Research at Calvary Health Care Bruce

Palliative Care and End of Life Research projects

 

The Calvary Centre for Palliative Care Research, Canberra, is a joint venture between Calvary Health Care and Australian Catholic University.

The Centre operates with three research strands: clinical care, care pathways and relationships. All projects and outputs are aligned with one or more of these areas. Each of the strands is directly connected with the Little Company of Mary core strategic areas in the 2011-15 plan, and specifically to priorities in: excellence in care, service development & innovation, and people & culture. Each project also addresses strategic national and local policy objectives.

The Centre’s mission is to make a substantial positive impact on palliative care, improve service delivery and improve patient and carer outcomes by:

  1. Conducting high quality, multidisciplinary research with a particular focus on the translation of research into practice.
  2. Building research capacity through training and mentoring palliative care clinicians, research students, career researchers and teaching staff.
  3. Advising, collaborating and consulting on key issues and challenges relating to palliative care research with the health industry, clinicians, government, patient/carer groups and other key stakeholders.
  4. Creating and sustaining a collegial, supportive and high performance research culture that is attractive to clinicians, the researchers and research students.

Project funding comes from competitive research grants and from the territory’s Health Department. Whenever possible, projects have national and international collaborators to embed the impact and engagement of work in multiple sites and contexts. We also work closely with relevant peak bodies, including Palliative Care Australia.

Example completed projects include: a trial of distance learning education for informal carers, a systematic review of subcutaneous hydration for people receiving palliative care, assessing a new model of care for integrating specialist palliative care into aged care, assessing the impact of family meetings on perceptions of empathy, examining the transparency of aged care fees on provider websites, examining conflict between families and clinicians in specialist palliative care.

Professor Liz Forbat

Lead Researcher

Professor Liz Forbat is Professor of Palliative Care and Director of the Calvary Centre for Palliative Care Research. She holds a joint appointment with Calvary Public Hospital Canberra and Australian Catholic University Canberra. She is a psycho-oncology researcher and clinician, specialising in palliative care. She has an extensive track record in carer research, commencing with her PhD which focused on family caregiving and was published as research monograph in 2005. She is also a family psychotherapist, and brings the theories, methods and techniques from her clinical work to her research.

Professor Forbat has established national and international research collaborations, in the fields of psycho-oncology and palliative care. Her work is concerned with relationships in ill-health, with a core focus on the relational component of care. Since her doctorate (1998-2001) she has focused on understanding and improving caregiving relationships, adopting a range of methodologies including qualitative approaches, surveys, trials and systematic reviews. She has published 69 articles in  peer review journals, and 3 books.

Prior to her current post, she was co-director of the Cancer Care Research Centre at the University of Stirling, Scotland, UK. She led the Families Children and Relationships research program, and the User Involvement work across the School of Health Sciences.

Current Studies

Funding: Department of Health and Ageing. $1,000,000 ($171,000 allocated to Prof Forbat’s team). Investigators: Prof Liz Forbat Led by Palliative Care Australia, alongside Alzheimer’s Australia and Hammond Care. Aims: This study is developing, implementing and testing new methods of supporting people with dementia. The project builds on Palliative Care Australia’s ‘Dying to Talk’ discussion starter. Study impact: This work will implement and test a national approach to advance care planning for people with dementia (>413,000 people are diagnosed with dementia in Australia). Working with the Peak Bodies for palliative care and Alzheimer’s disease means that there is the infrastructure to ensure uptake nationally of this work.

Study lead: Prof Liz Forbat Co-investigators: Dr Scott King, Calvary Bethlehem; Kate Maher, Calvary Canberra; Dr Michael Chapman, Canberra Hospital; Dr Kristen Ranse, University of Canberra, Dr Suhaila Kamrani, Canberra Hospital. Aim: Presentation to EDs for palliative care patients may be avoidable. Multiple ED visits can be considered markers of sub-optimal care (Earle et al 2003), and can cause distress to patients and carers (Wallace et al, 2012). Studies of nursing home residents’ use of EDs report high rates of admission, despite easy access to medical care, notably for pneumonia and urinary tract infections (Brownwell et al 2014). This study seeks to understand why patients in receipt of specialist palliative care out-patient (SPC) services attend the ED and to develop alternate care pathways. This is a mixed method study, with retrospective case-note audit of medical records combined with prospective qualitative data from clinician and patients. Study impact: The study is highly likely to lead to a change in practice across the Territory in reducing preventable presentations to the ED.

Funding: ACT Health Department. $287,887. Study lead: Prof Liz Forbat. Co-investigators: Clinicians at Calvary Public Hospital Bruce – Nikki Johnston and Clare Lovell, Professors Deb Parker, Meera Agar and Lawrence Lam at UTS, A/Prof Waiman Liu at ANU, and Dr Michael Chapman at Canberra Hospital. Aim: This study is implementing and evaluating a new model of care integrating specialist palliative care into aged care. We are using a stepped wedge randomised control trial design to implement the new model with 12 facilities (over 1200 residents) in care homes in the ACT. The primary outcome is reducing time spent in acute care, with secondary outcomes focused on improving staff knowledge and confidence in palliative care, better controlled symptoms of people at end of life, increasing people’s ability to die in their preferred place

Study impact: The study is highly likely to lead to a change in practice across the Territory. There is already uptake of the model inter-state. This work has been presented at a commonwealth Ministerial Think Tank with Ken Wyatt.

