About soniafullerton

Palliative physician, internet addict, mum of three.

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

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

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

Life in a hospice – reflections on caring for the dying

We have had an email from the Palliverse – Ann Richardson has kindly made her book “Life in a hospice” available as an e book. Life in a Hospice: reflections on caring for the dying is based on very honest interviews with a variety of hospice staff in England, talking anonymously about the joys and challenges of their work and its impact on their lives.

See below for her email. Let us know if you have read it! Thanks Ann for letting us know

Sonia Continue reading

Pallimed article on heart failure palliative care trial

Thanks to Dr Drew Rosielle for this thoughtful analysis of an important trial, comparing usual care to usual care plus palliative care in ambulatory heart failure patients.

http://www.pallimed.org/2017/07/palliative-care-chf-pal-hf-trial.html

Headline – palliative care improved quality of life. So this article is adding to the literature supporting this idea, which mostly occurs in the malignant domain.

Check out Pallimed if you have time, it’s got great stuff!

Enjoy!

Sonia

 

ANZSPM position on medicinal cannabis

ANZSPM criticises failure to consult on medicinal cannabis

The Australian and New Zealand Society of Palliative Medicine (ANZSPM) is calling for improved consultation with end-of-life care experts after yesterday’s Senate decision on medicinal cannabis.

ANZSPM President, Dr Carol Douglas FAChPM, expressed concern that the decision will have ramifications for both patient and practitioner protections:

Continue reading

Dying to talk?

Palliative Care Australia brings you this youtube video which you can share with patients, families and friends…

Jean Kittson says it’s important to complete the Dying to Talk Discussion Starter and encourages you to speak to your loved ones about your end-of-life care wishes.

If you make any advance care plans, bonus points for documenting something in writing it and sharing it with your substitute decision maker, your MyHealthRecord, your  GP and local hospital!

 

Integrated Palliative Care – what does this mean in 2017?

The team at @Palliverse are huge fans of Prof Jenny Philip, an inspirational speaker and all round wise and skilled person!

Come along to Monday Lunch (it’s a good lunch) next week and see Jenny share her thoughts on

Monday Lunch Live with Prof Jennifer Philip

8th May 2017

The Role of Integrated Palliative Medicine in Best Cancer Care

Victorian Comprehensive Cancer Centre

Lecture Theatre B, Level 7

305 Grattan St, Melbourne, VIC 3000

Book Now : come along, catch up live via webinar, or later when you have time. 

Continue reading