average delay of 3 days. The most common reasons for admission were falls, shortness of breath and sepsis. Most patients were in extremis at the time of referral, with an average time to death of 3 days; this was the most common barrier to returning patients to RACH (48%). In other cases (30%), the desired place of care was hospital or there was an urgent reason for admission, for example, fracture requiring surgery.

Conclusions: Once RACH patients are admitted to hospital for EoLC, there is little time to influence the trajectory of care. Future efforts should focus on supporting care in RACH and providing EoLC in situ.

Crosbie D, McCarthy M, Ghosh A, Hayes B, Suleiman M, Jones D.

Background: A considerable proportion of medical emergency team (MET) calls involves dying patients. Little is known regarding the quality of care for these patients and whether MET involvement in a dying patient is preventable.

Aims: To analyse a cohort of patient deaths at a metropolitan teaching hospital and compare the characteristics of those patients who received a MET review during their last admission with those who did not.

Methods: A retrospective analysis was conducted of all deaths occurring on general wards during 2022. Patients admitted for palliative care or those cared for solely in the intensive care unit or emergency departments were excluded. Demographics, comorbidities, frailty scores and resuscitation status were ascertained. For the patients who had a MET call during their last admission the number and aetiology of calls, intensive care unit (ICU) admission and time between last MET review and death were also recorded.

Results: Of 605 deaths, 567 (93.7%) fulfilled the inclusion criteria, of which 320 patients (56.3%) had a MET call. Patients receiving a MET call were less likely to have prior treatment limitations documented, and few were admitted to the ICU. Patients who received a MET call had a shorter time between treatment limitation and death.

Conclusions: Over half the patients who died on general wards had a MET call. These patients often had multiple reviews, and were less likely to have prior treatment limitations. Our study suggests that early review of treatment goals on admitted patients is warranted.

Hall K, McKeever S, Ojabo M, Simonda I, Tighe J, Shaw J.

Background: Generative Artificial Intelligence (Gen AI) enables nursing students to practice complex, sensitive end-of-life care discussions in a simulated environment. This approach provides opportunities to develop person-centred communication and feedback with students without involving real patients, supporting preparation for clinical practice.

Purpose: To explore Australian undergraduate nursing students' satisfaction and competence in conducting end-of-life (EOL) conversations after interacting with AI-generated characters representing diverse backgrounds.

Methods: An exploratory pre- and post-test survey design incorporating both quantitative and qualitative data. Third-year undergraduate nursing students from one Australian university participated. Pre-test surveys assessed self-reported competence in sensitive EOL conversations. Post-test surveys measured self-reports of competence in EOL conversations, confidence, and satisfaction with the learning experience. A total of 109 students completed the pre-test, and 82 completed the post-test. Data were analysed using descriptive statistics and thematic analysis.

Discussion: The intervention positively impacted students' confidence and competence in EOL conversations (respondents who stated, 'Strongly Agree' or 'Agree' increased by 15% to 34%). The identified qualitative themes included content-specific learning, as well as the development of knowledge, skills, and attributes. It was perceived as a safe learning environment that offered interactivity and engagement, realism, but also had challenges and emotional limitations.

Conclusion: Gen AI simulations enhanced students' competence and engagement in EOL discussions. While some participants noted a lack of emotional depth in AI responses, the overall experience was found to be safe, informative, and promising for nursing education.

Hardy J, Greer R, Foster K, Oliveira N, Good P, Vayne-Bossert P, et al.

Objectives: Men with castrate-resistant prostate cancer (CRPC) suffer from symptoms related to both their disease and its treatment with marked variation between individuals with respect to symptom expression. This study aimed to determine whether genetic variation in cytokine expression is associated with symptom severity.

Methods: An exploratory prospective, longitudinal consecutive patient cohort study was undertaken across two Queensland sites. Patient characteristics including tumour burden and current treatment were collected at baseline. Symptom severity was assessed 3-4 weekly for up to 6 assessments, with blood taken for genetic analysis once only during the study. Cytokine gene variants of each participant were assessed using a panel of single nucleotide polymorphisms (SNPs) most described in the literature.

Results: Of the 66 participants, 27/66 (41%) had a low, and 39/66 (59%) a high tumour burden. Symptom severity was not related to tumour burden or patient characteristics. Of the 142 SNPs analysed from 62 participants, 15 SNPs from 7 genes were significantly associated with symptom severity. After Benjamini-Hochberg adjustment, SNPs rs2069772 from Interleukin-2 (IL2) and rs230494 from Nuclear Factor kappa-light-chain-enhancer of activated B cells (NFKb) remained significant.

Conclusion: Although multiple factors can influence symptom severity, genetic variation may play a part. The early identification of men likely to develop severe symptoms during the course of their prostate cancer could theoretically enable symptoms to be managed more aggressively from an early stage. These preliminary findings need to be replicated in a larger cohort of men with CRPC.