Can supervise: YES
Daniels, B, Luckett, T, Holliday, S, Liauw, W, Lovell, M, Phillips, J, Rowett, D, John, TN, Tervonen, H & Pearson, S-A 2020, 'Patterns of oxycodone controlled release use in older people with cancer following public subsidy of oxycodone/naloxone formulations: An Australian population-based study', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY.View/Download from: Publisher's site
Luckett, T, Newton-John, T, Phillips, J, Holliday, S, Giannitrapani, K, Powell-Davies, G, Lovell, M, Liauw, W, Rowett, D, Pearson, S-A, Raymond, B, Heneka, N & Lorenz, K 2020, 'Risk of opioid misuse in people with cancer and pain and related clinical considerations: a qualitative study of the perspectives of Australian general practitioners.', BMJ open, vol. 10, no. 2.View/Download from: Publisher's site
OBJECTIVE:To explore the perspectives of general practitioners (GPs) concerning the risk of opioid misuse in people with cancer and pain and related clinical considerations. DESIGN:A qualitative approach using semistructured telephone interviews. Analysis used an integrative approach. SETTING:Primary care. PARTICIPANTS:Australian GPs with experience of prescribing opioids for people with cancer and pain. RESULTS:Twenty-two GPs participated, and three themes emerged. Theme 1 (Misuse is not the main problem) contextualised misuse as a relatively minor concern compared with pain control and toxicity, and highlighted underlying systemic factors, including limitations in continuity of care and doctor expertise. Theme 2 ('A different mindset' for cancer pain) captured participants' relative comfort in prescribing opioids for pain in cancer versus non-cancer contexts, and acknowledgement that compassion and greater perceived community acceptance were driving factors, in addition to scientific support for mechanisms and clinical efficacy. Participant attitudes towards prescribing for people with cancer versus non-cancer pain differed most when cancer was in the palliative phase, when they were unconcerned by misuse. Participants were equivocal about the risk-benefit ratio of long-term opioid therapy in the chronic phase of cancer, and were reluctant to prescribe for disease-free survivors. Theme 3 ('The question is always, 'how lazy have you been?') captured participants' acknowledgement that they sometimes prescribed opioids for cancer pain as a default, easier option compared with more holistic pain management. CONCLUSIONS:Findings highlight the role of specific clinical considerations in distinguishing risk of opioid misuse in the cancer versus non-cancer population, rather than diagnosis per se. Further efforts are needed to ensure continuity of care where opioid prescribing is shared. Greater evidence is needed to guide opioid prescribing in disease-free survivors a...
Hosie, A, Phillips, J, Lam, L, Kochovska, S, Noble, B, Brassil, M, Kurrle, S, Cumming, A, Caplan, GA, Chye, R, Ely, EW, Lawlor, PG, Bush, SH, Davis, JM, Lovell, M, Parr, C, Williams, S, Hauser, K, McArdle, S, Jacquier, K, Phillipson, C, Kuwahata, L, Kerfoot, J, Brown, L, Fazekas, B, Cheah, SL, Edwards, L, Green, A, Hunt, J, Attwood, R, Assen, T, Garcia, M, Wilcock, J & Agar, M 2020, 'A Multicomponent Nonpharmacological Intervention to Prevent Delirium for Hospitalized People with Advanced Cancer: A Phase II Cluster Randomized Waitlist Controlled Trial (The PRESERVE Pilot Study)', JOURNAL OF PALLIATIVE MEDICINE.View/Download from: Publisher's site
Clark, K, Byrne, PG, Hunt, J, Brown, L, Rowett, D, Watts, G, Lovell, M & Currow, DC 2020, 'Pharmacovigilance in Hospice/Palliative Care: De-Prescribing Combination Controlled Release Oxycodone-Naloxone.', Journal of palliative medicine, vol. 23, no. 5, pp. 656-661.View/Download from: Publisher's site
Background: Pharmacovigilance studies in hospice/palliative care provide extra information to improve medication safety. Combination controlled release oxycodone-naloxone offers an alternative opioid with less risk of opioid-induced constipation. Objective: To examine why palliative care clinicians chose to cease oxycodone-naloxone and to explore immediate and short-term benefits and harms of this medication change. Design: A consecutive cohort study. Setting: 112 adults from 13 palliative care centers. Measurements: Reasons for ceasing medication and the harms and benefits that followed this 24 and 72 hours later. Symptom burdens were summarised by the National Cancer Institute Common Terminology Criteria for Adverse Events Toxicity Gradings. Results: Combination medication was most commonly ceased because of poor pain control or impaired hepatic function. The last median oral morphine equivalent oxycodone dose before the switch was 45 mg (range 7.5-240 mg) with 76 switched to an alternative long-acting opioid (initial median oral morphine equivalent dose being 45 mg [range 5-210 mg]). Subgroup analysis of those switched because of clinicians' concerns about hepatic dysfunction demonstrated this group were receiving significantly lower opioid doses pre-cessation compared to those switched because of other reasons( p = 0.007). Regardless of why the medication was changed, improvements in pain and constipation scores were seen, the latter associated with an attendant increase in laxatives. Conclusions: This preliminary work suggests that despite theoretical concerns regarding the effect of the naloxone on opioid doses, most people were switched safely to very similar opioid doses with attendant improvements in pain control.