Completed Projects

Study lead: Prof Liz Forbat. Co-investigators: Nikki Johnston and Clare Lovell, Calvary Public Hospital Bruce; Dr Michael Chapman, Canberra Hospital; A/Prof Waiman Liu, Australian National University. Aim: This study sought to generate an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people. In so doing, care quality is improved by ensuring that there is adequate symptoms control, support and education for care staff and reduced use of days in hospital. We conducted an ethnography of triage meetings where specialist palliative care was being integrated into residential care. Findings: A checklist was developed and is freely available to use. Extracts from interviews with needs rounds participants illustrate the choice of items within the checklist and their importance in supporting the evolution towards efficient and effective high-quality specialist palliative care input to the care of older people living in residential care. Study impact: The work has been presented at international conferences, with requests for the checklist materials coming from across Australia and New Zealand. The checklist is already being used in services in New South Wales and South Australia.

Publications: The checklist was published in BMJ Supportive and Palliative Care

Study lead: Prof Liz Forbat. Study team: Rachel Bilton-Simek, Calvary Public Hospital Bruce; Rowena Robinson, Calvary Public Hospital Bruce and Australian Catholic University; Dr Erna Haraldsdottir, St Columbas Hospice Edinburgh, Prof Marsha Lewis, University at Buffalo, New York.

Aim: This study sought to address the shortcomings of carer support being delivered in face-to-face groups, by innovating a distance learning approach. This study had two phases. In Phase 1 distance learning materials were developed. In Phase 2 they were tested in a single-arm randomised trial, with pre/post measures and a process evaluation. Findings: Two modules were developed, focusing on areas of recognised unmet supportive care needs: pain management and nutrition/hydration. The materials consisted of written booklets and videos. Carers receiving the materials reported higher levels of preparedness for their care-giving role. Carers reported feeling that distance education was both feasible and acceptable. Study impact: The work has been presented at international conferences, with requests for the materials coming from across Australia and New Zealand. The materials are being used across the Australian Capital Territory for informal carers of people receiving palliative care services.

Publications: The protocol was published in BMJ Open. The findings were published in BMJ Supportive and Palliative Care. The resources can be found here and used by carers without charge.

For more details about research projects in Palliative Care, go to PUBMED.

Publications

  • Forbat, L,. Chapman, M,. Lovell, C,. Liu, W,. Johnston, N. (forthcoming) Improving specialist palliative care in residential care for older people: a checklist to guide practice. BMJ Supportive and Palliative Care.  
  • Forbat, L,. Robinson, R,. Bilton-Simek, R,. Francois, K,. Lewis, M,. Haraldsdottir, E. (forthcoming) Distance education methods are useful for delivering education to palliative caregivers: A single arm trial of an education package (PrECEPt). Palliative Medicine. 11.1177/0269216317712849
  • Carolan, C,. Smith, A,. Davies, G,. Forbat, L. (forthcoming) Seeking, Accepting and Declining Help for Emotional Distress in Cancer: A Systematic Review and Thematic Synthesis of Qualitative Evidence.European Journal of Cancer Care. DOI: 10.1111/ecc.12720
  • Francois, K,. Barclay, S,. Lobb, E,. Forbat, L. (forthcoming) The Nature of Conflict in Palliative Care: A Qualitative Exploration of the Experiences of Staff and Family Members. Patient Education and Counselling. DOI: 10.1016/j.pec.2017.02.019.
  • Forbat, L,. Kunicki, N,. Chapman, M,. Lovell, C. (forthcoming) How and why are subcutaneous fluids administered in an advanced illness population: A systematic review. Journal of Clinical Nursing. DOI: 10.1111/jocn.13683
  • Forbat, L., Simons, J,. Sayer, C., Davies, M,. and Barclay, S (2017) Training paediatric health care staff in recognising, understanding and managing conflict with patients and families: Findings from a survey on immediate and six-month impact. Archives of Disease in Childhood. 102 (3): 250-254.
  • Forbat, L,. Haraldsdottir, E,. Lewis, M,. Hepburn, K. (2016) Supporting the provision of palliative care in the home environment: A proof of concept single arm trial of a palliative carers education package (PrECEPt). BMJ Open. DOI: 10.1136/bmjopen-2016-012681 http://bmjopen.bmj.com/content/6/10/e012681.short?g=w_open_current_tab
  • Johnston, N,. Lovell, C,. Liu, W,. Chapman, M,. Forbat, L. (forthcoming) Normalising and planning for death in residential care: Findings from a qualitative focus group study of a specialist palliative care intervention. BMJ Supportive and Palliative Care. 10.1136/bmjspcare-2016-001127
  • Chapman, M,. Johnston, N,. Lovell, C,. Forbat, L,. Liu, W. (forthcoming) Avoiding costly hospitalisation at end of life: Findings from a specialist palliative care pilot in residential care for older adults. BMJ Supportive and Palliative Care. DOI: 10.1136/bmjspcare-2015-001071
  • Forbat, L,. Robertson, J. and McNamee, P. (forthcoming) Couple therapy following prostate cancer surgery: A manual to guide treatment. Journal of Family Therapy. DOI: 10.1111/1467-6427.12129