Edler-Buggy, S, Birtwistle, J, ElMokhallalati, Y, Kindl, K, Good, P & Bennett, MI 2020, 'Regular dosing compared with as-needed dosing of opioids for management of chronic cancer pain: systematic review and meta-analysis.', Pain, vol. 161, no. 4, pp. 703-712.View/Download from: Publisher's site
Opioids are the recommended form of analgesia for patients with persistent cancer pain, and regular dosing "by the clock" is advocated in many international guidelines on cancer pain management. The development of sustained-release opioid preparations has made regular dosing easier for patients. However, patients report that the intensity and impact of their cancer pain varies considerably day to day, and many try to find a trade-off between acceptable pain control and impact of cognitive (and other) adverse effects on daily activities. In acute care settings, (eg, postoperative) as-needed dosing and other opioid-sparing approaches have resulted in better patient outcomes compared with regular dosing. The aim of this study was to determine whether regular dosing of opioids was superior to as-needed dosing for persistent cancer pain. We systematically searched for randomised controlled trials that directly compared pain outcomes from regular dosing of opioids with as-needed dosing in adult cancer patients. We identified 4347 records, 25 randomised controlled trials meet the inclusion criteria, 9 were included in the review, and 7 of these included in meta-analysis. We found no clear evidence demonstrating superiority of regular dosing of opioids compared with as-needed dosing in persistent cancer pain, and regular dosing was associated with significantly higher total opioid doses. There was, however, a paucity of trials directly answering this question, and low-quality evidence limits the conclusions that can be drawn. It is clear that further high-quality clinical trials are needed to answer this question and to guide clinical practice.
Good, PD, Greer, RM, Huggett, GE & Hardy, JR 2020, 'An Open-Label Pilot Study Testing the Feasibility of Assessing Total Symptom Burden in Trials of Cannabinoid Medications in Palliative Care.', Journal of palliative medicine, vol. 23, no. 5, pp. 650-655.View/Download from: Publisher's site
Background: There is considerable interest in the use of cannabinoids for symptom control in palliative care, but there is little high-quality evidence to guide clinical practice. Objectives: Assess the feasibility of using global symptom burden measures to assess response to medicinal cannabis, to determine median tolerated doses of cannabidiol (CBD) and tetrahydrocannabinol (THC), and to document adverse events (AEs). Design: Prospective two-arm open-label pilot trial of escalating doses of CBD and THC oil. Setting/Subjects: Participants had advanced cancer and cancer-related symptoms in a palliative and supportive care service in an Australian cancer center. Measurements: The main outcome measures were the number of participants screened and randomized over the time frame, the number of participants completing days 14 and 28 and providing total symptom distress scores (TSDSs) (measured using the Edmonton Symptom Assessment Scale), and the change from baseline of the TSDS at day 14. Results: Of the 21 participants enrolled (CBD, n = 16; THC, n = 5), 18 (86%) completed the primary outcome measure at day 14 and 8 completed at day 28. The median maximum tolerated doses were CBD, 300 mg/day (range 100-600 mg); THC, 10 mg/day (range 5-30 mg). Nine of 21 patients (43%) met the definition of response (≥6 point reduction in TSDS). Drowsiness was the most common AE. Conclusions: Trials of medicinal cannabis in advanced cancer patients undergoing palliative care are feasible. The doses of THC and CBD used in this study were generally well tolerated and the outcome measure of total symptom distress is promising as a measure of overall symptom benefit. Trial registration: ACTRN12618001205224.
Hardy, J, Haywood, A, Gogna, G, Martin, J, Yates, P, Greer, R & Good, P 2020, 'Oral medicinal cannabinoids to relieve symptom burden in the palliative care of patients with advanced cancer: a double-blind, placebo-controlled, randomised clinical trial of efficacy and safety of 1:1 delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).', Trials, vol. 21, no. 1, pp. 611-611.View/Download from: Publisher's site
BACKGROUND:Despite improvements in medical care, patients with advanced cancer still experience substantial symptom distress. There is increasing interest in the use of medicinal cannabinoids but little high-quality evidence to guide clinicians. This study aims to define the role of a 1:1 delta-9-tetrahydrocannabinol/cannabidiol (THC/CBD) cannabinoid preparation in the management of symptom burden in patients with advanced cancer undergoing standard palliative care. METHODS AND DESIGN:One hundred fifty participants will be recruited from five sites within the Queensland Palliative Care Research Group (QPCRG) and randomly assigned to an active treatment or placebo group. This study is a pragmatic multicentre, randomised, placebo-controlled, two-arm trial of escalating doses of an oral 1:1 THC/CBD cannabinoid preparation. It will compare efficacy and safety outcomes of a titrated dose (10 mg/10 mg/mL oral solution formulation, dose range 2.5 mg/2.5 mg-30 mg/30 mg/day) against placebo. There is a 2-week patient-determined titration phase, using escalating doses of 1:1 THC/CBD or placebo, to reach a dose that achieves symptom relief with tolerable side effects. This is then followed by a further 2-week assessment period on the stable dose determined in collaboration with clinicians. The primary objective is to assess the effect of escalating doses of a 1:1 THC/CBD cannabinoid preparation against placebo on change in total symptom score, with secondary objectives including establishing a patient-determined effective dose, the change in total physical and emotional sores, global impression of change, anxiety and depression, opioid use, quality of life and adverse effects. DISCUSSION:This will be the first placebo-controlled clinical trial to rigorously evaluate the efficacy, safety and acceptability of 1:1 THC/CBD for symptom relief in advanced cancer patients. This study will allow the medical community to have some evidence to present to patients wishing to access ca...
Hardy, JR, Bundock, D, Cross, J, Gibbons, K, Pinkerton, R, Kindl, K, Good, P & Philip, J 2020, 'Prevalence of QTc Prolongation in Patients With Advanced Cancer Receiving Palliative Care-A Cause for Concern?', Journal of pain and symptom management, vol. 59, no. 4, pp. 856-863.View/Download from: Publisher's site
CONTEXT:Medications commonly used for symptom control along with other known risk factors have the potential to prolong ventricular repolarization as measured by the QT interval (the time from the start of the Q wave to the end of the T wave) on a standard electrocardiogram (ECG). OBJECTIVES:To document the prevalence of a prolonged QT interval corrected for heart rate (QTc) interval in the palliative/oncology setting, compare automatic ECG QTc measurements with manual readings and identify any correlation between QTc prolongation and the use of drugs or other risk factors. METHODS:A convenience sample of consecutive patients with cancer, admitted under or known to the palliative/supportive care teams in two metropolitan hospitals, and willing to provide an ECG recording and basic demographic information including QTc risk factors were included. Both automated and manually calculated QTc intervals were recorded. Multivariable analysis was used to determine risk factors independently associated with prolonged QTc intervals. RESULTS:Of the 389 participants, there was a significant difference in mean QTc between sites using automated but not manual calculations. Manual readings were therefore used with predetermined cutoffs of 0.44 seconds (males) and 0.46 seconds (females). Seventy-two (18.5%) of the participants had a prolonged QTc with six (1.5%) having a prolongation of >0.50 seconds. At-risk drugs were being taken by 218 participants (56.0% of total cohort). Factors shown to be associated with QTc prolongation included age, gender, performance status, and hypocalcemia. No specific medication was associated with increased risk. CONCLUSION:Although almost 20% of patients receiving palliative care had prolongation of QTc, the possibility of serious consequences appeared to be low despite the frequent occurrence of risk factors.
