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3. Assessment and Management of Sleep Disturbance in Palliative Care Settings.

Author

Jeon, Megan S., Allcroft, Peter, Brown, Linda Ruth, Currow, David, Kochovska, Slavica, Krishnan, Anu, Webster, Andrew, and Campbell, Rachel

Subjects
*CROSS-sectional method, *PALLIATIVE treatment, *QUESTIONNAIRES, *DESCRIPTIVE statistics, *ALLIED health personnel, *ATTITUDES of medical personnel, *QUALITY of life, *TERMINALLY ill, *COMPARATIVE studies, *PALLIATIVE care nurses, *PHYSICIANS, *HEALTH outcome assessment, *SLEEP quality, *SLEEP disorders
Abstract

Background: Sleep disturbances, including insomnia, sleep-disordered breathing, and circadian rhythm disorders with potential consequences including excessive daytime somnolence and worsening fatigue, are prevalent yet largely under-measured and therefore under-managed problems in people receiving palliative care. This has the potential to negatively affect the person's functioning and quality of life. Objectives: We aimed to review the current practice of assessment and management of sleep disturbances in people with life-limiting illnesses in Australian and New Zealand palliative care settings, and to define areas for improvement in assessment and management of sleep disturbances and further research. Design: A cross-sectional, online survey was conducted with palliative care health professionals (PCHPs) to explore current approaches to routine assessment of sleep disturbances and PCHPs' awareness of, and perceived access to, evidence-based resources for assessing and managing sleep disturbances in their local settings. Results: Fifty-four PCHPs responded to the survey, including allied health professionals (44%), palliative care nurses (26%), and physicians (19%). Over 70% of PCHPs endorsed routine verbal screening of sleep symptoms, and >90% recommended management with basic behavioral strategies. However, none of PCHPs used validated patient-reported outcome measures for sleep, and <10% of PCHPs demonstrated awareness or use of sleep-specific interventions (including medications). Only 40% reported they had access to sleep specialist services for patients. Conclusion: Our findings provide a useful snapshot of current approaches to managing sleep disturbances in palliative care. Gaps in current practice are highlighted, including the lack of structured, clinical assessment, referral pathways, and PCHPs' perceived lack of access to targeted interventions for sleep disturbances. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Subcutaneous cannula drainage for symptomatic lower limb oedema in advanced cancer: a case study.

Author

Priest, Lauren, Allcroft, Peter, Thomson, Margaret, and Lambrakis, Anthea

Subjects
LYMPHEDEMA treatment, METASTASIS, MAGNETIC resonance imaging, LEG, ANAL tumors, TREATMENT effectiveness, MEDICAL drainage, CATHETERIZATION, PALLIATIVE treatment, SQUAMOUS cell carcinoma, CATHETERS, DISEASE complications
Abstract

Secondary lymphoedema is a troubling and complex symptom in people with advanced metastatic cancer. Currently there is no standardised approach to managing secondary lymphoedema in the palliative care population. This case study of lower limb lymphoedema utilises subcutaneous drainage with specific cannula placement. The hope is that this insight may allow for future standardisation of this procedure.. [ABSTRACT FROM AUTHOR]

Published
2023

10. Phase III, international, multicentre, double-blind, dose increment, parallel-arm, randomised controlled trial of duloxetine versus pregabalin for opioid-unresponsive neuropathic cancer pain: A JORTC-PAL16 trial protocol

Author

Matsuoka, Hiromichi, Clark, Katherine, Fazekas, Belinda, Oyamada, Shunsuke, Brown, Linda, Ishiki, Hiroto, Matsuda, Yoshinobu, Hasuo, Hideaki, Ariyoshi, Keisuke, Lee, Jessica, Le, Brian, Allcroft, Peter, Kochovska, Slavica, Fujiwara, Noriko, Miyaji, Tempei, Lovell, Melanie, Agar, Meera, Yamaguchi, Takuhiro, Satomi, Eriko, Iwase, Satoru, Phillips, Jane, Koyama, Atsuko, Currow, David C., Matsuoka, Hiromichi, Clark, Katherine, Fazekas, Belinda, Oyamada, Shunsuke, Brown, Linda, Ishiki, Hiroto, Matsuda, Yoshinobu, Hasuo, Hideaki, Ariyoshi, Keisuke, Lee, Jessica, Le, Brian, Allcroft, Peter, Kochovska, Slavica, Fujiwara, Noriko, Miyaji, Tempei, Lovell, Melanie, Agar, Meera, Yamaguchi, Takuhiro, Satomi, Eriko, Iwase, Satoru, Phillips, Jane, Koyama, Atsuko, and Currow, David C.

