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Background: Caring for family members of dying patients is a vital component of end-of-life care, yet family members' needs at the end of life may be unmet. Aim(s): To explore hospital clinician assessment and facilitation of family needs and practices to support families at the end of life. Design(s): Descriptive study utilising a retrospective medical record audit. Setting and Sample: Undertaken in a large public hospital, the sample included 200 deceased patients from four specialities; general medicine (n = 50), intensive care (n = 50), inpatient palliative care (n = 50) and aged rehabilitation (n = 50). Data were analysed according to age; under 65-years and 65-years or over. Result(s): Deceased patients' mean age was 75-years, 60% were Christian and Next-of-Kin were documented in 96% of cases. 79% spoke English, yet interpreters were used in only 6% of cases. Formal family meetings were held in 64% of cases. An assessment of family needs was undertaken in 52% of cases, and more likely for those under 65-years (p = 0.027). Cultural/religious practices were supported/facilitated in only 6% of all cases. Specialist palliative care involvement was more likely for those aged 65-years or over (p = 0.040) and social work involvement more likely for those under 65-years (p = 0.002). Pastoral care and bereavement support was low across the whole sample. Conclusion(s): Prioritising family needs should be core to end-of-life care. Anticipation of death should trigger routine referral to support personnel/services to ensure practice is guided by family needs. More research is needed to evaluate how family needs assessment can inform end-of-life care, supported by policy.Copyright © The Author(s) 2021.

The global COVID-19 pandemic has challenged healthcare, aged care and palliative care provision in ways previously unimaginable. In Australia, this has been felt particularly amongst our most vulnerable members of society, those residing in residential aged care. Currently representing the majority (75%) of COVID-19 deaths and health-care worker infections, this vulnerable sector has borne the greatest impact. A collaborative response comprising a tertiary hospital palliative care outreach service, residential InReach geriatric service and a community palliative care service effectively delivered comprehensive and timely specialist care to residents infected with COVID-19. Daily videoconferencing rounds were efficient, minimised infection risk and facilitated family members attending virtually during patient assessments and care planning discussions. This model was both reactive and proactive and importantly scalable should further infective outbreaks occur in Australasian residential aged care facilities.Copyright © 2021 AJA Inc'.

Background: The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant. Aim(s): To examine the knowledge, attitudes and practices of geriatricians in providing palliative care and working with specialist palliative care services.We also aimed to capture self-reported barriers, confidence and satisfaction in providing palliative care. Design(s): A prospective cross-sectional study surveying Australasian geriatricians was conducted. Setting/Participants: This was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine. Result(s): A total of 168 completed responses were received; 58.3% were female and 36.6% had over 20 years of clinical experience.Most geriatricians (85%) reported caring for patients in their last 12 months of life represented a substantial aspect or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%) and derived satisfaction from providing palliative care (95%). The majority (69%) believed all patients with advanced illness should receive concurrent specialist palliative care. Regarding knowledge, participants scored an average of 13.5 correct answers out of 18 in aModified Palliative Care Knowledge Test. Conclusion(s): Geriatricians find reward in providing generalist palliative care to their patients; however, potential exists for improved collaborations with specialist palliative care services. An evidence base for geriatric patients who benefit most from specialist palliative care services is needed to improve resourcing, collaborative practice and ultimately palliative care delivery.Copyright © 2021 Oxford University Press. All rights reserved.

Background: Caring for family members of dying patients is a vital component of end-of-life care, yet family members’ needs at the end of life may be unmet. Aim: To explore hospital clinician assessment and facilitation of family needs and practices to support families at the end of life. Design: Descriptive study utilising a retrospective medical record audit. Setting and Sample: Undertaken in a large public hospital, the sample included 200 deceased patients from four specialities; general medicine (n = 50), intensive care (n = 50), inpatient palliative care (n = 50) and aged rehabilitation (n = 50). Data were analysed according to age; under 65-years and 65-years or over. Results: Deceased patients’ mean age was 75-years, 60% were Christian and Next-of-Kin were documented in 96% of cases. 79% spoke English, yet interpreters were used in only 6% of cases. Formal family meetings were held in 64% of cases. An assessment of family needs was undertaken in 52% of cases, and more likely for those under 65-years (p = 0.027). Cultural/religious practices were supported/facilitated in only 6% of all cases. Specialist palliative care involvement was more likely for those aged 65-years or over (p = 0.040) and social work involvement more likely for those under 65-years (p = 0.002). Pastoral care and bereavement support was low across the whole sample. Conclusions: Prioritising family needs should be core to end-of-life care. Anticipation of death should trigger routine referral to support personnel/services to ensure practice is guided by family needs. More research is needed to evaluate how family needs assessment can inform end-of-life care, supported by policy.

