Professor Jane Phillips is a professor of nursing with experience in delivering evidenced-based palliative care across diverse settings, including rural and regional Australia. She has led and evaluated complex health service reforms and has led a number of major cancer and palliative care reform initiatives at the local and national levels. Jane’s research aims to improve care outcomes for people in the last year of their life by strengthening the nexus between research, policy and practice. She is currently evaluating non-pharmacological interventions to improve pain, breathlessness and delirium; looking at health services that can improve care for older people with cancer, and; undertaking translational research in the areas of pain management and symptom management. She has developed and evaluated nurse-coordinated models of palliative care and has extensive experience in cancer and chronic disease nursing and research. Jane is the Director of the IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation at UTS.
- Member International Society Nursing Cancer Care
- Member Sigma Theta Tau International, Honour Society of Nursing, Xi Omicron Chapter
- Member Royal Australian College of Nursing
- Member Palliative Care Nurses Australia
- Member Cancer Nurses Society Australia
- Member NSW Palliative Care Association
- Member Clinical Oncology Society of Australia
- Cancer and palliative care
- Pain and symptom management
- Non-pharmacological interventions for pain management
- Geriatric Oncology
- Palliative care
- Non-communicable diseases
- Care of older peoples
- Mixed methods
- Translational research
Hickman, L.D., DiGiacomo, M., Phillips, J., Rao, A., Newton, P.J., Jackson, D. & Ferguson, C. 2018, 'Improving evidence based practice in postgraduate nursing programs: A systematic review: Bridging the evidence practice gap (BRIDGE project).', Nurse education today, vol. 63, pp. 69-75.View/Download from: Publisher's site
The nursing profession has a significant evidence to practice gap in an increasingly complex and dynamic health care environment.To evaluate effectiveness of teaching and learning strategies related to a capstone project within a Masters of Nursing program that encourage the development of evidence based practice capabilities.Systematic review that conforms to the PRISMA statement.Master's Nursing programs that include elements of a capstone project within a university setting.MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, ERIC and PsycInfo were used to search for RCT's or quasi experimental studies conducted between 1979 and 9 June 2017, published in a peer reviewed journal in English.Of 1592 studies, no RCT's specifically addressed the development of evidence based practice capabilities within the university teaching environment. Five quasi-experimental studies integrated blended learning, guided design processes, small group work, role play and structured debate into Masters of Nursing research courses. All five studies demonstrated some improvements in evidence based practice skills and/or research knowledge translation, with three out of five studies demonstrating significant improvements.There is a paucity of empirical evidence supporting the best strategies to use in developing evidence based practice skills and/or research knowledge translation skills for Master's Nursing students. As a profession, nursing requires methodologically robust studies that are discipline specific to identify the best approaches for developing evidence-based practice skills and/or research knowledge translation skills within the university teaching environment. Provision of these strategies will enable the nursing profession to integrate the best empirical evidence into nursing practice.
Heneka, N., Shaw, T., Rowett, D., Lapkin, S. & Phillips, J.L. 2018, 'Opioid errors in inpatient palliative care services: a retrospective review.', BMJ supportive & palliative care.View/Download from: Publisher's site
Opioids are a high-risk medicine frequently used to manage palliative patients' cancer-related pain and other symptoms. Despite the high volume of opioid use in inpatient palliative care services, and the potential for patient harm, few studies have focused on opioid errors in this population.To (i) identify the number of opioid errors reported by inpatient palliative care services, (ii) identify reported opioid error characteristics and (iii) determine the impact of opioid errors on palliative patient outcomes.A 24-month retrospective review of opioid errors reported in three inpatient palliative care services in one Australian state.Of the 55 opioid errors identified, 84% reached the patient. Most errors involved morphine (35%) or hydromorphone (29%). Opioid administration errors accounted for 76% of reported opioid errors, largely due to omitted dose (33%) or wrong dose (24%) errors. Patients were more likely to receive a lower dose of opioid than ordered as a direct result of an opioid error (57%), with errors adversely impacting pain and/or symptom management in 42% of patients. Half (53%) of the affected patients required additional treatment and/or care as a direct consequence of the opioid error.This retrospective review has provided valuable insights into the patterns and impact of opioid errors in inpatient palliative care services. Iatrogenic harm related to opioid underdosing errors contributed to palliative patients' unrelieved pain. Better understanding the factors that contribute to opioid errors and the role of safety culture in the palliative care service context warrants further investigation.
Vongmany, J., Luckett, T., Lam, L. & Phillips, J.L. 2018, 'Family behaviours that have an impact on the self-management activities of adults living with Type 2 diabetes: a systematic review and meta-synthesis.', Diabetic medicine : a journal of the British Diabetic Association, vol. 35, no. 2, pp. 184-194.View/Download from: Publisher's site
To identify family behaviours that adults with Type 2 diabetes' perceive as having an impact on their diabetes self-management.Research suggests that adults with Type 2 diabetes perceive that family members have an important impact on their self-management; however, it is unclear which family behaviours are perceived to influence self-management practices.This meta-synthesis identified and synthesized qualitative studies from the databases EMBASE, Medline and CINAHL published between the year 2000 and October 2016. Studies were eligible if they provided direct quotations from adults with Type 2 diabetes, describing the influence of families on their self-management. This meta-synthesis adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.Of the 2606 studies screened, 40 were included. This meta-synthesis identified that adults with Type 2 diabetes perceive family behaviours to be either: 1) facilitators of diabetes self-management; 2) barriers to diabetes self-management; or 3) equivocal behaviours with the potential to both support and/or impede diabetes self-management. Seven sub-themes were identified within these themes, including: four facilitator sub-themes ('positive care partnerships'; 'family watchfulness'; 'families as extrinsic motivator' and 'independence from family'); two barrier sub-themes ('obstructive behaviours' and 'limited capacity for family support'); and one equivocal behaviours subtheme ('regular reminders and/or nagging').While most family behaviours are unambiguously perceived by adults with Type 2 diabetes to act as facilitators of or barriers to self-management, some behaviours were perceived as being neither clear facilitators nor barriers; these were termed 'equivocal behaviours'. If the concept of 'equivocal behaviours' is confirmed, it may be possible to encourage the adult living with Type 2 diabetes to reframe these behaviours so that they are perceived as enabling their diabetes se...
Cahill, P.J., Lobb, E.A., Sanderson, C. & Phillips, J.L. 2017, 'What is the evidence for conducting palliative care family meetings? A systematic review.', Palliative Medicine, vol. 31, no. 3, pp. 197-211.View/Download from: UTS OPUS
Structured family meeting procedures and guidelines suggest that these forums enhance family-patient-team communication in the palliative care inpatient setting. However, the vulnerability of palliative patients and the resources required to implement family meetings in accordance with recommended guidelines make better understanding about the effectiveness of this type of intervention an important priority.This systematic review examines the evidence supporting family meetings as a strategy to address the needs of palliative patients and their families. The review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.Six medical and psychosocial databases and "CareSearch," a palliative care-specific database, were used to identify studies reporting empirical data, published in English in peer-reviewed journals from 1980 to March 2015. Book chapters, expert opinion, and gray literature were excluded. The Cochrane Collaboration Tool assessed risk of bias.Of the 5051 articles identified, 13 met the inclusion criteria: 10 quantitative and 3 qualitative studies. There was low-level evidence to support family meetings. Only two quantitative pre- and post-studies used a validated palliative care family outcome measure with both studies reporting significant results post-family meetings. Four other quantitative studies reported significant results using non-validated measures.Despite the existence of consensus-based family meeting guidelines, there is a paucity of evidence to support family meetings in the inpatient palliative care setting. Further research using more robust designs, validated outcome measures, and an economic analysis are required to build the family meeting evidence before they are routinely adopted into clinical practice.
Ferreira, D.H., Boland, J.W., Phillips, J.L., Lam, L. & Currow, D.C. 2017, 'The impact of therapeutic opioid agonists on driving-related psychomotor skills assessed by a driving simulator or an on-road driving task: A systematic review.', Palliative medicine, p. 269216317746583.View/Download from: UTS OPUS or Publisher's site
Driving cessation is associated with poor health-related outcomes. People with chronic diseases are often prescribed long-term opioid agonists that have the potential to impair driving. Studies evaluating the impact of opioids on driving-related psychomotor skills report contradictory results likely due to heterogeneous designs, assessment tools and study populations. A better understanding of the effects of regular therapeutic opioid agonists on driving can help to inform the balance between individual's independence and community safety.To identify the literature assessing the impact of regular therapeutic opioid agonists on driving-related psychomotor skills for people with chronic pain or chronic breathlessness.Systematic review reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement; PROSPERO Registration CRD42017055909.Six electronic databases and grey literature were systematically searched up to January, 2017. Inclusion criteria were as follows: (1) empirical studies reporting data on driving simulation, on-the-road driving tasks or driving outcomes; (2) people with chronic pain or chronic breathlessness; and (3) taking regular therapeutic opioid agonists. Critical appraisal used the National Institutes of Health's quality assessment tools.From 3809 records screened, three studies matched the inclusion criteria. All reported data on people with chronic non-malignant pain. No significant impact of regular therapeutic opioid agonists on people's driving-related psychomotor skills was reported. One study reported more intense pain significantly worsened driving performance.This systematic review does not identify impaired simulated driving performance when people take regular therapeutic opioid agonists for symptom control, although more prospective studies are needed.
Hayes, J.E., Hart, B. & Phillips, J. 2017, 'Specialist palliative care nurses' management of the needs of patients with depression.', International journal of palliative nursing, vol. 23, no. 6, pp. 298-305.View/Download from: UTS OPUS or Publisher's site
Depression is an important condition to consider if we are to optimise the care outcomes for patients with palliative care needs. Depression has a high incidence in palliative patients, with up to 15% diagnosed with major depression and 37% expressing some form of depressive symptoms ( O'Connor et al, 2010 ). The challenge is to ensure that palliative care patients with depression are identified in a timely manner and that their depression is effectively managed.To examine how Australian specialist inpatient palliative care nurses perceive, assess and respond to depression in a patient case study.This descriptive pilot study is a replication of a United States study by Little et al (2005) , exploring contemporary Australian specialist palliative care nurses' screening, assessment and management of depression in people with a progressive life-limiting illness. A survey titled 'Specialist palliative care nurses managing patients with complex care needs' questioned the nursing assessment, knowledge and clinical care priorities related to a case vignette of a patient demonstrating signs of depression.A total of 33 nurses completed this survey. Less than half (39.4%) of the participants identified depression as a major issue arising from the case vignette. Depression screening tools were not widely known. Functionality assessments measuring activities of daily living were the most recognised and widely used tools by participants.This small sample pilot study demonstrated that specialist palliative care nurses are still not confident in their screening and responding to a patient with depression. The available evidenced based depression screening tools were unfamiliar to these nurses and not widely used which can result in depression remaining undetected and undermanaged. The connections between physical health and mental health need stronger recognition and response within nursing care of palliative patients.
Hickman, L., DiGiacomo, M., Phillips, J., Rao, A., Newton, P., Jackson, D. & Ferguson, C. 2017, 'Improving evidence-based practice in postgraduate nursing programs: a systematic review', Nurse Education Today.
Kochovska, S., Luckett, T., Agar, M. & Phillips, J.L. 2017, 'Impacts on employment, finances, and lifestyle for working age people facing an expected premature death: A systematic review.', Palliative & supportive care, pp. 1-13.View/Download from: Publisher's site
The working ages (25-65 years) are a period when most people have significant work, financial, and family responsibilities. A small proportion of working age people will face an expected premature death from cancer or other life-limiting illness. Understanding the impact an expected premature death has on this population is important for informing support. The current study set out to summarize research describing the effects that facing an expected premature death has on employment, financial, and lifestyle of working age people and their families.A systematic review using narrative synthesis approach. Four electronic databases were searched in July 2016 for peer-reviewed, English language studies focusing on the financial, employment, and lifestyle concerns of working age adults living with an advanced life-limiting illness and/or their carers and/or children.Fifteen quantitative and 12 qualitative studies were included. Two-thirds (n = 18) were focused on cancer. All studies identified adverse effects on workforce participation, finances, and lifestyle. Many patients were forced to work less or give up work/retire early because of symptoms and reduced functioning. In addition to treatment costs, patients and families were also faced with child care, travel, and home/car modification costs. Being younger was associated with greater employment and financial burden, whereas having children was associated with lower functional well-being. Changes in family roles were identified as challenging regardless of diagnosis, whereas maintaining normalcy and creating stability was seen as a priority by parents with advanced cancer. This review is limited by the smaller number of studies focussing on the needs of working age people with nonmalignant disease. Significance of results Working age people facing an expected premature death and their families have significant unmet financial, employment, and lifestyle needs. Comparing and contrasting their severity, timing, and p...
Maltby, K.F., Sanderson, C.R., Lobb, E.A. & Phillips, J.L. 2017, 'Sleep disturbances in caregivers of patients with advanced cancer: A systematic review.', Palliative and Supportive Care, vol. 15, no. 1, pp. 125-140.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE: Sleep disturbances are a common issue for those who provide informal care to someone with a life-limiting condition. The negative consequences of poor sleep are well documented. The purpose of the present study was to determine the sleep patterns of caregivers of patients with advanced cancer. METHOD: An extensive systematic review of studies reporting empirical sleep data was undertaken in 2015 in accordance with the PRISMA Statement. A total of eight electronic databases were searched, with no date restrictions imposed. Additionally, a search of the bibliographies of the studies identified during the electronic search was conducted. Search terms included: "sleep," "insomnia," "sleep disturbance," "circadian rhythm," "caregiver," "carer," "advanced cancer," "palliative cancer," and MESH suggestions. The inclusion criteria required studies to be in English and to report primary qualitative and/or quantitative research that examined sleep in caregivers of patients with advanced cancer. Unpublished studies, conference papers, and dissertations were excluded. RESULTS: Overall, 10 studies met the inclusion criteria and were included in the review. Two major findings emerged from the data synthesis. First, at least 72% of caregivers reported moderate to severe sleep disturbance as measured by the Pittsburgh Sleep Quality Index. Second, objective measurement of caregivers' sleep identified that some caregivers experienced up to a 44% reduction in their total sleep time compared to the recommended eight hours. SIGNIFICANCE OF RESULTS: Reduction in total sleep time appears to be the biggest issue facing caregivers' sleep. Future studies need to explore the specific factors that cause these sleep disturbances and thus help to identify interventions to optimize sleep.