Abstract

Introduction: Management of neuropathic cancer pain (NCP) refractory to regular opioids remains an important challenge. The efficacy of pregabalin for NCP except chemotherapy-induced peripheral neuropathy (CIPN) has already been confirmed in two randomised controlled trials (RCTs) compared with placebo. Duloxetine offers the potential of analgesia in opioid refractory NCP. However, there are no RCT of duloxetine for the management of opioid-refractory NCP as a first line treatment. Both classes of drugs have the potential to reduce NCP, but there has been no head-to-head comparison for the efficacy and safety, especially given differing side effect profiles. Methods and analysis: An international, multicentre, double-blind, dose increment, parallel-arm, RCT is planned. Inclusion criteria include: adults with cancer experiencing NCP refractory to opioids; Brief Pain Inventory (BPI)-item 3 (worst pain) of ≥4; Neuropathic Pain on the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale of ≥12 despite of an adequate trial of regular opioid medication (≥60 mg/day oral morphine equivalent dose). Patients with CIPN are excluded. The study will recruit from palliative care teams (both inpatients and outpatients) in Japan and Australia. Participants will be randomised (1:1 allocation ratio) to duloxetine or pregabalin arm. Dose escalation is until day 14 and from day 14 to 21 is a dose de-escalation period to avoid withdrawal effects. The primary endpoint is defined as the mean difference in BPI item 3 for worst pain intensity over the previous 24 hours at day 14 between groups. A sample size of 160 patients will be enrolled between February 2020 and March 2023. Ethics and dissemination: Ethics approval was obtained at Osaka City University Hospital Certified Review Board and South Western Sydney Local Health District Human Research Ethics Committee. The results of this study will be submitted for publication in international journals and

Published
2022

11. Phase III, international, multicentre, double-blind, dose increment, parallel-arm, randomised controlled trial of duloxetine versus pregabalin for opioid-unresponsive neuropathic cancer pain: a JORTC-PAL16 trial protocol

Author

Matsuoka, Hiromichi, primary, Clark, Katherine, additional, Fazekas, Belinda, additional, Oyamada, Shunsuke, additional, Brown, Linda, additional, Ishiki, Hiroto, additional, Matsuda, Yoshinobu, additional, Hasuo, Hideaki, additional, Ariyoshi, Keisuke, additional, Lee, Jessica, additional, Le, Brian, additional, Allcroft, Peter, additional, Kochovska, Slavica, additional, Fujiwara, Noriko, additional, Miyaji, Tempei, additional, Lovell, Melanie, additional, Agar, Meera, additional, Yamaguchi, Takuhiro, additional, Satomi, Eriko, additional, Iwase, Satoru, additional, Phillips, Jane, additional, Koyama, Atsuko, additional, and Currow, David C, additional

Published
2022
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12. Additional file 1 of Health-related quality of life in patients with inoperable malignant bowel obstruction: secondary outcome from a double-blind, parallel, placebo-controlled randomised trial of octreotide

Author

McCaffrey, Nikki, Asser, Tegan, Fazekas, Belinda, Muircroft, Wendy, Agar, Meera, Clark, Katherine, Eckermann, Simon, Lee, Jessica, Rohit Joshi, Allcroft, Peter, Sheehan, Caitlin, and Currow, David C.

Subjects
stomatognathic diseases, otorhinolaryngologic diseases, social sciences, humanities
Abstract

Additional file 1: Table A1. Baseline and post-treatment EORTC QLQ-C15-PAL mean scores (multiple imputation). Baseline and post-treatment EORTC QLQ-C15-PAL mean scores for completed items and multiple imputation.

Published
2020
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13. Additional file 2 of Health-related quality of life in patients with inoperable malignant bowel obstruction: secondary outcome from a double-blind, parallel, placebo-controlled randomised trial of octreotide

Author

McCaffrey, Nikki, Asser, Tegan, Fazekas, Belinda, Muircroft, Wendy, Agar, Meera, Clark, Katherine, Eckermann, Simon, Lee, Jessica, Rohit Joshi, Allcroft, Peter, Sheehan, Caitlin, and Currow, David C.