Lobo, Y, Good, P & Murphy, F 2020, 'Polymyalgia rheumatica in a melanoma patient 11 months after completion of immunotherapy with nivolumab', Cancer Reports, vol. 3, no. 3.View/Download from: Publisher's site
© 2020 Wiley Periodicals, Inc. Background: Immune checkpoint inhibitor (ICI) therapy has revolutionised the treatment of several cancers but can also lead to the development of immune-related adverse effects including dermatologic, gastrointestinal, endocrine, hepatic, pulmonary and less commonly, rheumatic toxicities. Toxicities associated with ICI therapy can occur several months or even years after initiation. Case reports of polymyalgia rheumatica (PMR) associated with nivolumab use are rare. We herein describe, for the first time, a case of PMR in a melanoma patient after cessation of treatment with nivolumab. Case: An 88-year-old man with a history of stage IV M1c BRAF wild-type melanoma presented with a 1 month history of arthralgias and morning stiffness, predominantly affecting the shoulders and hips, associated with fatigue and weight loss. He had undergone wide local excision of a primary malignant melanoma in the left buttock region several years prior. Immunotherapy with nivolumab was initiated following disease relapse with multiple metastases. Nivolumab was discontinued due to demonstration of complete metabolic response on serial positron emission and computed tomography scans. Symptoms appeared 11 months after completion of treatment. A diagnosis of PMR was made and treatment with oral prednisone was initiated leading to complete resolution of symptoms within 1 week. We believe that the development of PMR in our patient was likely precipitated by nivolumab. Conclusion: This case demonstrates that PMR, although rare, may occur as an adverse effect both during and after treatment with nivolumab, leading to disabling symptoms and poor quality of life. Prompt diagnosis is crucial to enable timely commencement of corticosteroid therapy in order to avoid further impact on morbidity and mortality for cancer patients. This case highlights the importance of prompt referral to rheumatology, as well as the need for close collaboration between oncologists an...
Lukin, B, Greenslade, J, Kearney, AM, Douglas, C, Howell, T, Barras, M & Good, P 2020, 'Conversion of other opioids to methadone: a retrospective comparison of two methods.', BMJ supportive & palliative care, vol. 10, pp. 201-204.View/Download from: Publisher's site
CONTEXT:A rapid method of methadone conversion known as the Perth Protocol is commonly used in Australian palliative care units. There has been no follow-up or validation of this method and no comparison between different methods of conversion. OBJECTIVES:The primary objective of this study was to test the hypothesis that the achieved doses of methadone are independent of the conversion method (rapid vs slower). The secondary objectives included examining the relationship between calculated target doses, actual achieved doses and duration of conversions. METHODS:This is a retrospective chart audit conducted at two hospital sites in the Brisbane metropolitan area of Australia which used different methadone conversion methods. RESULTS:Methadone conversion ratios depended on previous opioid exposure and on the method of conversion used. The method most commonly used in Australia for calculating target doses for methadone when converting from strong opioids is a poor predictor of actual dose achieved. More appropriate conversion ratios are suggested. CONCLUSION:Further research is needed to refine the ratios used in practice when converting patients from strong opioids to methadone. Caution and clinical expertise are required. A palliative methadone registry may provide useful insights.
© 2020 Elsevier Ltd Within palliative care, clear and open communication about death is encouraged. Euphemisms are discouraged as threats to promoting clear understanding of the prognosis; to opening communication about what a good death means to individual patients and families; and to fostering collaborative planning aimed at achieving this 'good death'. Principles of patient-centred and culturally competent care, however, which reflect trends of individualisation, plurality and multiculturalism that are characteristic of late modernity, encourage respect for and support of patients' and families' preferences. These may include wishes to avoid open communication, preferences for euphemisms, and definitions of a 'good death' that vary from the practitioner's, and within families. The aim of this study was to examine how physicians navigate these competing priorities. Analysis is based on interviews with 23 doctors, ranging in experience from medical students through to senior palliative care specialists, and eight recorded observations of palliative care multidisciplinary team meetings with 52 clinicians collected in 2017 at two hospitals in one Australian metropolitan area. Findings show that synonyms familiar to clinicians are often used to communicate prognoses in multidisciplinary meetings. In communication with patients and families, doctors rely on emotional and cultural cues to decipher the preferred terminology and response. Drawing on a late modern re-imagination of emotion management, we conceptualise the work performed in this context as emotionally reflexive labour. These findings suggest that blanket protocols for direct communication overlook the complexity of end-of-life communication in an era where a 'good death' is understood to be culturally relative.
Abbato, S, Greer, R, Ryan, J, Vayne-Bossert, P & Good, P 2019, 'The Impact of Provision of Professional Language Interpretation on Length of Stay and Readmission Rates in an Acute Care Hospital Setting.', Journal of immigrant and minority health, vol. 21, no. 5, pp. 965-970.View/Download from: Publisher's site
The provision of professional interpreting services (PIS) in the hospital setting can decrease clinically significant communication errors and improve clinical outcomes. The aim of this study was to investigate the differences in length of stay (LOS) and 30 day readmission rates associated with provision of PIS in the Emergency Department (ED) and inpatient wards. A retrospective audit at a tertiary referral adult hospital in Brisbane, Australia, identified all admissions of patients requiring an interpreter. Patients provided an interpreter in the Emergency Department had a mean (age-adjusted) LOS 22.4 h less than patients not provided an interpreter in ED (95% CI 10.9-33.9). For patients provided with an interpreter on the ward the mean LOS was longer, (IRR 2.2, 1.8-2.3, p < 0.0001). There was no association between interpreter provision in either ED or the inpatient ward and readmission rate. Provision of PIS in the Emergency Department to those patients who require it can significantly reduce hospital LOS.
Alqabandi, N, Haywood, A, Kindl, K, Khan, S, Good, P & Hardy, J 2019, 'Managing diabetes at the end of life–a retrospective chart audit of two health providers in Queensland, Australia', Progress in Palliative Care, vol. 27, no. 2, pp. 51-57.View/Download from: Publisher's site
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: Diabetes at the end of life (EoL) is characterized by blood glucose fluctuations that result from decreased oral intake, side effects of medications, altered physiology, and end-stage organ failure. With limited life expectancy and the presence of comorbidities, diabetes management can be challenging. While there is little clinical evidence to guide decision-makers, current practice depends on empiric and expert recommendations. Objective: To evaluate the current prescribing patterns and monitoring parameters in diabetes management at the EoL in patients at two palliative care inpatient units. Design: Retrospective clinical chart review. Setting/subjects: Adult patients attending the Palliative and Supportive Care Services at St Vincent's Private Hospital and Mater Adults Hospital, South Brisbane, Australia over a 24-month period, from October 2014 to October 2016. Results: A total of 145 charts were analysed. 139 patients were identified as having received glucose-lowering therapy (51% female, median age 71 years). Insulin therapy was used in 74 (51%) patients and oral and/or non-insulin therapies in 62 (43%). Blood glucose level monitoring was carried out a median of 4 times, range 1–6 times daily. Either continuously or at some stage of their treatment, 74 patients were receiving corticosteroids. Conclusion: Insulin therapy appears to be the safest and most effective approach, taking into consideration the patient needs and pharmacodynamic profile of each preparation. Without evidence-based guidelines on the optimal intervention to control diabetes at the EoL, therapy plans must be individualized to prevent symptomatic hyper- and hypoglycaemia with minimal patient discomfort and adverse drug reactions.
Broom, J, Broom, A, Good, P & Lwin, Z 2019, 'Why is optimisation of antimicrobial use difficult at the end of life?', Internal medicine journal, vol. 49, no. 2, pp. 269-271.View/Download from: Publisher's site
The antibiotic optimisation imperative is now ubiquitous, with national policy frameworks in Organisation for Economic Co-operation and Development (OECD) countries incorporating the requirement for antimicrobial stewardship within healthcare services. Yet in practice, the optimisation agenda often raises complex ethical- and practice-based dilemmas. Antibiotic use at the end of life is multidimensional. It includes balancing complex issues, such as accuracy of prognostic estimates, benevolence to the individual versus the broader public health, personalised value judgement of time and quality of life and the right to treatment versus the right to die. It also occurs in an emotional context where the clinician and patient (and their family) collectively confront mortality. This provides a scenario where amplification of the already strong social and behavioural forces that drive overuse of antibiotics in many other clinical settings may occur. It therefore offers an important case for illustrating how antibiotic optimisation may be limited by social, value-based and ethical dilemmas.