McGregor, D., Rankin, N., Butow, P., York, S., White, K., Phillips, J., Stone, E., Barnes, D., Jones, R. & Shaw, T. 2017, 'Closing evidence-practice gaps in lung cancer: Results from multi-methods priority setting in the clinical context.', Asia-Pacific journal of clinical oncology, vol. 13, no. 1, pp. 28-36.View/Download from: UTS OPUS or Publisher's site
To establish priorities for implementation research to reduce evidence-practice gaps in lung cancer care.A modified Nominal Group Technique was used to prioritize evidence-practice gaps in lung cancer care with oncology professionals at three clinical study sites: one rural and two metropolitan. A multimethods design was used to gather quantitative and qualitative data. Quantitative data were analyzed with descriptive statistics, while qualitative data were thematically analyzed.Forty-two health professionals participated, representing a multidisciplinary spread across the care trajectory. A standout priority was identified: reducing the time from first presentation of symptoms to diagnosis and referral for treatment (gap 1), as well as significant focus on a number of presented priorities, including: utilization of active treatments; timely referral to palliative care services; screening as a potential diagnostic tool; and focusing on the care needs of our vulnerable population groups. We describe emerging themes from the qualitative analysis, including: patient help-seeking behavior, provider knowledge about lung cancer, service factors, patient and provider factors in not receiving treatment, the "flow on" effect of variations from optimal care, vulnerable populations of patients, psychosocial needs and early referral to palliative care services.This study is an example of a priority setting partnership between clinicians and health researchers. The priorities highlighted by this study guide future decision making for collaborative implementation of research in lung cancer care.
Sanderson, C.R., Cahill, P.J., Phillips, J.L., Johnson, A. & Lobb, E.A. 2017, 'Patient-centered family meetings in palliative care: a quality improvement project to explore a new model of family meetings with patients and families at the end of life.', Annals of palliative medicine, vol. 6, no. Suppl 2, pp. S195-S205.View/Download from: Publisher's site
Family meetings in palliative care can enhance communication with family members and identify unmet needs. However, the patient's voice may not be heard.This pre and post-test quality improvement project was conducted from 2013-2014 and investigated a patient-centered family meeting, which is a different approach to palliative care family meetings, to determine its feasibility and acceptability for patients, family and the palliative care team. Newly admitted patients to an Australian in-patient specialist palliative care unit were invited to ask anyone they wished to join them in a meeting with the palliative care team and to identify issues they wished to discuss. Consenting inpatients were interviewed shortly after admission; participated in a family meeting and re-interviewed 2-3 days after the meeting. Family members provided feedback at the end of the meeting. A focus group was held with staff for feedback on this new approach for family meetings. Meetings were observed, documented and thematically analyzed.Thirty-one newly admitted patients were approached to participate in a family meeting. Eighty-four percent had family meetings and the majority (96%) was attended by the patient. Thematic analysis revealed 69% of patient-centered meetings raised end-of-life concerns and 54% were "family-focused".Patient-centered family meetings in palliative care were shown to be feasible and acceptable for staff, patients and family members. Many patients and families spontaneously shared end-of-life concerns. A patient-centered approach to family meetings that includes active patient involvement may provide additional and valued opportunities for patients and families to: express mutual concerns, deliver messages of comfort and appreciation, and prepare for death. Further investigation of this approach, including families' bereavement outcomes, is warranted.
Rihari-Thomas, J., DiGiacomo, M., Phillips, J., Newton, P. & Davidson, P.M. 2017, 'Clinician Perspectives of Barriers to Effective Implementation of a Rapid Response System in an Academic Health Centre: A Focus Group Study', International Journal of Health Policy and Management, vol. 6, no. 8, pp. 447-456.View/Download from: UTS OPUS or Publisher's site
Background: Systemic and structural issues of rapid response system (RRS) models can hinder implementation. This study sought to understand the ways in which acute care clinicians (physicians and nurses) experience and negotiate care for deteriorating patients within the RRS.
Methods: Physicians and nurses working within an Australian academic health centre within a jurisdictional-based model of clinical governance participated in focus group interviews. Verbatim transcripts were analysed using thematic content analysis.
Results: Thirty-four participants (21 physicians and 13 registered nurses [RNs]) participated in six focus groups over five weeks in 2014. Implementing the RRS in daily practice was a process of informal communication and negotiation in spite of standardised protocols. Themes highlighted several systems or organisational-level barriers to an effective RRS, including (1) responsibility is inversely proportional to clinical experience; (2) actions around system flexibility contribute to deviation from protocol; (3) misdistribution of resources leads to perceptions of inadequate staffing levels inhibiting full optimisation of the RRS; and (4) poor communication and documentation of RRS increases clinician workloads.
Conclusion: Implementing a RRS is complex and multifactorial, influenced by various inter- and intra-professional factors, staffing models and organisational culture. The RRS is not a static model; it is both reflexive and iterative, perpetually transforming to meet healthcare consumer and provider demands and local unit contexts and needs. Requiring more than just a strong initial implementation phase, new models of care such as a RRS demand good governance processes, ongoing support and regular evaluation and refinement. Cultural, organizational and professional factors, as well as systems-based processes, require consideration if RRSs are to achieve their intended outcomes in dynamic healthcare settings.
Bhattarai, P., Newton-John, T. & Phillips, J.L. 2017, 'Quality and Usability of Arthritic Pain Self-Management Apps for Older Adults: A Systematic Review.', Pain medicine (Malden, Mass.).View/Download from: UTS OPUS or Publisher's site
To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to self-manage their arthritic pain.A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool.Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N=3). Three-quarters (N=3) of the apps fell below the acceptable moderate usability score (3), while one app obtained a moderate score (3.2).Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self-Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors.
Bhattarai, P. & Phillips, J.L. 2017, 'The role of digital health technologies in management of pain in older people: An integrative review.', Archives of Gerontology and Geriatrics, vol. 68, pp. 14-24.View/Download from: UTS OPUS or Publisher's site
Pain is one of the most distressing and debilitating health issues faced by older people. The burden of unrelieved pain experienced by older people and its associated high symptom and economic costs demands consideration of new strategies to better this condition. As the global uptake of digital technology increases, exploring its potential to impact positively on older peoples' pain self-management practices warrants investigation. This integrative review aimed to evaluate the use of digital health technology for management of older people's pain across care-settings. Searches were conducted to identify relevant English language studies published in CINHAL, Medline, Academic Search Complete, EMBASE, Cochrane library databases, and Google and Google Scholar websites. A total of 1003 papers were identified, 9 met the inclusion criteria. The highest level of evidence (Level II) was generated by three Phase II randomized controlled trials. These trials demonstrated the feasibility of computer based interactive or instructive video interventions however there was limited evidence to support their use for reduction of pain intensity and interference. Qualitative evidence demonstrated older people's willingness to use mobile technologies (iPhone or digital pen) to help manage their pain, however, the need of device-use training and connectedness with clinicians were highlighted. In conclusion, there is some evidence that integrating digital health technology into older peoples' pain self-management plan is feasible and acceptable. However, the provision of high-quality technological interventions informed by a thorough understanding of older people's digital technology pain management needs is required to ensure greater integration of this technology in clinical practice.
Hosie, A., Agar, M., Lobb, E., Davidson, P.M. & Phillips, J. 2017, 'Improving delirium recognition and assessment for people receiving inpatient palliative care: a mixed methods meta-synthesis.', International journal of nursing studies, vol. 75, pp. 123-129.View/Download from: UTS OPUS or Publisher's site
Delirium is a serious acute neurocognitive condition frequently occurring for hospitalized patients, including those receiving care in specialist palliative care units. There are many delirium evidence-practice gaps in palliative care, including that the condition is under-recognized and challenging to assess.To report the meta-synthesis of a research project investigating delirium epidemiology, systems and nursing practice in palliative care units.The Delirium in Palliative Care (DePAC) project was a two-phase sequential transformative mixed methods design with knowledge translation as the theoretical framework. The project answered five different research questions about delirium epidemiology, systems of care and nursing practice in palliative care units. Data integration and metasynthesis occurred at project conclusion.There was a moderate to high rate of delirium occurrence in palliative care unit populations; and palliative care nurses had unmet delirium knowledge needs and worked within systems and team processes that were inadequate for delirium recognition and assessment. The meta-inference of the DePAC project was that a widely-held but paradoxical view that palliative care and dying patients are different from the wider hospital population has separated them from the overall generation of delirium evidence, and contributed to the extent of practice deficiencies in palliative care units.Improving palliative care nurses' capabilities to recognize and assess delirium will require action at the patient and family, nurse, team and system levels. A broader, hospital-wide perspective would accelerate implementation of evidence-based delirium care for people receiving palliative care, both in specialist units, and the wider hospital setting.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2017, 'Can A Complex Online Intervention Improve Cancer Nurses' Pain Screening and Assessment Practices? Results from a Multicenter, Pre-post Test Pilot Study.', Pain Management Nursing, vol. 18, no. 2, pp. 75-89.View/Download from: UTS OPUS or Publisher's site
Unrelieved cancer pain has an adverse impact on quality of life. While routine screening and assessment forms the basis of effective cancer pain management, it is often poorly done, thus contributing to the burden of unrelieved cancer pain. The aim of this study was to test the impact of an online, complex, evidence-based educational intervention on cancer nurses' pain assessment capabilities and adherence to cancer pain screening and assessment guidelines. Specialist inpatient cancer nurses in five Australian acute care settings participated in an intervention combining an online spaced learning cancer pain assessment module with audit and feedback of pain assessment practices. Participants' self-perceived pain assessment competencies were measured at three time points. Prospective, consecutive chart audits were undertaken to appraise nurses' adherence with pain screening and assessment guidelines. The differences in documented pre-post pain assessment practices were benchmarked and fed back to all sites post intervention. Data were analyzed using inferential statistics. Participants who completed the intervention (n = 44) increased their pain assessment knowledge, assessment tool knowledge, and confidence undertaking a pain assessment (p < .001). The positive changes in nurses' pain assessment capabilities translated into a significant increasing linear trend in the proportion of documented pain assessments in patients' charts at the three time points ((2) trend = 18.28, df = 1, p < .001). There is evidence that learning content delivered using a spaced learning format, augmented with pain assessment audit and feedback data, improves inpatient cancer nurses' self-perceived pain screening and assessment capabilities and strengthens cancer pain guideline adherence.
Agar, M., Luckett, T., Luscombe, G., Phillips, J., Beattie, E., Pond, D., Mitchell, G., Davidson, P., Cook, J., Brooks, D., Houltram, J., Goodall, S. & Chenoweth, L. 2017, 'Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial', PLoS ONE, vol. 12, no. 8, pp. e0181020-e0181020.View/Download from: UTS OPUS
Luckett, T., Chenoweth, L., Phillips, J., Brooks, D., Cook, J., Mitchell, G., Pond, D., Davidson, P., Beattie, E., Luscombe, G., Goodall, S., Fischer, T. & Agar, M. 2017, 'A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: Perceptions of Palliative Care Planning Coordinators and other health professionals in the IDEAL Study', International Psychogeriatrics, vol. 29, pp. 1713-1722.View/Download from: UTS OPUS
Luckett, T., Phillips, J., Johnson, M.J., Farquhar, M., Swan, F., Assen, T., Bhattarai, P. & Booth, S. 2017, 'Contributions of a hand-held fan to self-management of chronic breathlessness.', The European respiratory journal, vol. 50, no. 2.View/Download from: UTS OPUS or Publisher's site
This study explored the benefits of a hand-held fan as perceived by patients with chronic breathlessness and their carers.A secondary multimethod analysis was conducted of interview data collected in three clinical trials. Two researchers independently coded level of benefit qualitatively reported by each patient. Univariate and multivariate statistics were used to explore perceived benefit as a factor of sex, age and diagnosis. Qualitative analysis used an integrative method.133 patients commented on the fan, of whom 72 had a carer. Diagnoses included nonmalignant (n=91, 68.4%) and malignant (n=21, 15.8%) conditions. Of 111 patients who provided codable data, four (3.6%) perceived no benefit, 16 (14.4%) were uncertain, 80 (72.0%) perceived some benefit and 11 (10.0%) perceived very substantial benefit. Multivariate analysis was inconclusive. Benefit was described in terms of shorter recovery time, especially after activity. 10 (7.5%) patients said the fan reduced their need for home oxygen or inhaled -agonist medications. Negative perceptions of a few included dislike of the cooling sensation and embarrassment in public.Findings suggest that a hand-held fan is a portable intervention with few disadvantages from which most patients with chronic breathlessness will derive benefit alongside other nonpharmacological and pharmacological strategies. Research is needed to optimise guidance on fan administration.
Virdun, C., Luckett, T., Lorenz, K., Davidson, P.M. & Phillips, J. 2017, 'Analyzing Consumer Priorities for Hospital End-of-Life Care Using a Systematic Review to Inform Policy and Practice', SAGE Research Methods Cases.View/Download from: UTS OPUS or Publisher's site
A systematic review is a useful method to answer a research question where prior studies have been conducted. A
well-designed and executed systematic review can inform policy and/or practice change. It can also identify gaps
and generate new research questions. Although the requirements considered essential for conducting a rigorous
systematic review are well defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
statement, the approaches taken to synthesize the data vary. This case study describes the narrative synthesis of
heterogeneous quantitative studies and the meta-synthesis of qualitative studies used to answer a complex
research question from the consumer perspective. The study design focused on the analysis of consumer data
only. As a result, the synthesis of both quantitative data and qualitative data has provided a detailed insight into
consumers' unique perspectives and needs. The synthesis approach for both datasets is described, and linkages
to key tools and resources to help facilitate this approach are provided. Processes used by the research team to
enable effective research governance and collaboration throughout are also detailed.
