#COSA17: #PalliativeCare reflections on the 44th Clinical Oncology Society of Australia Annual Scientific Meeting

Circular Quay

Despite being a Melburnian, I must admit that Sydney really is an irresistibly beautiful city when the sun comes out, especially by the water. The 44th Clinical Oncology Society of Australia (COSA) Annual Scientific Meeting was held in the newly renovated International Convention Centre in Sydney between 12-15th November 2017. With the sunlight streaming in through its many windows, reflecting off the waters of Darling Harbour, it really was the perfect place to be at the beginning of summer.

I attended the pre-conference workshop on cancer supportive care, which was organised by Judith Lacey, a palliative medicine specialist at Chris O’Brien LIfehouse. The whole-day workshop featured an interesting mixture of passionate speakers promoting a range of complementary treatments including medicinal cannabis, massage and probiotics; alongside others examining the evidence base for acupuncture, reviewing current clinical trials and prescribing pathways, and comparing different funding models for supportive care. It was a long but worthwhile day that set the mood for the rest of the conference.  Continue reading

New Zealand wins (again)

I have to confess I am a fan of the New Zealand health system from across the ditch. Sensible spending. strong palliative care health service connections… am I wrong Bro?

This article has not succeeded in reversing my bias in favour of New Zealand.

Palliative data nerds will no doubt recall this  fascinating study in Scotland by Professor Clark et al.  Published in Palliative Medicine, and quickly attaining the journal’s highest-ever Altmetrics score (1) , Clark showed that among 10,743 inpatients in 25 Scottish teaching and general hospitals on 31 March 2010,  3,098 (28.8%) patients died during the one-year follow-up period. The findings were replicated in 2013 with similar results.

The study by the fabulous  Professor  Merryn Gott et al showed that on the same date, the corresponding figure in New Zealand (including obstetrics) was about half at 14.5%. Patients at higher risk of dying were the elderly of over 80 years of age, Maori, those with cancer, those from socially disadvantaged backgrounds, and those admitted under medical specialties rather than surgical.

New Zealand seems to provide better end of life care outside the hospital setting, with stronger end-of-life care in the aged care setting. This has certainly been a focus for service development in Australia as well.

How would we rate in Australia I wonder?

I would love to hear from international colleagues

Ref (1)  https://www.gla.ac.uk/research/az/endoflifestudies/projects/imminence/

Sonia

Research priorities in Australian adult palliative care

We at Palliverse support open dialogue between researchers, clinicians, policy-makers and the broader community as to how things are going and what are the priority areas for future work. Please see below a research opportunity which is relevant to researchers and clinicians working in Australian adult palliative care settings. Continue reading

Palliverse researcher hub

It’s well known that research can be a demanding and sometimes lonely road, particularly for those new to the discipline. Early career researchers often have to build networks, lead projects, write applications to funders and ethics committees, liaise with project stakeholders, analyse data and present findings, all while building networks and managing a precarious career pathway with little security. Support and skill-sharing is critical during this process. The Palliverse researcher hub was formed in 2016, following a discussion between some of our crew at a conference. The idea was a regular, informal get-together for post-grad and early career palliative care researchers, to discuss aspects of our projects, seek advice and share experiences. We meet bi-monthly for around an hour, and keep a relatively open agenda, to aim for the kind of reflective discussion you don’t always get at departmental seminars or CPD sessions. We’ve started small, and now are ready to branch out a little. If you are a palliative care researcher working in Australia or New Zealand, and think you’d like to join our group, please get in touch with us by emailing craig.sinclair@uwa.edu.au. Happy researching!

‘Elder Abuse: A National Legal Response’ – Report from Australian Law Reform Commission

ElderRefugee

Today is World Elder Abuse Awareness Day. The United Nations, in their resolution 66/127, established June 15th as a global day, which aims to raise awareness about elder abuse as a global issue, ‘everybody’s business’ and one that will become of increasing importance as our global population ages.

Elder abuse is defined as ‘a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person’ (WHO). It can include physical, psychological, emotional, financial or sexual abuse, and neglect.

While palliative and end-of-life care is not solely an issue for older people, it is timely to remember that many people accessing palliative care are also ageing, and often experiencing issues associated with elderhood, including societal attitudes towards older people. Many of these issues can influence people’s access to support, social engagement, health services and the enjoyment of personal freedoms and decision-making rights, making this an area of direct relevance for palliative care.

