Guidelines and statements

IntroductionDespite evidence of improved outcomes, people with pancreatic cancer have highly variable access to effective pain relief and palliative care. We aimed to develop evidence-based, community-informed standardised pathways to timely pain management and early palliative care for people with pancreatic cancer.Main RecommendationsUsing a multi-method, comprehensive, community engagement and evidence-informed approach, we developed pathways to standardise referral to pain management and early palliative care for people with pancreatic cancer. Community engagement included representation from multidisciplinary clinicians, community groups and people with lived experience from across regions and all Australian states. We developed two pathways: (i) a pathway for pain management for people with resectable pancreatic cancer and (ii) an integrated pathway for pain management and palliative care for people with unresectable pancreatic cancer (https://www.pancare.org.au/pancreatic-cancer-roadmap-projects/pancreatic-cancer-pathways). Clinical guidance providing practical steps and links to evidence accompany the pathways. Key elements of the pathways included:screening for pain at each encounter, comprehensive holistic assessment and management;early consideration of interventional pain management in the event of refractory pain;introduction of palliative care at time of diagnosis of metastatic or unresectable pancreatic cancer with links to suggested language to address potential community hesitancy; andrecommendation to discuss referrals for palliative care and interventional pain management at cancer multidisciplinary meetings.Changes in Management as a Result of the GuidelinesThe pathways developed have set forth best practice standards grounded in evidence and expert consensus. The extensive clinical and community engagement ensures the relevance and ownership of these pathways. Implementation of the pathways will reduce existing variation in access and enhance the quality of care for people with pancreatic cancer. Furthermore, the pathways offer an opportunity to benchmark practice within and between services.

Jennifer Philip, Melanie R. Lovell, Kylee Bellingham, Gail Garvey, Gregory B. Crawford, Nicole M. Rankin, Kara Burns, Isabel Young, Vivienne Milch, Dorothy Keefe, Katrina Anderson, James Lawson, Meinir Krishnasamy

Introduction Lung cancer is the leading cause of cancer mortality in Australia. In July 2025, the Australian Government launched the National Lung Cancer Screening Program (the Program). The Program has been designed in accordance with the Medical Services Advisory Committee's recommendations. This article summarises the program guidelines, outlining Program parameters and delivery requirements. The screening and assessment pathway defines the Program structure. The purpose of the guidelines is to ensure safe, effective and high-quality Program delivery, detailing key steps for clinical practice and information for participating healthcare providers.Main RecommendationsThe guidelines provide recommendations for the delivery of targeted low-dose CT screening for lung cancer in the Australian context.Program eligibility is assessed using risk-based eligibility criteria recommended by the Medical Services Advisory Committee, targeting people between 50 and 70 years of age with a history of tobacco cigarette smoking.Smoking cessation supports are to be offered to all potential participants by healthcare providers across the lung cancer screening and assessment pathway.Low-dose CT scan assessment and reporting follow the National Lung Cancer Screening Program's nodule management protocol.Changes in Management as a Result of the GuidelineThis guideline provides recommendations for the delivery of targeted low-dose CT screening for lung cancer in the Australian context. Content includes: guidance on assessing Program eligibility; enrolling eligible participants in the National Cancer Screening Register; completing and fulfilling low-dose CT scan requests; assessing and reporting low-dose CT scan results; managing scan outcomes and actionable additional findings; and communicating scan results. The full guideline is available at https://www.health.gov.au/resources/publications/nlcsp-guidelines.

