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Brean SJ, Recoche K, William L, Lakhani A, Zhong Y, Shimoinaba K. Advance care plans for vulnerable and disadvantaged adults: systematic review and narrative synthesis. BMJ Support Palliat Care 2023:spcare-2023-004162. [PMID: 37380215 DOI: 10.1136/spcare-2023-004162] [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: 01/05/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Evidence suggests that there is a gap in advance care planning (ACP) completion between vulnerable and disadvantaged populations compared with the general population. This review seeks to identify tools, guidelines or frameworks that have been used to support ACP interventions with vulnerable and disadvantaged adult populations as well as their experiences and outcomes with them. The findings will inform practice in ACP programmes. METHODS A systematic search of six databases from 1 January 2010 to 30 March 2022 was conducted to identify original peer-reviewed research that used ACP interventions via tools, guidelines or frameworks with vulnerable and disadvantaged adult populations and reported qualitative findings. A narrative synthesis was conducted. RESULTS Eighteen studies met the inclusion criteria. Relatives, caregivers or substitute decision-makers were included in eight studies. SETTINGS hospital outpatient clinics (N=7), community settings (N=7), nursing homes (N=2), prison (N=1) and hospital (N=1). A variety of ACP tools, guidelines or frameworks were identified; however, the facilitator's skills and approach in delivering the intervention appeared to be as important as the intervention itself. Participants indicated mixed experiences, some positive, some negative and four themes emerged: uncertainty, trust, culture and decision-making behaviour. The most common descriptors relating to these themes were prognosis uncertainty, poor end-of-life communication and the importance of building trust. CONCLUSION The findings indicate that ACP communication could be improved. ACP conversations should incorporate a holistic and personalised approach to optimise efficacy. Facilitators should be equipped with the necessary skills, tools and information needed to assist ACP decision-making.
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Affiliation(s)
- Samantha Jane Brean
- Advance Care Planning, Eastern Health, Wantirna, Victoria, Australia
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Katrina Recoche
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Leeroy William
- Supportive and Palliative Care Service, Eastern Health, Wantirna, Victoria, Australia
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Ali Lakhani
- La Trobe University, School of Psychology and Public Health, Melbourne, Victoria, Australia
| | - Yaping Zhong
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Kaori Shimoinaba
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
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2
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Russell L, Howard R, Street M, Johnson CE, Berry D, Flemming-Judge E, Brean S, William L, Considine J. Cancer Decedents' Hospital End-of-Life Care Documentation: A Retrospective Review of Patient Records. J Palliat Care 2023:8258597231170836. [PMID: 37113101 DOI: 10.1177/08258597231170836] [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] [Indexed: 04/29/2023]
Abstract
Objective: International standards of end-of-life care (EOLC) intend to guide the delivery of safe and high-quality EOLC. Adequately documented care is conducive to higher quality of care, but the extent to which EOLC standards are documented in hospital medical records is unknown. Assessing which EOLC standards are documented in patients' medical records can help identify areas that are performed well and areas where improvements are needed. This study assessed cancer decedents' EOLC documentation in hospital settings. Methods: Medical records of 240 cancer decedents were retrospectively evaluated. Data were collected across six Australian hospitals between 1/01/2019 and 31/12/2019. EOLC documentation related to Advance Care Planning (ACP), resuscitation planning, care of the dying person, and grief and bereavement care was reviewed. Chi-square tests assessed associations between EOLC documentation and patient characteristics, and hospital settings (specialist palliative care unit, sub-acute/rehabilitation care settings, acute care wards, and intensive care units). Results: Decedents' mean age was 75.3 years (SD 11.8), 52.0% (n = 125) were female, and 73.7% lived with other adults or carers. All patients (n = 240; 100%) had documentation for resuscitation planning, 97.6% (n = 235) for Care for the Dying Person, 40.0% for grief and bereavement care (n = 96), and 30.4% (n = 73) for ACP. Patients living with other adults or carers were less likely to have a documented ACP than those living alone or with dependents (OR 0.48; 95% CI 0.26-0.89). EOLC documentation was significantly greater in specialist palliative care settings than that in other hospital settings (P < .001). Conclusion: The process of dying is well documented among inpatients diagnosed with cancer. ACP and grief and bereavement support are not documented enough. Organizational endorsement of a clear practice framework and increased training could improve documentation of these aspects of EOLC.
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Affiliation(s)
- L Russell
- Deakin University, School of Nursing and Midwifery, Geelong, Australia
- Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - R Howard
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - M Street
- Deakin University, School of Nursing and Midwifery, Geelong, Australia
- Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - C E Johnson
- Palliative Aged Care Outcomes Program, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - D Berry
- Deakin University, School of Nursing and Midwifery, Geelong, Australia
- Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - E Flemming-Judge
- Consumer Representative, Australian Resuscitation Council, Eastern Health, East Melbourne, VIC, Australia
- Consumer Representative, Safer Care Victoria, Melbourne VIC, Australia
- Consumer Representative, Eastern Health, Box Hill, VIC, Australia
- Consumer Representative, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - S Brean
- Advance Care Planning, Eastern Health, Melbourne, VIC, Australia
| | - L William
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - J Considine
- Deakin University, School of Nursing and Midwifery, Geelong, Australia
- Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
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3
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Kissane DW, Appleton J, Lennon J, Michael N, Chye R, King T, William L, Poon P, Kanathigoda S, Needham K, Bobevski I. Psycho-Existential Symptom Assessment Scale (PeSAS) Screening in Palliative Care. J Pain Symptom Manage 2022; 64:429-437. [PMID: 35961431 DOI: 10.1016/j.jpainsymman.2022.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/25/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Psycho-existential symptoms are common yet often missed or neglected in palliative care. Screening can be an effective way to recognize and respond to this need. OBJECTIVES We aimed to implement routine use of the Psycho-existential Symptom Assessment Scale (PeSAS) as a screening tool in Australian palliative care services and discern the symptom prevalence identified. METHODS In a multi-site rolling design, we established implementation site committees and embarked on experiential workshops to train clinicians in the tool's efficient use. Patient symptom prevalence data were collected to compare uptake across sites. Descriptive statistics were applied. RESULTS Over one year, we trained 216 clinicians across six palliative care services in the use of the PeSAS as a screening tool and collected data from 1405 patients. Clinicians reported significant growth in their sense of efficacy in assessing psycho-existential wellness. Services using electronic records implemented most easily. Psycho-existential symptoms with clinically significant prevalence (scores ≥ 4/10) included anxiety 41.1%, discouragement 37.6%, hopelessness 35.8%, pointlessness 26.9%, depression 30.3%, and the wish to die 17%. The precision of measurement within 3% was found for severe ratings (score ≥ 8/10) including anxiety 10.6%, depression 10.2%, the wish to die 7.6%, and confusion 3.6%. CONCLUSION Clinicians can be trained to screen with the Psycho-existential Symptom Assessment Scale, which serves as a valuable measure to better recognize symptoms of psycho-existential distress among palliative care patients. Implementation barriers included the prior ethos of the service, confidence in talking about these themes, electronic data entry, and perceived time pressures.
