1
|
Thomas A, Delic J, Hudson P, Batchelor M, Johannsen H, Grzeskowiak LE. A retrospective audit of adult and paediatric anaphylaxis management from two Australian metropolitan mixed emergency departments. BMC Emerg Med 2024; 24:67. [PMID: 38627619 PMCID: PMC11022440 DOI: 10.1186/s12873-024-00966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Anaphylaxis is a potentially life-threatening allergic reaction, with presentations to emergency departments (EDs) increasing across Australia. Understanding the features of those presenting with anaphylaxis and aspects related to its optimal clinical management across the admission, treatment and discharge settings is needed to minimise its impact. We aimed to evaluate the nature and management of presentations related to anaphylaxis across two Australian EDs. METHODS Retrospective audit of paediatric and adult patients presenting to a community or tertiary level ED with anaphylaxis from 1 May 2018 to 30 April 2019. Data extracted from medical records included demographic characteristics, causative agents, clinical features, treatments administered across community, ambulance or ED settings, as well as post-discharge care arrangements including provision of Adrenaline Auto-Injector (AAI) and Allergy/Anaphylaxis Action Plan (AAP). RESULTS A total of 369 (107 paediatric and 262 adult) ED presentations were identified. A total of 94 (36%) adult and 46 (43%) paediatric patients received pre-hospital adrenaline, with a further 91 (35%) adult and 29 (27%) paediatric patients receiving a dose of adrenaline in the ED. The most commonly administered treatment in ED were corticosteroids, given to 157 (60%) adult and 55 (51%) paediatric patients. Among those requiring an AAI for discharge, 123/210 (59%) adult and 57/91 (63%) of paediatric patients left hospital with an AAI. In contrast, among those requiring an allergy/anaphylaxis action plan (AAP) on discharge, 61/206 (30%) adult and 30/90 (33%) of paediatric patients left hospital with one. Factors associated with an increased likelihood of receiving AAI on discharge in paediatric and adult patients included receipt of any adrenaline, receipt of two or more doses of adrenaline, and longer duration of hospital stay. Adults presenting within business hours were more likely to be discharged with AAI, but no such difference was observed for paediatric patients. Similar findings were evident for provision of AAP on discharge. CONCLUSION These findings demonstrate the need to improve assessment and treatment in the ED. In particular, the observed large variability in provision of AAI and AAP on discharge presents opportunities to explore strategies to improve awareness and provision of these critical components of post-discharge care.
Collapse
Affiliation(s)
- A Thomas
- SA Pharmacy, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, Australia, Flinders Drive, 5042.
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia.
| | - J Delic
- Emergency Department, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - P Hudson
- Allergy/Clinical Immunology Department, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, Australia
| | - M Batchelor
- Allergy/Clinical Immunology Department, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, Australia
| | - H Johannsen
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Allergy/Clinical Immunology Department, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, Australia
| | - L E Grzeskowiak
- SA Pharmacy, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, Australia, Flinders Drive, 5042
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| |
Collapse
|
2
|
Lewis S, La Brooy C, Kerridge I, Holmes A, Olver I, Hudson P, Dooley M, Komesaroff P. Choreographing a good death: Carers' experiences and practices of enacting assisted dying. Sociol Health Illn 2024. [PMID: 38386331 DOI: 10.1111/1467-9566.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
The proliferation of assisted dying legislative reforms globally is a significant change in the social and medico-legal landscape of end-of-life care. Understanding the impacts of these legislative reforms on family members who care for a dying person is vital, yet under-theorised in research. In this article, drawing on semi-structured interviews with 42 carers for a person who has sought assisted dying in Australia, and extending ideas of ontological choreography we explore the new and complex choreographies enacted by carers in their endeavour to arrange a 'good death' for the dying person. We find that desires to fulfil the dying person's wishes are often accompanied by normative pressures, affective tensions and complexities in bereavement. Enacting assisted dying requires carers to perform a repertoire of highly-staged practices. Yet, institutional obstacles and normative cultural scripts of dying can constrain carer assisted dying practices. Understanding the nuances of carers' experiences and how they navigate this new end-of-life landscape, we argue, provides critical insights about how assisted dying legislation is producing new cultural touchpoints for caring at the end of life. Moreover, we show how emerging cultural scripts of assisted dying are impacting in the lives of these carers.
Collapse
Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Alex Holmes
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Dooley
- Alfred Health, Prahran, Victoria, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | | |
Collapse
|
3
|
Frias MA, Pagano S, Bararpour N, Sidibé J, Kamau F, Fétaud-Lapierre V, Hudson P, Thomas A, Lecour S, Strijdom H, Vuilleumier N. People living with HIV display increased anti-apolipoprotein A1 auto-antibodies, inflammation, and kynurenine metabolites: a case-control study. Front Cardiovasc Med 2024; 11:1343361. [PMID: 38414919 PMCID: PMC10896987 DOI: 10.3389/fcvm.2024.1343361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Objective This study aimed to study the relationship between auto-antibodies against apolipoprotein A1 (anti-apoA1 IgG), human immunodeficiency virus (HIV) infection, anti-retroviral therapy (ART), and the tryptophan pathways in HIV-related cardiovascular disease. Design This case-control study conducted in South Africa consisted of control volunteers (n = 50), people living with HIV (PLWH) on ART (n = 50), and untreated PLWH (n = 44). Cardiovascular risk scores were determined, vascular measures were performed, and an extensive biochemical characterisation (routine, metabolomic, and inflammatory systemic profiles) was performed. Methods Anti-apoA1 IgG levels were assessed by an in-house ELISA. Inflammatory biomarkers were measured with the Meso Scale Discovery® platform, and kynurenine pathway metabolites were assessed using targeted metabolomic profiling conducted by liquid chromatography-multiple reaction monitoring/mass spectrometry (LC-MRM/MS). Results Cardiovascular risk scores and vascular measures exhibited similarities across the three groups, while important differences were observed in systemic inflammatory and tryptophan pathways. Anti-apoA1 IgG seropositivity rates were 15%, 40%, and 70% in control volunteers, PLWH ART-treated, and PLWH ART-naïve, respectively. Circulating anti-apoA1 IgG levels were significantly negatively associated with CD4+ cell counts and positively associated with viremia and pro-inflammatory biomarkers (IFNγ, TNFα, MIPα, ICAM-1, VCAM-1). While circulating anti-apoA1 IgG levels were associated with increased levels of kynurenine in both control volunteers and PLWH, the kynurenine/tryptophan ratio was significantly increased in PLWH ART-treated. Conclusion HIV infection increases the humoral response against apoA1, which is associated with established HIV severity criteria and kynurenine pathway activation.
Collapse
Affiliation(s)
- Miguel A. Frias
- Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
- Department of Medical Specialties, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sabrina Pagano
- Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
- Department of Medical Specialties, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nasim Bararpour
- Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Genetics, Stanford University, Stanford, CA, United States
- Stanford Center for Genomics and Personalized Medicine, Stanford, CA, United States
| | - Jonathan Sidibé
- Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Festus Kamau
- Centre for Cardiometabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vanessa Fétaud-Lapierre
- Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
- Department of Medical Specialties, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Peter Hudson
- Cape Heart Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Aurélien Thomas
- Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Unit of Forensic Toxicology and Chemistry, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland
| | - Sandrine Lecour
- Cape Heart Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Hans Strijdom
- Centre for Cardiometabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
- Department of Medical Specialties, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
4
|
Hudson P, Marco D, De Abreu Lourenco R, Philip J. What are the cost and resource implications of voluntary assisted dying and euthanasia? AUST HEALTH REV 2024:AH24016. [PMID: 38316056 DOI: 10.1071/ah24016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
ObjectivesVoluntary assisted dying (VAD) legislation has now been passed in all Australian states. Although VAD has been operating in many settings worldwide for a considerable time, the specific costs associated with VAD seem unclear. The aim of this study was therefore to outline the common resource implications associated with VAD.MethodsA rapid literature review and grey literature search were undertaken.ResultsWe found a paucity of empirically informed detail regarding the actual costs required to implement VAD. Hence, we tabulated a list of potential costs that could be used for subsequent evaluation and a future research agenda.ConclusionsThere is a lack of publicly available information related to the costs associated with implementing VAD. Given that this is a significant change in policy and many multidisciplinary practitioners may be directly or indirectly involved in VAD it is important that associated costs are clearly outlined so that appropriate resources can be allocated.
Collapse
|
5
|
Passoni G, Coulson T, Cagnacci F, Hudson P, Stahler DR, Smith DW, Lachish S. Investigating tritrophic interactions using bioenergetic demographic models. Ecology 2024; 105:e4197. [PMID: 37897692 DOI: 10.1002/ecy.4197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/27/2023] [Accepted: 09/18/2023] [Indexed: 10/30/2023]
Abstract
A central debate in ecology has been the long-running discussion on the role of apex predators in affecting the abundance and dynamics of their prey. In terrestrial systems, research has primarily relied on correlational approaches, due to the challenge of implementing robust experiments with replication and appropriate controls. A consequence of this is that we largely suffer from a lack of mechanistic understanding of the population dynamics of interacting species, which can be surprisingly complex. Mechanistic models offer an opportunity to examine the causes and consequences of some of this complexity. We present a bioenergetic mechanistic model of a tritrophic system where the primary vegetation resource follows a seasonal growth function, and the herbivore and carnivore species are modeled using two integral projection models (IPMs) with body mass as the phenotypic trait. Within each IPM, the demographic functions are structured according to bioenergetic principles, describing how animals acquire and transform resources into body mass, energy reserves, and breeding potential. We parameterize this model to reproduce the population dynamics of grass, elk, and wolves in northern Yellowstone National Park (USA) and investigate the impact of wolf reintroduction on the system. Our model generated predictions that closely matched the observed population sizes of elk and wolf in Yellowstone prior to and following wolf reintroduction. The introduction of wolves into our basal grass-elk bioenergetic model resulted in a population of 99 wolves and a reduction in elk numbers by 61% (from 14,948 to 5823) at equilibrium. In turn, vegetation biomass increased by approximately 25% in the growing season and more than threefold in the nongrowing season. The addition of wolves to the model caused the elk population to switch from being food-limited to being predator-limited and had a stabilizing effect on elk numbers across different years. Wolf predation also led to a shift in the phenotypic composition of the elk population via a small increase in elk average body mass. Our model represents a novel approach to the study of predator-prey interactions, and demonstrates that explicitly considering and linking bioenergetics, population demography and body mass phenotypes can provide novel insights into the mechanisms behind complex ecosystem processes.
Collapse
Affiliation(s)
- Gioele Passoni
- Department of Biology, University of Oxford, Oxford, UK
- Animal Ecology Unit, Research and Innovation Centre (CRI), Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Tim Coulson
- Department of Biology, University of Oxford, Oxford, UK
| | - Francesca Cagnacci
- Animal Ecology Unit, Research and Innovation Centre (CRI), Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Peter Hudson
- The Huck Institutes, Penn State University, State College, Pennsylvania, USA
| | - Daniel R Stahler
- Yellowstone Center for Resources, Yellowstone National Park, Wyoming, USA
| | - Douglas W Smith
- Yellowstone Center for Resources, Yellowstone National Park, Wyoming, USA
| | - Shelly Lachish
- Commonwealth Scientific Industrial Research Organisation (CSIRO) Environment Unit, Dutton Park, Queensland, Australia
| |
Collapse
|
6
|
Shu R, Hammett M, Evtimov V, Pupovac A, Nguyen N, Islam R, Zhuang J, Lee S, Kang T, Lee K, Nisbet I, Hudson P, Lee JY, Boyd R, Trounson A. Engineering T cell receptor fusion proteins using nonviral CRISPR/Cas9 genome editing for cancer immunotherapy. Bioeng Transl Med 2023; 8:e10571. [PMID: 38023726 PMCID: PMC10658519 DOI: 10.1002/btm2.10571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/04/2023] [Accepted: 06/25/2023] [Indexed: 12/01/2023] Open
Abstract
Manufacture of chimeric antigen receptor (CAR)-T cells usually involves the use of viral delivery systems to achieve high transgene expression. However, it can be costly and may result in random integration of the CAR into the genome, creating several disadvantages including variation in transgene expression, functional gene silencing and potential oncogenic transformation. Here, we optimized the method of nonviral, CRISPR/Cas9 genome editing using large donor DNA delivery, knocked-in an anti-tumor single chain variable fragment (scFv) into the N-terminus of CD3ε and efficiently generated fusion protein (FP) T cells. These cells displayed FP integration within the TCR/CD3 complex, lower variability in gene expression compared to CAR-T cells and good cell expansion after transfection. CD3ε FP T cells were predominantly CD8+ effector memory T cells, and exhibited anti-tumor activity in vitro and in vivo. Dual targeting FP T cells were also generated through the incorporation of scFvs into other CD3 subunits and CD28. Compared to viral-based methods, this method serves as an alternative and versatile way of generating T cells with tumor-targeting receptors for cancer immunotherapy.