Austin, P, Lovell, M & Siddall, P 2019, 'The Efficacy of Virtual Reality for Persistent Cancer Pain: A Call for Research.', Journal of pain and symptom management, vol. 58, no. 4, pp. e11-e14.View/Download from: Publisher's site
Tieck, K, Mackenzie, L & Lovell, M 2019, 'The lived experience of refractory breathlessness for people living in the community', British Journal of Occupational Therapy, vol. 82, no. 2, pp. 127-135.View/Download from: Publisher's site
© The Author(s) 2018. Introduction: Refractory breathlessness occurs at rest or on minimal exertion and persists chronically despite optimal treatment of the underlying cause. The burden and prevalence of breathlessness is high, yet symptoms remain under-treated and those affected struggle daily with the condition. This study aims to gain a greater understanding of the lived experience of refractory breathlessness and its effect on daily activities. Method: Participants were recruited from a Sydney-based outpatient breathlessness clinic. An exploratory qualitative approach was undertaken with individual, semi-structured interviews, using NVivo software to conduct thematic analysis. The study recruited consecutive patients until thematic saturation was reached. Results: Six participants were interviewed and four main themes identified. 1. Living on the edge, referring to the extreme feeling of breathlessness experienced by patients; 2. Social meanings of breathlessness, describing the significance of social support; 3. Reduced to the basics, referring to the effect breathlessness has on basic daily tasks; and 4. Sources of security, which describes the measures participants take to protect themselves from their own breathlessness. Conclusion: Participants noted the importance of functional participation for improved engagement and quality of life. There is scope to develop specific interventions and occupational therapy services incorporating self-management and equipment prescription for people with dyspnoea.
Phillips, JL, Heneka, N, Lovell, M, Lam, L, Davidson, P, Boyle, F, McCaffrey, N, Fielding, S & Shaw, T 2019, 'A phase III wait-listed randomised controlled trial of novel targeted inter-professional clinical education intervention to improve cancer patients' reported pain outcomes (The Cancer Pain Assessment (CPAS) Trial): study protocol.', Trials, vol. 20, no. 1.View/Download from: Publisher's site
BACKGROUND:Variations in care models contribute to cancer pain being under-recognised and under-treated in half of all patients with cancer. International and national cancer pain management guidelines are achievable with minimal investment but require practice changes. While much of the cancer pain research over the preceding decades has focused on management interventions, little attention has been given to achieving better adherence to recommended cancer pain guideline screening and assessment practices. This trial aims to reduce unrelieved cancer pain by improving cancer and palliative doctors' and nurses' ('clinicians') pain assessment capabilities through a targeted inter-professional clinical education intervention delivered to participants' mobile devices ('mHealth'). METHODS:A wait-listed, randomised control trial design. Cancer and/or palliative care physicians and nurses employed at one of the six participating sites across Australia will be eligible to participate in this trial and, on enrolment, will be allocated to the active or wait-listed arm. Participants allocated to the active arm will be invited to complete the mHealth cancer pain assessment intervention. In this trial, mHealth is defined as medical or public health practice supported by mobile devices (i.e. phones, patient monitoring devices, personal digital assistants and other wireless devices). This mHealth intervention integrates three evidence-based elements, namely: the COM-B theoretical framework; spaced learning pedagogy; and audit and feedback. This intervention will be delivered via the QStream online platform to participants' mobile devices over four weeks. The trial will determine if a tailored mHealth intervention, targeting clinicians' cancer pain assessment capabilities, is effective in reducing self-reported cancer pain scores, as measured by a Numerical Rating Scale (NRS). DISCUSSION:If this mHealth intervention is found to be effective, in addition to improving cancer pain ...
