The Science Committee advises the Executive Committee of the APM on the scientific basis of palliative medicine, including responding to consultations and commenting on scientific documents for which APM endorsement is being sought. The Committee aims to develop a greater scientific profile for the specialty of palliative medicine, including setting priorities to seek new evidence, aiding in the development of evidence based guidelines and protocols for palliative medical interventions and helping to foster, facilitate and coordinate the development of an ethical research culture in palliative medicine and with other specialties.
|Dr Jason Boland||Chair|
|Prof Paddy Stone|
|Dr Elaine Boland|
|Dr Katherine Webber|
|Dr Ollie Minton|
|Dr Paul Perkins|
|Dr Helen McGee|
|Dr Simon Etkind||Trainee Representative|
|Frank Wang||Junior Representative|
BMJ Supportive & Palliative Care shortcuts
Please click on the link below to view resources for trainees wanting to carry out research
RESEARCH GOVERNANCE: A Guide for Hospices
Twycross Research Prize 2014
Winner: Dr Amara Nwosu
The assessment of hydration states in advanced cancer patients using novel technology: the evaluation of bioelectrical impedance vector analysis (BIVA) in the palliative care setting
Click here to see full research: Twycross Research Winning Entry 2014
Article(s) of the month
These articles have been picked for personal learning but also would be useful for a journal club discussion
Markus K. Schuler, MD, MSc, Leopold Hentschel, Dipl-Psych, Wadim Kisel, Michael Kramer, Dipl-Psych, Felicitas Lenz, BSc, Beate Hornemann, Dipl-Psych, Julia Hoffmann, Stephan Richter, MD, Gerhard Ehninger, MD, Martin Bornh€auser, MD, and Frank Kroschinsky, MD
Journal of Pain and Symptom Management January 2017; Vol. 53; No. 1; 57-66
This randomised controlled trial looked at the impact of a structured individual sports program on fatigue in patients with advanced cancer (undergoing curative and palliative treatments) over 12 and 24 weeks. They found no significant difference in general fatigue at 12 weeks but a significant reduction in mental fatigue both at 12 and at 24 weeks for the groups taught the exercise program and worsening of fatigue in the control group. There was a non significant advantage for the group that had twice weekly therapist supervision as well as the exercise program but as these patients had the worst baseline scores of fatigue this cannot be attributed to the supervision. Although their numbers are small and the study was not blinded, this study adds to the evidence for the advantages of physical therapy in improving fatigue in a heterogenous sample of patients, many of whom were having palliative treatment.
Evidence still insufficient that advance care documentation leads to engagement of healthcare professionals in end-of-life discussions: A systematic review
Ebony Lewis, Magnolia Cardona-Morrell, Kok Y Ong, Steven A Trankle and Ken Hillman
Palliative Medicine 2016, Vol 30(9), 807-824
This systematic review looked for evidence that the presence of Advance Care Documentation (ACD) enhanced clinician’s involvement in initiating End of Life (EOL) discussions and whether that engagement was perceived or measured as effective. 24 studies were included involving over 23,000 participants with most of the studies being qualitative in nature. The review only found one well designed cohort study that provided high level evidence of a statistical significant association indicating that the ACD prompted an EOLC discussion. The authors’ conclusion is that the evidence to date cannot provide an answer to the effectiveness of ACD on triggering conversations about EOL wishes despite most studies finding staff had a positive attitude to the use of ACD as instruments to improve communication.
Prepared by Helen McGee, on behalf of the APM Science committee
Authors: Lucy N Walker, St Catherine’s Hospice, Scarborough, UK. Lynne Russon, Sue Ryder Wheatfields Hospice, Leeds, UK
BMJ Supportive & Palliative Care
This interesting pair of papers gives an insight into the use of simulation in training for medical students and Palliarive Medicine trainees. It’s clear the training was valued and there are some tips on how to run such training.