Virdun, C., Luckett, T., Lorenz, K., Davidson, P.M. & Phillips, J. 2017, 'Dying in the hospital setting: A meta-synthesis identifying the elements of end-of-life care that patients and their families describe as being important.', Palliative medicine, vol. 31, no. 7, pp. 587-601.View/Download from: UTS OPUS or Publisher's site
Despite most expected deaths occurring in hospital, optimal end-of-life care is not available for all in this setting.To gain a richer and deeper understanding of elements of end-of-life care that consumers consider most important within the hospital setting.A meta-synthesis.A systematic search of Academic Search Complete, AMED, CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Google, Google Scholar and CareSearch for qualitative studies published between 1990 and April 2015 reporting statements by consumers regarding important elements of end-of-life hospital care. Study quality was appraised by two independent researchers using an established checklist. A three-stage synthesis approach focusing on consumer quotes, rather than primary author themes, was adopted for this review.Of 1922 articles, 16 met the inclusion criteria providing patient and family data for analysis. Synthesis yielded 7 patient and 10 family themes including 6 common themes: (1) expert care, (2) effective communication and shared decision-making, (3) respectful and compassionate care, (4) adequate environment for care, (5) family involvement and (6) financial affairs. Maintenance of sense of self was the additional patient theme, while the four additional family themes were as follows: (1) maintenance of patient safety, (2) preparation for death, (3) care extending to the family after patient death and (4) enabling patient choice at the end of life.Consumer narratives help to provide a clearer direction as to what is important for hospital end-of-life care. Systems are needed to enable optimal end-of-life care, in accordance with consumer priorities, and embedded into routine hospital care.
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.', Journal of Palliative Medicine, vol. 20, no. 5, pp. 528-532.View/Download from: UTS OPUS or Publisher's site
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.', Journal of Pain and Symptom Management, vol. 53, no. 1, pp. 33-39.View/Download from: UTS OPUS or Publisher's site
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.
Currow, D.C., Phillips, J. & Agar, M. 2017, 'Population-based models of planning for palliative care in older people.', Current opinion in supportive and palliative care, vol. 11, no. 4, pp. 310-314.View/Download from: UTS OPUS or Publisher's site
Health service planning requires demographic, clinical, and health systems data and is unique to each health system. Planning for palliative care in older people must include patients and their carers. This review explores literature from the last 24 months.The proportion of people living in skilled nursing facilities is increasing and many residents require quality palliative care. Simultaneously, the complexity of care for older people is also increasing. Systematic approaches to improving palliative care in these facilities have shown benefits that are cost-effective.Although advance care planning is widely promoted, a randomized controlled trial failed to show the benefits seen in nonrandomized trials. This requires a reconceptualization of current programs that seek to increase uptake.Caregivers take on complex decision-making which can be stressful. By contrast, patients are often very confident that the people who are close to them will make good decisions on their behalf.Specific subgroups considered in this review include carers (and the challenges they face), the 'oldest old' and people with dementia.Excellent research is being done to improve the care of older people with palliative care needs. Ultimately, how can key findings be incorporated into clinical care?
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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
Phillips, J.L., Lobb, E., Mohacsi, P., Heneka, N. & Currow, D. 2017, 'Identifying systems barriers that may prevent bereavement service access to bereaved carers: A report from an Australian specialist palliative care service', Collegian.View/Download from: UTS OPUS or Publisher's site
© 2017 Australian College of Nursing Ltd. Background: Bereavement follow up is an integral element of palliative care. However, little is known about the systems that link bereavement services with bereaved carers. Aim: To map how effectively a specialist palliative care service linked bereavement service to bereaved carers. Methodology: A retrospective medical audit, using process mapping was undertaken within one Australian specialist palliative care service to identify the systems that linked bereavement services to a consecutive cohort of palliative care decedents (n=60) next of kin. Results: Bereavement records were located for 80% of decedents. Nearly all (98%) had a nominated next of kin, with just over half (54%) of those nominated contacted by bereavement services. Incomplete or missing contact details was the main reason (75%) that the bereavement service was unable to contact the decedents' next of kin. Conclusion: Having access to a designated bereavement service can ensure that bereaved next of kin are contract routinely and in a timely way. However the effectiveness of this type of service is dependent upon the bereavement service having access to all relevant contact information. There are numerous opportunities to refine and strengthen the recording of palliative care next of kin details to optimize follow up.
Janssen, A., Shaw, T., Nagrial, A., Pene, C., Rabbets, M., Carlino, M., Zachulski, C., Phillips, J., Birnbaum, R., Gandhi, T. & Harnett, P. 2016, 'An Online Learning Module to Increase Self-Efficacy and Involvement in Care for Patients With Advanced Lung Cancer: Research Protocol', JMIR Research Protocols, vol. 5, no. 3, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
Background: Improving patient care for individuals with lung cancer is a priority due to the increasing burden of the disease globally. One way this can be done is by improving patient self-management capabilities through increasing their self-efficacy. This can improve positive outcomes for patients with chronic conditions and increase their ability to manage the challenges of such illnesses. Unfortunately, patients with chronic conditions often struggle to travel far from home to engage with patient education events, a common means of improving self-efficacy. The development of more accessible tools for improving patient self-efficacy is required to increase quality of life for patients with chronic conditions.
Objective: To evaluate the feasibility of delivering symptom identification and management information to patients with advanced lung cancer using an online program.
Methods: This article describes a pre-post test study to evaluate a Qstream online learning platform to improve patient self-efficacy for managing advanced lung cancer symptoms. Undertaking this program should increase participant knowledge about the side-effects they may experience as a result of their treatment and in turn increase help-seeking behavior and self-efficacy for the participant cohort. Quantitative data collected by the Qstream platform on the completion rates of participants will be used as a tool to evaluate the intervention. Additionally, validated scales will be used to collect data on patient self-efficacy. Qualitative data will also be collected via an exit survey and thematic content analysis of semi-structured interviews.
Results: The research is in the preliminary stages but thus far a protocol has been approved in support of the project. Additionally, advisory committee members have been identified and initial meetings have been undertaken.
Conclusions: Development of new approaches for increasing patient understanding of their care is important to ensure high qualit...
Phillips, J. & Ferguson, C. 2016, 'New approaches to care for acute stroke patients with uncertain prognoses', International Journal of Palliative Nursing, vol. 22, no. 10, pp. 471-471.View/Download from: UTS OPUS or Publisher's site
Rankin, N.M., McGregor, D., Butow, P.N., White, K., Phillips, J.L., Young, J.M., Pearson, S.A., York, S. & Shaw, T. 2016, 'Adapting the nominal group technique for priority setting of evidence-practice gaps in implementation science', BMC MEDICAL RESEARCH METHODOLOGY, vol. 16.View/Download from: UTS OPUS or Publisher's site
Athari, F., Davidson, P.M., Hillman, K.M. & Phillips, J. 2016, 'Implementing a palliative approach in the intensive care unit: an oxymoron or a realistic possibility?', International journal of palliative nursing, vol. 22, no. 4, pp. 163-165.View/Download from: UTS OPUS or Publisher's site
Phillips, J.L. & Agar, M.R. 2016, 'Exemplary nursing leadership is central to improving care of the dying', Journal of Nursing Management, vol. 24, no. 1, pp. 1-3.View/Download from: UTS OPUS or Publisher's site
Bhattarai, P., Hickman, L. & Phillips, J.L. 2016, 'Pain among hospitalized older people with heart failure and their preparation to manage this symptom on discharge: a descriptive-observational study', CONTEMPORARY NURSE, vol. 52, no. 2-3, pp. 204-215.View/Download from: UTS OPUS or Publisher's site
Hickman, L.D., Neville, S., Fischer, T., Davidson, P.M. & Phillips, J.L. 2016, 'Editorial: Call to action: greater investment in the registered nurse role is required to improve care outcomes for dementia patients living in residential aged care and their families.', Contemporary nurse, vol. 52, no. 2-3, pp. 137-139.View/Download from: UTS OPUS or Publisher's site
The number of people living with dementia will triple by 2050 (World Health Organization,
2012). Dementia is a complex terminal illness and international global public health priority
(World Health Organization, 2012). Whilst enormous efforts focus on dementia treatments,
there is an equally urgent need to address workforce issues and invest in increasing the registered
nurse role and ratios in residential aged care to meet the projections. In most high-income
countries residential aged care facilities have evolved over the past two to three decades from
homes for the aged into slow-stream hospices, caring for our most vulnerable community
members (Allen, Chapman, O'Connor, & Francis, 2008). This population has complex care
needs requiring the input of a range of health professionals, such as geriatricians, general practitioners,
registered nurses and care assistants (Hickman, Rolley, & Davidson, 2010; Phillips,
Heneka, Hickman, Lam, & Shaw, 2014). Over this same time period the number of registered
or enrolled nurses working in residential aged care facilities has fallen and those that remain
have been largely relegated to managerial responsibilities. As a result the bulk of nursing care
in residential aged care is now provided by a largely unskilled and unregulated workforce.
Without the prerequisite dementia knowledge, skills or training, these staff are supervised by a
small number of registered nurses (Hullick et al., 2016). This is in contrast to emerging evidence
from long-term care and acute care setting, that nurse qualifications impact outcome. It also differs
significantly from standards in countries like Germany, where a minimum RN ratio of 50% is
mandatory (Aiken et al., 2010)
Forber, J., DiGiacomo, M., Carter, B., Davidson, P., Phillips, J. & Jackson, D. 2016, 'In pursuit of an optimal model of undergraduate nurse clinical education: An integrative review', Nurse Education in Practice, vol. 21, pp. 83-92.View/Download from: UTS OPUS or Publisher's site
Clinical learning experiences are an essential part of nurse education programs. Numerous approaches to clinical education and student supervision exist. The aim of this integrative review was to explore how studies have compared or contrasted different models of undergraduate nurse clinical education. A search of eight databases was undertaken to identify peer-reviewed literature published between 2006 and 2015. Eighteen studies met the inclusion criteria. A diverse range of methodologies and data collection methods were represented, which primarily explored student experiences or perceptions. The main models of undergraduate nurse clinical education identified were: traditional or clinical facilitator model; the preceptorship or mentoring model; and the collaborative education unit model in addition to several novel alternatives. Various limitations and strengths were identified for each model with no single optimal model evident. Thematic synthesis identified four common elements across the models: the centrality of relationships; the need for consistency and continuity; the potential for variety of models; and the viability/sustainability of the model. The results indicate that effective implementation and key elements within a model may be more important than the overarching concept of any given model. Further research is warranted to achieve an agreed taxonomy and relate model elements to professional competence.
Hosie, A., Agar, M. & Phillips, J. 2016, 'Re-thinking our approach to care of the dying person with delirium: time for a new care paradigm.', International journal of palliative nursing, vol. 22, no. 10, pp. 472-473.View/Download from: UTS OPUS
Hosie, A., Lobb, E., Agar, M., Davidson, P., Chye, R., Lam, L. & Phillips, J. 2016, 'Measuring delirium point-prevalence in two Australian palliative care inpatient units.', International journal of palliative nursing, vol. 22, no. 1, pp. 13-21.View/Download from: UTS OPUS or Publisher's site
Internationally, delirium prevalence in palliative care is reported to range between 26-88%, yet little is known about the occurrence of delirium in Australian palliative care inpatient populations.To: 1) ascertain 24-hour delirium point-prevalence in an Australian palliative care inpatient population; 2) test the feasibility and acceptability of the delirium measurement methodology.This was a prospective cross-sectional study. Delirium was measured in patients of two palliative care units using the Nursing Delirium Screening Scale, Memorial Delirium Assessment Scale and DSM-5 diagnostic criteria. Descriptive statistics were used to report patient demographics, palliative care phase, function, delirium measure completion, and proportion of patients with a positive screen and diagnosis.Patients (n=47) had a mean age of 74 years (SD+10) and mostly malignant diagnoses (96%). All patients were screened for delirium, but few were capable of completing the Memorial Delirium Assessment Scale (n=2). One-third of patients (34%) screened positive for delirium and 19% were diagnosed as delirious according to the DSM-5.The Nursing Delirium Screening Scale and physician application of DSM-5 proved feasible and acceptable, while the Memorial Delirium Assessment Scale did not. Patients' advanced age and proportions screening positive for delirium and diagnosed as delirious attest to the need to rapidly recognise, assess and respond to patients experiencing this distressing disorder while being cared for in palliative care inpatient settings.
