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Professor David Currow

Professor, Faculty of Health
BMed (N'cle), MPH, PhD
 

Chapters

Currow, D. & Phillips, J.L. 2016, 'Chronic Conditions and Cancer at the End of Life' in Cancer and Chronic Conditions, Springer, pp. 455-475.
Conditions. and. Cancer. at. the. End. of. Life. David C. Currow and Jane L. Phillips Abstract The majority of people diagnosed with cancer are older and therefore are likely to have co-morbidities at the time it is diagnosed and if the cancer ...
Currow, D. & Phillips, J.L. 2015, 'Policies on palliative care for older people in Australia' in Palliative care for older people A public health perspective, OUP Oxford.
The book begins by outlining the range of policies towards palliative care for older people that are found worldwide.
LeBlanc, T.W., Currow, D., Phillips, J.L. & Abernethy, A.P. 2014, 'Management of dyspnea' in Palliative Care and Ethics, Common Ground and Cutting Edges, Oxford University Press, Oxford.
Currow, D. & Phillips, J.L. 2014, 'Models of care in palliative medicine' in Palliative Surgery, Springer-Verlag, Berlin.

Conferences

Disler, R., Luckett, T., Phillips, J., Johnson, M., Garcia, M., Bhattarai, P., Hutchinson, A., Currow, D., Carrieri-Kohlman, V., Whelan, B., Newton, P., Agar, M., Chye, R., Sheehan, C., Ivynian, S. & Davidson, P. 2017, 'RESPIRATORY PATIENT EXPERIENCES IN SELF-MANAGING EMERGENCY DEPARTMENT 'NEAR-MISS' FOR BREATHLESSNESS: A STRENGTHS-BASED QUALITATIVE STUDY', RESPIROLOGY, WILEY, pp. 184-184.
Disler, R., Cui, Y., Luckett, T., Donesky, D., Irving, L., Currow, D., Horsfall, L. & Smallwood, N. 2017, 'RESPIRATORY NURSES' KNOWLEDGE AND PRACTICE BEHAVIOURS IN COPD-RELATED ADVANCE CARE PLANNING: PRELIMINARY FINDINGS FROM A CROSSSECTIONAL SURVEY STUDY', RESPIROLOGY, WILEY, pp. 20-20.
Stone, E., Rankin, N., Bewes, T., Kerr, S., Phillips, J., Fong, K., Currow, D. & Shaw, T. 2017, 'MDT V NON-MDT CARE IN LUNG CANCER: DOES CO-MORBIDITY STATUS HAVE AN IMPACT?', RESPIROLOGY, WILEY, pp. 29-29.
Disler, R., Luckett, T., Donesky, D., Irving, L., Currow, D., Horsfall, L., Cui, Y. & Smallwood, N. 2017, 'PALLIATIVE CARE NURSES' ATTITUDES AND PERCEIVED BARRIERS TO COPD-RELATED ADVANCE CARE PLANNING: PRELIMINARY FINDINGS FROM A CROSS-SECTIONAL SURVEY STUDY', RESPIROLOGY, WILEY, pp. 184-184.
King, M., Currow, D., Agar, M., Hardy, J., Fazekas, B. & McCaffrey, N. 2016, 'Assessing health-related quality of life (HRQOL) in palliative care settings: head-to-head comparison of the EORTC QLQ-C15-PAL, FACT-G7, FACIT-Pal and FACIT-Pal-14 patient-reported outcome measures (PROMs)', QUALITY OF LIFE RESEARCH, SPRINGER, pp. 75-76.
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.
Smith, A., Currow, D., Abernethy, A., Miao, Y. & Ritchie, C. 2015, 'Dyspnea in Older Adults: Epidemiology and Outcomes', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, pp. 455-456.
Currow, D., Temel, J., Fearon, K., Friend, J., Yan, Y. & Abernethy, A. 2015, 'ROMANA 3: A safety extension study of anamorelin in advanced non-small cell lung cancer (NSCLC) patients with cachexia', EUROPEAN JOURNAL OF CANCER, pp. S239-S239.
Lovell, M., Luckett, T., Phillips, J., Agar, M., Ryan, L., Lam, L., McCaffrey, N., Boyle, F., Stubbs, J., Shaw, T., Currow, D., Hosie, A. & Davidson, P. 2015, 'Clinical Trial Protocol - Implementing Clinical Practice Guidelines For Cancer Pain In Adults To Ensure Equitable, Cost-Effective, Evidence-Based, Person-Centred Care: A Phase III Pragmatic Stepped Wedge Cluster Randomised Controlled Trial Of Guidelines And Screening With Implementation Strategies Versus Guidelines And Screening Alone To Improve Pain In Adults With Cancer Attending Outpatients Oncology And Palliative Care Centres', Asia-Pacific Journal of Clinical Oncology, pp. 162-162.
Disler, R.T., Inglis, S.C., Newton, P.J., Currow, D.C., Macdonald, P., Glanville, A.R., Donesky, D., Carrieri-Kohlman, V. & Davidson, P.M. 2015, 'Perspectives Of Online Health Information And Support In Chronic Disease Respiratory Disease: Focus Group Study', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE.
Disler, R.T., Inglis, S.C., Newton, P.J., Currow, D.C., Macdonald, P., Glanville, A.R., Donesky, D., Carrieri-Kohlman, V. & Davidson, P.M. 2015, 'Technology Use In Patients Attending A Cardiopulmonary Clinic', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE.
Johnson, M.J., Bland, J.M., Gahbauer, E.A., Ekstrom, M., Sinnarajah, A., Gill, T.M. & Currow, D.C. 2015, 'Breathlessness In The Elderly During The Last Year Of Life Sufficient To Restrict Activity', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE.
Young, J.M., Stacey, I., Dobbins, T., Dunlop, S., Dessaix, A. & Currow, D. 2015, 'How Can We Best Evaluate The Impact of Public Health Legislation? Use of Interrupted Time Series Analysis to Investigate the Introduction of Tobacco Plain Packaging Legislation in Australia', INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, pp. 86-87.
Bonomi, P., Temel, J., Currow, D., Fearon, K., Gleich, L., Yan, Y., Friend, J. & Abernethy, A. 2014, 'Anamorelin for the Treatment of Cancer Anorexia-Cachexia in Advanced NSCLC Patients: Results From ROMANA 1, a Pivotal Phase 3 Study', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, pp. S3-S3.
Abernethy, A.P., Currow, D., Fearon, K., Gleich, L.L., Friend, J. & Temel, J.S. 2014, 'Anamorelin for the treatment of cancer anorexia-cachexia: Baseline characteristics from three phase III clinical trials (the ROMANA program)', JOURNAL OF CLINICAL ONCOLOGY.
Yee, J., Davis, G.M., Beith, J.M., Wilcken, N., Hui, R., Harrison, M.L., Currow, D., Emery, J., Phillips, J., Martin, A., Segelov, E. & Kilbreath, S.L. 2013, 'Physical activity and fitness in women with metastatic breast cancer.', JOURNAL OF CLINICAL ONCOLOGY.
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Abernethy, A.P., Temel, J.S., Currow, D., Gleich, L.L. & Friend, J. 2013, 'Phase III clinical trials with anamorelin HCl, a novel oral treatment for NSCLC cachexia.', JOURNAL OF CLINICAL ONCOLOGY.
Yee, J., Davis, G.M., Beith, J.M., Wilcken, N., Hui, R., Harrison, M.L., Currow, D., Emery, J., Phillips, J., Martin, A., Segelov, E. & Kilbreath, S.L. 2013, 'Physical activity and fitness in women with metastatic breast cancer.', JOURNAL OF CLINICAL ONCOLOGY, Breast Cancer Symposium, AMER SOC CLINICAL ONCOLOGY, San Francisco, CA.
Currow, D.C., Hardy, J., Quinn, S., Fazekas, B., Plummer, J., Eckermann, S., Agar, M., Spruyt, O. & Debra, R. 2012, 'A randomized, double-blind, placebo-controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain.', JOURNAL OF CLINICAL ONCOLOGY.
Currow, D.C., Hardy, J., Agar, M., Sanderson, C., Spruyt, O., Eckermann, S., Plummer, J. & Quinn, S. 2011, 'A Randomised, Double-blind, Placebo Controlled, Multi-site Study of Subcutaneous Ketamine in the Management of Cancer Pain', EUROPEAN JOURNAL OF CANCER, pp. S152-S152.
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.
Abernethy, A.P., Currow, D.C., Shelby-James, T., Williams, H., Roder-Allen, G., Hunt, R., Rowett, D., Esterman, A., May, F. & Phillips, P.A. 2006, 'Improving palliative care: A 2x2x2 factorial cluster randomized controlled trial of case conferencing and educational outreach visiting.', JOURNAL OF CLINICAL ONCOLOGY, pp. 472S-472S.

Journal articles

DiGiacomo, M., Hatano, Y., Phillips, J., Lewis, J., Abernathy, A. & Currow, D. 2017, 'Caregiver characteristics and bereavement needs: findings from a population study', Palliative Medicine, vol. 31, no. 5, pp. 465-474.
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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.
Clark, K., Lam, L.T., Talley, N.J., Phillips, J.L. & Currow, D.C. 2017, 'Identifying Factors That Predict Worse Constipation Symptoms in Palliative Care Patients: A Secondary Analysis.', J Palliat Med, vol. 20, no. 5, pp. 528-532.
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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...
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.
Agar, M., Lawlor, P., Quinn, S., Draper, B., Caplan, G., Rowett, D., Sanderson, C., Hardy, J., Le, B., Eckermann, S., McCaffrey, N., Devilee, L., Fazekas, B., Hill, M. & Currow, D. 2017, 'Efficacy of Oral Risperidone, Haloperidol, or Placebo for Symptoms of Delirium Among Patients in Palliative Care A Randomized Clinical Trial', JAMA Internal Medicine, vol. 177, no. 1, pp. 34-42.
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Importance: Antipsychotics are widely used for distressing symptoms of delirium, but efficacy has not been established in placebo-controlled trials in palliative care. Objective: To determine efficacy of risperidone or haloperidol relative to placebo in relieving target symptoms of delirium associated with distress among patients receiving palliative care. Design, Setting, and Participants: A double-blind, parallel-arm, dose-titrated randomized clinical trial was conducted at 11 Australian inpatient hospice or hospital palliative care services between August 13, 2008, and April 2, 2014, among participants with life-limiting illness, delirium, and a delirium symptoms score (sum of Nursing Delirium Screening Scale behavioral, communication, and perceptual items) of 1 or more. Interventions: Age-adjusted titrated doses of oral risperidone, haloperidol, or placebo solution were administered every 12 hours for 72 hours, based on symptoms of delirium. Patients also received supportive care, individualized treatment of delirium precipitants, and subcutaneous midazolam hydrochloride as required for severe distress or safety. Main Outcome and Measures: Improvement in mean group difference of delirium symptom score (severity range, 0-6) between baseline and day 3. Five a priori secondary outcomes: delirium severity, midazolam use, extrapyramidal effects, sedation, and survival. Results: Two hundred forty-seven participants (mean [SD] age, 74.9 [9.8] years; 85 women [34.4%]; 218 with cancer [88.3%]) were included in intention-to-treat analysis (82 receiving risperidone, 81 receiving haloperidol, and 84 receiving placebo). In the primary intention-to-treat analysis, participants in the risperidone arm had delirium symptom scores that were significantly higher than those among participants in the placebo arm (on average 0.48 Units higher; 95% CI, 0.09-0.86; P = .02) at study end. Similarly, for those in the haloperidol arm, delirium symptom scores were on average 0.24 Units h...
Tervonen, H.E., Morrell, S., Aranda, S., Roder, D., You, H., Niyonsenga, T., Walton, R., Baker, D. & Currow, D. 2017, '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.
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.
Phillips, J.L. & Currow, D.C. 2017, 'Would reframing aged care facilities as a 'hospice' instead of a 'home' enable older people to get the care they need?', Collegian, vol. 24, no. 1, pp. 1-2.
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Pidgeon, T.M., Johnson, C.E., Lester, L., Currow, D., Yates, P., Allingham, S.F., Bird, S. & Eagar, K. 2017, 'Perceptions of the care received from Australian palliative care services: A caregiver perspective.', Palliat Support Care, pp. 1-11.