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Affiliation(s)
- David W Kissane
- School of Medicine (D.W.K, J.A., J.L., N.M., K.N., I.B.), University of Notre Dame Australia; St. Vincent's Hospital (D.W.K., J.A., J.L., R.C., K.N.), Sydney, NSW; Cabrini Health (D.W.K., N.M., I.B.), Melbourne, Victoria; School of Clinical Sciences (D.W.K., N.M., L.W., P.P., I.B.), Monash University, Victoria; Monash Health (D.W.K., P.P.), Melbourne, Victoria.
| | - Jane Appleton
- School of Medicine (D.W.K, J.A., J.L., N.M., K.N., I.B.), University of Notre Dame Australia; St. Vincent's Hospital (D.W.K., J.A., J.L., R.C., K.N.), Sydney, NSW
| | - Jonathon Lennon
- School of Medicine (D.W.K, J.A., J.L., N.M., K.N., I.B.), University of Notre Dame Australia; St. Vincent's Hospital (D.W.K., J.A., J.L., R.C., K.N.), Sydney, NSW
| | - Natasha Michael
- School of Medicine (D.W.K, J.A., J.L., N.M., K.N., I.B.), University of Notre Dame Australia; Cabrini Health (D.W.K., N.M., I.B.), Melbourne, Victoria; School of Clinical Sciences (D.W.K., N.M., L.W., P.P., I.B.), Monash University, Victoria
| | - Richard Chye
- St. Vincent's Hospital (D.W.K., J.A., J.L., R.C., K.N.), Sydney, NSW
| | - Tania King
- Eastern Palliative Care (T.K.), Victoria
| | - Leeroy William
- School of Clinical Sciences (D.W.K., N.M., L.W., P.P., I.B.), Monash University, Victoria; Eastern Health (L.W.), Melbourne, Victoria
| | - Peter Poon
- School of Clinical Sciences (D.W.K., N.M., L.W., P.P., I.B.), Monash University, Victoria; Monash Health (D.W.K., P.P.), Melbourne, Victoria
| | | | - Katarina Needham
- School of Medicine (D.W.K, J.A., J.L., N.M., K.N., I.B.), University of Notre Dame Australia; St. Vincent's Hospital (D.W.K., J.A., J.L., R.C., K.N.), Sydney, NSW
| | - Irene Bobevski
- School of Medicine (D.W.K, J.A., J.L., N.M., K.N., I.B.), University of Notre Dame Australia; Cabrini Health (D.W.K., N.M., I.B.), Melbourne, Victoria; School of Clinical Sciences (D.W.K., N.M., L.W., P.P., I.B.), Monash University, Victoria
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4
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Russell B, William L, Chapman M. An Ethical Framework for Visitation of Inpatients Receiving Palliative Care in the COVID-19 Context. J Bioeth Inq 2022; 19:191-202. [PMID: 35175512 PMCID: PMC8853187 DOI: 10.1007/s11673-022-10173-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/10/2022] [Indexed: 05/03/2023]
Abstract
Human connection is universally important, particularly in the context of serious illness and at the end of life. The presence of close family and friends has many benefits when death is close. Hospital visitation restrictions during the Coronavirus (COVID-19) pandemic therefore warrant careful consideration to ensure equity, proportionality, and the minimization of harm. The Australian and New Zealand Society for Palliative Medicine COVID-19 Special Interest Group utilized the relevant ethical and public health principles, together with the existing disease outbreak literature and evolving COVID-19 knowledge, to generate a practical framework of visiting restrictions for inpatients receiving palliative and end-of-life care. Expert advice from an Infectious Diseases physician ensured relevance to community transmission dynamics. Three graded levels of visitor restrictions for inpatient settings are proposed, defining an appropriate level of minimum access. These depend upon the level of community transmission of COVID-19, the demand on health services, the potential COVID-19 status of the patient and visitors, and the imminence of the patient's death. This framework represents a cohesive, considered, proportionate, and ethically robust approach to improve equity and consistency for inpatients receiving palliative care during the COVID-19 pandemic and may serve as a template for future disease outbreaks.
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Affiliation(s)
- Bethany Russell
- Palliative Nexus Research Group, University of Melbourne & St Vincent’s Hospital Melbourne, St Vincent’s Hospital, 41 Victoria Pde, Fitzroy, Victoria 3065 Australia
- Department of Palliative Care, St Vincent’s Hospital Melbourne, St Vincent’s Hospital, 41 Victoria Pde, Fitzroy, Victoria 3065 Australia
| | - Leeroy William
- Supportive & Palliative Care Unit, Eastern Health, Monash University, Melbourne, Australia
- Eastern Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Public Health Palliative Care Unit, La Trobe University, Wantirna Health, 251 Mountain Highway, Wantirna, 3152 Australia
| | - Michael Chapman
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
- Department of Palliative Care, Canberra Hospital, PO Box 11, Woden, ACT 2606 Australia
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5
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Cheyne S, Lindley RI, Smallwood N, Tendal B, Chapman M, Fraile Navarro D, Good PD, Jenkin P, McDonald S, Morgan D, Murano M, Millard T, Naganathan V, Srikanth V, Tuffin P, Vogel J, White H, Chakraborty SP, Whiting E, William L, Yates PM, Callary M, Elliott J, Agar MR. Care of older people and people requiring palliative care with COVID-19: guidance from the Australian National COVID-19 Clinical Evidence Taskforce. Med J Aust 2021; 216:203-208. [PMID: 34865227 PMCID: PMC9299653 DOI: 10.5694/mja2.51353] [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: 04/06/2021] [Revised: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 12/26/2022]
Abstract
Introduction Older people living with frailty and/or cognitive impairment who have coronavirus disease 2019 (COVID‐19) experience higher rates of critical illness. There are also people who become critically ill with COVID‐19 for whom a decision is made to take a palliative approach to their care. The need for clinical guidance in these two populations resulted in the formation of the Care of Older People and Palliative Care Panel of the National COVID‐19 Clinical Evidence Taskforce in June 2020. This specialist panel consists of nursing, medical, pharmacy and allied health experts in geriatrics and palliative care from across Australia. Main recommendations The panel was tasked with developing two clinical flow charts for the management of people with COVID‐19 who are i) older and living with frailty and/or cognitive impairment, and ii) receiving palliative care for COVID‐19 or other underlying illnesses. The flow charts focus on goals of care, communication, medication management, escalation of care, active disease‐directed care, and managing symptoms such as delirium, anxiety, agitation, breathlessness or cough. The Taskforce also developed living guideline recommendations for the care of adults with COVID‐19, including a commentary to discuss special considerations when caring for older people and those requiring palliative care. Changes in management as result of the guideline The practice points in the flow charts emphasise quality clinical care, with a focus on addressing the most important challenges when caring for older individuals and people with COVID‐19 requiring palliative care. The adult recommendations contain additional considerations for the care of older people and those requiring palliative care.