Collapse
Affiliation(s)
- Runzhe Shu
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | - Maree Hammett
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | - Vera Evtimov
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | - Aleta Pupovac
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | - Nhu‐Y Nguyen
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | - Rasa Islam
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | - Junli Zhuang
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | | | | | | | - Ian Nisbet
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | - Peter Hudson
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | | | - Richard Boyd
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
| | - Alan Trounson
- Cartherics Pty Ltd.Notting HillAustralia
- Australian Regenerative Medicine InstituteMonash UniversityClaytonAustralia
- Department of Obstetrics and GynaecologyMonash UniversityClaytonAustralia
| |
Collapse
|
7
|
Coventry A, Gerdtz M, McInnes E, Dickson J, Hudson P. Supporting families of patients who die in adult intensive care: A scoping review of interventions. Intensive Crit Care Nurs 2023; 78:103454. [PMID: 37253283 DOI: 10.1016/j.iccn.2023.103454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Families who perceive themselves as prepared for an impending death experience reduced psychological burden during bereavement. Understanding which interventions promote death preparedness in families during end-of-life care in intensive care will inform future intervention development and may help limit the burden of psychological symptoms associated with bereavement. AIM To identify and characterise interventions that help prepare families for the possibility of death in intensive care, incorporating barriers to intervention implementation, outcome variables and instruments used. DESIGN Scoping review using Joanna Briggs methodology, prospectively registered and reported using relevant guidelines. DATA SOURCES A systematic search of six databases from 2007 to 2023 for randomised controlled trials evaluating interventions that prepared families of intensive care patients for the possibility of death. Citations were screened against the inclusion criteria and extracted by two reviewers independently. RESULTS Seven trials met eligibility criteria. Interventions were classified: decision support, psychoeducation, information provision. Psychoeducation involving physician-led family conference, emotional support and written information reduced symptoms of anxiety, depression, prolonged grief, and post-traumatic stress in families during bereavement. Anxiety, depression, and post-traumatic stress were assessed most frequently. Barriers and facilitators to intervention implementation were seldom reported. CONCLUSION This review provides a conceptual framework of interventions to prepare families for death in intensive care, while highlighting a gap in rigorously conducted empirical research in this area. Future research should focus on theoretically informed, family-clinician communication, and explore the benefits of integrating existing multidisciplinary palliative care guidelines to deliver family conference within intensive care. IMPLICATIONS FOR CLINICAL PRACTICE Intensive care clinicians should consider innovative communication strategies to build family-clinician connectedness in remote pandemic conditions. To prepare families for an impending death, mnemonic guided physician-led family conference and printed information could be implemented to prepare families for death, dying and bereavement. Mnemonic guided emotional support during dying and family conference after death may also assist families seeking closure.
Collapse
Affiliation(s)
- Alysia Coventry
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria 3010, Australia; The Centre for Palliative Care, St Vincent's Hospital Melbourne, 172 Victoria Parade, East Melbourne, Victoria 3002, Australia; Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia. https://twitter.com/@AlysiaCoventry
| | - Marie Gerdtz
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria 3010, Australia. https://twitter.com/@MarieGerdtz
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
| | - Jessica Dickson
- Library and Academic Research Services, Australian Catholic University, Melbourne, Australia. https://twitter.com/@jess_dickson15
| | - Peter Hudson
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria 3010, Australia; The Centre for Palliative Care, St Vincent's Hospital Melbourne, 172 Victoria Parade, East Melbourne, Victoria 3002, Australia; Vrije University, Brussels, Belgium
| |
Collapse
|
8
|
Ly L, Pascoe A, Philip J, Hudson P, Smallwood N. Social determinants of advanced chronic respiratory interventions: a scoping review. Eur Respir Rev 2023; 32:230068. [PMID: 37611947 PMCID: PMC10445107 DOI: 10.1183/16000617.0068-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/28/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Income, education, occupation, social class, sex and race/ethnicity are essential social determinants of health (SDH). Reporting of SDH when testing complex interventions for people with advanced chronic respiratory diseases or how they impact accessibility, engagement and effectiveness within sub-populations is unclear. AIMS AND METHODS This scoping review examined reporting of SDH in pulmonary rehabilitation (PR), singing for lung health (SLH) and multicomponent palliative care interventions (MPCI). Reporting of SDH was assessed from studies from PubMed and three systematic reviews. RESULTS Eight SLH, 35 MPCI and 351 PR studies were included. Sex was most reported (PR: n=331, 94.3%; SLH: n=6, 75.0%; MPCI: n=31, 88.6%), while social class was only mentioned in one PR study (n=1, 0.3%). 18 PR studies (5.1%), two SLH studies (25.0%) and three MPCI studies (8.6%) reported no SDH. Included studies were predominantly from high-income countries (304 PR studies from 26 countries, six SLH studies from two countries and all the MPCI studies from 12 countries), published from 2000 to 2022 with reporting in PR progressively increasing. CONCLUSION Reporting of SDH is limited. Consequently, impacts of these social barriers on engagement in clinical trials or whether the complex interventions are effective universally or within certain sub-populations is unclear.
Collapse
Affiliation(s)
- Lena Ly
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Amy Pascoe
- Central Clinical School, Monash University, Melbourne, Australia
| | - Jennifer Philip
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Australia
| | - Peter Hudson
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Australia
- Vrije University Brussels, Brussels, Belgium
| | - Natasha Smallwood
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
- The Alfred Hospital, Prahran, Melbourne, Australia
| |
Collapse
|
9
|
Van Goethem V, Dierickx S, Matthys O, Northouse L, Lund L, Jordan C, Turola E, van der Wel M, Scott D, Harding R, Deliens L, Lapeire L, Hudson P, De Vleminck A, Cohen J. A self-management psychoeducational eHealth program to support and empower people with advanced cancer and their family caregivers: Development using the scrum methodology. Internet Interv 2023; 33:100659. [PMID: 37593143 PMCID: PMC10428037 DOI: 10.1016/j.invent.2023.100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
Background eHealth programs could be a flexible and scalable resource to support and empower people with advanced cancer and their family caregivers. A face-to-face intervention that has demonstrated effectiveness is the "FOCUS" program, developed and tested in the USA. Recently the FOCUS program was translated and adapted to the European context as part of an international study in six European countries, resulting in the "FOCUS+" program. FOCUS+ served as the basis for development of the web-based iFOCUS program. Objective We aim to (1) describe the development process of the iFOCUS program, (2) outline the challenges we encountered and how they were overcome, and (3) present findings regarding the acceptability and usability of iFOCUS. Methods We used the four phased agile Scrum methodology to develop iFOCUS and applied set timeframes of rapid program development and evaluation (sprints). Five teams were involved in the development i.e. a core development group, a web development team, an international consortium, audio-visual experts, and potential end-users. Results Development followed seven steps, integrated across the four phases of Scrum: (1) concept design, (2) development of mock-ups, (3) Feedback from the international consortium, (4) technical development of iFOCUS, (5) creating versions for the six participating countries, (6) preliminary testing of iFOCUS and (7) implementing the final version in a randomized controlled trial. User testing included 42 participants (twenty patient-family caregiver dyads and two bereaved family caregivers) who reviewed the iFOCUS program. Users found the iFOCUS program to be acceptable and usable. Feedback mainly focused on text size and fonts. Minor changes to the content, tailoring, and program flow were required. During development we encountered program specific and general challenges. Using the Scrum methodology facilitated iterative development to address these issues. For some challenges, such as tailoring, we had to make pragmatic choices due to time and resource limitations. Conclusions/discussion The development of a tailored, self-managed psychoeducational eHealth program for people with advanced cancer and their family caregivers is an intense process and requires pragmatic choices. By keeping the emphasis on the target population during development, no specific remarks pertaining to advanced cancer were identified. Some challenges we encountered are common to eHealth development, others were related to program specific requirements. Using the Scrum methodology allows teams to efficiently collaborate during program development and increases the flexibility of the development process. Interpersonal contact between research staff and potential end-users is recommended during and after the development of eHealth programs.
Collapse
Affiliation(s)
- Vincent Van Goethem
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University, Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Sigrid Dierickx
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University, Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Orphé Matthys
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University, Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | | | - Line Lund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Catherine Jordan
- University College Dublin, National University of Ireland, Dublin, Ireland
| | - Elena Turola
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - David Scott
- The School of Nursing and Midwifery, Queen's University of Belfast, Belfast, United Kingdom
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Luc Deliens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University, Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Lore Lapeire
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University Hospital, Department of Medical Oncology, C. Heymanslaan 10, 9000 Ghent, Belgium
| | | | - Peter Hudson
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- St Vincent's Hospital and the Univeristy of Melbourne, Centre of Palliative Care, Melbourne, Australia
| | - Aline De Vleminck
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Joachim Cohen
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| |
Collapse
|
10
|
Tieman J, Hudson P, Thomas K, Saward D, Parker D. Who cares for the carers? carerhelp: development and evaluation of an online resource to support the wellbeing of those caring for family members at the end of their life. BMC Palliat Care 2023; 22:98. [PMID: 37474919 PMCID: PMC10357776 DOI: 10.1186/s12904-023-01225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Most people living with a terminal illness and approaching death will need the assistance of a non-professional carer such as a family member, friend, or neighbour to provide physical, emotional, and practical caring supports. A significant portion of these carers can feel overwhelmed, isolated and experience psychological and/or financial distress. Carers can have unmet information needs and information needs can change across the caring period. METHODS Guided by an Australian National Reference Group, this project undertook a multiphase set of activities to enable the development of an online carer resource. These activities included a literature review of key issues and considerations for family carers supporting someone with a terminal illness, a scoping scan of existing online resources, and interviews and focus groups with eighteen carers to understand their needs and context of caring. This information formed the basis for potential digital content. A web project team was established to create the information architecture and content pathways. User testing survey and usability assessment of the CarerHelp Website was undertaken to assess/optimise functionality prior to release. An evaluation process was also devised. RESULTS The literature review identified carer needs for practical and psychological support along with better education and strategies to improve communication. The scoping scan of available online resources suggested that while information available to carers is plentiful, much of that which is provided is general, disparately located, inadequately detailed, and disease specific. The eighteen carers who were interviewed highlighted the need for helpful information on: services, symptom management, relationships, preparation for death, managing the emotional and psychological burden that often accompanies caring, and support during bereavement. User testing and usability assessment of the prototype resource led to changes to enhance the user experience and effectiveness of navigation. It also highlighted a lack of awareness of existing resources and the needs of marketing and communication to address this problem. CONCLUSIONS The project led to the development of an open access online resource, CarerHelp ( www.carerhelp.com.au ), for use by carers and families caring for a person who has palliative care needs. The web metrics demonstrate substantial use of the resources.
