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.
Callander E, Hu Y, Bull C, Flenady V, Ellwood D, Lancaster A, et al.
Background: Delivering timely, accessible, and cost-effective perinatal bereavement support to parents is essential to support their emotional and mental wellbeing. However, there is limited evidence on the economic impact of online-based support programs.
Objective: This study conducted a cost-utility analysis of parents who participated in a randomised controlled trial - comparing the Living with Loss program (LWL; eight-week online program for parents following perinatal death) with care-as-usual (CAU), from the perspective of the healthcare system.
Methods: A health service utilisation survey was designed to collect the hospital and out-of-hospital health services, and prescription medications accessed by participants during the study period. Total costs included costs to the governments and individuals (AUD 2023/24) over time. Utility was measured using quality-adjusted life years (QALYs) calculated based on the Assessment of Quality of Life (AQoL)-8D.
Findings: Among the 95 randomised parents, 52 (20 LWL, 32 CAU) completed economic assessments at baseline (week 0) and post-program (week 9). Of these 52 participants, 39 (16 LWL, 23 CAU) further completed the three-month follow up assessment (week 21). Compared with CAU, the LWL program showed trends towards costs savings in primary care and maintained similar health outcomes at post-program (-$264.59 per participant, p = 0.47; QALY gained=-0.001, p = 0.9) and three-month follow up (-$531.52 per participant, p = 0.3; QALY gained=-0.002, p = 0.94).
Conclusion: This study provides preliminary evidence of potential economic benefits of the LWL Program. Future studies with larger sample sizes and adequate power are needed to fully assess the cost-effectiveness of online perinatal bereavement support services.
George G, Kirk D, Porock D.
Aim: This paper aims to explain the process of formulating a robust theory that comprehensively explains the nurse's role during the transition from curative to the palliative phase in advanced cancer care.
Design: A qualitative theory synthesis approach was applied, utilising Turner's 9-step theory synthesis method to integrate five grounded theories and 10 qualitative studies. The Walker and Avant method of concept development and analysis further ensured rigour.
Methods: Turner's theory synthesis was used to formulate a more comprehensive, testable theory from five existing grounded theories and 10 other qualitative studies that explain the nurse's role in supporting and facilitating the transition from curative to palliative care in oncology.
Results: The synthesis preparation stage involved a detailed literature review that located five grounded theories and 10 qualitative studies. The theory synthesis phase from steps 1-8 produced the following theory. 'During transitions from curative to palliative care in advanced cancer, nurses perform various roles that fall within the known and recognised-"visible spectrum" and the unknown and unrecognised-"invisible spectrum". Step 9 involves the refinement of the theory by further interrogation of its merit in the real world.
Conclusion: Theory synthesis offers a new possibility of cumulating all the evidence research that is already done to adapt it to practice and helping to build theory-driven evidence-based practice.
Impact: This paper offers a novel theoretical framework that explicates the visible and invisible roles of nurses in transitioning patients with advanced cancer from curative to palliative care. It contributes to clinical practice by clarifying complex nursing responsibilities that are often unacknowledged, such as brokering referrals, emotional reframing and cultural advocacy. The theory, validated through expert review, can inform curriculum development, support professional recognition and guide practice standards. Broader impacts include enhancing patient-centred care, improving interdisciplinary collaboration and shaping policies that acknowledge the full scope of nursing work in oncology and palliative care transitions.
Helyar M, Eamens M, Coombs S, Smeal T, Mherekumombe M, Jaaniste T.
Objectives: Pediatric end-of-life (EOL) care at home is often provided by community palliative care (CPC) nurses who do not specialize in pediatrics. This study aimed to better understand the challenges CPC nurses face when providing EOL care to children at home.
Methods: A total of 52 CPC nurses across New South Wales (NSW), Australia, participated in an online survey about their training, attitudes, and experiences regarding the provision of home-based pediatric EOL care. Participants were asked to reflect back over a "negative" experience of caring for a child at EOL, where things did not go as well as hoped, and a "positive" EOL care experience, where nurses perceived that care of the child and family went well, and respond to questions about these experiences.