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BACKGROUND: Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families. OBJECTIVE: Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. METHOD: Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. RESULTS: Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR]&nbsp;=&nbsp;0.29; 95% confidence interval [CI 95%]&nbsp;=&nbsp;0.14, 0.59), with patient psychological care (OR&nbsp;=&nbsp;0.56; CI 95%&nbsp;=&nbsp;0.32, 0.98), and with family support (OR&nbsp;=&nbsp;0.52; CI 95%&nbsp;=&nbsp;0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR&nbsp;=&nbsp;0.98; CI 95%&nbsp;=&nbsp;0.97, 0.98) and carer payments (OR&nbsp;=&nbsp;0.99; CI 95%&nbsp;=&nbsp;0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR&nbsp;=&nbsp;0.41; CI 95%&nbsp;=&nbsp;0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR&nbsp;=&nbsp;0.60; CI 95%&nbsp;=&nbsp;0.45, 0.81). SIGNIFICANCE OF RESULTS: While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in c...
Pidgeon, T., Johnson, C.E., Currow, D., Yates, P., Banfield, M., Lester, L., Allingham, S.F., Bird, S. & Eagar, K. 2016, 'A survey of patients' experience of pain and other symptoms while receiving care from palliative care services.', BMJ supportive & palliative care, vol. 6, no. 3, pp. 315-322.
In Australia, patients at the end of life with complex symptoms and needs are often referred to palliative care services (PCSs), but little is known about the symptoms of patients receiving palliative care in different settings.To explore patients' levels of pain and other symptoms while receiving care from PCSs.PCSs registered through Australia's national Palliative Care Outcomes Collaboration (PCOC) were invited to participate in a survey between 2008 and 2011. Patients (or if unable, a proxy) were invited to complete the Palliative Care Outcome Scale.Questionnaires were completed for 1800 patients. One-quarter of participants reported severe pain, 20% reported severe 'other symptoms', 20% reported severe patient anxiety, 45% reported severe family anxiety, 66% experienced depressed feelings and 19% reported severe problems with self-worth. Participants receiving care in major cities reported higher levels of depressed feelings than participants in inner regional areas. Participants receiving care in community and combined service settings reported higher levels of need for information, more concerns about wasted time, and lower levels of family anxiety and depressed feelings when compared to inpatients. Participants in community settings had lower levels of concern about practical matters than inpatients.Patients receiving care from Australian PCSs have physical and psychosocial concerns that are often complex and rated as 'severe'. Our findings highlight the importance of routine, comprehensive assessment of patients' concerns and the need for Specialist Palliative Care clinicians to be vigilant in addressing pain and other symptoms in a timely, systematic and holistic manner, whatever the care setting.
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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Hui, D., Bansal, S., Strasser, F., Morita, T., Caraceni, A., Davis, M., Cherny, N., Kaasa, S., Currow, D., Abernethy, A., Nekolaichuk, C. & Bruera, E. 2016, 'Reply to the letter to the editor 'Integration between oncology and palliative care: does one size fit all?' by Verna et al.', ANNALS OF ONCOLOGY, vol. 27, no. 3, pp. 549-550.
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Masso, M., Allingham, S.F., Johnson, C.E., Pidgeon, T., Yates, P., Currow, D. & Eagar, K. 2016, 'Palliative Care Problem Severity Score: Reliability and acceptability in a national study', PALLIATIVE MEDICINE, vol. 30, no. 5, pp. 479-485.
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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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Johnson, M.J., Allgar, V., Macleod, U., Jones, A., Oliver, S. & Currow, D. 2016, 'Family Caregivers Who Would Be Unwilling to Provide Care at the End of Life Again: Findings from the Health Survey for England Population Survey', PLOS ONE, vol. 11, no. 1.
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Johnson, M.J. & Currow, D.C. 2016, 'How much evidence isn't in evidence-based guidelines?', ANNALS OF ONCOLOGY, vol. 27, no. 1, pp. 205-205.
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Johnson, M.J., Booth, S., Currow, D.C., Lam, L.T. & Phillips, J.L. 2016, 'A Mixed-Methods, Randomized, Controlled Feasibility Trial to Inform the Design of a Phase III Trial to Test the Effect of the Handheld Fan on Physical Activity and Carer Anxiety in Patients With Refractory Breathlessness', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 51, no. 5, pp. 807-815.
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Nikles, J., Mitchell, G.K., Hardy, J., Senior, H., Carmont, S.-.A., Schluter, P.J., Vora, R., Currow, D. & Yelland, M. 2016, 'Single-patient multiple crossover studies to determine the effectiveness of paracetamol in relieving pain suffered by patients with advanced cancer taking regular opioids: A pilot study', PALLIATIVE MEDICINE, vol. 30, no. 8, pp. 800-802.
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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.
Tervonen, H.E., Aranda, S., Roder, D., Walton, R., Baker, D., You, H. & Currow, D. 2016, 'Differences in impact of Aboriginal and Torres Strait Islander status on cancer stage and survival by level of socio-economic disadvantage and remoteness of residence-A population-based cohort study in Australia', CANCER EPIDEMIOLOGY, vol. 41, pp. 132-138.
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Bausewein, C., Daveson, B.A., Currow, D.C., Downing, J., Deliens, L., Radbruch, L., Defilippi, K., Lopes Ferreira, P., Costantini, M., Harding, R. & Higginson, I.J. 2016, 'EAPC White Paper on outcome measurement in palliative care: Improving practice, attaining outcomes and delivering quality services - Recommendations from the European Association for Palliative Care (EAPC) Task Force on Outcome Measurement.', Palliative medicine, vol. 30, no. 1, pp. 6-22.
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Outcome measurement plays an increasing role in improving the quality, effectiveness, efficiency and availability of palliative care.To provide expert recommendations on outcome measurement in palliative care in clinical practice and research.Developed by a European Association for Palliative Care Task Force, based on literature searches, international expert workshop, development of outcome measurement guidance and international online survey. A subgroup drafted a first version and circulated it twice to the task force. The preliminary final version was circulated to wider expert panel and 28 international experts across 20 European Association for Palliative Care member associations and the European Association for Palliative Care Board of Directors and revised according to their feedback. The final version was approved by the European Association for Palliative Care Board for adoption as an official European Association for Palliative Care position paper.In all, 12 recommendations are proposed covering key parameters of measures, adequate measures for the task, introduction of outcome measurement into practice, and national and international outcome comparisons and benchmarking. Compared to other recommendations, the White Paper covers similar aspects but focuses more on outcome measurement in clinical care and the wider policy impact of implementing outcome measurement in clinical palliative care. Patient-reported outcome measure feedback improves awareness of unmet need and allows professionals to act to address patients' needs. However, barriers and facilitators have been identified when implementing outcome measurement in clinical care that should be addressed.The White Paper recommends the introduction of outcome measurement into practice and outcomes that allow for national and international comparisons. Outcome measurement is key to understanding different models of care across countries and, ultimately, patient outcome having controlled for differing p...
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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Dunlop, S., Lyons, C., Dessaix, A. & Currow, D. 2016, 'How are tobacco smokers using e-cigarettes? Patterns of use, reasons for use and places of purchase in New South Wales', MEDICAL JOURNAL OF AUSTRALIA, vol. 204, no. 9, pp. 355-355.
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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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Delaney, G.P., Gandhidasan, S., Walton, R., Terlich, F., Baker, D. & Currow, D. 2016, 'The Pattern of Use of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer in New South Wales, Australia, 2008 to 2012', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, vol. 96, no. 2, pp. 266-272.
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Kirby, S., Barlow, V., Saurman, E., Lyle, D., Passey, M. & Currow, D. 2016, 'Are rural and remote patients, families and caregivers needs in life-limiting illness different from those of urban dwellers? A narrative synthesis of the evidence', AUSTRALIAN JOURNAL OF RURAL HEALTH, vol. 24, no. 5, pp. 289-299.
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Creighton, N., Walton, R., Roder, D., Aranda, S. & Currow, D. 2016, 'Validation of administrative hospital data for identifying incident pancreatic and periampullary cancer cases: a population-based study using linked cancer registry and administrative hospital data in New South Wales, Australia', BMJ OPEN, vol. 6, no. 7.
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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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McCaffrey, N., Al-Janabi, H., Currow, D., Hoefman, R. & Ratcliffe, J. 2016, 'Protocol for a systematic review of preference-based instruments for measuring care-related outcomes and their suitability for the palliative care setting.', BMJ Open, vol. 6, no. 9, p. e012181.
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INTRODUCTION: Despite informal caregivers' integral role in supporting people affected by disease or disability, economic evaluations often ignore the costs and benefits experienced by this group, especially in the palliative setting. The purpose of this systematic review is to identify preference-based instruments for measuring care-related outcomes and provide guidance on the selection of instrument in palliative care economic evaluations. METHODS AND ANALYSIS: A comprehensive search of the literature will be conducted from database inception (ASSIA; CINAHL; Cochrane library including DARE, NHS EED, HTA; Econlit; Embase; PsychINFO; PubMed). Published peer-reviewed, English-language articles reporting preference-based instruments for measuring care-related outcomes in any clinical area will be included. One researcher will complete the searches and screen the results for potentially eligible studies. A randomly selected subset of 10% citations will be independently screened by two researchers. Any disagreement will be resolved by consensus among the research team. Subsequently, a supplementary search will identify studies detailing the development, valuation, validation and application of the identified instruments. The degree of suitability of the instruments for palliative economic evaluations will be assessed using criteria in the International Society for Quality of Life Research minimum standards for patient-reported outcome measures, the checklist for reporting valuation studies of multiattribute utility-based instruments and information on the development of the instrument in the palliative setting. A narrative summary of the included studies and instruments will be provided; similarities and differences will be described and possible reasons for variations explored. Recommendations for practice on selection of instruments in palliative care economic analyses will be provided. ETHICS AND DISSEMINATION: This is a planned systematic review of published lite...
Dunlop, S., Dessaix, A. & Currow, D. 2016, 'How are tobacco smokers using e-cigarettes? Patterns of use, reasons for use and places of purchase in New South Wales REPLY', MEDICAL JOURNAL OF AUSTRALIA, vol. 205, no. 7, pp. 336-336.
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Ekstrom, M., Johnson, M.J., Schioler, L., Kaasa, S., Hjermstad, M.J. & Currow, D.C. 2016, 'Who experiences higher and increasing breathlessness in advanced cancer? The longitudinal EPCCS Study', SUPPORTIVE CARE IN CANCER, vol. 24, no. 9, pp. 3803-3811.
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Currow, D. & Aranda, S. 2016, 'Financial toxicity in clinical care today: a "menu without prices"', MEDICAL JOURNAL OF AUSTRALIA, vol. 204, no. 11, pp. 397-397.
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Dunlop, S., Perez, D., Dessaix, A. & Currow, D. 2016, 'Australia's plain tobacco packs: anticipated and actual responses among adolescents and young adults 2010-2013.', Tob Control.
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BACKGROUND: In December 2012, Australia introduced world-first legislation mandating plain packaging for all tobacco products. To date, there is very little evidence on youth responses to the changed packs. AIM: To assess attitudes towards, and responses to, tobacco plain packs preimplementation and postimplementation. METHODS: The Tobacco Promotion Impact Study (TPIS) was a yearly cross-sectional telephone survey of adolescents and young adults (12-24years) from the states of New South Wales (NSW) and Queensland, conducted at three time points preimplementation (June 2010; June 2011; June 2012) and one time point postimplementation (June 2013; total n=8820). RESULTS: There were significant increases in support for plain packaging from preimplementation to postimplementation for: never smokers (56% in 2012 vs 63% in 2013; OR=0.77, 95% CI 0.65 to 0.90, p=0.001), experimenters/ex-smokers (55% in 2012 vs 72% in 2013; OR=0.51, 95% CI 0.38 to 0.68, p<0.001) and current smokers (35% in 2012 vs 55% in 2013; OR=0.49, 95% CI 0.32 to 0.75, p=0.001). At postimplementation, 16% of never smokers reported that plain packaging made them less likely to try smoking and 18% of experimenters/ex-smokers reported that plain packaging made them less likely to smoke again. Youth were significantly less likely to have anticipated these responses preimplementation (never smokers: 8% in 2011; OR=0.43, 95% CI 0.28 to 0.65, p<0.00; experimenters/ex-smokers: 11%; OR=0.65, 95% CI 0.52 to 0.82, p<0.001). At postimplementation, 34% of smokers reported a quitting-related response to plain packaging (tried to quit or thought about quitting); the proportion who anticipated such a response preimplementation was significantly less (14% in 2011; OR=0.33, 95% CI 0.20 to 0.53, p<0.001). 28% of smokers reported a social denormalisation response at postimplementation (hid their pack from view, used a case to cover their pack, felt embarrassed); the proportion who anticipated such a response preimplement...