Shepherd, HL, Geerligs, L, Butow, P, Masya, L, Shaw, J, Price, MA, Dhillon, HM, Hack, TF, Girgis, A, Luckett, T, Lovell, M, Kelly, B, Beale, P, Grimison, P, Shaw, T, Viney, R & Rankin, NM 2019, 'The elusive search for success: defining and measuring implementation outcomes in a real-world hospital trial', Frontiers in Public Health, vol. 7.View/Download from: Publisher's site
Lovell, M, Birch, M-R, Luckett, T, Phillips, J, Davidson, PM, Agar, M & Boyle, F 2019, 'Screening and Audit as Service-Level Strategies to Support Implementation of Australian Guidelines for Cancer Pain Management in Adults: A Feasibility Study.', Pain Management Nursing, vol. 20, no. 2, pp. 113-117.View/Download from: Publisher's site
BACKGROUND:Pain in people with cancer is common but often under-recognized and under-treated. Guidelines can improve the quality of pain care, but need targeted strategies to support implementation. AIM:To test the feasibility of two service-level strategies for supporting guideline implementation: a screening system and medical record audit. DESIGN:Multimethods. SETTING:One oncology outpatient service, and one palliative care outpatient and inpatient service. PARTICIPANTS:Patients with advanced cancer. METHODS:Patients were screened in the waiting room with a modified version of the Edmonton Symptom Assessment System-revised either electronically or in paper-based format. Feasibility indicated the percentage of patients successfully screened from the total number attending the services. An audit assessed adherence to key indicators of pain assessment and management. Feasibility thresholds were set at 75% incidence for screening and a median of 30 minutes per patient for audit. RESULTS:Of 452 patient visits, 95% (n = 429) were successfully screened, 34% (n = 155) electronically and 61% (n = 274) paper-based. Electronic pain screening was technically challenging and time-intensive for nurses. Thirty-one patients consented to have their records audited. The median audit time was 37.5 minutes (range 10-120 minutes). Variability arose from the number and type of record (outpatient or inpatient). Adherence to indicators varied from 63% (pain assessment at first presentation) to 94% (regular pain assessment and medication prescribed at regular intervals). CONCLUSIONS:This study confirmed the need to implement evidence-based guidelines for cancer pain and generated useful insights into the feasibility of pain screening and audit.
Luckett, T, Davidson, PM, Green, A, Marie, N, Birch, M-R, Stubbs, J, Phillips, J, Agar, M, Boyle, F & Lovell, M 2019, 'Development of a cancer pain self-management resource to address patient, provider, and health system barriers to care', PALLIATIVE & SUPPORTIVE CARE, vol. 17, no. 4, pp. 472-478.View/Download from: Publisher's site
Raymond, B, Luckett, T, Johnson, M, Hutchinson, A, Lovell, M & Phillips, J 2019, 'Low-intensity educational interventions supporting self-management to improve outcomes related to chronic breathlessness: a systematic review.', NPJ primary care respiratory medicine, vol. 29, no. 1.View/Download from: Publisher's site
Chronic breathlessness is debilitating and frightening, often resulting in emergency department presentations with acute-on-chronic breathlessness. Self-management is complex, involving 14 components as identified by the Practical Systematic Review in Self-Management Support (PRISMS). Low-intensity educational interventions that support breathlessness self-management through written/visual educational materials, alongside limited health professional support, are available. Our aim was to describe components of low-intensity educational interventions that support and improve self-management for adults with chronic breathlessness and evaluate their efficacy for improving breathlessness-related outcomes. A systematic review was conducted, including RCTs that compared these interventions with usual care in adults with chronic disease. Synthesis took a narrative approach utilizing the PRISMS taxonomy and Template for Intervention Description and Replication (TIDieR) checklist. Of the 1948 articles identified, 7 met criteria reporting 7 RCTs using 6 interventions. Studies utilized 12 out of 14 PRISMS components, the most frequent being training/rehearsal for psychological strategies. Evidence for effectiveness was inconsistent and attempts to identify beneficial components were confounded by intervention complexity and heterogeneity. The optimal content and delivery of low-intensity educational interventions that support self-management to improve chronic breathlessness-related outcomes in adults cannot be defined from current published literature. Future research should incorporate more detailed, standardized reporting to enable comparison and meta-analysis.
