Research at Calvary Mater Newcastle

Palliative Care and End of Life Research projects

The Palliative Care Research Team at Calvary Mater Newcastle consists of a dynamic team of nurses, doctors and administrative support staff who work together to enable and facilitate multi-professional research within our department. We have a core staff of dedicated clinical trials and research nurses who co-ordinate all departmental research, quality improvement and audits and have recently established a central Research, Education and Evaluation Working Party which has established formal collaboration with other hospital departments and academia with three of our core staff holding formal positions with various national and international universities.

We are an important recruiting site for the Palliative Care Clinical Studies Collaborative (PaCCSC) ensuring our continuous involvement with important palliative care clinical trials. We also regularly contribute to the PaCCSC phase 4 pharmacovigilance studies.

We have a number of current ongoing departmental research activities including the development and roll out of a hospital wide quality end of life care program, evaluation of a multi-professional dyspnoea intervention, a survey of cannabis use in the community, the evaluation and role of meaning making in bereavement and the rate of pressure injures in palliative care community patients. In the recent past we have completed funded studies in constipation and gastric emptying in people receiving palliative care.

Collaboration is a core feature of our research department with our clinical trials nurse sitting on the Scientific Committee for PC4 and a member of the Palliative Care Research Network of Victoria (PCRNV), two of our team also sit on the Hunter New England Human Research Ethics Committee. In this spirit of collaboration we also host project-focussed researchers from around the country.

Current Studies

A pragmatic, phase III, multi-site, double-blind, placebo controlled, parallel arm, dose increment randomised trial of regular, low dose extended release morphine for chronic refractory breathlessness. Funding: Palliative Care Clinical Studies Collaborative (PaCCSC). Aims: to enhance the evidence base for the pharmacological treatment of chronic refractory breathlessness using potential therapies compared to placebo.

A prospective, randomised, placebo-controlled, double-blind, cross-over study of the efficacy of sustained-release low dose morphine in the subjective sensation of dyspnoea as a result of maximally treated mesothelioma or asbestosis or other causes of interstitial lung disease in opioid naïve participants. Funding: Palliative Care Clinical Studies Collaborative – SAPS. Aims: to define any changes in the unpleasantness of breathlessness and the intensity of the subjective sensation of dyspnoea in people with mesothelioma and, separately, people with asbestosis and other causes of interstitial lung disease by comparing low dose sustained-release morphine with placebo in steady doses.

A prospective observational study – understanding the burden of adverse drug reactions and their impact on symptoms at end of life. Funding: Palliative Care Clinical Studies Collaborative PaCCSC. Aims: a) to prospectively collect information on the therapeutic benefit of medications commonly used in palliative care; b) to prospectively collect information on the toxicity (drug/host) of medications commonly used in palliative care; c) to prospectively collect information on any significant drug/drug interactions of medications commonly used in palliative care.

Exploring the use of Cannabis for medicinal purposes in a Palliative Care population

Investigators: Investigators: Dr. Cate Hayes, Ms Naomi Byfieldt
Dr Jessica Stabler. Aims: The primary aim of this project is to explore the local experiences of people using cannabis for medicinal purposes. The secondary aim is to build a profile of perceived benefits and side effects and most common method of cannabis use within the palliative population. The project objectives are: a) to understand the use of cannabis for medicinal purposes within the local context; b) to gain an understanding of the side effect profile within our patient population; c) to review the financial and social impact of product access within the local context.

A Review of Specialist Palliative Care (SPC) in Residential Aged Care Facilities (RACFs)

The aim of having NPs provide SPC service to RACFs was to provide equitable and quality end of life care to residents in nursing homes when required. However inappropriate referrals are resource burdensome and investigation into the referrals being received by the NPs within the department may identify a gap in educational needs of staff within RACFs. Additionally, education of patients in RACFs and their families may be required. Investigators: Ms. Naomi Byfield, Lynette Campbell, Ludmilla Sneesby, Gareth Watts

This Pathways through Grief is an ongoing bereavement support program operating 3 times per year. Each program spans a 3 month time frame. Until 2016 only one support group program was evaluated per year. Since that date we have collected ongoing evaluations of all groups which will be compiled into one annual report. Investigator: Fiona Harris. Aims: to seek consumer feedback on a) Is the group meeting the stated purpose; b) Overalls satisfaction with the operation of the group; c) identify any improvements required.