Collapse
Affiliation(s)
- Jennifer Tieman
- Research Centre for Palliative Care, Death and Dying. CareSearch Director, Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Peter Hudson
- Centre for Palliative Care, University of Melbourne & St Vincent's Hospital, Professor Vrije University, Melbourne, Brussels, Australia
| | - Kristina Thomas
- Centre for Palliative Care, University of Melbourne & St Vincent's Hospital, Melbourne, Australia
| | - Di Saward
- Research Nurse/Project Officer Centre for Palliative Care, St Vincent's Hospital, Melbourne, Australia
| | - Deborah Parker
- School of Nursing and Midwifery, IMPACCT University of Technology Sydney (UTS), Sydney, NSW, Australia
| |
Collapse
|
11
|
Häger Tibell L, Årestedt K, Holm M, Wallin V, Steineck G, Hudson P, Kreicbergs U, Alvariza A. Preparedness for caregiving and preparedness for death: Associations and modifiable thereafter factors among family caregivers of patients with advanced cancer in specialized home care. Death Stud 2023; 48:407-416. [PMID: 37441803 DOI: 10.1080/07481187.2023.2231388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
The purpose of this study was to (1) explore associations between preparedness for caregiving and preparedness for death among family caregivers of patients with advanced cancer and (2) explore modifiable preparedness factors, such as communication and support. Data was derived from a baseline questionnaire collected in specialized home care. The questionnaire included socio-demographics, the Preparedness for Caregiving Scale, and single items addressing preparedness for death, received support and communication about incurable illness. Data was analyzed using descriptive statistics and Spearman correlations. Altogether 39 family caregivers participated. A significant association was found between preparedness for caregiving and preparedness for death. Received support and communication about the illness was associated with higher levels of preparedness for caregiving and death. This study contributes to evidence on the association between preparedness for caregiving and death, but also that communication and support employed by healthcare professionals could improve family caregiver preparedness and wellbeing.
Collapse
Affiliation(s)
- Louise Häger Tibell
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Tema Cancer, BES: Breast-Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Maja Holm
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Viktoria Wallin
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Gunnar Steineck
- Department of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Cancer Epidemiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Hudson
- Centre for Palliative Care, St Vincent´s Hospital and The University of Melbourne, Melbourne, Australia
- Vrije University Brussels, Brussels, Belgium
| | - Ulrika Kreicbergs
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anette Alvariza
- Research and Development-Unit/Palliative Care, Stockholms Sjukhem, Stockholm, Sweden
| |
Collapse
|
12
|
Hudson P, Gould H, Marco D, Mclean M, Benson W, Coperchini M, Le B, McLachlan SA, Philip J, Boughey M, McKinnon F. Assessing the quality of care for people dying of cancer in hospital: development of the QualDeath framework. AUST HEALTH REV 2023:AH23001. [PMID: 37429819 DOI: 10.1071/ah23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/07/2023] [Indexed: 07/12/2023]
Abstract
ObjectiveHigh-quality end-of-life care involves addressing patients' physical, psychosocial, cultural and spiritual needs. Although the measurement of the quality of care associated with dying and death is an important component of health care, there is a lack of evidence-based, systematic processes to examine the quality of dying and death of patients in hospital settings. Our purpose was to develop a systematic appraisal framework (QualDeath) for reviewing the quality of dying and death for patients with advanced cancer. The objectives were to: (1) explore the evidence regarding existing tools and processes related to appraisal of end-of-life care; (2) examine existing practices related to appraisal of quality of dying and death in hospital settings; and (3) develop QualDeath with consideration of potential acceptability and feasibility factors.MethodsA co-design multiple methods approach was used. For objective 1, a rapid literature review was undertaken; for objective 2 we carried out semi-structured interviews and focus groups with key stakeholders in four major teaching hospitals; and for objective 3 we interviewed key stakeholders and held workshops with the project team to reach consensus.ResultsWe developed QualDeath, a framework to assist hospital administrators and clinicians to systematically and retrospectively review the quality of dying and death for patients expected to die from advanced cancer. It offers four levels of potential implementation for hospitals to select from and incorporates medical record review, multidisciplinary meetings, quality of end-of-life care surveys and bereavement interviews with family carers.ConclusionsThe QualDeath framework provides hospitals with recommendations to formalise processes to evaluate end-of-life care. Although QualDeath was underpinned by several research methods, further research is needed to rigorously explore its impact and test its feasibility.
Collapse
|
13
|
Kluger BM, Hudson P, Hanson LC, Bužgovà R, Creutzfeldt CJ, Gursahani R, Sumrall M, White C, Oliver DJ, Pantilat SZ, Miyasaki J. Palliative care to support the needs of adults with neurological disease. Lancet Neurol 2023; 22:619-631. [PMID: 37353280 DOI: 10.1016/s1474-4422(23)00129-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/08/2023] [Accepted: 03/27/2023] [Indexed: 06/25/2023]
Abstract
Neurological diseases cause physical, psychosocial, and spiritual or existential suffering from the time of their diagnosis. Palliative care focuses on improving quality of life for people with serious illness and their families by addressing this multidimensional suffering. Evidence from clinical trials supports the ability of palliative care to improve patient and caregiver outcomes by the use of outpatient or home-based palliative care interventions for people with motor neuron disease, multiple sclerosis, or Parkinson's disease; inpatient palliative care consultations for people with advanced dementia; telephone-based case management for people with dementia in the community; and nurse-led discussions with decision aids for people with advanced dementia in long-term care. Unfortunately, most people with neurological diseases do not get the support that they need for their palliative care under current standards of healthcare. Improving this situation requires the deployment of routine screening to identify individual palliative care needs, the integration of palliative care approaches into routine neurological care, and collaboration between neurologists and palliative care specialists. Research, education, and advocacy are also needed to raise standards of care.
Collapse
Affiliation(s)
- Benzi M Kluger
- University of Rochester Medical Center, Rochester, NY, USA.
| | - Peter Hudson
- The University of Melbourne, Fitzroy, VIC, Australia; St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia; Vrije Universiteit Brussel, Brussel, Belgium
| | - Laura C Hanson
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Radka Bužgovà
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | - Roop Gursahani
- Hinduja Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Malenna Sumrall
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Charles White
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Steven Z Pantilat
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | |
Collapse
|
14
|
Matthys O, Dierickx S, Deliens L, Lapeire L, Hudson P, Van Audenhove C, De Vleminck A, Cohen J. Is pre-bereavement collaboration between family caregivers and healthcare professionals associated with post-bereavement emotional well-being? A population-based survey. Patient Educ Couns 2023; 110:107654. [PMID: 36805930 DOI: 10.1016/j.pec.2023.107654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate pre-bereavement collaboration with healthcare professionals and its association with emotional well-being of family caregivers of people with serious illness post-bereavement. METHODS Population-based cross-sectional survey of bereaved family caregivers of people with serious illness (N = 3000) who died two to six months before the sample was drawn (November 2019), identified through three sickness funds in Belgium. RESULTS Response rate was 55%. As measured by the Positive and Negative Affect Schedule (PANAS), family caregivers scored lower on positive affect (PA) and higher on negative affect (NA) compared to a normative sample. Most family caregivers evaluated the pre-bereavement collaboration with healthcare professionals positively. Family caregivers' evaluation of collaboration with healthcare professionals pre-bereavement was positively associated with PA and negatively with NA, also when controlling for confounding effects of socio-demographic and clinical characteristics of the bereaved family caregiver and the deceased person. CONCLUSION There is a positive association between perceived quality of collaboration at the end of life between healthcare professionals and family caregivers and post-bereavement emotional well-being of family caregivers. PRACTICE IMPLICATIONS Our findings suggest the pertinence of attention from healthcare professionals to effective collaboration with family caregivers.
Collapse
Affiliation(s)
- Orphé Matthys
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Sigrid Dierickx
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lore Lapeire
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Peter Hudson
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Centre for Palliative Care, The University of Melbourne, Melbourne, Australia
| | | | - Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
15
|
Hudson P. The potential for property-level flood adaptation as a flood disaster mental health intervention. Public Health 2023; 218:173-175. [PMID: 37060736 DOI: 10.1016/j.puhe.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVES This study aimed to discuss the overlap between property-level flood adaptation and public health and flood risk management and identify areas of future research. DESIGN AND METHODS A short essay-based contribution arguing in favour of a future research direction from the perspective of a disaster risk researcher. RESULTS Promoting property-level flood adaption has multiple areas of benefit to both flooding and mental health risk management as a potential invention. This is because both fields display common interests in enabling and promoting personal responsibility to limit disaster consequences and build resilience. CONCLUSIONS The promotion and development of property-level flood adaptation strategies can be a productive locus of behaviour for further active collaboration and research, as well as a joint intervention for improving human welfare postdisaster. However, more proactive research is required.
Collapse
Affiliation(s)
- P Hudson
- Department of Environment and Geography, University of York, York, UK.
| |
Collapse
|
16
|
Caldwell L, Kim-Fine S, Antosh D, Husk K, Meriwether K, Long J, Heisler C, Hudson P, Lozo S, Iyer S, Weber-LeBrun E, Rogers R. Development of a standardized counseling tool for postoperative return to sexual activity after pelvic reconstructive surgery. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.12.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
|
17
|
Halkett GKB, Lobb EA, Phillips JL, McDougall E, Clarke J, Campbell R, Dhillon HM, McGeechan K, Hudson P, King A, Wheeler H, Kastelan M, Long A, Nowak AK. Carer preparedness improved by providing a supportive educational intervention for carers of patients with high-grade glioma: RCT results. J Neurooncol 2023; 161:501-513. [PMID: 36658381 PMCID: PMC9992082 DOI: 10.1007/s11060-023-04239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/24/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND High-grade glioma (HGG) is a rapidly progressing and debilitating disease. Family carers take on multiple responsibilities and experience high levels of distress. We aimed to deliver a nurse-led intervention (Care-IS) to carers to improve their preparedness to care and reduce distress. METHODS We conducted a randomised controlled trial (ACTRN:12612001147875). Carers of HGG patients were recruited during patients' combined chemoradiation treatment. The complex intervention comprised four components: (1) initial telephone assessment of carer unmet needs; (2) tailored hard-copy resource folder; (3) home visit; and, (4) monthly telephone support for up to 12 months. Primary outcomes included preparedness for caregiving and distress at 2, 4, 6 and 12 months. Intervention effects were estimated using linear mixed models which included a time by group interaction. Secondary outcomes included anxiety, depression, quality of life, carer competence and strain. RESULTS We randomised 188 carers (n = 98 intervention, n = 90 control). The intervention group reported significantly higher preparedness for caregiving at 4 months (model β = 2.85, 95% CI 0.76-4.93) and all follow-up timepoints including 12 months (model β = 4.35, 95% CI 2.08-6.62), compared to the control group. However, there was no difference between groups in carer distress or any secondary outcomes. CONCLUSIONS This intervention was effective in improving carer preparedness. However, carer distress was not reduced, potentially due to the debilitating/progressive nature of HGG and ongoing caring responsibilities. Future research must explore whether carer interventions can improve carer adjustment, self-efficacy and coping and how we support carers after bereavement. Additionally, research is needed to determine how to implement carer support into practice.
Collapse
Affiliation(s)
- Georgia K B Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia.
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah, Sydney, NSW, Australia.,School of Medicine, The University of Notre Dame, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Emma McDougall
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Jenny Clarke
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Peter Hudson
- Centre for Palliative Care St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Nursing, University of Melbourne, Melbourne, VIC, Australia.,Vrije University Brussels, Brussels, Belgium
| | - Anne King
- Cancer Network Western Australia, North Metropolitan Health Service, Perth, WA, Australia
| | - Helen Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Marina Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, NSW, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia
| | | |
Collapse
|
18
|
Bryk A, Roberts G, Hudson P, Harms L, Gerdtz M. The concept of holism applied in recent palliative care practice: A scoping review. Palliat Med 2023; 37:26-39. [PMID: 36333861 DOI: 10.1177/02692163221129999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Whilst there is a sense of holism existing within palliative care practice, what is not clear is the extent to which holism, as applied in recent palliative care practice, has been adequately researched. Currently, no reviews on this topic were identified through systematic and scoping review registries. AIM To identify and describe the available published evidence on the key features of holism and the core domains underpinning the application of holism in relation to recent palliative care practice. DESIGN Scoping review using the Johanna Briggs Institute design. DATA SOURCES MEDLINE, EMCARE, and CINAHL (Ovid), PsycINFO, SocINDEX, SCOPUS and Web of Science. (International, peer-reviewed, published papers in the English language from January 2010to December 2020). RESULTS Five studies met inclusion criteria. Two studies used qualitative methods, one used mixed-methods, and two were randomised controlled trials. The research investigated (1) frameworks for holistic care and (2) assessment tools applied in palliative care settings. CONCLUSIONS The results from the review led to identifying key features of palliative care that were presented as interconnected aspects of holistic care domains in both assessments and interventions. The literature revealed a focus on curative and biomedical approaches to disease management with holistic aspects acknowledged, but not in the forefront of core service delivery. Holism was generally conceptualised as an overarching theoretical framework to palliative care service provision and positioned as an adjunct to palliative models of care. These findings point to a gap in research that links the concept of holism to applied palliative care practices.