Subjects
stomatognathic diseases, otorhinolaryngologic diseases, social sciences, humanities
Abstract

Additional file 2: Table A2. Baseline and post-treatment EORTC QLQ-C15-PAL completion rates.

Published
2020
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16. Stigma and the in(visible) perspectives and expectations of home oxygen therapy among people with chronic breathlessness syndrome: A qualitative study

Author

Breaden, Katrina, Collier, Aileen, Litster, Caroline, Allcroft, Peter, Currow, David C., Phillips, Jane L., Breaden, Katrina, Collier, Aileen, Litster, Caroline, Allcroft, Peter, Currow, David C., and Phillips, Jane L.

Abstract

Background: Chronic breathlessness syndrome in the context of advancing disease is distressing for all concerned. Oxygen is commonly prescribed in this setting; however, little is known about the perspectives of breathless people who either are on oxygen or are yet to have it prescribed. Aim: To understand and describe the perspectives and experiences of breathless people towards oxygen use at home. Design: This qualitative study utilised an interpretive description approach using semi-structured interviews and thematic analysis. Setting/participants: A total of 19 people with chronic breathlessness syndrome living in South Australia participated in semi-structured interviews. Participants were divided into sub-groups according to whether they were chronically breathless and (1) not using home oxygen (n = 6), (2) using funded home oxygen for severe hypoxaemia (n = 7) and (3) using home oxygen for palliation outside of funding guidelines (n = 6). Results: Three main themes were identified: (1) managing distress and living with chronic breathlessness syndrome, with or without oxygen, requires a range of self-management strategies; (2) expectations of oxygen use: ‘Not as good as I thought it would be’; and (3) the stigma of using oxygen: the visible and invisible. Conclusion: People living with chronic breathlessness struggle daily with both the progression of the underlying disease and the distressing nature of the syndrome. While oxygen does provide benefit for some people, its use and the perceptions of its use are often associated with both the visible and invisible manifestations of stigma. Clinicians need to promote self-management strategies and give careful thought to the prescribing of home oxygen, especially outside the current funding guidelines.

Published
2019

19. The need to research refractory breathlessness

Author

Currow, David C., Abernethy, Amy P., Allcroft, Peter, Banzett, Robert B., Bausewein, Claudia, Booth, Sara, Carrieri-Kohlman, Virginia, Davidson, Patricia, Disler, Rebecca, Donesky, DorAnne, Dudgeon, Deborah, Ekstrom, Magnus, Farquhar, Morag, Higginson, Irene, Janssen, Daisy, Jensen, Dennis, Jolley, Caroline, Krajnik, Malgorzata, Laveneziana, Pierantonio, McDonald, Christine, Maddocks, Matthew, Morelot-Panzini, Capucine, Moxham, John, Mularski, Richard A., Noble, Simon, O'Donnell, Denis, Parshall, Mark B., Pattinson, Kyle, Phillips, Jane, Ross, Joy, Schwartzstein, Richard M., Similowski, Thomas, Simon, Steffen T., Smith, Tracy, Wells, Athol, Yates, Patsy, Yorke, Janelle, Johnson, Miriam J., Currow, David C., Abernethy, Amy P., Allcroft, Peter, Banzett, Robert B., Bausewein, Claudia, Booth, Sara, Carrieri-Kohlman, Virginia, Davidson, Patricia, Disler, Rebecca, Donesky, DorAnne, Dudgeon, Deborah, Ekstrom, Magnus, Farquhar, Morag, Higginson, Irene, Janssen, Daisy, Jensen, Dennis, Jolley, Caroline, Krajnik, Malgorzata, Laveneziana, Pierantonio, McDonald, Christine, Maddocks, Matthew, Morelot-Panzini, Capucine, Moxham, John, Mularski, Richard A., Noble, Simon, O'Donnell, Denis, Parshall, Mark B., Pattinson, Kyle, Phillips, Jane, Ross, Joy, Schwartzstein, Richard M., Similowski, Thomas, Simon, Steffen T., Smith, Tracy, Wells, Athol, Yates, Patsy, Yorke, Janelle, and Johnson, Miriam J.

