Concord Hospital Concord Hospital
Palliative Care Service

Research Projects

The Concord Palliative care service is an active member of the following palliative care clinical trials collaboratives:
PaCCSC: Palliative Care Clinical Studies Collaborative
The Palliative Care Clinical Studies Collaborative (PaCCSC) is a national research network that aims to:
·Generate high quality research evidence to support the use of medicines and other interventions at the end of life to better manage or alleviate symptoms in patients such as: pain; confusion; breathlessness; appetite; and gastrointestinal problems including nausea; bowel obstruction; and constipation.
·Build capacity within the health workforce in the conduct of high quality clinical research in patients nearing the end of life and the translation of research results into clinical practice
 
ImPaCCT: Improving Palliative Care through Clinical Trials
ImPaCCT (Improving Palliative Care through Clinical Trials) is the New South Wales (NSW) collaborative clinical trials group in palliative care. ImPaCCT’s mission is to improve NSW palliative care services for people with advanced cancer and other life limiting illness through ethical, scientifically rigorous, collaborative research
  
Publications
 
McKenzie H, Kwok C, Tsang H, Moreau E. Community Nursing Care of Chinese-Australian Cancer Patients: A Qualitative Study. Cancer Nurs. 2015 Jul-Aug;38(4):E53-60.
 
Garrard J, Graham C, McKinnon T, Myhill B. Key performance indicators for palliative care social work: a pilot study from New South Wales, Australia. EJPC. 2015 22(4):194-197.
 
Sanderson C, Quinn SJ, Agar M, Chye R, Clark K, Doogue M, Lee J, Lovell MR, Rowett D, Spruyt O, Currow DC. Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain. BMJ Support Palliat Care. 2014 Oct 16.
 
 
Lee YY, Hau E, Browne LH, Chin Y, Lee J, Szwajcer A. Breast irradiation causes pallor in the nipple-areolar complex in women with Celtic skin type (result from the St. George and Wollongong randomised breast boost trial). J Med Imaging Radiat Oncol. 2014 Apr;58(2):229-36.
 
Brown MA, Crail SM, Masterson R, Foote C, Robins J, Katz I, Josland E, Brennan F, Stallworthy EJ, Brennan F, Siva B, Crail S, Brennan F, Siva B, Brennan F, Brown M, Miller C, Urban AK, Sajiv C, Stallworthy EJ, Glavish RN, May S, Langham R, Walker R, Fassett RG, Morton RL, Crail SM, Stewart C, Brennan F, Phipps L, Walker R, Healy H, Berquier I, Crail SM; ANZSN renal supportive care 2013: opinion pieces [corrected]. Australian and New Zealand Society of Nephrology. Nephrology (Carlton). 2013 Jun;18(6):401-54.
 
Urban AK. Models of Care - End of Life Pathways. Nephrology (Carlton). 2013 Apr 16.
 
Palliative care teams in the intensive care unit: a randomized, controlled, feasibility study. Cheung W, Aggarwal G, Fugaccia E, Thanakrishanan G, Milliss D, Anderson R, Stock D, Bird G, Tan J, Fryc AC. Critical Care and Resuscitation 2010; 12(1): 28-35
 
Teaching Palliative Care in resource poor settings: an Australian-Malaysian collaboration. Aggarwal G, Hamzah E, Davis, JM. Together: Cultural Connections for quality care at the end of life. 10th APCC and PCA 2009
 
The effect of the palliative care team on quality indicators for end-of-life care in the intensive care unit: a randomized, controlled study. Cheung W, Aggarwal G, Fugaccia E, Thanakrishanan G, Milliss D, Anderson R, Stock D, Bird G, Tan J, Fryc AC. Together: Cultural Connections for quality care at the end of life. 10th APCC and PCA 2009
 
Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care. Clayton JM, Butow PN, Tattersall MHN, Devine RJ, Simpson JM, Aggarwal G, Clark KJ, Currow DC, Elliott LM, Lacey J, Lee PG, Noel MA. Journal Of Clinical Oncology 2007; 25(6):715-723
 
Palliative and shared care concepts in patients with advanced colorectal cancer. Aggarwal G, Glare P, Clarke S, Chapuis PH. ANZ Journal of Surgery 2006; 76:175-180
 