Cross, J, Fischer, A, Shotton, D, Pollicino, C, May, A, Vora, R, Dubrowin, NB & Good, P 2019, 'Supporting choice: an innovative model of integrated palliative care funded by a private health insurer.', Internal medicine journal, vol. 50, pp. 931-937.View/Download from: Publisher's site
SETTING:The number of Australians dying each year is predicted to double in the next 25 years and there is an urgent need to establish sustainable models for providing high quality end-of-life care. An innovative community care model (Bupa Palliative Care Choices Program or BPCCP) was developed and piloted with the purpose of supporting patients in achieving their choices surrounding end-of-life care. OBJECTIVES:This study evaluates whether BPCCP patients were more likely to die in their place of choice compared with patients receiving standard care. Additional aims were evaluating patient and carer satisfaction and insurer cost. DESIGN:This prospective, comparative cohort study comprises a clinical chart audit and survey of patient and carer experience. RESULTS:More BPCCP participants preferred to die at home (53% vs 31%). A lower proportion of BPCCP patients died in acute hospitals (10% vs 19%) and more of this cohort died at home (46% vs 26%). In both cohorts, nearly 90% of patients were able to die in their preferred location. Patient and carer satisfaction with the program was very high in the small cohort who responded to the survey. There was a decrease in average claims spend per patient enrolled in the program during the first 12-month period of implementation compared to historical claims spend for inpatients only. CONCLUSIONS:This evaluation of an innovative community palliative care intervention indicates that the extra services available to patients supports the choice of dying at home and the ability to do so while generating claims cost efficiencies. This article is protected by copyright. All rights reserved.
Good, P, Haywood, A, Gogna, G, Martin, J, Yates, P, Greer, R & Hardy, J 2019, 'Oral medicinal cannabinoids to relieve symptom burden in the palliative care of patients with advanced cancer: a double-blind, placebo controlled, randomised clinical trial of efficacy and safety of cannabidiol (CBD).', BMC palliative care, vol. 18, no. 1, pp. 110-110.View/Download from: Publisher's site
BACKGROUND:Despite improvements in medical care, patients with advanced cancer still experience substantial symptom distress. There is increasing interest in the use of medicinal cannabinoids, but there is little high quality evidence to guide clinicians. This study aims to define the role of cannabidiol (CBD) in the management of symptom burden in patients with advanced cancer undergoing standard palliative care. METHODS AND DESIGN:This study is a multicentre, randomised, placebo controlled, two arm, parallel trial of escalating doses of oral CBD. It will compare efficacy and safety outcomes of a titrated dose of CBD (100 mg/mL formulation, dose range 50 mg to 600 mg per day) against placebo. There is a 2-week patient determined titration phase, using escalating doses of CBD or placebo to reach a dose that achieves symptom relief with tolerable side effects. This is then followed by a further 2-week assessment period on the stable dose determined in collaboration with clinicians. DISCUSSION:A major strength of this study is that it will target symptom burden as a whole, rather than just individual symptoms, in an attempt to describe the general improvement in wellbeing previously reported by some patients in open label, non controlled trials of medicinal cannabis. Randomisation with placebo is essential because of the well-documented over reporting of benefit in uncontrolled trials and high placebo response rates in cancer pain trials. This will be the first placebo controlled clinical trial to evaluate rigorously the efficacy, safety and acceptability of CBD for symptom relief in advanced cancer patients. This study will provide the medical community with evidence to present to patients wishing to access medicinal cannabis for their cancer related symptoms. TRIAL REGISTRATION NUMBER:ALCTRN12618001220257 Registered 20/07/2018.
Haywood, A, Duc, J, Good, P, Khan, S, Rickett, K, Vayne-Bossert, P & Hardy, JR 2019, 'Systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults.', The Cochrane database of systematic reviews, vol. 2.View/Download from: Publisher's site
BACKGROUND:Dyspnoea is a common symptom in advanced cancer, with a prevalence of up to 70% among patients at end of life. The cause of dyspnoea is often multifactorial, and may cause considerable psychological distress and suffering. Dyspnoea is often undertreated and good symptom control is less frequently achieved in people with dyspnoea than in people with other symptoms of advanced cancer, such as pain and nausea. The exact mechanism of action of corticosteroids in managing dyspnoea is unclear, yet corticosteroids are commonly used in palliative care for a variety of non-specific indications, including pain, nausea, anorexia, fatigue and low mood, despite being associated with a wide range of adverse effects. In view of their widespread use, it is important to seek evidence of the effects of corticosteroids for the management of cancer-related dyspnoea. OBJECTIVES:To assess the effects of systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults. SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase, CINAHL, Science Citation Index Web of Science, Latin America and Caribbean Health Sciences (LILACS) and clinical trial registries, from inception to 25 January 2018. SELECTION CRITERIA:We included randomised controlled trials that included adults aged 18 years and above. We included participants with cancer-related dyspnoea when randomised to systemic corticosteroids (at any dose) administered for the relief of cancer-related dyspnoea or any other indication, compared to placebo, standard or alternative treatment. DATA COLLECTION AND ANALYSIS:Five review authors independently assessed trial quality and three extracted data. We used means and standard deviations for each outcome to report the mean difference (MD) with 95% confidence interval (CI). We assessed the risk of bias and quality of evidence using GRADE. We extracted primary outcomes of sensory-perceptual experience of dyspnoea (intensity of dyspnoea), affective distre...
Pinkerton, E, Good, P, Kindl, K, Richard, R, Fischer, A & Hardy, JR 2019, 'Quality use of medicines: Oral corticosteroids in advanced cancer.', Palliative medicine, vol. 33, no. 10, pp. 1325-1326.View/Download from: Publisher's site
Cirrhosis with decompensation has a poor prognosis, high symptom burden and causes carer stress. This pilot research in one tertiary hospital found that patients with cirrhosis with decompensation were infrequently referred to specialist palliative care. Despite this, they had a heavy symptom burden, high predicted mortality, frequent unplanned readmissions, long admissions and intensive care unit admissions. Few had adequate advance care planning.
Win, MM, Fischer, A & Good, P 2019, 'The pattern and timing of changes in preferred place of death for patients admitted to a community specialist palliative care service', Progress in Palliative Care, vol. 27, no. 1, pp. 4-9.View/Download from: Publisher's site
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. For patients receiving palliative care, expressing a preferred place of death (PPD) reduces anxiety and depression and increases the likelihood of achieving their preference. However, during the course of a life-limiting illness, patients commonly change their PPD at least once prior to death. The aim of this study was to identify the pattern and timing of how patients (and families) receiving specialist palliative care change their PPD over time. A retrospective chart audit was conducted of patients who died over a 7-month period whilst in the care of a metropolitan-based Community Specialist Palliative Care Service where PPD is routinely recorded every time a discussion on the topic occurs. These discussions are triggered by various factors which highlight the need to re-assess or confirm PPD. Results showed that 80% of patients achieved their PPD. There was no change to PPD in 64% of patients after the initial assessment, while 36% changed preferences once (27%), twice (8%) or three times (1%). Symptom management (10%) and family requests (30%) were cited as reasons for changing PPD. This study highlights that providers should revisit end-of-life discussions with patients along the disease trajectory and facilitate the consideration of all possible places for a good and safe death and the different scenarios that may influence patient decisions.
Hardy, JR, Skerman, H, Philip, J, Good, P, Currow, DC, Mitchell, G & Yates, P 2019, 'Methotrimeprazine versus haloperidol in palliative care patients with cancer-related nausea: a randomised, double-blind controlled trial.', BMJ open, vol. 9, no. 9.View/Download from: Publisher's site
OBJECTIVES:Methotrimeprazine is commonly used for the management of nausea but never tested formally against other drugs used in this setting. The aim was to demonstrate superior antiemetic efficacy. DESIGN:Double-blind, randomised, controlled trial of methotrimeprazine versus haloperidol. SETTING:11 palliative care sites in Australia. PARTICIPANTS:Participants were >18 years, had cancer, an average nausea score of ≥3/10 and able to tolerate oral medications. Ineligible patients had acute nausea related to treatment, nausea for which a specific antiemetic was indicated, were about to undergo a procedure or had received either of the study drugs or a change in glucocorticoid dose within the previous 48 hours. INTERVENTIONS:Based on previous studies, haloperidol was used as the control. Participants were randomised to encapsulated methotrimeprazine 6·25 mg or haloperidol 1·5 mg one time or two times per day and assessed every 24 hours for 72 hours. MAIN OUTCOME MEASURES:A ≥two-point reduction in nausea score at 72 hours from baseline. Secondary outcome measures were as follows: complete response at 72 hours (end nausea score less than 3), response at 24 and 48 hours, vomiting episodes, use of rescue antiemetics, harms and global impression of change. RESULTS:Response to treatment at 72 hours was 75% (44/59) in the haloperidol (H) arm and 63% (36/57) in the methotrimeprazine (M) arm with no difference between groups (intention-to-treat analysis). Complete response rates were 56% (H) and 51% (M). In the per protocol analysis, there was no difference in response rates: (85% (44/52) (H) and 74% (36/49) (M). Complete per protocol response rates were 64% (H) and 59% (M). Toxicity worse than baseline was minimal with a trend towards greater sedation in the methotrimeprazine arm. CONCLUSION:This study did not demonstrate any difference in response rate between methotrimeprazine and haloperidol in the control of nausea. TRIAL REGISTRATION NUMBER:ACTRN 12615000177550.