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Affiliation(s)
- Saskia Cheyne
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW.,Cochrane Australia, Monash University, Melbourne, VIC
| | - Richard I Lindley
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW.,George Institute for Global Health, Sydney, NSW
| | | | - Britta Tendal
- Cochrane Australia, Monash University, Melbourne, VIC
| | | | | | | | | | | | - Deidre Morgan
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA.,Flinders University, Adelaide, SA
| | | | - Tanya Millard
- Cochrane Australia, Monash University, Melbourne, VIC
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CRGH), University of Sydney, Sydney, NSW
| | | | - Penelope Tuffin
- Royal Perth Hospital, Perth, WA.,Fiona Stanley Hospital, Perth, WA
| | - Joshua Vogel
- Cochrane Australia, Monash University, Melbourne, VIC.,Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC
| | - Heath White
- Cochrane Australia, Monash University, Melbourne, VIC
| | | | | | - Leeroy William
- Cochrane Australia, Monash University, Melbourne, VIC.,Eastern Health, Melbourne, VIC
| | - Patsy M Yates
- Centre for Cancer and Palliative Care Outcomes, Queensland University of Technology, Brisbane, QLD
| | | | | | - Meera R Agar
- IMPACCT Centre, University of Technology Sydney, Sydney, NSW
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6
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Tham K, Shiu A, William L, Walpole G, Rashed S. Refractory hyperactive delirium in the dying: pharmacological management. BMJ Support Palliat Care 2021; 12:471-474. [PMID: 34819327 DOI: 10.1136/bmjspcare-2021-003139] [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: 04/24/2021] [Accepted: 10/21/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Delirium is a prevalent clinical presentation in advanced illness. The hyperactive phase can cause severe symptoms at the end of life. There is no published study of the pharmacological management of this symptom in Australian palliative medicine practice. OBJECTIVES To describe the pharmacological management of hyperactive delirium at the end of life in an Australian inpatient palliative care setting. METHODS Retrospective audit of deaths from October 2019 where a medication of interest (MOI) was used following admission to the palliative care unit (PCU) of Eastern Health. The clinical notes of those included were reviewed to further describe the clinical details surrounding the use of the MOI. RESULTS Forty patients were included. Midazolam was the most common medication used (57.5%). The most common dual agent combination was midazolam plus levomepromazine. CONCLUSIONS This audit is the first description of pharmacological management of severe hyperactive delirium at the end of life requiring sedation in an Australian PCU.
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Affiliation(s)
- Kathryn Tham
- Supportive and Palliative Care Service, Wantirna Health, Wantirna, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Angela Shiu
- Supportive and Palliative Care Service, Wantirna Health, Wantirna, VIC, Australia .,Pharmacy Department, Eastern Health, Wantirna, VIC, Australia
| | - Leeroy William
- Supportive and Palliative Care Service, Wantirna Health, Wantirna, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Public Health Palliative Care Unit, Latrobe University, Melbourne, VIC, Australia
| | - Grace Walpole
- Supportive and Palliative Care Service, Wantirna Health, Wantirna, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Saly Rashed
- Supportive and Palliative Care Service, Wantirna Health, Wantirna, VIC, Australia.,Pharmacy Department, Eastern Health, Wantirna, VIC, Australia
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7
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Ewais T, Hunt G, Munro J, Pun P, Hogan C, William L, Teodorczuk A. Schwartz Rounds for Staff in an Australian Tertiary Hospital: Protocol for a Pilot Uncontrolled Trial (Preprint). JMIR Res Protoc 2021; 11:e35083. [PMID: 35475785 PMCID: PMC9096633 DOI: 10.2196/35083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Schwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care. Objective Although Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia. Methods This mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory–Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach. Results The study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021; study completion is anticipated by May 2022. Conclusions The study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621001473853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/35083
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Affiliation(s)
- Tatjana Ewais
- Mater Young Adult Health Centre, Mater Health, Mater Misericordiae Ltd, South Brisbane, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- Mater Clinical School, Faculty of Medicine, University of Queensland, South Brisbane, Australia
| | - Georgia Hunt
- Mater Young Adult Health Centre, Mater Health, Mater Misericordiae Ltd, South Brisbane, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Jonathan Munro
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Paul Pun
- Mater in Mind, Mater Health, Mater Misericordiae Ltd, South Brisbane, Australia
| | - Christy Hogan
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Leeroy William
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Andrew Teodorczuk
- Mater Clinical School, Faculty of Medicine, University of Queensland, South Brisbane, Australia
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8
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Sodhi A, Steinberg C, Chakrabarti S, Mondesert B, De Marco C, Chan W, Leong Sit P, Bennett M, Sikkel M, Alqarawi W, Rizkallah J, Dognin N, William L. DRIVING RESTRICTION AND EARLY ARRHYTHMIAS IN PATIENTS RECEIVING A SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (DREAM SICD STUDY). Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.101] [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: 11/15/2022] Open
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9
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Ho A, Norman JS, Joolaee S, Serota K, Twells L, William L. How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers. Palliat Care Soc Pract 2021; 15:26323524211045996. [PMID: 34568826 PMCID: PMC8458666 DOI: 10.1177/26323524211045996] [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: 05/12/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. Aim To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Design Qualitative thematic analysis of semi-structured interviews. Participants Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto (n = 22) were interviewed in person or by phone. Participants included physicians (n = 22), nurses (n = 15), social workers (n = 7), and allied health professionals (n = 4). Results Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Conclusion Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care.