Collapse
Affiliation(s)
- Andrea Bryk
- Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Greg Roberts
- Jesuit Social Services, Support After Suicide, Melbourne, VIC, Australia
| | - Peter Hudson
- Centre for Palliative Care, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Louise Harms
- Department of Social Work, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Marie Gerdtz
- Department of Nursing & Centre for Cancer Research, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
19
|
Matthys O, Dierickx S, Deliens L, Lapeire L, Hudson P, Van Audenhove C, De Vleminck A, Cohen J. How are family caregivers of people with a serious illness supported by healthcare professionals in their caregiving tasks? A cross-sectional survey of bereaved family caregivers. Palliat Med 2022; 36:529-539. [PMID: 35090372 DOI: 10.1177/02692163211070228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Due to medical advances and an increasingly ageing population, the number of people living with a serious illness is rising. This has major implications for the burden on family members of assisting with care. Support of family caregivers by healthcare professionals is needed to ensure they can provide quality care for people with serious illness. AIM To investigate how family caregivers of people with serious illness are supported by healthcare professionals in their caregiving tasks. DESIGN/PARTICIPANTS Population-based cross-sectional survey of bereaved family caregivers of people with serious illness (N = 3000) who cared for a person who had died 2-6 months before the sample was drawn (November 2019), as identified through three sickness funds in Flanders, Belgium. The survey explored support from healthcare professionals for family caregivers 3 months prior to bereavement. RESULTS Response rate was 55.0%. Most family caregivers received support from one or more healthcare professionals for family caregiving tasks, ranging from 71% for promoting social interaction to 95% for managing symptoms. The type of support mostly involved providing information. Use of palliative care services was the strongest predictor of such support across physical, psychosocial and practical tasks. CONCLUSION Most family caregivers of those with serious illness get some form of support from healthcare professionals for their tasks. However, an empowering support strategy for example one aimed at increasing self-efficacy of the family caregiver is rare and end-of-life communication between healthcare professionals and family caregivers needs improvement.
Collapse
Affiliation(s)
- Orphé Matthys
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Lore Lapeire
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Peter Hudson
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Centre for Palliative Care, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| |
Collapse
|
20
|
Ayati E, Hudson P, James K, Bargen EV. Intravaginal cleansing practices among women attending a female pelvic medicine and reconstructive surgery clinic. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
21
|
Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
| | - Peter Hudson
- Centre for Palliative Care, St Vincent’s Hospital and The University of Melbourne, Melbourne, Australia
- End of Life Research Department, Vrije University Brussels (VUB), Ixelles, Belgium
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
22
|
Klaic M, Kapp S, Hudson P, Chapman W, Denehy L, Story D, Francis JJ. Implementability of healthcare interventions: an overview of reviews and development of a conceptual framework. Implement Sci 2022; 17:10. [PMID: 35086538 PMCID: PMC8793098 DOI: 10.1186/s13012-021-01171-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/02/2021] [Indexed: 11/11/2022] Open
Abstract
Background Implementation research may play an important role in reducing research waste by identifying strategies that support translation of evidence into practice. Implementation of healthcare interventions is influenced by multiple factors including the organisational context, implementation strategies and features of the intervention as perceived by people delivering and receiving the intervention. Recently, concepts relating to perceived features of interventions have been gaining traction in published literature, namely, acceptability, fidelity, feasibility, scalability and sustainability. These concepts may influence uptake of healthcare interventions, yet there seems to be little consensus about their nature and impact. The aim of this paper is to develop a testable conceptual framework of implementability of healthcare interventions that includes these five concepts. Methods A multifaceted approach was used to develop and refine a conceptual framework of implementability of healthcare interventions. An overview of reviews identified reviews published between January 2000 and March 2021 that focused on at least one of the five concepts in relation to a healthcare intervention. These findings informed the development of a preliminary framework of implementability of healthcare interventions which was presented to a panel of experts. A nominal group process was used to critique, refine and agree on a final framework. Results A total of 252 publications were included in the overview of reviews. Of these, 32% were found to be feasible, 4% reported sustainable changes in practice and 9% were scaled up to other populations and/or settings. The expert panel proposed that scalability and sustainability of a healthcare intervention are dependent on its acceptability, fidelity and feasibility. Furthermore, acceptability, fidelity and feasibility require re-evaluation over time and as the intervention is developed and then implemented in different settings or with different populations. The final agreed framework of implementability provides the basis for a chronological, iterative approach to planning for wide-scale, long-term implementation of healthcare interventions. Conclusions We recommend that researchers consider the factors acceptability, fidelity and feasibility (proposed to influence sustainability and scalability) during the preliminary phases of intervention development, evaluation and implementation, and iteratively check these factors in different settings and over time. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01171-7.
Collapse
|
23
|
Marco DJT, Thomas K, Ivynian S, Wilding H, Parker D, Tieman J, Hudson P. Family carer needs in advanced disease: systematic review of reviews. BMJ Support Palliat Care 2022; 12:132-141. [PMID: 34996834 DOI: 10.1136/bmjspcare-2021-003299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Family carers are vital in the management and delivery of home-based palliative care. Decision-makers need to know what the most commonly expressed unmet needs of family carers are to target available support services. AIM To identify the most commonly expressed needs of family carers of people with an advanced disease, assess the quality of current evidence, and set an agenda for future research and clinical practice. DESIGN A systematic review of reviews, prospectively registered on PROSPERO. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist for systematic reviews and research syntheses. DATA SOURCES MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Informit and Cochrane Library were searched for reviews about the needs of carers looking after patients with advanced disease from 2010 to 2020. RESULTS Findings from 21 reviews identified emotional support, disease-specific knowledge, carer role responsibilities, self-care and general practical support as the most commonly expressed needs expressed by family carers. Additionally, access to professional services, formal education opportunities and communication with health professionals were identified as caregivers' preferred ways of having these needs met. Extraction of carer-specific needs was challenging at times as results were often combined with patient results in reviews. CONCLUSION Practical difficulties exist in effectively resourcing services to meet the needs of family carers. Information regarding the most commonly expressed needs shared by caregivers and their preferred delivery source can provide an opportunity to focus available support services to achieve the highest possible impact for carers of patients with advanced disease. PROSPERO REGISTRATION NUMBER CRD42018088678.
Collapse
Affiliation(s)
- David John-Tom Marco
- Centre for Palliative Care, St Vincent's Hospital Melbourne Pty Ltd, Melbourne, Victoria, Australia .,Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kristina Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne Pty Ltd, Melbourne, Victoria, Australia
| | - Serra Ivynian
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Helen Wilding
- Library Service, St Vincent's Hospital Melbourne Pty Ltd, Melbourne, Victoria, Australia
| | - Deborah Parker
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jennifer Tieman
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne Pty Ltd, Melbourne, Victoria, Australia.,Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Matthys O, De Vleminck A, Dierickx S, Deliens L, Van Goethem V, Lapeire L, Groenvold M, Lund L, Arnfeldt CM, Sengeloev L, Pappot H, Johnsen AT, Guerin S, Larkin PJ, Jordan C, Connolly M, D'Alton P, Costantini M, Di Leo S, Guberti M, Turola E, van der Heide A, Witkamp E, Rietjens J, van der Wel M, Brazil K, Prue G, Reid J, Scott D, Bristowe K, Harding R, Normand C, May P, Cronin C, Northouse L, Hudson P, Cohen J. Effectiveness of a nurse-delivered (FOCUS+) and a web-based (iFOCUS) psychoeducational intervention for people with advanced cancer and their family caregivers (DIAdIC): study protocol for an international randomized controlled trial. BMC Palliat Care 2021; 20:193. [PMID: 34963453 PMCID: PMC8713043 DOI: 10.1186/s12904-021-00895-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Worldwide, millions of people with advanced cancer and their family caregivers are experiencing physical and psychological distress. Psychosocial support and education can reduce distress and prevent avoidable healthcare resource use. To date, we lack knowledge from large-scale studies on which interventions generate positive outcomes for people with cancer and their informal caregivers’ quality of life. This protocol describes the DIAdIC study that will evaluate the effectiveness of two psychosocial and educational interventions aimed at improving patient-family caregiver dyads’ emotional functioning and self-efficacy. Methods We will conduct an international multicenter three-arm randomized controlled trial in Belgium, Denmark, Ireland, Italy, The Netherlands, and the United Kingdom. In each country, 156 dyads (936 in total) of people with advanced cancer and their family caregiver will be randomized to one of the study arms: 1) a nurse-led face-to-face intervention (FOCUS+), 2) a web-based intervention (iFOCUS) or 3) a control group (care as usual). The two interventions offer tailored psychoeducational support for patient-family caregiver dyads. The nurse-led face-to-face intervention consists of two home visits and one online video session and the web-based intervention is completed independently by the patient-family caregiver dyad in four online sessions. The interventions are based on the FOCUS intervention, developed in the USA, that addresses five core components: family involvement, optimistic outlook, coping effectiveness, uncertainty reduction, and symptom management. The FOCUS intervention will be adapted to the European context. The primary outcomes are emotional functioning and self-efficacy of the patient and the family caregiver, respectively. The secondary outcomes are quality of life, benefits of illness, coping, dyadic communication, and ways of giving support of the patient and family caregiver. Discussion DIAdIC aims to develop cost-effective interventions that integrate principles of early palliative care into standard care. The cross-country setup in six European countries allows for comparison of effectiveness of the interventions in different healthcare systems across Europe. By focusing on empowerment of the person with cancer and their family caregiver, the results of this RCT can contribute to the search for cost-effective novel interventions that can relieve constraints on professional healthcare. Trial registration Registration on ClinicalTrials.gov on 12/11/2020, identifier NCT04626349. Date and version identifier 20211209_DIAdIC_Protocol_Article. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00895-z.
Collapse
Affiliation(s)
- Orphé Matthys
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Sigrid Dierickx
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Vincent Van Goethem
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Lore Lapeire
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen and Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Line Lund
- Department of Public Health, University of Copenhagen and Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Caroline Moeller Arnfeldt
- Department of Public Health, University of Copenhagen and Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lisa Sengeloev
- Department of Oncology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Belfield, Ireland
| | - Philip J Larkin
- Palliative and Supportive Care Service, Chair of Palliative Care Nursing, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Catherine Jordan
- UCD School of Psychology, University College Dublin, Belfield, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Paul D'Alton
- UCD School of Psychology, University College Dublin, Belfield, Ireland
| | - Massimo Costantini
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Monica Guberti
- Nursing & Health Care Professions Directorate, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Elena Turola
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Agnes van der Heide
- Deparmtent of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Erika Witkamp
- Deparmtent of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith Rietjens
- Deparmtent of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maaike van der Wel
- Deparmtent of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Gillian Prue
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - David Scott
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Katherine Bristowe
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Richard Harding
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.,Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Dublin, Ireland
| | - Catherine Cronin
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | | | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital, Melbourne, Australia.,Vrije University Brussels (VUB), Brussels, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| |
Collapse
|
25
|
Parker D, Hudson P, Tieman J, Thomas K, Saward D, Ivynian S. Evaluation of an online toolkit for carers of people with a life-limiting illness at the end-of-life: health professionals' perspectives. Aust J Prim Health 2021; 27:473-478. [PMID: 34802508 DOI: 10.1071/py21019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022]
Abstract
Carers of people with a life-limiting illness report unmet information, practical, and emotional support needs, and are often unaware of services available to help improve preparedness, wellbeing, and reduce strain. CarerHelp is the first e-health toolkit that focuses on the information and support needs of carers of people with a life-limiting illness at the end-of-life, using a pathway approach. This study investigated the usefulness of CarerHelp, from the perspective of health professionals who care for these people. Through a 10-min online survey, health professionals provided feedback about their user experience and perceived usefulness of the website. Their expert opinion was sought to ascertain whether CarerHelp could increase carers' preparedness and confidence to support the person for whom they are caring and thereby improve carers' own psychological wellbeing. Health professionals also evaluated whether CarerHelp adequately raised awareness of support services available. CarerHelp was perceived as a useful resource for increasing preparedness for the caring role, including physical tasks and emotional support. Health professionals reported that CarerHelp would increase carers' knowledge of services, confidence to care and ability for self-care. Health professionals endorsed CarerHelp as a useful information source, guide for support, and would promote CarerHelp to clients and their families.
