deprescribing at end of life

My pen poised over the drug chart, I hesitate.

Mr Jones* is a 58-year-old patient that my consultation palliative care team is seeing while he’s in hospital with complications of chemotherapy for advanced lung cancer. I am reviewing his discharge medications before he returns home to the care of the community palliative care team.

He is a very optimistic person, not keen to discuss the possibility of his cancer not getting better. An overweight hypertensive smoker, he’s on a full hand of antihypertensives, anti cholesterol medications, vitamin D supplements, a multi-vitamin, and antiplatelet therapy.

His prognosis is likely less than a year in my mind. Does he need all these medications?

A retrospective cohort study by Todd et al examined this question in groups of people with advanced lung cancer in the United States and the UK. The patients had died and been admitted to hospital then discharged at least once in their last 6 months of life.  Continue reading

#ANZSPM18 Conference – New Frontiers

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The Australian and New Zealand Society of Palliative Medicine 2018 Conference #ANZSPM18 is off the a great start, with many excellent plenaries & proffered papers presented on day 1 – following an excellent Trainee Day & pre-Conference workshop on thought leadership.

Day 2 promises to be even more awesome, starting off with keynote speaker Tom Le Blanc sharing his insights on collaboration & integration between palliative care & haematology. The rest of the day will feature a variety of plenaries & concurrent sessions on the new frontiers of palliative medicine – the theme of the conference. I’m also looking forward to the conference dinner tonight!

You can find the sides for my presentation on Palliative Care in Heart & Lung Transplantation here: HLTX PC ANZSPM18 Chi Li

Enjoy!

#ANZSPM Study Day for trainees & new fellows

VCCC

Beautiful spaces inside the Victorian Comprehensive Cancer Centre, the new home of the Peter MacCallum Cancer Centre in Melbourne, Australia

[The following article by Dr Sarah Dunlop, advanced trainee in palliative medicine, was first published in the Australian & New Zealand Society of Palliative Medicine (ANZSPM) Newsletter. The next ANZSPM study day will be held on September 6th in Sydney prior the the upcoming ANZSPM 2018 Conference. Follow #ANZSPM18 for updates from this biennial meeting – Chi] 

While there are many benefits of living in Western Australia (the weather, the beaches, and charming, debonair palliative medicine trainees), there are also downsides to living in one of the most isolated cities in the world… specifically the isolation! The decision to travel interstate to a course or conference usually hinges on three questions: can I get the time off, can I afford it, and is it going to improve my practice? So after charming my colleagues into giving a debonair trainee a day off and boarding the red-eye to Melbourne, I can confirm that the Study Day for Trainees and New Fellows met all my requirements.  Continue reading

A reflection on voluntary assisted dying and conscientious objection

Dying sculture

[Image by rmac8oppo from pixabay]

[The following essay by Dr Adrian Dabscheck, an experienced palliative care physician in Melbourne, explores the evolution of our society’s views towards death and reflects on the role of palliative care and voluntary assisted dying in this context – Chi]

During a recent period of enforced rest, I had time to reflect on my attitude to the recently enacted voluntary assisted dying legislation in Victoria and consider my response.I will detail my reaction to the Act and why I have chosen to become a so-called conscientious objector.

In his essay Western Attitudes Toward Death,French historian Philippe Ariès illustrates the evolution of our attitudes to death.

Initially, and for millennia, there had been a general resignation to the destiny of our species for which he used the phrase, Et moriemur, and we shall all die. This was replaced in the twelfth century by the more modern concept of the importance of one’s self, and he used the phrase, la mort de soi, one’s own death.  Continue reading

Palliative Care in the emergency department – PhD scholarship (Melbourne)

https://medicine.unimelb.edu.au/news-and-events/phd-scholarship-palliative-care-in-the-emergency-department-research

This looks like an interesting and worthwhile project under the wonderful  Prof Jenny Philip…..

The Project:

Hospital Emergency Departments (ED) face significant pressures and the challenge of providing quality care to high numbers of patients. In particular, patients with advanced cancer are known to frequently present to ED for worsening symptoms, treatment-related complications and need for additional support.