Results: Confidence of CPC nurses when providing EOL care to pediatric patients was significantly lower than when caring for adults (p's < .05). Most respondents expressed the desire for more training in pediatric EOL care. Cases identified as negative by CPC nurses did not significantly differ from positive cases in terms of the timing of the referral to CPC, clinical symptoms at EOL, or how well informed the nurses felt. Siblings were present at EOL in 74% of the negative experiences and 86% of the positive experiences, reportedly receiving significantly poorer support in the negative experiences (p = .002).
Conclusion: This research contributes to an improved understanding of the challenges associated with home-based pediatric EOL care and highlights potential areas for improvement in CPC service delivery and training.
Lee JT, Lovell MR, Ritchie M, Butcher BE, Sheehan C, Fazekas B, et al.
Context: Extended continuous subcutaneous infusion of lidocaine for neuropathic cancer pain is currently used in clinical practice.
Objective: To determine the feasibility of conducting an adequately powered, multi-site, double-blind, parallel group, titrated dose, randomized controlled trial of continuous subcutaneous infusion of lidocaine versus placebo in palliative care patients with neuropathic cancer pain.
Methods: Adults with neuropathic cancer pain were randomized to receive lidocaine hydrochloride 10%w/v (3000 mg/30 mL) diluted in sodium chloride 0.9% or sodium chloride 0.9% as a continuous subcutaneous infusion titrated daily for 72 hours. The dose increased from one to two mg/kg/h, capped at 120mg/hour (2800mg/day, rounded down).
Results: Seventeen participants were recruited over 54 months. There was a 93% [95%CI 88%-98%] completion rate of study medication and procedures meeting the predefined feasibility criteria. Eighty-eight percent of participants completed 72 hours of study medication. Treatment-emergent adverse events were infrequent and generally mild or moderate nervous system, cardiac and vascular abnormalities. There were no electrocardiogram abnormalities. Rapid titration from one to two mg/kg/h was tolerated. Both intervention and control groups demonstrated a reduction in pain intensity with no significant difference.
Conclusion: This pilot demonstrates that a phase III clinical trial of extended continuous subcutaneous infusion of lidocaine for neuropathic cancer pain is feasible and provides important insights into modifications required to improve recruitment. Serum levels and relative safety suggest higher lidocaine doses could be cautiously evaluated. As the only prospective trial we are aware of to date, this trial informs clinical use of subcutaneous lidocaine infused over days.
McDonald J, Wicks C, Ross L.
Objectives: SSc is a complex, multiorgan disease, associated with the early onset of significant symptoms, impaired quality-of-life and increased mortality due to cardiopulmonary disease. While palliative care could potentially impact the quality of life of patients and caregivers, there is currently no evidence that examines the role or efficacy of palliative care in SSc. This study describes the model of care provided in a clinic of early, integrated palliative care for patients with advanced SSc and their caregivers at a tertiary hospital.
Methods: A prospective audit of the palliative care clinic's model of care was conducted during its first 12 months. Descriptive data quantified which aspects of care the patients and caregivers engaged with.
Results: Between 01/07/2023 and 01/07/2024, 24 patients received 52 clinic reviews. Disease-directed management was changed for 50% of patients. Pharmacological management was prescribed for 88%. Psychological assessment and support was provided for 96% of patients and caregivers, while social support assessment was conducted for 100%. The majority of patients (88%) accepted serious illness discussion, while 58% engaged in a prognostic discussion. Advance care planning discussions were common (83%), while 42% of patients completed an advance care directive and 46% completed a medical power of attorney. Informal multidisciplinary team discussion occurred for 83% of patients.
Conclusion: This clinic provided disease-orientated, multidisciplinary care alongside symptom management, psychosocial support and serious illness communication. The high uptake of key tasks signals a previously unmet palliative care need and suggests this model of care may be acceptable to patients and caregivers.
Last updated 30 April 2024