Collapse
Affiliation(s)
- D Parker
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - P Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia; and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia; and Vrije University, Brussels, Belgium
| | - J Tieman
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA, Australia
| | - K Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - D Saward
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - S Ivynian
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; and Corresponding author.
| |
Collapse
|
26
|
Hudson P, Collins A, Boughey M, Philip J. Reframing palliative care to improve the quality of life of people diagnosed with a serious illness. Med J Aust 2021; 215:443-446. [PMID: 34676567 PMCID: PMC9298245 DOI: 10.5694/mja2.51307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Peter Hudson
- St Vincent's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC.,Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Jennifer Philip
- St Vincent's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| |
Collapse
|
27
|
Hudson P, Woudberg N, Abrahams C, Kamau F, Vuilleumier N, Strijdom H, Frias M, Lecour S. High-density lipoprotein (HDL) subclasses and functionality in HIV patients. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
28
|
Marsh JR, Hudson P, Framenau VW. A ghost in the salt: A new species of halotolerant tube-web spider in the genus emAriadna/em (Araneae: Segestriidae). Zootaxa 2021; 4952:zootaxa.4952.3.10. [PMID: 33903362 DOI: 10.11646/zootaxa.4952.3.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Indexed: 11/04/2022]
Abstract
A new species of halotolerant Ariadna Audouin, 1826 is described from Western Australia, based on morphological features of both the male and female, and elevating the total number of described species of Ariadna in Australia to 14. This is the first record of the tube-web spider family Segestriidae Simon, 1893 inhabiting salt lakes, where they construct burrows in to the lake surface. The species is likely to be of conservation importance, due to its specialised habitat requirements and the many threats posed to the salt lake ecosystem. We provide recommendation for Ariadna phantasma sp. nov. to be considered for inclusion in the IUCN Red List.
Collapse
Affiliation(s)
- Jessica R Marsh
- Harry Butler Research Institute, Murdoch University, Murdoch, Western Australia 6150, Australia. Charles Darwin University, Darwin City, Northern Territory 0800, Australia..
| | | | | |
Collapse
|
29
|
Russell B, Philip J, Wawryk O, Vogrin S, Burchell J, Collins A, Le B, Brand C, Hudson P, Sundararajan V. Validation of the responding to urgency of need in palliative care (RUN-PC) triage tool. Palliat Med 2021; 35:759-767. [PMID: 33478366 DOI: 10.1177/0269216320986730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool is a novel, evidence-based tool by which specialist palliative care services can manage waiting lists and workflow by prioritising access to care for those patients with the most pressing needs in an equitable, efficient and transparent manner. AIM This study aimed to establish the intra- and inter-rater reliability, and convergent validity of the RUN-PC Triage Tool and generate recommended response times. DESIGN An online survey of palliative care intake officers applying the RUN-PC Triage Tool to a series of 49 real clinical vignettes was assessed against a reference standard: a postal survey of expert palliative care clinicians ranking the same vignettes in order of urgency. SETTING/PARTICIPANTS Intake officers (n = 28) with a minimum of 2 years palliative care experience and expert clinicians (n = 32) with a minimum of 10 years palliative care experience were recruited from inpatient, hospital consultation and community palliative care services across metropolitan and regional Victoria, Australia. RESULTS The RUN-PC Triage Tool has good intra- and inter-rater reliability in inpatient, hospital consultation and community palliative care settings (Intraclass Correlation Coefficients ranged from 0.61 to 0.74), and moderate to good correlation to expert opinion used as a reference standard (Kendall's Tau rank correlation coefficients ranged from 0.68 to 0.83). CONCLUSION The RUN-PC Triage Tool appears to be a reliable and valid tool for the prioritisation of patients referred to specialist inpatient, hospital consultation and community palliative care services.
Collapse
Affiliation(s)
- Bethany Russell
- Palliative Nexus Research Group, University of Melbourne and St Vincent's Hospital Melbourne, VIC, Australia.,Department of Palliative Care, St Vincent's Hospital Melbourne, VIC, Australia
| | - Jennifer Philip
- Palliative Nexus Research Group, University of Melbourne and St Vincent's Hospital Melbourne, VIC, Australia.,Department of Palliative Care, St Vincent's Hospital Melbourne, VIC, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia.,Department of Palliative Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Olivia Wawryk
- Palliative Nexus Research Group, University of Melbourne and St Vincent's Hospital Melbourne, VIC, Australia.,Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne and University of Melbourne, Melbourne, VIC, Australia
| | - Jodie Burchell
- Department of Medicine, St Vincent's Hospital Melbourne and University of Melbourne, Melbourne, VIC, Australia
| | - Anna Collins
- Palliative Nexus Research Group, University of Melbourne and St Vincent's Hospital Melbourne, VIC, Australia
| | - Brian Le
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia.,Department of Palliative Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Caroline Brand
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia.,Department of Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,End-of-life Care Research Group, Vrije University, Brussels, Belgium.,School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Vijaya Sundararajan
- Department of Public Health, La Trobe University, Melbourne, VIC, Australia.,Department of Medicine, St Vincent's Hospital Melbourne and University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
30
|
Vermorgen M, Vandenbogaerde I, Van Audenhove C, Hudson P, Deliens L, Cohen J, De Vleminck A. Are family carers part of the care team providing end-of-life care? A qualitative interview study on the collaboration between family and professional carers. Palliat Med 2021; 35:109-119. [PMID: 32928056 DOI: 10.1177/0269216320954342] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The attention of healthcare professionals is directed mainly towards the recipients of care and often insufficiently towards family carers. However, an effective collaboration between professionals and family carers is vital to provide quality palliative and end-of-life care. Such collaboration is under-studied in a palliative care context. AIM This study aimed to investigate how family carers of people who live at home with a life-limiting chronic illness experience and perceive collaboration with different healthcare professionals in the last phase of life. DESIGN Face-to-face semi-structured interviews were conducted with the primary family carers of people with a life-limiting chronic illness. Interpretative phenomenological analysis was used to analyse the data. SETTING/PARTICIPANTS A heterogeneous sample of 30 family carers of people with cancer, heart failure or dementia was recruited through a variety of care providers and services, in order to reflect the heterogeneity of caregiving in serious illness. RESULTS Five main themes emerged from interpretative phenomenological analysis that describe the quality of the collaboration between family carers and professionals: respecting family carers both as someone with care needs and as a member of the care team; the continuous availability and accessibility of healthcare professionals; the provision of information and communication including family carer issues; the coordination of care between all parties and contextual factors. The dominant experience by family carers was one of missed opportunities across these themes. CONCLUSIONS This qualitative study about the experiences and perceptions of family carers of people with a chronic life-limiting illness living at home regarding the collaboration with different healthcare providers in the last phase life, showed that family carers experience a lot of possibilities, but perceive missed opportunities as well, for healthcare professionals to effectively collaborate with them for palliative care.
Collapse
Affiliation(s)
- Maarten Vermorgen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Isabel Vandenbogaerde
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | | | - Peter Hudson
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Centre for Palliative Care, St Vincent's Hospital Melbourne and University of Melbourne, Melbourne, Australia
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| |
Collapse
|
31
|
Hudson P, Girgis A, Thomas K, Philip J, Currow DC, Mitchell G, Parker D, Liew D, Brand C, Le B, Moran J. Do family meetings for hospitalised palliative care patients improve outcomes and reduce health care costs? A cluster randomised trial. Palliat Med 2021; 35:188-199. [PMID: 33135552 DOI: 10.1177/0269216320967282] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications. AIMS To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice. DESIGN Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted. RESULTS 297 dyads recruited; control (n = 153) and intervention (n = 144). The intervention group demonstrated significantly lower psychological distress (Diff: -1.68, p < 0.01) and higher preparedness (Diff: 3.48, p = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures. CONCLUSIONS Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12615000200583.
Collapse
Affiliation(s)
- Peter Hudson
- St Vincent's Hospital Melbourne, Victoria, Australia.,The University of Melbourne, Victoria, Australia.,Vrije University Brussels, Belgium
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales (UNSW Sydney), NSW, Australia
| | | | - Jennifer Philip
- St Vincent's Hospital Melbourne, Victoria, Australia.,The University of Melbourne, Victoria, Australia.,Victorian Comprehensive Cancer Centre, Australia
| | | | | | | | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Caroline Brand
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Brian Le
- Melbourne Health, Parkville, Victoria, Australia
| | - Juli Moran
- Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
32
|
Grant M, Hudson P, Forrest A, Collins A, Israel F. Developing a model of bereavement care in an adult tertiary hospital. AUST HEALTH REV 2020; 45:110-116. [PMID: 33353586 DOI: 10.1071/ah19270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/15/2020] [Indexed: 11/23/2022]
Abstract
Objectives Hospitals are the most common place of death in Australia. Bereavement care is recognised by national standards as being central to providing high-quality care at the end of life, and has significant health implications on morbidity, mortality and health service usage. Despite this, bereavement care is not routinely or systematically provided in most Australian hospitals. This study aimed to develop a comprehensive, evidence-based model of bereavement care specific to the needs of an acute Australian adult tertiary hospital. Methods This study used a multiple-methods design, which included a scoping literature review, a survey of current institutional bereavement practices, interviews with bereaved family members and staff focus groups and the development of a model of bereavement care for the acute hospital service through advisory group and expert consensus. Results Staff and bereaved family members strongly supported a systematic approach to bereavement, perceiving the need for greater support, training, coordination and follow-up. In all, 10 core elements were developed to support a structured model of bereavement care provision and follow-up for the acute hospital organisation. Conclusions This evidence-generated model of care promotes the provision of quality and systematic bereavement care in the acute hospital setting. What is known about the topic? Acute hospitals are the most common place to die in Australia, yet there is a lack of understanding of how bereavement care is or should be provided in these environments. The bereavement period is associated with increased use of health services and worse morbidity and mortality, and thus has significant implications for public health. The provision of bereavement care in acute hospitals is often sporadic, often involving untrained staff who may not provide evidence-based care. What does this paper add? This paper describes the development of a comprehensive, evidence-based model of bereavement care specific to the needs of an Australian acute hospital. What are the implications for practitioners? Developing a consistent approach to bereavement for the acute care sector has the potential to support staff, minimise conflict at the end of life, facilitate recognition of those suffering from difficult bereavement and proactively engage services for these people. It is hoped that such a model of care can find relevance across acute hospitals in Australia, to improve the quality and consistency of bereavement care.
Collapse
Affiliation(s)
- Matthew Grant
- The Centre for Palliative Care, St Vincent's Hospital, Melbourne, Vic. 3065, Australia. ; ; and Department of Palliative Medicine, St Vincent's Hospital, Melbourne, Vic. 3065, Australia; and Palliative Nexus, Department of Medicine, The University of Melbourne, Melbourne, Vic. 3010, Australia. ; and Corresponding author.
| | - Peter Hudson
- The Centre for Palliative Care, St Vincent's Hospital, Melbourne, Vic. 3065, Australia. ; ; and Vrije Universiteit Brussel, Brussels, Belgium; and Department of Medicine, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Annie Forrest
- Mission Directorate, St Vincent's Hospital, Melbourne, Vic. 3065, Australia.
| | - Anna Collins
- Palliative Nexus, Department of Medicine, The University of Melbourne, Melbourne, Vic. 3010, Australia.
| | - Fiona Israel
- The Centre for Palliative Care, St Vincent's Hospital, Melbourne, Vic. 3065, Australia. ;
| |
Collapse
|
33
|
Hudson P, Woudberg NJ, Kamau F, Strijdom H, Frias MA, Lecour S. HIV-related cardiovascular disease: any role for high-density lipoproteins? Am J Physiol Heart Circ Physiol 2020; 319:H1221-H1226. [PMID: 33006917 DOI: 10.1152/ajpheart.00445.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The introduction of antiretroviral therapy (ART) has improved the life expectancy of patients infected with human immunodeficiency virus (HIV). However, this population is at an increased risk for noncommunicable diseases, including atherosclerotic cardiovascular disease (CVD). Both ART and viral infection may be potential contributors to the pathophysiology of HIV-related CVD. The mechanisms behind this remain unclear, but it is critical to delineate early biomarkers of cardiovascular risk in the HIV population. In this review, we postulate that potential biomarkers could include alterations to high-density lipoprotein (HDL). Indeed, recent data suggest that HIV and ART may induce structural changes of HDL, thus resulting in shifts in HDL subclass distribution and HDL functionality.