BACKGROUND: Journey mapping involves the creation of visual narrative timelines depicting the multidimensional relationship between a consumer and a service. The use of journey maps in medical research is a novel and innovative approach to understanding patient healthcare encounters. OBJECTIVE(S): To determine possible applications of journey mapping in medical research and the clinical setting. Specialist palliative care services were selected as the model to evaluate this paradigm, as there are numerous evidence gaps and inconsistencies in the delivery of care that may be addressed using this tool. METHOD(S): A purposive convenience sample of specialist palliative care providers from the Supportive and Palliative Care unit of a major Australian tertiary health service were invited to evaluate journey maps illustrating the final year of life of inpatient palliative care patients. Sixteen maps were purposively selected from a sample of 104 consecutive patients. This study utilised a qualitative mixed-methods approach, incorporating a modified Delphi technique and thematic analysis in an online questionnaire. RESULT(S): Our thematic and Delphi analyses were congruent, with consensus findings consistent with emerging themes. Journey maps provided a holistic patient-centred perspective of care that characterised healthcare interactions within a longitudinal trajectory. Through these journey maps, participants were able to identify barriers to effective palliative care and opportunities to improve care delivery by observing patterns of patient function and healthcare encounters over multiple settings. CONCLUSION(S): This unique qualitative study noted many promising applications of the journey mapping suitable for extrapolation outside of the palliative care setting as a review and audit tool, or a mechanism for providing proactive patient-centred care. This is particularly significant as machine learning and big data is increasingly applied to healthcare.Copyright © 20

Abstract Background The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant. Aim To examine the knowledge, attitudes and practices of geriatricians in providing palliative care and working with specialist palliative care services. We also aimed to capture self-reported barriers, confidence and satisfaction in providing palliative care. Design A prospective cross-sectional study surveying Australasian geriatricians was conducted. Setting/Participants This was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine. Results A total of 168 completed responses were received; 58.3% were female and 36.6% had over 20 years of clinical experience. Most geriatricians (85%) reported caring for patients in their last 12 months of life represented a substantial aspect or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%) and derived satisfaction from providing palliative care (95%). The majority (69%) believed all patients with advanced illness should receive concurrent specialist palliative care. Regarding knowledge, participants scored an average of 13.5 correct answers out of 18 in a Modified Palliative Care Knowledge Test. Conclusions Geriatricians find reward in providing generalist palliative care to their patients; however, potential exists for

Background: Despite clear benefits and increased efforts towards earlier integration of palliative care (PC) with oncology, there are concerns that PC remains stigmatized and predominantly associated with end-of-life care (EOLC). This project aims to explore current perceptions and understanding of PC in cancer patients. Method(s): Prospective survey conducted in the oncology ward of a tertiary academic hospital in Melbourne, Australia. Over a 4-month period a 16-item questionnaire was distributed to all cancer patients upon admission to the ward (N=103). Chi-Squared test was used to examine for significant factors related to patients' perceptions of PC. Result(s): Ninety-six patients (93%) completed the questionnaire; of which 76% had metastatic cancer. Of the domains explored, salient findings were: 1) Familiarity and experience: 76% had heard of PC; while only 21% had received PC. Self-rating of PC knowledge was varied, and evenly distributed: 31% good/excellent, 36% average and 33% below average/poor. 2) Roles of PC and oncology: 86% believed they could receive concurrent oncology care and 81% believed they could receive anti-cancer treatment whilst receiving PC. Those who had heard of PC were significantly more likely to respond that they could receive concurrent anti-cancer treatment (p=0.005), as well as those who had better self-rated PC knowledge (p=0.045). 3) Perceptions: 45% believed PC was only associated with EOLC. Those more likely to disagree with this statement had received PC services (p=0.039). The majority (77%) felt comforted with PC involvement; this was significantly associated with older age (p=0.047) and an understanding that oncology (p<0.005) and anti-cancer treatment (p=0.013) could continue. However, 40% felt frightened and 29% felt hopeless about a referral to PC. Notably, 50% felt more comfortable with "supportive care" services (versus PC), 25% were neutral and 25% were not. Conclusion(s): This survey had an excellent response rate and

