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Professor David Currow

Professor, Faculty of Health
 

Conferences

Agar, M., Lawlor, P., Quinn, S., Caplan, G., Draper, B., Rowett, D., Devilee, L., Fazekas, B., Sanderson, C., McCaffrey, N., Hardy, J., Le, B., Eckermann, S., Hill, M. & Currow, D. 2015, 'Phase III randomized double-blind controlled trial of oral risperidone, haloperidol or placebo with rescue subcutaneous midazolam for delirium management in palliative care', JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, pp. S99-S99.
Phillips, J.L., Ramadge, J., Evans, R. & Currow, D. 2009, 'CanNET a new service model: linking regional and metropolitan cancer services into single networks', 10th National Rural Health Conference, National Rural Health Conference, National Rural Health Alliance, Cairns, Australia, pp. 1-11.
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Background: The treatment for cancer is often complex, involving many disciplines and therapies, which makes it difficult for Australians living in rural and remote areas to access the full range of care required within their local community. Aim: The Cancer Service Networks National Demonstration Program (CanNET) is a Commonwealth initiative which aimed to improve access to cancer care by linking regional and metropolitan cancer services. Method: Up to $7 million was made available across seven jurisdictions over a two year period from 2007 to 2009. This funding was to assist the development of sustainable links between cancer specialists and other leading health professionals in metropolitan cancer services and their colleagues in rural and regional centres. Each jurisdiction also made a contribution to the development of the cancer service networks. The cancer service network model is underpinned by: active consumer involvement; the development of agreed referral pathways; a multidisciplinary approach to cancer control; involvement of primary care and allied health professionals; championing of evidence-based practice; access to continuing professional development and training; and integration of rural and regional cancer services into a broad practice network.

Journal articles

Collier, A., Breaden, K., Phillips, J.L., Agar, M., Litster, C. & Currow, D.C. 2017, 'Caregivers' Perspectives on the Use of Long-Term Oxygen Therapy for the Treatment of Refractory Breathlessness: A Qualitative Study.', J Pain Symptom Manage, vol. 53, no. 1, pp. 33-39.
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CONTEXT: Despite limited clinical evidence, long-term oxygen therapy (LTOT) is used for the management of refractory breathlessness in people with life-limiting illnesses who are not necessarily hypoxemic. OBJECTIVES: The aim of this study was to understand caregiver factors associated with caring for someone with LTOT from the perspectives and experiences of caregivers themselves. METHODS: The qualitative study used semistructured interviews. The study was conducted in two states in Australia. Participants (n = 20) were self-nominated caregivers of people receiving LTOT for refractory breathlessness in the palliative setting. RESULTS: Data analyses established one overarching theme titled: "Oxygen giveth (something to help caregivers relieve breathlessness) and oxygen taketh away (from patients who lose some autonomy)." The theme captured caregivers' feelings of extreme distress in response to witnessing refractory breathlessness, and oxygen fulfilling several critical and beneficial roles in this context. In parallel, caregivers also explicitly and implicitly articulated several downsides to the use of LTOT. CONCLUSION: Caregivers find caring for someone with refractory breathlessness extremely distressing. The benefits of LTOT are often overestimated, whereas its potential harms are underestimated. As significant stakeholders of people receiving LTOT, caregivers should be provided with opportunities to collaborate with clinicians in evidence-based decision making, efforts should be made to provide them with information and education about the most effective pharmacological and nonpharmacological strategies to manage refractory breathlessness in a palliative care setting including the appropriate use of LTOT to enable them to do so.
Creighton, N., Walton, R., Roder, D.M., Aranda, S., Richardson, A.J., Merrett, N. & Currow, D. 2017, 'Pancreatectomy is underused in NSW regions with low institutional surgical volumes: a population data linkage study.', Med J Aust, vol. 206, no. 1, pp. 23-29.
OBJECTIVE: To examine differences in the proportions of people diagnosed with pancreatic cancer who underwent pancreatectomy, post-operative outcomes and 5-year survival in different New South Wales administrative health regions of residence. DESIGN, SETTING AND PARTICIPANTS: Retrospective analysis of NSW data on pancreatic cancer incidence and surgery, 2005-2013. MAIN OUTCOME MEASURES: The proportion of newly diagnosed patients with pancreatic cancer who were resected in each region; 90-day post-operative mortality; one-year post-operative survival; 5-year post-diagnosis survival. RESULTS: 14% of people diagnosed with pancreatic cancer during 2010-2013 (431 of 3064) underwent pancreatectomy, an average of 108 resections per year. After adjusting for age, sex and comorbidities, the proportion that underwent resection varied significantly between regions, ranging between 8% and 21% (P<0.001). Higher resection rates were not associated with higher post-operative 90-day mortality or lower one-year survival (unadjusted and risk-adjusted analyses). Higher resection rates were associated with higher 5-year post-diagnosis survival: the mean survival in regions with resection rates below 10% was 3.4%, compared with 7.2% in regions with rates greater than 15% (unadjusted and adjusted survival analyses; P<0.001). There was a positive association between regional resection rate and the pancreatectomy volume of hospitals during 2005-2009. An additional 32 people would be resected annually if resection rates in low rate regions were increased to the 80th percentile regional resection rate (18%). CONCLUSION: There is significant geographic variation in the proportion of people with pancreatic cancer undergoing pancreatectomy, and the 5-year survival rate is higher in regions where this proportion is higher.
McCaffrey, N., Hardy, J., Fazekas, B., Agar, M., Devilee, L., Rowett, D. & Currow, D. 2016, 'Potential economic impact on hospitalisations of the Palliative Care Clinical Studies Collaborative (PaCCSC) ketamine randomised controlled trial', AUSTRALIAN HEALTH REVIEW, vol. 40, no. 1, pp. 100-105.
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Langton, J., Reeve, R., Srasuebkul, P., Haas, M., Viney, R., Currow, D. & Pearson, S.-.A. 2016, 'Health service use and costs in the last six months of life in elderly decedents with a history of cancer: A comprehensive analysis from a health payer perspective', British Journal of Cancer, vol. 114, no. 11, pp. 1293-1302.
