ORCID Profile
0000-0002-8661-2221
Current Organisations
Eastern Health
,
La Trobe University
,
Monash University Eastern Health Clinical School
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Publications
Clinical care of pregnant and postpartum women with COVID‐19: Living recommendations from the National COVID‐19 Clinical Evidence Taskforce
Publisher: Wiley
Date: 29-10-2020
DOI: 10.1111/AJO.13270
How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/26323524211045996
Abstract: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Qualitative thematic analysis of semi-structured interviews. Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto ( n = 22) were interviewed in person or by phone. Participants included physicians ( n = 22), nurses ( n = 15), social workers ( n = 7), and allied health professionals ( n = 4). Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care.
Refractory hyperactive delirium in the dying: pharmacological management.
Publisher: BMJ
Date: 24-11-2022
DOI: 10.1136/BMJSPCARE-2021-003139
Abstract: Delirium is a prevalent clinical presentation in advanced illness. The hyperactive phase can cause severe symptoms at the end of life. There is no published study of the pharmacological management of this symptom in Australian palliative medicine practice. To describe the pharmacological management of hyperactive delirium at the end of life in an Australian inpatient palliative care setting. Retrospective audit of deaths from October 2019 where a medication of interest (MOI) was used following admission to the palliative care unit (PCU) of Eastern Health. The clinical notes of those included were reviewed to further describe the clinical details surrounding the use of the MOI. Forty patients were included. Midazolam was the most common medication used (57.5%). The most common dual agent combination was midazolam plus levomepromazine. This audit is the first description of pharmacological management of severe hyperactive delirium at the end of life requiring sedation in an Australian PCU.
Percutaneous Sacroplasty for Painful Bone Metastases: A Case Report
Publisher: Wiley
Date: 30-12-2017
DOI: 10.1111/PAPR.12538
Abstract: The occurrence of bone metastases is common in patients with advanced cancer. The literature supports percutaneous vertebroplasty and kyphoplasty as minimally invasive procedures to relieve pain and improve quality of life for selected patients with disabling pain from pathological vertebral fractures secondary to bone metastases. We describe a case of a 71-year-old patient with castrate-resistant metastatic prostate cancer who underwent sacroplasty for painful sacral metastases. The patient had previously been treated with maximally tolerated analgesics and anticancer therapies including systemic anticancer treatments and local radiotherapy. After sacroplasty, he experienced significant pain reduction and improvement in mobility and function. This case and recent literature demonstrate positive outcomes of sacroplasty in terms of pain reduction and improved mobility. Further research is warranted to establish the role of such minimally invasive percutaneous procedures for pain management in cancer patients.
Schwartz Rounds for Staff in an Australian Tertiary Hospital: Protocol for a Pilot Uncontrolled Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 20-11-2021
Abstract: chwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care. lthough Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia. his mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory–Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach. he study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021 study completion is anticipated by May 2022. he study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic. ustralian New Zealand Clinical Trials Registry ACTRN12621001473853 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769& isReview=true ERR1-10.2196/35083
Inpatients With Advanced Lung Cancer: Palliative Care Service Referral Rates, Symptom Profile, and Outcomes in a Teaching Hospital Network—An Exploratory Study
Publisher: SAGE Publications
Date: 11-2019
Hospital rapid response team and patients with life-limiting illness: A multicentre retrospective cohort study
Publisher: SAGE Publications
Date: 29-01-2015
Abstract: Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered. We aim to review the characteristics and compare outcomes of rapid response team consultations on patients with and without a life-limiting illness. A 3-month retrospective cohort study of all rapid response team consultations was conducted. The s le population included all adult inpatients in a major teaching hospital network. We identified 351 patients – including 139 with a life-limiting illness – receiving a total of 456 rapid response team consultations. The median time from admission to the first rapid response team consultation was 3 days. Patients with a life-limiting illness had a significantly higher mortality rate (41.7% vs 13.2%), were older (72.6 vs 63.5 years), more likely to come from a residential aged-care facility (29.5% vs 4.1%) and had a shorter hospital stay (10 vs 13 days). Rapid response team consultations resulted in a change to more palliative goals of care in 28.5% of patients, of whom two-thirds had a life-limiting illness. Patients with a life-limiting illness had worse outcomes post–rapid response team consultation. Our findings suggest that a routine clarification of goals of care for this cohort, within 3 days of hospital admission, may be advantageous. These discussions may provide clarity of purpose to treating teams, reduce the burden of unnecessary interventions and promote patient-centred care agreed upon in advance of any deterioration.