Background: In geriatric inpatient rehabilitation settings, where the goal is to optimise function, providing end-of-life care can be challenging. Aim(s): The aim of this study is to explore how end-of-life care goals and decision-making are communicated in a geriatric inpatient rehabilitation setting. Design(s): The design is a qualitative descriptive design using semi-structured individual and group interviews. Setting/participants: This study was conducted in a 154-bed facility in metropolitan Melbourne, Australia, providing geriatric inpatient rehabilitation for older patients; medical, nursing and allied health clinicians, who had cared for an inpatient who died, were recruited. Data collection: Participants were interviewed using a conversational approach, guided by an 'aide memoire'. Result(s): A total of 19 clinicians participated in this study, with 12 interviewed individually and the remaining 7 clinicians participating in group interviews. The typical patient was described as older, frail and with complex needs. Clinicians described the challenge of identifying patients who were deteriorating towards death, with some relying on others to inform them. How patient deterioration and decision-making was communicated among the team varied. Communication with the patient/family about dying was expected but did not always occur, nor was it always documented. Some clinicians relied on documentation, such as commencement of a dying care pathway to indicate when a patient was dying. Conclusion(s): Clinicians reported difficulties recognising patient deterioration towards death. Uncertainty and inconsistent communication among clinicians about patient deterioration negatively impacted team understanding, decision-making, and patient and family communication. Further education for all members of the multidisciplinary team focusing on how to recognise and communicate impending death will aid multidisciplinary teams to provide quality end-of-life care when required.Cop

Background: Significant challenges exist in meeting the healthcare needs of older people. Care is often provided for older people in subacute hospital settings where, despite a focus on optimising functioning, many older people will die. Aim(s): To investigate end of life care provision for older people in a subacute hospital setting. Design(s): A retrospective chart audit of all inpatient deaths in a 183-bed subacute hospital. Result(s): Of more than 3000 admissions in one year, 54 inpatients died. Most were transferred from an acute hospital, had multiple comorbidities including cognitive impairment (42.6%), with a mean age of 83 years (SD=9). There was no evidence of advance care planning, hence admission goals included 'Assessment', 'To establish a safe discharge destination' and 'Rehabilitation'. Recognition of patient deterioration and dying resulted in limitations of treatment in 77.8% of patients. 57.4% received terminal care guided by the available guideline and 53.7% were referred for specialist palliative care review. While the average wait time for review by the palliative care team was 0.6days (SD=0.8), 11.1% of patients died before review. Two key time points were identified, the first was information-related, representing the first documented evidence of patient deterioration towards death. The second time point was decisionrelated, representing the first documented evidence of a decision to provide end of life care. The use of unclear and ambiguous written language to communicate patient deterioration and dying may have impacted clinician understanding and delayed end of life care. Conclusion(s): Pre-hospital advance care planning is sub-optimal and should be prioritised in older people. Education is needed to improve recognition of patient deterioration and dying by clinicians. How patient deterioration and dying is documented in the medical record and communicated amongst the treating team requires further attention to facilitate timely, high quali

Background: Palliative care patients have numerous rehabilitation needs that increase with disease progression. Palliative rehabilitation practices and perceptions of palliative medicine physicians towards the role of rehabilitation are largely unstudied. Aim(s): To explore palliative medicine physicians' attitudes and perceptions towards rehabilitation delivered within inpatient palliative care units. Design(s): Qualitative study utilizing semi-structured interviews. Transcribed interviews were analysed using thematic analysis and major themes reported as results. Participant(s): Australian palliative medicine physicians working in inpatient palliative care units. Result(s): In total, 20 physicians participated, representing specialist palliative care services across Australia. A total of 11 (55%) were males with an average of 12.5 years' experience working in palliative care. Most participants believed rehabilitation was an important aspect of palliative care; however, few felt adequate rehabilitation programmes were available. Participants varied in their concepts of what palliative rehabilitation entailed. The term rehabilitation was seen by some as helpful (fostering hope and aiding transitions) and by others to be misleading (creating unrealistic expectations). Four key themes emerged when describing physicians' attitudes, including (1) integrating rehabilitation within palliative care, (2) the intervention, (3) possibilities and (4) the message of rehabilitation. Conclusion(s): A lack of consensus exists among palliative medicine specialists regarding the definition and scope of palliative rehabilitation. Participants generally expressed a wish to offer enhanced rehabilitation interventions, however described resource and skill-set limitations as significant barriers. Further research is required to establish an evidence base for palliative rehabilitation, to support its acceptance and widespread integration within specialist inpatient palliative care.Copyrig

