Case conferences in palliative care - a substudy of a cluster randomised controlled trial.

Background: In palliative care, case conferences have demonstrated improved maintenance of function and a significant reduction in hospitalisations. This study aimed to define the content and themes of palliative care case conferences.

Methods: This was a substudy of a cluster randomised controlled trial.

Palliative care case conferencing involving general practice: an argument for a facilitated standard process.

Objective: To discuss the results of a qualitative analysis of the group dynamics of General Practitioner (GP)-led case conferences for palliative care patients, where the GP becomes the care coordinator. Two outcomes are sought: (1) raise the understanding of this type of case conferencing for palliative care patients; and (2) recommend improvements to this process that will positively affect its efficacy.

Methods: Original data is the qualitative component of quantitative and qualitative study of 17 GP-led case conferences for palliative care patients.

Designing and conducting randomized controlled trials in palliative care: A summary of discussions from the 2010 clinical research forum of the Australian Palliative Care Clinical Studies Collaborative.

Rigorous clinical research in palliative care is challenging but achievable. Trial participants are likely to have deteriorating performance status, co-morbidities and progressive disease. It is difficult to recruit patients, and attrition unrelated to the intervention being trialled is high.

Planning phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations.

Goals Of Work: Multiple sites enable more successful completion of adequately powered phase III studies in palliative care. Audits of the frequency and distribution of the symptoms of interest can better inform research planning by determining realistic recruitment goals for each site. The proposed studies are to improve the evidence-base for registration and subsidy applications for frequently encountered symptoms where current pharmacological interventions are being used 'off-licence'.

Multidisciplinary care planning and teamwork in primary care.

Objective: To examine policy and implementation issues around multidisciplinary care planning (MDP) as a means of improving outcomes for patients with chronic disease and/or complex care needs.

Methods: We conducted a series of five systematic reviews of the literature from 1990 to 2006, sampling a spectrum of issues associated with chronic disease and complex health care needs, with a focus on planning and provision of multidisciplinary care.

Results: Our review showed that MDP does improve many functional outcomes in the areas studied.

Promoting patient centred palliative care through case conferencing.

Background: What are the characteristics of case conferences between general practitioners and specialised palliative care services (SPCS)?

Methods: Study participants were adults (N=461) with pain in the preceding 3 months who were referred to a SPCS and their GPs (N=230). Patients were randomised to case conferences or routine care by SPCS.

Results: One hundred and sixty-seven conferences were held; 46 patients withdrew and 142 died before the conference could be conducted.

Prescribing in palliative care as death approaches.

Objectives: To determine how prescribing for comorbid illnesses and symptom control changes during the palliative phase of a terminal illness.

Design: This prospective cohort study explores the relative contribution to prescribing of symptom-specific medications (SSMs) and long-term medications for comorbid medical conditions.

Setting: Regional consultative palliative care program, Adelaide, South Australia.

Handheld computers for data entry: high tech has its problems too.

Background: The use of handheld computers in medicine has increased in the last decade, they are now used in a variety of clinical settings. There is an underlying assumption that electronic data capture is more accurate that paper-based data methods have been rarely tested. This report documents a study to compare the accuracy of hand held computer data capture versus more traditional paper-based methods.

The impact of conducting a regional palliative care clinical study.

End-of-life care must be informed by methodologically rigorous, high-quality research, but well-documented barriers make the conduct of palliative care clinical trials difficult. With careful consideration to study design and procedures, these barriers are surmountable. This paper discusses the approach used in a large scale, randomised, controlled trial of service-based interventions in a regional palliative care service in South Australia, and the impact of this trial on palliative care research more broadly, the changes to the service in which it was conducted, and on health policy beyond palliative care.

Impact of single dose azithromycin on group A streptococci in the upper respiratory tract and skin of Aboriginal children.

Background: Aboriginal children living in remote Australia experience high rates of bacterial infection such as trachoma, otitis media and streptococcal skin infection, which often progress to associated chronic diseases in later life.

Methods: In February, 1995, single dose azithromycin was given to 130 Aboriginal children with trachoma and their contacts. The impact of this program on respiratory and skin group A Streptococcus pyogenes carriage and infection was also monitored.