Latest Australian Research

To assess palliative care utilization, estimate duration of care, and identify predictors of care duration among general practitioner (GP)-referred patients following commencement of specialist palliative care.

Multicenter retrospective cohort study.

This study included patients with life-limiting illnesses referred by GPs between July 1, 2019, and June 30, 2024, and who received care from services registered with the Australian Palliative Care Outcomes Collaboration.

Two outcomes were assessed: (1) palliative care utilization (inpatient vs community) and (2) duration of palliative care, measured in days. Binary logistic regression identified factors associated with inpatient vs community palliative care utilization, and quantile regression identified predictors of palliative care duration from first admission to death.

Of 25,124 GP-referred patients, 92.2% were admitted to community palliative care and 44.4% died during the study period. Most deaths (81.3%) occurred within 3 months of commencing specialist palliative care. Admission to inpatient care was more likely among patients with cancer and those experiencing distress from breathlessness, nausea, or psychological/spiritual problems, and less likely among those with higher functional status, older age, distress from appetite or fatigue, and family/carer problems. Among decedents, shorter duration of palliative care was associated with inpatient care, functional decline, distress from pain, breathlessness, and family/carer problems.

GP-referred patients were predominantly admitted to community-based palliative care, and most of them received specialist palliative care for a shorter duration than recommended. Future research in primary care, exploring needs-based referral models and referral acceptance, may support timely access and comprehensive care.

Polypharmacy can increase symptom burden and reduce quality of life in palliative care patients. The Drug Burden Index (DBI) measures patients’ exposure to anticholinergic and sedative medications, but has not previously been validated in the palliative care population. This study aimed to quantify the DBI in an older palliative care inpatient population, and examine its associated functional, symptom and delirium outcomes.

A retrospective cohort study was conducted on patients aged 65 years and older admitted to a specialist palliative care unit in Sydney, Australia, over a 3-month period. Demographic data, admission characteristics, medication exposure and clinical scores were collected via medical record review. Patients’ DBI on admission and at 24 hours post-admission were calculated based on regular and pro re nata (PRN) medications.

79 patients were enrolled, who used a mean of 6.3 (SD 4.4) regular medications on admission, with a corresponding mean DBI of 0.69 (SD 0.55). At 24 hours post-admission, the DBI increased in 37% of patients and the resultant mean DBI was 0.82 (SD 0.58), which increased to 1.01 (SD 0.64) when administered PRN medications were included. There was no significant correlation on univariate analysis between patients’ DBI on admission and their functional, symptom or delirium scores or length of hospital stay.

Older palliative care patients are frequently exposed to anticholinergic and sedative medications. The DBI is a practical tool which can prompt medication review and inform safe, individualised prescribing in the palliative care setting in line with patients’ goals of care.