Matsuoka, H, Agar, M, Vandersman, Z, Good, P, Fazekas, B, Brown, L, Hardy, J, Weil, J & Currow, DC 2019, 'Harms From Haloperidol for Symptom Management in Palliative Care-a Post Hoc Pooled Analysis of Three Randomized Controlled Studies and Two Consecutive Cohort Studies.', Journal of Pain and Symptom Management, vol. 58, no. 3, pp. e6-e8.View/Download from: Publisher's site
Good, P, Pinkerton, R, Bowler, S, Craig, J & Hardy, J 2018, 'Impact of Opioid Therapy on Sleep and Respiratory Patterns in Adults With Advanced Cancer Receiving Palliative Care', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 55, no. 3, pp. 962-967.View/Download from: Publisher's site
Heng, S, Hardy, J & Good, P 2018, 'A retrospective audit on usage of Diatrizoate Meglumine (Gastrografin((R))) for intestinal obstruction or constipation in patients with advanced neoplasms', PALLIATIVE MEDICINE, vol. 32, no. 1, pp. 294-298.View/Download from: Publisher's site
Jessop, M, Fischer, A, McNeilly, A, May, A & Good, P 2018, 'Characteristics of community palliative care patients requiring acute admission to hospital', Progress in Palliative Care, vol. 26, no. 2, pp. 73-80.View/Download from: Publisher's site
© 2018 Informa UK Limited, trading as Taylor & Francis Group. Background: A substantial proportion of palliative care patients cared for in the community require acute hospital admission during their terminal illness. A greater understanding of the multifactorial reasons leading to acute admission to hospital may enable some potential hospital admissions to be avoided through provision of appropriate community palliative care support. Aim: To identify the characteristics of community specialist palliative care team (CSPCT) patients requiring acute admission to hospital. Methods: A retrospective audit of all patients known to the CSPCT who required acute admission to hospital over a five-month period between January and June 2016. Results: A total of 97 hospital admissions occurred, involving 88 patients. The majority of patients had a malignant diagnosis (80%) with 31% still undergoing anti-neoplastic therapy. Of these admissions, 58% were to acute hospital facilities and 42% were to hospital-based palliative care units. The leading reasons for hospitalization were pain (27%), patient/relative distress (24%) and dyspnoea (16%). Conclusion: This study described the characteristics of CSPCT patients who required acute admission to hospital. Further research is needed to understand the reasons patients seek acute hospital admission and to explore if interventions in the community can decrease the rate of acute hospital admissions.
Kirby, E, Kenny, K, Broom, A, Macartney, J & Good, P 2018, 'The meaning and experience of bereavement support: A qualitative interview study of bereaved family caregivers', PALLIATIVE & SUPPORTIVE CARE, vol. 16, no. 4, pp. 396-405.View/Download from: Publisher's site
Kirby, E, Lwin, Z, Kenny, K, Broom, A, Birman, H & Good, P 2018, '"It doesn't exist...": Negotiating palliative care from a culturally and linguistically diverse patient and caregiver perspective', BMC Palliative Care, vol. 17, no. 1.View/Download from: Publisher's site
© 2018 The Author(s). Background: The end of life represents a therapeutic context that acutely raises cultural and linguistic specificities, yet there is very little evidence illustrating the importance of such dynamics in shaping choices, trajectories and care practices. Culture and language interplay to offer considerable potential challenges to both patient and provider, with further work needed to explore patient and caregiver perspectives across cultures and linguistic groups, and provider perspectives. The objective of this study was to develop a critical, evidence-based understanding of the experiences of people from Culturally and Linguistically Diverse (CALD) backgrounds, and their caregivers, in a palliative care setting. Methods: A qualitative study, using semi-structured interviews to explore key experiences and perspectives of CALD patients and caregivers currently undergoing treatment under oncology or palliative care specialists in two Australian hospitals. Interviews were digitally audio recorded and transcribed in full. A thematic analysis was conducted utilising the framework approach. Results: Sixteen patients and fourteen caregivers from a range of CALD backgrounds participated in semi-structured interviews. The research identified four prevalent themes among participants: (1) Terminology in the transition to palliative care; (2) Communication, culture and pain management; (3) (Not) Talking about death and dying; and, (4) Religious faith as a coping strategy: challenging the terminal diagnosis. Conclusions: CALD patients and caregivers' experiences are multifaceted, particularly in negotiating linguistic difficulties, beliefs about treatment, and issues related to death and dying. Greater attention is needed to develop effective communication skills, recognise CALD patients' particular cultural, linguistic and spiritual values and needs, and acknowledge the unique nature of each doctor-patient interaction.
Sullivan, KA, Kingi, N, Good, P, Vayne-Bossert, P & Hardy, JR 2018, 'Castrate-resistant prostate cancer: Lessons learnt from a pilot study in the palliative care research population', International Journal of Palliative Nursing, vol. 24, no. 2, pp. 96-98.View/Download from: Publisher's site
© 2018 MA Healthcare Ltd. Background: Palliative care patients are inherently difficult to recruit to and retain on studies. Even when patients are recruited, it is hard to complete studies with sufficient data. There is a dearth of literature specific to men with castrate resistant prostate cancer (CRPC) and the clinical trials coordinator/research nurses perspective in improving trial outcomes in palliative care. Objectives: To describe the lessons learnt (by the nursing research team) from a prospective cohort study of men with CRPC and the practical implications for future research in this area. Methods: A pilot feasibility cohort study that followed patients with CRPC from referral until death. The participants completed questionnaires while the researcher documented treatments, disease status and symptom burden. The recruitment methods, data quality and results were analysed. Results and discussion: Several lessons have been learnt with regard to facilitating trial recruitment and design. These lessons are: the importance of building relationships with local urology teams, including all men with the diagnosis of CRPC as documented by a medical oncologist or urologist, reducing questionnaire burden, capturing symptom scores in clinic, actively following up patients by phone, and recording all reasons for drop-out or lost to follow-up. These lessons can now be implemented to improve future studies involving this demographic.
Syrmis, W, Richard, R, Jenkins-Marsh, S, Chia, SC & Good, P 2018, 'Oral water soluble contrast for malignant bowel obstruction', Cochrane Database of Systematic Reviews, vol. 2018, no. 3.View/Download from: Publisher's site
© 2018 The Cochrane Collaboration. Background: Malignant bowel obstruction (MBO) is a common problem in patients with intra-abdominal cancer. Oral water soluble contrast (OWSC) has been shown to be useful in the management of adhesive small bowel obstruction in identifying patients who will recover with conservative management alone and also in reducing the length of hospital stay. It is not clear whether the benefits of OWSC in adhesive small bowel obstruction are also seen in patients with MBO. Objectives: To determine the reliability of OWSC media and follow-up abdominal radiographs in predicting the success of conservative treatment in resolving inoperable MBO with conservative management. To determine the efficacy and safety of OWSC media in reducing the duration of obstruction and reducing hospital stay in people with MBO. Search methods: We identified studies from searching Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in Process, Embase, CINAHL, Science Citation Index (Web of Science) and Conference Proceedings Citation Index - Science (Web of Science). We also searched registries of clinical trials and the CareSearch Grey Literature database. The date of the search was the 6 June 2017. Selection criteria: Randomised controlled trials (RCTs), or prospective controlled studies, that evaluated the diagnostic potential of OWSC in predicting which malignant bowel obstructions will resolve with conservative treatment. RCTs, or prospective controlled studies, that assessed the therapeutic potential of OWSC in managing MBO at any level compared with placebo, no intervention or usual treatment or supportive care. Data collection and analysis: We used standard methodological procedures expected by Cochrane. We assessed risk of bias and assessed the evidence using GRADE and created a 'Summary of findings' table. Main results: We found only one RCT meeting the selection criteria for the second objective (therapeutic potential) of this...