Watts, G.J., Clark, K., Agar, M., Davidson, P.M., McDonald, C., Lam, L.T., Sajkov, D., McCaffrey, N., Doogue, M., Abernethy, A.P., Currow, D.C. & Australian national Palliative Care Clinical Studies Collaborative (PaCCSC) 2016, 'Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness.', BMJ Open, vol. 6, no. 11, p. e013177.
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INTRODUCTION: Breathlessness remains a highly prevalent and distressing symptom for many patients with progressive life-limiting illnesses. Evidence-based interventions for chronic breathlessness are limited, and there is an ongoing need for high-quality research into developing management strategies for optimal palliation of this complex symptom. Previous studies have suggested that selective serotonin reuptake inhibitors such as sertraline may have a role in reducing breathlessness. This paper presents the protocol for a large, adequately powered randomised study evaluating the use of sertraline for chronic breathlessness in people with progressive life-limiting illnesses. METHODS AND ANALYSIS: A total of 240 participants with modified Medical Research Council Dyspnoea Scale breathlessness of level 2 or higher will be randomised to receive either sertraline or placebo for 28days in this multisite, double-blind study. The dose will be titrated up every 3days to a maximum of 100mg daily. The primary outcome will be to compare the efficacy of sertraline with placebo in relieving the intensity of worst breathlessness as assessed by a 0-100mm Visual Analogue Scale. A number of other outcome measures and descriptors of breathlessness as well as caregiver assessments will also be recorded to ensure adequate analysis of participant breathlessness and to allow an economic analysis to be performed. Participants will also be given the option of continuing blinded treatment until either study data collection is complete or net benefit ceases. Appropriate statistical analysis of primary and secondary outcomes will be used to describe the wealth of data obtained. ETHICS AND DISSEMINATION: Ethics approval was obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals and the key findings presented at national and international conferences. TRIAL REGISTRATION NUMBER: ACTRN12610000464066.
Aranda, S. & Currow, D. 2016, 'Financial toxicity in clinical care today: a "menu without prices".', Med J Aust, vol. 205, no. 11, pp. 529-530.
Ekstrom, M., Ahmadi, Z., Bornefalk-Hermansson, A., Abernethy, A. & Currow, D. 2016, 'Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 11.
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Johnston, A.K., Creighton, N. & Currow, D. 2016, 'BREAST RECONSTRUCTION FOLLOWING MASTECTOMY IN NSW, 2008-2011', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 12, pp. 111-111.
Collins, A., Burchell, J., Sundararajan, V., Millar, J., Le, B., Currow, D., Hudson, P., McLachlan, S.-.A., Mileshkin, L. & Krishnasamy, M. 2016, 'Transition to Palliative Care for Patients with Metastatic Prostate Cancer: How Well Have We Integrated?', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 6, pp. E150-E151.
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Clark, K., Connolly, A., Clapham, S., Quinsey, K. & Currow, D. 2016, 'The Prevalence and Intensity of People's Physical Symptoms at the Time That Dying Was Diagnosed: A Prospective Cohort Study', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 6, pp. E17-E17.
Reigada, C., Fairhurst, C., Yorke, J., Ross, J., Boland, J., Hart, S., Currow, D., Grande, G., Bajwah, S., Wells, A., Macleod, U., Bland, M. & Johnson, M. 2016, 'CONSTRUCT VALIDITY OF THE NEEDS ASSESSMENT TOOL PROGRESSIVE DISEASES FOR INTERSTITIAL LUNG DISEASE (NAT: PD-ILD) PATIENTS', THORAX, vol. 71, pp. A266-A266.
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Collins, A., Burchell, J., Ritchie, D., Le, B., Sundararajan, V., Hudson, P., McLachlan, S.-.A., Krishnasamy, M., Millar, J., Currow, D., Mileshkin, L. & Philip, J. 2016, 'Exploring the Landscape of Palliative Care for People with Non-Hodgkin's Lymphoma: Do They Receive Quality End-of-Life Care?', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 6, pp. E151-E152.
Currow, D., Temel, J., Abernethy, A., Friend, J., Giorgino, R. & Fearon, K.C. 2016, 'Anamorelin in cachectic patients with non-small cell lung cancer (NSCLC) and acute phase protein reaction (APPR): Pooled analysis of two phase 3 trials (ROMANA 1 and ROMANA 2)', ANNALS OF ONCOLOGY, vol. 27.
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Philip, J., Collins, A., Burchell, J., Krishnasamy, M., Mileshkin, L., McLachlan, S.-.A., Le, B., Millar, J., Currow, D., Hudson, P. & Sundararajan, V. 2016, 'Integration of Palliative Care for Patients with Metastatic Breast Cancer: Have We Achieved Quality End-of-Life Care?', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 52, no. 6, pp. E152-E152.
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. 2015, 'Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain.', BMJ supportive & palliative care, vol. 5, no. 3, pp. 273-280.
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Hospice/palliative care patients may differ from better studied populations, and data from other populations cannot necessarily be extrapolated into hospice/palliative care clinical practice. Pharmacovigilance studies provide opportunities to understand the harms and benefits of medications in routine practice. Gabapentin, a -amino butyric acid analogue antiepileptic drug, is commonly prescribed for neuropathic pain in hospice/palliative care. Most of the evidence however relates to non-malignant, chronic pain syndromes (diabetic neuropathy, postherpetic neuralgia, central pain syndromes, fibromyalgia). The aim of this study was to quantify the immediate and short-term clinical benefits and harms of gabapentin in routine hospice/palliative care practice.Multisite, prospective, consecutive cohort.127 patients, 114 of whom had cancer, who started gabapentin for neuropathic pain as part of routine clinical care.42 centres from seven countries. Data were collected at three time points-at baseline, at day 7 (and at any time; immediate and short-term harms) and at day 21 (clinical benefits).At day 21, the average dose of gabapentin for those still using it (n=68) was 653mg/24h (range 0-1800mg) and 54 (42%) reported benefits, of whom 7 (6%) experienced complete pain resolution. Harms were reported in 39/127 (30%) patients at day 7, the most frequent of which were cognitive disturbance, somnolence, nausea and dizziness. Ten patients had their medication ceased due to harms. The presence of significant comorbidities, higher dose and increasing age increased the likelihood of harm.Overall, 42% of people experienced benefit at a level that resulted in continued use at 21days.
Dunlop, S., Kite, J., Grunseit, A.C., Rissel, C., Perez, D.A., Dessaix, A., Cotter, T., Bauman, A., Young, J. & Currow, D. 2015, 'Out of Sight and Out of Mind? Evaluating the Impact of Point-of-Sale Tobacco Display Bans on Smoking-Related Beliefs and Behaviors in a Sample of Australian Adolescents and Young Adults', NICOTINE & TOBACCO RESEARCH, vol. 17, no. 7, pp. 761-768.
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Young, J., Badgery-Parker, T., Dobbins, T., Jorgensen, M., Gibbs, P., Faragher, I., Jones, I. & Currow, D. 2015, 'Comparison of ECOG/WHO Performance Status and ASA Score as a Measure of Functional Status', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 49, no. 2, pp. 258-264.
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Holloway, K., Toye, C., McConigley, R., Tieman, J., Currow, D. & Hegarty, M. 2015, 'National consultation informing development of guidelines for a palliative approach for aged care in the community setting', AUSTRALASIAN JOURNAL ON AGEING, vol. 34, no. 1, pp. 21-26.
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Currow, D.C., Quinn, S., Agar, M., Fazekas, B., Hardy, J., McCaffrey, N., Eckermann, S., Abernethy, A.P. & Clark, K. 2015, 'Double-Blind, Placebo-Controlled, Randomized Trial of Octreotide in Malignant Bowel Obstruction', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 49, no. 5, pp. 814-821.
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Young, J.M., O'Halloran, A., McAulay, C., Pirotta, M., Forsdike, K., Stacey, I. & Currow, D. 2015, 'Unconditional and conditional incentives differentially improved general practitioners' participation in an online survey: randomized controlled trial', JOURNAL OF CLINICAL EPIDEMIOLOGY, vol. 68, no. 6, pp. 693-697.
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Hoefman, R., Al-Janabi, H., McCaffrey, N., Currow, D. & Ratcliffe, J. 2015, 'Measuring caregiver outcomes in palliative care: a construct validation study of two instruments for use in economic evaluations', QUALITY OF LIFE RESEARCH, vol. 24, no. 5, pp. 1255-1273.
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Phillips, J., Dal Grande, E., Ritchie, C., Abernethy, A.P. & Currow, D.C. 2015, 'A population-based cross-sectional study that defined normative population data for the Life-Space Mobility Assessment-composite score.', Journal of pain and symptom management, vol. 49, no. 5, pp. 885-893.
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Mobility is linked to health status and quality of life. Life-Space Mobility Assessment (LSMA; range 0-120) measures the spatial extent of people's excursion and physical support needs over the preceding month.The aim of this study was to generate normative population data for an LSMA-Composite (LSMA-C) score, irrespective of age or health service contact and explore the LSM of people with diabetes, current asthma, arthritis, and osteoporosis.LSMA questions were included in the 2011 South Australian Health Omnibus Survey, a multistage, systematic, and clustered sample of household face-to-face interviews. Sociodemographic and clinical variables were explored in relation to LSMA scores using descriptive, univariable, and multivariable analyses and receiver operator curves.For the 3032 respondents, the mean LSMA score was 98.3 (SD 20.3; median 100; interquartile range 34 [86-120]; range 6-120). Five percent of respondents scored <60, 11% scored between 60 and 79, 27% scored between 80 and 99, and the remainder scored between 100 and 120. After 55 years of age, LSMA-C scores declined, more so in females. In multivariable analysis, declining scores were associated with being female, being older, living in rural areas, lower educational attainment, not working, lower household income, and higher numbers of chronic conditions (R(2) = 0.35, P < 0.001). The receiver operator curve demonstrated a highly specific but relatively insensitive measure.Having controlled for known confounders, the male/female difference cannot be easily explained. These data will help to contextualize studies in the future that use the LSMA-C score.
Ekström, M., Bornefalk-Hermansson, A., Abernethy, A. & Currow, D. 2015, 'Low-dose opioids should be considered for symptom relief also in advanced chronic obstructive pulmonary disease (COPD).', Evidence-based medicine, vol. 20, no. 1, p. 39.
Clark, K. & Currow, D. 2015, 'Midazolam in Palliative Care: At What Cost?', JOURNAL OF PALLIATIVE MEDICINE, vol. 18, no. 2, pp. 96-97.
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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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Reigada, C., Bajwah, S., Ross, J., Boland, J., Wells, A., Yorke, J., Grande, G., Hart, S., Currow, D., Papadopoulos, T., Macleod, U. & Johnson, M. 2015, 'Adaptation, face and content validation of a palliative care needs assessment tool for people with interstitial lung disease.', BMJ supportive & palliative care, vol. 5, no. 1, pp. 111-112.
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INTRODUCTION: Interstitial lung disease (ILD) is a non-malignant progressive disease which causes breathlessness, cough, fatigue, psycho-social, financial and spiritual distress; difficult for patients and their family carers. The Needs Assessment Tool: Progressive Disease (NAT:PD-C) was developed as an "aide-memoire" to help clinicians identify a range of palliative care needs in people with cancer, and their carers, in daily practice. We have adapted this tool for people with ILD. AIMS AND METHODS: Our aim was to adapt, and then test face and content validity of the adapted version. The NAT:PD-C was adapted for people with ILD using data from a systematic review of the literature and previously completed qualitative interviews. Focus groups were held (patients [N=7], carers [N=3], clinicians [N=8] followed by an Expert Consensus Group to discuss face and content validity of the NAT:PD-ILD. The Expert Group also discussed issues regarding implementation in practice. The discussion was audio and video-recorded, and cognitive mapping was used. Data was analysed following the principles of inductive theory building. Further validation and reliability testing is ongoing. We present the preliminary results of the face/content validation. RESULTS: All sections ("red flags" for high risk patients; priority referral; patient wellbeing; ability of carer to provide care; carer wellbeing) of the tool were felt to be important. Some symptoms (voice, mucous and mobility) were added by patients. Clinicians identified training needs about "Spiritual or existential concerns". Carers highlighted the need for support for themselves. CONCLUSIONS: The NAT:PD-ILD appears to have face and content validity and the content and structure reflected the experience of all groups. *This research was funding by Marie Curie Care Cancer Research UK.