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Currow, D.C., Abernethy, A.P., Allcroft, P., Banzett, R.B., Bausewein, C., Booth, S., Carrieri-Kohlman, V., Davidson, P., Disler, R., Donesky, D., Dudgeon, D., Ekstrom, M., Farquhar, M., Higginson, I., Janssen, D., Jensen, D., Jolley, C., Krajnik, M., Laveneziana, P., McDonald, C., Maddocks, M., Morelot-Panzini, C., Moxham, J., Mularski, R.A., Noble, S., O'Donnell, D., Parshall, M.B., Pattinson, K., Phillips, J., Ross, J., Schwartzstein, R.M., Similowski, T., Simon, S.T., Smith, T., Wells, A., Yates, P., Yorke, J. & Johnson, M.J. 2016, 'The need to research refractory breathlessness', EUROPEAN RESPIRATORY JOURNAL, vol. 47, no. 1, pp. 342-343.
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Davidson, P.M., Phillips, J.L., Dennison-Himmelfarb, C., Thompson, S.C., Luckett, T. & Currow, D.C. 2016, 'Providing palliative care for cardiovascular disease from a perspective of sociocultural diversity: a global view', CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE, vol. 10, no. 1, pp. 11-17.
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Sanderson, C., Quinn, S.J., Agar, M., Chye, R., Clark, K., Doogue, M., Fazekas, B., Lee, J., Lovell, M.R., Rowett, D., Spruyt, O. & Currow, D.C. 2016, 'Pharmacovigilance in hospice/palliative care: net effect of pregabalin for neuropathic pain.', BMJ Supportive and Palliative Care, vol. 6, pp. 323-330.
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Real-world effectiveness of many medications has been poorly researched, including in hospice/palliative care. Directly extrapolating findings from other clinical settings may not yield robust clinical advice. Pharmacovigilance studies provide an opportunity to understand better the net impact of medications. The study aimed to examine immediate and short-term benefits and harms of pregabalin in routine practice for neuropathic pain in hospice/palliative care.A consecutive cohort of 155 patients from 62 centres in 5 countries was started on pregabalin and studied prospectively. Data were collected at three time points: baseline; day 7 (immediate, short-term harms); ad hoc reports of any harms 21days; and day 21 (short-term benefits).Median dose for 155 patients at day 21 was 150mg/24h. Benefits were reported by 61 patients (39%), of whom 11 (7%) experienced complete pain resolution. Harms were reported by 51 (35%) patients at or before 7days, the most frequent of which were somnolence, fatigue, cognitive disturbance and dizziness. 10 patients (6%) ceased pregabalin due to harms, but 82 patients (53%) were being treated at 21days. In regression modelling, people with worse baseline pain derived more benefit (OR=8.5 (95% CI 2.5 to 28.68).Pregabalin delivered benefit to many patients, with 4 of 10 experiencing pain reductions by 21days. Harms, occurring in 1 in 3 patients, may be difficult to detect in clinical practice, as they mostly involve worsening of symptoms prevalent at baseline.
Currow, D.C., Phillips, J. & Clark, K. 2016, 'Using opioids in general practice for chronic non-cancer pain: an overview of current evidence.', Med J Aust, vol. 204, no. 8, pp. 305-309.
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Chronic non-cancer pain (lasting more than 3 months) is highly prevalent in Australia (17% of males and 20% of females) and its optimal management is crucial to the health and wellbeing of the community. For 5% of the population, such pain interferes markedly with daily function. Part of the treatment for acute non-cancer pain for many people will include opioid analgesics at least for days to weeks. However, as pain becomes chronic, evidence to support ongoing prescription of opioids is lacking. There is increasing pressure to ensure that prescribing opioid analgesics is minimised to reduce not only the risk of dependence and illicit diversion but also the potential harms associated with tolerance, side effects and complications. Frameworks for considering opioid prescribing include assessing suitability of the patient for opioids; initiating a trial of therapy; and monitoring long term use. There is limited evidence of the long term efficacy of opioids for chronic non-cancer pain, and documented clinical consequences beyond addiction include acceleration of loss of bone mineral density, hypogonadism and an association with increased risk of acute myocardial infarction. Careful clinical selection of patients can help optimise the evidence-based use of opioids for chronic non-cancer pain: only treat pain that has been as well defined as possible when non-opioid therapies have not been effective; consider referral to specialist services for assessment if doses are above 100 mg oral morphine equivalent per 24 hours or the duration of therapy is longer than 4 weeks; limit prescribing to only one practitioner; seek an agreement with the patient for the initiation and potential withdrawal of opioids if the therapeutic trial is not effective.
Luckett, T., Disler, R., Hosie, A., Johnson, M., Davidson, P., Currow, D., Sumah, A. & Phillips, J. 2016, 'Content and quality of websites supporting self-management of chronic breathlessness in advanced illness: a systematic review.', NPJ primary care respiratory medicine, vol. 26, p. 16025.
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Chronic breathlessness is a common, burdensome and distressing symptom in many advanced chronic illnesses. Self-management strategies are essential to optimise treatment, daily functioning and emotional coping. People with chronic illness commonly search the internet for advice on self-management. A review was undertaken in June 2015 to describe the content and quality of online advice on breathlessness self-management, to highlight under-served areas and to identify any unsafe content. Google was searched from Sydney, Australia, using the five most common search terms for breathlessness identified by Google Trends. We also hand-searched the websites of national associations. Websites were included if they were freely available in English and provided practical advice on self-management. Website quality was assessed using the American Medical Association Benchmarks. Readability was assessed using the Flesch-Kincaid grades, with grade 8 considered the maximum acceptable for enabling access. Ninety-one web pages from 44 websites met the inclusion criteria, including 14 national association websites not returned by Google searches. Most websites were generated in the USA (n=28, 64%) and focused on breathing techniques (n=38, 86%) and chronic obstructive pulmonary disease (n=27, 61%). No websites were found to offer unsafe advice. Adherence to quality benchmarks ranged from 9% for disclosure to 77% for currency. Fifteen (54%) of 28 written websites required grade 9 reading level. Future development should focus on advice and tools to support goal setting, problem solving and monitoring of breathlessness. National associations are encouraged to improve website visibility and comply with standards for quality and readability.
Clark, K., Lam, L.T., Talley, N.J., Quinn, J., Blight, A., Byfieldt, N. & Currow, D.C. 2016, 'Assessing the Presence and Severity of Constipation with Plain Radiographs in Constipated Palliative Care Patients.', Journal of palliative medicine, vol. 19, no. 6, pp. 617-621.