Nicole M. Rankin, Rebecca Zosel, Lisa J. Whop, Raglan Maddox, Annette McWilliams, Miranda Siemienowicz, Jon Emery, Maria A. R. Lantin, Georgia Bartlett, Mikayla Wolfe, Abbey Diaz, Katrina Anderson, Lillian Liu, Cindy Toms, Sarah McDermott, Peter Bligh, Jeremy Chalke, Stephen Melsom, Claire E. Nightingale, Alison Brown, Sam Pope, Julia Brotherton, Anne Fidler, Michel Itel, Mark Brooke, Diane M. Pascoe, Fraser Brims, Tracy L. Leong, Emily Stone, Dorothy Keefe, Vivienne Milch

Introduction For many people entering custody, abrupt changes in alcohol or other drug use is associated with the risk of experiencing a withdrawal syndrome. Management of withdrawal from alcohol and other drugs in a custodial setting is complicated by both a limited evidence base and structural barriers to the delivery of best practice healthcare interventions to people in custody. Main Recommendations A multidisciplinary expert panel representing all Australian states and territories participated in a modified Delphi process. The process generated 22 recommendations to custodial services, health services and government for the management of withdrawal from alcohol and other drugs in custodial settings across five domains: screening for withdrawal risk; assessment of withdrawal; management of withdrawal; specific considerations for the care of First Nations people; and organisational support. Notable recommendations include using universal and timely assessment for withdrawal at reception to custody; using validated clinical tools and evidence-based interventions to assess and manage withdrawal syndromes; and ensuring that the safest location for withdrawal from alcohol or other drugs is provided. Changes in Management as a Result of the Statement This statement presents best practice standards for the management of withdrawal from alcohol and other drugs in Australian custodial settings, as informed by evidence and expert consensus. Implementing the recommendations set out in this statement will improve the quality and consistency of withdrawal care provided to people entering Australian custodial settings and reduce harms associated with incarceration for people who use alcohol and other drugs. This statement has been endorsed by the Royal Australasian College of Physicians, the Australasian Professional Society on Alcohol and Other Drugs, the National Prisons Hepatitis Network, the Pharmaceutical Society of Australia and the Australian Injecting and Illicit Drug Users League. The statement is also approved as an Accepted Clinical Resource by the Royal Australian College of General Practitioners.

Grace FitzGerald, Jocelyn Chan, Jon Cook, Mark Stoove, Michael Curtis, Suzanne Nielsen, Rebecca J. Winter, Thileepan Naren

Introduction Patent foramen ovale (PFO) is implicated in 25%–50% of cryptogenic strokes in patients aged <60years. Recent clinical trials demonstrated the benefit of PFO closure in selected patients. However, there is considerable variability in Australian and New Zealand clinical practice regarding investigation and management approaches. A multidisciplinary consensus group comprising stroke neurologists and an interventional cardiologist from major centres employed a modified nominal group technique to develop evidence-based recommendations for standardising PFO-associated stroke management. Main Recommendations Twelve recommendations were developed across three domains. For patient selection: Universal PFO screening for cryptogenic stroke patients aged ≤60years, with selective screening for patients aged >60years with embolic stroke of undetermined source, absent vascular risk factors and excluded atrial fibrillation. For diagnostic investigations: Transcranial Doppler (TCD) bubble study as preferred first-line screening where available, with transthoracic echocardiography as an alternative when TCD is unavailable and transoesophageal echocardiography for confirmation before closure consideration. For treatment decisions: Incorporation of the PFO-Associated Stroke Causal Likelihood (PASCAL) classification system rather than the Risk of Paradoxical Embolism (RoPE) score alone, consideration of TCD grading results for risk stratification and mandatory multidisciplinary heart–brain team evaluation for all closure decisions. Changes in Management as a Result of This Consensus Statement These recommendations will standardise practice through enhanced TCD service provision, structured heart–brain team development and evidence-based patient selection using the PASCAL classification. The emphasis on TCD as first-line screening represents a departure from traditional transthoracic echocardiography-based approaches. Implementation will improve patient outcomes through appropriate intervention in suitable candidates while avoiding unnecessary procedures in those unlikely to benefit, thereby promoting equitable access to optimal PFO management across Australia and New Zealand.