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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Disler, R.T., Inglis, S.C., Newton, P.J., Currow, D.C., Macdonald, P.S., Glanville, A.R., Donesky, D., Carrieri-Kohlman, V. & Davidson, P.M. 2015, 'Patterns of Technology Use in Patients Attending a Cardiopulmonary Outpatient Clinic: A Self-Report Survey', Interactive journal of medical research, vol. 4, no. 1, pp. e5-e5.
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Roder, D., Creighton, N., Baker, D., Walton, R., Aranda, S. & Currow, D. 2015, 'Changing roles of population-based cancer registries in Australia', AUSTRALIAN HEALTH REVIEW, vol. 39, no. 4, pp. 425-428.
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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, 'USE OF TECHNOLOGY IN CARDIOPULMONARY PATIENTS', RESPIROLOGY, vol. 20, pp. 13-13.
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.
Hui, D., Bansal, S., Strasser, F., Morita, T., Caraceni, A., Davis, M., Cherny, N., Kaasa, S., Currow, D., Abernethy, A., Nekolaichuk, C. & Bruera, E. 2015, 'Indicators of integration of oncology and palliative care programs: an international consensus', ANNALS OF ONCOLOGY, vol. 26, no. 9, pp. 1953-1959.
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Clark, K., Quinn, S.J., Doogue, M., Sanderson, C., Lovell, M. & Currow, D.C. 2015, 'Routine prescribing of gabapentin or pregabalin in supportive and palliative care: what are the comparative performances of the medications in a palliative care population?', SUPPORTIVE CARE IN CANCER, vol. 23, no. 9, pp. 2517-2520.
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Brewer, C., Abernethy, A., Currow, D., Fearon, K., Friend, J. & Temel, J. 2015, 'EVALUATION OF ANOREXIA-CACHEXIA SYMPTOMS/CONCERNS FROM ROMANA 2, A PHASE III TRIAL OF ANAMORELIN IN NON-SMALL CELL LUNG CANCER PATIENTS WITH CACHEXIA.', ONCOLOGY NURSING FORUM, vol. 42, no. 2, pp. E229-E229.
Nipp, R.D., Currow, D.C., Cherny, N.I., Strasser, F., Abernethy, A.P. & Zafar, S.Y. 2015, 'Best supportive care in clinical trials: review of the inconsistency in control arm design', BRITISH JOURNAL OF CANCER, vol. 113, no. 1, pp. 6-11.
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Hutchinson, A., Booth, S., Currow, D., Higginson, I. & Johnson, M. 2015, 'Invisible suffering: breathlessness in and beyond the clinic-a reply', LANCET RESPIRATORY MEDICINE, vol. 3, no. 8, pp. E29-E29.
Smallwood, N., Le, B., Currow, D., Irving, L. & Philip, J. 2015, 'Management of refractory breathlessness with morphine in patients with chronic obstructive pulmonary disease', INTERNAL MEDICINE JOURNAL, vol. 45, no. 9, pp. 898-904.
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McLoughlin, K., Rhatigan, J., McGilloway, S., Kellehear, A., Lucey, M., Twomey, F., Conroy, M., Herrera-Molina, E., Kumar, S., Furlong, M., Callinan, J., Watson, M., Currow, D. & Bailey, C. 2015, 'INSPIRE (INvestigating Social and PractIcal suppoRts at the End of life): Pilot randomised trial of a community social and practical support intervention for adults with life-limiting illness', BMC PALLIATIVE CARE, vol. 14.
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Swetenham, K., Tieman, J., Butow, P. & Currow, D. 2015, 'Communication differences when patients and caregivers are seen separately or together.', International journal of palliative nursing, vol. 21, no. 11, pp. 557-563.
Southern Adelaide Palliative Care Services introduced a nurse-led early introduction to a palliative care clinic in 2011. The clinic offers a thorough psychosocial assessment and the provision of information and an introduction to future care planning. The patients and their caregivers are seen together by the nurse practitioner initially for a physical assessment. They are then seen by a social worker to focus on advanced care planning and assessment of social and emotional factors. After the social work visit, the patient and caregiver are separated, and the patient sees the psychosocial nurse for coping and adjustment to illness and the carer sees the caregiver network facilitator to assess their informal supports to assist in the role of community-based caregiving. The pilot study looks at the nature of communication in the clinic where patient and carer are together and compares that to when they are separated.A total of 33 patients and their caregivers agreed for their coversations to be tape recorded between May and November of 2013. All tape recordings were transcribed verbatim. Ten patient transcripts (n=40) have been coded for quantitative analysis. The codes identify content and function of speech, cues for information and emotion and whether they are responded to by clinicians.Pilot results reveal that caregivers contribute little in the combined clinics and dominate the conversation in the private clinic. Patients, when seen alone, predominantly express emotion related cues, opposed to cues for information. The clinicians focus on their area of specialty, which results in little duplication in this clinic setting.An earlier evaluation of this clinic found that patients and their caregivers appreciate being separated in the clinic setting to have time and privacy to reveal fears and feelings related to end-of-life care. This current study quantifies the patient and caregiver experience and confirms those earlier findings.
Tervonen, H., Aranda, S., Walton, R., Baker, D., Currow, D., Morrell, S., You, H. & Roder, D. 2015, 'HOW CAN WE BETTER MEASURE AND ADDRESS SOCIO-DEMOGRAPHIC DISADVANTAGE IN CANCER OUTCOMES?', Asia-Pacific Journal of Clinical Oncology, vol. 11, pp. 65-65.
Hudson, P.L., Girgis, A., Mitchell, G.K., Philip, J., Parker, D., Currow, D., Liew, D., Thomas, K., Le, B., Moran, J. & Brand, C. 2015, 'Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol', BMC PALLIATIVE CARE, vol. 14.
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Abernethy, A., Fearon, K., Friend, J., Yan, Y., Duus, E. & Currow, D. 2015, 'Results From Phase III Trials of Anamorelin in Advanced Non-Small Cell Lung Cancer Patients with Cachexia: ROMANA 1 and 2', JOURNAL OF THORACIC ONCOLOGY, vol. 10, no. 9, pp. S791-S792.
Phillips, J.L., Johnson, M. & Currow, D. 2015, 'Heart failure and palliative care: Are we there yet?', Cardiology Today, vol. 5, no. 1, pp. 13-16.
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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
Lewis, J., DiGiacomo, M., Currow, D.C. & Davidson, P.M. 2014, 'Social capital in a lower socioeconomic palliative care population: a qualitative investigation of individual, community and civic networks and relations', BMC Palliative Care, vol. 13, no. 30.
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The article reports findings from a qualitative investigation of the needs and experiences of palliative care patients and caregivers who are experiencing financial hardship or disadvantage. This article highlights the individual, community and civic networks and relations relevant to these experiences.
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.
Johnson, M.J., Bland, J.M., Davidson, P.M., Newton, P.J., Oxberry, S.G., Abernethy, A.P. & Currow, D.C. 2014, 'The Relationship Between Two Performance Scales: New York Heart Association Classification and Karnofsky Performance Status Scale', Journal of Pain and Symptom Management, vol. 47, no. 3, pp. 652-658.
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To, T.H.M., Agar, M., Yates, P. & Currow, D.C. 2014, 'Prescribing for Nausea in Palliative Care: A Cross-Sectional National Survey of Australian Palliative Medicine Doctors', JOURNAL OF PALLIATIVE MEDICINE, vol. 17, no. 9, pp. 1032-1036.
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Bush, S.H., Leonard, M.M., Agar, M., Spiller, J.A., Hosie, A., Wright, D.K., Meagher, D.J., Currow, D.C., Bruera, E. & Lawlor, P.G. 2014, 'End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 48, no. 2, pp. 215-230.
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Bush, S.H., Bruera, E., Lawlor, P.G., Kanji, S., Davis, D.H.J., Agar, M., Wright, D.K., Hartwick, M., Currow, D.C., Gagnon, B., Simon, J. & Pereira, J.L. 2014, 'Clinical Practice Guidelines for Delirium Management: Potential Application in Palliative Care', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 48, no. 2, pp. 249-258.
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Lawlor, P.G., Davis, D.H.J., Ansari, M., Hosie, A., Kanji, S., Momoli, F., Bush, S.H., Watanabe, S., Currow, D.C., Gagnon, B., Agar, M., Bruera, E., Meagher, D.J., de Rooij, S.E.J.A., Adamis, D., Caraceni, A., Marchington, K. & Stewart, D.J. 2014, 'An Analytical Framework for Delirium Research in Palliative Care Settings: Integrated Epidemiologic, Clinician-Researcher, and Knowledge User Perspectives', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 48, no. 2, pp. 159-175.
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Clark, K., Lam, L., Currow, D.C. & Agar, M. 2014, 'A Prospective Study to Investigate Contributory Factors That Lead to Constipation in Palliative Care Patients', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 47, no. 6, pp. E1-E4.
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Bush, S.H., Kanji, S., Pereira, J.L., Davis, D.H.J., Currow, D.C., Meagher, D.J., Rabheru, K., Wright, D.K., Bruera, E., Agar, M., Hartwick, M., Gagnon, P.R., Gagnon, B., Breitbart, W., Regnier, L. & Lawlor, P.G. 2014, 'Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 48, no. 2, pp. 231-248.
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Hegarty, M., Breaden, K., Agar, M., Devery, K., Goh, C., Shaw, R., Swetenham, K. & Currow, D.C. 2014, 'Asia Pacific Palliative Care Development Through Education', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 47, no. 2, pp. E7-E9.
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Sweet, L., Adamis, D., Meagher, D.J., Davis, D., Currow, D.C., Bush, S.H., Barnes, C., Hartwick, M., Agar, M., Simon, J., Breitbart, W., MacDonald, N. & Lawlor, P.G. 2014, 'Ethical Challenges and Solutions Regarding Delirium Studies in Palliative Care', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 48, no. 2, pp. 259-271.
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Swetenham, K., Tieman, J. & Currow, D. 2014, 'Do patients and carers find separate palliative care clinic consultations acceptable? A pilot study.', International journal of palliative nursing, vol. 20, no. 6, pp. 301-305.
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BACKGROUND: As differing patient and carer information needs have been reported, and in light of changing health-system priorities and issues identified in a self-assessment study, a specialist palliative care service established an interdisciplinary psychosocial assessment clinic to separately assess patient and carer needs. AIM: To determine the acceptability of the separate assessment to patients and carers. METHOD: Patients with a high functional score and who were deemed well enough to manage an appointment were invited to attend the clinic. Consent to follow-up was obtained. Patient and carer satisfaction surveys were developed based on existing tools. Questionnaires were posted out with a pre-paid reply envelope to patients and carers. Data from completed surveys was entered into a data management system and frequency analysis completed. A secondary analysis of the comments was undertaken. FINDINGS: The clinic was attended by 41 patients and 37 carers between September 2011 and the end of February 2012. There was a 46% response rate, with 24 questionnaires returned from both the patient and their carer, 6 from patients only, and 6 from carers only (2 of whom were bereaved). The opportunity for privacy to discuss their own fears and concerns related to the illness was appreciated by 94% of the patients and 83% of the carers. CONCLUSION: This initial pilot data shows patient and carer satisfaction with this clinic model. Further qualitative data would provide more information on the patient and carer experiences of the clinic.
Scott, N., Donato-Hunt, C., Crane, M., Lafontaine, M., Varlow, M., Seale, H. & Currow, D. 2014, 'Knowledge, attitudes and beliefs about lung cancer in three culturally and linguistically diverse communities living in Australia: a qualitative study', HEALTH PROMOTION JOURNAL OF AUSTRALIA, vol. 25, no. 1, pp. 46-51.
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McCaffrey, N., Skuza, P., Breaden, K., Eckermann, S., Hardy, J., Oaten, S., Briffa, M. & Currow, D. 2014, 'Preliminary Development and Validation of a New End-of-Life Patient-Reported Outcome Measure Assessing the Ability of Patients to Finalise Their Affairs at the End of Life', PLOS ONE, vol. 9, no. 4.