Collapse
Affiliation(s)
- Peter Hudson
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Nicholas J Woudberg
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Festus Kamau
- Faculty of Medicine and Health Sciences, Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Stellenbosch University, Stellenbosch, South Africa
| | - Hans Strijdom
- Faculty of Medicine and Health Sciences, Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Stellenbosch University, Stellenbosch, South Africa
| | - Miguel A Frias
- Department of Diagnostics, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sandrine Lecour
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
34
|
Wang A, Thomas K, Weil J, Hudson P. Characteristics of family meetings for patients with advanced disease in an Australian metropolitan tertiary hospital. BMJ Support Palliat Care 2020:bmjspcare-2020-002250. [PMID: 32718937 DOI: 10.1136/bmjspcare-2020-002250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Family meetings (FMs) between clinicians, patients and family are recommended as a valuable communication and care planning method in the delivery of palliative care. However, there is a dearth of knowledge regarding FM characteristics, with few studies describing the prevalence, circumstances and content of FMs. The aims of this study were to: (1) measure the prevalence of FMs, (2) examine circumstance and timing of FMs, and (3) explore the content of FMs. METHODS A retrospective medical record audit was conducted of 200 patients who died in an Australian hospital of an expected death from advanced disease. Details of FMs were collected using an audit tool, along with patient demographics and admission data. RESULTS 33 patients (16.5%) had at least one FM during their inpatient stay. The majority of FMs occurred for patients admitted to an inpatient palliative care unit (59.5%) and were most commonly facilitated by doctors (81.0%). Patient attendance was frequent (40.5%). FM content fell into six categories: medical information, supportive communication behaviours of clinicians, psychosocial support for patients and families, end-of-life discussions, discharge planning and administrative arrangements. CONCLUSIONS Despite the benefits FMs confer, FMs appear to be infrequently used at the end of life. When FMs are used, there is a strong medical focus on both facilitation and content. Available FM documentation tools also appear to be underused. Clinicians are encouraged to have a greater understanding of FMs to optimise their use and adopt a proactive and structured approach to the conduct and documentation of FMs.
Collapse
Affiliation(s)
- Amy Wang
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Kristina Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jennifer Weil
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Vrije University Brussels, Brussels, Belgium
| |
Collapse
|
35
|
Sorvillo TE, Rodriguez SE, Hudson P, Carey M, Rodriguez LL, Spiropoulou CF, Bird BH, Spengler JR, Bente DA. Towards a Sustainable One Health Approach to Crimean-Congo Hemorrhagic Fever Prevention: Focus Areas and Gaps in Knowledge. Trop Med Infect Dis 2020; 5:tropicalmed5030113. [PMID: 32645889 PMCID: PMC7558268 DOI: 10.3390/tropicalmed5030113] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022] Open
Abstract
Crimean–Congo hemorrhagic fever virus (CCHFV) infection is identified in the 2018 World Health Organization Research and Development Blueprint and the National Institute of Allergy and Infectious Diseases (NIH/NIAID) priority A list due to its high risk to public health and national security. Tick-borne CCHFV is widespread, found in Europe, Asia, Africa, the Middle East, and the Indian subcontinent. It circulates between ticks and several vertebrate hosts without causing overt disease, and thus can be present in areas without being noticed by the public. As a result, the potential for zoonotic spillover from ticks and animals to humans is high. In contrast to other emerging viruses, human-to-human transmission of CCHFV is typically limited; therefore, prevention of spillover events should be prioritized when considering countermeasures. Several factors in the transmission dynamics of CCHFV, including a complex transmission cycle that involves both ticks and vertebrate hosts, lend themselves to a One Health approach for the prevention and control of the disease that are often overlooked by current strategies. Here, we examine critical focus areas to help mitigate CCHFV spillover, including surveillance, risk assessment, and risk reduction strategies concentrated on humans, animals, and ticks; highlight gaps in knowledge; and discuss considerations for a more sustainable One Health approach to disease control.
Collapse
Affiliation(s)
- Teresa E. Sorvillo
- One Health Institute, School of Veterinary Medicine, University of California Davis, 1089 Veterinary Medicine Drive, Davis, CA 95616, USA;
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
- Correspondence: ; Tel.: +1-530-752-7526
| | - Sergio E. Rodriguez
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA; (M.C.); (D.A.B.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Peter Hudson
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA;
| | - Megan Carey
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA; (M.C.); (D.A.B.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Luis L. Rodriguez
- Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Agricultural Research Service, United States Department of Agriculture, Orient Point, NY 11957, USA;
| | - Christina F. Spiropoulou
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
| | - Brian H. Bird
- One Health Institute, School of Veterinary Medicine, University of California Davis, 1089 Veterinary Medicine Drive, Davis, CA 95616, USA;
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
| | - Jessica R. Spengler
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (S.E.R.); (C.F.S.); (J.R.S.)
| | - Dennis A. Bente
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA; (M.C.); (D.A.B.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| |
Collapse
|
36
|
Hudson P, Morrison RS, Schulz R, Brody AA, Dahlin C, Kelly K, Meier DE. Improving Support for Family Caregivers of People with a Serious Illness in the United States: Strategic Agenda and Call to Action. Palliat Med Rep 2020; 1:6-17. [PMID: 34223450 PMCID: PMC8241318 DOI: 10.1089/pmr.2020.0004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background: An estimated 30% of the adult American population are caregivers and many of the people they support live with serious illnesses. Caregivers provide an average of 20 hours of services per week and are heavily involved in assisting with activities of daily living. This input represents considerable economic value to the health care system and to the well-being of communities. However, the impact of the burden on caregivers is considerable with negative outcomes on their physical, psychological, social, and financial well-being. The current landscape of caregiver policy in the United States is not well coordinated and does not meet the needs of this population. Objective: To develop a strategy to enhance the future of family caregiver support of people with serious illness within the United States. Methods: (1) Creation of project steering and key stakeholder groups; (2) survey and in-depth interviews with key stakeholders; (3) review of key family caregiver reports, systematic reviews, policies, and financial initiatives. Results: A strategy to provide clear direction to enhance the future of family caregiver support of people with serious illness within the United States was developed focusing explicitly on policy, research, training, service delivery, and public engagement. Conclusions: The strategy is an initial step aimed at enhancing support for family caregivers of people living with serious illness. It outlines key recommendations and a “call to action.” Subsequent work will be needed on prioritization of tasks, gaining buy-in at all levels of the policy-making apparatus, operationalization, and implementation.
Collapse
Affiliation(s)
- Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Vrije University Brussels, Belgium
| | - R Sean Morrison
- National Palliative Care Research Center, Icahn School of Medicine of Mount Sinai, New York, New York, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine of Mount Sinai, New York, New York, USA.,Lilian and Benjamin Hertzberg Palliative Care Institute, Mount Sinai Hospital, New York, New York, USA
| | - Richard Schulz
- Center for Social and Urban Research, Education, and Policy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, School of Medicine, Education, and Policy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Caregiving Research, Education, and Policy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Abraham Aizer Brody
- Rory Meyers College of Nursing, New York University, New York, New York, USA.,Hartford Institute for Geriatric Nursing, New York University, New York, New York, USA
| | - Constance Dahlin
- Center to Advance Palliative Care, New York, New York, USA.,Hospice and Palliative Nurses Association, Pittsburgh, Pennsylvania, USA.,North Shore Medical Center, Salem, Massachusetts, USA
| | - Kathleen Kelly
- Family Caregiver Alliance, National Center on Caregiving, San Francisco, California, USA
| | - Diane E Meier
- North Shore Medical Center, Salem, Massachusetts, USA.,Patty and Jay Baker National Palliative Care Center, Icahn School of Medicine of Mount Sinai, New York, New York, USA.,Department of Geriatrics and Palliative Medicine, Icahn School of Medicine of Mount Sinai, New York, New York, USA.,Medical Ethics, Icahn School of Medicine of Mount Sinai, New York, New York, USA
| |
Collapse
|
37
|
Sainsbury AW, Chantrey J, Ewen JG, Gurnell J, Hudson P, Karesh WB, Kock RA, Lurz PWW, Meredith A, Tompkins DM. Implications of squirrelpox virus for successful red squirrel translocations within mainland
UK. Conservat Sci and Prac 2020. [DOI: 10.1111/csp2.200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
| | - Julian Chantrey
- School of Veterinary Science, University of Liverpool Liverpool UK
| | - John G. Ewen
- Institute of Zoology, Zoological Society of London Regent's Park, London UK
- IUCN SSC Conservation Translocation Specialist Group UK
| | | | - Peter Hudson
- Nelson Mandela African Institute—Arusha, A co‐hire of The Huck Institutes & The Institutes of Energy & The Environment Penn State University Pennsylvania USA
| | - William B. Karesh
- IUCN SSC Wildlife Health Specialist Group Chair, EcoHealth Alliance New York New York USA
| | | | - Peter W. W. Lurz
- Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh Roslin, Midlothian UK
| | - Anna Meredith
- Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh Roslin, Midlothian UK
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne Parkville VIC Australia
| | | |
Collapse
|
38
|
Bradley S, Leach D, Panza J, Sassani J, Escobar C, Ogorek J, Jackson E, Hudson P, Hamner J, Smith P, Schroeder M, Wyman A, Gutman R. 17: A multicenter retrospective cohort comparing urethral diverticulectomy with and without concomitant pubovaginal sling. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Russell B, Vogrin S, Philip J, Hennessy-Anderson N, Collins A, Burchell J, Le B, Brand C, Hudson P, Sundararajan V. Triaging the Terminally Ill-Development of the Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool. J Pain Symptom Manage 2020; 59:95-104.e11. [PMID: 31419540 DOI: 10.1016/j.jpainsymman.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Evidence-based resource allocation is receiving increasing attention as we strive for equity, transparency, and cost-effectiveness across health care. In the context of finite resources, which of our patients with terminal illness should be prioritized for urgent palliative care? OBJECTIVES To develop the scoring system for the novel Responding to Urgency of Need in Palliative Care triage tool. METHODS Online international discrete choice experiment involving palliative care clinicians to establish the relative importance of seven key attributes of palliative care triage identified during an earlier qualitative study. RESULTS Participants (n = 772) were mainly female (79.9%) with a decade of clinical experience. All attributes contributed significantly (all P-values < 0.001) and independently to clinician assessment of urgency. This study found physical suffering (coefficient 3.45; 95% confidence interval: 3.24 to 3.66) was the most important determinant of urgency, followed by imminent dying (coefficient 1.56; 1.43 to 1.69), psychological suffering (coefficient 1.49; 1.37 to 1.60), caregiver distress (coefficient 1.47; 1.35 to 1.59), discrepancy between care needs and care arrangements (coefficient 1.14; 1.02 to 1.26), mismatch between current and desired site of care (coefficient 0.94; 0.85 to 1.03), and unmet communication needs (coefficient 0.84; 0.76 to 0.92). CONCLUSION Palliative care triage, which is complex and contextual, has been made more transparent through this discrete choice experiment. The Responding to Urgency of Need in Palliative Care triage tool provides an important step toward evidence-based assessment of priority for palliative care. Further research is underway to determine the validity of the tool in clinical practice and its impact on patient and caregiver outcomes.