Promoting Patient Participation: A Randomised Controlled Trial of a Question Prompt List for Palliative Care Consultations. Clayton J, Butow P, Devine R, Noel M, Lee P, Aggarwal G, Lacey J, Simpton J, Tattersall M. ANZPM 2005
 
 
 
Concord palliative Care Service is actively involved in a number of research projects.
End of life decision making in care of the dying patient - phase 2
This is a comparative study with the data collected by the Palliative care team in 2002 around care of the dying patient at Concord Hospital. Previous international studies have revealed that dying patients can be given unnecessary medications or be subjected to unwarranted medical procedures immediately prior to dying. This research will involve a retrospective chart audit of 150 consecutive deaths at CRGH between January 2011 and June 2011. The auditing will involve identification of documentation of a not-for-resuscitation (NFR) order , the timing of the NFR order in the days prior to death and assessment whether the presence of an NFR order changes the medication given to, or interventions performed on, the patient. The study will also look at the language around death and dying and the way this has been documented in patient notes. The last 72 hours of the person's life will be studied via the medical record to document if the presence of an NFR makes any difference to patient care or level of intervention. This study will provide some insight into the care of the dying patient and provide clinicians with some evidence that may contribute toward better care of the dying patient at Concord Hospital.
Carer satisfaction survey: Evaluation of the effectiveness of the Palliative Care Consultative service at Concord Repatriation General Hospital (CRGH)
The carer satisfaction survey aims to evaluate the effectiveness of the Palliative Care Consultative service at CRGH by measuring carer satisfaction. The study will utilise the FAMCARE-2 which is a validated tool for assessing family members' perceptions of, and satisfaction with, the palliative care service offered to their loved ones. The tool contains 17 items that relate to:
  • Control of physical symptoms and comfort
  • Provision of information
  • Family support
  • Practical assistance
  • Psychological care
FAMCARE-2 is a modified version of the original FAMCARE and reflects changes in palliative care practice. These changes include a multi-disciplinary team approach to patient care as opposed to a singular clinician involvement. It also reflects the changing requirements of discharge planning and continuity of care for palliative patients from the acute setting to the home or hospice.
This tool has been utilised nationally by the Palliative Care Outcomes Collaboration (PCOC) as part of a Carer Satisfaction National Survey to assist palliative care services to improve practice and meet the Standards for Providing Quality Palliative Care for all Australians as set out by Palliative Care Australia.
 
Single Question in Delirium
Delirium is a common syndrome among cancer patients and can be distressing to patients and their families. People with delirium often stay in hospital longer and can experience additional medical complications. Early diagnosis enables us to determine the cause sooner and thus improve the success of delirium treatments.
Research has shown that the diagnosis of delirium is often missed or delayed. In order to improve detection and management we aim to develop and evaluate a simple test question for delirium that is sensitive as well as easy to use. 
Lead investigator: Dr Meg Sands, Prince of Wales Hospital
 
Opioids + 1
A five stage, national, multi-site, double-blind, parallel arm, block randomised, placebo controlled factorial (dose increment) phase III study of opioids for chronic refractory breathlessness in people with chronic obstructive pulmonary disease (COPD).
Internationally, no medication is registered for the symptomatic reduction of chronic refractory breathlessness despite recommendations from the American Thoracic Society, the American College of Physicians, the Canadian Thoracic Society and the American College of Chest Physicians that regular, low-dose morphine is the evidence-based pharmaceutical option.
The objective of this study is to compare the difference of the net clinical effect (benefits and side effects) on chronic refractory breathlessness in people with chronic obstructive pulmonary disease (COPD) taking once daily, sustained release morphine at two different doses when compared to placebo.
This study will open for recruitment shortly.
This is being conducted in conjunction with the Palliative Care Clinical Studies Collaborative. https://www.caresearch.com.au/caresearch/tabid/97/Default.aspx
 
 
The Stop Cancer PAIN Trial: A guideline implementation study
 
The Stop Cancer PAIN Trial will evaluate a complex intervention designed to implement a national clinical practice guideline and clinical pathway for screening, assessment and management of pain in adults with cancer attending oncology and palliative care outpatient services. The guideline and pathway are available free-of-charge on the Cancer Council Australia Cancer Guideline Wiki
Lead investigator: Dr Melanie Lovell, The University of Sydney and HammondCare
For more information on any of these studies, please contact Dr Jessica Lee on 97676799.