Hosie, A, Phillips, J, Lam, L, Kochovska, S, Noble, B, Brassil, M, Kurrle, SE, Cumming, A, Caplan, GA, Chye, R, Le, B, Ely, EW, Lawlor, PG, Bush, SH, Davis, JM, Lovell, M, Brown, L, Fazekas, B, Cheah, SL, Edwards, L & Agar, M 2019, 'Multicomponent non-pharmacological intervention to prevent delirium for hospitalised people with advanced cancer: study protocol for a phase II cluster randomised controlled trial.', BMJ open, vol. 9, no. 1, pp. e026177-e026177.View/Download from: Publisher's site
INTRODUCTION:Delirium is a significant medical complication for hospitalised patients. Up to one-third of delirium episodes are preventable in older inpatients through non-pharmacological strategies that support essential human needs, such as physical and cognitive activity, sleep, hydration, vision and hearing. We hypothesised that a multicomponent intervention similarly may decrease delirium incidence, and/or its duration and severity, in inpatients with advanced cancer. Prior to a phase III trial, we aimed to determine if a multicomponent non-pharmacological delirium prevention intervention is feasible and acceptable for this specific inpatient group. METHODS AND ANALYSIS:The study is a phase II cluster randomised wait-listed controlled trial involving inpatients with advanced cancer at four Australian palliative care inpatient units. Intervention sites will introduce delirium screening, diagnostic assessment and a multicomponent delirium prevention intervention with six domains of care: preserving natural sleep; maintaining optimal vision and hearing; optimising hydration; promoting communication, orientation and cognition; optimising mobility; and promoting family partnership. Interdisciplinary teams will tailor intervention delivery to each site and to patient need. Control sites will first introduce only delirium screening and diagnosis, later implementing the intervention, modified according to initial results. The primary outcome is adherence to the intervention during the first seven days of admission, measured for 40 consecutively admitted eligible patients. Secondary outcomes relate to fidelity and feasibility, acceptability and sustainability of the study intervention, processes and measures in this patient population, using quantitative and qualitative measures. Delirium incidence and severity will be measured to inform power calculations for a future phase III trial. ETHICS AND DISSEMINATION:Ethical approval was obtained for all four sites. Trial r...
Estacio, CF, Butow, PN, Lovell, MR, Dong, ST & Clayton, JM 2018, 'Exploring symptom meaning: perspectives of palliative care physicians', SUPPORTIVE CARE IN CANCER, vol. 26, no. 8, pp. 2769-2784.View/Download from: Publisher's site
Butow, P, Shaw, J, Shepherd, HL, Price, M, Masya, L, Kelly, B, Rankin, NM, Girgis, A, Hack, TF, Beale, P, Viney, RC, Dhillon, HM, Coll, J, Kelly, P, Lovell, M, Grimison, P, Shaw, T, Luckett, T, Cuddy, J & White, F 2018, 'Comparison of implementation strategies to influence adherence to the clinical pathway for screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP): study protocol of a cluster randomised controlled trial', BMC Cancer, vol. 18:1077.View/Download from: Publisher's site
Luckett, T, Phillips, J, Agar, M, Lam, L, Davidson, PM, McCaffrey, N, Boyle, F, Shaw, T, Currow, DC, Read, A, Hosie, A & Lovell, M 2018, 'Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial', BMC HEALTH SERVICES RESEARCH, vol. 18.View/Download from: Publisher's site
Xu, X, Luckett, T, Wang, AY, Lovell, M & Phillips, JL 2018, 'Cancer pain management needs and perspectives of patients from Chinese backgrounds: a systematic review of the Chinese and English literature', PALLIATIVE & SUPPORTIVE CARE, vol. 16, no. 6, pp. 785-799.View/Download from: Publisher's site
Corbett, M, Lovell, M & Siddall, PJ 2017, 'The role of spiritual factors in people living with chronic pain:A qualitative investigation', Journal for the Study of Spirituality, vol. 7, no. 2, pp. 142-153.View/Download from: Publisher's site
© 2017 British Association for the Study of Spirituality and Taylor & Francis. The role of existential and spiritual factors has been relatively underexplored in the field of chronic pain. The aim of this study was to explore in detail how people understood the spiritual dimension and, in particular, its relevance for and impact on their experience of pain. We undertook a qualitative study using semi-structured interviews and Interpretative Phenomenological Analysis with six people with chronic pain. Participants' views of the spiritual dimension varied widely with some seeing it within a religious context and others describing a strong sense of the spiritual that had no religious context. Meaning and purpose were, however, consistent elements of all participants' spirituality. Pain had an impact on people's sense of meaning, purpose and identity which was very much intertwined with their relationships with others and, for some, a transcendent connection to nature or a higher being. The ability to redefine or recapture a sense of meaning, purpose, and identity through these relationships was central to their ability to adjust successfully to the presence of chronic pain.