Published
2016

20. The need to research refractory breathlessness (Letter to the Editor)

Author

Currow, David, Abernethy, Amy, Allcroft, Peter, Banzett, Robert, Bausewein, Claudia, Booth, Sara, Carrieri-Kohlman, Virginia, Davidson, Patricia M., Disler, Rebecca, Donesky, Doranne, Dudgeon, Deborah, Ekstrom, Magnus, Farquhar, Morag, Higginson, Irene, Janssen, Daisy, Jensen, Dennis, Jolley, Caroline, Krajnik, Malgorzata, Laveneziana, Pierantonio, McDonald, Christine, Maddocks, Matthew, Morelot-Panzini, Capucine, Moxham, John, Mularski, Richard A., Noble, Simon, O'Donnell, Denis, Parshall, Mark B., Pattinson, Kyle, Phillips, Jane, Ross, Joy, Schwartzstein, Richard M., Similowski, Thomas, Simon, Steffen T., Smith, Tracy A., Wells, Athol, Yates, Patsy, Yorke, Janelle, Johnson, Miriam J., Currow, David, Abernethy, Amy, Allcroft, Peter, Banzett, Robert, Bausewein, Claudia, Booth, Sara, Carrieri-Kohlman, Virginia, Davidson, Patricia M., Disler, Rebecca, Donesky, Doranne, Dudgeon, Deborah, Ekstrom, Magnus, Farquhar, Morag, Higginson, Irene, Janssen, Daisy, Jensen, Dennis, Jolley, Caroline, Krajnik, Malgorzata, Laveneziana, Pierantonio, McDonald, Christine, Maddocks, Matthew, Morelot-Panzini, Capucine, Moxham, John, Mularski, Richard A., Noble, Simon, O'Donnell, Denis, Parshall, Mark B., Pattinson, Kyle, Phillips, Jane, Ross, Joy, Schwartzstein, Richard M., Similowski, Thomas, Simon, Steffen T., Smith, Tracy A., Wells, Athol, Yates, Patsy, Yorke, Janelle, and Johnson, Miriam J.

Abstract

High-quality research is needed to improve quality of life for people with chronic refractory breathlessness in COPD http://ow.ly/Q2GDY

Published
2016

21. The need to research refractory breathlessness

Author

Currow, David C., primary, Abernethy, Amy P., additional, Allcroft, Peter, additional, Banzett, Robert B., additional, Bausewein, Claudia, additional, Booth, Sara, additional, Carrieri-Kohlman, Virginia, additional, Davidson, Patricia, additional, Disler, Rebecca, additional, Donesky, DorAnne, additional, Dudgeon, Deborah, additional, Ekstrom, Magnus, additional, Farquhar, Morag, additional, Higginson, Irene, additional, Janssen, Daisy, additional, Jensen, Dennis, additional, Jolley, Caroline, additional, Krajnik, Malgorzata, additional, Laveneziana, Pierantonio, additional, McDonald, Christine, additional, Maddocks, Matthew, additional, Morelot-Panzini, Capucine, additional, Moxham, John, additional, Mularski, Richard A., additional, Noble, Simon, additional, O'Donnell, Denis, additional, Parshall, Mark B., additional, Pattinson, Kyle, additional, Phillips, Jane, additional, Ross, Joy, additional, Schwartzstein, Richard M., additional, Similowski, Thomas, additional, Simon, Steffen T., additional, Smith, Tracy, additional, Wells, Athol, additional, Yates, Patsy, additional, Yorke, Janelle, additional, and Johnson, Miriam J., additional

Published
2015
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28. Chronic refractory dyspnoea: Evidence based management

Author

Wiseman, Rachel, Debra Rowett, Allcroft, Peter, Abernethy, Amy, and Currow, David

Subjects
Heart Failure, Pulmonary Disease, Chronic Obstructive, Benzodiazepines, Dyspnea, Morphine, General & Internal Medicine, Chronic Disease, Oxygen Inhalation Therapy, Quality of Life, Humans, Neurodegenerative Diseases, Walking, Lung Diseases, Interstitial
Abstract

Background: Chronic refractory dyspnoea is defined as breathlessness daily for 3 months at rest or on minimal exertion where contributing causes have been treated maximally. Prevalent aetiologies include chronic obstructive pulmonary disease, heart failure, advanced cancer and interstitial lung diseases. Objective: To distil from the peer reviewed literature (literature search and guidelines) evidence that can guide the safe, symptomatic management of chronic refractory dyspnoea. Discussion: Dyspnoea is mostly multifactorial. Each reversible cause should be managed (Level 4 evidence). Non-pharmacological interventions include walking aids, breathing training and, in chronic obstructive pulmonary disease, pulmonary rehabilitation (Level 1 evidence). Regular, low dose, sustained release oral morphine (Level 1 evidence) titrated to effect (with regular aperients) is effective and safe. Oxygen therapy for patients who are not hypoxaemic is no more effective than medical air. If a therapeutic trial is indicated, any symptomatic benefit is likely within the first 72 hours.