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Young, J.M., Currow, D. & Dunlop, S. 2014, 'The association between tobacco plain packaging and Quitline calls REPLY', MEDICAL JOURNAL OF AUSTRALIA, vol. 200, no. 6, pp. 315-315.
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Tracey, E., Watt, H., Currow, D., Young, J. & Armstrong, B. 2014, 'Investigation of poorer bladder cancer survival in women in NSW, Australia: a data linkage study', BJU INTERNATIONAL, vol. 113, no. 3, pp. 437-448.
Hardy, J.R., Spruyt, O., Quinn, S.J., Devilee, L.R. & Currow, D.C. 2014, 'Implementing practice change in chronic cancer pain management: clinician response to a phase III study of ketamine', INTERNAL MEDICINE JOURNAL, vol. 44, no. 6, pp. 586-591.
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Russell, B.J., Rowett, D., Abernethy, A.P. & Currow, D.C. 2014, 'Prescribing for comorbid disease in a palliative population: focus on the use of lipid-lowering medications', INTERNAL MEDICINE JOURNAL, vol. 44, no. 2, pp. 177-184.
Johnson, C., Rushton, S., Tieman, J., Currow, D. & Aranda, S. 2014, 'Reclaiming the midnight hours: up-to-date evidence in just one click', EUROPEAN JOURNAL OF CANCER CARE, vol. 23, no. 6, pp. 760-761.
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Young, J.M., Stacey, I., Dobbins, T.A., Dunlop, S., Dessaix, A.L. & Currow, D.C. 2014, 'Association between tobacco plain packaging and Quitline calls: a population-based, interrupted time-series analysis.', The Medical journal of Australia, vol. 200, no. 1, pp. 29-32.
OBJECTIVES: To investigate whether the introduction of tobacco plain packaging in Australia from 1&nbsp;October 2012&nbsp;was associated with a change in the number of calls to the smoking cessation helpline, Quitline, and to compare this with the impact of the introduction of graphic health warnings from 1&nbsp;March 2006. DESIGN AND SETTING: Whole-of-population interrupted time-series analysis in New South Wales and the Australian Capital Territory between 1&nbsp;March 2005&nbsp;and October 2006&nbsp;for the comparator, graphic health warnings, and October 2011&nbsp;and April 2013&nbsp;for the intervention of interest, tobacco plain packaging. MAIN OUTCOME MEASURE: Weekly number of calls to the Quitline, after adjusting for seasonal trends, anti-tobacco advertising, cigarette costliness and the number of smokers in the community. RESULTS: There was a 78% increase in the number of calls to the Quitline associated with the introduction of plain packaging (baseline, 363/week; peak, 651/week [95% CI, 523-780/week; P <&nbsp;0.001]). This peak occurred 4&nbsp;weeks after the initial appearance of plain packaging and has been prolonged. The 2006&nbsp;introduction of graphic health warnings had the same relative increase in calls (84%; baseline, 910/week; peak, 1673/week [95% CI, 1383-1963/week; P <&nbsp;0.001]) but the impact of plain packaging has continued for longer. CONCLUSIONS: There has been a sustained increase in calls to the Quitline after the introduction of tobacco plain packaging. This increase is not attributable to anti-tobacco advertising activity, cigarette price increases nor other identifiable causes. This is an important incremental step in comprehensive tobacco control.
Dunlop, S., Dobbins, T., Young, J., Perez, D. & Currow, D. 2014, 'SHORT-TERM IMPACT OF AUSTRALIA'S NEW TOBACCO PLAIN PACKS ON ADULT SMOKERS' PACK-RELATED PERCEPTIONS AND RESPONSES: RESULTS FROM A CONTINUOUS TRACKING SURVEY', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 10, pp. 6-6.
Yee, J., Davis, G.M., Beith, J.M., Wilcken, N., Currow, D., Emery, J., Phillips, J., Martin, A., Hui, R., Harrison, M., Segelov, E. & Kilbreath, S.L. 2014, 'Physical activity and fitness in women with metastatic breast cancer', JOURNAL OF CANCER SURVIVORSHIP, vol. 8, no. 4, pp. 647-656.
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Chan, R.J., Webster, J., Phillips, J. & Currow, D.C. 2014, 'The withdrawal of the Liverpool Care Pathway in the United Kingdom: what are the implications for Australia?', The Medical journal of Australia, vol. 200, no. 10, p. 573.
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Ekstrom, M.P., Bornefalk-Hermansson, A., Abernethy, A. & Currow, D.C. 2014, 'Safety Of Benzodiazepines And Opioids In Very Severe COPD: A National Prospective Study', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, vol. 189.
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.
Davidson, P.M., Abernethy, A.P., Newton, P.J., Clark, K. & Currow, D.C. 2013, 'The caregiving perspective in heart failure: a population based study', BMC Health Services Research, vol. 13, no. 342.
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McCaffrey, N., Agar, M., Harlum, J., Karnon, J., Currow, D. & Eckermann, S. 2013, 'Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot.', BMJ supportive & palliative care, vol. 3, no. 4, pp. 431-435.
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OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of a home-based palliative care model relative to usual care in expediting discharge or enabling patients to remain at home. DESIGN: Economic evaluation of a pilot randomised controlled trial with 28 days follow-up. METHODS: Mean costs and effectiveness were calculated for the Palliative Care Extended Packages at Home (PEACH) and usual care arms including: days at home; place of death; PEACH intervention costs; specialist palliative care service use; acute hospital and palliative care unit inpatient stays; and outpatient visits. RESULTS: PEACH mean intervention costs per patient ($3489) were largely offset by lower mean inpatient care costs ($2450) and in this arm, participants were at home for one additional day on average. Consequently, PEACH is cost-effective relative to usual care when the threshold value for one extra day at home exceeds $1068, or $2547 if only within-study days of hospital admission are costed. All estimates are high uncertainty. CONCLUSIONS: The results of this small pilot study point to the potential of PEACH as a cost-effective end-of-life care model relative to usual care. Findings support the feasibility of conducting a definitive, fully powered study with longer follow-up and comprehensive economic evaluation.
Nikles, J., Mitchell, G.K., Hardy, J., Agar, M., Senior, H., Carmont, S.-.A., Schluter, P.J., Good, P., Vora, R. & Currow, D. 2013, 'Do pilocarpine drops help dry mouth in palliative care patients: a protocol for an aggregated series of n-of-1 trials', BMC PALLIATIVE CARE, vol. 12.
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Hardy, J., Quinn, S., Fazekas, B., Agar, M. & Currow, D. 2013, 'Can the LANSS scale be used to classify pain in chronic cancer pain trials?', SUPPORTIVE CARE IN CANCER, vol. 21, no. 12, pp. 3387-3391.
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Agar, M., Ko, D.N., Sheehan, C., Chapman, M. & Currow, D.C. 2013, 'Informed Consent in Palliative Care Clinical Trials: Challenging but Possible', JOURNAL OF PALLIATIVE MEDICINE, vol. 16, no. 5, pp. 485-491.
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Sr, H.E.J., Mitchell, G.K., Nikles, J., Carmont, S.-.A., Schluter, P.J., Currow, D.C., Vora, R., Yelland, M.J., Agar, M., Good, P.D. & Hardy, J.R. 2013, 'Using aggregated single patient (N-of-1) trials to determine the effectiveness of psychostimulants to reduce fatigue in advanced cancer patients: a rationale and protocol', BMC PALLIATIVE CARE, vol. 12.
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To, T.H.M., Agar, M. & Currow, D.C. 2013, 'Rapid death after hospitalisation', INTERNAL MEDICINE JOURNAL, vol. 43, no. 4, pp. 471-471.
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Currow, D.C., Agar, M. & Abernethy, A.P. 2013, 'Hospital Can Be the Actively Chosen Place for Death', JOURNAL OF CLINICAL ONCOLOGY, vol. 31, no. 5, pp. 651-652.
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To, T.H.M., Agar, M., Shelby-James, T., Abernethy, A.P., Doogue, M., Rowett, D., Ko, D. & Currow, D.C. 2013, 'Off-label prescribing in palliative care - a cross-sectional national survey of Palliative Medicine doctors', PALLIATIVE MEDICINE, vol. 27, no. 4, pp. 320-328.
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van Zandwijk, N., Clarke, C., Henderson, D., Musk, A.W., Fong, K., Nowak, A., Loneragan, R., McCaughan, B., Boyer, M., Feigen, M., Currow, D., Schofield, P., Ivimey, B., Pavlakis, N., McLean, J., Marshall, H., Leong, S., Keena, V. & Penman, A. 2013, 'Guidelines for the diagnosis and treatment of malignant pleural mesothelioma', JOURNAL OF THORACIC DISEASE, vol. 5, no. 6, pp. E254-E307.
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Currow, D., Johnson, M., White, P. & Abernethy, A. 2013, 'Evidence-based intervention for chronic refractory breathlessness: practical therapies that make a difference', BRITISH JOURNAL OF GENERAL PRACTICE, vol. 63, no. 616, pp. 609-610.
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Cranston, J.M., Crockett, A., Currow, D. & Ekstrom, M. 2013, 'Oxygen therapy for dyspnoea in adults (vol 16, CD004769, 2008)', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 11.
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Yates, P., Schofield, P., Zhao, I. & Currow, D. 2013, 'Supportive and palliative care for lung cancer patients', JOURNAL OF THORACIC DISEASE, vol. 5, pp. S623-S628.
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Girgis, A., Lambert, S., Johnson, C., Waller, A. & Currow, D. 2013, 'Physical, psychosocial, relationship, and economic burden of caring for people with cancer: a review.', Journal of oncology practice, vol. 9, no. 4, pp. 197-202.
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The aim of this article is to provide an overview of the issues faced by caregivers of people diagnosed with cancer, with a particular emphasis on the physical, psychosocial, and economic impact of caring. A review of the literature identified cancer as one of the most common health conditions in receipt of informal caregiving, with the majority of caregivers reporting taking on the role of caring because of family responsibility and there being little choice or no one else to provide the care. For some, caregiving can extend for several years and become equivalent to a full-time job, with significant consequent health, psychosocial, and financial burdens. Having a better understanding of the critical and broad roles that caregivers play in the oncology setting and the impact of these on their health and well-being may assist health care professionals in supporting caregivers with these tasks and targeting services and interventions toward those most in need.
Hardy, J., Quinn, S., Fazekas, B., Eckermann, S., Agar, M.R., Spruyt, O., Rowett, D. & Currow, D. 2013, 'Ketamine in the Management of Cancer Pain Reply', JOURNAL OF CLINICAL ONCOLOGY, vol. 31, no. 10, pp. 1375-1376.
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Allcroft, P., Currow, D., Margitinovic, V., Greene, A., Agar, M., Clark, K. & Abernethy, A. 2013, 'THE ROLE OF BENZODIAZEPINES IN BREATHLESSNESS: A SINGLE-SITE, OPEN-LABEL, PILOT OF OPIOID SPARING ABILITY', RESPIROLOGY, vol. 18, pp. 57-57.
Soeberg, M., You, H., Allemani, C., Bannon, F., Carreira, H., Harewood, R., Wang, X.-.S., Ahn, J., Currow, D., Coleman, M. & Grp, C.O.N.C.O.R.D.W. 2013, 'AUSTRALIAN DATA IN GLOBAL SURVEILLANCE OF POPULATION-BASED CANCER SURVIVAL (THE CONCORD PROGRAMME)', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 9, pp. 134-134.
Crane, M., Aranda, S., Stacey, I., Lafontaine, M., Scott, N., O'Hara, B. & Currow, D. 2013, 'AWARENESS ABOUT THE SIGNS AND SYMPTOMS OF LUNG CANCER IN AUSTRALIA, A MIXED METHODS STUDY', JOURNAL OF THORACIC ONCOLOGY, vol. 8, pp. S250-S251.
Wiseman, R., Rowett, D., Allcroft, P., Abernethy, A. & Currow, D. 2013, 'Chronic refractory dyspnoea Evidence based management', AUSTRALIAN FAMILY PHYSICIAN, vol. 42, no. 3, pp. 137-139.
LeBlanc, T.W., Abernethy, A.P., Currow, D.C. & Kutner, J.S. 2013, 'Considerations in reporting palliative care clinical trials: standardizing information reported and authorship practices (vol 6, pg 494, 2012)', CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE, vol. 7, no. 1, pp. 129-129.