Collapse
Affiliation(s)
- Bethany Russell
- Palliative Medicine Research Group, University of Melbourne & St Vincent's Hospital Melbourne, Melbourne, Australia; Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jennifer Philip
- Palliative Medicine Research Group, University of Melbourne & St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Australia; Department of Palliative Care, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Anna Collins
- Palliative Medicine Research Group, University of Melbourne & St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jodie Burchell
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Brian Le
- Victorian Comprehensive Cancer Centre, Melbourne, Australia; Department of Palliative Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Caroline Brand
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia; Department of Preventive Medicine, Monash University, Clayton, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Vrije University Brussels, Brussels, Belgium; School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Vijaya Sundararajan
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Public Health, La Trobe University, Bundoora, Australia
| |
Collapse
|
40
|
McKibben L, Brazil K, Hudson P, McLaughlin D. Informational needs of family caregivers of people with intellectual disability who require palliative care: a two-phase integrative review of the literature. Int J Palliat Nurs 2019; 25:4-18. [PMID: 30676158 DOI: 10.12968/ijpn.2019.25.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: People with intellectual disabilities are living longer, with increasingly complex needs and their family caregivers may have a broad scope of unmet needs. AIMS: To identify the most common needs of family caregivers, to identify gaps in the literature, and distinguish the information needs of family caregivers of people with intellectual disabilities who require palliative care. METHODS: This two phase literature review used five electronic databases (CINAHL, PsycINFO, Medline, Cochrane and Pubmed). Phase 1 involved a review of systematic reviews of the needs of family caregivers across healthcare settings. Phase 2 explored the commonly reported information needs from phase 1, in relation to family caregivers of people with intellectual disability who require palliative care. There was no research explicit to the information needs of these family caregivers. FINDINGS: This review reveals potential information needs which may exist, guided by the palliative caregiving literature; alluding to information needs surrounding the disease, finances, and psychological or practical support. CONCLUSION: It is surmised that a greater scope of informational need exists for this population and further research is pertinent for international healthcare settings.
Collapse
Affiliation(s)
- Laurie McKibben
- PhD graduate, School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Kevin Brazil
- Professor, School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Peter Hudson
- Professor, Centre for Palliative Care, Centre for Palliative Care, St Vincent's Hospital and The University of Melbourne, Fitzroy, Victoria, Australia
| | - Dorry McLaughlin
- Lecturer, School of Nursing and Midwifery, Queen's University Belfast, UK
| |
Collapse
|
41
|
Lunn TJ, Restif O, Peel AJ, Munster VJ, de Wit E, Sokolow S, van Doremalen N, Hudson P, McCallum H. Dose-response and transmission: the nexus between reservoir hosts, environment and recipient hosts. Philos Trans R Soc Lond B Biol Sci 2019; 374:20190016. [PMID: 31401955 PMCID: PMC6711301 DOI: 10.1098/rstb.2019.0016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 01/11/2023] Open
Abstract
Dose is the nexus between exposure and all upstream processes that determine pathogen pressure, and is thereby an important element underlying disease dynamics. Understanding the relationship between dose and disease is particularly important in the context of spillover, where nonlinearities in the dose-response could determine the likelihood of transmission. There is a need to explore dose-response models for directly transmitted and zoonotic pathogens, and how these interactions integrate within-host factors to consider, for example, heterogeneity in host susceptibility and dose-dependent antagonism. Here, we review the dose-response literature and discuss the unique role dose-response models have to play in understanding and predicting spillover events. We present a re-analysis of dose-response experiments for two important zoonotic pathogens (Middle East respiratory syndrome coronavirus and Nipah virus), to exemplify potential difficulties in differentiating between appropriate models with small exposure experiment datasets. We also discuss the data requirements needed for robust selection between dose-response models. We then suggest how these processes could be modelled to gain more realistic predictions of zoonotic transmission outcomes and highlight the exciting opportunities that could arise with increased collaboration between the virology and epidemiology disciplines. This article is part of the theme issue 'Dynamic and integrative approaches to understanding pathogen spillover'.
Collapse
Affiliation(s)
- Tamika J. Lunn
- Environmental Futures Research Institute, Griffith University, Kessels Road, Nathan, Queensland 4111, Australia
| | - Olivier Restif
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Alison J. Peel
- Environmental Futures Research Institute, Griffith University, Kessels Road, Nathan, Queensland 4111, Australia
| | - Vincent J. Munster
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, MT 59840, USA
| | - Emmie de Wit
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, MT 59840, USA
| | - Sanna Sokolow
- Stanford Woods Institute for the Environment, Stanford University, Serra Mall, Stanford, CA 94305, USA
| | - Neeltje van Doremalen
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, MT 59840, USA
| | - Peter Hudson
- Center for Infectious Disease Dynamics, Pennsylvania State University, State College, Pennsylvania, PA 16801, USA
| | - Hamish McCallum
- Environmental Futures Research Institute, Griffith University, Kessels Road, Nathan, Queensland 4111, Australia
| |
Collapse
|
42
|
Scott D, Hudson P, Charnley K, Payne C, Westcott G. Development of an eHealth information resource for family carers supporting a person receiving palliative care on the island of Ireland. BMC Palliat Care 2019; 18:74. [PMID: 31470841 PMCID: PMC6717391 DOI: 10.1186/s12904-019-0457-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/13/2019] [Indexed: 01/22/2023] Open
Abstract
Background Many people receiving palliative care wish to die at home. Often, support from family or friends is key to ensuring that this wish is fulfilled. However, carers report feeling underprepared to undertake this role. This paper describes the process of developing a consensus and evidence based website to provide core information to help people support someone receiving palliative care on the island of Ireland. Methods The project comprised three phases: (1) a review of systematic reviews facilitated the identification of core information needs; (2) content was developed in collaboration with a Virtual Reference Group (VRG) comprising patients, carers and professionals; and, (3) subject experts within the project team worked with a web developer to précis the agreed content and ensure it was in a format that was appropriate for a website. Members of the VRG were then invited to test and approve the website before it was made available to the general public. Results Nineteen systematic reviews identified nine consensus areas of core information required by carers; a description of palliative care; prognosis and treatment of the condition; medication and pain management; personal care; specialist equipment; locally available support services; what to do in an emergency; nutrition; and, support for the carer. This information was shared with the VRG and used to develop website content. Conclusions We engaged with service users and professionals to develop an evidence-based website addressing the agreed core information needs of non-professional carers who wish to provide palliative care to a friend or relative.
Collapse
Affiliation(s)
- David Scott
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Lisburn Road, Belfast, BT9 7BL, UK.
| | - Peter Hudson
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Lisburn Road, Belfast, BT9 7BL, UK
| | - Karen Charnley
- All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin 6, Ireland
| | - Cathy Payne
- All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin 6, Ireland
| | - Gareth Westcott
- All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin 6, Ireland
| |
Collapse
|
43
|
Mc Veigh C, Reid J, Larkin P, Porter S, Hudson P. Palliative care for people with non-malignant respiratory disease and their carers: a review of the current evidence. J Res Nurs 2019; 24:420-430. [PMID: 34394556 DOI: 10.1177/1744987119840066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Internationally, non-malignant respiratory disease is on the increase. However, although palliative care is recommended as an appropriate healthcare option for this client group, evidence suggests that these patients and their carers do not receive the same standards of palliative care as patients with a malignant lung condition. Aim The aim of this review was to provide a critical overview of the current evidence base in relation to the palliative service provision for people with non-malignant respiratory disease and their carers. Methods A review of the literature was conducted in July 2015 and updated in October 2017 and focused on the palliative care service provision for patients with interstitial lung disease, chronic obstructive pulmonary disease and bronchiectasis. Results In total, 71 empirical studies were included in the review and grouped into two main themes: patient and carer's bio-psychosocial symptom needs and management, and palliative care service provision for patients with non-malignant respiratory disease and their carers. Conclusion The majority of palliative research focuses on patients with a diagnosis of chronic obstructive pulmonary disease. A deeper insight is required into the palliative service provision experienced by those with other forms of non-malignant respiratory disease such as bronchiectasis and interstitial lung disease.
Collapse
Affiliation(s)
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Philip Larkin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, UK
| | - Peter Hudson
- Centre for Palliative Care, Vincent's University Hospital, Melbourne, Australia
| |
Collapse
|
44
|
Philip J, Collins A, Le B, Sundararajan V, Brand C, Hanson S, Emery J, Hudson P, Mileshkin L, Ganiatsas S. A randomised phase II trial to examine feasibility of standardised, early palliative (STEP) care for patients with advanced cancer and their families [ACTRN12617000534381]: a research protocol. Pilot Feasibility Stud 2019; 5:44. [PMID: 30915228 PMCID: PMC6417202 DOI: 10.1186/s40814-019-0424-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/24/2019] [Indexed: 11/12/2022] Open
Abstract
Background Current international consensus is that 'early' referral to palliative care services improves cancer patient and family carer outcomes; however, in practice, these referrals are not routine. Uncertainty about the 'best time' to refer has been highlighted as contributing to care variation. Previous work has identified clear disease-specific transition points in the cancer illness which heralded subsequent poor prognosis (less than 6 months) and which, we contest, represent times when palliative care should be routinely introduced as a standardised approach, if not already in place, to maximise patient and carer benefit. This protocol details a trial that will test the feasibility of a novel standardised outpatient model of early palliative care [Standardised Early Palliative Care (STEP Care)] for advanced cancer patients and their family carers, with referrals occurring at the defined disease-specific evidence-based transition points.The aims of this study are to (1) determine the feasibility of conducting a definitive phase 3 randomised trial, which evaluates effectiveness of STEP Care (compared to usual best practice cancer care) for patients with advanced breast or prostate cancer or high grade glioma; (2) examine preliminary efficacy of STEP Care on patient/family caregiver outcomes, including quality of life, mood, symptoms, illness understanding and overall survival; (3) document the impact of STEP Care on quality of end-of-life care; and (4) evaluate the timing of palliative care introduction according to patients, families and health care professionals. Methods Phase 2, multicenter, open-label, parallel-arm, randomised controlled trial (RCT) of STEP Care plus standard best practice cancer care versus standard best practice cancer care alone. Discussion The research will test the feasibility of standardised palliative care introduction based on illness transitions and provide guidance on subsequent development of phase 3 studies of integration. This will directly address the current uncertainty about palliative care timing. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000534381.
Collapse
Affiliation(s)
- Jennifer Philip
- 1Department of Medicine, University of Melbourne, c/o St Vincent's Hospital, Victoria Pde, Fitzroy, 3065 Australia.,2Palliative Care Service, St Vincent's Hospital Melbourne, Fitzroy, Australia.,3Palliative Care Service, Royal Melbourne Hospital, Parkville, Australia.,4Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Anna Collins
- 1Department of Medicine, University of Melbourne, c/o St Vincent's Hospital, Victoria Pde, Fitzroy, 3065 Australia
| | - Brian Le
- 3Palliative Care Service, Royal Melbourne Hospital, Parkville, Australia.,4Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Vijaya Sundararajan
- 1Department of Medicine, University of Melbourne, c/o St Vincent's Hospital, Victoria Pde, Fitzroy, 3065 Australia.,5Public Health, La Trobe University, Bundoora, Australia
| | - Caroline Brand
- 6Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Jon Emery
- 8Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Peter Hudson
- 9Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Linda Mileshkin
- 10Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Soula Ganiatsas
- 9Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia
| |
Collapse
|
45
|
Santin O, McShane T, Hudson P, Prue G. Using a six-step co-design model to develop and test a peer-led web-based resource (PLWR) to support informal carers of cancer patients. Psychooncology 2019; 28:518-524. [PMID: 30597666 PMCID: PMC6590360 DOI: 10.1002/pon.4969] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/28/2018] [Accepted: 12/13/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To co-design and test the acceptability of a peer-led web-based resource (PLWR) for cancer carers to provide practical and emotional advice on common issues. METHODS A six-step co-design model informed PLWR development. Content was developed through three cancer carer workshops and monthly meetings with an expert advisory team (n = 12). User-testing was conducted via web-based survey and telephone interview. Descriptive statistics and thematic analysis were utilised. Google analytics explored site visits, commonly used components, and time spent using the PLWR. RESULTS The PLWR was developed to deliver cancer carer information tailored to each stage of the illness trajectory regardless of cancer type, in the form of videoed personal experiences. From November to May 2018, there were 2789 unique visits to the PLWR with 743 returners. The majority of time was spent on the full unclipped peer stories (414 views), and diagnosis-specific information (159 views), with less time spent on bereavement, cancer treatment, or self-care (120 views each). Fifty-five individuals completed the resource evaluation, with 10 participating in telephone interviews. Fifty-four carers rated the resource as excellent, useful, and easy to use. The web-based videos were regarded as convenient as and less burdensome than written information. The resource provided relevant information, potentially reducing isolation and uncertainty. CONCLUSION The content and design of the PLWR appear acceptable to cancer carers. The co-design model is an effective way to develop appropriate information for service users and could be utilised as a framework for development of other interventions in a variety of disease groups.