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PhD scholarships available – improving psychosocial support for people with cancer & their carers

Palliverse has heard about two PhD scholarships in the area of improving psychosocial support and education for people with cancer and their carers, at Curtin University in Perth, WA. Scholarships are available to health professionals (particularly nurses and radiation therapists). For more details see the Curtin University website.

Supporting communities to start conversations about end of life care

community

Many of you who are regular Palliverse readers will be aware of our ongoing promotion regarding the need for the community as a whole to support open discussions about death, dying and end-of-life care. A group of researchers from the University of Alabama have recently published on a novel approach to this issue. In this study, they report on the effects of training lay community members as ‘health navigators’, who work with patients in hospital to help them understand the process of advance care planning, and to facilitate their further discussions with their family and healthcare team.

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Journal club on delirium #hpmjc

hpmjc

Delirium is a syndrome associated with a sudden change in a person’s mental function that interferes with their thinking and awareness. It is a common problem that confronts many patients, families and clinicians in the palliative care setting. Delirium usually develops as a result of a serious medical condition, which can often be found and treated. However, the symptoms of delirium – such as fluctuating confusion, reduced attention, disturbed sleep-wake cycle, and/or hallucinations – can be very distressing for everyone involved, and may persist for many days to weeks.

Medications – including antipsychotics such as haloperidol and risperidone – are often used to manage the symptoms of delirium. But do they actually work?

To answer this question, Professor Meera Agar (@meera_agar) and colleagues from the Palliative Care Clinical Studies Collaborative (PaCCSC) conducted a study examining the use of these medications. The results of their research was published in JAMA Internal Medicine recently, and also discussed on various media platforms (examples here, here and here).

Please join Hospice and Palliative Medicine Journal Club (#hpmjc) in January 2017 for an in-depth discussion about this important study. The journal club will be hosted by Chi Li (@Dr_Chi_Li) from Palliverse and feature the paper’s first author, Meera Agar (@meera_agar)!

When? The hour-long online journal club will start at (please note the different dates):

  • Auckland: 9am, Tuesday 24th January
  • Sydney: 7am, Tuesday 24th January
  • London: 8pm, Monday 23rd January
  • New York / Toronto: 3pm, Monday 23rd January
  • Other cities

Who? Anyone and everyone who has:

  • Experienced delirium themselves
  • Cared for or lived with someone with delirium
  • An interest in improving the treatment of delirium
  • An interest in enhancing palliative care

How? It’s easy!

What? We will be discussing the following topics during the journal club

  • Topic 1: Why was the study conducted? Are the study questions / aims relevant to you and/or your work?
  • Topic 2: How was the study conducted? What did you like about the study methodology? Would you have done anything differently?
  • Topic 3: What were the main findings from the study? Were you surprised by any of the study results?
  • Topic 4: Has this study changed the way you think about delirium in the palliative care setting? Why and why not? What’s next?

If you would like more information, or are having trouble accessing the paper, please feel free to contact us via Twitter (@Dr_Chi_Li or @palliverse) or by email (chi.li.australia@gmail.com or palliverse@gmail.com).

We hope you can join us for a great discussion about this important study!

 

Healthcare communication – A network for our region

Palliverse was lucky enough to be present for the excellent Teaching communication in Healthcare conference in Melbourne hosted by the Cancer Council Victoria last December.  At this conference multiple members of the European Association of Healthcare Communication including Jonathan Silverman and current president Evelyn Van Weel -Baumgarten joined local representatives of EACH Peter Martin and Megan Chiswell.
healthcomms
During the event the key message was of the importance of communication skills to be able to provide care that is patient-centred, empathetic, safe, ethical, efficient and high-quality.  Unlike many other clinical skills communication is also largely universal in that it is practiced by clinicians in all encounters.  Supporting communication skills education is therefore a critical way of improving the quality of care provided by our healthcare system.

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Drugs for #delirium don’t work, and may in fact harm

Meera Agar, University of Technology Sydney

Delirium robs dying people of their autonomy, dignity and last conversations with loved ones, at a time when every moment is precious.

Symptoms are highly distressing to experience and watch. Confusion, incoherent communication, poor attention, agitation, drowsiness and hallucinations are some markers of this common complication for people dying in hospital from cancer and other advanced illnesses. On average one in three people in end-of-life hospital care are affected.

Doctors commonly prescribe antipsychotic medications to try to relieve these symptoms. However, our study just published in JAMA Internal Medicine, raises serious concerns about their safety and efficacy.

So, what are we to do for people experiencing delirium, who are robbed of their mental awareness and ability to communicate?

Continue reading