Using Single Patient Trials To Determine The Effectiveness Of Psychostimulants In Fatigue In Advanced Cancer Patients
Funder
National Health and Medical Research Council
Funding Amount
$162,563.00
Summary
The lack of good evidence in palliative care (PC) is widely acknowledged but research in PC is difficult. Methodological barriers include: difficulties in recruitment, high rates of attrition, problems with maintaining distinct and sustainable intervention strategies, poorly chosen outcomes and opposition to randomization. Organizational barriers include: lack of research infrastructure, few trained clinical researchers, prioritisation of clinical responsibilities and funding difficulties. The h ....The lack of good evidence in palliative care (PC) is widely acknowledged but research in PC is difficult. Methodological barriers include: difficulties in recruitment, high rates of attrition, problems with maintaining distinct and sustainable intervention strategies, poorly chosen outcomes and opposition to randomization. Organizational barriers include: lack of research infrastructure, few trained clinical researchers, prioritisation of clinical responsibilities and funding difficulties. The hierarchy of evidence rates RCTs as the gold standard. An alternative is the n-of-1 trial: a randomized, double-blind cross-over comparison of active drug with placebo or another drug. The patient is in effect their own control. N-of-1 trials provide an objective means of testing the effectiveness of medicines in individual patients, providing evidence stronger than RCT evidence for the efficacy of that drug in that particular individual. If multiple n-of-1 trials are conducted, the resultant data amounts to RCT evidence for that treatment in a population. We propose n-of-1 trials as a workable option for researching the benefit of drugs and other therapies in PC patients. If successful, this model could be accepted internationally as the gold standard for research in this difficult population group. This would be a world first and of great national and international significance. In advanced cancer, the prevalence of fatigue is very high at 60-90% and can be related to the treatment or the disease itself. The impact of fatigue on function (physical, mental, social and spiritual) and hence quality of life (QOL) is very significant for many palliative patients as well as their families-carers. The role of pyschostimulants in the management of fatigue in patients with advanced cancer and life limiting disease needs to be defined. We will conduct n-of-1 trials of psychostimulants (i.e. methylphenidate) for fatigue in a group of 40 patients, recruited from 5 sites around Australia through a national clinical trial network recently set up for palliative care research. Managing fatigue with treatment supported by the best possible evidence for individual patients and producing any improvement in fatigue will improve patients� functional status, and will greatly improve QOL for patients and carers.Read moreRead less
Renal Dialysis Abatement: Decision-making & Social Impact Of The Transition To Terminal Care
Funder
National Health and Medical Research Council
Funding Amount
$100,000.00
Summary
A study of the impact on patients and their families of the decision to stop kidney machine dialysis, and the transition to terminal care, either in an in-patient hospice-palliative care unit or domicillary service. The study will employ a combination of quantitative demographic and qualitative social science methodologies. There will be a special focus on the decision-making process, given that a dialysis cessation decision will usually lead to death within a few weeks.
Pilot Randomised Study Of Telemedicine Consultation Versus Face-to-face Consultation In Palliative Medicine
Funder
National Health and Medical Research Council
Funding Amount
$76,085.00
Summary
This study will compare the experiences of patients referred for a palliative care consultation who have a face - to - face consultation with a palliative care physician (PCP) in Dubbo versus those whose consultation is achieved via telemedicine with a PCP in Sydney but in the presence of a palliative care nurse in Dubbo. Immediately following the consultations and one week later, a research nurse will interview the patient and their care giver, and the palliative care nurse in attendance and th ....This study will compare the experiences of patients referred for a palliative care consultation who have a face - to - face consultation with a palliative care physician (PCP) in Dubbo versus those whose consultation is achieved via telemedicine with a PCP in Sydney but in the presence of a palliative care nurse in Dubbo. Immediately following the consultations and one week later, a research nurse will interview the patient and their care giver, and the palliative care nurse in attendance and the interview will be audio-recorded for subsequent detailed analysis. It is proposed to conduct 30 consultations in this study, and the results will inform the further development of a telemedicine palliative care consultative service.Read moreRead less
Palliative Care In Aged Care Facilities For Residents With A Non-cancer Diagnosis
Funder
National Health and Medical Research Council
Funding Amount
$70,000.00
Summary
Preliminary studies have suggested there may be deficiencies in the care of residents in aged care facilities who have advanced terminal illnesses other than cancer. Aged care residents do not have access to the expertise and resources available to clients of palliative care services where cancer is the major diagnosis. This study aims to investigate the extent and nature of any deficits experienced in aged care facilities and to employ palliative care standards to develop strategies so that any ....Preliminary studies have suggested there may be deficiencies in the care of residents in aged care facilities who have advanced terminal illnesses other than cancer. Aged care residents do not have access to the expertise and resources available to clients of palliative care services where cancer is the major diagnosis. This study aims to investigate the extent and nature of any deficits experienced in aged care facilities and to employ palliative care standards to develop strategies so that any unmet needs can be addressed.Read moreRead less
A Wireless Electric Nerve-guide For Peripheral Nerve Repair
Funder
National Health and Medical Research Council
Funding Amount
$805,064.00
Summary
We aim to deliver a radical new precision intervention for peripheral nerve repair to improve the lives of people with peripheral nerve damage. Drawing from our recently awarded work on 'electric neural tissue engineering', we will pre-clinically test our invention of a unique clinically-amenable electric nerve-guide (e-nerve-guide), designed to act as a protective nerve conduit and wirelessly electrically-stimulate damaged nerves for their regeneration and restoration of function.