Introduction: The occurrence of bone metastases is common in patients with advanced cancer. The literature supports percutaneous vertebroplasty and kyphoplasty as minimally invasive procedures to relieve pain and improve quality of life for selected patients with disabling pain from pathological vertebral fractures secondary to bone metastases. Case: We describe a case of a 71-year-old patient with castrate-resistant metastatic prostate cancer who underwent sacroplasty for painful sacral metastases. The patient had previously been treated with maximally tolerated analgesics and anticancer therapies including systemic anticancer treatments and local radiotherapy. After sacroplasty, he experienced significant pain reduction and improvement in mobility and function. Conclusion(s): This case and recent literature demonstrate positive outcomes of sacroplasty in terms of pain reduction and improved mobility. Further research is warranted to establish the role of such minimally invasive percutaneous procedures for pain management in cancer patients.Copyright © 2016 World Institute of Pain

Introduction: Advanced cancer patients have numerous rehabilitation needs that increase with disease progression. Palliative rehabilitation practices, and perceptions of palliative medicine physicians towards the role of rehabilitation are largely unstudied. Objective(s): To explore palliative medicine physicians' attitudes towards rehabilitation, and examine current models of palliative rehabilitation delivered within inpatient palliative care units. Method(s): Australian palliative medicine physicians working in inpatient palliative care units were purposefully sampled and invited to participate in a semi-structured interview. Transcribed interviews were analysed using thematic analysis and major themes reported as results. Result(s): Twenty physicians participated, representing specialist palliative care units across Australia. Eleven (55%) were male with an average of 12.5 years experience working in palliative care. Most participants believed rehabilitation was an important aspect of palliative care, however few felt adequate rehabilitation programs were available. The term rehabilitation was seen by some as helpful (fostering hope, aiding transitions) and by others misleading (creating unrealistic expectations). Four key themes emerged when describing physicians' attitudes, including 1) Integrating rehabilitation within palliative care, 2) The intervention, 3) Possibilities and 4) The message of rehabilitation. Conclusion(s): There is a lack of consensus amongst palliative medicine specialists regarding many aspects of palliative rehabilitation. Many expressed a wish to offer enhanced rehabilitation interventions, however described resource and skill-set limitations as significant barriers. Further research is required to establish an evidence base and consensus for palliative rehabilitation to support its integration within specialist inpatient palliative care.

Background: Palliative care patients have numerous rehabilitation needs that increase with disease progression. Palliative rehabilitation practices, and perceptions of palliative medicine physicians towards the role of rehabilitation are largely unstudied. Objective(s): To explore palliative medicine physicians' attitudes towards rehabilitation, and examine current models of palliative rehabilitation delivered within inpatient palliative care units. Method(s): Australian palliativemedicine physicians working in inpatient palliative care units were purposefully sampled and invited to participate in a semi-structured interview. Transcribed interviews were analysedusing thematic analysis and major themes reported as results. Result(s): Twenty physicians participated, representing specialist palliative care units across Australia. Eleven (55%) were male with an average of 12.5 years experience working in palliative care. Most participants believed rehabilitation was an important aspect of palliative care, however few felt adequate rehabilitation programs were available. Varied concepts were described by participants about what constituted palliative rehabilitation. The term rehabilitation was seen by some as helpful (fostering hope, aiding transitions) and by others to be misleading (creating unrealistic expectations). Four key themes emerged when describing physicians' attitudes, including 1) Integrating rehabilitation within palliative care, 2) The intervention, 3) Possibilities and 4) The message of rehabilitation. Conclusion(s): A lack of consensus exists amongst palliative medicine specialists regarding many aspects of palliative rehabilitation. Many participants expressed a wish to offer enhanced rehabilitation interventions, however described resource and skill-set limitations as significant barriers. Further research is required to establish an evidence base and consensus for palliative rehabilitation to support its integration within specialist inpatient pallia