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Palliative care guidelines recommend plain radiographs to assess constipation based on the presumption that visible fecal shadowing represents stool retention. Despite this, using plain radiographs in this way is not well validated.This work's main aim was to compare clinicians' reports of fecal loading on radiographs. This study also compares clinicians' assessments with radio-opaque marker transit studies and patients' self-reported constipation symptoms.This study was conducted in a sample of 30 constipated palliative care patients taking laxatives who had all undergone colon transit studies and contemporaneous assessment of constipation symptoms with the Patient Assessment of Constipation Symptom (PAC-SYM) questionnaire. Four separate clinicians independently reported their opinions of fecal loading using a previously developed fecal loading scale. Participant details were summarized and pair-wise inter-rater agreement among all four raters were examined using the Bland-Altman approach. For the comparisons of the clinician-assigned fecal loading score between the radiographic assessment of the normal and slow colon transit time, the nonparametric approach of Mann-Whitney U tests were applied. Spearman's correlation analyses were employed to investigate the association between the clinician-assigned fecal loading score and the patient self-reported PAC-SYM score.The results of this study are very similar to other studies conducted in functional constipation, highlighting systematic disagreement between observers. Further poor correlations were noted between fecal loading scores and colon transit times and with patient self-reported symptoms.These results, when considered with other work in chronic constipation, question the ongoing use of radiographs in the diagnosis of constipation.
Crane, M., Scott, N., O'Hara, B.J., Aranda, S., Lafontaine, M., Stacey, I., Varlow, M. & Currow, D. 2016, 'Knowledge of the signs and symptoms and risk factors of lung cancer in Australia: mixed methods study', BMC PUBLIC HEALTH, vol. 16.
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DiGiacomo, M., Hatano, Y., Phillips, J., Lewis, J., Abernathy, A. & Currow, D. 2016, 'Caregiver characteristics and bereavement needs: findings from a population study', Palliative Medicine.
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Background: Globally, the majority of care for people with life-limiting illnesses is provided by informal caregivers. Identifying characteristics of caregivers that may have unmet needs and negative outcomes can enable provision of better support to facilitate their adjustment. Aim: We compared characteristics, expressed unmet needs, and outcomes for spousal caregivers, with other caregivers at the end of life, by gender and age. Design: The South Australian Health Omnibus is an annual, random, face-to-face, cross-sectional survey wherein respondents are asked about end-of-life care. Setting/Participants: Participants were aged over 15, resided in households in South Australia, and had someone close to them die from a terminal illness in the last five years. Results: Of the 1,540 respondents who provided hands-on care for someone close at the end of life, 155 were widows/widowers. Bereaved spousal caregivers were more likely to: be older, female, better educated, have lower incomes, less full-time work, English as second language, sought help with grief, and provided more day-to-day care for longer periods. Spousal caregivers were less likely to be willing to take on caregiving again, less able to 'move on' with life, and needed greater emotional support and more information about the illness and services. The only difference between widows and widowers was older age of spouse in women. Younger spousal caregivers perceived greater unmet emotional needs and were significantly less likely to be able to 'move on'. Conclusions: Spousal caregivers are different from other caregivers, with more intense needs that are not fully met. These have implications for bereavement, health, and social services.
Hatano, Y., Moroni, M., Wilcock, A., Quinn, S., Csikós, Á., Allan, S.G., Agar, M., Clark, K., Clayton, J.M. & Currow, D.C. 2016, 'Pharmacovigilance in hospice/palliative care: the net immediate and short-term effects of dexamethasone for anorexia.', BMJ supportive & palliative care, vol. 6, no. 3, pp. 331-337.
Loss of appetite is prevalent in palliative care and distressing for patients and families. Therapies include corticosteroids or progestogens. This study explores the net effect of dexamethasone on anorexia.Prospective data were collected when dexamethasone was started for anorexia as part of routine care. The National Cancer Institute's Common Toxicity Criteria for Adverse Events (NCICTCAE) Likert scales assessed severity of anorexia and immediate and short-term harms at 2 time points: baseline and 7days.This study (41 sites, 8 countries) collected data (July 2013 to July 2014) from 114 patients (mean age 71 (SD 11), 96% with cancer). Median Australian-modified Karnofsky Performance Scale was 50% (range 20-70). Mean baseline NCICTCAE anorexia score was 2.7 (SD 0.6; median 3). 6 patients died by day 7. Of 108 evaluable patients, 74 (68.5%; 95% CI 59.0% to 76.7%) reported 1 reduction anorexia scores by day 7, of whom 30 were 0. Mean dexamethasone dose on day 7 was 4.1mg/day (SD 3.4; median 4; range 0-46mg). 24 patients reported 1 harms (32.4% CI 22.6% to 44.1%; insomnia n=10, depression n=7, euphoria n=7 and hyperglycaemia n=7). Of 24 patients with no benefit, 10 reported 1 harms.This study shows positive and negative effects of 7days of dexamethasone as an appetite stimulant in patients with advanced life-limiting illnesses. Identifying clinicodemographic characteristics of people most at risk of harms with no benefit is a crucial next step. Longer term follow-up will help to understand longer term and cumulative harms.
Agar, M.R., Quinn, S.J., Crawford, G.B., Ritchie, C.S., Phillips, J.L., Collier, A. & Currow, D.C. 2016, 'Predictors of Mortality for Delirium in Palliative Care', JOURNAL OF PALLIATIVE MEDICINE, vol. 19, no. 11, pp. 1205-1209.
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Luckett, T.R., Phillips, J., Lintzeris, N., Allsop, D., Lee, J., Solowij, N., Martin, J., Lam, L., Aggarwal, R., McCaffrey, N., Currow, D., Chye, R., Lovell, M., McGregor, I. & Agar, M. 2016, 'Clinical trials of medicinal cannabis for appetite-related symptoms from advanced cancer: A survey of preferences, attitudes and beliefs among patients willing to consider participation', Internal Medicine Journal, vol. 46, no. 11, pp. 1269-1275.
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Bush, S.H., Lacaze-Masmonteil, N., McNamara-Kilian, M.T., MacDonald, A.R., Tierney, S., Momoli, F., Agar, M., Currow, D.C. & Lawlor, P.G. 2016, 'The preventative role of exogenous melatonin administration to patients with advanced cancer who are at risk of delirium: study protocol for a randomized controlled trial', TRIALS, vol. 17.
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Clark, K., Lam, L.T., Talley, N.J., Phillips, J.L. & Currow, D.C. 2016, 'Identifying Factors That Predict Worse Constipation Symptoms in Palliative Care Patients: A Secondary Analysis.', J Palliat Med.