© 2018, © 2018 Informa UK Limited, trading as Taylor & amp; Francis Group. Background: The primary aim when providing advice to patients on fitness to drive is the safety of the patient and the general public. Within the current Australian guidelines there is little specific information in regards to providing advice to palliative care patients about driving. Method: Online survey. Objective: To investigate the current practice of doctors and the advice provided to palliative care patients about their fitness to drive. Discussion: When advising a patient with a medical condition that could affect fitness to drive, most respondents were not in consensus with the driving guidelines with only 38% following the recommended procedure. It found some disparity in the advice provided and differences to the Australian driving guidelines.
Ashar, A, Hardy, J, Good, P & Fischer, A 2017, 'Corticosteroids as Co-analgesics With Opioids for Cancer-Related Pain: A Feasibility Study', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 54, no. 6, pp. E1-E2.View/Download from: Publisher's site
George, R, Haywood, A, Good, P, Hennig, S, Khan, S, Norris, R & Hardy, J 2017, 'Can Saliva and Plasma Methadone Concentrations Be Used for Enantioselective Pharmacokinetic and Pharmacodynamic Studies in Patients With Advanced Cancer?', CLINICAL THERAPEUTICS, vol. 39, no. 9, pp. 1840-1848.View/Download from: Publisher's site
Haywood, A, Duc, J, Good, P, Khan, S, Rickett, K, Vayne-Bossert, P & Hardy, JR 2017, 'Systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults', Cochrane Database of Systematic Reviews, vol. 2017, no. 6.View/Download from: Publisher's site
© 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults.
Kirby, E, Broom, A, Good, P, Bowden, V & Lwin, Z 2017, 'Experiences of interpreters in supporting the transition from oncology to palliative care: A qualitative study', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 13, no. 5, pp. E497-E505.View/Download from: Publisher's site
MacArtney, JI, Broom, A, Kirby, E, Good, P & Wootton, J 2017, 'The Liminal and the Parallax: Living and Dying at the End of Life', QUALITATIVE HEALTH RESEARCH, vol. 27, no. 5, pp. 623-633.View/Download from: Publisher's site
Pinkerton, E, Good, P, Gibbons, K & Hardy, J 2017, 'An open-label pilot study of oral vitamin C as an opioid-sparing agent in patients with chronic pain secondary to cancer', Supportive Care in Cancer, vol. 25, no. 2, pp. 341-343.View/Download from: Publisher's site
© 2016, Springer-Verlag Berlin Heidelberg. Purpose: The purpose of this study is to assess the efficacy of oral Vitamin C as an opioid-sparing agent when used in conjunction with opioids and standard adjuvant therapy in the management of chronic cancer pain. Methods: An open-label pilot study of patients ≥18 years of age with chronic pain secondary to cancer and/or its treatment and a Brief Pain Inventory average pain score of ≥3/10. In addition to opioid analgesia, patients received 1 g of vitamin C twice daily over 3 days (total daily dose of 2 g). Patients' usual medications, including breakthrough medications, were continued throughout the study period. The primary endpoint was total daily opioid use during vitamin C administration compared with that immediately prior to study. Results: Thirty-four patients were enrolled in the study. Seven failed to complete the trial. Across the 17 evaluable patients, the median daily opioid consumption was 360 mg oral morphine equivalents (OME) on the days prior to vitamin C and 390 mg when administered with vitamin C. Conclusion: This study failed to demonstrate any clinically significant benefit from vitamin C in conjunction with opioids in cancer-related pain and does not provide support for embarking on a larger randomised trial to determine efficacy.
Ryan, J, Abbato, S, Greer, R, Vayne-Bossert, P & Good, P 2017, 'Rates and predictors of professional interpreting provision for patients with limited english proficiency in the emergency department and inpatient ward', Inquiry (United States), vol. 54.View/Download from: Publisher's site
© The Author(s) 2017. The provision of professional interpreting services in the hospital setting decreases communication errors of clinical significance and improves clinical outcomes. A retrospective audit was conducted at a tertiary referral adult hospital in Brisbane, Australia. Of 20 563 admissions of patients presenting to the hospital emergency department (ED) and admitted to a ward during 2013-2014, 582 (2.8%) were identified as requiring interpreting services. In all, 19.8% of admissions were provided professional interpreting services in the ED, and 26.1% were provided on the ward. Patients were more likely to receive interpreting services in the ED if they were younger, spoke an Asian language, or used sign language. On the wards, using sign language was associated with 3 times odds of being provided an interpreter compared with other languages spoken. Characteristics of patients including their age and type of language spoken influence the clinician's decision to engage a professional interpreter in both the ED and inpatient ward.
Vayne-Bossert, P, Hardy, J, Skerman, H, Yates, P, Sullivan, K & Good, P 2017, 'Symptom Clusters in Men With Castrate-Resistant Prostate Cancer', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 54, no. 3, pp. E1-E3.View/Download from: Publisher's site
Vayne-Bossert, P, Haywood, A, Good, P, Khan, S, Rickett, K & Hardy, JR 2017, 'Corticosteroids for adult patients with advanced cancer who have nausea and vomiting (not related to chemotherapy, radiotherapy, or surgery)', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 7.View/Download from: Publisher's site
Vayne-Bossert, P, Richard, E, Good, P, Sullivan, K & Hardy, JR 2017, 'Integration of oncology and palliative care: setting a benchmark', SUPPORTIVE CARE IN CANCER, vol. 25, no. 10, pp. 3253-3259.View/Download from: Publisher's site
Weir, N, Fischer, A & Good, P 2017, 'Assessing the practice of palliative care doctors: what driving advice do they give patients with advanced disease?', INTERNAL MEDICINE JOURNAL, vol. 47, no. 10, pp. 1161-1165.View/Download from: Publisher's site
Broom, A, Kirby, E, Good, P & Lwin, Z 2016, 'Nursing futility, managing medicine: Nurses' perspectives on the transition from life-prolonging to palliative care', HEALTH, vol. 20, no. 6, pp. 653-670.View/Download from: Publisher's site
George, R, Lobb, M, Haywood, A, Khan, S, Hardy, J, Good, P, Hennig, S & Norris, R 2016, 'Quantitative determination of the enantiomers of methadone in human plasma and saliva by chiral column chromatography coupled with mass spectrometric detection', Talanta, vol. 149, pp. 142-148.View/Download from: Publisher's site
© 2015 Elsevier B.V. All rights reserved. Methadone is a potent lipophilic synthetic opioid that is effective in the treatment of cancer pain and perceived benefit in difficult pain control scenarios (especially in cases of neuropathic pain). The use of methadone in clinical practice is challenging however, due to the narrow therapeutic window and large inter- and intra-individual variability in therapeutic response. Quantitation of the enantiomers d- and l-methadone (d- and l-MTD) in plasma and saliva provides a basis for studying its pharmacokinetics in patients with cancer and for monitoring efficacy, toxicity and side-effects. This assay involves quantitation of the enantiomers of methadone using their respective deuterated internal standards, in plasma and saliva matrices with no impact of ion suppression in either matrix. The analytical recoveries of d- and l-MTD from the saliva collection devices (Salivette®) are optimised in this novel method with an accurate and simple extraction method employing dichloromethane. Optimal enantioselective separations were achieved using an α1-acid glycoprotein chiral stationary phase and triple quadrupole tandem mass spectrometer. Linearity was demonstrated over 0.05-1000 μg/L for both enantiomers in plasma and in saliva with correlation coefficients greater than 0.998. The lower limit of quantitation (LLOQ) was determined to be 0.1 μg/L in plasma and saliva for d- and l-MTD. Accuracy of the method ranges from 100% to 106% even at the LLOQ and total precision, expressed as the coefficient of variation, was between 0.2% and 4.4% for both analytes in both matrices. A simple one step extraction procedure resulted in recoveries greater than 95% for both analytes, at concentrations as low as 0.5 μg/L, from the Salivette®. The validated method was applied successfully in 14 paired plasma and saliva samples obtained from adult patients with cancer pain receiving methadone.