Brian R. Chambers, Lauren M. Sanders, Amanda Gilligan, Carlos Garcia-Esperon, Jan Ho, John Fink, Matias Yudi, Matthew Lee-Archer, Vimal Stanislaus, Andrew A. Wong

Introduction This consensus statement from multidisciplinary experts and consumers across Australia provides comprehensive recommendations on the prevention and management of frailty in community-dwelling older adults. Methods The study uses a modified Delphi design. Phase I involved iterative discussion among six frailty care working groups, based on current evidence and expert opinion, to draft the statements. Phase II involved validation of each statement across two Delphi rounds conducted to determine level of agreement. Main Recommendations A lifelong approach to health promotion for frailty prevention should focus on raising awareness, annual screening (65+ years) and personalised counselling around accessible health behaviours to manage chronic comorbidities. An individualised, balanced, protein-rich diet is likely to be effective in delaying the onset of frailty. Protein–energy malnutrition and nutritional deficiencies should be identified and treated. A nutrition care plan that considers the relaxation of dietary restrictions aligned with goals of care should be planned for older adults with severe frailty. Progressive, individualised and ongoing exercise should be a combination of aerobic and resistance exercise, and balance and functional training tailored to frailty level and supervised by professionals. Social prescribing for older adults should be co-designed with a link worker to support meaningful, accessible and culturally appropriate activities that foster social engagement, with plans customised to the individual's frailty level. A comprehensive, multidisciplinary medication review tailored to the older adult's health status, preferences and frailty degree helps optimise medication use, minimise harm and support functional independence across all stages of frailty. Older adults with severe frailty need a regularly reviewed, personalised care plan, which involves carers in decision-making, supports advance care planning and ensures high-quality end-of-life care. Changes in Management Informed by This Statement The consensus statements introduce an integrated, evidence-informed and consumer-focused framework to guide healthcare professionals in delivering personalised and effective care for community-dwelling older adults living with or at risk of frailty.

Lisa Kouladjian O’Donnell, Marc Sim, Michelle Miller, Peta Dampney, Pazit Levinger, Shannon King, Ruth E. Hubbard, on behalf of the Australian Frailty Network Working Group

Introduction: Older people face higher risks of medicine-related harm due to polypharmacy and the use of potentially inappropriate medicines. Current treatment guidelines rarely specify when to stop medicines, leading to medicines often being continued indefinitely without a clear deprescribing plan. While deprescribing guidelines exist for some medicine classes, limited guidance is a major barrier to deprescribing. These new guidelines address this gap by providing structured recommendations that complement more detailed drug-specific deprescribing guidance, disease-specific therapeutic guidelines and non-pharmacological management resources. These guidelines were developed by a team of 72 experts, including consumer representatives, and were further shaped by feedback from public consultation and independent reviewers.Main Recommendations: The guidelines are intended for all healthcare professionals involved in prescribing, dispensing or administering medicines to older people. The guidelines specifically address polypharmacy and medicines commonly dispensed for regular use in people aged ≥ 65 years, as well as other medicines where there is evidence to consider deprescribing in this cohort. The guidelines provide 185 consensus-based recommendations and 70 good practice statements, covering both specific medicine categories and general deprescribing principles. The guidelines are structured into four areas: (1) when to deprescribe; (2) ongoing treatment needs; (3) how to deprescribe; and (4) monitoring requirements.Changes in Care as a Result of the Guideline: This guideline emphasises deprescribing as an integral part of the prescribing continuum. Applying a deprescribing approach encourages prescribers to consider the ongoing need for a medicine each time a prescription is re-issued, to balance benefits and harms as they evolve over time, and to ensure treatment decisions reflect an individual's goals through shared decision-making. The guideline was developed based on currently available evidence for deprescribing and expert multidisciplinary and consumer input. It supports health professionals in reviewing regular medicines, minimising harm and planning ongoing treatment or monitoring. The detailed guideline is available at https://deprescribing.com.