Estacio, CF, Butow, PN, Lovell, MR, Dong, ST & Clayton, JM 2017, 'What is symptom meaning? A framework analysis of communication in palliative care consultations', PATIENT EDUCATION AND COUNSELING, vol. 100, no. 11, pp. 2088-2094.View/Download from: Publisher's site
Forster, BC, Proskurin, H, Kelly, B, Lovell, MR, Ilchef, R & Clayton, JM 2017, 'Psychiatry trainees' views and educational needs regarding the care of patients with a life-limiting illness', PALLIATIVE & SUPPORTIVE CARE, vol. 15, no. 2, pp. 231-241.View/Download from: Publisher's site
Franklin, AE, Lovell, MR & Boyle, F 2017, 'A Case of Opioid Toxicity on Conversion From Extended-Release Oxycodone and Naloxone to Extended-Release Oxycodone in a Patient With Liver Dysfunction', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 53, no. 2, pp. E1-E2.View/Download from: Publisher's site
Lovell, M 2016, 'Australian cancer pain guidelines', Asia-pacific journal of clinical oncology, vol. 12, pp. 86-86.
Zdenkowski, N, Tesson, S, Lombard, J, Lovell, M, Hayes, S, Francis, PA, Dhillon, HM & Boyle, FM 2016, 'Supportive care of women with breast cancer: key concerns and practical solutions', MEDICAL JOURNAL OF AUSTRALIA, vol. 205, no. 10, pp. 471-+.View/Download from: Publisher's site
Luckett, TR, 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: Publisher's site
Agar, M, Koh, E-S, Gibbs, E, Barnes, EH, Hovey, E, Livingstone, A, Sawkins, K, Chye, R, Lovell, MR, Clark, K, Vardy, J & King, M 2016, 'Validating self-report and proxy reports of the Dexamethasone Symptom Questionnaire -Chronic for the evaluation of longer-term corticosteroid toxicity', SUPPORTIVE CARE IN CANCER, vol. 24, no. 3, pp. 1209-1218.View/Download from: Publisher's site
Dong, ST, Butow, PN, Agar, M, Lovell, MR, Boyle, F, Stockler, M, Forster, BC & Tong, A 2016, 'Clinicians' Perspectives on Managing Symptom Clusters in Advanced Cancer: A Semi-Structured Interview Study.', Journal of Pain and Symptom Management, vol. 51, no. 4, pp. 706-717.View/Download from: Publisher's site
Managing "symptom clusters," or multiple concurrent symptoms in patients with advanced cancer remains a clinical challenge. The optimal processes constituting effective management of symptoms clusters remain uncertain.To describe the attitudes and strategies of clinicians in managing multiple co-occurring symptoms in patients with advanced cancer.Semi-structured interviews were conducted with 48 clinicians (palliative care physicians [n=10], oncologists [n=6], general practitioners [n=6], nurses [n=12], and allied health providers [n=14]), purposively recruited from two acute hospitals, two palliative care centers, and four community general practices in Sydney, Australia. Transcripts were analyzed using thematic analysis and adapted grounded theory.Six themes were identified: uncertainty in decision making (inadequacy of scientific evidence, relying on experiential knowledge, pressure to optimize care); attunement to patient and family (sensitivity to multiple cues, prioritizing individual preferences, addressing psychosocial and physical interactions, opening "Pandora's Box"); deciphering cause to guide intervention (disaggregating symptoms and interactions, flexibility in assessment, curtailing investigative intrusiveness); balancing complexities in medical management (trading off side effects, minimizing mismatched goals, urgency in resolving severe symptoms); fostering hope and empowerment (allaying fear of the unknown, encouraging meaning making, championing patient empowerment, truth telling); and depending on multidisciplinary expertise (maximizing knowledge exchange, sharing management responsibility, contending with hierarchical tensions, isolation and discontinuity of care).Management of symptom clusters, as both an art and a science, is currently fraught with uncertainty in decision making. Strengthening multidisciplinary collaboration; continuity of care; more pragmatic planning of clinical trials to address more than one symptom; and training in sym...