Rao, A., Hickman, L.D., Phillips, J.L. & Sibbritt, D. 2016, 'Prevalence and characteristics of Australian women who use prayer or spiritual healing: A nationally representative cross-sectional study', COMPLEMENTARY THERAPIES IN MEDICINE, vol. 27, pp. 35-42.View/Download from: UTS OPUS or Publisher's site
Rao, A., Hickman, L.D., Sibbritt, D., Newton, P.J. & Phillips, J.L. 2016, 'Is energy healing an effective non-pharmacological therapy for improving symptom management of chronic illnesses? A systematic review', Complementary Therapies in Clinical Practice, vol. 25, pp. 26-41.View/Download from: UTS OPUS or Publisher's site
Heneka, N., Shaw, T., Rowett, D. & Phillips, J.L. 2016, 'Quantifying the burden of opioid medication errors in adult oncology and palliative care settings: A systematic review', Palliative Medicine, vol. 30, no. 6, pp. 520-532.View/Download from: UTS OPUS or Publisher's site
Vongmany, J., Hickman, L.D., Lewis, J., Newton, P.J. & Phillips, J.L. 2016, 'Anxiety in chronic heart failure and the risk of increased hospitalisations and mortality: A systematic review.', European Journal of Cardiovascular Nursing.View/Download from: UTS OPUS or Publisher's site
Anxiety is a serious affective mood disorder that affects many chronic heart failure patients. While there is ample evidence that depression increases hospitalisations and mortality in chronic heart failure patients, it is unclear whether this association also exists for anxiety.The purpose of this study was to report on prospective cohort studies investigating anxiety in chronic heart failure patients and its association with hospitalisations and mortality rates. This systematic review aims to improve the current knowledge of anxiety as a potential prognostic predictor in chronic heart failure populations.This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by accessing electronic databases Embase, Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Studies were included if they: employed a prospective cohort study design, included chronic heart failure participants with a confirmed clinical diagnosis plus anxiety confirmed by a validated anxiety assessment tool and/or clinical diagnosis and reported longitudinal hospitalisation rates and mortality data in chronic heart failure.Six studies were identified for inclusion. A study investigating hospitalisations and mortality rates found a significant (p<0.05) association solely between hospitalisation and anxiety. Of four studies reporting on hospitalisations alone, only two reported significant associations with anxiety. One study reported rates of mortality alone and identified no significant associations between mortality and anxiety. There was some variation in quality of the studies in regards to their methodology, analysis and reported measures/outcomes, which may have affected the results reported.It is possible that anxiety does predict hospitalisations in chronic heart failure populations, however further research is required to confirm this observation.
Wylie, A., DiGiacomo, M., Phillips, J., Davidson, P.M. & Jackson, D. 2016, 'Acknowledging attributes that enable the career academic nurse to thrive in the tertiary education sector: a qualitative systematic review', Nurse Education Today, vol. 45, pp. 212-218.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
Currow, D.C., Phillips, J. & Clark, K. 2016, 'Using opioids in general practice for chronic non-cancer pain: an overview of current evidence.', The Medical journal of Australia, vol. 205, no. 7, pp. 334-335.View/Download from: UTS OPUS or Publisher's site
Currow, D.C., Phillips, J. & Clark, K. 2016, 'Using opioids in general practice for chronic non-cancer pain: an overview of current evidence.', The Medical journal of Australia, vol. 204, no. 8, pp. 305-309.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
Phillips, J.A., Chan, A., Paeschke, K. & Zakian, V.A. 2015, 'The pif1 helicase, a negative regulator of telomerase, acts preferentially at long telomeres.', PLoS Genet, vol. 11, no. 4, p. e1005186.View/Download from: Publisher's site
Telomerase, the enzyme that maintains telomeres, preferentially lengthens short telomeres. The S. cerevisiae Pif1 DNA helicase inhibits both telomerase-mediated telomere lengthening and de novo telomere addition at double strand breaks (DSB). Here, we report that the association of the telomerase subunits Est2 and Est1 at a DSB was increased in the absence of Pif1, as it is at telomeres, suggesting that Pif1 suppresses de novo telomere addition by removing telomerase from the break. To determine how the absence of Pif1 results in telomere lengthening, we used the single telomere extension assay (STEX), which monitors lengthening of individual telomeres in a single cell cycle. In the absence of Pif1, telomerase added significantly more telomeric DNA, an average of 72 nucleotides per telomere compared to the 45 nucleotides in wild type cells, and the fraction of telomeres lengthened increased almost four-fold. Using an inducible short telomere assay, Est2 and Est1 no longer bound preferentially to a short telomere in pif1 mutant cells while binding of Yku80, a telomere structural protein, was unaffected by the status of the PIF1 locus. Two experiments demonstrate that Pif1 binding is affected by telomere length: Pif1 (but not Yku80) -associated telomeres were 70 bps longer than bulk telomeres, and in the inducible short telomere assay, Pif1 bound better to wild type length telomeres than to short telomeres. Thus, preferential lengthening of short yeast telomeres is achieved in part by targeting the negative regulator Pif1 to long telomeres.
Staley, C., Gould, T.J., Wang, P., Phillips, J., Cotner, J.B. & Sadowsky, M.J. 2015, 'High-throughput functional screening reveals low frequency of antibiotic resistance genes in DNA recovered from the Upper Mississippi River.', J Water Health, vol. 13, no. 3, pp. 693-703.View/Download from: Publisher's site
In this study, we determined the frequency of antibiotic resistance genes (ARGs) in the Upper Mississippi River using a high-throughput, functional, metagenomic screening procedure. Fosmid libraries containing 10,000 clones were screened for resistance to ampicillin, cephalothin, kanamycin, and tetracycline. We hypothesized that nutrient concentrations, land cover type, and taxonomic community composition may select for ARGs. Resistance to ampicillin, cephalothin, and kanamycin was low (<1.00%), and no resistance to tetracycline was detected. Ammonium and total dissolved solids (TDS) concentrations were correlated with kanamycin and cephalothin resistances (r=0.617 and -0.449, P=0.002 and 0.036, respectively). Cephalothin resistance was also positively correlated with the percentage of forested land cover (r=0.444, P=0.039). Only the candidate division OD1, among 35 phyla identified, was correlated with ampicillin resistance (r=0.456, P=0.033), suggesting that minority members of the community may be responsible for dissemination of ARGs in this ecosystem. Results of this study suggest that ammonium and TDS may be involved in a complex selection process for ARGs. Furthermore, we suggest that minority species, potentially contributed in low numbers from sediment and biofilm reservoirs, may be the primary carriers of ARGs in this riverine system.
Collier, A., Phillips, J.L. & Iedema, R. 2015, 'The meaning of home at the end of life: A video-reflexive ethnography study', PALLIATIVE MEDICINE, vol. 29, no. 8, pp. 695-702.View/Download from: UTS OPUS or Publisher's site
Goldsbury, D.E., O'Connell, D.L., Girgis, A., Wilkinson, A., Phillips, J.L., Davidson, P.M. & Ingham, J.M. 2015, 'Acute hospital-based services used by adults during the last year of life in New South Wales, Australia: a population-based retrospective cohort study', BMC HEALTH SERVICES RESEARCH, vol. 15.View/Download from: UTS OPUS or Publisher's site
Koch, J., Everett, B., Phillips, J. & Davidson, P.M. 2015, 'Is there a relationship between the diversity characteristics of nursing students and their clinical placement experiences? A literature review', Collegian, vol. 22, no. 3, pp. 307-318.View/Download from: UTS OPUS or Publisher's site
Background: There has been an increase in ethno-cultural, linguistic, and socio-demographical diversity in students enrolling in undergraduate nursing programs. Diversity also involves other characteristics, but little is known about how diversity impacts on the clinical experiences of nursing students. Aim: The aim of this review is to identify studies which describe the clinical placement experiences of nursing students who have a broad range of diversity characteristics. Methods: Major databases were searched and original studies published from 2003 to 30 June 2013 were eligible for inclusion. An expanded definition of diversity was used to include characteristics such as ethnicity, language, age, religion, gender, socioeconomic status, carer responsibilities, sexual orientation and special needs/disability. Findings: Male gender and speaking English as a second language are diversity characteristics associated with a less positive clinical experience. These students are also more likely to leave their nursing program. Mature-aged students and those from ethnic minority groups were also noted to have a less positive clinical experience and in some cases, this also increased attrition. However, it was difficult to determine the impact of these characteristics alone as they appeared to be linked with other characteristics such as financial difficulties and carer responsibilities in the case of mature-aged students, and language and international student status in the case of ethnicity. Conclusions: Given the significant benefits associated with preparing a diverse nursing workforce, it is an imperative to better understand the impact of diversity on nursing students to ensure that every placement becomes a positive and valuable learning experience. © 2014 Australian College of Nursing Ltd.
Hickman, L.D., Phillips, J.L., Newton, P.J., Halcomb, E.J., Al Abed, N. & Davidson, P.M. 2015, 'Multidisciplinary team interventions to optimise health outcomes for older people in acute care settings: A systematic review', Archives of Gerontology and Geriatrics, vol. 61, no. 3, pp. 322-329.View/Download from: UTS OPUS or Publisher's site
Halkett, G.K.B., Lobb, E.A., Miller, L., Phillips, J.L., Shaw, T., Moorin, R., Long, A., King, A., Clarke, J., Fewster, S., Hudson, P., Agar, M. & Nowak, A.K. 2015, 'Protocol for the Care-IS Trial: a randomised controlled trial of a supportive educational intervention for carers of patients with high-grade glioma (HGG)', BMJ OPEN, vol. 5, no. 10.View/Download from: UTS OPUS or Publisher's site
Hosie, A., Lobb, E., Agar, M., Davidson, P.M., Chye, R. & Phillips, J. 2015, 'Nurse perceptions of the Nursing Delirium Screening Scale in two palliative care inpatient units: a focus group study', JOURNAL OF CLINICAL NURSING, vol. 24, no. 21-22, pp. 3276-3285.View/Download from: UTS OPUS or Publisher's site
Rao, A., Sibbritt, D., Phillips, J.L. & Hickman, L.D. 2015, 'Prayer or spiritual healing as adjuncts to conventional care: a cross sectional analysis of prevalence and characteristics of use among women', BMJ Open, vol. 5, no. 6, pp. e007345-e007345.View/Download from: UTS OPUS or Publisher's site
DiGiacomo, M., Lewis, J., Phillips, J., Nolan, M. & Davidson, P.M. 2015, 'The business of death: a qualitative study of financial concerns of widowed older women', BMC Women's Health, vol. 15, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
The feminisation of ageing and increasing number of widowed women in contemporary society has significant implications. Older women are at risk of poor health, social, and economic outcomes upon widowhood. The aim of the study was to describe women's experiences in the period soon after their husbands' death, including their financial issues and concerns, and the ways in which these experiences impacted on the transition to widowhood late in life.
This was a longitudinal study using serial in-depth semi-structured interviews with 21 community-dwelling women over the age of 65 in Australia. Verbatim transcripts underwent Interpretive Phenomenological Analysis.
Thematic analysis revealed: 1) administrative burden increases vulnerability; 2) gender roles impact on transitions; and 3) financial adjustments render housing insecurity and health risk. High administrative burden within the context of significant grief and mourning was a defining feature of the early bereavement period. Complicated protracted administrative processes, insensitive interactions, and reminders of loss contributed to distress, anxiety and feelings of demoralisation. Several women identified assumption of household financial management as the most difficult aspect of coping with their husband's death.
Older women may have unmet needs for assistance with administrative, financial, and legal issues immediately following spousal death and potentially for years afterward. Lack of familiarity and absence of instrumental support with financial and legal issues signal the need for policy reform, resources to improve financial literacy in women throughout the life course, increased advocacy, and consideration of different support and service models.
Agar, M., Beattie, E., Luckett, T., Phillips, J., Luscombe, G., Goodall, S., Mitchell, G., Pond, D., Davidson, P.M. & Chenoweth, L. 2015, 'Pragmatic cluster randomised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol', BMC Palliative Care, vol. 14, no. 63.View/Download from: UTS OPUS or Publisher's site
There is consensus that survivorship care should be integrated, risk or needs stratified, individualised, coordinated and multidisciplinary. But further research is needed to determine the service models that can best deliver optimal outcomes in the most cost-effective way. Model heterogeneity and diversity is needed to address issues that are disease, treatment or symptom specific, and account for other modifying influences such as comorbid illness and lifestyle. Further work is needed to determine the key elements within models of care configured to support cancer survivors that positively influence outcomes, and how these elements can be best delivered across a diverse range of care settings. In the meantime, adopting a needs based approach to care at the individual patient level will ensure that those in most need have access to relevant support and care from specialist palliative care services. Fortunately, current Australian health reforms provide a climate of plasticity and innovation that is conducive to the paradigm shifts required.
Lovell, M., Luckett, T., Boyle, F., Stubbs, J., Phillips, J., Davidson, P.M., Olver, I., von Dincklage, J. & Agar, M. 2015, 'Adaptation of international guidelines on assessment and management of cancer pain for the Australian context', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 11, no. 2, pp. 170-177.View/Download from: UTS OPUS or Publisher's site
Lovell, M.R., Phillips, J., Luckett, T. & Agar, M. 2015, 'Improving the system for managing cancer pain', INTERNAL MEDICINE JOURNAL, vol. 45, no. 3, pp. 361-362.View/Download from: UTS OPUS or Publisher's site
Virdun, C. & Phillips, J. 2015, 'Commentary on Jack B, Baldry C, Groves K, Whelan A, Sephton J and Gaunt K (2013) Supporting home care for the dying: an evaluation of healthcare professionals' perspectives of an individually tailored hospice at home service. Journal of Clinical Nursing 22, 2778-2786', JOURNAL OF CLINICAL NURSING, vol. 24, no. 7-8, pp. 1147-1148.View/Download from: UTS OPUS or Publisher's site
Virdun, C., Luckett, T., Davidson, P.M. & Phillips, J. 2015, 'Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important.', Palliative Medicine, vol. 29, no. 9, pp. 774-796.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: The majority of expected deaths occur in hospitals where optimal end-of-life care is not yet fully realised, as evidenced by recent reviews outlining experience of care. Better understanding what patients and their families consider to be the most important elements of inpatient end-of-life care is crucial to addressing this gap. AIM AND DESIGN: This systematic review aimed to ascertain the five most important elements of inpatient end-of-life care as identified by patients with palliative care needs and their families. DATA SOURCES: Nine electronic databases from 1990 to 2014 were searched along with key internet search engines and handsearching of included article reference lists. Quality of included studies was appraised by two researchers. RESULTS: Of 1859 articles, 8 met the inclusion criteria generating data from 1141 patients and 3117 families. Synthesis of the top five elements identified four common end-of-life care domains considered important to both patients and their families, namely, (1) effective communication and shared decision making, (2) expert care, (3) respectful and compassionate care and (4) trust and confidence in clinicians. The final domains differed with financial affairs being important to families, while an adequate environment for care and minimising burden both being important to patients. CONCLUSION: This review adds to what has been known for over two decades in relation to patient and family priorities for end-of-life care within the hospital setting. The challenge for health care services is to act on this evidence, reconfigure care systems accordingly and ensure universal access to optimal end-of-life care within hospitals.
