Palliative Medicine Research The National Agenda and Lancaster Initiatives Mike Bennett Professor of...
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Transcript of Palliative Medicine Research The National Agenda and Lancaster Initiatives Mike Bennett Professor of...
Palliative Medicine ResearchThe National Agenda and Lancaster Initiatives
Mike BennettProfessor of Palliative Medicine
Lancaster University
Before 1987…
• Single centre studies
• Largely observational
• Charismatic champions of research
• Cicely Saunders original vision– clearly stated research is
integral to hospice care
• Robert Twycross
• The first RCT in palliative care?
Br J Pharmacol. 1972 November; 46(3): 554P–555P.
1987 - 2000
• Palliative Care Research Society– Formed as PCRF in 1995– dedicated to promoting research into all aspects
of palliative care and to facilitating its dissemination.
• EAPC research forum – First meeting in Berlin 2000– HQ in Trondheim, Norway (Prof Stein Kaasa)
1987 - 2000
• In 1988– Zero academic chairs in palliative medicine
• In 1998– 5 substantive academic chairs in palliative
medicine (not honorary)• London (2) - Kings, St Thomas’• Bristol, Cardiff, and Sheffield
1987 - 2000• Steady output of
descriptive research
• Few RCTs, all around service delivery
Palliat Med. 1995 Jan;9(1):27-35. LinksRegional Study of Care for the
Dying: methods and sample characteristics.
Addington-Hall J, McCarthy M.
British Journal of Cancer (2002) 87, 733-739.
The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team
G W Hanks et al
2000 - 2008Strategic initiatives
• 2001– NCRI formed and
established Strategic Planning Group for palliative care research (2002)
• 2003– Palliative Care clinical
studies group formed within NCRN
2000 - 2008
• 2006– Additional funding for 2 ‘SuPaC’ research
collaboratives (£1.9m each over 5 years)
2000 - 2008
• COMPASS:– COMPlex Interventions: Assessment, TrialS and
Implementation of Services• www.compasscollaborative.com
• CECo – Cancer Experiences Collaborative• www.ceco.org.uk
2000 - 2008Research priorities
• Yorkshire scoping exercise– Symptoms– Service delivery– Poor capacity
• but better in hospices
• Other surveys– ‘Coal face workers’
• symptom management dominates– ‘Ivory tower academics’
• Methodological issues e.g. outcomes assessment, design
Current activity
• NCRN Palliative Care group– 4 subgroups• Pain (Prof Fallon)• Prognostication (Dr Stone)• Breathlessness (Dr Booth)• Cachexia (Dr Wilcock)
Future challenges
• Intervention studies– testing hypotheses– answering important clinical questions about
therapies
• Multicentre studies– conducting research effectively– answering questions with greater power– harnessing potential of hospices
Future challenges
• Primary palliative care – Service delivery• Including symptom control at home
– Integration of ‘community’ services• Primary care• Hospice services• Community specialist nurses
Future challenges
• End of life care strategy – Prognostication
– Service delivery for patients at home• or ‘in the community’
Current themes and activities
• 1. Cancer pain– 1.1. Older people’s experiences– 1.2. Educational interventions– 1.3. TENS clinical trial– 1.4. QST to determine analgesic therapy
• 2. End of Life Care– 2.1. Screening for psychological distress– 2.2. Impact of information on rehydration decisions
The vision• Create network of research active hospices in
North Lancashire and Cumbria
• Undertake UKCRN portfolio research studies– locally developed – contribute to multicentre recruitment
• Building capacity – involving clinical staff in research– integrating research activity and findings into routine
palliative care services
Network of research active hospices
• Core funding from Cumbria and Lancashire CLRN to support 3 hospices– £55k per year for 3 years– Lancaster, Blackpool, Preston– Consultant sessions – Full time health research practitioner• Will co-ordinate governance and management of
studies• Attract additional research support staff
Network studies
• DVD trial – Brief educational
intervention for cancer pain
– Feasibility study underway
– RCT planned early 2009
• Links with industry• Increased capacity for pharma trials
– Nasal fentanyl for breakthrough pain– Methylnaltrexone for opioid induced constipation
• Contributing to other multicentre UKCRN trials• Fatigue
– Using exercise as an outcome measure • Breathlessness
– RCT of fan for breathlessness• Pain
– S-ketamine in cancer neuropathic pain
Network studies