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Affiliation(s)
- Anita Ho
- Centre for Applied Ethics, The University of British Columbia, 227 - 6356 Agricultural Road, Vancouver, BC V6T 1Z2, Canada
| | - Joshua S Norman
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Soodabeh Joolaee
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada; Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kristie Serota
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Louise Twells
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Leeroy William
- Supportive & Palliative Care Unit, Eastern Health, Melbourne, VIC, Australia
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10
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Dai Y, Walpole G, Ding J, Scanlon C, Ho L, Khoo RH, Huang C, Cook A, William L, Johnson CE. Symptom trajectories for palliative care inpatients with and without hyperactive delirium in the last week of life. J Adv Nurs 2021; 78:142-153. [PMID: 34252213 DOI: 10.1111/jan.14966] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
AIMS Hyperactive delirium (HD) is a common and distressing symptom among palliative care patients. This study aimed to describe the characteristics of HD and associated symptoms among palliative care inpatients and evaluate relationships between HD development and symptom trajectories in this population. DESIGN A retrospective study was conducted. METHODS A retrospective review of medical records was conducted for all patients who died in a large Australian specialist palliative care unit between 1 January and 31 December 2019. Patients were assessed daily using the Symptoms Assessment Scale (SAS) and Palliative Care Problem Severity Scale (PCPSS). Multilevel models were used to estimate the differences in symptoms trajectories in the last 7 days of life between the two groups. RESULTS Of the 501 included patients, 64.5% (323) had an episode of HD. For 30% (95) of patients, HD occurred prior to admission. Compared with patients without HD, those with HD had significantly higher odds ratios (ORs) for four of the seven SAS symptoms (sleep problems, appetite, fatigue and pain; OR range: 1.94-4.48, p < .05), and all four PCPSS items (OR range: 2.00-3.00, p < .05) in the last week of life. CONCLUSIONS Palliative care inpatients commonly experience HD in their last week of life. There are higher levels of symptom distress, complexity, psychological concerns and family/carer concerns among patients with HD compared with those without HD. IMPACT The high prevalence of HD, and its association with higher levels of symptom distress, highlights the importance of routine screening and optimal management for HD among palliative care patients. Given the widely recognized challenges facing palliative care professionals in assessment and management of delirium, provision of relevant training among these professionals is recommended.
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Affiliation(s)
- Yunyun Dai
- School of Nursing, Guilin Medical University, Guilin, China
| | - Grace Walpole
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Cian Scanlon
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia
| | - Luke Ho
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia
| | - Ru Hui Khoo
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Angus Cook
- Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Leeroy William
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Claire E Johnson
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Monash Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
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11
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Stephens E, William L, Lim LL, Allen J, Zappa B, Newnham E, Vivekananda K. Complex conversations in a healthcare setting: experiences from an interprofessional workshop on clinician-patient communication skills. BMC Med Educ 2021; 21:343. [PMID: 34126985 PMCID: PMC8204413 DOI: 10.1186/s12909-021-02785-7] [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] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Communication is pivotal to the effective care and treatment of patients in our health care systems. Despite this understanding, clinicians are not sufficiently educated to confidently conduct complex discussions with patients. Communication skills workshops have been shown to be an effective educational format to improve clinician skills. However, despite the increasing interprofessional focus within modern medicine, there have been few studies looking at interprofessional communication workshops. METHODS A qualitative study was conducted to assess how an interprofessional communication skills workshop affected the communication skills of clinicians at a tertiary health service. Pre- and post-workshop surveys were undertaken by participants, followed by focus group interviews eight-weeks post workshop. RESULTS Clinicians were able to incorporate learnt communication skills into their daily practice. This was associated with an improvement in confidence of clinicians in having complex discussions, in addition to a reduction in the burden of having complex discussions. Participants responded positively to the interdisciplinary format, reporting benefits from the learning experience that translated into daily practice. CONCLUSION Clinicians' communication skills in conducting complex clinician-patient conversations can be improved by participation in interprofessional communication skills workshops. We identified that the interprofessional aspect of the workshops not only improved interprofessional understanding and relationships, but also developed increased self-awareness during complex discussions, and reduced the sense of burden felt by clinicians.
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Affiliation(s)
- Edward Stephens
- Eastern Health, Arnold Street, Box Hill, Victoria, Australia.
| | - Leeroy William
- Eastern Health, Arnold Street, Box Hill, Victoria, Australia
| | - Lyn-Li Lim
- Eastern Health, Arnold Street, Box Hill, Victoria, Australia
| | - Judy Allen
- Eastern Health, Arnold Street, Box Hill, Victoria, Australia
| | - Bernadette Zappa
- Eastern Health Cancer Services, Eastern Health, Arnold Street, Box Hill, Victoria, Australia
| | - Evan Newnham
- Eastern Health, Arnold Street, Box Hill, Victoria, Australia
| | - Kitty Vivekananda
- Monash University, Level 1 Learning and Teaching Building, 19 Ancora Imparo Way, Clayton, Victoria, Australia
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12
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Affiliation(s)
- Eswaran Waran
- Eastern Health Melbourne VIC
- Monash University Melbourne VIC
| | - Leeroy William
- Eastern Health Melbourne VIC
- Monash University Melbourne VIC
- La Trobe University Melbourne VIC
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13
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Chosich B, Burgess M, Earnest A, Franco M, Runacres F, William L, Poon P, Yoong J. Cancer patients' perceptions of palliative care. Support Care Cancer 2019; 28:1207-1214. [PMID: 31218415 DOI: 10.1007/s00520-019-04917-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 02/09/2019] [Accepted: 06/05/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Despite clear benefits of early integration of palliative care (PC) and oncology, concerns remain about negative perceptions of PC. Our aim was to explore current knowledge and perceptions of PC in cancer patients. METHODS We conducted a prospective, cross-sectional survey. A 16-item questionnaire was distributed to all cancer patients (N = 103) upon admission to the oncology ward of an Australian tertiary academic hospital. Chi-squared test was used to examine for significant factors related to patients' perceptions. RESULTS Ninety-six patients (93%) completed the questionnaire; 76% had metastatic cancer. We explored the following domains:Experience and knowledge: 76% had heard of PC; 21% had received PC. Self-rated PC knowledge was varied. Forty-five percent believed that PC was only associated with EOLC; those more likely to disagree had received PC services (p = 0.039).Integration of PC and oncology: Majority believed that they could receive oncology care (86%) and anti-cancer treatment (81%) whilst receiving PC. Those who had heard of PC and with better self-rated knowledge were more likely to believe that they could receive concurrent anti-cancer treatment (p = 0.005, p = 0.045, respectively).Feelings: 77% felt comforted with PC involvement; this was significantly associated with older age (p = 0.047) and understanding that oncology (p < 0.005) and anti-cancer treatment (p = 0.013) could continue. However, some felt frightened (40%) and hopeless (29%) about referral to PC. Fifty percent felt more comfortable with referral to 'supportive care' services (versus PC). CONCLUSIONS Our survey demonstrates reasonable understanding and relatively positive feelings about PC, associated with experience and knowledge. Nonetheless, there is ongoing need for better patient and public education about PC.