29. Academic detailing of general practitioners by a respiratory physician for diagnosis and management of refractory breathlessness: a randomised pilot study

Author

Debra Rowett, Aine Greene, Peter Allcroft, Aileen Collier, David C. Currow, Collier, Aileen, Rowett, Debra, Allcroft, Peter, Greene, Aine, and Currow, David C

Subjects
Male, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Palliative care, Alternative medicine, Pilot Projects, Health informatics, Health administration, Translational Research, Biomedical, Academic detailing, Nursing, General Practitioners, Surveys and Questionnaires, Advanced cancer, medicine, advanced cancer, Humans, Aged, general practice, Aged, 80 and over, palliative care, business.industry, Health Policy, Public health, Nursing research, breathlessness, Disease Management, Middle Aged, Dyspnea, Family medicine, Feasibility Studies, academic detailing, Female, General practice, business, Specialist Physician, Breathlessness, Specialization, Research Article
Abstract

Background: Academic detailing (AD; also known as educational visiting) facilitates the translation of evidence into practice and has been widely adopted internationally to facilitate practice change. The potential of AD linked to a specific patient and delivered by a specialist physician to general practitioners has not been evaluated. This pilot study assessed the feasibility and acceptability of AD on the knowledge and confidence of GPs caring for people with advanced cancer who had breathlessness at the end of life. Methods: In this randomised controlled pilot, 35 patient/GP dyads were randomised to AD or usual care. Key messages included: ensuring reversible causes were optimally treated; non-pharmacological and pharmacological treatments were considered; and oxygen considered for hypoxaemic patients. Results: Acceptability: The majority of GPs randomised to AD agreed to participate, reporting benefits to practice. The majority of GPs in the control group requested a copy of academic detailing written materials at study completion. Feasibility: AD visits to GPs' offices could be timetabled reasonably easily, with 24 detailing visits occurring. Self-reported knowledge and beliefs: Ninety two percent of GPs reported the topics covered in the AD sessions were useful, with 83 % reporting an increase in knowledge and confidence. AD sessions resulted in 58 % of GPs reporting a change in their approach to the management of breathlessness. By contrast, 81 % of the usual care group reported low confidence in the management and knowledge of breathlessness. Conclusion: AD was acceptable and feasible to participating GPs. This pilot supports proceeding to a fully powered study. Refereed/Peer-reviewed

Published
2015

30. Stigma and the in(visible) perspectives and expectations of home oxygen therapy among people with chronic breathlessness syndrome: A qualitative study.

Author

Breaden K, Collier A, Litster C, Allcroft P, Currow DC, and Phillips JL

Subjects
Adult, Age Factors, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Qualitative Research, South Australia, Chronic Disease psychology, Chronic Disease therapy, Dyspnea psychology, Dyspnea therapy, Home Nursing psychology, Oxygen Inhalation Therapy psychology, Social Stigma
Published
2019
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31. The need to research refractory breathlessness.

Author

Currow DC, Abernethy AP, Allcroft P, Banzett RB, Bausewein C, Booth S, Carrieri-Kohlman V, Davidson P, Disler R, Donesky D, Dudgeon D, Ekstrom M, Farquhar M, Higginson I, Janssen D, Jensen D, Jolley C, Krajnik M, Laveneziana P, McDonald C, Maddocks M, Morelot-Panzini C, Moxham J, Mularski RA, Noble S, O'Donnell D, Parshall MB, Pattinson K, Phillips J, Ross J, Schwartzstein RM, Similowski T, Simon ST, Smith T, Wells A, Yates P, Yorke J, and Johnson MJ

Subjects
Advance Care Planning, Dyspnea etiology, Humans, Pulmonary Disease, Chronic Obstructive complications, Research, Respiratory Therapy, Dyspnea therapy, Pulmonary Disease, Chronic Obstructive therapy
Published
2016
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