Collapse
Affiliation(s)
- Olinda Santin
- School of Nursing and MidwiferyQueen's University Belfast, Medical Biology CentreBelfastUK
| | - Theresa McShane
- School of Nursing and MidwiferyQueen's University Belfast, Medical Biology CentreBelfastUK
| | - Peter Hudson
- The University of Melbourne, Centre for Palliative Care, St Vincent's HospitalMelbourneAustralia
| | - Gillian Prue
- School of Nursing and MidwiferyQueen's University Belfast, Medical Biology CentreBelfastUK
| |
Collapse
|
46
|
Philip J, Russell B, Collins A, Brand C, Le B, Hudson P, Sundararajan V. The Ethics of Prioritizing Access to Palliative Care: A Qualitative Study. Am J Hosp Palliat Care 2019; 36:577-582. [DOI: 10.1177/1049909119833333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jennifer Philip
- St Vincent’s Hospital and Victorian Comprehensive Cancer Centre, University of Melbourne, Victoria, Australia
- St Vincent’s Hospital, University of Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Bethany Russell
- St Vincent’s Hospital, University of Melbourne, Victoria, Australia
| | - Anna Collins
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Caroline Brand
- Department of Preventive Medicine, Monash University, Victoria, Australia
| | - Brian Le
- Department of Medicine, University of Melbourne, Victoria, Australia
- Department of Palliative Care, Royal Melbourne Hospital, Victoria, Australia
- Pain and Palliative Care Service, Peter McCallum Cancer Centre, Victoria, Australia
| | - Peter Hudson
- St Vincent’s Hospital, University of Melbourne, Victoria, Australia
- Vrije University, Brussels, Belgium
| | - Vijaya Sundararajan
- Department of Medicine, University of Melbourne, Victoria, Australia
- LaTrobe University, Victoria, Australia
| |
Collapse
|
47
|
Philip J, Collins A, Ritchie D, Le B, Millar J, McLachlan SA, Krishnasamy M, Hudson P, Sundararajan V. Patterns of end-of-life hospital care for patients with non-Hodgkin lymphoma: exploring the landscape. Leuk Lymphoma 2019; 60:1908-1916. [PMID: 30732498 DOI: 10.1080/10428194.2018.1564047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Rapid change, treatment responsiveness, and prognostication difficulties present challenges for palliative care integration for hematology patients. This Australian study aimed to document end-of-life hospital care for patients with non-Hodgkin lymphoma (NHL) to consider opportunities for palliative care integration. A retrospective population cohort design examining existing linked datasets of health service utilization and death registration. The results revealed 4380 NHL patients, majority male (58%) and aged 70+ years (70%), spent 32 days (median) in hospital in final 6 months of life, and in the last month, 56% had more than 1 hospital admission, and 57% stayed more than 14 days. Forty-one percent accessed palliative care, with first contact 23 days (median) before death, and for 77% in final admission. Early palliative care was more likely for patients with greater symptom burden. This study mapping patterns of care for patients who die from NHL establishes a baseline enabling comparisons for future care innovations.
Collapse
Affiliation(s)
- Jennifer Philip
- a Department of Medicine , University of Melbourne , Melbourne , Australia.,b St Vincent's Hospital , Melbourne , Australia.,c Palliative Care Service, Royal Melbourne Hospital & Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Anna Collins
- a Department of Medicine , University of Melbourne , Melbourne , Australia
| | - David Ritchie
- d Department of Clinical Haematology , Royal Melbourne Hospital , Melbourne , Australia
| | - Brian Le
- c Palliative Care Service, Royal Melbourne Hospital & Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Jeremy Millar
- e Department of Radiation Oncology , Alfred Health , Melbourne , Australia
| | - Sue-Anne McLachlan
- f Department of Medical Oncology , St Vincent's Hospital Melbourne , Melbourne , Australia
| | - Meinir Krishnasamy
- g Department of Nursing , University of Melbourne , Melbourne , Australia
| | - Peter Hudson
- h Centre for Palliative Care , St Vincent's Hospital & University of Melbourne & Vrije University , Brussels , Belgium
| | - Vijaya Sundararajan
- a Department of Medicine , University of Melbourne , Melbourne , Australia.,i Department of Public Health , La Trobe University , Australia
| |
Collapse
|
48
|
Collins A, Sundararajan V, Millar J, Burchell J, Le B, Krishnasamy M, McLachlan SA, Hudson P, Mileshkin L, Philip J. The trajectory of patients who die from metastatic prostate cancer: a population-based study. BJU Int 2018; 123 Suppl 5:19-26. [DOI: 10.1111/bju.14593] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Anna Collins
- Department of Medicine; St Vincent's Hospital; University of Melbourne; Melbourne Vic. Australia
| | - Vijaya Sundararajan
- Department of Medicine; St Vincent's Hospital; University of Melbourne; Melbourne Vic. Australia
- Department of Public Health; La Trobe University; Melbourne Vic. Australia
| | - Jeremy Millar
- Radiation Oncology; Alfred Health; Melbourne Vic. Australia
| | - Jodie Burchell
- Department of Medicine; St Vincent's Hospital; University of Melbourne; Melbourne Vic. Australia
| | - Brian Le
- Parkville Integrated Palliative Care Service; Victorian Comprehensive Cancer Centre; Melbourne Vic. Australia
| | - Mei Krishnasamy
- Department of Nursing; University of Melbourne; Melbourne Vic. Australia
| | | | - Peter Hudson
- Centre for Palliative Care; St Vincent's Hospital Melbourne; University of Melbourne; Melbourne Vic. Australia
- Vrije University; Brussels Belgium
| | - Linda Mileshkin
- Medical Oncology; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Jennifer Philip
- Department of Medicine; St Vincent's Hospital; University of Melbourne; Melbourne Vic. Australia
- Parkville Integrated Palliative Care Service; Victorian Comprehensive Cancer Centre; Melbourne Vic. Australia
| |
Collapse
|
49
|
Collins A, Sundararajan V, Burchell J, Millar J, McLachlan SA, Krishnasamy M, Le BH, Mileshkin L, Hudson P, Philip J. Transition Points for the Routine Integration of Palliative Care in Patients With Advanced Cancer. J Pain Symptom Manage 2018; 56:185-194. [PMID: 29608934 DOI: 10.1016/j.jpainsymman.2018.03.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
CONTEXT Increasing emphases are being placed on early integration of palliative care for patients with advanced cancers, yet barriers to implementation in clinical practice remain. Criteria to standardize referral have been endorsed, but their application is yet to be tested at the population level. OBJECTIVES This study sought to establish the need for standardized referral by examining current end-of-life care outcomes of decedents with cancer and define transition points within a cancer illness course, which are associated with poor prognosis, whereby palliative care should be routinely introduced to augment clinician-based decision making. METHODS Population cohort study of admitted patients with advanced cancer diagnosed with non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), prostate or breast cancer between 2000 and 2010 in Victoria, Australia, identified from routinely collected, linked, hospital discharge, emergency department, and death registration data. Descriptive statistics described quality indicators for end-of-life care outcomes for decedents. Kaplan-Meier analyses were used to test the predefined transition point that mostly accurately predicted survival of six months or lesser. RESULTS About 46,700 cases (56% females) were admitted with metastatic NSCLC (n = 14,759; 31.6%), SCLC (n = 2932; 6%), prostate (n = 9445; 20.2%), and breast cancer (n = 19,564; 41.9%). Of the 29,680 decedents, most (80%) died in hospital, had suboptimal end-of-life care outcomes (83%), and 59% received a palliative approach to care, a median of 27 days before death. Transition points in the cancer illness course of all cases were identified as first admission with any metastatic disease (NSCLC: 3.8 months [interquartile range {IQR} 1.1, 16.0]; n = 14,666; and SCLC: 4.2 months [IQR 1.0, 10.6]; n = 2914); first multiday admission with any metastatic disease (prostate: 6.0 months [IQR 1.3, 26.4]; n = 7174); and first multiday admission with at least one visceral metastatic site (breast: 6.0 months [IQR 1.2, 29.8]; n = 7120). CONCLUSION Despite calls for integrated palliative care, this occurs late or not at all for many patients with cancer. Our findings demonstrate the application of targeted cancer-specific transition points to trigger integration of palliative care as a standard part of quality oncological care and augment clinician-based referral in routine clinical practice.
Collapse
Affiliation(s)
- Anna Collins
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; VCCC Palliative Medicine Research Group, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.
| | - Vijaya Sundararajan
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jodie Burchell
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
| | - Brian H Le
- Palliative Care Service, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Mileshkin
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne & University of Melbourne, Melbourne, Victoria, Australia; Vrije University, Brussel, Belgium
| | - Jennifer Philip
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; VCCC Palliative Medicine Research Group, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
50
|
Russell B, Sundararajan V, Hennesy-Anderson N, Collins A, Burchell J, Vogrin S, Le B, Brand C, Hudson P, Philip J. Responding to urgency of need: Initial qualitative stage in the development of a triage tool for use in palliative care services. Palliat Med 2018; 32:1246-1254. [PMID: 29936903 DOI: 10.1177/0269216318773221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care services face the challenge of a workload increasing in volume and diversity. An evidence-based triage method to assess urgency of palliative care needs is required to ensure equitable, efficient and transparent allocation of specialist resources when managing waiting lists. AIM As the initial stage of a mixed-method sequential design, this study aimed to explore palliative care providers' practices and attitudes towards triaging palliative care needs and their views regarding the implementation of a standardised approach. DESIGN A qualitative study was conducted involving focus groups and interviews. Transcripts were subjected to deductive thematic analysis. SETTING/PARTICIPANTS A total of 20 palliative care providers were purposively sampled to ensure representation across disciplines (primary, specialist; medicine, nursing and allied health), service types (inpatient, hospital liaison and community) and locations (metropolitan and rural). RESULTS A series of markers of urgency were identified, including physical and psychological suffering, caregiver distress, discrepancy between care needs and care arrangements, mismatch between current site of care and desired site of death when in terminal phase and complex communication needs. Performance status and phase of disease were reported to be less informative when considered in isolation. Interpersonal and system-based barriers to the implementation of a palliative care triage tool were highlighted. CONCLUSION The process of triage in the palliative care setting is complex but can be conceptualised using a limited number of domains. Further research is required to establish the relative value clinicians attribute to these domains and thus inform the development of an acceptable and useful evidence-based palliative care triage tool.
Collapse
Affiliation(s)
- Bethany Russell
- 1 VCCC Palliative Medicine Research Group, Department of Medicine, University of Melbourne, Victoria, Australia.,2 Centre for Palliative Care, St Vincent's Hospital Melbourne, Victoria, Australia.,3 Department of Palliative Care, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Vijaya Sundararajan
- 2 Centre for Palliative Care, St Vincent's Hospital Melbourne, Victoria, Australia.,4 VDepartment of Medicine, St Vincent's Hospital Melbourne and University of Melbourne, Victoria, Australia
| | | | - Anna Collins
- 1 VCCC Palliative Medicine Research Group, Department of Medicine, University of Melbourne, Victoria, Australia
| | - Jodie Burchell
- 4 VDepartment of Medicine, St Vincent's Hospital Melbourne and University of Melbourne, Victoria, Australia
| | - Sara Vogrin
- 4 VDepartment of Medicine, St Vincent's Hospital Melbourne and University of Melbourne, Victoria, Australia
| | - Brian Le
- 5 Victorian Comprehensive Cancer Centre, Victoria, Australia.,6 Department of Palliative Care, Royal Melbourne Hospital, Victoria, Australia
| | - Caroline Brand
- 7 Melbourne Epicentre, University of Melbourne and Melbourne Health, Victoria, Australia.,8 Department of Preventive Medicine, Monash University, Victoria, Australia
| | - Peter Hudson
- 2 Centre for Palliative Care, St Vincent's Hospital Melbourne, Victoria, Australia.,9 Vrije University Brussels, Belgium.,10 School of Health Sciences, University of Melbourne, Victoria, Australia
| | - Jennifer Philip
- 1 VCCC Palliative Medicine Research Group, Department of Medicine, University of Melbourne, Victoria, Australia.,3 Department of Palliative Care, St Vincent's Hospital Melbourne, Victoria, Australia.,5 Victorian Comprehensive Cancer Centre, Victoria, Australia
| |
Collapse
|