Author Archives: Anna

What’s new in research?

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New trial published in the Lancet Respiratory Medicine provides evidence for early integration of palliative care in patients with advanced disease suffering from breathlessness.

Higginson and colleagues randomised 105 people with advanced disease and refractory breathlessness (MRC dyspnoea scale score >2) to receive a breathlessness support service or usual care. The breathlessness support service involved, sequentially: 1) An outpatient clinic appointment involving assessment and treatment by respiratory medicine and palliative care clinicians, as well as a breathlessness information and management pack;  2) An allied health home assessment and promotion of self-management techniques approximately 2-3 weeks post the clinic; and 3) A final discharge planning outpatient clinic appointment with a palliative care clinician approximately 4 weeks post the clinic.

Mastery of breathlessness symptoms significantly improved for patients attending the breathlessness support service, compared to usual care (16% improvement, p=0.048). For patients with COPD and interstitial lung disease (but not cancer): survival rate from randomisation to 6 months was greater in those who attended the breathlessness support service (94%) versus usual care (75%), as was overall survival (p=0.048). Total health care costs calculated from patient-reported health service use were not significantly different between groups.

Have a read: http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70226-7/fulltext

Higginson IJ, Bausewein C, Reilly CC, Gao W, Gysels M, Dzingina M et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. The Lancet Respiratory Medicine. 2014. 2(12):979-987. DOI: 10.1016/S2213-2600(14)70226-7

 

What’s new in research?

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Trial published in JCO suggests even experienced clinicians benefit from communication skills training… AND so do their patients!

A study by Fujimori and colleagues examined the effects of a person-centred communication skills training program for 30 oncologists who were randomised to either receive the training or not. A total of 1,192 patients who had consultations with participating oncologists reported their psychological distress, satisfaction, and trust in the oncologist. In addition, oncologists were objectively assessed on their performance and confidence in communication using simulated, videotaped consultations. Those oncologists who received the training improved on several communication outcomes. While the training did not significantly impact patient’s satisfaction with their oncologist, patients reported greater trust in their oncologist and less depression. Results suggest experienced clinicians (9.3 – 30.3 years of practice) can benefit from communication skills training, and accordingly, so do their patients.

Have a read: http://jco.ascopubs.org/content/early/2014/06/09/JCO.2013.51.2756.abstract

Study reference: Fujimori M, Shirai Y, Asai M, Kubota K, Katsumata N, Uchitomi Y. The effect of communication skills training program for oncologists based on patient preferences for communication when receiving bad news: A randomized controlled trial. J Clin Oncol 2014, June 9 [Epub ahead of print]

Striving for better research: Transparency, reproducibility, robustness

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Transparency, reproducibility, and robustness… These are central concepts to undertaking thorough research that, importantly, can be replicated or reliably used by the broader field of science to advance medicine… or whatever field it is that we choose to dabble in.

The world’s most influential (i.e. ‘highly cited’) scientific journal Nature, with its impact factor of no less than 38.597 (Thomson Reuters, 2013), has drawn light to “the worrying extent” to which our research “have been found wanting” in terms of reproducibility.

It’s an interesting idea. While our research may be robust enough to pass the test of a reviewer, does it ensure sufficient transparency for reproducibility? And if indeed it’s not reproducible, how can we ever know it’s false?

Have a read: go.nature.com/huhbyr

New Palliative Care Resource

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We’ve seen this new, free, online palliative care education resource developed by the folk at Centre for Palliative Care in Victoria. It’s targeted towards health professionals from a variety of clinical settings who have an interest in caring for patients and their families living with a life-threatening illness or who wish to find out more about palliative care.
 

Children On Death

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As both mere humans and as professionals in the palliative care sphere, how often do we catch ourselves or those around us contemplating the big questions of life, or more specifically, death? Quite often, I imagine… Yet many of us still find ourselves tongue-tied on the subject. Even as professionals in the ‘business’ of dying, we may approach conversations on the subject with a certain reluctance. How do we gauge the readiness of a person to face their own mortality? How do we establish a person’s preferences for disclosure? These are complex questions with perhaps no one easy answer – unless of course, you’re a kid, right? Continue reading →