The IMPACCT Rapid Program prospectively evaluates medicines that are used on a day-to-day basis so that clinicians can make better decisions at the bedside.
Adult
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Help us guide clinicians in their understanding of which antidepressant agent could be best suited for different palliative patient profiles.
The assessment and management of depression can be challenging due to the symptoms and complications of advanced illnesses. To date, it is unclear if patients tolerate and receive actual benefit from antidepressants in real-world palliative care clinical practice, particularly when life expectancy is in the range of days to weeks.
The series will compare the clinical benefits and harms of four commonly prescribed antidepressant agents in palliative care: mirtazapine, duloxetine, citalopram and escitalopram.
By collecting data for this series, you will be helping us to understand clinicians’ prescribing practices, as well as the harms and benefits of antidepressant use in the palliative care setting.
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Benzodiazepines are sedative medications that are recommended for short-term use in the treatment of anxiety and insomnia. For some time now, benzodiazepines are also routinely recommended and prescribed as adjuvant agents in the palliation of breathlessness. However, there is no evidence for or against benzodiazepines for the relief of breathlessness in people with advanced cancer and COPD. A systematic review highlighted that benzodiazepines cause more drowsiness as an adverse effect compared to placebo and suggested that benzodiazepines may be considered as a second- or third-line treatment when opioids and non-pharmacological measures have failed to control breathlessness.
This phase IV pharmacovigilance study is uniquely examining real clinical experience when palliative care patients receive benzodiazepines as part of their dyspnoea management. This is very important data as it will not only enhance understanding of the reasons that clinicians choose to prescribe benzodiazepines but also examine the safety of the process.
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Are you treating breathlessness using handheld fans?
Clinical trials suggest that hand-held fans can improve breathlessness-related outcomes, but evidence varies between measures and patient populations. There is limited guidance for patients and clinicians on how to use hand-held fans optimally, especially in relation to other strategies for breathlessness management. It therefore seems likely that practice varies between services and clinicians, with unknown implications for effectiveness.
Help us understand clinician practices regarding hand-held fans and their perceived benefits and adverse effects in everyday clinical settings
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In this series we are striving to understand how clinicians manage sialorrhea in ALS/MND and get a sense of which interventions are effective as well as which harms are associated with interventions for sialorrhea.
We are asking clinicians about their use of glycopyrrolate, scopolamine, atropine, tricyclic antidepressants, and salivary gland botulinum toxin. We are also inviting clinicians to write in other agents or approaches they are using to manage sialorrhea in this patient population.These interventions are commonly used for sialorrhea in ALS/MND. However, there is limited evidence for the medication interventions, and they are recognised to have side effects.
Help us to better understand common practice patterns for sialorrhea management in ALS/MND and whether they vary geographically. We would also benefit from understanding which interventions are associated with improvement in sialorrhea and better characterising their toxicities. -
Pruritus is an unpleasant cutaneous sensation associated with the desire to scratch and can have a significant impact on patients’ quality of life. It is a symptom experienced in a diverse range of life-limiting illnesses in the palliative care population.
Lidocaine is a systemic local anaesthetic and membrane stabilising agent which blocks sodium channels. Anecdotal reports suggest that continuous subcutaneous infusion of lidocaine used in the palliative care setting can result in significant improvement in pruritus of various underlying causes, with rapid onset and minimal side effects or toxicity. Despite this, the evidence base for lidocaine in pruritus is currently very limited.
Help us collect data to improve the evidence base for the use of lidocaine in pruritus in palliative care and guide clinicians for best practice. -
There is wide public interest in the role of medicinal cannabis in cancer care generally, and palliative care in particular. Despite this substantial interest, many clinicians in palliative care remain wary of prescribing medicinal cannabis. They cite concerns about the lack of evidence underpinning the role of medical cannabis, concerns about the potential for adverse effects and the unconventional way by which cannabis came to be listed as a medicine in many jurisdictions, including Australia.
This series will address some of these concerns by establishing a significant database of real-time monitoring of patients prescribed cannabis who are receiving palliative care. These data will capture the benefits or effects, as well as adverse effects seen for patients. Specifically, all patients attending palliative care services who are prescribed medical cannabis for any indication will have a series of outcomes documented (1) at time of prescription, and (2) at subsequent standardised follow-up times. Outcomes of interest include evidence of effects upon symptoms such as pain, appetite, nausea, sleep and on overall quality of life. In addition, data will be collected around any evidence of adverse effects such as sedation, confusion and other potential side effects. The doses of cannabis and of other medications prescribed for symptom relief will be collected.