Transcutaneous drainage of lymphatic fluid - a novel technique for management of peripheral oedema in palliative care
Publisher: Wiley
Date: 05-2013
DOI: 10.1111/IMJ.12153
Complex conversations in a healthcare setting: experiences from an interprofessional workshop on clinician-patient communication skills
Publisher: Springer Science and Business Media LLC
Date: 14-06-2021
DOI: 10.1186/S12909-021-02785-7
Abstract: Communication is pivotal to the effective care and treatment of patients in our health care systems. Despite this understanding, clinicians are not sufficiently educated to confidently conduct complex discussions with patients. Communication skills workshops have been shown to be an effective educational format to improve clinician skills. However, despite the increasing interprofessional focus within modern medicine, there have been few studies looking at interprofessional communication workshops. A qualitative study was conducted to assess how an interprofessional communication skills workshop affected the communication skills of clinicians at a tertiary health service. Pre- and post-workshop surveys were undertaken by participants, followed by focus group interviews eight-weeks post workshop. Clinicians were able to incorporate learnt communication skills into their daily practice. This was associated with an improvement in confidence of clinicians in having complex discussions, in addition to a reduction in the burden of having complex discussions. Participants responded positively to the interdisciplinary format, reporting benefits from the learning experience that translated into daily practice. Clinicians’ communication skills in conducting complex clinician-patient conversations can be improved by participation in interprofessional communication skills workshops. We identified that the interprofessional aspect of the workshops not only improved interprofessional understanding and relationships, but also developed increased self-awareness during complex discussions, and reduced the sense of burden felt by clinicians.
Ketamine and cancer pain: The reports of my death have been greatly exaggerated
Publisher: American Society of Clinical Oncology (ASCO)
Date: 04-2013
Navigating the complexities of voluntary assisted dying in palliative care
Publisher: AMPCo
Date: 23-08-2020
DOI: 10.5694/MJA2.50729
Critical appraisal of randomized controlled trials: The beginning of thought ⋯
Publisher: Elsevier BV
Date: 04-2014
The use of moderately hypofractionated post-operative radiation therapy for breast cancer in clinical practice: A critical review
Publisher: Elsevier BV
Date: 12-2020
Cancer patients’ perceptions of palliative care
Publisher: Springer Science and Business Media LLC
Date: 19-06-2020
DOI: 10.1007/S00520-019-04917-8
Abstract: Despite clear benefits of early integration of palliative care (PC) and oncology, concerns remain about negative perceptions of PC. Our aim was to explore current knowledge and perceptions of PC in cancer patients. We conducted a prospective, cross-sectional survey. A 16-item questionnaire was distributed to all cancer patients (N = 103) upon admission to the oncology ward of an Australian tertiary academic hospital. Chi-squared test was used to examine for significant factors related to patients' perceptions. Ninety-six patients (93%) completed the questionnaire 76% had metastatic cancer. We explored the following domains:Experience and knowledge: 76% had heard of PC 21% had received PC. Self-rated PC knowledge was varied. Forty-five percent believed that PC was only associated with EOLC those more likely to disagree had received PC services (p = 0.039).Integration of PC and oncology: Majority believed that they could receive oncology care (86%) and anti-cancer treatment (81%) whilst receiving PC. Those who had heard of PC and with better self-rated knowledge were more likely to believe that they could receive concurrent anti-cancer treatment (p = 0.005, p = 0.045, respectively).Feelings: 77% felt comforted with PC involvement this was significantly associated with older age (p = 0.047) and understanding that oncology (p < 0.005) and anti-cancer treatment (p = 0.013) could continue. However, some felt frightened (40%) and hopeless (29%) about referral to PC. Fifty percent felt more comfortable with referral to 'supportive care' services (versus PC). Our survey demonstrates reasonable understanding and relatively positive feelings about PC, associated with experience and knowledge. Nonetheless, there is ongoing need for better patient and public education about PC.