Clark, K., Sheehan, C. & Currow, D.C. 2013, 'Letter to the editor re "Four essential drugs needed for quality care of the dying: a Delphi-study based international expert consensus opinion".', Journal of palliative medicine, vol. 16, no. 7, pp. 721-722.
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Allcroft, P., Margitanovic, V., Greene, A., Agar, M.R., Clark, K., Abernethy, A.P. & Currow, D.C. 2013, 'The role of benzodiazepines in breathlessness: a single site, open label pilot of sustained release morphine together with clonazepam.', Journal of palliative medicine, vol. 16, no. 7, pp. 741-744.
BACKGROUND: Breathlessness at rest or on minimal exertion despite optimal treatment of underlying cause(s) is distressing and prevalent. Opioids can reduce the intensity of chronic refractory breathlessness and an anxiolytic may be of benefit. This pilot aimed to determine the safety and feasibility of conducting a phase III study on the intensity of breathlessness by adding regular benzodiazepine to low-dose opioid. METHODS: This is a single site, open label phase II study of the addition of regular clonazepam 0.5 mg nocte orally to Kapanol(R) 10 mg (sustained release morphine sulphate) orally mane together with docusate/sennosides in people with modified Medical Research Council Scale 2. Breathlessness intensity on day four was the efficacy outcome. Participants could extend for another 10 days if they achieved >15% reduction over their own baseline breathlessness intensity. RESULTS: Eleven people had trial medication (eight males, median age 78 years (68 to 89); all had COPD; median Karnofsky 70 (50 to 80); six were on long-term home oxygen. Ten people completed day four. One person withdrew because of unsteadiness on day four. Five participants reached the 15% reduction, but only three went on to the extension study, all completing without toxicity. CONCLUSION: This study was safe, feasible and there appears to be a group who derive benefits comparable to titrated opioids. Given the widespread use of benzodiazepines for the symptomatic treatment of chronic refractory breathlessness and its poor evidence base, there is justification for a definitive phase III study.
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.
Hardy, J., Quinn, S., Fazekas, B., Plummer, J., Eckermann, S., Agar, M., Spruyt, O., Rowett, D. & Currow, D.C. 2012, 'Randomized, Double-Blind, Placebo-Controlled Study to Assess the Efficacy and Toxicity of Subcutaneous Ketamine in the Management of Cancer Pain', JOURNAL OF CLINICAL ONCOLOGY, vol. 30, no. 29, pp. 3611-3617.
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Sheehan, C., Agar, M. & Currow, D.C. 2012, 'End-of-Life Research: Do We Need To Build Proxy Consent into All Clinical Trial Protocols Studying the Terminal Phase?', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 9, pp. 962-962.
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Shelby-James, T.M., Hardy, J., Agar, M., Yates, P., Mitchell, G., Sanderson, C., Luckett, T., Abernethy, A.P. & Currow, D.C. 2012, 'Designing and conducting randomized controlled trials in palliative care: A summary of discussions from the 2010 clinical research forum of the Australian Palliative Care Clinical Studies Collaborative', PALLIATIVE MEDICINE, vol. 26, no. 8, pp. 1042-1047.
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Clark, K., Smith, J., Lovell, M. & Currow, D.C. 2012, 'Longitudinal Pain Reports in a Palliative Care Population', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 12, pp. 1335-1341.
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Harrington, A., Mitchell, P., Jones, J., Swetenham, K. & Currow, D. 2012, 'Transition to an in-patient palliative care unit: carers share their experiences.', International journal of palliative nursing, vol. 18, no. 11, pp. 548-552.
BACKGROUND: For a carer, transitioning the care of a person who is dying to others may be a challenging experience. At this time, more than any other, carers' experiences need to be understood. The emotional impact of care transitions may have clinical significance for both carers and those they care for. AIM: To explore carers experiences of the transition of the person they were caring for to in-patient care. METHOD: Carers reflected on their. experiences through an explorative/descriptive research methodology. RESULTS: Feelings of guilt and relief figured prominently in the participants' discourses. CONCLUSIONS: Prominent feelings of guilt and relief overshadowed the participants' experiences of transitioning care. This finding needs to be considered by care providers.
McConigley, R., Aoun, S., Kristjanson, L., Colyer, S., Deas, K., O'Connor, M., Harris, R., Currow, D. & Yates, P. 2012, 'Implementation and evaluation of an education program to guide palliative care for people with motor neurone disease', PALLIATIVE MEDICINE, vol. 26, no. 8, pp. 994-1000.
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Waller, A., Girgis, A., Johnson, C., Lecathelinais, C., Sibbritt, D., Forstner, D., Liauw, W. & Currow, D.C. 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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To, T., Agar, M., Shelby-James, T., Abernethy, A., Doogue, M., Rowett, D. & Currow, D.C. 2012, 'Off-Label Prescribing in Palliative Care: A Cross-sectional National Survey of Australian Palliative Medicine Doctors', JOURNAL OF PALLIATIVE CARE, vol. 28, no. 3, pp. 189-190.
Hardy, J. & Currow, D.C. 2012, 'Sector-wide approach to phase III studies', PALLIATIVE MEDICINE, vol. 26, no. 6, pp. 864-864.
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Currow, D.C. & Abernethy, A.P. 2012, 'The ultimate personalised medicine', INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, vol. 66, no. 9, pp. 824-826.
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Clark, K., Byfieldt, N., Dawe, M. & Currow, D.C. 2012, 'Treating Constipation in Palliative Care: The Impact of Other Factors Aside From Opioids', AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, vol. 29, no. 2, pp. 122-125.
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Dear, R.F., Barratt, A.L., Askie, L.M., Butow, P.N., McGeechan, K., Crossing, S., Currow, D.C. & Tattersall, M.H.N. 2012, 'Impact of a cancer clinical trials web site on discussions about trial participation: a cluster randomized trial', ANNALS OF ONCOLOGY, vol. 23, no. 7, pp. 1912-1918.
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Tracey, E.A., Roder, D.M. & Currow, D.C. 2012, 'What factors affect the odds of NSW cancer patients presenting with localised as opposed to more advanced cancer?', CANCER CAUSES & CONTROL, vol. 23, no. 2, pp. 255-262.
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Clark, K. & Currow, D.C. 2012, 'Response to "A cross-sectional study of constipation and laxative use in advanced cancer patients: insights for revision of current practise"', SUPPORTIVE CARE IN CANCER, vol. 20, no. 12, pp. 3027-3028.
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Toye, C., Abbey, J., Currow, D., Hegarty, M., Holloway, K. & Tieman, J. 2012, 'Community aged care: guidelines for a palliative approach', AUSTRALASIAN JOURNAL ON AGEING, vol. 31, pp. 67-67.
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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Uronis, H., McCrory, D.C., Samsa, G., Currow, D. & Abernethy, A. 2011, 'Symptomatic oxygen for non-hypoxaemic chronic obstructive pulmonary disease', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 6.
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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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Nikles, J., Mitchell, G.K., Schluter, P., Good, P., Hardy, J., Rowett, D., Shelby-James, T., Vohra, S. & Currow, D. 2011, 'Aggregating single patient (n-of-1) trials in populations where recruitment and retention was difficult: The case of palliative care', JOURNAL OF CLINICAL EPIDEMIOLOGY, vol. 64, no. 5, pp. 471-480.
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To, T.H.M., Greene, A.G., Agar, M.R. & Currow, D.C. 2011, 'A point prevalence survey of hospital inpatients to define the proportion with palliation as the primary goal of care and the need for specialist palliative care', INTERNAL MEDICINE JOURNAL, vol. 41, no. 5, pp. 430-433.
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Currow, D.C., Foley, K., Zafar, S.Y., Wheeler, J.L. & Abernethy, A.P. 2011, 'The need for a re-evaluation of best supportive care studies reported to date', BRITISH JOURNAL OF CANCER, vol. 104, no. 3, pp. 390-391.
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Hardy, J., Agar, M.R. & Currow, D.C. 2011, 'Progressing an evidence-base beyond case series.', Journal of palliative medicine, vol. 14, no. 12, p. 1283.
Currow, D.C., Agar, M.R., To, T.H., Rowett, D., Greene, A. & Abernethy, A.P. 2011, 'Adverse events in hospice and palliative care: a pilot study to determine feasibility of collection and baseline rates.', Journal of palliative medicine, vol. 14, no. 3, pp. 309-314.
BACKGROUND: Continuous quality improvement is fundamental in all health care, including hospice and palliative care. Identifying and systematically reducing symptomatic adverse events is limited in hospice and palliative care because these events are mostly attributed to disease progression. OBJECTIVES: The aim of this study was to assess the feasibility of symptomatic adverse events in hospice and palliative care and assessing their incidence. METHODS: A retrospective, consecutive cohort of notes from a specialist palliative care inpatient service was surveyed by a clinical nurse consultant for symptomatic adverse events: falls, confusion, decreased consciousness, hypo- and hyperglycaemia, urinary retention, and hypotension. Demographic and clinical factors were explored for people at higher risk. RESULTS: Data were available on the most recent admissions of 65 people, generating >900 inpatient days. Fifty people (78%) had events precipitating admission, of whom 31 (62%) had at least one further event during admission. Eleven of 15 people who were admitted without an event experienced at least one during their admissions. Only 4 did not have an adverse event. During their stay, there were 0.13 (standard deviation [SD]=0.19) events per patient per day. No drug-drug or drug-host events were noted. No clinical or demographic factors predicted groups at higher risk. CONCLUSIONS: This pilot highlights the feasibility of collecting, and ubiquity of, symptomatic adverse events, and forms a baseline against which future interventions to decrease the frequency or intensity can be measured. Given the frailty of hospice and palliative patients, any adverse event is likely to accelerate irreversibly their systemic decline.
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.
Currow, D. & Agar, M. 2010, 'The Necessary Work Program for Safe Delivery of Combinations of Injectable Medications', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 9, pp. 1052-1052.
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Currow, D.C., Agar, M., Plummer, J.L., Blyth, F.M. & Abernethy, A.P. 2010, 'Chronic pain in South Australia - population levels that interfere extremely with activities of daily living', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 34, no. 3, pp. 232-239.
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Agar, M., To, T., Plummer, J., Abernethy, A. & Currow, D. 2010, 'Anti-Cholinergic Load, Health Care Utilization, and Survival in People with Advanced Cancer: A Pilot Study', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 6, pp. 745-752.
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Clark, K., Lam, L.T., Agar, M., Chye, R. & Currow, D.C. 2010, 'The impact of opioids, anticholinergic medications and disease progression on the prescription of laxatives in hospitalized palliative care patients: a retrospective analysis', PALLIATIVE MEDICINE, vol. 24, no. 4, pp. 410-418.
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Currow, D.C., Shelby-James, T.M., Agar, M., Plummer, J., Rowett, D., Glare, P., Spruyt, O. & Hardy, J. 2010, 'Planning phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations', SUPPORTIVE CARE IN CANCER, vol. 18, no. 12, pp. 1571-1579.
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Burns, C.M., LeBlanc, T.W., Abernethy, A. & Currow, D. 2010, 'Young Caregivers in the End-of-Life Setting: A Population-Based Profile of an Emerging Group', JOURNAL OF PALLIATIVE MEDICINE, vol. 13, no. 10, pp. 1225-1235.
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Aoun, S., Bird, S., Kristjanson, L.J. & Currow, D. 2010, 'Reliability testing of the FAMCARE-2 scale: measuring family carer satisfaction with palliative care', PALLIATIVE MEDICINE, vol. 24, no. 7, pp. 674-681.
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Horton, R., Rocker, G. & Currow, D. 2010, 'The dyspnea target: can we zero in on opioid responsiveness in advanced chronic obstructive pulmonary disease?', Current opinion in supportive and palliative care, vol. 4, no. 2, pp. 92-96.
PURPOSE OF REVIEW: Despite recognition that opioids alleviate dyspnea in chronic obstructive pulmonary disease, many clinicians remain reluctant to use them outside of the final days of life. This article defines the term 'opioid responsiveness' as it pertains to dyspnea, and poses that it may be possible to predict more accurately the patients with chronic obstructive pulmonary disease and refractory dyspnea who might benefit from opioid treatment for either short-term use during episodes of dyspnea crisis or for long-term use for chronic dyspnea on minimal exertion. RECENT FINDINGS: This article highlights recent evidence of known dimensions contributing to the sensation of dyspnea in chronic obstructive pulmonary disease and builds on clinical observational experience to generate a conceptual model of opioid responsiveness. The 'dyspnea target' and 'opioid responsiveness score' are proposed as a means of defining more clearly the sensations encountered by a given patient and the likelihood of symptomatic improvement in response to opioids. SUMMARY: The 'dyspnea target' or similar conceptual models that attempt to predict how specific aspects of dyspnea may affect response to treatments offer clinicians the potential to more effectively target interventions. The model is presented in its theoretical stage in order to stimulate further discussion and research in an area of current interest.