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.
Integrating a palliative approach with active management can help identify and address the significant needs of patients with advanced heart failure.
Introducing a palliative approach to care of patients with heart failure while still attempting to modify the disease course through treatment can improve patients' quality of life.
Patients who would benefit from a palliative approach can be better identified by tools that assess needs rather than prognosis.
Optimal palliative care of patients with heart failure integrates ongoing active management with specific interventions to manage symptoms such as breathlessness and oedema.
A plan for deactivation of implantable cardioverter defibrillators at the end of life should be devised and discussed with patients.
Patients should be given the opportunity to reflect on and communicate their preferences for end-of-life care early in the disease process.
Phillips, J.L., Lovell, M., Luckett, T., Agar, M., Green, A.R. & Davidson, P.M. 2015, 'Australian survey of current practice and guideline use in adult cancer pain assessment and management: The community nurse perspective', Collegian, vol. 22, no. 1, pp. 33-41.View/Download from: UTS OPUS or Publisher's site
Cancer pain remains a major public health concern. Despite effective treatmentsbeing available to manage the majority of cancer pain, this debilitating symptom is frequentlyunder treated. As cancer has becomes a chronic disease a range of health professionals, includ-ing community nurses in Australia are increasingly caring for people living with cancer relatedpain. Yet, little is known about community nurses capacity to assess and manage cancer painin accordance with best available evidence.
Virdun, C., Brown, N., Phillips, J.L., Luckett, T., Agar, M., Green, A.R. & Davidson, P.M. 2015, 'Elements of optimal paediatric palliative care for children and young people: An integrative review using a systematic approach', Collegian, vol. 22, no. 4, pp. 421-431.View/Download from: UTS OPUS or Publisher's site
Background: Models of palliative care need to address the unmet needs of children, youngpeople and families.Objective: To undertake an integrative review to identify the key elements of optimal paediatric palliative care from the perspectives of children and young people with palliative care needs and their parents.
Ni, P., Zhou, J., Wang, Z.X., Nie, R., Phillips, J. & Mao, J. 2014, 'Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study', Journal of the American Medical Directors Association, vol. 15, no. 10, pp. 751-756.View/Download from: UTS OPUS or Publisher's site
© 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Objectives: To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD. Design: Population-based cross-sectional survey. Settings: Nursing homes (n= 31) in Wuhan, Mainland Southern China. Participants: Cognitively intact nursing home residents (n= 467) older than 60 years. Measures: Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences. Results: Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about life-sustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098). Conclusions: Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China.
Koch, J., Everett, B., Phillips, J. & Davidson, P.M. 2014, 'Diversity characteristics and the experiences of nursing students' during clinical placements: A qualitative study of students and supervisors views.', Contemporary nurse, pp. 4839-4881.View/Download from: UTS OPUS or Publisher's site
Abstract Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. Aim: To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. Methods: Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N=704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. Findings: Qualitative findings were clustered into three main themes, differences, difficulty and discrimination, each with three subthemes. Conclusion: Findings suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience.
Clark, K., Byfieldt, N., Green, M., Saul, P., Lack, J. & Phillips, J.L. 2014, 'Dying in two acute hospitals: would usual care meet Australian national clinical standards?', Australian Health Review, vol. 38, no. 2, pp. 223-229.View/Download from: UTS OPUS or Publisher's site
The Australian Commission for Quality and Safety in Health Care (ACQSHC) has articulated 10 clinical standards with the aim of improving the consistency of quality healthcare delivery. Currently, the majority of Australians die in acute hospitals. But despite this, no agreed standard of care exists to define the minimum standard of care that people should accept in the final hours to days of life. As a result, there is limited capacity to conduct audits that focus on the gap between current care and recommended care. There is, however, accumulating evidence in the end of life literature to define which aspects of care are likely to be considered most important to those people facing imminent death. These themes offer standards against which to conduct audits. This is very apt given the national recommendation that healthcare should be delivered in the context of considering peoples wishes while always treating people with dignity and respect. This work describes a gap analysis undertaken to explore if issues defined as important by people facing imminent death would have been addressed by usual care of the dying in general hospital wards. The specific issues examined included the documentation that was available to define that this person was likely to die soon and how engaged the person dying seemed to be in discussions, how the person was monitored to ensure distressing symptoms were addressed when necessary and what investigations were considered necessary after the time the person was identified as dying.
Cancer pain assessment enables diagnosis of the cause and mechanism of cancer pain and also the impact of the pain on the patient. Sensitive, empathic communication is important for the ongoing relationship between GPs and patients with cancer.
Ni, P., Zhou, J., Wang, Z.X., Nie, R., Phillips, J. & Mao, J. 2014, 'Advance directive and end-of-life care preferences among nursing home residents in Wuhan, China: a cross-sectional study.', Journal of the American Medical Directors Association, vol. 15, no. 10, pp. 751-756.View/Download from: UTS OPUS or Publisher's site
OBJECTIVES: To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD. DESIGN: Population-based cross-sectional survey. SETTINGS: Nursing homes (n = 31) in Wuhan, Mainland Southern China. PARTICIPANTS: Cognitively intact nursing home residents (n = 467) older than 60 years. MEASURES: Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences. RESULTS: Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about life-sustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098). CONCLUSIONS: Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China.
Phillips, J. 2014, 'A service versus an approach: the importance of building primary palliative care.', International journal of palliative nursing, vol. 20, no. 10, p. 471.View/Download from: UTS OPUS or Publisher's site
Koch, J., Everett, B., Phillips, J. & Davidson, P.M. 2014, 'Diversity characteristics and the experiences of nursing students during clinical placements: A qualitative study of student, faculty and supervisors' views.', Contemporary Nurse, vol. 49, pp. 15-26.View/Download from: UTS OPUS or Publisher's site
Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. AIM: To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. METHODS: Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N = 704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. FINDINGS: Qualitative findings were clustered into three main themes: differences, difficulty and discrimination, each with three sub-themes. CONCLUSION: FINDINGS suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience.
O'Connell, D.L., Goldsbury, D.E., Davidson, P.M., Girgis, A., Phillips, J.L., Piza, M., Wilkinson, A. & Ingham, J.M. 2014, 'Acute hospital-based services utilisation during the last year of life in New South Wales, Australia: methods for a population-based study', BMJ Open, vol. Online (4), no. 3.View/Download from: UTS OPUS or Publisher's site
The aim of this study is to describe healthcare utilisation in the last year of life for people in Australia, to help inform health services planning. The methods and datasets that are being used are described in this paper.
Hickman, L.D., Kelly, H. & Phillips, J.L. 2014, 'EVITEACH: A study exploring ways to optimise the uptake of evidence-based practice to undergraduate nurses', NURSE EDUCATION IN PRACTICE, vol. 14, no. 6, pp. 598-604.View/Download from: UTS OPUS or Publisher's site
Phillips, J.L., Andrews, L. & Hickman, L. 2014, 'Role ambiguity, role conflict or burnout: are these areas of concern for Australian palliative care volunteers?', American Journal of Hospice and Palliative Medicine, vol. 31, no. 7, pp. 749-755.View/Download from: UTS OPUS or Publisher's site
To determine whether burnout, role ambiguity, or conflict affects Australian hospice volunteers.
Hosie, A. & Phillips, J. 2014, 'Editorial: Nurses' role in improving interdisciplinary delirium care in inpatient settings: steps for action.', Journal of clinical nursing, vol. 23, no. 21-22, pp. 2995-2997.View/Download from: UTS OPUS or Publisher's site
Hosie, A., Agar, M., Lobb, E., Davidson, P.M. & Phillips, J.L. 2014, 'Palliative care nurses' recognition and assessment of delirium symptoms: a qualitative study using Critical Incident Technique.', International Journal of Nursing Studies, vol. 51, no. 10, pp. 1353-1365.View/Download from: UTS OPUS or Publisher's site
Delirium is prevalent in palliative care inpatient settings and management is often challenging. Despite nurses integral patient care role, little is known about palliative care nurses capacity to recognise, assess and respond to patients delirium symptoms.
Hosie, A., Lobb, E., Agar, M., Davidson, P.M. & Phillips, J. 2014, 'Identifying the barriers and enablers to palliative care nurses' recognition and assessment of delirium symptoms: a qualitative study.', Journal of pain and symptom management, vol. 48, no. 5, pp. 815-830.View/Download from: UTS OPUS or Publisher's site
CONTEXT: Delirium is underrecognized by nurses, including those working in palliative care settings where the syndrome occurs frequently. Identifying contextual factors that support and/or hinder palliative care nurses' delirium recognition and assessment capabilities is crucial, to inform development of clinical practice and systems aimed at improving patients' delirium outcomes. OBJECTIVES: The aim of the study was to identify nurses' perceptions of the barriers and enablers to recognizing and assessing delirium symptoms in palliative care inpatient settings. METHODS: A series of semistructured interviews, guided by critical incident technique, were conducted with nurses working in Australian palliative care inpatient settings. A hypoactive delirium vignette prompted participants' recall of delirium and identification of the perceived factors (barriers and enablers) that impacted on their delirium recognition and assessment capabilities. Thematic content analysis was used to analyze the qualitative data. RESULTS: Thirty participants from nine palliative care services provided insights into the barriers and enablers of delirium recognition and assessment in the inpatient setting that were categorized as patient and family, health professional, and system level factors. Analysis revealed five themes, each reflecting both identified barriers and current and/or potential enablers: 1) value in listening to patients and engaging families, 2) assessment is integrated with care delivery, 3) respecting and integrating nurses' observations, 4) addressing nurses' delirium knowledge needs, and 5) integrating delirium recognition and assessment processes. CONCLUSION: Supporting the development of palliative care nursing delirium recognition and assessment practice requires attending to a range of barriers and enablers at the patient and family, health professional, and system levels.
Phillips, J.L., Heneka, N.A., Hickman, L., Lam, L. & Shaw, T. 2014, 'Impact of a novel online learning module on specialist palliative care nurses' pain assessment competencies and patients' reports of pain: Results from a quasi-experimental pilot study', Palliative Medicine, vol. 28, no. 6, pp. 521-529.View/Download from: UTS OPUS or Publisher's site
Background: Pain is a complex multidimensional phenomenon moderated by consumer, provider and health system factors. Effective pain management cuts across professional boundaries, with failure to screen and assess contributing to the burden of unrelieved pain.
Lovell, M.R., Luckett, T., Boyle, F.M., Phillips, J., Agar, M. & Davidson, P.M. 2014, 'Patient Education, Coaching, and Self-Management for Cancer Pain', JOURNAL OF CLINICAL ONCOLOGY, vol. 32, no. 16, pp. 1712-+.View/Download from: UTS OPUS or Publisher's site
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, pp. 573-573.View/Download from: UTS OPUS or Publisher's site
Integrated care pathways are documents that outline the essential steps of multidisciplinary care in dealing with a specific clinical problem.1 They can be used to introduce best clinical practice, to ensure that the most appropriate management occurs at the most appropriate time, and that it is provided by the most appropriate health professional. By providing clear instructions, decision support and a framework for clinician–patient interactions, care pathways guide the systematic provision of best evidence-based care. The Liverpool Care Pathway for the Dying Patient (LCP) is an example of an integrated care pathway — it was designed in the United Kingdom in the 1990s to guide care for people with cancer who were in their last days of life and expected to die in hospital.2,3 This pathway evolved out of a recognised local need to better support non-specialist palliative care providers to care for patients dying of cancer in their inpatient units. Historically, despite the many people in acute care settings whose treatment intent was palliative,4 dying patients in these settings tended to receive insufficient attention from senior medical and nursing staff.5 As the quality of end-of-life care was considered inadequate, much could be learned from the way patients were cared for by palliative care services.5 The LCP was a strategy to improve this end-of-life care and was based on the care received by those dying in the palliative care setting.2,3
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
PURPOSE: This study aimed to explore differences in physical activity and fitness between women with metastatic breast cancer compared to healthy controls and factors associated with their physical activity levels. METHODS: Seventy-one women with metastatic breast cancer, aged (mean (SD)) 57.7 (9.5) and 2.9 (3.1)years after the onset of metastatic disease, and 71 healthy controls aged 55.0 (9.4)years participated. Of those with metastatic disease, 27% had bone-only metastases, 35% visceral-only metastases and 38% bone and visceral metastases. Patient-reported outcomes and physical measures of muscle strength and aerobic fitness assessments were obtained. Participants wore a SenseWear® physical activity monitor over 7 days, and the average steps/day and the time spent in moderate-to-vigorous intensity physical activity were determined. RESULTS: Women with metastases were significantly (i) less aerobically fit than the control group (25.3 (5.4) vs. 31.9 (6.1)mL*kg(-1)*min(-1); P<0.001); (ii) weaker (e.g. lower limb strength for the metastatic and control groups was 53.5 (23.7) vs. 76.0 (27.4)kg, respectively; P<0.001); (iii) less active, with the metastatic group attaining only 56% of the mean daily step counts of the healthy women; and (iv) more symptomatic, reporting higher levels of fatigue and dyspnoea (P<0.001). CONCLUSION: Women living in the community with metastatic breast cancer possessed lower aerobic fitness, reduced muscular strength and less daily physical activity compared to healthy counterparts. They also experienced poorer functioning and higher symptom burden. IMPLICATIONS FOR CANCER SURVIVORS: Women living with metastatic breast cancer may benefit from a physical activity programme to address their physical impairments.
Luckett, T., Phillips, J.L., Agar, M., Virdun, C., Green, A.R. & Davidson, P.M. 2014, 'Elements of effective palliative care models: a rapid review', BMC Health Services Research, vol. 14, pp. 1-22.View/Download from: UTS OPUS or Publisher's site
Background: Population ageing, changes to the profiles of life-limiting illnesses and evolving societal attitudes prompt a critical evaluation of models of palliative care. We set out to identify evidence-based models of palliative care to inform policy reform in Australia.