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OBJECTIVE: The aim of this work was to investigate whether variables identified as likely to impact the experience of constipation in other clinical settings similarly affected the experiences of constipated palliative care patients. BACKGROUND: The majority of palliative care patients with cancer are likely to be bothered by constipation symptoms at some point in their disease trajectory. Despite this, it remains unclear as to which factors predict more severe problems. METHODS: This study was conducted in a sample of 94 constipated palliative care patients who were asked to voluntarily complete a series of questions regarding their demographic and other characteristics, including whether they had chronic constipation symptoms, that is, constipation symptoms for 12 months. Other variables included age, body mass index, sex, performance status, and regular opioids and their doses. At the same time, they were asked to complete the Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires. RESULTS: Descriptive statistics summarized baseline data. Unadjusted associations between the selected variables on PAC-SYM were examined by using bi-variate analyses. Significant variables identified on bi-variate analyses were included in a multivariate analysis. The final results identified that only the chronicity of constipation symptoms predicted more severe symptoms. This relationship persisted when this single variable was retained in the final model, illustrating that PAC-SYM scores are 0.41 higher in patients with chronic constipation compared with those without it (p=0.02). In contrast, regular opioid use was not identified as a significant factor (p=0.56). DISCUSSION: This study suggests that the factor most likely to predict worse constipation symptoms was the duration that people had experienced problems. Further, those who perceived their constipation symptoms to be more severe had a po...
Tervonen, H.E., Morrell, S., Aranda, S., Roder, D., You, H., Niyonsenga, T., Walton, R., Baker, D. & Currow, D. 2016, 'The impact of geographic unit of analysis on socioeconomic inequalities in cancer survival and distant summary stage - a population-based study.', Aust N Z J Public Health.
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OBJECTIVE: When using area-level disadvantage measures, size of geographic unit can have major effects on recorded socioeconomic cancer disparities. This study examined the extent of changes in recorded socioeconomic inequalities in cancer survival and distant stage when the measure of socioeconomic disadvantage was based on smaller Census Collection Districts (CDs) instead of Statistical Local Areas (SLAs). METHODS: Population-based New South Wales Cancer Registry data were used to identify cases diagnosed with primary invasive cancer in 2000-2008 (n=264,236). Logistic regression and competing risk regression modelling were performed to examine socioeconomic differences in odds of distant stage and hazard of cancer death for all sites combined and separately for breast, prostate, colorectal and lung cancers. RESULTS: For all sites collectively, associations between socioeconomic disadvantage and cancer survival and distant stage were stronger when the CD-based socioeconomic disadvantage measure was used compared with the SLA-based measure. The CD-based measure showed a more consistent socioeconomic gradient with a linear upward trend of risk of cancer death/distant stage with increasing socioeconomic disadvantage. Site-specific analyses provided similar findings for the risk of death but less consistent results for the likelihood of distant stage. CONCLUSIONS: The use of socioeconomic disadvantage measure based on the smallest available spatial unit should be encouraged in the future. Implications for Public Health: Disadvantage measures based on small spatial units can more accurately identify socioeconomic cancer disparities to inform priority settings in service planning.
Scott, N., Crane, M., Lafontaine, M., Seale, H. & Currow, D. 2015, 'Stigma as a barrier to diagnosis of lung cancer: patient and general practitioner perspectives', PRIMARY HEALTH CARE RESEARCH AND DEVELOPMENT, vol. 16, no. 6, pp. 618-622.
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McCaffrey, N., Agar, M., Harlum, J., Karnon, J., Currow, D. & Eckermann, S. 2015, 'Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space', PLOS ONE, vol. 10, no. 3.
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Currow, D.C., Clark, K., Kamal, A., Collier, A., Agar, M.R., Lovell, M.R., Phillips, J.L. & Ritchie, C. 2015, 'The Population Burden of Chronic Symptoms that Substantially Predate the Diagnosis of a Life-Limiting Illness', JOURNAL OF PALLIATIVE MEDICINE, vol. 18, no. 6, pp. 480-485.
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Nikles, J., Mitchell, G.K., Hardy, J., Agar, M., Senior, H., Carmont, S.-.A., Schluter, P.J., Good, P., Vora, R. & Currow, D. 2015, 'Testing pilocarpine drops for dry mouth in advanced cancer using n-of-1 trials: A feasibility study', PALLIATIVE MEDICINE, vol. 29, no. 10, pp. 967-974.
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Luckett, T., Bhattarai, P., Phillips, J., Agar, M., Currow, D., Krastev, Y. & Davidson, P.M. 2015, 'Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria', AUSTRALIAN HEALTH REVIEW, vol. 39, no. 5, pp. 552-560.
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Agar, M., Lawlor, P., Quinn, S., Caplan, G., Draper, B., Rowett, D., Devilee, L., Fazekas, B., Sanderson, C., McCaffery, N., Hardy, J., Le, B., Eckermann, S., Hill, M. & Currow, D. 2015, 'Phase III randomised double-blind controlled trial of oral risperidone, haloperidol or placebo with rescue subcutaneous midazolam for delirium management in palliative care', AUSTRALASIAN JOURNAL ON AGEING, vol. 34, no. S1, pp. 33-33.
Guidelines recommend targeted use of antipsychotics indelirium for specic symptoms however this approach has notbeen evaluated in randomised trials. To compare the efcacyof risperidone relative to placebo in the control of specicdelirium symptoms in palliative care patients (communica-tion, behaviour and/or perceptual disturbances on NursingDelirium Screening Scale) at 72 hours after study commence-ment. Secondary aims were to compare haloperidol andplacebo; and risperidone and haloperidol
Disler, R., Inglis, S., Newton, P., Currow, D., Macdonald, P., Glanville, A., Donesky, D., Carrieri-Kohlman, V. & Davidson, P. 2015, 'ATTITUDES TO ONLINE DELIVERY OF HEALTH INFORMATION AND CHRONIC DISEASE MANAGEMENT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FOCUS GROUP STUDY', RESPIROLOGY, vol. 20, pp. 105-105.
Disler, R., Spiliopoulos, N., Inglis, S., Currow, D. & Davidson, P. 2015, 'INDIVIDUALS ATTITUDES TO COGNITIVE IMPAIRMENT AND IMPACT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FOCUS GROUP STUDY', RESPIROLOGY, vol. 20, pp. 105-105.
Disler, R.T., Green, A.R., Luckett, T., Newton, P.J., Inglis, S., Currow, D. & Davidson, P.M. 2014, 'Experience of advanced chronic obstructive pulmonary disease: Metasynthesis of qualitative data.', Journal of Pain and Symptom Management, vol. 48, no. 6, pp. 1182-1199.
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Context. Chronic obstructive pulmonary disease (COPD) is a life-limiting illness. Despite best available treatments, individuals continue to experience symptom burden and have high health-care utilization. Objectives. To increase understanding of the experience and ongoing needs of individuals living with COPD.