This important study will enable prospective monitoring of a medication that is already available and where the evidence underpinning its use is limited. Australian palliative care services are uniquely placed to contribute to this real-time data monitoring and reporting project with potential to inform practice worldwide.
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Are you prescribing or administering melatonin to people in palliative care?
This series examines the use, efficacy and safety of prescription melatonin for the treatment of insomnia in people receiving palliative care.
Melatonin, secreted by the pineal gland, is a naturally occurring hormone that regulates circadian rhythm and the sleep-wake cycle in humans. Prescription melatonin is regarded as safe and is known to improve quality of sleep as well as morning alertness in people over the age of 55.
Help us collect data to improve the evidence that information best-practice clinical decision making about prescription melatonin in palliative care.
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Worried about your patients having night sweats? If you are administering NSAIDS, corticosteroids or paracetamol for night sweats, you can help improve our understanding of how to best manage this troubling symptom.
Night sweats are prevalent for people with advanced malignant mesothelioma and other cancers. They can cause significant sleep disturbance, excessive sleepiness and mood disturbances. This impacts cancer cachexia syndrome leading to a net decrease in the overall quality of life.
Few pharmacological therapies have been trialled in the management of night sweats in people with advanced cancer, including mesothelioma. Due to the lack of evidence, there are no specific pharmacological guidelines to inform how clinicians can best manage night sweats.
This series studies three classes of medications that are often prescribed to treat night sweats – NSAIDS Corticosteroids and paracetamol. There are therefore three separate case report forms for this series – choose the one that matches the medication that you are prescribing or administering.
learn more - read the series manual (PDF, 10KB)
collect data - download the case report FORM for nsaids (PDF, 398KB)
COLLECT DATA - DOWNLOAD THE CASE REPORT FORM FOR CORTICOSTEROIDS (PDF, 448KB)
COLLECT DATA - DOWNLOAD THE CASE REPORT FORM FOR PARACETAMOL (PDF, 398KB)
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Nausea is a common and distressing symptom for people with advanced illness. While nausea caused by chemotherapy and/or radiotherapy has been intensively studied and multiple medications, including ondansetron, have proven to be beneficial, it has not been effectively studied for people with non-cancer-related nausea. Despite this, it has become common clinical practice to prescribe ondansetron for nausea for non-cancer-related nausea.
In this series, we seek to understand the role of ondansetron for people with nausea unrelated to cancer treatment. The focus is on the patient profile when it is used, the drug's efficacy, and the associated adverse effects.
You can collect data for this series to help us better understand the effects of this medication.
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Are you prescribing H2 antagonists such as Ranitidine or Famotidine for malignant bowel obstruction?
Malignant bowel obstruction (MBO) is a common and serious complication of advanced cancer, with a poor prognosis. In cases of inoperable MBO, the primary objective is to alleviate distressing symptoms, such as nausea and vomiting
Ranitidine and famotidine are histamine (H2) receptor antagonists (H2 antagonists) that are sometimes used to reduce gastric secretion, thereby improving vomiting. To date, no study has been published looking at how effective and safe these medications are in MBO patients in a palliative care setting. The current evidence base in this area is insufficient to make any recommendations.
Your contribution to this study will help us examine the current clinical practice, and the benefits and harms of ranitidine or famotidine use in MBO and how effective it is in reducing vomiting.
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What is the real clinical experience when people in palliative care receive Temazepam for insomnia?
In this series, we will explore the use, efficacy and safety of Temazepam, a benzodiazepine, for the treatment of insomnia in palliative care.
Insomnia impacts physical, psychological and social aspects of life. Improving sleep using safe, effective and accessible pharmacotherapy is a tangible way to improve quality of life for people receiving palliative care.
But, there are challenges with prescribing benzodiazepines, especially when co-prescribed with opioids. You can collect data for this series to help us better understand the clinical experience of Temazepam for insomnia.
Nursing
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Can you help us? If you are looking after wounds that won't heal, we want to hear from you. You can collect data to help us understand common practices for managing malignant cutaneous wounds.
In this series, we want to identify the wound management procedures clinicians use for malignant cutaneous wounds, how clinicians decide on what course of management they will take for the wound, and which management/s achieve the goals of care.
Malodour is an overwhelming concern for the person with the wound, their family, and carers. The physiological, psychological and sociological consequences of living with a malodorous wound have a dramatic impact on comfort, pain, and quality of life.
The holistic management of these wounds is challenging. There is no robust evidence for which of the current treatment options are the most effective at improving quality of life or managing symptoms. Join this series to improve the evidence for best practice.