CYP2B6∗6 allele and age substantially reduce steady-state ketamine clearance in chronic pain patients: Impact on adverse effects
Publisher: Wiley
Date: 06-2015
DOI: 10.1111/BCP.12614
Non-palliative care staff need to deliver generalist end of life care
Publisher: BMJ
Date: 20-05-2014
DOI: 10.1136/BMJ.G3426
Insights into hospitalisation of advanced cancer patients: a study of medical records
Publisher: Hindawi Limited
Date: 22-04-2015
DOI: 10.1111/ECC.12295
Abstract: The aim of this study was to explore reasons for the hospitalisation and place of death outcomes of terminal cancer patients. The methodology involved a qualitative content analysis of medical records pertaining to the last 3 months of life of 39 patients with one of four malignancies: prostate, breast, lung, or haematological. The results presentation is organised around three themes: decision hierarchy in health care, meanings of 'home', and late recognition of dying. Based on the detailed findings, this paper suggests that important insights into the broader goals of advanced cancer patients are offered by allied health staff, and that more effective use of the multidisciplinary team may support endeavours to achieve more home deaths for cancer patients who want this outcome. The analysis also provides new insights into the meaning of 'home' in interactions between advanced cancer patients and health professionals. The wish for 'home' appears bound up with other patient goals and the implications of this are discussed.
Transfer to a Preferred Place of Death
Publisher: Springer International Publishing
Date: 2018
Successful large volume ‘lymphocentesis’ for refractory lymphoedema in lower and upper limbs
Publisher: Wiley
Date: 05-2017
DOI: 10.1111/IMJ.13410
Hip fractures and dementia: clinical decisions for the future
Publisher: Oxford University Press (OUP)
Date: 02-2016
DOI: 10.1093/OMCR/OMW001
Bilateral cordotomy post-failure of intrathecal analgesia in a palliative care setting
Publisher: Wiley
Date: 05-2015
DOI: 10.1111/IMJ.12743
Symptom trajectories for palliative care inpatients with and without hyperactive delirium in the last week of life
Publisher: Wiley
Date: 12-07-2022
DOI: 10.1111/JAN.14966
Abstract: Hyperactive delirium (HD) is a common and distressing symptom among palliative care patients. This study aimed to describe the characteristics of HD and associated symptoms among palliative care inpatients and evaluate relationships between HD development and symptom trajectories in this population. A retrospective study was conducted. A retrospective review of medical records was conducted for all patients who died in a large Australian specialist palliative care unit between 1 January and 31 December 2019. Patients were assessed daily using the Symptoms Assessment Scale (SAS) and Palliative Care Problem Severity Scale (PCPSS). Multilevel models were used to estimate the differences in symptoms trajectories in the last 7 days of life between the two groups. Of the 501 included patients, 64.5% (323) had an episode of HD. For 30% (95) of patients, HD occurred prior to admission. Compared with patients without HD, those with HD had significantly higher odds ratios (ORs) for four of the seven SAS symptoms (sleep problems, appetite, fatigue and pain OR range: 1.94-4.48, p < .05), and all four PCPSS items (OR range: 2.00-3.00, p < .05) in the last week of life. Palliative care inpatients commonly experience HD in their last week of life. There are higher levels of symptom distress, complexity, psychological concerns and family/carer concerns among patients with HD compared with those without HD. The high prevalence of HD, and its association with higher levels of symptom distress, highlights the importance of routine screening and optimal management for HD among palliative care patients. Given the widely recognized challenges facing palliative care professionals in assessment and management of delirium, provision of relevant training among these professionals is recommended.
Management of breakthrough pain in patients with cancer
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.2165/00003495-200868070-00003
Abstract: Breakthrough pain (BTP) in patients with cancer lacks a consensus definition and is subsequently inadequately diagnosed and assessed, therefore making it more challenging to manage. Cancer pain is generally moderate to severe in intensity and persistent in nature. Despite the problematic definition of BTP, it is generally described as having similar intensity, but may also be transitory and variable in predictability. Most breakthrough analgesia fails to be effective in the time required for BTP. No useful analgesia is therefore provided but drug adverse effects escalate. Cancer pain management relies on the WHO analgesic ladder. The frequency of BTP and its inadequate management means that it has significant adverse effects on patients, their families and those involved in their care. This article outlines a systematic, clinical and evidence-based approach to managing BTP in patients with cancer that emphasizes a holistic approach and an understanding of multidimensional 'total pain'. Guidelines for managing BTP are presented and areas of developing research are identified.