Phillips, J.L., Chan, R. & Currow, D.C. 2014, 'Do palliative care health professionals settle for low level evidence?', Palliative Medicine, vol. 28, no. 1.
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Invited editorial
Phillips, J.L., Lam, L., Luckett, T., Agar, M. & Currow, D. 2014, 'Is the Life Space Assessment applicable to a palliative care population? : A brief methodological report on its relationship to measures of performance and quality of life. Brief Methodological Report.', Journal of Pain and Symptom Management, vol. 47, no. 6, pp. 1121-1127.
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The spatial environments that palliative care patients frequent for business and leisure constrict as their disease progresses and their physical functioning deteriorates. Measuring a persons movement within his or her own environment is a clinically relevant and patient-centered outcome because it measures function in a way that reflects actual and not theoretical participation.
Lewis, J., DiGiacomo, M., Luckett, T., Davidson, P.M. & Currow, D. 2013, 'A Social Capital Framework for Palliative Care: Supporting Health and Well-Being for People With Life-Limiting Illness and Their Carers Through Social Relations and Networks', Journal of Pain and Symptom Management, vol. 45, no. 1, pp. 92-103.
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This paper summarizes the literature on social capital, well-being, and quality of life for key outcomes to inform a model of social capital in palliative care.
Waller, A., Girgis, A., Davidson, P.M., Newton, P.J., Lecathelinais, C., Macdonald, P., Hayward, C. & Currow, D. 2013, 'Facilitating needs-based support and palliative care for people with chronic heart failure: preliminary evidence for the acceptability, inter-rater reliability and validity of a needs assessment tool', Journal of Pain and Symptom Management, vol. 45, no. 5, pp. 912-925.
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Context. Understanding the types and extent of need is critical to informing needs-based care for people with chronic heart failure (CHF). Objectives. To explore the psychometric quality of a newly developed rapid screening measure to assess the supportive and palliative care needs of people with CHF.
Luckett, T., Davidson, P.M., Lam, L., Phillips, J.L., Currow, D. & Agar, M. 2013, 'Do Community Specialist Palliative Care Services That Provide Home Nursing Increase Rates of Home Death for People with Life-Limiting Illnesses? A Systematic Review and Meta-Analysis of Comparative Studies', Journal of Pain and Symptom Management, vol. 45, no. 2, pp. 279-297.
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Context. Systematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly.
Crawford, G., Agar, M., Quinn, S., Phillips, J.L., Litster, C., Michael, N., Doogue, M., Rowett, D. & Currow, D. 2013, 'Pharmacovigilance in hospice/palliative care. Net effect of haloperidol for delirium', Journal Of Palliative Medicine, vol. 16, no. 11, pp. 1335-1341.
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Prescribing practice in hospice/palliative care is largely extrapolated from other areas of clinical practice, with few studies of net medication effects (benefits and harms) in hospice/palliative care to guide prescribing decisions. Hospice/palliative care patients differ in multiple ways from better studied participant groups, hence the applicability of studies in other participant groups is uncertain. Haloperidol, a butyrophenone derivative and dopamine antagonist, is commonly prescribed for nausea, vomiting, and delirium in hospice/palliative care. Its frequent use in delirium occurs despite little evidence of the effect of antipsychotics on the untreated course of delirium. The aim of this study was to examine the immediate and short-term clinical benefits and harms of haloperidol for delirium in hospice/palliative care patients. METHOD: A consecutive cohort of participants from 14 centers across four countries who had haloperidol commenced for delirium were recruited. Data were collected at three time points: baseline, 48 hours (clinical benefits), and day 10 (clinical harms). Investigators were also able to report clinical harms at any time up to 14 days after it was commenced. RESULTS: Of the 119 participants included, the average dose was 2.1?mg per 24 hours; 42 of 106 (35.2%) reported benefit at 48 hours. Harm was reported in 14 of 119 (12%) at 10 days, the most frequent being somnolence (n=11) and urinary retention (n=6). Seven participants had their medication ceased due to harms (2 for somnolence and 2 for rigidity). Approximately half (55/119) were still being treated with haloperidol after 10 days. CONCLUSION: Overall, 1 in 3 participants gained net clinical benefit at 10 days.
Currow, D. & Phillips, J.L. 2013, 'Evolution of palliative care in Australia 1973-2013', Cancer Forum, vol. 37, no. 1, pp. 38-42.
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In parallel with the rapid development of oncology in Australia, palliative and supportive care has evolved rapidly. The sponsorship for such development was largely generated by oncology services in response to unmet needs that were encountered daily. Development of state, territory and national strategies has mirrored the professional development in service delivery, education (of existing practitioners and tomorrows clinicians) and research. More recently, national programs are delivering better outcomes for palliative care patients and their families, world-leading clinical research, improved access to essential medications in the community and the ability to access quality evidence to inform practice and policy. These initiatives provide a valuable foundation for continuing to improve access to high quality clinical care wherever people live.
Breaden, K., Phillips, J.L., Agar, M., Grbich, C., Abernethy, A. & Currow, D. 2013, 'The clinical and social dimension of prescribing home oxygen for the relief of refractory dyspnea', Journal Of Palliative Medicine, vol. 16, no. 3, pp. 268-273.
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Background: Chronic breathlessness is a significant problem in palliative care and oxygen is often prescribed in an attempt to ameliorate it. Often, this prescription falls outside the current funding guidelines for long-term home oxygen use. The aim of this qualitative study was to understand the factors that most influence Australian specialist palliative care nurses' initiation of home oxygen for their patients. Methods: A series of focus groups were held across three states in Australia in 2011 involving specialist palliative care nurses. The invitation to the nurses was sent by e-mail through their national association. Recorded and transcribed data were coded for themes and subthemes. A summary, which included quotes, was provided to participants to confirm. Results: Fifty-one experienced palliative care nurses participated in seven focus groups held in three capital cities. Two major themes were identified: 1) logistic/health service issues (not reported in this paper as specific to the Australian context) involving the local context of prescribing and, 2) clinical care issues that involved assessing the patient's need for home oxygen and ongoing monitoring concerns. Palliative care nurses involved in initiating or prescribing oxygen often reported using oxygen as a second-line treatment after other interventions had been trialed and these had not provided sufficient symptomatic benefit. Safety issues were a universal concern and a person living alone did not emerge as a specific issue among the nurses interviewed. Conclusion: The role of oxygen is currently seen as a second-line therapy in refractory dyspnea by specialist palliative care nurses.
