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.
Tassos M, Carey LB, Gjorgioski S, Hodge B, Riley M.
Background: Existing research has long established that direct exposure to patient trauma, such as severe injuries, chronic illnesses and end-of-life care, places clinical healthcare workers at heightened risk of secondary traumatic stress, compassion fatigue and burnout. However, comparatively little attention has been paid to the impact on non-clinical healthcare personnel, such as health information managers (HIMs) who, despite being removed from direct patient care, regularly handle distressing and sensitive patient information.
Objective: This scoping review explores the literature concerning non-clinical healthcare professionals and the potential impact upon their biopsychosocial-spiritual (BPSS) well-being given prolonged exposure to medical and/or patient records.
Method: Arksey and O'Malley's five-stage scoping review strategy was utilised. An initial search of the literature yielded no results specific to HIMs and other non-clinical healthcare professionals. Therefore, the scope of the review was broadened, and a second search of the literature was conducted to explore comparable non-patient/client-facing populations such as transcriptionists.
Results: In total 1226 articles were initially identified and 13 articles revealed either a biological, psychological, social and/or spiritual impact when professionals were exposed to traumatic and/or sensitive data.
Conclusion: Exploring the roles of comparable non-patient/client-facing populations provides insight into the potential impact that exposure to traumatic and/or sensitive information may have on the health and well-being of HIMs and other non-clinical health professionals.Implications for health information management practice:Further research is recommended to explore the potential BPSS impact that HIMs and other non-clinical health professionals experience due to the exposure of traumatic and/or sensitive information.
Ven S, Steele M, Burston A, Fulbrook P, Lovegrove J, Miles S, et al.
Aim: To describe the cumulative incidence and characteristics of hospital-acquired pressure injury in acute palliative patients.
Design: Secondary data analysis of hospital-acquired pressure injuries during 2019-2022.
Methods: The setting was a palliative care unit at a tertiary hospital in Queensland, Australia, including adult (≥ 18 years) acute-phase palliative inpatients. Retrospective data from four databases were used to identify and analyse hospital-acquired pressure injury cases from 2019 to 2022. Clinical characteristics of patients with and without hospital-acquired pressure injury were compared.
Results: The incidence of hospital-acquired pressure injury in acute palliative care patients was 3.9% over the 4 years. These patients were predominantly male, with an average age of 74 years, with 66 of 78 cases developing in the deteriorating palliative care phase. Using the Waterlow Score, 51.3% of patients were assessed as at very high risk of pressure injury. Ninety-five hospital-acquired pressure injuries were reported in 78 patients; 16.8% were medical device-related, 40% were Stage 1 injuries, and the most common injury sites were the sacrum, heels and genitals. Patients with hospital-acquired pressure injury had significantly higher (worse) scores on both the palliative care Resource Utilisation Group-Activities of Daily Living and Problem Severity Scores. Regression analysis identified a high Problem Severity Score on admission as a significant predictor for hospital-acquired pressure injury development.
Conclusion: The incidence of hospital-acquired pressure injury in acute palliative patients is lower than in previous studies. However, many injuries occurred in those in the deteriorating phase, with higher scores for severity of symptoms. These findings suggest that acute palliative patients do require nursing care for pressure injury prevention, as well as for symptom management and activities-of-daily-living. Overall, this research contributes to a deeper understanding of pressure injury incidence and characteristics for acute palliative care patients. Future research should focus on population-specific pressure injury risk assessment to explore risk factors in greater detail.
Implications for the profession and/ or patient care: Current pressure injury risk assessment tools, like the Waterlow Score, may not provide the comprehensive evaluation needed for the acute palliative care cohort. To better address the unique needs of this cohort, it may be necessary to refine existing tools or develop new instruments that integrate palliative-specific assessments, such as the Resource Utilisation Group-Activities-of-Daily-Living (RUG-ADL) and Problem (symptom) Severity Score (PSS). These adaptations could help improve pressure injury prevention care planning and enhance outcomes for patients in this setting.
Impact: This study separated acute palliative care patients from those at end-of-life and found a 3.9% cumulative incidence of pressure injuries. There were no significant differences in age, gender, or cancer diagnosis
Wojnar R, Sulistio M, Gorelik A, Michael N.
Background: Therapeutic drug monitoring of methadone for opioid replacement therapy in the management of opioid dependence is well-described. However, only a few studies have described the correlation between serum methadone concentration and cancer pain during palliative care.
Methods: Patients were recruited from an exploratory randomized controlled trial (RCT) comparing methadone rotation with other opioid rotations for refractory cancer-induced bone pain. Serum methadone trough levels and 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) levels on day 14 of the rotation were analyzed using validated liquid chromatography-mass spectrometry. The average and worst pain intensities were rated at baseline and on day 14, preceding the recorded methadone levels. The Common Terminology Criteria for Adverse Events composite score was used to determine the adverse effects of methadone. The Spearman ρ was used to examine the correlation between methadone trough levels and pain reduction.
Results: Among the 20 patients who were randomized to receive methadone in the RCT, eight consented to this substudy. The mean (SD) steady-state 24-hour methadone dose was 11.6 (2.6) mg, whereas the mean (SD) serum methadone trough concentration was 93.7 (45.6) ng/mL with an acceptable adverse effect profile. All patients had an EDDP concentration of <0.01 mg/L, suggesting good metabolite clearance.
Conclusion: The reported methadone concentration required for therapeutic benefit was significantly lower than that reported previously. The study highlights that further appropriately powered studies are required to establish the role of routine trough methadone monitoring in patients newly rotated for the management of refractory cancer pain.
Jeong SY, Cleasby P, Ohr SO, Barrett T.
Abstract: Although advance care planning (ACP) has been widely promoted to enhance future provision of end-of-life care, there continues to be a need to better understand the ways in which individuals engage with ACP processes and their perceptions of resultant documentation (e.g. completed advance care directives (ACDs)). The aim of the study was to shed light on the views of patients participating in an RN-led ACP service. Data were collected from 85 completed ACDs and 43 surveys completed by patients and their carers. Diversity was demonstrated across the choice of substitute decision makers, preferred place of care, impact of future limitations, storage and communication of completed documentation. The findings provide clinicians, researchers and policy makers with insights into what matters to people in life and at the very end of life, and how to orientate services towards the preferences for care documented in ACDs. REGISTRATION: The study was retrospectively registered on 8/10/2018 with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246).
Ley Greaves L, Willmott L, Feeney R, White BP.
Abstract: Legalization of voluntary assisted dying (VAD), is increasingly being considered in many countries worldwide. Some regimes have a designated implementation period, after the law has passed but before it comes into force, to develop processes and systems required for VAD to be integrated within existing healthcare. This study is the first qualitative analysis of semi-structured interviews with 31 medical practitioners holding no in-principle objection to VAD, who may go on to provide VAD, during an implementation phase. It looks to understand perspectives on implementation and expectations of participating in VAD. Thematic analysis conceptualized four major themes: a new practice with many unknowns, perspectives on implementation, practicalities of the law, and clinical considerations. Findings highlight appropriate consideration is needed during the implementation phase to prepare the workforce in a sustainable way. Involvement of palliative care physicians in education and support for those involved in all end-of-life care would also be beneficial.
Last updated 30 April 2024