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Palliative Medicine ResearchThe National Agenda and Lancaster Initiatives
Mike BennettProfessor of Palliative Medicine
Lancaster University
Outline
• A short history lesson
• Current activity
• Future directions
Before 1987…
• Single centre studies
• Largely observational
• Charismatic champions of research
• Cicely Saunders original vision– clearly stated research is
integral to hospice care
• Early examples– John Hinton
• Robert Twycross
• The first RCT in palliative care?
Br J Pharmacol. 1972 November; 46(3): 554P–555P.
1987 - 2000
• Palliative Care Research Society– Formed as PCRF in 1995– dedicated to promoting research into all aspects
of palliative care and to facilitating its dissemination.
• EAPC research forum – First meeting in Berlin 2000– HQ in Trondheim, Norway (Prof Stein Kaasa)
1987 - 2000
• In 1988– Zero academic chairs in palliative medicine
• In 1998– 5 substantive academic chairs in palliative
medicine (not honorary)• London (2) - Kings, St Thomas’• Bristol, Cardiff, and Sheffield
1987 - 2000• Steady output of
descriptive research
• Few RCTs, all around service delivery
Palliat Med. 1995 Jan;9(1):27-35. LinksRegional Study of Care for the
Dying: methods and sample characteristics.
Addington-Hall J, McCarthy M.
British Journal of Cancer (2002) 87, 733-739.
The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team
G W Hanks et al
2000 - 2008Strategic initiatives
• 2001– NCRI formed and
established Strategic Planning Group for palliative care research (2002)
• 2003– Palliative Care clinical
studies group formed within NCRN
2000 - 2008
• 2006– Additional funding for 2 ‘SuPaC’ research
collaboratives (£1.9m each over 5 years)
2000 - 2008
• COMPASS:– COMPlex Interventions: Assessment, TrialS and
Implementation of Services• www.compasscollaborative.com
• CECo – Cancer Experiences Collaborative• www.ceco.org.uk
2000 - 2008Research priorities
• Yorkshire scoping exercise– Symptoms– Service delivery– Poor capacity
• but better in hospices
• Other surveys– ‘Coal face workers’
• symptom management dominates– ‘Ivory tower academics’
• Methodological issues e.g. outcomes assessment, design
Current activity
• In 2008– 10 academic chairs– New posts • Liverpool (2), Edinburgh (2), Lancaster
Current activity
• NCRN Palliative Care group– 4 subgroups• Pain (Prof Fallon)• Prognostication (Dr Stone)• Breathlessness (Dr Booth)• Cachexia (Dr Wilcock)
Future challenges
• Intervention studies– testing hypotheses– answering important clinical questions about
therapies
• Multicentre studies– conducting research effectively– answering questions with greater power– harnessing potential of hospices
Future challenges
• Primary palliative care – Service delivery• Including symptom control at home
– Integration of ‘community’ services• Primary care• Hospice services• Community specialist nurses
Future challenges
• End of life care strategy – Prognostication
– Service delivery for patients at home• or ‘in the community’
Lancaster initiatives
• International Observatory on End of Life Care
Lancaster initiatives
Current themes and activities
• 1. Cancer pain– 1.1. Older people’s experiences– 1.2. Educational interventions– 1.3. TENS clinical trial– 1.4. QST to determine analgesic therapy
• 2. End of Life Care– 2.1. Screening for psychological distress– 2.2. Impact of information on rehydration decisions
The vision• Create network of research active hospices in
North Lancashire and Cumbria
• Undertake UKCRN portfolio research studies– locally developed – contribute to multicentre recruitment
• Building capacity – involving clinical staff in research– integrating research activity and findings into routine
palliative care services
Network of research active hospices
• Core funding from Cumbria and Lancashire CLRN to support 3 hospices– £55k per year for 3 years– Lancaster, Blackpool, Preston– Consultant sessions – Full time health research practitioner• Will co-ordinate governance and management of
studies• Attract additional research support staff
Lancaster initiatives
Network studies• CR-UK TENS– Feasibility study
nearing completion
– RCT starting early 2009
Network studies
• DVD trial – Brief educational
intervention for cancer pain
– Feasibility study underway
– RCT planned early 2009
• Links with industry• Increased capacity for pharma trials
– Nasal fentanyl for breakthrough pain– Methylnaltrexone for opioid induced constipation
• Contributing to other multicentre UKCRN trials• Fatigue
– Using exercise as an outcome measure • Breathlessness
– RCT of fan for breathlessness• Pain
– S-ketamine in cancer neuropathic pain
Network studies
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