Disler, R.T., Inglis, S., Currow, D. & Davidson, P.M. 2012, 'Palliative and supportive care in COPD: research priorities to decrease suffering.', Journal of Pulmonary and Respiratory Medicine, vol. 1, no. 6, pp. 1-3.
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Chronic obstructive pulmonary disease (COPD) affects 80 million people worldwide, is the fourth most prevalent cause of death globally and accounts for 3.5% of total years lost due to disability. Despite the similarities with malignant disease, many individuals suffer unnecessarily and continue to have limited access to palliative and endof-life care.
Disler, R.T., Currow, D., Phillips, J.L. & Davidson, P.M. 2012, 'Interventions to support a palliative care approach in patients with chronic obstructive pulmonary disease: An integrative review.', International Journal of Nursing Studies, vol. 49, no. 11, pp. 1443-1458.
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End-stage chronic obstructive pulmonary disease (COPD) is a debilitating, life-limiting condition. A palliative approach is appropriate for individuals with end-stage COPD, yet currently few interventions embrace this holistic, multidisciplinary and inclusive perspective.
Waller, A., Girgis, A., Johnson, C., Lecathelinais, C., Sibbritt, D., Forstner, D. & Currow, D. 2012, 'Improving outcomes for people with progressive cancer: interrupted time series trial of a needs assessment intervention', Journal of Pain and Symptom Management, vol. 43, no. 3, pp. 569-581.
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Improving the effectiveness of cancer care delivery has become a major focus of research. This study assessed the uptake and impact of the Palliative Care Needs Assessment Guidelines and Needs Assessment Tool: Progressive DiseasedCancer (NAT: PD-C) on the outcomes of people with advanced cancer.
Disler, R.T., Green, A.R., Luckett, T., Newton, P.J., Inglis, S., Currow, D. & Davidson, P.M. 2012, 'Unmet needs in chronic obstructive pulmonary disease: a metasynthesis protocol', International Journal of Research in Nursing, vol. 3, no. 1, pp. 15-20.
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Abstract: Problem statement: Chronic obstructive pulmonary disease is a chronic progressive illness. Despite the high burden experienced by individuals in the advanced stages of illness, individuals with advanced COPD continue to have unmet needs and limited access to palliative care. This Metasynthesis seeks to describe: the barriers and facilitators care access and provision; the unmet needs of individuals with advanced COPD, their families and carers; and the experiences of health professionals. Data sources: Medline, PsychINFO, AMED, CINAHL and Sociological Abstracts were searched for articles published between 1990 and December 31st 2011. Medical Subject Headings (MeSH) and key words will be used to guide the search. The strategy will be reviewed by the CareSearch palliative knowledge network and a health informatics expert. Approach: Metasyntheses are increasingly used to gain new insights and understandings of complex research questions through the amalgamation of data from individual qualitative studies. The principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and thematic synthesis will be used to achieve consistent reporting and transparency of methods. Results: Inclusion of studies, quality assessment and allocation of free codes into EPPI-Reviewer 4 software will be carried out by two independent investigators. Auditing of random cases will be undertaken and disagreements resolved through group discussion of an expert panel. Descriptive and analytical themes will be developed through thematic synthesis and expert panel discussion. Conclusion: Qualitative data provide useful information in understanding the individual's unique experience. Combining discrete qualitative studies provides an important opportunity to provide a voice to patients, their families and professional careers in managing advanced COPD.
Waller, A., Girgis, A., Johnson, C., Lecathelinais, C., Sibbritt, D., Seldon, N., Bonaventura, A. & Currow, D. 2012, 'Implications of a needs assessment intervention for people with progressive cancer: Impact on clinical assessment, response and service utlisation.', Psycho-oncology, vol. 21, no. 5, pp. 550-557.
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To assess the impact of the systematic use of the Palliative Care Needs Assessment Guidelines and Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C) on clinical assessment, response and service utilisation.
Currow, D., Allingham, S., Bird, S., Yates, P., Lewis, J., Dawber, J. & Eagar, K. 2012, 'Referral patterns and proximity to palliative care inpatient services by level of socio-economic disadvantage. A national study using spatial analysis', BMC Health Services Research, vol. 12, no. 424, pp. 1-14.
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A range of health outcomes at a population level are related to differences in levels of social disadvantage. Understanding the impact of any such differences in palliative care is important. The aim of this study was to assess, by level of socio-economic disadvantage, referral patterns to specialist palliative care and proximity to inpatient services. This study examined all inpatient and community palliative care services nationally were geocoded (using postcode) to one nationally standardised measure of socio-economic deprivation Socio-Economic Index for Areas (SEIFA; 2006 census data). Referral to palliative care services and characteristics of referrals were described through data collected routinely at clinical encounters. Inpatient location was measured from each person's home postcode, and stratified by socio-economic disadvantage. This study covered July-December 2009 with data from 10,064 patients. People from the highest SEIFA group (least disadvantaged) were significantly less likely to be referred to a specialist palliative care service, likely to be referred closer to death and to have more episodes of inpatient care for longer time. Physical proximity of a persons home to inpatient care showed a gradient with increasing distance by decreasing levels of socio-economic advantage. These data suggest that a simple relationship of low socioeconomic status and poor access to a referral-based specialty such as palliative care does not exist. Different patterns of referral and hence different patterns of care emerge.
Agar, M., Draper, B., Phillips, P., Phillips, J., Collier, A., Harlum, J. & Currow, D. 2012, 'Making Decisions About Delirium: A Qualitative Comparison Of Decision Making Between Nurses Working In Palliative Care, Aged Care, Aged Care Psychiatry, And Oncology', Palliative Medicine, vol. 26, no. 7, pp. 887-896.
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Background: Delirium has a significant impact on nursing practice from diagnosis and management, with under-detection and variable management of delirium being international problems. This study aimed to explore nurses' assessment and management of delir
Agar, M., Draper, B., Phillips, J.L., Collier, A., Harlum, J. & Currow, D. 2012, 'Making decisions about delirium: a qualitative comparison of decision making between nurses working in palliative care, aged care, aged care psychiatry, and oncology.', Palliative Medicine, vol. 26, no. 7, pp. 887-896.