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Affiliation(s)
- Benjamin Chosich
- McCulloch House Supportive and Palliative Care Unit, Monash Health, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Monash University, Melbourne, VIC, Australia
| | - Marjorie Burgess
- McCulloch House Supportive and Palliative Care Unit, Monash Health, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Monash University, Melbourne, VIC, Australia
| | | | - Michael Franco
- McCulloch House Supportive and Palliative Care Unit, Monash Health, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Monash University, Melbourne, VIC, Australia
| | - Fiona Runacres
- McCulloch House Supportive and Palliative Care Unit, Monash Health, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Monash University, Melbourne, VIC, Australia.,Calvary Health Care Bethlehem, Melbourne, VIC, Australia.,The University of Notre Dame, Darlinghurst, NSW, Australia
| | - Leeroy William
- McCulloch House Supportive and Palliative Care Unit, Monash Health, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Monash University, Melbourne, VIC, Australia.,Eastern Health, Melbourne, VIC, Australia
| | - Peter Poon
- McCulloch House Supportive and Palliative Care Unit, Monash Health, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Monash University, Melbourne, VIC, Australia
| | - Jaclyn Yoong
- McCulloch House Supportive and Palliative Care Unit, Monash Health, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia. .,Monash University, Melbourne, VIC, Australia. .,Northern Health, Melbourne, VIC, Australia.
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14
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Sladden T, Hopkins P, Linhardt R, Chambers D, Yerkovich S, Pohlner P, Prabhu A, William L, Zhang F, Yu Y, Han X, Ouyang Y. Hyaluronan in Ex Vivo Lung Perfusion: A Key Component in Lung Endothelium and Possible Therapeutic Intervention. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.062] [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: 10/26/2022]
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15
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Affiliation(s)
- Wendy Margaret Muircroft
- Locum Specialist in Palliative Medicine, North Shore Hospice, 7 Shea Terrace, Takapuna, Auckland, 0622 New Zealand
| | - Judy McKimm
- Centre for Medical and Health Sciences, University of Auckland, Auckland, New Zealand, and University of Bedfordshire, Luton, UK
| | - Leeroy William
- McCulloch House, Supportive and Palliative Care Unit, Melbourne, Australia
| | - Roderick Duncan MacLeod
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
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16
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Tham K, Kenner DJ, William L. Inpatients With Advanced Lung Cancer: Palliative Care Service Referral Rates, Symptom Profile, and Outcomes in a Teaching Hospital Network-An Exploratory Study. J Palliat Care 2018; 34:245-247. [PMID: 30381989 DOI: 10.1177/0825859718810720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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]
Affiliation(s)
- Kathryn Tham
- Palliative Care Service, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - David J Kenner
- Specialist Palliative Care Service North, Launceston, Tasmania, Australia
| | - Leeroy William
- Eastern Health, Melbourne, Australia.,Monash University, Melbourne, Australia
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17
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William L. Medical assistance in dying: a disruption of therapeutic relationships. Med J Aust 2018; 209:286-287. [DOI: 10.5694/mja17.01217] [Citation(s) in RCA: 3] [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] [Received: 12/09/2017] [Accepted: 04/09/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Leeroy William
- Eastern Health, Melbourne, VIC
- Monash University, Melbourne, VIC
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18
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Yoong J, Chosich B, Burgess M, Earnest A, Runacres F, William L, Franco M, Poon P. Cancer patients’ perceptions of palliative care. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy295.012] [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: 11/13/2022] Open
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19
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Yoong J, Franco M, William L, Poon P. Perspectives of cancer treatment providers regarding voluntary assisted dying in Victoria. Intern Med J 2018; 48:770-773. [DOI: 10.1111/imj.13939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jaclyn Yoong
- Supportive and Palliative Care Unit; Monash Health; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - Michael Franco
- Supportive and Palliative Care Unit; Monash Health; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - Leeroy William
- Supportive and Palliative Care Unit; Monash Health; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - Peter Poon
- Supportive and Palliative Care Unit; Monash Health; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
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20
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Negrini S, Arienti C, William L, Grubišic F, Ilieva E, Gimigliano F, Meyer T, Engkasan J, Rathore F, Malmivaara A, Oral A, Pollet J, Howe T, Kiekens C. Organization and functioning of Cochrane rehabilitation field. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1228] [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: 11/25/2022]
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21
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Graef F, Mutabazi KD, Sieber S, Asch F, Makoko B, Bonatti M, Brüntrup M, Gornott C, Herrmann L, Herrmann R, Kaburire L, Kahimba FC, Kimaro A, Kuntosch A, König HJ, Lagwen P, Lana MA, Lambert C, Levy C, Löhr K, Maeda C, Mbwana H, Mchau D, Mnimbo MT, Munder S, Mwinuka L, Ngwenya P, Nickson E, Nkonya E, Saidia P, Schäfer MP, Schindler J, Silayo V, Uckert G, Wambura J, William L. Multi-Disciplinary North-South Collaboration in Participatory Action Research on Food Value Chains: a German-Tanzanian Case Study on Perceptions, Experiences and Challenges. Syst Pract Action Res 2018. [DOI: 10.1007/s11213-018-9458-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Poon P, Shaw T, Franco M, Runacres F, William L, Yoong J. Successful large volume 'lymphocentesis' for refractory lymphoedema in lower and upper limbs. Intern Med J 2017; 47:607. [PMID: 28503873 DOI: 10.1111/imj.13410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Poon
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Eastern Palliative Care, Melbourne, Victoria, Australia
| | - Tiffany Shaw
- Austin Health, Melbourne, Victoria, Australia.,Bupa Aged Care, Sydney, New South Wales, Australia
| | - Michael Franco
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Fiona Runacres
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Calvary Health Care Bethlehem, Melbourne, Victoria, Australia.,The University of Notre Dame, Sydney, New South Wales, Australia
| | - Leeroy William
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Eastern Health, Melbourne, Victoria, Australia
| | - Jaclyn Yoong
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Northern Health, Melbourne, Victoria, Australia
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23
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Yoong J, Chandra RV, William L, Franco M, Goldschlager T, Runacres F, Poon P. Percutaneous Sacroplasty for Painful Bone Metastases: A Case Report. Pain Pract 2016; 17:945-951. [PMID: 27910200 DOI: 10.1111/papr.12538] [Citation(s) in RCA: 3] [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] [Received: 06/06/2016] [Revised: 09/08/2016] [Accepted: 10/16/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The occurrence of bone metastases is common in patients with advanced cancer. The literature supports percutaneous vertebroplasty and kyphoplasty as minimally invasive procedures to relieve pain and improve quality of life for selected patients with disabling pain from pathological vertebral fractures secondary to bone metastases. CASE We describe a case of a 71-year-old patient with castrate-resistant metastatic prostate cancer who underwent sacroplasty for painful sacral metastases. The patient had previously been treated with maximally tolerated analgesics and anticancer therapies including systemic anticancer treatments and local radiotherapy. After sacroplasty, he experienced significant pain reduction and improvement in mobility and function. CONCLUSION This case and recent literature demonstrate positive outcomes of sacroplasty in terms of pain reduction and improved mobility. Further research is warranted to establish the role of such minimally invasive percutaneous procedures for pain management in cancer patients.