Vayne-Bossert, P, Afsharimani, B, Good, P, Gray, P & Hardy, J 2016, 'Interventional options for the management of refractory cancer pain-what is the evidence?', SUPPORTIVE CARE IN CANCER, vol. 24, no. 3, pp. 1429-1438.View/Download from: Publisher's site
MacArtney, JI, Broom, A, Kirby, E, Good, P, Wootton, J & Adams, J 2016, 'Locating care at the end of life: burden, vulnerability, and the practical accomplishment of dying.', Sociology of health & illness, vol. 38, no. 3, pp. 479-492.View/Download from: Publisher's site
Home is frequently idealised as the preferred location for end-of-life care, while in-patient hospital care is viewed with suspicion and fear. Yet many people with a terminal illness spend their final days in some form of medicalised institutional setting, such as a specialist palliative care in-patient unit. Drawing on semi-structured interviews with in-patients at a specialist palliative care unit, we focus on their difficulties in finding a better place of care at the end of their life. We found that participants came to conceptualise home though a sense of bodily vulnerabilities and that they frequently understood institutional care to be more about protecting their family from the social, emotional and relational burdens of dying. For a significant number of participants the experience of dying came to be understood through what could be practically accomplished in different locales. The different locales were therefore framed around providing the best care for the patient and their family.
Afsharimani, B, Kindl, K, Good, P & Hardy, J 2015, 'Pharmacological options for the management of refractory cancer pain-what is the evidence?', SUPPORTIVE CARE IN CANCER, vol. 23, no. 5, pp. 1473-1481.View/Download from: Publisher's site
Bista, SR, Hardy, J, Tapuni, A, Fu, J, Gibbons, K, Good, P, Norris, R & Haywood, A 2015, 'Validation of a Fentanyl Transdermal Adhesion Scoring Tool for Use in Clinical Practice', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 49, no. 5, pp. 934-938.View/Download from: Publisher's site
Bista, SR, Haywood, A, Norris, R, Good, P, Tapuni, A, Lobb, M & Hardy, J 2015, 'Iron Chelation in Thalassemia Major', CLINICAL THERAPEUTICS, vol. 37, no. 12, pp. 2882-2883.View/Download from: Publisher's site
Bista, SR, Haywood, A, Norris, R, Good, P, Tapuni, A, Lobb, M & Hardy, J 2015, 'Saliva versus Plasma for Pharmacokinetic and Pharmacodynamic Studies of Fentanyl in Patients with Cancer', CLINICAL THERAPEUTICS, vol. 37, no. 11, pp. 2468-2475.View/Download from: Publisher's site
Broom, A, Kirby, E, Good, P, Wootton, J, Yates, P & Hardy, J 2015, 'Negotiating Futility, Managing Emotions: Nursing the Transition to Palliative Care', QUALITATIVE HEALTH RESEARCH, vol. 25, no. 3, pp. 299-309.View/Download from: Publisher's site
Haywood, A, Good, P, Khan, S, Leupp, A, Jenkins-Marsh, S, Rickett, K & Hardy, JR 2015, 'Corticosteroids for the management of cancer-related pain in adults', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 4.View/Download from: Publisher's site
Kindl, K & Good, P 2015, 'Evidence-Based Palliative Care 13 Years On: Has anything changed?', JOURNAL OF PALLIATIVE CARE, vol. 31, no. 3, pp. 133-140.
Syrmis, W, Richard, R, Jenkins-Marsh, S, Chia, SC & Good, P 2015, 'Oral water soluble contrast for malignant bowel obstruction', Cochrane Database of Systematic Reviews, vol. 2015, no. 12.View/Download from: Publisher's site
© 2015 The Cochrane Collaboration. This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the reliability of oral water soluble contrast media and follow up abdominal radiographs in predicting the success of conservative treatment in resolving inoperable malignant bowel obstructions with conservative management. To determine the efficacy and safety of oral water soluble contrast media in reducing the duration of obstruction and reducing hospital stay in people with malignant bowel obstruction.
Vayne-Bossert, P, Haywood, A, Good, P, Khan, S, Rickett, K, Jenkins-Marsh, S & Hardy, JR 2015, 'Corticosteroids for adult patients with advanced cancer who have nausea and vomiting (not related to chemo- or radiotherapy, or surgery)', Cochrane Database of Systematic Reviews, vol. 2015, no. 12.View/Download from: Publisher's site
© 2015 The Cochrane Collaboration. This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of corticosteroids on nausea and vomiting not related to chemotherapy, radiotherapy, or surgery in adult cancer patients.
Mitchell, GK, Hardy, JR, Nikles, CJ, Carmont, S-AS, Senior, HE, Schluter, PJ, Good, P & Currow, DC 2015, 'The Effect of Methylphenidate on Fatigue in Advanced Cancer: An Aggregated N-of-1 Trial.', J Pain Symptom Manage, vol. 50, no. 3, pp. 289-296.View/Download from: Publisher's site
CONTEXT: Fatigue is common in life-limiting cancer. Methylphenidate (MPH), a psychostimulant, may be a useful therapy. Gathering evidence in patients with advanced cancer can be challenging. OBJECTIVES: To determine if MPH improves cancer-related fatigue in people with advanced cancer. METHODS: N-of-1 trials are multicycle, double-blind, randomized, controlled crossover trials using standardized measures of effect in individuals. They are normally used to assess treatment effects in individuals. Aggregated N-of-1 trials from participants with end-stage cancer suffering fatigue were used to assess the group effect of MPH, producing an estimate of equivalent power to a parallel-group randomized controlled trial (RCT) but requiring less than half of the sample size. Up to three cycles of MPH 5 mg twice daily (three days) vs. identical placebo (three days) capsules were offered to participants. Primary outcome was improvement in fatigue as measured by the Functional Assessment of Chronic Illness Therapy-Fatigue Scale and the Wu Cancer Fatigue Scale. Analysis used Bayesian statistical methods using intention-to-treat principles. RESULTS: Forty-three participants completed 84 cycles of MPH and placebo in random order, exceeding sample size estimates. Overall, MPH did not improve fatigue (mean difference 3.2; 95% credible interval -2.0, 9.0; posterior probability of favorable effect 0.890). Eight participants showed important improvement, and one participant showed important worsening of fatigue on MPH. There were no features that distinguished participants whose fatigue responded to MPH compared with those who did not. CONCLUSION: MPH does not improve fatigue in the population of patients with end-stage cancer. Aggregated N-of-1 trial methodology is feasible and produces population-based sample estimates with less than half the sample size required for the equivalent parallel-group RCT. It also identified individuals who did and did not respond to MPH, which is a featu...
Nikles, J, Mitchell, GK, Hardy, J, Agar, M, Senior, H, Carmont, S-A, Schluter, PJ, Good, P, Vora, R & Currow, D 2015, 'Testing pilocarpine drops for dry mouth in advanced cancer using n-of-1 trials: A feasibility study', PALLIATIVE MEDICINE, vol. 29, no. 10, pp. 967-974.View/Download from: Publisher's site
MacArtney, JI, Broom, A, Kirby, E, Good, P, Wootton, J, Yates, PM & Adams, J 2015, 'On resilience and acceptance in the transition to palliative care at the end of life', HEALTH, vol. 19, no. 3, pp. 263-279.View/Download from: Publisher's site
Good, P, Afsharimani, B, Movva, R, Haywood, A, Khan, S & Hardy, J 2014, 'Therapeutic challenges in cancer pain management: A systematic review of methadone', Journal of Pain and Palliative Care Pharmacotherapy, vol. 28, no. 3, pp. 197-205.View/Download from: Publisher's site
The proven therapeutic efficacy of methadone in cancer pain is hindered by a challenging pharmacokinetic-pharmacodynamic profile, considerable interpatient variation, and increasing concern about the complexities of dosing. The objective of this study was to assess the evidence for the use of methadone in cancer pain management. The authors conducted a systematic literature search for randomized controlled trials (RCTs) published post the 2007 Cochrane review of methadone in cancer pain. Trial quality was assessed using the Oxford Quality Scoring System and Cochrane Handbook for Systematic Reviews of Interventions. Of the 152 abstracts found, 4 were RCTs (272 participants). Two RCTs compared the efficacy and safety of methadone with placebo or active control and two investigated rotation to methadone from other opioids. The studies used different routes of administration, dosing, initiation, and titration of methadone and distinct pain scoring tools and did not address the issues raised by the Cochrane review. Methadone has an important role in the management of cancer pain, with many advantages including low cost, high oral bioavailability, rapid onset of action, once-daily dosing, and postulated benefits in difficult pain control scenarios. However, due to limited research in this area, methadone dosing remains a challenge, with vigilant dose initiation, adjustment, and monitoring required. There is a need for further studies using standardized methodology to evaluate the optimal dosing strategy of methadone, the effect on different types of pain, and the role of pharmacokinetics and pharmacogenomics in clinical outcomes. © 2014 Informa Healthcare USA, Inc.