Stephen Tucker, John D. G. Watson, Donna Wellins, Tim Whitmore, Christopher Etherton-Beer, Amy T. Page

Introduction The Australian Guidelines for the Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder were released in May 2025. These guidelines, updated from the 2016 Australian Guide, were developed through extensive stakeholder consultation, a comprehensive review of empirical evidence and the application of a novel Grading of Recommendations, Development and Evaluation (GRADE)-based approach for developing evidence-based diagnostic criteria. Recommendations The guidelines include 11 GRADE-based recommendations, forming the core of the diagnostic criteria, and 11 lived experience statements, supporting client-centred assessment approaches. The guidelines also feature 40 good practice statements and 18 implementation considerations, tools and tips as practical resources and supports for practitioners. Changes in Management as a Result of the Guidelines Key changes in the new guidelines include: A minimum prenatal alcohol exposure threshold for diagnosis to support more precise identification of fetal alcohol spectrum disorder (FASD); The assessment of neurodevelopmental impairments and functioning has been refined, including detailed advice for practitioners seeking to identify clinically significant impairments; Inclusion/exclusion of neurodevelopmental domains as part of the assessment; and Revisions to some of the content of the included neurodevelopmental domains. Changes have also been made with attention to the needs of First Nations Australians and people from other culturally and linguistically diverse backgrounds. The guidelines advocate for the use of shared decision-making approaches, promoting collaboration between practitioners, individuals attending for assessment and their support network. Importantly, the guidelines will enable an accessible, holistic and flexible assessment process, supporting timely and accurate assessment and diagnosis of FASD in Australia. The rigorous development process also provides practitioners with confidence in the guidelines, promoting increased uptake of assessment and diagnostic practices, and informing international diagnostic criteria and guidelines.

Natasha Reid · Nicole Hewlett, Nicole Hayes, Zachary Munn, Haydn Till, Delyse Hutchinson · James Stewart, Max Naglazas, Andrea Crawford, Raewyn C. Mutch, Carmela F. Pestell, Rowena Friend, Lisa K. Akison · Chelsea Vanderpeet, Prue Walker, Matthew Gullo, Doug Shelton, Elizabeth J. Elliott, Fiona Kay, Katrina Harris, Jayden Logan, Storm Anderson · Natalie R. Kippin, Seema Padencheri, Sophie Harrington, Diana Barnett, Kelly Skorka, Robyn Doney · Philippa Middleton

IntroductionThe Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025 establishes a new clinical standard for the diagnosis and management of acute coronary syndromes (ACS) in Australia. The new guideline replaces the 2016 guideline, representing the first major update in nearly a decade.Main RecommendationsThe new guideline features critical new information, including: (1) new terminology and revised definition of myocardial infarction; (2) electrocardiogram (ECG) patterns of acute coronary occlusion myocardial infarction (ACOMI), beyond ST-segment elevation; (3) use of clinical decision pathways incorporating high-sensitivity cardiac troponin (hs-cTn) assays for more efficient risk assessment; (4) stronger emphasis on the optimal timing of primary percutaneous coronary intervention in people with ST-segment elevation myocardial infarction (STEMI); (5) use of intravascular imaging-guided percutaneous coronary intervention in people with non-ST-segment elevation acute coronary syndromes (NSTEACS); (6) treatment guidance for specific groups, including those with cardiogenic shock, multivessel disease or spontaneous coronary artery dissection; (7) timing of platelet P2Y12 inhibitor administration in STEMI and NSTEACS; (8) more detailed advice on post-discharge care, including cardiac rehabilitation and secondary prevention programs, medicine adherence strategies, vaccinations and screening for mental health conditions; (9) treatment algorithms to enable more tailored prescribing of antiplatelet and anticoagulation therapies; (10) new recommended treatment target for low-density lipoprotein cholesterol (LDL-C); and (11) new recommendations on select medicines including PCSK9 inhibitors, β-blockers and angiotensin receptor-neprilysin inhibitors.Changes in Management as a Result of the GuidelineThe new guideline introduces key practice changes including broader recognition of ECG patterns of ACOMI, integration of hs-cTn testing into clinical decisions pathways and selective use of intravascular imaging in NSTEACS. Updated P2Y12 inhibitor timing, stricter LDL-C targets and PCSK9 inhibitor use support more tailored and evidence-based care in the secondary prevention of ACS. The full guideline is available at www.heartfoundation.org.au/for-professionals/acs-guideline.