Psycho-Existential Symptom Assessment Scale (PeSAS) Screening in Palliative Care
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.JPAINSYMMAN.2022.08.002
Abstract: Psycho-existential symptoms are common yet often missed or neglected in palliative care. Screening can be an effective way to recognize and respond to this need. We aimed to implement routine use of the Psycho-existential Symptom Assessment Scale (PeSAS) as a screening tool in Australian palliative care services and discern the symptom prevalence identified. In a multi-site rolling design, we established implementation site committees and embarked on experiential workshops to train clinicians in the tool's efficient use. Patient symptom prevalence data were collected to compare uptake across sites. Descriptive statistics were applied. Over one year, we trained 216 clinicians across six palliative care services in the use of the PeSAS as a screening tool and collected data from 1405 patients. Clinicians reported significant growth in their sense of efficacy in assessing psycho-existential wellness. Services using electronic records implemented most easily. Psycho-existential symptoms with clinically significant prevalence (scores ≥ 4/10) included anxiety 41.1%, discouragement 37.6%, hopelessness 35.8%, pointlessness 26.9%, depression 30.3%, and the wish to die 17%. The precision of measurement within 3% was found for severe ratings (score ≥ 8/10) including anxiety 10.6%, depression 10.2%, the wish to die 7.6%, and confusion 3.6%. Clinicians can be trained to screen with the Psycho-existential Symptom Assessment Scale, which serves as a valuable measure to better recognize symptoms of psycho-existential distress among palliative care patients. Implementation barriers included the prior ethos of the service, confidence in talking about these themes, electronic data entry, and perceived time pressures.
Predictors of functional recovery in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.CPR.2017.09.007
Abstract: Three out of four first-episode psychosis (FEP) patients achieve clinical remission following treatment. Unfortunately, functional recovery lags behind symptomatic remission, and many in iduals with FEP remain socially isolated with poor functional outcomes. To systematically compile and analyse predictors of functional recovery in FEP. Systematic review and meta-analysis of peer-reviewed, longitudinal studies reporting predictors of functioning, with a minimum 12-month follow-up and at least 80% of participants diagnosed with FEP. Out of 2205 citations, 274 articles were retrieved for detailed evaluation resulting in 50 eligible studies (N=6669). Sociodemographic, clinical, physical and neuroimaging variables had little impact on long-term functioning. Conversely duration of untreated psychosis (DUP), most cognitive variables, and concurrent remission of positive and negative symptoms were independently related to functional recovery. These findings strongly support the rationale for early intervention in FEP. Novel treatments targeting cognitive deficits may improve functional outcomes in FEP.
Acute Cancer Pain Syndromes in Palliative Care Emergencies
Publisher: Springer International Publishing
Date: 2018
Dexamethasone for cancer-related fatigue
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-02-2014
Perspectives of cancer treatment providers regarding voluntary assisted dying in Victoria
Publisher: Wiley
Date: 07-2018
DOI: 10.1111/IMJ.13939
Abstract: A survey of cancer treatment providers at our institution exploring their perspectives regarding voluntary assisted dying in Victoria and the imminent legislation showed that while almost all were aware of the Bill (92%), reported knowledge and understanding of it was much less (38%). As many clinicians supported the Bill as opposed it (28%) 44% were uncertain of their stance. Most were unwilling to directly provide voluntary assisted dying if they did, would refer to palliative care services for ongoing support.
Schwartz Rounds for Staff in an Australian Tertiary Hospital: Protocol for a Pilot Uncontrolled Trial
Publisher: JMIR Publications Inc.
Date: 27-04-2022
DOI: 10.2196/35083
Abstract: Schwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care. Although Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia. This mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory–Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach. The study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021 study completion is anticipated by May 2022. The study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic. Australian New Zealand Clinical Trials Registry ACTRN12621001473853 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769& isReview=true DERR1-10.2196/35083
Related Organisations
Royal College Of General Practitioners
Location: United Kingdom of Great Britain and Northern Ireland
Royal London Hospital
Location: United Kingdom of Great Britain and Northern Ireland
University Of St Andrews
Location: United Kingdom of Great Britain and Northern Ireland
University Of Southampton
Location: United Kingdom of Great Britain and Northern Ireland
Cardiff University
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Leeroy William.