Good, P, Richard, R, Syrmis, W, Jenkins-Marsh, S & Stephens, J 2014, 'Medically assisted hydration for adult palliative care patients', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 4.View/Download from: Publisher's site
Good, P, Richard, R, Syrmis, W, Jenkins-Marsh, S & Stephens, J 2014, 'Medically assisted nutrition for adult palliative care patients', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 4.View/Download from: Publisher's site
Higgins, I, van der Riet, P, Sneesby, L & Good, P 2014, 'Nutrition and hydration in dying patients: the perceptions of acute care nurses', JOURNAL OF CLINICAL NURSING, vol. 23, no. 17-18, pp. 2609-2617.View/Download from: Publisher's site
Objectives: Nurses are generally present, and often influential, in supporting patient and family acceptance of medical futility and in assisting doctors in negotiating referral to palliative care. Yet the specificities of the nursing role and how nurses may contribute to timely and effective referrals is not well understood. This study aimed to systematically explore hospital-based nurses' accounts of the transition to palliative care, and the potential role of nurses in facilitating more effective palliative care transitions.Design: Qualitative study using semistructured interviews.Setting: Two health services with public as well as private clinical environments in a major metropolitan area of Australia.Participants: Hospital-based nurses (n=20) who regularly work with patients at the point of referral and in managing transitions to palliative care.Results: Four significant themes emerged from thematic analysis. These include: (1) professional dynamics and the roles played by nurses in initiating the transition to palliative care; (2) the value of nurses' informal interactions in timely and effective transitions; (3) the emerging challenge of managing task-oriented nursing versus intense emotional nursing work at the point of medical futility and (4) the emotional burden experienced by nurses within this clinical context. Nurses self-reported occupying critical albeit complex roles in the management of medical futility and the transition to palliative care. They reported experiencing significant emotional burden in balancing interpersonal and interprofessional relationships during this time.Conclusions: The results suggest that nurses may be utilised in a more formalised and systematic fashion in the context of managing medical futility and the need to topicalise the transition, with the focus shifted away from medical referrals towards more team-based and patientcentred timely transitions. Further research focused on the experiences of doctors, allied health p...
Lwin, Z, Broom, A, Cosman, R, Livingstone, A, Sawkins, K, Good, P, Kirby, E, Koh, ES & Hovey, E 2014, 'Culturally and linguistically diverse patient participation in glioma research', Neuro-Oncology Practice, vol. 1, no. 3, pp. 101-105.View/Download from: Publisher's site
© The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. Marginal communities, such as culturally and linguistically diverse (CALD) patients, have significantly lower rates of recruitment, accrual, and retention in cancer clinical trials. A combination of language and cultural barriers means that trial participation from CALD communities remains at suboptimal levels, which in turn favors research findings that are biased towards therapeutic effects or toxicities within the context of non-CALD populations. Here we outline some key challenges and implications for CALD patient participation in glioma research in countries such as Australia, where English is the language of governance and health services implementation. We highlight multistakeholder interventions to improve both investigator recruitment and participation of CALD communities in future glioma research, particularly in this era when global migration has come of age. Enhancing research participation of CALD communities ensures not only wider understanding of genetic heterogeneity to improve glioma outcomes but also equity in access to care.
Lwin, Z, Kirby, E, Broom, A, Adams, J & Good, P 2014, 'NEGOTIATING PALLIATIVE CARE IN THE CONTEXT OF CULTURAL AND LINGUISTIC DIVERSITY: A QUALITATIVE STUDY OF INTERPRETERS' EXPERIENCES', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 10, pp. 62-62.
Syrmis, W, Good, P, Wootton, J & Spurling, G 2014, 'Opioid conversion ratios used in palliative care: is there an Australian consensus?', INTERNAL MEDICINE JOURNAL, vol. 44, no. 5, pp. 483-489.View/Download from: Publisher's site
Broom, A, Kirby, E, Good, P, Wootton, J & Adams, J 2014, 'The troubles of telling: Managing communication about the end of life', Qualitative Health Research, vol. 24, no. 2, pp. 151-162.View/Download from: Publisher's site
Communication about palliative care represents one of the most difficult interpersonal aspects of medicine. Delivering the terminal diagnosis has traditionally been the focus of research, yet transitions to specialist palliative care are equally critical clinical moments. Here we focus on 20 medical specialists strategies for engaging patients around referral to specialist palliative care. Our aim was to develop an understanding of the logics that underpin their communication strategies when negotiating this transition. We draw on qualitative interviews to explore their accounts of deciding whether and when to engage in referral discussions; the role of uncertainty and the need for hope in shaping communication; and their perceptions of how patient biographies might shape their approaches to, and communication about, the end of life. On the basis of our analysis, we argue that communication is embedded in social relations of hope, justice, and uncertainty, as well as being shaped by patient biographies.
©2014,©2014 Taylor & Francis. Families play important roles in transitions to end-of-life care, yet we know little about the social relations between doctors and families at the point of referral to specialist palliative care. In this study, we explore how medical specialists negotiated the transition to specialist palliative care with families. Drawing on data from 20 qualitative interviews, we examine data accounts about the roles of family members in discussions with clinical specialists about palliative care, and how families shape interpersonal dynamics. Our results indicate that families fulfil important 'functions' and 'roles'in these delicate and emotionally laden conversations. Specialists' accounts articulated referral processes as distinctly relational moments, with families viewed as potential 'resources' but also as 'complications', in attempts to encourage the 'smooth'transition to end-of-life care. On the basis of these results, we argue that further attention should be paid to the centrality of families in key moments in care (and communication therein) and how they may be utilised, managed and experienced by a range of health professionals.
Kirby, E, Broom, A, Good, P, Wootton, J & Adams, J 2014, 'Medical specialists' motivations for referral to specialist palliative care: a qualitative study', BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 4, no. 3, pp. 277-284.View/Download from: Publisher's site
Broom, A, Good, P, Kirby, E & Lwin, Z 2013, 'Negotiating palliative care in the context of culturally and linguistically diverse patients', INTERNAL MEDICINE JOURNAL, vol. 43, no. 9, pp. 1043-1046.View/Download from: Publisher's site
Hardy, JR, Jenkins-Marsh, S, Pinkerton, E, Rickett, K & Good, P 2013, 'Corticosteroids for the management of cancer-related pain in adults', Cochrane Database of Systematic Reviews, vol. 2013, no. 10.View/Download from: Publisher's site
© 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the analgesic effects of corticosteroids for the management of cancer-related pain in adults.
Nikles, J, Mitchell, GK, Hardy, J, Agar, M, Senior, H, Carmont, S-A, Schluter, PJ, Good, P, Vora, R & Currow, D 2013, 'Do pilocarpine drops help dry mouth in palliative care patients: a protocol for an aggregated series of n-of-1 trials', BMC PALLIATIVE CARE, vol. 12.View/Download from: Publisher's site
Senior, HE, Mitchell, GK, Nikles, J, Carmont, S-A, Schluter, PJ, Currow, DC, Vora, R, Yelland, MJ, Agar, M, Good, PD & Hardy, JR 2013, 'Using aggregated single patient (N-of-1) trials to determine the effectiveness of psychostimulants to reduce fatigue in advanced cancer patients: a rationale and protocol.', BMC palliative care, vol. 12, no. 1, pp. 17-17.View/Download from: Publisher's site
BACKGROUND: It is estimated that 29% of deaths in Australia are caused by malignant disease each year and can be expected to increase with population ageing. In advanced cancer, the prevalence of fatigue is high at 70-90%, and can be related to the disease and/or the treatment. The negative impact of fatigue on function (physical, mental, social and spiritual) and quality of life is substantial for many palliative patients as well as their families/carers. METHOD/DESIGN: This paper describes the design of single patient trials (n-of-1 s or SPTs) of a psychostimulant, methylphenidate hydrochloride (MPH) (5 mg bd), compared to placebo as a treatment for fatigue, with a population estimate of the benefit by the aggregation of multiple SPTs. Forty patients who have advanced cancer will be enrolled through specialist palliative care services in Australia. Patients will complete up to 3 cycles of treatment. Each cycle is 6 days long and has 3 days treatment and 3 days placebo. The order of treatment and placebo is randomly allocated for each cycle. The primary outcome is a reduction in fatigue severity as measured by the Functional Assessment of Cancer Therapy-fatigue subscale (FACIT-F). Secondary outcomes include adverse events, quality of life, additional fatigue assessments, depression and Australian Karnovsky Performance Scale. DISCUSSION: This study will provide high-level evidence using a novel methodological approach about the effectiveness of psychostimulants for cancer-related fatigue. If effective, the findings will guide clinical practice in reducing this prevalent condition to improve function and quality of life. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12609000794202.