This PhD builds upon previous work to explore novel ways of identifying patients with cancer at increased risk of ED presentation.  This will include, but not be limited to, using established hospital and clinical datasets, to consider the development of a tool of risk stratification.   The candidate will be supported to further this project to develop potential interventional responses for palliative care patients in the emergency department.  The development of epidemiological data analytical skills will be an important outcome for this PhD candidate.

The Scholarship:

This PhD provides an exciting opportunity to work alongside other researchers and clinicians within a clinically embedded palliative research care unit at St Vincent’s Hospital in collaboration with other clinical partners as part of the Victorian Comprehensive Cancer Centre.

The successful candidate will be enrolled through the Department of Medicine at the University of Melbourne and be supervised by Professor Jennifer Philip, Associate Professor Brian Le in collaboration with Professor Vijaya Sundararajan (LaTrobe University). The candidate would also be supported by an established project team with interests in developing palliative care in the emergency department.

A competitive three year scholarship is available to the successful applicant to support their candidature.  Interested applicants are encouraged to apply and will be interviewed.

Amount awarded:

The scholarship is $30,000 per year for 3 years.

Eligibility/Selection Criteria:

  • An Honours degree in a health-related field such as Psychology, Medicine, Nursing, Public Health
  • Candidate must be competitive for an RTP scholarship or equivalent
  • Experience with quantitative datasets, or population-based research is desirable
  • Ability to work independently
  • Good written and oral communication skills
  • Good project management skills

Please contact Professor Jennifer Philip or Nora Hanafi if have any questions and/or to express your interest in the PhD project and scholarship.

Nora Hanafi

Research Programs Coordinator

Melbourne Medical School | Faculty of Medicine, Dentistry and Health Sciences

E: shanafi@unimelb.edu.au

Whisper No More

‘Whisper No More‘ is a learning package that contains stories from Aboriginal people about their experience of cancer. Linked to a decade of research, it was prompted by findings from ‘A whispered sort of stuff‘, a report on a study undertaken with mid-west communities in Western Australia.

‘Whisper No More’ is freely available online for registered users and includes videos, discussion questions and links to key articles and websites. There is also specific content relating to future planning and discussions about end of life care.

FINAL_Flyer_WhisperNoMore_180528 (palliverse)

Understanding decision-making among people living with dementia

Decision-making in dementia survey

Researchers from the University of Western Australia and the Cognitive Decline Partnership Centre are trying to understand more about how Australian healthcare professionals understand and make judgements on decision-making among people living with dementia.

If you are an Australian health care professional or aged care worker and provide care, services or treatment to people living with dementia as part of your role, you are invited to participate in this short, online survey.

The study information and survey is available here

Study of palliative care triage in Australia

Demand for palliative care services in inpatient, community, outpatient and consultation services is increasing. In the context of finite resources, patients referred should undergo ‘triage’ – derived from the French term ‘trier’ meaning ‘to sort’ – the process of deciding which patients should be treated first based on how urgent their needs are.

A new study conducted in Victoria, Australia, explored palliative care providers’ practices and attitudes towards triaging palliative care needs and their views regarding the implementation of a standardised approach.

Continue reading

Bring dying refugee to Australia for palliative care, urge health professionals

Thousands of doctors have signed a petition calling on the immigration minister, Peter Dutton, to bring a refugee dying of advanced lung cancer to Australia for palliative care.

The 63-year-old is being held on Nauru and is a member of the persecuted Hazara minority in Afghanistan. He has been formally recognised as a refugee. But the Australian Border Force told the man that he could not come to Australia for palliative care, despite claims that the palliative care available on Nauru is inadequate.

The Australian Border Force  (ABF) has told the 63-year-old patient, who is suffering from advanced lung cancer, that he is deemed to have “refused treatment” because he declined to be moved to Taiwan to die. Cynically, the ABF has also offered the patient $25,000 to return home to Afghanistan. Continue reading

APLI forum Sydney 5 September promoting palliative care in Asia-Pacific

Interesting in helping to develop palliative care in the Asia-Pacific region?

APLI is the Australasian Palliative Link International.

It is a small charitable organisation made up of Australian and New Zealand palliative care clinicians. APLI aims :

  • to develop and foster links between palliative care providers and organisations in Australia and New Zealand and the Asia-Pacific region
  • to raise awareness of the needs of new palliative care services and the need for further development of the discipline in the region.
  • to provide a forum for the exchange of information and ideas between providers of palliative care in the region.

Continue reading