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 time series design.', BMC palliative care, vol. 9, p. 2.
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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. METHODS/DESIGN: People with advanced cancer and their caregivers completed bi-monthly telephone interviews over a period of up to 18 months to assess unmet needs, anxiety and depression, quality of life, satisfaction with care and service utilisation. The intervention, introduced after at least two baseline phone interviews, involved a) training medical, nursing and allied health professionals at each recruitment site on the use of the Palliative Care Needs Assessment Guidelines and the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C); b) health professionals completing the NAT: PD-C with participating patients approximately monthly for the rest of the study period. Changes in outcomes will be compared pre-and post-intervention. DISCUSSION: The study will determine whether the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of clinical settings is a feasible and effective strategy for facilitating the timely provision of needs based care. TRIALS REGISTRATION: ISRCTN21699701.
Sladek, R.M., Tieman, J. & Currow, D.C. 2010, 'Searchers be aware: limiting PubMed searches to 'humans' loses more than you think', INTERNAL MEDICINE JOURNAL, vol. 40, no. 1, pp. 88-89.
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Hardy, J., Shelby-James, T. & Currow, D.C. 2010, 'Research in palliative care: is death always an adverse event?', INTERNAL MEDICINE JOURNAL, vol. 40, no. 1, pp. 89-90.
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Davidson, P.M., Macdonald, P.S., Newton, P.J. & Currow, D.C. 2010, 'End stage heart failure patients - palliative care in general practice.', Australian Family Physician, vol. 39, no. 12, pp. 916-920.
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. OBJECTIVE: This article summarises the fundamentals of implementing palliative care in general practice and provides guidelines on caring for chronic heart failure patients at the end of life. DISCUSSION: The high mortality in chronic heart failure underscores the importance of effective communication, symptom management and advanced care planning. The unpredictability and uncertainty around the timing of death mean that individuals, and their families, may be less likely to have an understanding of their prognosis or have access to supportive and palliative care. Ideally, patients with symptomatic chronic heart failure should be managed in collaboration with a multidisciplinary heart failure program. Symptom management can be achieved by additive therapies and access to specialist palliative care services should be considered when the symptom burden is high.
Shelby-James, T., Agar, M.R. & Currow, D.C. 2010, 'A case study evaluation of ethics review systems for multicentre clinical trials.', The Medical journal of Australia, vol. 192, no. 5, p. 292.
Gordon, R., Eagar, K., Currow, D. & Green, J. 2009, 'Current Funding and Financing Issues in the Australian Hospice and Palliative Care Sector', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 38, no. 1, pp. 68-74.
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Agar, M., Currow, D., Plummer, J., Seidel, R., Carnahan, R. & Abernethy, A.P. 2009, 'Changes in anticholinergic load from regular prescribed medications in palliative care as death approaches', PALLIATIVE MEDICINE, vol. 23, no. 3, pp. 257-265.
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Currow, D.C., Agar, M., Smith, J. & Abernethy, A.P. 2009, 'Does palliative home oxygen improve dyspnoea? A consecutive cohort study', PALLIATIVE MEDICINE, vol. 23, no. 4, pp. 309-316.
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Roder, D. & Currow, D. 2009, 'Cancer in Aboriginal and Torres Strait Islander People of Australia', ASIAN PACIFIC JOURNAL OF CANCER PREVENTION, vol. 10, no. 5, pp. 729-733.
Rocker, G., Horton, R., Currow, D., Goodridge, D., Young, J. & Booth, S. 2009, 'Palliation of dyspnoea in advanced COPD: revisiting a role for opioids', THORAX, vol. 64, no. 10, pp. 910-915.
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Nikles, J., Mitchell, G., Walters, J., Hardy, J., Good, P., Rowett, D., Shelby-James, T. & Currow, D. 2009, 'Prioritising drugs for single patient (n-of-1) trials in palliative care', PALLIATIVE MEDICINE, vol. 23, no. 7, pp. 623-634.
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Cherny, N.I., Abernethy, A.P., Strasser, F., Sapir, R., Currow, D. & Zafar, S.Y. 2009, 'Improving the Methodologic and Ethical Validity of Best Supportive Care Studies in Oncology: Lessons From a Systematic Review', JOURNAL OF CLINICAL ONCOLOGY, vol. 27, no. 32, pp. 5476-5486.
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Clark, K., Lam, L.T., Gibson, S. & Currow, D. 2009, 'The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials', ANAESTHESIA, vol. 64, no. 6, pp. 652-657.
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Ferris, F.D., Bruera, E., Cherny, N., Cummings, C., Currow, D., Dudgeon, D., JanJan, N., Strasser, F., von Gunten, C.F. & Von Roenn, J.H. 2009, 'Palliative Cancer Care a Decade Later: Accomplishments, the Need, Next Steps-From the American Society of Clinical Oncology', JOURNAL OF CLINICAL ONCOLOGY, vol. 27, no. 18, pp. 3052-3058.
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Clark, K., Lam, L. & Currow, D. 2009, 'Reducing gastric secretions-a role for histamine 2 antagonists or proton pump inhibitors in malignant bowel obstruction?', SUPPORTIVE CARE IN CANCER, vol. 17, no. 12, pp. 1463-1468.
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Dorman, S., Jolley, C., Abernethy, A., Currow, D., Johnson, M., Farquhar, M., Griffiths, G., Peel, T., Moosavi, S., Byrne, A., Wilcock, A., Alloway, L., Bausewein, C., Higginson, I. & Booth, S. 2009, 'Researching breathlessness in palliative care: consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup', PALLIATIVE MEDICINE, vol. 23, no. 3, pp. 213-227.
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Abernethy, A., Burns, C., Wheeler, J. & Currow, D. 2009, 'Defining distinct caregiver subpopulations by intensity of end-of-life care provided', PALLIATIVE MEDICINE, vol. 23, no. 1, pp. 66-79.
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Agar, M., Currow, D., Plummer, J., Seidel, R., Carnahan, R. & Abernethy, A.P. 2009, 'Changes in Anticholinergic Load From Regular Prescribed Medications in Palliative Care as Death Approaches Editorial Comment', JOURNAL OF UROLOGY, vol. 182, no. 6, pp. 2840-2840.
Tieman, J.J., Sladek, R.M. & Currow, D.C. 2009, 'Multiple sources: mapping the literature of palliative care', PALLIATIVE MEDICINE, vol. 23, no. 5, pp. 425-431.
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Zafar, S.Y., Abernethy, A.P. & Currow, D. 2009, 'Other Problems With Phase III Best Supportive Care Studies IN REPLY', JOURNAL OF CLINICAL ONCOLOGY, vol. 27, no. 5, pp. 829-829.
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Rose, M. & Currow, D.C. 2009, 'The need for chemical compatibility studies of subcutaneous medication combinations used in palliative care.', Journal of pain & palliative care pharmacotherapy, vol. 23, no. 3, pp. 223-230.
When a person with a life-limiting illness is unable to swallow, the subcutaneous route of administration is a widely used way of administering many medications, either as repeated bolus injections or by continuous infusions to complement transdermal, sublingual, or rectal routes of administration. To optimize symptom control as changes are made from other routes of administration to subcutaneous delivery, basic principles for ensuring optimal net clinical benefit (therapeutic benefit and minimizing side effects) must be understood as fully as science will allow. Despite the widespread use of combinations of injectable medications in this clinical setting and the availability of the technology to do the studies, the limited work done suggests that there may be significant drug loss with some combinations of medications without any visual or physical changes apparent. Work needs to be done urgently to evaluate a wide range of medication combinations used extensively in hospice and palliative care for chemical compatibility, while ensuring the work that has been done in other areas (anesthetics, chronic pain) is adopted into practice as results become available. Almost all of these medications are off-patent and there is therefore no financial incentive for the pharmaceutical industry to do the studies on medications now produced generically. Other sources of funding need to be identified. At best, it is likely that optimal symptom control is at times compromised in palliative care without chemical compatibility data for combinations of injectable medications and, at worst, toxicity is generated unknowingly.
Clark, K., Currow, D.C., Agar, M., Fazekas, B.S. & Abernethy, A.P. 2008, 'A pilot phase II randomized, cross-over, double-blinded, controlled efficacy study of octreotide versus hyoscine hydrobromide for control of noisy breathing at the end-of-life.', Journal of pain & palliative care pharmacotherapy, vol. 22, no. 2, pp. 131-138.
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Noisy breathing at the end of life (noisy breathing ("NB") occurs in up to 90% of people. Interventions have not been systematically evaluated. There has been clinical observation coupled with a proposed mechanism of effect that supports a role for octreotide in management of NB. The aim of this phase II study was to assess ten completed participants for the feasibility of an adequately powered phase III study. This randomized, double-blind, crossover pilot trial recruited participants from an inpatient palliative unit. Participants while well and their proxies simultaneously provided written informed consent. If NB were encountered, people were randomized to 200 mcg octreotide or 400 mcg hyoscine hydrobromide subcutaneously. If subsequent treatment was needed, the other medication was administered. A five point categorical scale documented the nurses' assessment of secretions over six hours. Eighty participants were consented of whom 10 (3 females, 7 males; median age 79, all with advanced cancer) received medication, five in each arm. There was no difference in the median time to administration of the second medication (3 hours). Two participants in each arm had a 2 category reduction of intensity after the second medication. Although feasible to consent and study this population in a way that respects autonomy and dignity even in the terminal hours of life, this pilot study suggests reconsideration of the pharmacological interventions (choice of agents, dosing, timing of dosing and pharmacokinetic profiles), standardizing of non-pharmacological care; and ways to measure directly family distress before further randomized studies for this symptom.
Jeyasingam, L., Agar, M., Soares, M., Plummer, J. & Currow, D. 2008, 'A prospective study of unmet activity of daily living needs in palliative care inpatients', AUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, vol. 55, no. 4, pp. 266-272.
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Agar, M., Currow, D.C., Shelby-James, T.M., Plummer, J., Sanderson, C. & Abernethy, A.P. 2008, 'Preference for place of care and place of death in palliative care: are these different questions?', PALLIATIVE MEDICINE, vol. 22, no. 7, pp. 787-795.
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Agar, M., Currow, D.C., Plummer, J., Chye, R. & Draper, B. 2008, 'Differing management of people with advanced cancer and delirium by four sub-specialties', PALLIATIVE MEDICINE, vol. 22, no. 5, pp. 633-640.
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Currow, D.C., Agar, M., Tientan, J. & Abernethy, A.P. 2008, 'Multi-site research allows adequately powered palliative care trials; web-based data management makes it achievable today', PALLIATIVE MEDICINE, vol. 22, no. 1, pp. 91-92.
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Currow, D.C., Agar, M., Sanderson, C. & Abernethy, A.P. 2008, 'Populations who die without specialist palliative care: does lower uptake equate with unmet need?', PALLIATIVE MEDICINE, vol. 22, no. 1, pp. 43-50.
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Tieman, J., Sladek, R. & Currow, D. 2008, 'Changes in the Quantity and Level of Evidence of Palliative and Hospice Care Literature: The Last Century', JOURNAL OF CLINICAL ONCOLOGY, vol. 26, no. 35, pp. 5679-5683.
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Waller, A., Girgis, A., Currow, D. & Lecathelinais, C. 2008, 'Development of the Palliative Care Needs Assessment Tool (PC-NAT) for use by multi-disciplinary health professionals', PALLIATIVE MEDICINE, vol. 22, no. 8, pp. 956-964.
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Zafar, S.Y., Currow, D. & Abernethy, A.P. 2008, 'Defining Best Supportive Care', JOURNAL OF CLINICAL ONCOLOGY, vol. 26, no. 31, pp. 5139-5140.