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Affiliation(s)
- Jaclyn Yoong
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Northern Health, Melbourne, Victoria, Australia
| | - Ronil Vikesh Chandra
- Monash University, Melbourne, Victoria, Australia.,Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Leeroy William
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Eastern Health, Melbourne, Victoria, Australia
| | - Michael Franco
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Tony Goldschlager
- Monash University, Melbourne, Victoria, Australia.,Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Fiona Runacres
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Calvary Health Care Bethlehem, Melbourne, Victoria, Australia
| | - Peter Poon
- Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Eastern Palliative Care, Melbourne, Victoria, Australia
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24
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Waran E, William L. Hip fractures and dementia: clinical decisions for the future. Oxf Med Case Reports 2016; 2016:19-21. [PMID: 26949537 PMCID: PMC4758228 DOI: 10.1093/omcr/omw001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/07/2016] [Accepted: 01/12/2016] [Indexed: 11/12/2022] Open
Abstract
Severe dementia is a life-limiting condition; hip fractures are more common in patients who have dementia. This study outlines the case of a 92-year-old female with severe dementia who sustained a hip fracture. Despite having a terminal diagnosis (severe dementia and hip fracture) and poor premorbid quality of life, she had a life-prolonging surgery. The report outlines issues around treatment options in such circumstances, informed consent and substitute decision-making. The authors propose a 'goals of care' approach to manage patients in whom the best treatment is unclear, during their attendance to the emergency department. It is suggested that utilization of such a model may help with substitute decision-making and true informed consent.
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Affiliation(s)
- Eswaran Waran
- Territory Palliative Care , Royal Darwin Hospital , Tiwi, NT, Australia
| | - Leeroy William
- Monash Health, Clayton, VIC, Australia; Eastern Health, Box Hill, VIC, Australia; Monash University, Clayton, VIC, Australia
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Collazossp F, Gutierrez C, ruth P, Carmen V, William L. Immigrants in emergency rooms: The role of culture in the diagnostic process and diagnostic certainty. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.280] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IntroductionTransnationalism provides a serious challenge in mental health care, especially due to the crucial role of communication. Emergency room interactions offer an opportunity to analyze the role of cultural competency among providers and how they relate to immigrants in the clinical encounter.ObjectivesThis study addresses three aims: to assess the level of provider-perceived accuracy of diagnoses; to evaluate the use of restraints; and to compare diagnoses rates between patients of diverse racial/ethnic groups.MethodsWe examined patients’ race/ethnicity and their relation to service use and perceived certainty of mental health diagnoses. Three hundred and forty-seven migrants and 67 natives as well as their providers were interviewed in psychiatry emergency rooms in Barcelona (Spain).ResultsThe perceived certainty of clinical diagnosis is lower for Asians (OR = 0.2, 95% CI [0.07–0.63]), and higher when the clinician feels comfortable with the patient (OR = 5.41, 95% CI [2.53–11.58]). The probability of restraints is higher for Maghreb patients compared to native born (OR = 3.56, 95% CI [1.03–12.26]). The probability of compulsory admission is lower for Latinos compared to native born (OR = 0.26, 95% CI [0.08–0.88]). The probability of receiving a diagnosis of psychosis is lower when the clinician can communicate in the patient's language (OR = 0.37, CI 95% [0.16–0.83]).ConclusionsCultural factors such as level of comfort and communication in the patient's language play a central role in diagnosis and treatment. This study highlights the importance of culture in psychiatric diagnosis and the role of cultural competency for mental health providers.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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26
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William L, Jackson K, Bostanci A, Ward J, Martin P, Pittman L, Moore G. Diagnosis matters: the differing
clinical trajectories for terminal prostate,
lung and haematological cancers. Aust Fam Physician 2015; 44:479-484. [PMID: 26590493] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND There is a belief that end-of-life care issues are similar for all cancer patients, irrespective of their primary cancer diagnosis. This exploratory study into the terminal trajectories of three common cancers challenges this belief. METHODS A retrospective, systematic, and mixed qualitative and quantitative medical record review of 30 deceased patients in 2010 was performed between two Victorian networks. The last 90 days of life were examined in three equally distributed cancer groups - prostate, lung and haematological. RESULTS The trajectories for the three malignancies differed in temporal, symptomatic, supportive and interventional characteristics. DISCUSSION Our study suggests diagnosis does indeed matter. The varying symptomatology for the different cancers markedly influenced clinical management, utilisation of palliative care services and the site of care and site of death. Our study suggests potential areas for better collaboration between general practitioners, community and specialist palliative care services. Emerging work supports our findings, but this area warrants further research.
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Affiliation(s)
- Leeroy William
- BSc (Hons), MBBS, MRCGP, FAChPM (RACP), Palliative Care Physician, Supportive and Palliative Care Unit, Monash Health and Monash University, Clayton, VIC
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Li Y, Jackson KA, Slon B, Hardy JR, Franco M, William L, Poon P, Coller JK, Hutchinson MR, Currow DC, Somogyi AA. CYP2B6*6 allele and age substantially reduce steady-state ketamine clearance in chronic pain patients: impact on adverse effects. Br J Clin Pharmacol 2015; 80:276-84. [PMID: 25702819 DOI: 10.1111/bcp.12614] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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: 09/28/2014] [Revised: 12/07/2014] [Accepted: 02/16/2015] [Indexed: 01/10/2023] Open
Abstract
AIMS Ketamine analgesia is limited by low intrinsic efficacy compounded by large interindividual variability in drug responses, possibly due to the heterogeneity in drug concentration. The CYP2B6*6 allele is associated with substantially reduced ketamine metabolism in vitro and, therefore, may affect ketamine clearance. Our aims were to examine the impact of the CYP2B6*6 allele on ketamine plasma clearance and on adverse effects in chronic pain patients. METHODS CYP2B6 genotypes were identified in 49 chronic pain patients who received 24 h continuous subcutaneous infusions of ketamine. Steady-state plasma concentrations of ketamine (Css,k ) and norketamine (Css,nk ) were determined using HPLC. RESULTS The median plasma clearance of ketamine after 100 mg 24 h(-1) dose was significantly lower in patients with the CYP2B6*6/*6 (21.6 l h(-1) ) and CYP2B6*1/*6 (40.6 l h(-1) ) genotypes compared with patients with the CYP2B6*1/*1 genotype (68.1 l h(-1) , P < 0.001). The ketamine : norketamine plasma metabolic ratio was significantly higher in patients with the CYP2B6*6/*6 genotype than in those with the CYP2B6*1/*6 and the CYP2B6*1/*1 genotypes (P < 0.001). Patients who experienced adverse effects had lower plasma clearance (45.6 l h(-1) ) than those who did not (52.6 l h(-1) , P = 0.04). The CYP2B6*6 genotype and age, and their combined impact explained 40%, 30% and 60% of the variation in Css,k , respectively. Similar results were observed after higher doses. CONCLUSIONS The CYP2B6*6 allele is associated with a substantial decrease in steady-state ketamine plasma clearance in chronic pain patients. The decreased clearance and resultant higher plasma concentrations may be associated with a higher incidence of ketamine adverse effects.