Quality Improvement Projects

This project aims to de-clutter existing storage area, reduce trip hazards, improve housekeeping, reduce manual handling forces/ loads and improve compliance with infection control

Investigators: Jenny Gleeson; Emily Baird; Joanne Davis; Natasha Atkinson; Lisa Collins-Morgan; Barbara Bagley.

This project aims to identify recliner and alternate seating options for hospice inpatients – seating audit and seating quick reference guide for staff. Investigators: Joanne Davis; Lisa Collins-Morgan; Barbara Bagley; Jenny Gleeson; Natasha Atkinson; Emily Baird. Aims: a) to ensure a range of seating options are available to meet the varied needs of hospice inpatients; b) to create a resource that all staff can use to assist in the appropriate selection of seating for hospice inpatients; c) to ensure that we have the most up to date seating options or awareness of availability in particular for patients with complex seating needs.

The project aims to ensure timely access and availability or patient ADL equipment in Hospice to facilitate safety and comfort. Investigators: Barbara Bagley; Joanne Davis; Jenny Gleeson; Lisa Collins-Morgan

This project aims to develop a staff resource folder to create a quick reference guide outlining the use and functions of the various inpatient hospice bed available to best suit patient needs. Investigators: Emily Baird; Lisa Collins-Morgan

This project aims to develop guidelines for pressure care equipment (mattress and cushions) for Hospice patients. Investigators: Joanne Davis; Jenny Gleeson; Natasha Atkinson; Lisa Collins-Morgan

Publications

  • Currow, D., G. J. Watts, M. Johnson, C. F. McDonald, J. O. Miners, A. A. Somogyi, L. Denehy, N. McCaffrey, D. J. Eckert and P. McCloud (2017). “A pragmatic, phase III, multisite, double-blind, placebo-controlled, parallel-arm, dose increment randomised trial of regular, low-dose extended-release morphine for chronic breathlessness: Breathlessness, Exertion And Morphine Sulfate (BEAMS) study protocol.” BMJ open 7(7): e018100.
  • Watts, G. J., K. Clark, M. Agar, P. M. Davidson, C. McDonald, L. T. Lam, D. Sajkov, N. McCaffrey, M. Doogue and A. P. Abernethy (2016). “Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness.” BMJ open 6(11): e013177.
  • Lucas, C. J., Patel, J., & Martin, J. H. (2017). Predicting drug interactions in addiction treatment. Internal Medicine Journal, 47(8), 872-878.
  • Patel, J., Martin, J. H., & Lucas, C. J. (2017). Comment on a paper by Dupoiron et al.“A phase III randomized controlled study on the efficacy and improved bowel function of prolonged‐release (PR) oxycodone‐naloxone (up to 160/80 mg daily) versus oxycodone PR”. European Journal of Pain, 21(10), 1772-1773.
  • Hourn, M.M., Quinn, R., Waller, A., Boyle, K., Jordan, L.A., Salaris, M., Byfieldt, N., Shaw, L. & Marsden, D. (2017). Exploring current inpatient practice in transitioning people after stroke from acute to palliative care and in advance care planning: The Plan Assess Understand Survival after Stroke (PAUSe after Stroke) Project. International Journal Of Stroke (Vol. 12, Pp. 23-23).
  • Clark, K., Willis, A. & Byfieldt, N. (2017). An Observational Study to Explore the Feasibility of Assessing Bereaved Relatives’ Experiences Before and After a Quality Improvement Project to Improve Care of Dying Medical Inpatients. American Journal of Hospice and Palliative Medicine, 34(3), pp.263-268.
  • Clark, K., Lam, L.T., Talley, N.J., Quinn, J., Blight, A., Byfieldt, N. & Currow, D.C. (2016). Assessing the Presence and Severity of Constipation with Plain Radiographs in Constipated Palliative Care Patients. Journal of palliative medicine, 19(6), pp.617-621.