Dong, ST, Butow, PN, Tong, A, Agar, M, Boyle, F, Forster, BC, Stockler, M & Lovell, MR 2016, 'Patients' experiences and perspectives of multiple concurrent symptoms in advanced cancer: a semi-structured interview study', SUPPORTIVE CARE IN CANCER, vol. 24, no. 3, pp. 1373-1386.View/Download from: Publisher's site
Dong, ST, Costa, DSJ, Butow, PN, Lovell, MR, Agar, M, Velikova, G, Teckle, P, Tong, A, Tebbutt, NC, Clarke, SJ, van der Hoek, K, King, MT & Fayers, PM 2016, 'Symptom Clusters in Advanced Cancer Patients: An Empirical Comparison of Statistical Methods and the Impact on Quality of Life', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 51, no. 1, pp. 88-98.View/Download from: Publisher's site
Sanderson, C, Quinn, SJ, Agar, M, Chye, R, Clark, K, Doogue, M, Fazekas, B, Lee, J, Lovell, MR, Rowett, D, Spruyt, O & Currow, DC 2016, 'Pharmacovigilance in hospice/palliative care: net effect of pregabalin for neuropathic pain.', BMJ Supportive and Palliative Care, vol. 6, pp. 323-330.View/Download from: Publisher's site
Real-world effectiveness of many medications has been poorly researched, including in hospice/palliative care. Directly extrapolating findings from other clinical settings may not yield robust clinical advice. Pharmacovigilance studies provide an opportunity to understand better the net impact of medications. The study aimed to examine immediate and short-term benefits and harms of pregabalin in routine practice for neuropathic pain in hospice/palliative care.A consecutive cohort of 155 patients from 62 centres in 5 countries was started on pregabalin and studied prospectively. Data were collected at three time points: baseline; day 7 (immediate, short-term harms); ad hoc reports of any harms ≤21 days; and day 21 (short-term benefits).Median dose for 155 patients at day 21 was 150 mg/24 h. Benefits were reported by 61 patients (39%), of whom 11 (7%) experienced complete pain resolution. Harms were reported by 51 (35%) patients at or before 7 days, the most frequent of which were somnolence, fatigue, cognitive disturbance and dizziness. 10 patients (6%) ceased pregabalin due to harms, but 82 patients (53%) were being treated at 21 days. In regression modelling, people with worse baseline pain derived more benefit (OR=8.5 (95% CI 2.5 to 28.68).Pregabalin delivered benefit to many patients, with 4 of 10 experiencing pain reductions by 21 days. Harms, occurring in 1 in 3 patients, may be difficult to detect in clinical practice, as they mostly involve worsening of symptoms prevalent at baseline.
Lovell, M, Luckett, T, Boyle, F, Stubbs, J, Phillips, J, Davidson, PM, 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: Publisher's site
Phillips, JL, Lovell, M, Luckett, T, Agar, M, Green, AR & Davidson, PM 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: 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.
Currow, DC, Clark, K, Kamal, A, Collier, A, Agar, MR, Lovell, MR, Phillips, JL & 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: Publisher's site
Sanderson, C, Quinn, SJ, Agar, M, Chye, R, Clark, K, Doogue, M, Fazekas, B, Lee, J, Lovell, MR, Rowett, D, Spruyt, O & Currow, DC 2015, 'Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 5, no. 3, pp. 273-280.View/Download from: Publisher's site
Clark, K, Quinn, SJ, Doogue, M, Sanderson, C, Lovell, M & Currow, DC 2015, 'Routine prescribing of gabapentin or pregabalin in supportive and palliative care: what are the comparative performances of the medications in a palliative care population?', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, vol. 23, no. 9, pp. 2517-2520.View/Download from: Publisher's site
Neuropathic pain is a prevalent and distressing problem faced by people with life-limiting illness that is often difficult to palliate. Gabapentin and pregabalin are widely prescribed as part of the routine approach to palliating neuropathic pain. Although they are often viewed as interchangeable agents, very little comparative data of their benefits and harms exists in clinical practice. Two previously reported pharmacovigilance studies that had used the same methodology for gabapentin and pregabalin were compared. These studies examined the benefits and harms of gabapentin and pregabalin after the medications had been routinely prescribed by clinicians working in a network of palliative care services using the same data collection tools with the same definitions and the same time points. Data were collected over 21 days from 282 patients prescribed either gabapentin or pregabalin for pain. Items included medication doses, pain scores, and adverse effects. In order to compare the medication responses, the final doses of pregabalin were converted to gabapentin does equivalents using previously published recommendations. The final pain scores were similar for both groups, and the reduction in pain were similar (OR = 11.2; 95 % CI 3.9, 32.7, p < 0.001). However, this was achieved at lower doses of gabapentin compared to pregabalin. Those receiving gabapentin were more likely to experience harms (OR = 3.5; 95 % CI 1.4, 9.1, p = 0.009) with the reported harms including somnolence, ataxia, nausea, tremor and nystagmus This hypothesis-generating work strongly supports the need for further trials to best delineate clinical differences in the GABA analogues.