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Affiliation(s)
- Yibai Li
- Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kate A Jackson
- Supportive and Palliative Care Unit, Monash Health and Monash University, Monash Medical Centre, Victoria, Australia
| | - Barry Slon
- Department of Anaesthesia, Monash Medical Centre, Victoria, Australia
| | - Janet R Hardy
- Department of Palliative Care, Mater Adult Hospital, Brisbane, Australia
| | - Michael Franco
- Supportive and Palliative Care Unit, Monash Health and Monash University, Monash Medical Centre, Victoria, Australia
| | - Leeroy William
- Supportive and Palliative Care Unit, Monash Health and Monash University, Monash Medical Centre, Victoria, Australia
| | - Peter Poon
- Supportive and Palliative Care Unit, Monash Health and Monash University, Monash Medical Centre, Victoria, Australia
| | - Janet K Coller
- Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Mark R Hutchinson
- Discipline of Physiology, School of Medical Sciences, University of Adelaide, Adelaide, Australia
| | - David C Currow
- Department of Palliative and Supportive Service, Flinders University, Adelaide, Australia
| | - Andrew A Somogyi
- Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Adelaide, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia.,Centre for Personalised Cancer Medicine, University of Adelaide, Adelaide, Australia
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Hosking SPM, Franco ME, Poon P, William L. Bilateral cordotomy post-failure of intrathecal analgesia in a palliative care setting. Intern Med J 2015; 45:586-7. [PMID: 25955466 DOI: 10.1111/imj.12743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/02/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S P M Hosking
- Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - M E Franco
- Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - P Poon
- Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Monash University, Melbourne, Victoria, Australia.,Eastern Palliative Care Association, Melbourne, Victoria, Australia
| | - L William
- Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Monash University, Melbourne, Victoria, Australia.,Palliative Care Department, Eastern Health, Melbourne, Victoria, Australia
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Bostanci A, Horey D, Jackson K, William L, Pittmann L, Ward J, Moore G, Martin P, Hudson P, Philip J. Insights into hospitalisation of advanced cancer patients: a study of medical records. Eur J Cancer Care (Engl) 2015; 25:190-201. [PMID: 25904221 DOI: 10.1111/ecc.12295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/27/2022]
Abstract
The aim of this study was to explore reasons for the hospitalisation and place of death outcomes of terminal cancer patients. The methodology involved a qualitative content analysis of medical records pertaining to the last 3 months of life of 39 patients with one of four malignancies: prostate, breast, lung, or haematological. The results presentation is organised around three themes: decision hierarchy in health care, meanings of 'home', and late recognition of dying. Based on the detailed findings, this paper suggests that important insights into the broader goals of advanced cancer patients are offered by allied health staff, and that more effective use of the multidisciplinary team may support endeavours to achieve more home deaths for cancer patients who want this outcome. The analysis also provides new insights into the meaning of 'home' in interactions between advanced cancer patients and health professionals. The wish for 'home' appears bound up with other patient goals and the implications of this are discussed.
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Affiliation(s)
- Adam Bostanci
- Centre for Palliative Care, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
| | - Dell Horey
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kate Jackson
- McCulloch House, Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia
| | - Leeroy William
- McCulloch House, Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia
| | - Lise Pittmann
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Jennifer Ward
- McCulloch House, Supportive and Palliative Care Unit, Monash Health, Melbourne, Victoria, Australia
| | - Gaye Moore
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Peter Martin
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Centre for Palliative Care, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
BACKGROUND Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered. AIMS We aim to review the characteristics and compare outcomes of rapid response team consultations on patients with and without a life-limiting illness. DESIGN/SETTING A 3-month retrospective cohort study of all rapid response team consultations was conducted. The sample population included all adult inpatients in a major teaching hospital network. RESULTS We identified 351 patients - including 139 with a life-limiting illness - receiving a total of 456 rapid response team consultations. The median time from admission to the first rapid response team consultation was 3 days. Patients with a life-limiting illness had a significantly higher mortality rate (41.7% vs 13.2%), were older (72.6 vs 63.5 years), more likely to come from a residential aged-care facility (29.5% vs 4.1%) and had a shorter hospital stay (10 vs 13 days). Rapid response team consultations resulted in a change to more palliative goals of care in 28.5% of patients, of whom two-thirds had a life-limiting illness. CONCLUSION Patients with a life-limiting illness had worse outcomes post-rapid response team consultation. Our findings suggest that a routine clarification of goals of care for this cohort, within 3 days of hospital admission, may be advantageous. These discussions may provide clarity of purpose to treating teams, reduce the burden of unnecessary interventions and promote patient-centred care agreed upon in advance of any deterioration.