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Background: Delirium has a significant impact on nursing practice from diagnosis and management, with under-detection and variable management of delirium being international problems. This study aimed to explore nurses' assessment and management of delirium when caring for people with cancer, the elderly or older people requiring psychiatric care in the inpatient setting. Methods: Participants in this qualitative study were nurses working in Australian public hospital inpatient dedicated units in palliative care, aged care (geriatrics), aged care (geriatric) psychiatry and oncology. Semi-structured interviews were used to explore nurses' views about specific areas of delirium assessment and management. Purposive sampling was used and interviews conducted until thematic saturation reached. A thematic content analysis was performed from a grounded theory perspective. Results: A total of 40 participants were included in the study. The analysis revealed four broad analytical themes: (1) superficial recognition and understanding of the operational definition of delirium or recognition of delirium as a syndrome; (2) nursing assessment: investigative versus a problem solving approach; (3) management: maintaining dignity and minimizing chaos; and (4) distress and the effect on others. Discussion: Nurses have limited knowledge of the features of delirium regardless of their specialty discipline. Delirium was uniformly identified as a highly distressing experience for patients, families and staff alike. The majority of nurses had a superficial understanding of delirium management, and adopted a task-orientated approach aimed at addressing the more noticeable problems. These findings have implications for both education and knowledge translation. Innovative approaches are needed to align health professional behaviours with best evidence delirium care.
Johnson, C., Girgis, A., Paul, C., Currow, D., Adams, J. & Aranda, S. 2011, 'Australian Palliative Care Providers Perceptions And Experiences Of The Barriers And Facilitators To Palliative Care Provision', Supportive Care in Cancer, vol. 19, no. 3, pp. 343-351.
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People with advanced cancer who may benefit from specialised palliative care (SPC) do not necessarily access such services. To obtain a deeper understanding of issues affecting access to SPC, five focus groups were undertaken with nurses (35), physicians
Du, H., Newton, P.J., Zecchin, R., Denniss, A.R., Salamonson, Y., Everett, B., Currow, D., Macdonald, P. & Davidson, P.M. 2011, 'An intervention to promote physical activity and self-management in people with stable chronic heart failure The Home-Heart-Walk study: study protocol for a randomized controlled trial', Trials, vol. 12, no. 63.
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Background: Chronic heart failure (CHF) is a chronic debilitating condition with economic consequences, mostly because of frequent hospitalisations. Physical activity and adequate self-management capacity are important risk reduction strategies in the management of CHF. The Home-Heart-Walk is a self-monitoring intervention. This model of intervention has adapted the 6-minute walk test as a home-based activity that is self-administered and can be used for monitoring physical functional capacity in people with CHF. The aim of the Home-Heart-Walk program is to promote adherence to physical activity recommendations and improving self-management in people with CHF. Methods/Design: A randomised controlled trial is being conducted in English speaking people with CHF in four hospitals in Sydney, Australia. Individuals diagnosed with CHF, in New York Heart Association Functional Class II or III, with a previous admission to hospital for CHF are eligible to participate. Based on a previous CHF study and a loss to follow-up of 10%, 166 participants are required to be able to detect a 12-point difference in the study primary endpoint (SF-36 physical function domain). All enrolled participant receive an information session with a cardiovascular nurse. This information session covers key self-management components of CHF: daily weight; diet (salt reduction); medication adherence; and physical activity. Participants are randomised to either intervention or control group through the study randomisation centre after baseline questionnaires and assessment are completed. For people in the intervention group, the research nurse also explains the weekly Home-Heart-Walk protocol. All participants receive monthly phone calls from a research coordinator for six months, and outcome measures are conducted at one, three and six months.
Davidson, P.M., Jiwa, M., Goldsmith, A.J., McGrath, S., DiGiacomo, M., Phillips, J.L., Agar, M., Newton, P.J. & Currow, D. 2011, 'Decisions for lung cancer chemotherapy: the influence of physician and patient factors', Supportive Care in Cancer, vol. 19, no. 8, pp. 1261-1266.
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Purpose The purpose of this study is to review the literature examining how the beliefs and behaviours of physicians and patients influence clinical communication, doctor-patient interaction and treatment decisions for lung cancer treatment. Methods Literature was obtained via electronic database searches and hand searching of journals from 1990 to 2011. Results Wide variability in perceptions of the value of chemotherapy in lung cancer is present among both physicians and patients. There is a mismatch in the degree patients and physicians weigh survival, such that patients value survival benefits highly whilst physicians strongly emphasize toxicity and associated symptoms. This lack of congruence between patients and clinicians is influenced by a range of factors and has implications for treatment decisions, long-term survival and quality of life in people affected by lung cancer. Conclusion The divergence of treatment priorities indicates a need for improved communication strategies addressing the needs and concerns of both patients and clinicians. Patients should understand the benefits and risks of treatment options, while clinicians can gain a greater awareness of factors influencing patients' decisions on treatments. Reflecting these perspectives and patient preferences for lung cancer treatment in clinical guidelines may improve clinician awareness.
Johnson, C., Paul, C., Girgis, A., Adams, J. & Currow, D. 2011, 'Australian General Practitioners And Oncology Specialists Perceptions Of Barriers And Facilitators Of Access To Specialist Palliative Care Services', Journal Of Palliative Medicine, vol. 14, no. 4, pp. 429-435.
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Purpose: Doctors in Australia play an important role in facilitating access to specialist palliative care (SPC) services for people with advanced cancer. This study aimed to describe doctors perceptions of barriers to referring patients for SPC, and to i
Lewis, J., DiGiacomo, M., Currow, D. & Davidson, P.M. 2011, 'Dying in the margins: understanding palliative care and socioeconomic deprivation in the developed world', Journal of Pain and Symptom Management, vol. 42, no. 1, pp. 105-118.
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Individuals from low socioeconomic (SE) groups have less resources and poorer health outcomes. Understanding the nature of access to appropriate end-of-life care services for this group is important. This article evaluated the literature in the developed world for barriers to access for low SE groups. Electronic databases searched in the review included MEDLINE (1996&acirc;2010), CINAHL (1996&acirc;2010), PsychINFO (2000&acirc;2010), Cochrane Library (2010), and EMBASE (1996&acirc;2010). Publications were searched for key terms &acirc;socioeconomic disadvantage,&acirc; &acirc;socioeconomic,&acirc; &acirc;poverty,&acirc; &acirc;poor&acirc; paired with &acirc;end-of-life care,&acirc; &acirc;palliative care,&acirc; &acirc;dying,&acirc; and &acirc;terminal Illness.&acirc; Articles were analyzed using existing descriptions for dimensions of access to health services, which include availability, affordability, acceptability, and geographical access. A total of 67 articles were identified for the literature review. Literature describing end-of-life care and low SE status was limited. Findings from the review were summarized under the headings for dimensions of access. Low SE groups experience barriers to access in palliative care services. Identification and evaluation of interventions aimed at reducing this disparity is required.