Phillips, J. 2013, 'What will it take to put talking about death on our agenda?', Collegian (Royal College of Nursing, Australia), vol. 20, no. 4, pp. 205-206.View/Download from: UTS OPUS or Publisher's site
Prouse, J. & Phillips, J.L. 2013, 'Care of older people living with cancer: The role of the specialist nurse and allied health professionals', Cancer Forum, vol. 37, no. 3, pp. 226-239.View/Download from: UTS OPUS
Older people with cancer have unique physiological, psychological and social needs. This article has identified several key actions that can readily be integrated into existing cancer care services to improve care outcomes for older people referred for cancer treatment, namely: embedding an integrated assessment into the initial visit to ensure early identification of symptoms and unmet needs; monitoring the effectiveness of cancer treatment and changing needs; optimising function through early and appropriate referral; maintaining GP contact; ensuring the provision of well-coordinated care; addressing psychosocial, emotional and financial needs; and minimising caregiver burden.
Phillips, J.L., West, P., Davidson, P.M. & Agar, M. 2013, 'Does case conferencing for people with advanced dementia living in nursing homes improve care outcomes: Evidence from an integrative review?', International Journal of Nursing Studies, vol. 50, no. 8, pp. 1122-1135.View/Download from: UTS OPUS or Publisher's site
Objective: This integrative review aimed to appraise the evidence for case conferencing as an intervention to improve palliative care outcomes for older people living with advanced dementia in nursing homes.
Hosie, A., Davidson, P.M., Agar, M., Sanderson, C.R. & Phillips, J.L. 2013, 'Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review', Palliative Medicine, vol. 27, no. 6, pp. 486-498.View/Download from: UTS OPUS or Publisher's site
Background: Delirium is a serious neuropsychiatric syndrome frequently experienced by palliative care inpatients. This syndrome is under-recognized by clinicians. While screening increases recognition, it is not a routine practice. Aim and design: This systematic review aims to examine methods, quality, and results of delirium prevalence and incidence studies in palliative care inpatient populations and discuss implications for delirium screening.
DiGiacomo, M., Lewis, J., Nolan, M., Phillips, J.L. & Davidson, P.M. 2013, 'Transitioning From Caregiving to Widowhood', Journal of Pain and Symptom Management, vol. 46, no. 6, pp. 817-825.View/Download from: UTS OPUS or Publisher's site
Older women commonly assume a caregiving role for their husbands at the end of life and are more vulnerable to poorer health, well-being, and social and economic challenges. The aim of this study was to ascertain older women's experiences of spousal caregiving at the end of life and the ways in which this experience impacts on the transition to widowhood.
DiGiacomo, M., Lewis, J., Nolan, M.T., Phillips, J. & Davidson, P.M. 2013, 'Health transitions in recently widowed older women: a mixed methods study', BMC Health Services Research, vol. 13, no. 143.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
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.
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.
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.View/Download from: UTS OPUS or Publisher's site
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.
Phillips, J.L., Piza, M. & Ingham, J.M. 2012, 'Continuing professional development programmes for rural nurses involved in palliative care delivery: an integrative review', Nurse Education Today, vol. 32, no. 4, pp. 385-392.View/Download from: UTS OPUS or Publisher's site
Purpose To review published studies evaluating the impact of continuing professional development (CPD) programmes on rural nurses palliative care capabilities in order to inform the development of targeted learning activities for this population. Design An integrative review. Methods Searches of key electronic databases and the World Wide Web was undertaken using key words, followed by hand searching for relevant articles. All studies were reviewed by two authors using a critical appraisal tool and level of evidence hierarchy. Results The search strategies generated 74 articles, with 10 studies meeting the inclusion criteria. All of these studies evaluated palliative care CPD programmes involving rural nurses which focused on increasing palliative care capabilities. The evidence generated by this review was limited by the absence of randomised controlled trials. A level III-1 study, with a small sample size provided the highest level of evidence, but the lack of control negated the investigators' capacity to confirm causality. Few studies measured the impact of CPD on the quality of care or utilised novel technology to address the tyranny of distance. Despite, these limitations valuable insights into the barriers and facilitators to engaging rural nurses in palliative care learning opportunities were identified.
Phillips, J.L., Rolley, J.X. & Davidson, P.M. 2012, 'Developing Targeted Health Service Interventions Using the PRECEDE-PROCEED Model: Two Australian Case Studies', Nursing Research and Practice, vol. 2012, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
Aims and Objectives. This paper provides an overview of the applicability of the PRECEDE-PROCEED Model to the development of targeted nursing led chronic illness interventions. Background. Changing health care practice is a complex and dynamic process that requires consideration of social, political, economic, and organisational factors. An understanding of the characteristics of the target population, health professionals, and organizations plus identification of the determinants for change are also required. Synthesizing this data to guide the development of an effective intervention is a challenging process. The PRECEDE-PROCEED Model has been used in global health care settings to guide the identification, planning, implementation, and evaluation of various health improvement initiatives. Design. Using a reflective case study approach, this paper examines the applicability of the PRECEDE-PROCEED Model to the development of targeted chronic care improvement interventions for two distinct Australian populations: a rapidly expanding and aging rural population with unmet palliative care needs and a disadvantaged urban community at higher risk of cardiovascular disease. Results. The PRECEDE-PROCEED Model approach demonstrated utility across diverse health settings in a systematic planning process. In environments characterized by increasing health care needs, limited resources, and growing community expectations, adopting planning tools such as PRECEDE-PROCEEDModel at a local level can facilitate the development of the most effective interventions. Relevance to Clinical Practice. The PRECEDE-PROCEED Model is a strong theoretical model that guides the development of realistic nursing led interventions with the best chance of being successful in existing health care environments.
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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
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
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.View/Download from: UTS OPUS or Publisher's site
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.
Phillips, J.L. 2011, 'A population based approach to palliative care', Primary Times: Supporting Nurses in Primary Care, vol. 11, no. 3, pp. 30-31.
Care at the end of life is not just the responsibility of the palliative care community, but rather `everyones business. The role of the general practitioner (GP) and primary health care nurse is fundamental to the provision of high quality care for people living in the community who are approaching the end of their life.
Phillips, J. 2011, 'Narrowing the palliative care gap for Aboriginal and Torres Strait Islanders: the Practice Nurse Role.', Primary Times: Supporting Nurses in Primary Care, vol. 11, no. 4, pp. 19-21.
Phillips, J.L. 2011, 'A population based approach to palliative care', Primary Times, vol. 11, no. 3, pp. 30-31.
Care at the end of life is not just the responsibility of the palliative care community, but rather 'everyone's business'.
The role of the general practitioner (GP) and primary health care nurse is fundamental to the provision of high quality care for people living in the community who are approaching the end of their life.
Phillips, J.L., Halcomb, E. & Davidson, P.M. 2011, 'End-of-Life Care Pathways in Acute and Hospice Care: An Integrative Review', Journal of Pain and Symptom Management, vol. 41, no. 5, pp. 940-955.View/Download from: UTS OPUS or Publisher's site
Context. Over the past decade, there has been widespread adoption of end-of life care pathways as a tool to better manage care of the dying in a variety of care settings. The adoption of various end-of-life care pathways has occurred despite lack of robust evidence for their use. Objectives. This integrative review identified published studies evaluating the impact of an end-of-life care pathway in the acute and hospice care setting from January 1996 to April 2010. Methods. A search of the electronic databases Scopus and Cumulative Index of Nursing and Allied Health Literature as well as Medline and the World Wide Web were undertaken. Articles were reviewed by two authors using a critical appraisal tool. Results. The search revealed 638 articles. Of these, 26 articles met the inclusion criteria for this integrative review. No randomized controlled trials were reported. The majority of these articles reported baseline and post implementation pathway chart audit data, whereas a smaller number were local, national, or international benchmarking studies. Most of the studies emerged from the United Kingdom, with a smaller number from the United States, The Netherlands, and Australia. Conclusion. Existing data demonstrate the utility of the end-of-life pathway in improving care of the dying. The absence of randomized controlled trial data, however, precludes definitive recommendations and underscores the importance of ongoing research.
Phillips, J.L., Salamonson, Y. & Davidson, P.M. 2011, 'An instrument to assess nurses' and care assistants' self-efficacy to provide a palliative approach to older people in residential aged care: A validation study', International Journal of Nursing Studies, vol. 48, no. 9, pp. 1096-1100.View/Download from: UTS OPUS or Publisher's site
Objective: This study investigated the psychometric properties of the 'Palliative care self-efficacy scale', an instrument designed to assess clinicians' degree of confidence in engaging in patient and family interactions at the end-of-life. Design: The
Hosie, A., Fazekas, B., Shelby-James, T., Mills, E., Byfieldt, N., Margitanovic, V., Hunt, J. & Phillips, J.L. 2011, 'Palliative Care Clinical Trials: How nurses are contributing to ethical, integrated and evidence based care of palliative care patients participating in clinical trials', International Journal of Palliative Nursing, vol. 17, no. 5, pp. 224-230.View/Download from: UTS OPUS or Publisher's site
The aim of this paper is to describe the emerging role of the palliative care clinical trials nurse in an era of evidence-based practice and increasing clinical trial activity in palliative care settings across Australia. An overview of the current clinical trials work is provided, with a focus on three aspects of clinical trials nursing practice that have significant implications for patients: managing the consent process, integrating clinical trials into multidisciplinary care, and establishing and building the evidence base to inform practice in palliative care settings. Clinical trials roles provide palliative care nurses with an opportunity to contribute to clinical research, help expand palliative care's evidence base, and develop their own research capabilities.
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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
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.
BACKGROUND: Australia is a culturally and ethnically diverse country. Within such diversity there will be differing beliefs systems about death and dying. This may be a challenging prospect for health professionals. OBJECTIVE: This article discusses how cultural diversity may impact care and provides some strategies for the general practitioner when considering the provision of end of life care. DISCUSSION: This article does not attempt to provide GPs with a prescriptive approach to multicultural care, as this would run the risk of stereotyping individuals. Rather, it discusses the barriers to end of life care among different cultural and ethnic groups, and suggests ways in which to improve understanding of different cultural needs in end of life care.
Globally there is an epidemic of chronic illnesses challenging individuals, health care providers and systems.9 In contemporary society, many people live for extended periods with conditions which were in previous decades an immediate death sentence. However, these welcome changes in longevity do not defy the future certainty of death.
Ramjan, J.M., Costa, C.M., Hickman, L., Kearns, M. & Phillips, J.L. 2010, 'Integrating palliative care content into a new undergraduate nursing curriculum: The University of Notre Dame, Australia - Sydney experience', Collegian, vol. 17, no. 2 Special Issue, pp. 85-91.View/Download from: UTS OPUS or Publisher's site
The majority of society's deaths occur in a health care environment. Regardless of whether a death occurs in acute care, hospice, residential aged care or community settings, nurses are the health professionals that will spend the largest proportion of time with the patient who has a terminal condition and their families. As few nurses have specialist palliative care qualifications it is essential that nursing education prepares graduates to achieve the core capabilities required for the delivery of best evidenced based palliative care. This reality makes the integration of palliative care content into the undergraduate nursing curricula an important priority. This paper aims to describe how palliative care content has been embedded throughout the three-year University of Notre Dame Australia, Sydney (UNDA) undergraduate nursing degree. Method: The School of Nursing at the University of Notre Dame Australia, Sydney campus is committed to ensuring that students graduate with the capabilities to deliver appropriate care to people with requiring end-of-life care. The establishment of this new School of Nursing coincided with the release of the 'The Palliative Care Curricula for Undergraduates Program' (PCC4U) learning resources. These resources have been integrated into relevant units across the three-year nursing curricula. The nursing curriculum has been design to supports the integration of palliative care knowledge into clinical practice. The Palliative Care Curricula for Undergraduates Program learning resources offer engaging palliative care case studies and scenarios for academics to utilise. Adopting an iterative approach where palliative care content is spiralled across multiple units provides opportunities for undergraduate nursing students to sequentially build and consolidate their palliative care capabilities.
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.
Phillips, J.L., Davidson, P.M. & Willcock, S. 2009, 'An Insight Into the Delivery of a Palliative Approach in Residential Aged Care : The General Practitioner Perspective', Journal of Applied Gerontology, vol. 28, no. 3, pp. 395-405.View/Download from: UTS OPUS or Publisher's site
Managing the complex care needs of older people is a global concern. General practitioners (GPs) play a pivotal role in aged care, yet little is known abouttheir capacity to provide palliative care in nursing homes. This study aimed to investigate GPs' perceptions and understanding of a palliative approach. A convenience sample of rural GPs (n = 13) participated in a series of three focus groups undertaken in August, 2005. These focus groups were all audio-taped, transcribed, and analyzed using thematic content analysis. Four key themes emerged: uncertainty about a palliative approach, a need to reorientate providers, the challenges of managing third parties, and making it work and moving forward. These preliminary findings suggest that integrating a palliative approach in aged care requires GPs to have a greater awareness of this paradigm and to be more effectively engaged in multidisciplinary care planning.
Davidson, P.M., Dracup, K., Phillips, J.L., Daly, J. & Padilla, G. 2008, 'Preparing for the worst while hoping for the best: The relevance of hope in the heart failure illness trajectory', Journal of Cardiovascular Nursing, vol. 22, no. 3, pp. 159-165.View/Download from: UTS OPUS or Publisher's site
Background: Patients with heart failure have higher mortality rates than those with most malignant diseases. The heart failure illness trajectory is one of gradual decline characterized by unpredictable events such as acute decompensation of heart failure or a sudden cardiac death. Health professionals have an obligation to give patients and their families concise and honest information concerning their prognosis. The challenge exists to give what ostensibly may seem a bleak prognosis within a context of hope and optimism. Aim: To explore the role of hope in heart disease and the potential utility of this construct in the development of nursing interventions. Methods: The electronic databases CINAHL, MEDLINE, EmBASE, and PSYCHlit were searched from 1982 to August 2004 using the key words "hope," "hopelessness," "heart disease," and "heart failure." Articles were subsequently sorted to meet the inclusion criteria of (1) a philosophical discussion of the construct of hope and/or (2) investigation of hope in heart disease. Results: This search retrieved 768 articles, and 24 met the inclusion criteria. Key findings from the review indicate that "hope" and "hopelessness" are underdeveloped, yet important constructs and conceptually linked with depression and spirituality. Intriguing findings from descriptive, observational studies have demonstrated the positive impact of expression of hope on cardiovascular outcomes. These findings need to be validated in randomized controlled trials.