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Affiliation(s)
- Merlina Sulistio
- Department of Palliative Medicine, Cabrini Health, Melbourne, VIC, Australia
| | - Michael Franco
- McCulloch House Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia Monash University, Melbourne, VIC, Australia
| | - Amanda Vo
- McCulloch House Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Peter Poon
- McCulloch House Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia Monash University, Melbourne, VIC, Australia Eastern Palliative Care, Melbourne, VIC, Australia
| | - Leeroy William
- McCulloch House Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia Monash University, Melbourne, VIC, Australia Palliative Care Unit, Eastern Health, Melbourne, VIC, Australia
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Franco M, William L, Poon P, Jackson K. Critical appraisal of randomized controlled trials: the beginning of thought…. J Pain Symptom Manage 2014; 47:e1-2. [PMID: 24480528 DOI: 10.1016/j.jpainsymman.2013.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 11/23/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Franco
- Palliative and Supportive Care Unit, Monash Cancer Centre, Monash Health, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Leeroy William
- Palliative and Supportive Care Unit, Monash Health, Faculty of Medicine, Monash University, Palliative Care Service, Eastern Health, Melbourne, Victoria, Australia
| | - Peter Poon
- Palliative and Supportive Care Unit, Monash Health, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kate Jackson
- Palliative and Supportive Care Unit, Monash Health, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
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Affiliation(s)
- Michael Franco
- Palliative and Supportive Care Unit, Monash Health; Monash Cancer Centre, Monash Health, Melbourne, Australia
| | - Leeroy William
- Palliative and Supportive Care Unit, Monash Health; Monash Cancer Centre, Monash Health, Melbourne, Australia
| | - Peter Poon
- Palliative and Supportive Care Unit, Monash Medical Centre, Monash Health; Monash University, Melbourne, Australia
| | - Arun Azad
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Jackson K, Franco M, William L, Poon P, Pisasale M, Kenner D, Brumley D, Mewett G, Ashby M, Viney M, Kerr D. Ketamine and cancer pain: the reports of my death have been greatly exaggerated. J Clin Oncol 2013; 31:1373-4. [PMID: 23423743 DOI: 10.1200/jco.2012.47.1235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hu YL, De Lay M, Rose SD, Carbonell WS, Aghi MK, Rose SD, Carbonell WS, De Lay M, Hu YL, Paquette J, Tokuyasu T, Tsao S, Chaumeil M, Ronen S, Aghi MK, Matlaf LA, Soroceanu L, Cobbs C, Soroceanu L, Matlaf L, Harkins L, Cobbs C, Garzon-Muvdi T, Rhys CA, Smith C, Kim DH, Kone L, Farber H, An S, Levchenko A, Quinones-Hinojosa A, Lemke D, Pfenning PN, Sahm F, Klein AC, Kempf T, Schnolzer M, Platten M, Wick W, Smith SJ, Rahman R, Rahman C, Barrow J, Macarthur D, Rose F, Grundy RG, Kaley TJ, Huse J, Karimi S, Rosenblum M, Omuro A, DeAngelis LM, de Groot JF, Kong LY, Wei J, Wang T, Piao Y, Liang J, Fuller GN, Qiao W, Heimberger AB, Jhaveri N, Cho H, Torres S, Wang W, Schonthal A, Petasis N, Louie SG, Hofman F, Chen TC, Yamada R, Sumual S, Buljan V, Bennett MR, McDonald KL, Weiler M, Pfenning PN, Thiepold AL, Jestaedt L, Gronych J, Dittmann LM, Jugold M, Kosch M, Combs SE, von Deimling A, Weller M, Bendszus M, Platten M, Wick W, Kwiatkowska A, Paulino V, Tran NL, Symons M, Stockham AL, Borden E, Peereboom D, Hu Y, Chaturbedi A, Hamamura M, Mark E, Zhou YH, Abbadi S, Guerrero-Cazares H, Pistollato F, Smith CL, Ruff W, Puppa AD, Basso G, Quinones-Hinojosa A, Monje M, Freret ME, Masek M, Fisher PG, Haddix T, Vogel H, Kijima N, Hosen N, Kagawa N, Hashimoto N, Fujimoto Y, Kinoshita M, Sugiyama H, Yoshimine T, Anneke N, Bob H, Pieter W, Arend H, William L, Eoli M, Calleri A, Cuppini L, Anghileri E, Pellegatta S, Prodi E, Bruzzone MG, Bertolini F, Finocchiaro G, Zhu D, Hunter SB, Vertino PM, Van Meir EG, Cork SM, Kaur B, Cooper L, Saltz JH, Sandberg EM, Van Meir EG, Burrell K, Hill R, Zadeh G, Parker JJ, Dionne K, Massarwa R, Klaassen M, Niswander L, Kleinschmidt-DeMasters BK, Waziri A, Jalali S, Wataya T, Salehi F, Croul S, Gentili F, Zadeh G, Jalali S, Foltz W, Burrell K, Lee JI, Agnihorti S, Menard C, Chung C, Zadeh G, Torres S, Jhaveri N, Wang W, Schonthal AH, Louie SG, Hofman FM, Chen TC, Elena P, Faivre G, Demopoulos A, Taillibert S, Rosenblum M, Omuro A, Kirsch M, Martin KD, Bertram A, uckermann O, Leipnitz E, Weigel P, Temme A, Schackert G, Geiger K, Gerstner E, Jennings D, Chi AS, Plotkin S, Kwon SJ, Pinho M, Polaskova P, Batchelor TT, Sorensen AG, Hossain MB, Gururaj AE, Cortes-Santiago N, Gabrusiewicz K, Yung WKA, Fueyo J, Gomez-Manzano C, Gil OD, Noticewala S, Ivkovic S, Esencay M, Zagzagg D, Rosenfeld S, Bruce JN, Canoll P, Chang JH, Seol HJ, Weeks A, Smith CA, Rutka JT, Georges J, Samuelson G, Misra A, Joy A, Huang Y, McQuilkin M, Yoshihiro A, Carpenter D, Butler L, Feuerstein B, Murphy SF, Vaghaiwalla T, Wotoczek-Obadia M, Albright R, Mack D, Lawn S, Henderson F, Jung M, Dakshanamurthy S, Brown M, Forsyth P, Brem S, Sadr MS, Maret D, Sadr ES, Siu V, Alshami J, Trinh G, Denault JS, Faury D, Jabado N, Nantel A, Del Maestro R. ANGIOGENESIS AND INVASION. Neuro Oncol 2011; 13:iii1-iii9. [PMCID: PMC3222963 DOI: 10.1093/neuonc/nor147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
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Muircroft WM, McKimm J, William L, MacLeod RD. A New Zealand perspective on palliative care for Māori. J Palliat Care 2010; 26:54-58. [PMID: 20402187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Wendy Margaret Muircroft
- Locum Specialist in Palliative Medicine, North Shore Hospice, 7 Shea Terrace, Takapuna, Auckland, 0622 New Zealand.
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Abstract
Breakthrough pain (BTP) in patients with cancer lacks a consensus definition and is subsequently inadequately diagnosed and assessed, therefore making it more challenging to manage. Cancer pain is generally moderate to severe in intensity and persistent in nature. Despite the problematic definition of BTP, it is generally described as having similar intensity, but may also be transitory and variable in predictability. Most breakthrough analgesia fails to be effective in the time required for BTP. No useful analgesia is therefore provided but drug adverse effects escalate. Cancer pain management relies on the WHO analgesic ladder. The frequency of BTP and its inadequate management means that it has significant adverse effects on patients, their families and those involved in their care. This article outlines a systematic, clinical and evidence-based approach to managing BTP in patients with cancer that emphasizes a holistic approach and an understanding of multidimensional 'total pain'. Guidelines for managing BTP are presented and areas of developing research are identified.
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Earnhardt JN, McCray B, Dobrzeniecka M, Keeler BE, Tabernilla AVC, Nick HS, Anderson DK, Evelyn F, William L. Quantitative assessment of gene expression following acute spinal cord injury. J Neurochem 2008. [DOI: 10.1046/j.1471-4159.81.s1.41_2.x] [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: 11/20/2022]
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Meyers FJ, Cardiff RD, Quadro R, Gribble M, Kohler M, Medrano V, Mitchell EP, Shiffman R, William L. Epirubicin in non-oat cell lung cancer--response rates and the importance of immunopathology: a Northern California Oncology Group Study. Cancer Treat Rep 1986; 70:805-6. [PMID: 2425963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Meyers FJ, Lewis B, Mitchell E, William L, Hannigan JF, Gribble M, Torti FM. Phase II trial of 4'-epi-doxorubicin in advanced colorectal carcinoma: a Northern California Oncology Group study. Cancer Treat Rep 1985; 69:143-4. [PMID: 3855385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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