Broom, A, Kirby, E, Good, P, Wootton, J & Adams, J 2013, 'The art of letting go: Referral to palliative care and its discontents', Social Science & Medicine, vol. 78, no. 1, pp. 9-16.View/Download from: Publisher's site
Accompanying patients from active treatment towards specialist palliative care is a complex sphere of clinical practice that can be fraught with interpersonal and emotional challenges. While medical specialists are expected to break `bad news to their patients and ease their transitions to specialist palliative care if required, few have received formal training in such interpersonal complexities.
Broom, A, Kirby, E, Good, P, Wootton, J & Adams, J 2012, 'Specialists' Experiences and Perspectives on the Timing of Referral to Palliative Care: A Qualitative Study', Journal Of Palliative Medicine, vol. 15, no. 11, pp. 1-6.View/Download from: Publisher's site
Background: Specialist referral practices regarding palliative care are variable and their decision-making practices regarding timing and communication remains an under-researched issue. More effective referral practices have been shown to enhance patient and carer experiences at the end of life, reduce the burden on pre-palliative care services, and even extend life expectancy in some cases.
Good, P, Sneesby, L, Higgins, I & Van der Riet, P 2011, 'Medical Officers in Acute Care Settings: Their views on medically assisted hydration at the end of life', JOURNAL OF PALLIATIVE CARE, vol. 27, no. 4, pp. 303-309.View/Download from: Publisher's site
Sneesby, L, Satchell, R, Good, P & van der Riet, P 2011, 'Death and dying in Australia: perceptions of a Sudanese community', JOURNAL OF ADVANCED NURSING, vol. 67, no. 12, pp. 2696-2702.View/Download from: Publisher's site
Nikles, J, Mitchell, GK, Schluter, P, Good, P, Hardy, J, Rowett, D, Shelby-James, T, Vohra, S & Currow, D 2011, 'Aggregating single patient (n-of-1) trials in populations where recruitment and retention was difficult: The case of palliative care', JOURNAL OF CLINICAL EPIDEMIOLOGY, vol. 64, no. 5, pp. 471-480.View/Download from: Publisher's site
Jackson, K, Ashby, M, Howell, D, Petersen, J, Brumley, D, Good, P, Pisasale, M, Wein, S & Woodruff, R 2010, 'The Effectiveness and Adverse Effects Profile of "Burst" Ketamine in Refractory Cancer Pain: The VCOG PM 1-00 study', JOURNAL OF PALLIATIVE CARE, vol. 26, no. 3, pp. 176-183.View/Download from: Publisher's site
van der Riet, P, Higgins, I, Good, P & Sneesby, L 2009, 'A discourse analysis of difficult clinical situations in relation to nutrition and hydration during end of life care', JOURNAL OF CLINICAL NURSING, vol. 18, no. 14, pp. 2104-2111.View/Download from: Publisher's site
Nikles, J, Mitchell, G, Walters, J, Hardy, J, Good, P, Rowett, D, Shelby-James, T & Currow, D 2009, 'Prioritising drugs for single patient (n-of-1) trials in palliative care', PALLIATIVE MEDICINE, vol. 23, no. 7, pp. 623-634.View/Download from: Publisher's site
Good, P, Cavenagh, J, Mather, M & Ravenscroft, P 2008, 'Medically assisted nutrition for palliative care in adult patients', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, no. 4.View/Download from: Publisher's site
Mather, MA, Good, PD, Cavenagh, JD & Ravenscroft, PJ 2008, 'Survey of bereavement support provided by Australian palliative care services', MEDICAL JOURNAL OF AUSTRALIA, vol. 188, no. 4, pp. 228-+.View/Download from: Publisher's site
van der Riet, P, Good, P, Higgins, I & Sneesby, L 2008, 'Palliative care professionals' perceptions of nutrition and hydration at the end of life.', International journal of palliative nursing, vol. 14, no. 3, pp. 145-151.View/Download from: Publisher's site
The provision of medically administered nutrition and hydration (MNH) for the terminally ill patient is a controversial issue and there has been much debate in the literature concerning this sensitive subject. This article reports on a qualitative research study that explores palliative care nurses' and doctors' perceptions and attitudes to patient nutrition and hydration at the end of life. Participants were from an urban and rural palliative care service. Three main discourses were identified: carers' distress at the non-provision of MNH; palliative care doctors' and nurses' position that terminal dehydration lessened the burden of suffering for dying patients; and polarisation between the acute care setting and the palliative care setting. Overlaying these three main discourses are contesting discourses involving cure vs comfort, and acute care vs palliative care. Importantly, the findings of this study reveal that palliative doctors and nurses believe that medically assisted nutrition and hydration at the end stage of life rarely benefits patients, and as long as adequate mouth care is given, patients do not suffer. However, family members do experience emotional distress in dealing with this situation. In caring for dying people, the nurse's and doctor's role is one of education and communication, involving a team approach to manage this difficult issue.
This is the protocol for a review and there is no abstract. The objectives are as follows: The objectives of this review are to determine the effect of medically assisted hydration in palliative care patients on their quality and length of life. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Schneider, JJ, Good, P & Ravenscroft, PJ 2006, 'Effect of tubing on loss of clonazepam administered by continuous subcutaneous infusion', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 31, no. 6, pp. 563-567.View/Download from: Publisher's site
Good, PD, Cavenagh, JD, Currow, DC, Woods, DA, Tuffin, PH & Ravenscroft, PJ 2006, 'What are the essential medications in pallative care? - a survey of Australian palliative care doctors.', Australian family physician., vol. 35, no. 4, pp. 261-264.
BACKGROUND: There is a disparity of availability and cost of drugs in the community for palliative care patients through the Pharmaceutical Benefits Scheme (PBS) compared to those available to inpatients in public hospitals. METHODS: The Joint Therapeutics Committee of the Australian and New Zealand Society of Palliative Medicine, Palliative Care Australia and the Clinical Oncological Society of Australia surveyed palliative care practitioners in Australia to compile a list of drugs they considered essential. RESULTS: Drugs nominated generally had good levels of evidence for use in palliative care, although many practitioners still used some without evidence of benefit. DISCUSSION: We are now working with the Commonwealth Department of Health and Ageing to agree on a list of drugs for specific palliative care indications. As a result, the first ever section in the PBS for a specific patient population has been created. There is a need for high quality studies in palliative care to determine the best drugs to add to the list.
Good, P, Tullio, F, Jackson, K, Goodchild, C & Ashby, M 2005, 'Prospective audit of short-term concurrent ketamine, opioid and anti-inflammatory ('triple-agent') therapy for episodes of acute on chronic pain', INTERNAL MEDICINE JOURNAL, vol. 35, no. 1, pp. 39-44.View/Download from: Publisher's site
Good, PD, Ravenscroft, PJ & Cavenagh, J 2005, 'Effects of opioids and sedatives on survival in an Australian inpatient palliative care population', INTERNAL MEDICINE JOURNAL, vol. 35, no. 9, pp. 512-517.View/Download from: Publisher's site
Good, PD, Cavenagh, J & Ravenscroft, PJ 2004, 'Survival after enrollment in an Australian palliative care program', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 27, no. 4, pp. 310-315.View/Download from: Publisher's site
Good, PD, Schneider, JJ & Ravenscroft, PJ 2004, 'The compatibility and stability of midazolam and dexamethasone in infusion solutions', JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 27, no. 5, pp. 471-475.View/Download from: Publisher's site
Good, PD 2003, 'Advances in palliative care relevant to the wider delivery of healthcare', MEDICAL JOURNAL OF AUSTRALIA, vol. 179, no. 6, pp. S44-S46.
© 2012 Future Medicine Ltd. All rights reserved. Opioids remain the mainstay of treatment for controlling severe cancer pain. Morphine is the WHO opioid of choice. Diamorphine is the parenteral opioid of choice for the treatment of chronic cancer pain in the UK. Morphine and diamorphine should be used with caution in renal failure.