Forster, B, Proskurin, H, Kelly, B, Lovell, M, Ilchef, R & Clayton, J 2014, 'PSYCHIATRY REGISTRARS' VIEWS AND EDUCATIONAL NEEDS REGARDING THE CARE OF PATIENTS WITH LIFE-LIMITING ILLNESSES', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 10, pp. 201-201.
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.
Lovell, MR, Luckett, T, Boyle, FM, Phillips, J, Agar, M & Davidson, PM 2014, 'Patient Education, Coaching, and Self-Management for Cancer Pain', JOURNAL OF CLINICAL ONCOLOGY, vol. 32, no. 16, pp. 1712-+.View/Download from: Publisher's site
Luckett, T, Davidson, PM, Boyle, F, Liauw, W, Agar, M, Green, A & Lovell, M 2014, 'Australian survey of current practice and guideline use in adult cancer pain assessment and management: Perspectives of oncologists', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 10, no. 2, pp. E99-E107.View/Download from: Publisher's site
Dong, S, Butow, P, Tong, A, Lovell, M & Agar, M 2014, '"Finding the Balance Between Art and Science": Healthcare Providers' Perspectives on Multiple Symptoms in Advanced Cancer', PSYCHO-ONCOLOGY, vol. 23, pp. 223-224.
Dong, S, Butow, P, Tong, A, Lovell, M & Agar, M 2014, '"Longing for an End to the Emotional Rollercoaster": A Qualitative Study on Patients' Attitudes and Experiences of Multiple Symptoms in Advanced Cancer', PSYCHO-ONCOLOGY, vol. 23, pp. 221-222.
Dong, ST, Butow, PN, Costa, DSJ, Lovell, MR & Agar, M 2014, 'Symptom clusters in patients with advanced cancer: a systematic review of observational studies.', Journal of Pain and Symptom Management, vol. 48, no. 3, pp. 411-450.View/Download from: Publisher's site
CONTEXT: Advanced cancer patients typically experience multiple symptoms, which may influence patient outcomes synergistically. The composition of these symptom clusters (SCs) differs depending on various clinical variables and the timing and method of their assessment. OBJECTIVES: The objective of this systematic review was to examine the composition, longitudinal stability, and consistency across methodologies of common SCs, as well as their common predictors and outcomes. METHODS: A search of MEDLINE, CINAHL, Embase, Web of Science, and PsycINFO was conducted using variants of symptom clusters, cancer, and palliative care. RESULTS: Thirty-three articles were identified and reviewed. Many SCs were identified, with four common groupings being anxiety-depression, nausea-vomiting, nausea-appetite loss, and fatigue-dyspnea-drowsiness-pain. SCs in most cases were not stable longitudinally. The various statistical methods used (most commonly principal component analysis, exploratory factor analysis, and hierarchical cluster analysis) tended to reveal different SCs. Different measurement tools were used in different studies, each containing a different array of symptoms. The predictors and outcomes of SCs were also inconsistent across studies. No studies of patient experiences of SCs were identified. CONCLUSION: Although the articles reviewed revealed four groups of symptoms that tended to cluster, there is limited consistency in the way in which SCs and variables associated with them are identified. This is largely due to a lack of agreement about a robust, clinically relevant definition of SCs. Future research should focus on patients' subjective experience of SCs to inform a clinically relevant definition of SCs and how they are managed over time.
