Mater Research -UQ Palliative Care Research University of - - PDF document

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Mater Research -UQ Palliative Care Research University of - - PDF document

12/7/18 Mater Research -UQ Palliative Care Research University of Queensland Prof J Hardy A/Prof P Good Janet Hardy Phillip Good Russel Richard, Rohan Vora, Korana Kindl, Will Syrmis, Rebecca Olsen Jess Cross, Petra


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12/7/18 1

Palliative Care Research University of Queensland

  • Janet Hardy
  • Phillip Good
  • Rebecca Olsen
  • Geoff Mitchell
  • Sarah Winch

Mater Research -UQ

  • Prof J Hardy
  • A/Prof P Good
  • Russel Richard, Rohan Vora, Korana Kindl, Will Syrmis,

Jess Cross, Petra Vayne-Bossert, Geoff Mitchell, Alison Haywood, Ross Norris, Patsy Yates, Carol Douglas, Rebecca Olsen….

Mater Research -UQ

  • An open label pilot study of oral water soluble contrast

(Gastrografin) in addition to conservative medical management for the resolution of malignant bowel

  • bstruction in adult patients
  • Quality Use of Medicine: The Use of oral corticosteroids in

patients with advanced cancer

  • Assessing physical activity as an outcome of pain

management in patients with advanced cancer

Mater Research -UQ

  • Genomic variation in symptom expression in Men with

Castrate Resistant Prostate Cancer (CRPC)

  • The prevalence of QTc prolongation in patients with

cancer

  • Randomised double-blind placebo-controlled phase III

trial of oral melatonin for the prevention of delirium in hospital in people with advanced cancer (PaCCSC)

Mater Research -UQ

  • Oral Medicinal Cannabinoids to Relieve Symptom Burden

in the Palliative Care of Patients with Advanced Cancer: a double-blind, placebo controlled, randomised clinical trial

  • f efficacy and safety of 1:1 delta-9-tetrahydrocannabinol

(THC) and cannabidiol (CBD)

  • MRFF grant
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Mater Research -UQ

  • An open label pilot study of medicinal cannabis to relieve

symptom burden in patients with cancer

  • Using pharmacokinetic and pharmacodynamics data to
  • ptimise cannabinoid dosing in palliative care setting
  • A qualitative study of cancer patients’ perceptions and

attitudes toward use of medicinal cannabinoids in palliative care

Rebecca E. Olson, Senior Lecturer in Sociology, UQ

Hardy, J., Good, P., Lintzeris, N., Martin, J., Yates, P., Chye, R., Haywood, A., & Olson, R. NHMRC Medical Research Future Fund, ‘Medicinal cannabinoids to relieve symptom burden in the palliative care of patients with advanced cancer,’ 2018, $1,363,040. Hardy, J., Good, P., & Olson, R. Mater Clinical Research Seeding Grant, ‘A qualitative study of cancer patients’ perceptions and attitudes toward use of medicinal cannabinoids in palliative care,’ 2017-2018, $19,496.

Qualitative sub-study to RCT, using medicinal cannabinoids in palliative care

  • Examines social and culturally relative

perceptions of medicinal cannabinoids, in particular stigma, as a possible barrier to effective use for symptom burden

Rebecca E. Olson, Senior Lecturer in Sociology, UQ

Good, P., Hardy, J., & Olson, R. Clinical Seeding Grant, Mater Clinical Research Seeding Grant. ‘Talking about death: A mixed methods study into palliative care communication,’ $19,320.

‘Talking about death’: Qualitative study of how medical

professionals balance protocols on open communication about EoL with family/cultural preferences for indirect communication.

  • In interactions with other clinicians, in multidisciplinary

team meetings, synonyms are often used

  • In interactions with patients and families, doctors perform

‘culturally and emotionally reflexive labour’ to decipher the preferred terminology

CRICOS code 00025B

Primary Palliative Care research 2019

CRICOS code 00025B CRICOS code 00025B

RCT of structured screening for potential deaths within months vs unguided intuition

  • structured screening no better than intuition
  • but doing anything to identify patients is far more effective than doing nothing

Palliat Med 2018 Feb;32(2):384-394.

Case controlled study identifying factors predicting death in general practice populations (RACGP funded)

  • determined independent predictors to facilitate online searching for potential patients at

risk of dying

  • also generated a nomogram that calculates a percentage risk of dying several months
  • ut
  • needs formal testing

A Woolfield (Hons student) – paper under review

Identifying people at risk of dying in primary care

[Presentation Title] | [Date] 11

[Entity Name]

CRICOS code 00025B CRICOS code 00025B

GP end of life minimum dataset Development and piloting of an end of life minimum dataset GP self reporting of practice and challenges for patients reported dead in the 6 months before death Data collection through sentinel practices.

Johnson, Mitchell, Deckx, Chua - current

Systematic review of GP performance in end of life care (five papers reporting 248 studies 2000-17)

National and international research group – PC4 support

Determining GP practice at end of life (HCF RACGP grant)

[Presentation Title] | [Date] 12

[Entity Name]

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CRICOS code 00025B CRICOS code 00025B

  • 1. Describing GP practice at the last months before death

Critical points are:

  • GPs choose whether to participate in PC or not
  • Do patients articulate awareness that end of life is approaching?

ŸIf yes – structured planning, PC involvement ŸIf no – unspoken changing of goals of care to comfort care

Deckx et al (under review)

How do GPs practice when a patient approaches death?

[Presentation Title] | [Date] 13

[Entity Name]

CRICOS code 00025B CRICOS code 00025B

  • 2. The why and how for GPs initiating EOL conversation

[Presentation Title] | [Date] 14

[Entity Name]

WHY

  • It is part of being a GP – you have to do it

1.People also appreciate it more often than not 2.It prevents people from being hurt 3.It saves time down the line 4.It is rewarding HOW

  • Normalise the conversation

1.embedding it within routine older person care health assessment, document statement of choices 2.bringing it up repeatedly in normal consultations

  • Find other entry point to start the conversation

1.clear evidence of declining health 2.unexpected hospitalization

  • Spread it over multiple consultations

Deckx, Thomas, Sieben, Mitchell – in Preparation

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CRICOS code 00025B CRICOS code 00025B

Follows PhD thesis to determine how to maximise taste acceptance and efficiency of delivery

PhD - Estafanos, Supervisors Steadman, Senior, Mitchell

N-of-1 study of Pilocarpine Oral Dose Tablets in palliative care patients with dry mouth

Richards, Hardy, Good, Mitchell, Nikles, Senior, McGree

Buccal Pilocarpine for dry mouth

[Presentation Title] | [Date] 19

[Entity Name]

Dr Sarah Winch

Head of the Medical Ethics, Law and Professionalism discipline at the Faculty of Medicine, University of Queensland. CEO of Health Ethics Australia “The best death: how to die well”