Phillips, J.L., Davidson, P.M., Newton, P.J. & DiGiacomo, M. 2008, 'Supporting patients and their caregivers after-hours at the end of life: the role of telephone support', Journal of Pain and Symptom Management, vol. 36, no. 1, pp. 11-21.View/Download from: UTS OPUS or Publisher's site
Twenty-four hour access is accepted as a gold standard for palliative care service delivery, yet minimal data exist to justify the cost of this initiative to health care planners and policy makers. Further, there is scant information concerning optimal and efficient methods for delivering after-hours palliative care advice and support, particularly in regional and rural settings. This article reports on an evaluation of a local after-hours telephone support service in regional Australia. A centralized after-hours telephone support service was provided by generalist nurses at a Multipurpose Service in a rural community. A mixed-method evaluation, including semistructured interviews, was undertaken after 20 months of operation. During the period March 31, 2005 until November 15, 2006, 357 patients were registered as part of the Mid North Coast Rural Palliative Care Program. Ten percent of patients or their caregivers accessed the After-Hours Telephone Support Service, representing 55 occasions of service.
Phillips, J.L., Davidson, P.M., Jackson, D.E. & Kristjanson, L. 2008, 'Multi-Faceted Palliative Care Intervention: Aged Care Nurses' And Care Assistants' Perceptions And Experiences', Journal of Advanced Nursing, vol. 62, no. 2, pp. 216-227.View/Download from: UTS OPUS or Publisher's site
Aim. This paper is a report of a study to describe residential aged care nurses' and care assistants' perceptions of a multi-faceted palliative care intervention to identify potential areas to be addressed during subsequent action research phases. Backgr
Grubbs, R.S. & Sica, D.A. 2007, 'Taking the Pressure off Type 2 Diabetes Mellitus: Implementing Hypertension Guidelines', Progress in Cardiovascular Nursing, vol. 22, no. 3, pp. 159-165.View/Download from: Publisher's site
Davidson, P.M., Dracup, K., Phillips, J.L., Padilla, G. & Daly, J. 2007, 'Maintaining hope in transition: A conceptual framework to guide interventions for people with heart failure', Journal of Cardiovascular Nursing, vol. 22, no. 1, pp. 58-64.View/Download from: UTS OPUS or Publisher's site
Theoretical frameworks provide a structure for the planning and delivery of nursing care and for research. Heart failure (HF), a condition of increasing prevalence in communities internationally, is responsible for high rates of morbidity, mortality, and great societal burden. The HF illness trajectory can be unpredictable and uncertain. Markers of transition, such as functional decline and increasing dependence, can signal the need for transition to a more palliative approach. This transition challenges clinicians to deliver information and interventions and to support patients and their families not only in relation to their physical status but also in the social, psychological, and existential dimensions. This article describes a theoretical framework, Maintaining Hope in Transition, informed by transition theory, to assist patients to cope with a diagnosis of HF and to guide development of nursing interventions. Transition theory provides a useful context to assist clinicians, patients, and their families adjust to the challenges inherent in a diagnosis of HF and negotiating the illness trajectory. Key factors acknowledged in the Maintaining Hope in Transition framework that determine its utility in models of care for HF patients are (1) acknowledging the changing of life circumstances, (2) restructuring reality, (3) dealing with vulnerability, (4) achieving normalization, and (5) resolving uncertainty. It is likely that incorporation of these factors in care planning, information, and interventions can facilitate patients' and their families' abilities to negotiate the HF illness trajectory, particularly in the advanced stages.
Halcomb, E., Gholizadeh, L., DiGiacomo, M., Phillips, J.L. & Davidson, P.M. 2007, 'Considerations in undertaking focus group research with culturally and linguistically diverse groups in Bibliographies and Literature Reviews', Journal of Clinical Nursing, pp. 1000-1011.
Focus groups are a popular, widely accepted, and legitimate research method to determine attitudes, experiences, perceptions, and knowledge on a wide range of topics in many fields of endeavor. Focus groups lead to the voicing of attitudes and insights not readily attainable from other qualitative forms of data collection. The spectrum of interest in focus groups covers virtually all disciplines, and the variety of the applications for this technique is extraordinary. As part of the SAGE Benchmarks in Social Research Methods series, Graham Walden explores what a focus group is, how they are best used, the strengths and weaknesses of focus groups and the ethical issues surrounding focus groups, amongst other things. Volume 2, Part 2, 'Bibliographies and Literature Reviews' contains Halcomb et al.'s "Considerations in undertaking focus group research with culturally and linguistically diverse groups". URL: http://www.sagepub.com/books/Book235672/toc
Halcomb, E., Gholizadeh, L., DiGiacomo, M., Phillips, J.L. & Davidson, P.M. 2007, 'Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups', Journal Of Clinical Nursing, vol. 16, no. 6, pp. 1000-1011.View/Download from: UTS OPUS or Publisher's site
Aims. This integrated literature review seeks to identify the key considerations in conducting focus groups and discusses the specific considerations for focus group research with culturally and linguistically diverse groups. Background. The focus group method is a technique of group interview that generates data through the opinions expressed by participants. Focus groups have become an increasingly popular method of data collection in health care research. Although focus groups have been used extensively with Western populations, they are a particularly useful tool for engaging culturally and linguistically diverse populations. The success of focus groups in this context is dependent upon the cultural competence of the research team and the research questions.
Phillips, J.L., Davidson, P.M., Ollerton, R., Jackson, D.E. & Kristjanson, L. 2007, 'A survey of commitment and compassion among nurses in residential aged care', International Journal of Palliative Nursing, vol. 13, no. 6, pp. 282-290.View/Download from: UTS OPUS or Publisher's site
To assess the views and attitudes of aged care staff providing direct care towards palliative care and to identify their learning needs. Design: Survey design using purposive sampling methods. Findings: Nurses and care assistants (n=222) employed within nine residential aged care facilities in regional Australia completed the survey. The majority had received on the job training and were committed to providing end-of-life care. Differences in the level of confidence to deal with patient/family interactions and manage complex palliative care scenarios were evident between nurses and care assistants (p<0.05). Both nurses and care assistants perceived a need for further education in symptom management and communication, yet their content need differed significantly between groups. Conclusions: Nurses and care assistants in residential aged care facilities demonstrate commitment to the delivery of palliative care and express a need for increased palliative care competencies. The heterogeneity of roles and educational preparation within the aged care workforce indicate that tailored palliative care education initiatives are required to meet the learning needs of aged care nurses and care assistants, particularly in relation to end-of-life care. These data have implications for skill-mix and model of care development.
Davidson, P.M., Halcomb, E., Hickman, L., Phillips, J.L. & Graham, B. 2006, 'Beyond the rhetoric: what do we mean by a model of care?', Australian Journal of Advanced Nursing, vol. 23, no. 3, pp. 47-55.View/Download from: UTS OPUS
This paper aims to define what is meant by the term 'model of care' and document the pragmatic systems and processes necessary to develop, plan, implement and evaluate novel models of care delivery.
Phillips, J.L., Davidson, P.M., Jackson, D.E., Kristjanson, L., Bennett, M. & Daly, J. 2006, 'Enhancing palliative care delivery in a regional community in Australia', Australian Health Review, vol. 30, no. 3, pp. 370-379.View/Download from: UTS OPUS
Although access to palliative care is a fundamental right for people in Australia and is endorsed by government policy, there is often limited access to specialist palliative care services in regional, rural and remote areas. This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales.
Phillips, J.L., Davidson, P.M., Jackson, D.E., Kristjanson, L., Daly, J. & Curran, J. 2006, 'Residential aged care: The last frontier for palliative care', Journal Of Advanced Nursing, vol. 55, no. 4, pp. 416-424.View/Download from: UTS OPUS or Publisher's site
This paper is a report of an explorative study describing the perceptions and beliefs about palliative care among nurses and care assistants working in residential aged care facilities in Australia. Background. Internationally, the number of people dying in residential aged care facilities is growing. In Australia, aged care providers are being encouraged and supported by a positive policy platform to deliver a palliative approach to care, which has generated significant interest from clinicians, academics and researchers. However, a little is known about the ability and capacity of residential aged care services to adopt and provide a palliative approach to care. Methods. Focus groups were used to investigate the collective perceptions and beliefs about palliative care in a convenience sample of nurses and care assistants working in residential aged care facilities in Australia. Thematic content analysis was used to analyse the data, which were collected during 2004. Results. Four major themes emerged: (1) being like family; (2) advocacy as a key role; (3) challenges in communicating with other healthcare providers; (4) battling and striving to succeed against the odds. Although participants described involvement and commitment to quality palliative care, they also expressed a need for additional education and support about symptom control, language and access to specialist services and resources.
Phillips, J.L. & Hickman, L. 2017, 'Preparing for practice' in Contexts of Nursing, Elsevier.
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 progresses
to advanced disease. Guidance in the process of managing long-term co-morbidities
at the end of life requires clarity about the goals of care for the person's cancer, and
for each of his/her co-morbidities. Why was a particular therapy started in the first
place? What risk is the therapy mitigating, and does it need to be continued? Very
few studies help to inform the process of ceasing medications. For example, with
cachexia and its associated weight loss, frequently encountered in advanced cancer,
the management of two of the most frequent conditions—hypertension and diabetes
—will change. The need for anti-hypertensives will decrease or the person will risk
postural symptoms and the need for lower doses of hypoglycaemic agents and
liberalised diets will be hallmarks of managing diabetes in order to avoid hypoglycaemia.
Mostly, this care is in the setting of multiple co-morbidities, making
review a complex and continuing process. Changes in co-morbidities can also
directly influence the anti-cancer therapies that are available to patients, because of
characteristics of the drug itself or changes in metabolism or elimination. Adjusting
chemotherapy in advanced disease also requires careful evaluation of the goals of
palliative treatment—are there symptoms that can best be addressed by disease
modifying treatments or are there other more direct, better tolerated symptom
control therapies available? Not only will there be a need for active management of
long-term co-morbidities, but people will need to adjust psychologically to these
changes. Modifying the goals of treatment is often the most overt signal to people
that their disease is progressing and therefore can be particularly confronting. Such
changes will often precipitate, or are an opportunity for, much wider conversations
about life, dying and dea...
Phillips, J.L., Ingham, J. & McLeod, R. 2015, 'The development of palliative medicine in Australia and New Zealand' in Textbook of Palliative Medicine and Supportive Care, Second Edition, CRC Press, London.
This edition also contains new material on chemotherapy- and radiation therapy-induced emesis, geriatric palliative care, and hormonal therapy and targeted agents.
Ingham, J., Moore, H., Phillips, J.L. & Portenoy, R.K. 2015, 'Measurement of, and tools for, pain and other symptoms' in Oxford Textbook of Palliative Medicine, Oxford University Press, USA, pp. 376-390.
This fifth edition of the Oxford Textbook of Palliative Medicine is dedicated to the memory of Professor Geoffrey Hanks, pioneer in the field ofpalliative medicine, and co-editor of the previous four editions.
Phillips, J.L., Ingham, J. & McLeod, R. 2015, 'The development of palliative medicine in Australia and New Zealand' in Bruera, E. & Higginson, I. (eds), Palliative Medicine, Hodder Arnold, London, pp. 59-70.
Agar, M. & Phillips, J.L. 2015, 'Palliative medicine and care of the elderly' in The Oxford Textbook of Palliative Medicine, Oxford University Press.
Agar, M. & Phillips, J.L. 2015, 'Palliative medicine and care of the elderly' in Cherny, N., Fallon, M., Kaasa, S., Portenoy, R., Currow, D. & Morita, J. (eds), Oxford Textbook of Palliative Medicine, Oxford University Press, Oxford, pp. In press-In press.View/Download from: UTS OPUS
Phillips, J.L., Davidson, P. & Hosie, A. 2015, 'Palliative Care in the Nursing Home' in Cherny, N., Fallon, M., Kaasa, S., Portenoy, R., Currow, D. & Morita, J. (eds), The Oxford Textbook of Palliative Medicine, Oxford University Press, Oxford.View/Download from: UTS OPUS
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, Oxford University Press.View/Download from: UTS OPUS or Publisher's site
The book begins by outlining the range of policies towards palliative care for older people that are found worldwide.
Ingham, J.M., Moore, H., Phillips, J.L. & Portenoy, R.K. 2014, 'Measurement of, and tools for, pain and other symptoms' in Cherny, N., Fallon, M., Kaasa, S., Portenoy, R., Currow, C.D. & Morita, J. (eds), Oxford Textbook of Palliative Medicine, Oxford University Press, Oxford.View/Download from: UTS OPUS
Phillips, J.L. 2014, 'Palliative Care in the Nursing Home' in Cherny, N., Fallon, M., Kaasa, S., Portenoy, R., Currow, C.D. & Morita, J. (eds), Oxford Textbook of Palliative Medicine, Oxford University Press, Oxford, p. INPRESS.View/Download from: UTS OPUS
Currow, D. & Phillips, J.L. 2014, 'Models of care in palliative medicine' in Palliative Surgery, Springer, Berlin.