Tai, V & Lovell, MR 2013, 'Pain relief and the end of life', Medicine Today, vol. 14, no. 4, pp. 16-24.
Good pain control is possible in most patients in the months, weeks and days preceding death. This leads not only to better patient care but also to a better bereavement experience for families.
Lovell, M, Agar, M, Luckett, T, Davidson, PM, Green, AR & Clayton, J 2013, 'Australian survey of current practice and guideline use in adult cancer pain assessment and management: Perspectives of palliative care physicians', Journal of Palliative Medicine, vol. 16, no. 11, pp. 1403-1409.View/Download from: Publisher's site
Background: Cancer pain continues to be undertreated, despite the availability of evidence-based guidelines. The Australian National Pain Strategy identified establishment of systems and guidelines to adequately manage cancer pain as a high priority.
Luckett, T, Davidson, PM, Green, AR, Boyle, F, Stubbs, J & Lovell, M 2013, 'Assessment and Management of Adult Cancer Pain: A Systematic Review and Synthesis of Recent Qualitative Studies Aimed at Developing Insights for Managing Barriers and Optimizing Facilitators Within a Comprehensive Framework of Patient Care', Journal of Pain and Symptom Management, vol. 46, no. 2, pp. 229-253.View/Download from: Publisher's site
Objectives: To develop insights for managing barriers and optimizing facilitators to adult cancer pain assessment and management within a comprehensive framework of patient care.
Marie, N, Luckett, T, Davidson, PM, Lovell, M & Lal, S 2013, 'Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis', Supportive Care in Cancer, vol. 21, no. 12, pp. 3529-3537.View/Download from: Publisher's site
Purpose: Previous systematic reviews have found patient education to be moderately efficacious in decreasing the intensity of cancer pain, but variation in results warrants analysis aimed at identifying which strategies are optimal. Methods: A systematic review and meta-analysis was undertaken using a theory-based approach to classifying and comparing educational interventions for cancer pain. The reference lists of previous reviews andMEDLINE, PsycINFO, and CENTRAL were searched in May 2012. Studies had to be published in a peer-reviewed English language journal and compare the effect on cancer pain intensity of education with usual care. Meta-analyses used standardized effect sizes (ES) and a random effects model. Subgroup analyses compared intervention components categorized using the Michie et al. (Implement Sci 6:42, 2011) capability, opportunity, and motivation behavior (COM-B) model.
Clark, K, Smith, J, Lovell, M & Currow, DC 2012, 'Longitudinal Pain Reports in a Palliative Care Population', JOURNAL OF PALLIATIVE MEDICINE, vol. 15, no. 12, pp. 1335-1341.View/Download from: Publisher's site
Lovell, MR & Boyle, FM 2010, 'Cancer pain management', Medicine Today, vol. 11, no. 1, pp. 33-38.
Pain is one of the most feared and debilitating symptoms of cancer. Cancer pain can be controlled in most patients with strategies that are available in the community. By correcting misconceptions about opioids and providing comprehensive assessment and pain management, a patient's quality of life can be improved.
Lovell, MR & Boyle, FM 2010, 'Cancer pain management', Medicine Today, vol. 11, no. 1, pp. 39-40.
Lovell, MR, Forder, PM, Stockler, MR, Butow, P, Briganti, EM, Chye, R, Goldstein, D & Boyle, FM 2010, 'A Randomized Controlled Trial of a Standardized Educational Intervention for Patients with Cancer Pain', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 40, no. 1, pp. 49-59.View/Download from: Publisher's site
© Oxford University Press, 2010. All rights reserved. Pain is a significant cause of suffering for cancer patients. The onset of pain can herald a host of fears of death, disability, disfigurement, dependence, and distress. The role of healthcare professionals is to offer competent pain management with compassion and commitment to excellence, central to which is facilitating communication with the patient. Pain is not an event in isolation. It occurs in a personal and physical environment influenced by the social, cultural, spiritual, and biological inheritance of the patient. Thus, the experience of pain has a unique impact on, and meaning for, each individual. At the time of assessment, factors such as associated fatigue, depression, and anxiety may result in the pain becoming overwhelming. Assessing the pain involves not only measuring the level of pain and determining the nature of the pain, so as to diagnose the aetiology and mechanism of pain, but also exploring the 'deeper level of pain experience'. Failure to do so can result in poor pain control and a lost opportunity for transformation of the experience and healing of the individual.