David B. Brieger, Louise A. Cullen, Tom G. Briffa, Sarah Zaman, Ian A. Scott, Cynthia Papendick, Elaine Ho, Victoria Leitch, Dannii Dougherty, Garry Jennings

These first Australian evidence-based guidelines will serve as a clinical aid to practitioners who provide services to men with infertility and will facilitate evidence-based care for the most common areas of male infertility

Darren J Katz · Liza O’Donnell · Robert I McLachlan · Tim J Moss · Clare V Boothroyd · Veena Jayadev · Sarah R Catford

A summary of recommendations and practice points for key population subgroups who were identified as potentially benefitting from routine hepatocarcinoma surveillance in the form of ultrasound scans, with or without ?-fetoprotein testing

Jacob George · Nicole L Allard · Stuart K Roberts · Leon A Adams · Jane Davies · Behzad Hajarizadeh · Jennifer H MacLachlan · Suzanne E Mahady · Rosalie Altus · Catherine Brown · David C Fry · Belinda Greenwood‐Smith · Natali Smud · Patricia C Valery · Nafisa Yussf · Kate Broun · Denise Campbell · Karen Canfell · Chelsea Carle Harrison · Victoria Freeman · Paul Grogan · Catherine Holliday · Suzanne Hughes · Anna Kelly · Cathelijne Kemenade · Claire Latumahina · Amanda McAtamney · Megan Varlow · Joachim Worthington · Susan Yuill · Eleonora Feletto

In recognition of the increasing burden of metabolic dysfunction-associated fatty liver disease (MAFLD) in Australia, and the lack of clear guidelines for general practitioners, this consensus statement summary presents 21 recommendations on the assessment and monitoring of MAFLD in adult patients in primary care

Leon A Adams · William W Kemp · Kate R Muller · Elizabeth E Powell · Stuart K Roberts · Luis Calzadilla Bertot · Stephanie Best · Gary Deed · Jon D Emery · Samantha L Hocking · Graham R Jones · John S Lubel · Sinead Sheils · Stephen M Twigg · Gerald F Watts · Jacob George

A molecular diagnosis of monogenic diabetes can guide family planning, cascade testing and surveillance for other manifestations

Sunita MC De Sousa · Timothy ME Davis · James Harraway · Mark Greenslade · Kathy HC Wu · Ryan G Paul · Juliet Taylor · Aleena S Ali · Elif I Ekinci · Rinki Murphy · Jerry R Greenfield

Updated recommendations for the screening, diagnosis and classification of hyperglycaemia in pregnancy

Arianne Sweeting · Matthew JL Hare · Susan J Jersey · Alexis L Shub · Julia Zinga · Cecily Foged · Rosemary M Hall · Tang Wong · David Simmons

Poor bone health is highly treatable with appropriate widely available lifestyle and dietary measures and pharmacological agents; the updated guideline is an evidence-based pragmatic tool to assist general practitioners in the day-to-day care of such patients in partnership with bone specialists

Peter Wong · Weiwen Chen · Dan Ewald · Christian Girgis · Morton Rawlin · John Tsingos · Justine Waters