Somatostatin Analogues Compared With Placebo and Other Pharmacologic Agents in the Management of Symptoms of Inoperable Malignant Bowel Obstruction: A Systematic Review
George P. Obita, MB, ChB, MPHCM, MSc, MFPH’Correspondence information about the author MB, ChB, MPHCM, MSc, MFPH George P. ObitaEmail the author MB, ChB, MPHCM, MSc, MFPH George P. Obita, Elaine G. Boland, MD, MRCP, PhD, David C. Currow, BMed, MPH, PhD, FRACP, FAHMS, Miriam J. Johnson, MBChB (Hons), FRCP, MD, Jason W. Boland, MB, BChir, FRCP, PhD
JPSM – Journal of Pain and Symptom Management
There’s been a lot of debate about the use of these drugs recently. This is a great starting point for those interested. The implications for future research section is worth reading for anyone who is thinking about doing any further work in the area.
Prepared by Paul Perkins, on behalf of the APM Science committee
A useful study examining why haematological patients die in hospital. While it reinforces the complex and uncertain trajectory of some of these conditions there is a distinction drawn between younger and older patients. There is also a patient expectation to be able to access hospital and on-going supportive treatment which community and hospice settings cannot match. The final theme is that it is not always practical to manage a death at home if complicated. It is probably worth sharing with your local haematologist as includes bereaved relatives views.
Effect of communication skills training on outcomes in critically ill patients with life-limiting illness referred for intensive care management: a before-and-after study
A brave attempt to do a communication skills intervention on the effects of ITU admissions. The study was in Australia but could equally apply to the UK. However the focus was on goals of care and the intervention with simulated patients around this. It is then not surprising the documentation related to this increased but overall admission rate and outcomes did not. The study focused on those admitted to the ICU and you are left wondering if the focus should be on preventing these admissions in the first instance. As a recent conference slide said “ one hour of difficult conversation can prevent two weeks of ITU admission and death”. There is increasing evidence of who is likely to benefit from admission and who won’t – the paper talks about disease specific trajectories to focus on.
The costs, resource use and cost-effectiveness of Clinical Nurse Specialist–led interventions for patients with palliative care needs: A systematic review of international evidence
This is a review attempting to quantify the CNS role. Unfortunately the methodology used for the papers does not allow a clear delineation of the role and cost effectiveness. I doubt this is a unique palliative care phenomenon. There is a clear recognition of the value added but a disappointing lack of evidence for business cases – although there is an impact on length of stay and re-admission rates which is maybe all that is needed.
What factors influence emergency department visits by patients with cancer at the end of life? Analysis of a 124,030 patient cohort
This is a reminder of patient factors previously identified for those who use acute services towards the end of their lives. There is more quantified data than usual as it looks at those who attended A&E at least twice. The findings are not unexpected – those of a lower socio-economic class and multi- morbidities are more likely to do so. Also patients with head and neck or lung cancer. This is a large cohort study & the data can be usefully used to target these groups locally through GSF meetings or the like.
Cancer Treatment Side Effects: A Meta-Analysis of the Relationship between Response Expectancies and Experience
This is an updated meta-analysis examining the relationship between perceived and experienced side effects of chemotherapy. This is poorly understood mechanism but may be relevant for patients undergoing palliative treatment and especially with newer immunotherapy. The conclusions suggest that it would be helpful to fag up potential toxicities and to measure their impact on treatment- something on which we can all agree especially when the aim of treatment is quality of life and symptom control.
Prepared by Ollie Minton, on behalf of the APM Science committee
This paper uses interviews with current and formerly homeless people, homelessness staff, and health and social care professionals to explore end of life care delivery for homeless people.
The findings highlight that homeless people often remain in hostels as health deteriorates, and sometimes for end of life care, due to a lack of alternatives. The authors conclude that person centred care is often lacking for this vulnerable group, and that improved training and in-reach into hostels may be beneficial.
Article Available at: http://journals.sagepub.com/doi/full/10.1177/026921631771710