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Boyle, P., Anderson, B.O., Andersson, L.C., Ariyaratne, Y., Auleley, G.-.R., Barbacid, M., Bartelink, H., Baselga, J., Behbehani, K., Belardelli, F., Berns, A., Bishop, J., Brawley, O., Burns, H., Clanton, M., Cox, B., Currow, D., Dangou, J.-.M., de Valeriola, D., Dinshaw, K., Eggermont, A., Fitzpatrick, J., Forstmane, M., Garaci, E., Gavin, A.T., Kakizoe, T., Kasler, M., Keita, N., Kerr, D., Khayat, D., Khleif, S., Khuhaprema, T., Knezevic, T., Kubinova, R., Mallath, M., Martin-Moreno, J., McCance, D., McVie, J.G., Merriman, A., Ngoma, T., Nowacki, M., Orgelbrand, J., Park, J.-.G., Pierotti, M., Ashton, L.P., Puska, P., Escobar, C.V.R., Rajan, B., Rajkumar, T., Ringborg, U., Robertson, C., Rodger, A., Roovali, L., Santini, L.A., Sarhan, M., Seffrin, J., Semiglazov, V., Shrestha, B.M., Soo, K.C., Stamenic, V., Tamblyn, C., Thomas, R., Tuncer, M., Tursz, T., Vaitkiene, R., Vallejos, C., Veronesi, U., Wojtyla, A., Yach, D., Yoo, K.-.Y., Zatonski, W., Zaridze, D., Zeng, Y.-.X., Zhao, P. & Zheng, T. 2008, 'Need for global action for cancer control', ANNALS OF ONCOLOGY, vol. 19, no. 9, pp. 1519-1521.
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Cranston, J.M., Crockett, A. & Currow, D. 2008, 'Oxygen therapy for dyspnoea in adults', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 3.
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Aoun, S., Kristjanson, L.J., Oldham, L. & Currow, D. 2008, 'A qualitative investigation of the palliative care needs of terminally ill people who live alone', COLLEGIAN, vol. 15, no. 1, pp. 3-9.
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Clayton, J.M., Hancock, K., Parker, S., Butow, P.N., Walder, S., Carrick, S., Currow, D., Ghersi, D., Glare, P., Hagerty, R., Olver, I.N. & Tattersall, M.H.N. 2008, 'Sustaining hope when communicating with terminally ill patients and their families: a systematic review', PSYCHO-ONCOLOGY, vol. 17, no. 7, pp. 641-659.
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Currow, D.C., Christou, T., Smith, J., Carmody, S., Lewin, G., Aoun, S. & Abernethy, A.P. 2008, 'Do Terminally Ill People Who Live Alone Miss Out on Home Oxygen Treatment? An Hypothesis Generating Study (vol 11, pg 1015, 2008)', JOURNAL OF PALLIATIVE MEDICINE, vol. 11, no. 9, pp. 1285-1285.
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Currow, D.C., Burns, C.M. & Abernethy, A.P. 2008, 'Financial burden of caring until the end of life', INTERNAL MEDICINE JOURNAL, vol. 38, no. 9, pp. 745-745.
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Dupont, A., Abernethy, A., Bums, C.M., Wheeler, J. & Currow, D. 2008, 'Defining distinct Caregiver sub-populations by intensity of end-of-life care provided', PSYCHO-ONCOLOGY, vol. 17, pp. S122-S122.
Uronis, H.E., Currow, D.C., McCrory, D.C., Samsa, G.P. & Abernethy, A.P. 2008, 'Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis', BRITISH JOURNAL OF CANCER, vol. 98, no. 2, pp. 294-299.
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Johnson, C.E., Girgis, A., Paul, C.L. & Currow, D.C. 2008, 'Cancer specialists' palliative care referral practices and perceptions: results of a national survey', PALLIATIVE MEDICINE, vol. 22, no. 1, pp. 51-57.
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Hancock, K., Clayton, J.M., Parker, S.M., Wall der, S., Butow, P.N., Carrick, S., Currow, D., Ghersi, D., Glare, P., Hagerty, R. & Tattersall, M.H.N. 2007, 'Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review', PALLIATIVE MEDICINE, vol. 21, no. 6, pp. 507-517.
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Hancock, K., Clayton, J.M., Parker, S.M., Walder, S., Blttow, P.N., Carrick, S., Currow, D., Ghersi, D., Glare, P., Hagerty, R. & Tattersall, M.H.N. 2007, 'Discrepant perceptions about end-of-life communication: A systematic review', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 34, no. 2, pp. 190-200.
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Parker, S.M., Clayton, J.M., Hancock, K., Walder, S., Butow, P.N., Carrick, S., Currow, D., Ghersi, D., Glare, P., Hagerty, R. & Tattersall, M.H.N. 2007, 'A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information.', Journal of pain and symptom management, vol. 34, no. 1, pp. 81-93.
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Evidence-based recommendations concerning how to discuss dying, life expectancy, and likely future symptoms with patients with a limited life expectancy and their families are lacking. The aim of this systematic review was to review studies regarding prognostic/end-of-life communication with adult patients in the advanced stages of a life-limiting illness and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases up to November 2004. One hundred twenty-three studies met the criteria for the full review, and 46 articles reported on patient/caregiver preferences for content, style, and timing of information. The majority of the research was descriptive. Although there were individual differences, patients/caregivers in general had high levels of information need at all stages of the disease process regarding the illness itself, likely future symptoms and their management, and life expectancy and information about clinical treatment options. Patient and caregiver information needs showed a tendency to diverge as the illness progressed, with caregivers needing more and patients wanting less information. Patients and caregivers preferred a trusted health professional who showed empathy and honesty, encouraged questions, and clarified each individual's information needs and level of understanding. In general, most patients/caregivers wanted at least some discussion of these topics at the time of diagnosis of an advanced, progressive, life-limiting illness, or shortly after. However, they wanted to negotiate the content and extent of this information.
Aoun, S., Kristjanson, L.J., Currow, D., Skett, K., Oldham, L. & Yates, P. 2007, 'Terminally-ill people living alone without a caregiver: an Australian national scoping study of palliative care needs', PALLIATIVE MEDICINE, vol. 21, no. 1, pp. 29-34.
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Parker, S.M., Clayton, J.M., Hancock, K., Walder, S., Butow, P.N., Carrick, S., Currow, D., Ghersi, D., Glare, P., Eth, A., Hagerty, R. & Tattersall, M.H.N. 2007, 'A systematic review of Prognostic/End-of-Life communication with adults in the advanced stages of a life-limiting illness: Patient/caregiver preferences for the content, style, and timing of information', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 34, no. 1, pp. 81-93.
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Tieman, J., Mitchell, G., Shelby-James, T., Currow, D., Fazekas, B., O'Doherty, L., Hegarty, M., Eriksson, L., Brown, R. & Reid-Orr, D. 2007, 'Integration, coordination and multidisciplinary care: What can these approaches offer to Australian primary health care?', AUSTRALIAN JOURNAL OF PRIMARY HEALTH, vol. 13, no. 2, pp. 56-65.
Clayton, J.M., Hancock, K.M., Butow, P.N., Tattersall, M.H., Currow, D.C., Adler, J., Aranda, S., Auret, K., Boyle, F., Britton, A., Chye, R., Clark, K., Davidson, P., Davis, J.M., Girgis, A., Graham, S., Hardy, J., Introna, K., Kearsley, J., Kerridge, I., Kristjanson, L., Martin, P., McBride, A., Meller, A., Mitchell, G., Moore, A., Noble, B., Olver, I., Parker, S., Peters, M., Saul, P., Stewart, C., Swinburne, L., Tobin, B., Tuckwell, K. & Yates, P. 2007, 'Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers.', The Medical journal of Australia, vol. 186, no. 12 Suppl, pp. S77-108.
Currow, D. & Abernethy, A.P. 2006, 'A framework for managing comorbid conditions in palliative care', JOURNAL OF PALLIATIVE MEDICINE, vol. 9, no. 3, pp. 620-620.
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Agar, M., Chye, R., Currow, D. & Draper, B. 2006, 'Survey of current practice: Management of delirium by palliative care, psychogeriatric, geriatric, and oncology specialists in Australia and New Zealand', JOURNAL OF PALLIATIVE CARE, vol. 22, no. 3, pp. 209-210.
Currow, D., Hegarty, M., Allen, K., Swetenham, K. & Abernethy, A. 2006, 'Bereavement help-seeking following a palliative death', JOURNAL OF PALLIATIVE CARE, vol. 22, no. 3, pp. 192-192.
Allen, K., Swetenham, K., Currow, D., Hegarty, M. & Abernthy, A. 2006, 'Bereavement help-seeking following a palliative death-a cross-sectional randomised population survey', PSYCHO-ONCOLOGY, vol. 15, no. 2, pp. S425-S426.
Currow, D., Shelby-James, T., Plummer, J., Stevenson, J. & Abernethy, A. 2006, 'Polypharmacy worsens as death approaches', JOURNAL OF PALLIATIVE CARE, vol. 22, no. 3, pp. 214-214.
Hall, W., Christie, M.J. & Currow, D. 2005, 'Cannabinoids and cancer: causation, remediation, and palliation', LANCET ONCOLOGY, vol. 6, no. 1, pp. 35-42.
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Toye, C., Kristjanson, L., White, K., Sullivan, K., Currow, D., Cordingley, S., Oldham, L., Hearn, L., Leavesley, S., Cook, P., Taylor, A., Shiels, W., Harris, P., Schaper, F. & Walton, J. 2004, 'The Volunteering in Palliative Residential Aged Care Project', AUSTRALASIAN JOURNAL ON AGEING, vol. 23, pp. A3-A3.
Currow, D., Andrews, G. & Lawrence, J. 2004, 'Palliative care in aged care - a key initiative for the aged care sector', AUSTRALASIAN JOURNAL ON AGEING, vol. 23, pp. A51-A52.
Currow, D. 2003, 'From Australia', PALLIATIVE MEDICINE, vol. 17, no. 2, pp. 158-159.
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Currow, D. 2002, 'Australia: State of palliative service provision 2002', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 24, no. 2, pp. 170-172.
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Mitchell, G. & Currow, D. 2002, 'Chemotherapy and radiotherapy. When to call it quits.', Australian family physician, vol. 31, no. 2, pp. 129-133.
BACKGROUND: Patients diagnosed with cancer are often treated with chemotherapy and radiotherapy with curative intent. The transition from curative to palliative intent involves re-evaluation of treatment, and has to take into account the attitudes, beliefs and life aims of the patient. OBJECTIVE: To discuss the difficulties in determining when to cease chemotherapy and radiotherapy in patients with advanced cancer. DISCUSSION: The concept of treatment evaluation using a 'burden versus benefit' paradigm is discussed. Treatment aims must be in concordance with those of the patient, which are often couched in functional terms or linked to future significant life events. Chemotherapy and radiotherapy can offer patients in the palliative phase of cancer illness, benefits in terms of relief of symptoms and meaningful prolongation of life, and should be considered in appropriate circumstances.
Hall, W.D., Degenhardt, L.J. & Currow, D. 2001, 'Allowing the medical use of cannabis', MEDICAL JOURNAL OF AUSTRALIA, vol. 175, no. 1, pp. 39-40.
Barton, M.B., Dawson, R., Jacob, S., Currow, D., Stevens, G. & Morgan, G. 2001, 'Palliative radiotherapy of bone metastases: an evaluation of outcome measures', JOURNAL OF EVALUATION IN CLINICAL PRACTICE, vol. 7, no. 1, pp. 47-64.
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Stuart-Harris, R., Joel, S.P., McDonald, P., Currow, D. & Slevin, M.L. 2000, 'The pharmacokinetics of morphine and morphine glucuronide metabolites after subcutaneous bolus injection and subcutaneous infusion of morphine', BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, vol. 49, no. 3, pp. 207-214.
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Dawson, R., Currow, D., Stevens, G., Morgan, G. & Barton, M.B. 1999, 'Radiotherapy for bone metastases: A critical appraisal of outcome measures', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 17, no. 3, pp. 208-218.
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Currow, D. & Cooney, N. 1994, 'Comparison of metal versus Vialon subcutaneous catheters in a palliative care setting.', Palliative medicine, vol. 8, no. 4, pp. 333-336.
In 63 evaluable palliative care patients requiring intermittent bolus subcutaneous administration of medication, who were randomly assigned either a standard metal subcutaneous needle or a PTFE (Vialon) catheter, there was a significantly greater incidence of local reactions at the insertion site with the metal needles (9/30) compared with the PTFE catheters (2/33). Despite this, there was no significant difference between the two in functional survival. Volume of medication injected per day was the best predictor of total time that the subcutaneous lines remained in situ.