Introduction: Opioid use and dependence are prevalent among incarcerated people, contributing to elevated rates of overdose and other harms in this population. Opioid agonist treatment (OAT) has been shown to be an effective intervention to mitigate these risks. However, challenges to health care implementation in the custodial sector result in suboptimal and variable access to OAT in prisons nationally. Main recommendations: Among a national multidisciplinary expert panel, we conducted a modified Delphi study that yielded 19 recommendations to government, relevant health authorities and custodial health services. These recommendations cover five core domains: induction or continuation of OAT, OAT options and administration, transition of care to the community, special populations, and organisational support. Key recommendations include prompt recognition and treatment of opioid withdrawal, active linkage to community‐based OAT providers upon release, and ensuring appropriate organisational support through local protocols, adequate funding, and monitoring of key program indicators. Changes in management as a result of this statement: This consensus statement addresses a significant gap in national policy on OAT in Australian prisons. The recommendations, finalised in July 2024, set forth best practice standards grounded in evidence and expert consensus. We expect that implementing these recommendations will enhance the quality, consistency and continuity of OAT both within prison and upon release. Optimising OAT provision is crucial for improving health outcomes and addressing the risk of overdose, which is the leading cause of death among people released from prison.

Jocelyn Chan · Jon Cook · Michael Curtis · Adrian J Dunlop · Ele Morrison · Suzanne Nielsen · Rebecca J Winter · Thileepan Naren

The emergence of Buruli ulcer in previously non-endemic areas highlights the importance of increasing clinician and community awareness of this disease

Stephen Muhi · Victoria RV Cox · Matthew O'Brien · Jonathan T Priestley · Jodie Hill · Adrian Murrie · Anthony McDonald · Peter Callan · Grant A Jenkin · N Deborah Friedman · Kasha P Singh · Callum Maggs · Peter Kelley · Eugene Athan · Paul DR Johnson · Daniel P O'Brien

This two-part position statement provides a practical resource for clinicians on current best-practice consensus recommendations for managing adults with MS in the Australian and New Zealand health care settings

the MS Interest Group, Australian and New Zealand Association of Neurologists

A safe, effective and comprehensive approach to managing MS is crucial for improving long term outcomes and quality of life in individuals affected by MS

the MS Interest Group, Australian and New Zealand Association of Neurologists

The upcoming introduction of 4FPCC to Australia and New Zealand for warfarin reversal will allow for comprehensive replacement of vitamin K-dependent clotting factors and improved and safter rapid INR correction

Danielle Robinson · James McFadyen · Eileen Merriman · Chee Wee Tan · Ross Baker · Huyen Tran

The 2023 International evidence-based guideline for the assessment and management of polycystic ovary syndrome provides updated evidence-based recommendations for the clinical assessment and management of polycystic ovary syndrome

Helena J Teede · Aya Mousa · Chau T Tay · Michael F Costello · Leah Brennan · Robert J Norman · Alexia S Pena · Jacqueline A Boyle · Anju Joham · Lorna Berry · Lisa Moran

If we are to offer accessible, equitable, cost-effective fertility services to people who desire a child, we need to align to best practice evidence

For the Australian NHMRC Centre for Research Excellence in Reproductive Life UI Guideline Network and the ESHRE guideline group for unexplained infertility

The 2023 SOMANZ guideline presents significant updates on evidence-based recommendations for screening, prevention and management of hypertensive disorders of pregnancy

Renuka Shanmugalingam · Helen L Barrett · Amanda Beech · Lucy Bowyer · Tim Crozier · Amanda Davidson · Marloes Dekker Nitert · Kerrie Doyle · Luke Grzeskowiak · Nicole Hall · Hicham Ibrahim Cheikh Hassan · Annemarie Hennessy · Amanda Henry · David Langsford · Vincent WS Lee · Zachary Munn · Michael J Peek · Joanne M Said · Helen Tanner · Rachel Taylor · Meredith Ward · Jason Waugh · Linda LY Yen · Ellie Medcalf · Katy JL Bell · Deonna Ackermann · Robin Turner · Angela Makris