LeBlanc, T.W., Currow, D., Phillips, J.L. & Abernethy, A.P. 2014, 'Management of dyspnea' in Quill, T.E. & Miller, F.G. (eds), Palliative Care and Ethics, Oxford University Press, Oxford.View/Download from: UTS OPUS
Davidson, P.M. & Phillips, J.L. 2012, 'Palliative Care in Chronic Illness' in O'Connor, M., Lee, S. & Aranda, S. (eds), Palliative Care Nursing A Guide to Practice 3rd Edition, AUSMED Publications Pty Ltd, North Melbourne, VIC Australia, pp. 291-307.
Chronic illnesses are a major cause of death and disability globally. Many people now live for an extended period of time with a life-limiting illness. This is particularly pronounced in the context of population ageing. This chapter focuses on the issues involved in providing a palliative approach to care for individuals with chronic life-threatening illnesses other than cancer.
Davidson, P.M. & Phillips, J.L. 2010, 'Focus Group Methodology: Being Guided on a Journey from Novice to Expert' in Minichiello, V. & Kottler, J.A. (eds), Qualitative Journeys: Student and Mentor Experiences with Research, SAGE, Thousand Oaks, California, pp. 255-276.View/Download from: UTS OPUS
Rihari-Thomas, J., DiGiacomo, M., Phillips, J., Newton, P. & Davidson, P.M. 2017, 'Physicians' and Nurses' Perspectives of a Rapid Response System in an Academic Health Centre: A Focus Group Study', 13th International Conference on Rapid Response Systems and Medical Emergency Teams, International Society for Rapid Response Systems (iSSRS), Chicago.
Ferguson, C., Hickman, L., Phillips, J., Newton, P., Inglis, S., Lam, L. & Bajorek, B. 2017, 'An mHealth intervention to improve nurses' atrial fibrillation and anticoagulation knowledge and practice: the EVICOAG study', International Journal of Stroke, Stroke Society of Australasia, SAGE Publications, Queenstown, New Zealand, pp. 9-9.
Ferguson, C., Hickman, L., Phillips, J., Newton, P., Inglis, S., Lam, L. & Bajorek, B. 2017, 'Exploring the acute care registered nurses' contribution in anticoagulation decision making for stroke prevention in atrial fibrillation', International Journal of Stroke, Stroke Society of Australasia, SAGE Publications, Queenstown, New Zealand, pp. 48-48.
Phillips, J.L., Kochovska, S., Luckett, T. & Agar, M. 2017, 'Impacts on Employment, Finances and Lifestyle for Working Age People Facing an Expected Premature Death: A Systematic Review', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, WILEY, pp. 220-220.
Vongmany, J., Luckett, T., Lam, L. & Phillips, J.L. 2017, 'Family Behaviours that Impact on the Capacity of Adults Living with Type 2 Diabetes to Adhere to Their Self-Management Plan: A Systematic Review and Meta-Synthesis', DIABETES, 77th Scientific Sessions of the American-Diabetes-Association, AMER DIABETES ASSOC, San Diego, CA, pp. A221-A221.
Xu, X., Luckett, T., Wang, A.Y., Lovell, M. & Phillips, J.L. 2017, 'Cancer Pain Management Needs and Perspectives of Patients from Chinese Backgrounds: A Systematic Review of the Chinese and English Literature', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, WILEY, pp. 220-221.
Disler, R.T., Luckett, T., Phillips, J.L., 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.M. 2017, 'Respiratory Patient Experiences In Self-Managing Emergency Department 'near-Miss' For Breathlessness: A Strengths-Based Qualitative Study', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, International Conference of the American-Thoracic-Society (ATS), AMER THORACIC SOC, Washington, DC.
Johnson, M., Swan, F., Booth, S., Currow, D., Hart, S. & Phillips, J.L. 2017, 'The Hand-Held Fan For Breathlessness, How Do Patients Use It And Does It Help?', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, International Conference of the American-Thoracic-Society (ATS), AMER THORACIC SOC, Washington, DC.
Stone, E., Rankin, N., Phillips, J.L., Fong, K. & Shaw, T. 2016, 'THE LUNG CANCER DATABASE MAP IN AUSTRALIA: OVERVIEW OFA DESCRIPTIVE STUDY PROTOCOL', Respirology, Wiley: 12 months, pp. 108-108.
Rao, A., DiGiacomo, M., Newton, P., Phillips, J., Davidson, P.M. & Hickman, L. 2016, 'Meditation as a secondary prevention strategy for heart disease: a systematic review', Australian Cardiac Rehabilitation Association Conference, Adelaide.
Rao, A., Sibbritt, D., Phillips, J. & Hickman, L. 2016, ''Prayer or spiritual healing as adjuncts to conventional care: A cross sectional analysis of the prevalence and characteristics of use among women.', Australian Longitudinal Study on Women's Health Scientific Meeting, Newcastle, Australia.View/Download from: UTS OPUS
Rao, A., Sibbritt, D., Phillips, J. & Hickman, L. 2016, ''Prayer or spiritual healing as adjuncts to conventional care: A cross sectional analysis of the prevalence and characteristics of use among women.', Australian Longitudinal Study on Women's Health Scientific Meeting, Newcastle, Australia.View/Download from: UTS OPUS
Rao, A., Sibbritt, D., Phillips, J. & Hickman, L.D. 2016, 'Prayer or spiritual healing for the health and well-being of two generations of women: A nationally representative cross-sectional study.', 21st international Council on Women's Health Issues (ICOWHI) Congress. Scale and Sustainability: Moving Women's Health Issues Forward., Baltimore, Maryland, USA.View/Download from: UTS OPUS
Chroinin, D.N., Goldsbury, D., O'Connell, D.L., Beveridge, A., Davidson, P., Girgis, A., Ingham, N., Phillips, J.L., Wilkinson, A. & Ingham, J. 2015, 'Patterns of hospital-based healthcare use amongst dementia patients in their last year of life in New South Wales (NSW)', AUSTRALASIAN JOURNAL ON AGEING, pp. 22-22.
Phillips, J.L. 2015, 'The importance of undertaking and publishing feasibility studies: the results from a randomized controlled pilot trial of The Pink Women's Wellness Program', MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY, pp. 921-922.View/Download from: Publisher's site
Heneka, N., Phillips, J.L., Rowett, D. & Shaw, T. 2015, 'Identifying opioid medication error types, incidence and patient impact in adult oncology and palliative care settings: a systematic review', Asia-Pacific Journal of Clinical Oncology, pp. 128-128.View/Download from: UTS OPUS
DiGiacomo, M., Lewis, J., Phillips, J., Davidson, P.M. & Nolan, M. 2015, 'The role of gender, administrative burden, and financial concerns in the transition to widowhood; a qualitative study', Australian Association of Gerontology, Alice Springs.
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.
Goldsbury, D., Ingham, J.M., Girgis, A., Wilkinson, A., Phillips, J., Davidson, P. & O'Connell, D.L. 2014, 'HOSPITAL-BASED CARE IN THE LAST YEAR OF LIFE FOR PEOPLE DYING FROM CANCER IN NEW SOUTH WALES: A RETROSPECTIVE COHORT STUDY', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, WILEY-BLACKWELL, pp. 95-96.
Rankin, N., Shaw, T., McGregor, D., Butow, P., White, K., Young, J., Phillips, J., Pearson, S., York, S., Simes, J., Jones, R., Barnes, D. & Stone, E. 2014, 'BUILDING AN IMPLEMENTATION SCIENCE PROGRAM IN LUNG CANCER CARE: RESULTS FROM SYDNEY CATALYST TRANSLATIONAL CANCER RESEARCH CENTRE', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, WILEY-BLACKWELL, pp. 85-85.
Shaw, T., Rankin, N., McGregor, D., White, K., Phillips, J., Butow, P., Young, J., Trevena, L., Pearson, S. & York, S. 2014, 'A SYSTEMATIC APPROACH TO CLOSING EVIDENCE GAPS IN CANCER CARE', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, WILEY-BLACKWELL, pp. 22-22.
Phillips, J.L., Heneka, N. & Hickman, L. 2014, 'Impact of a Qstream online learning module on palliative care nurses' pain assessment competencies and patients' report on pain: Results from a quasi-experimental pilot study', Asia Pacific Journal of Clinical Oncology, Wiley: 12 months.View/Download from: UTS OPUS
Phillips, J.L., Heneka, N., Lam, L. & Shaw, T. 2014, 'A complex Qstream (R) pain assessment intervention on cancer nurses' pain screening and assessment practices: results from a quasi-experimental study', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 136-136.
Phillips, J.L., Heneka, N., Lam, L.T. & Shaw, T. 2014, 'Multi-Centre Pre-Post Test Trial of a complex Qstream (C) pain assessment intervention on cancer nurses' pain screening and assessment practices', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 206-206.
Lovell, M.R., Birch, M.-.R., Luckett, T., Davidson, P.M., Phillips, J., Agar, M., Boyle, F.M., Stubbs, J. & Spruyt, O. 2014, 'PILOT OF PAIN INDICATOR AUDIT TOOL AS PART OF A COMPLEX INTERVENTION TO IMPROVE CANCER PAIN OUTCOMES', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 45-45.
Lovell, M.R., Luckett, T., Phillips, J., Boyle, F., Davidson, P.M., Stubbs, J., Birch, M.-.R., Spruyt, O. & Agar, M. 2014, 'CANCER PAIN: CLOSING THE EVIDENCE-PRACTICE GAP', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 101-101.
Phillips, J. 2013, 'PALLIATIVE CARE SYSTEMS: EVIDENCE FOR KEY MODELS OF CARE ELEMENTS', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, WILEY-BLACKWELL, pp. 95-95.
RaNKin, N.M., Shaw, T., Mcgregor, D., Butow, P., Young, J., White, K., Phillips, J., Pearson, S., Simes, J., O'Connell, R., Stone, E. & Barnes, D. 2013, 'IDENTIFYING EVIDENCE-PRACTICE GAPS IN LUNG CANCER AND PRIORITY SETTING WITH CLINICIANS IN NSW, AUSTRALIA', JOURNAL OF THORACIC ONCOLOGY, LIPPINCOTT WILLIAMS & WILKINS, pp. S699-S700.
Phillips, J., Heneka, N. & Shaw, T. 2013, 'EXPLORING OPIATE ERRORS IN THE SPECIALIST CANCER AND PALLIATIVE CARE SETTING: PERCEPTIONS OF KEY STAKEHOLDERS', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 127-127.
Phillips, J., Heneka, N. & Shaw, T. 2013, 'MAPPING CANCER PAIN SCREENING, ASSESSMENT AND REASSESSMENT PRACTICES WITHIN ONE AUSTRALIAN HEALTH DISTRICT: RESULTS FROM A BASELINE CHART AUDIT', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 126-127.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2013, 'Can a novel on-line pain assessment learning module improve specialist palliative care nurse's pain assessment knowledge?: Results from a pilot Spaced Education initiative', 16th CNSA Winter Congress, Brisbane Convention and Exhibition Centre, Queensland.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2012, 'Spaced Education in the Specialist Palliative Care Setting: exploring it's potential to improve pain management', 4th Biennial Palliative Care Nurses Australia Conference, Melbourne.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2013, 'The impact of a novel, online learning module on specialist palliative care nurses' pain assessment knowledge and practices', European Journal of Palliative Care, European Palliative Care Association Conference, Prague.
Hickman, L., Kelly, H. & Phillips, J.L. 2012, 'EVITECH: a pilot study exploring ways to optimise the uptake of evidence-based practice to undergraduate nurses', 23rd Research Conference, Sigma, Theta Tau International, Research Conference, Sigma, Theta Tau International, Brisbane, QLD.
Phillips, J.L., Andrews, L. & Hickman, L. 2012, 'Factors predicting stays of over 30 days in patients dying in a specialist palliative care unit', 19th International Congress on Women's Health, Mahidol University Bangkok, Thailand.
Clark, K., Currow, D., Talley, N., Dinning, P., Lam, L., Agar, M., Davidson, P., Shelby-James, T. & Phillips, J. 2012, 'Exploring the Underlying Physical Changes That Contribute to Bowel Problems in Palliative Care: Preliminary Result', JOURNAL OF PALLIATIVE CARE, pp. 223-224.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2012, 'Enhancing interdisciplinary team pain assessment communication: Can Spaced Education improve comprehensive pain assessment practices in the specialist palliative care setting?', Palliative Care NSW State Conference, Dubbo.
Phillips, J.L., Hickman, L., Heneka, N. & Shaw, T. 2012, 'Assessing specialist palliative care nurses pain assessment capabilities: identifying opportunities to improve patient outcomes', 16th Cancer Nurses Society Australia Conference, Hobart.
Phillips, J.L., Hickman, L., Heneka, N. & Shaw, T. 2012, 'Can a novel on-line CPD program increase specialist palliative care nurses pain assessment capabilities and reduce patients' reported pain scores?', WA Palliative Care Conference, Perth, WA.
DiGiacomo, M., Davidson, P.M., Lewis, J., Phillips, J. & Nolan, M. 2012, 'Early Widowhood in Older Women: A Time of Vulnerability and Health Stress', International Council on Women's Health Issues (ICOWHI) Congress, Bangkok.
Clayton, J., Davidson, P.M., Phillips, J., Luckett, T., Green, A., Agar, M., Broadbent, A., Lovell, M. & ImPaCCT, S.T.O.P.P.P.T. 2012, 'STOP PAIN PROJECT: A COLLABORATIVE, INTERDISCIPLINARY PROJECT TO IMPROVE THE PERSON-CENTREDNESS OF ASSESSMENT AND MANAGEMENT OF CANCER PAIN', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 267-267.
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.View/Download from: UTS OPUS
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.
Jane regularly collaborates with members of the National Palliative Care Clinical Studies Collaborative (PaCCSC) and is the current Chair of the Trails Management Group. She is an active member of the Improving Palliative Care through Clinical Trials (ImPaCCT) - The NSW collaborative trials group in palliative care. She has an established research relationship with palliative care clinicians at Cambridge University and Hull York Medical School, in the UK, as well as nursing scholars at Johns Hopkins University, School of Nursing, Baltimore USA.