Currow, D., Burns, C., Agar, M., Phillips, J.L., McCaffrey, N. & Abernethy, A. 2011, 'Palliative caregivers who would not take on the role again', Journal of Pain and Symptom Management, vol. 41, no. 4, pp. 661-672.
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Abstract Context Health and social services rely heavily on family and friends for caregiving at the end of life. Objectives This study sought to determine the prevalence and factors associated with an unwillingness to take on the caregiving role again by interviewing former caregivers of palliative care patients. Methods The setting for this study was South Australia, with a population of 1.6 million people (7% of the Australian population) and used the South Australian Health Omnibus, an annual, face-to-face, cross-sectional, whole-of-population, multistage, systematic area sampling survey, which seeks a minimum of 3000 respondents each year statewide. One interview was conducted per household with the person over the age of 15 who most recently had a birthday. Using two years of data (n = 8377; 65.4% participation rate), comparisons between those who definitely would care again and those who would not was undertaken.
Lobb, E.A., Swetenham, K., Agar, M. & Currow, D.C. 2011, 'A Collateral Benefit of Research in Palliative Care', JOURNAL OF PALLIATIVE MEDICINE, vol. 14, no. 9, pp. 986-987.
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Dear, R., Barratt, A., Askie, L., McGeechan, K., Arora, S., Crossing, S., Currow, D. & Tattersall, M. 2011, 'Adding value to clinical trial registries: insights from Australian Cancer Trials Online, a website for consumers', CLINICAL TRIALS, vol. 8, no. 1, pp. 70-76.
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Clark, K., Lam, L. & Currow, D. 2011, 'Exploring the Relationship Between the Frequency of Documented Bowel Movements and Prescribed Laxatives in Hospitalized Palliative Care Patients', AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, vol. 28, no. 4, pp. 258-263.
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Davidson, P.M., Macdonald, P., Newton, P.J. & Currow, D. 2010, 'End stage heart failure patients: Palliative care in general practice', Australian family physician, vol. 39, no. 12, pp. 2-6.
Background: Chronic heart failure is common, particularly in older individuals, and comorbidities are frequent. Patients with end stage heart failure can be highly symptomatic and require careful monitoring and treatment adjustment to improve symptoms.
Davidson, P.M. & Currow, D. 2010, 'Management of refractory dyspnoea:evidence-based interventions', Cancer Forum, vol. 34, no. 2, pp. 86-90.
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Breathlessness is a common and distressing symptom in both malignant and non-malignant conditions. Both pharmacological and non-pharmacological strategies are necessary to minimise symptom burden and distress. Assessing the individual&acirc;s needs and clarifying the goals of treatment is an important first step in determining an effective treatment plan. Although the evidence supporting the use of some of these therapies is variable, there is an increasing evidence base to inform clinical decision making and treatment plans. Pharmacotherapy with opioids is a common and effective strategy for managing breathlessness, yet requires judicious titration and management. The adverse effects of opioid therapy, including constipation and drowsiness, can be anticipated and managed with adjunctive therapies. The use of oxygen in people who are hypoxaemic is supported, but is of limited value in people who are not hypoxaemic. Individualised strategies and advance care planning is important to avoid unnecessary hospitalisations and futile treatments at the end of life. There is a clear mismatch between the prevalence and burden of this problem and data to inform evidence-based guidelines. Refractory breathlessness is a fertile area for ongoing research and requires increased attention to address the burden of this highly prevalent symptom.
Currow, D., Smith, J., Davidson, P.M., Newton, P.J., Agar, M., Care, M.P. & Abernethy, A. 2010, 'Do the Trajectories of Dyspnea Differ in Prevalence and Intensity By Diagnosis at the End of Life? A Consecutive Cohort Study', Journal of Pain and Symptom Management, vol. 39, no. 4, pp. 680-690.
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Context. Breathlessness reportedly worsens as death approaches for many people, but the differences in intensity and time course between underlying causes are not well described. Objectives. To determine differences in the intensity of breathlessness by diagnosis over time as death approaches in a consecutive cohort seen by a specialist palliative care service. Methods. Patients referred to Silver Chain Hospice Care Service over a period of four years (January 2004 to December 2007) had dyspnea evaluated at every clinical encounter until death. A numeric rating scale (NRS) was used to measure the intensity. Patients were categorized into five clusters (lung cancer, secondary cancer to lung, heart failure, end-stage pulmonary disease, and no identifiable cardiorespiratory cause) at three time points (60e53 [T3], 30e23 [T2], and 7e0 [T1] days before death [T0]). Group differences were assessed using analysis of variance. Joinpoint regression models defined significant changes in mean breathlessness intensity.
Waller, A., Girgis, A., Lecathelinais, C., Scott, W., Foot, L., Sibbritt, D. & Currow, D. 2010, 'Validity, reliability and clinical feasibility of a Needs Assessment Tool for people with progressive cancer', Psycho-oncology, vol. 19, pp. 726-733.
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Background: Needs assessment is a valuable approach for determining the way health and social services allocate resources to people with cancer and their caregivers. Aim: To assess the reliability, validity and acceptability of a Needs Assessment Tool (NAT) in a palliative care clinical setting.
Waller, A., Girgis, A., Johnson, C., Mitchell, G., Yates, P., Kristjanson, L., Tattersall, M., Lecathelinais, C., Sibbritt, D., Kelly, B., Gorton, E. & Currow, D. 2010, 'Facilitating needs based cancer care for people with a chronic disease: Evaluation of an intervention using a multi-centre interrupted timeseries design', BMC Palliative Care, vol. 9, no. 2, pp. 1-6.
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Background: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis [1]. This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer.
Phillips, J.L. & Currow, D. 2010, 'Cancer as a chronic disease', Collegian, vol. 17, no. 2, pp. 47-50.
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Background Over the past two decades the number of people living with cancer has increased. Many cancer survivors end up with long term disabilities requiring ongoing care and support. For many people, cancer survival now means living with a chronic and complex condition. Aim The purpose of this paper is to provide an overview of the long term management issues for cancer survivors and strategies to enhance their care. Discussion Cancer survivors require ongoing support in four key areas: prevention; surveillance; intervention for consequences of cancer and its treatment; and coordination between specialist and generalist providers. Conclusion Cancer survivors experience significant physical and psychological morbidity which makes minimising their burden of disability and distress an important priority. Survivors require ongoing care that is well co-ordinated, focuses on prevention, provides going surveillance whilst minimising and managing the long term effects of treatment and other co-morbidities.