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Implementing and sustaining an evidence base for the assessment and management of cancer pain, in palliative domiciliary patients

Implementing and sustaining an evidence base for the assessment and management of cancer pain, in palliative domiciliary patients


Outline, including interdisciplinary dimension

Pain occurs in up to 70% of patients with advanced cancer. Despite best practice guidelines and policy at local, national and international level, poorly controlled pain is common in patients with advanced cancer.  Poorly managed cancer pain is an important quality-of-care outcome and a high priority for patients, lay and professional carers, and health care policy maker. Additionally, with health policy increasingly focusing on enabling patients to die at home, health care professionals who care for domiciliary patients are increasingly responsible for symptom management of patients near the end of life.

This PhD study will explore provider attributes; conditions in the practice environment and processes of care which undermine and facilitate adherence to good practice for palliative cancer pain assessment and management. In line with policy direction and reflective of recent research this PhD study will focus on domiciliary care provision in Northern Ireland. The study will use mixed methods guided by normalization process theory. Data will be gathered from interdisciplinary domiciliary care providers, including specialist and generalist palliative healthcare professionals. Participants will represent all disciplines of care providers in the domiciliary palliative care setting who routinely deal with pain assessment and management for patients with advanced cancer. Data will be gathered using survey, semi-structured interviews and document review. Analysis will identify factors which influence practice for palliative cancer pain assessment and management.

Implications from this research will identify strategies to positively impact on care in relation to this highly prevalent and distressing symptom in palliative care.

Key words/descriptors

cancer, pain, interdiscplinary, international

First supervisor

Dr Joanne Reid - School of Nursing and Midwifery

Secondary supervisor from a complementary discipline

Professor Kevin Brazil - School of Nursing and Midwifery

Dr Sharon Kaasalainen - McMaster University, Canada

Supervisors’ track record of PhD completions, plus excellence and international standing in the project area

Professor Brazil, Dr Kaasalainen and Dr Reid have all have supervised candidates through to completion of PhDs. All supervisors have publications and grant income from palliative care research.  All have delivered invited presentations at international conferences and public lectures on their research in end of life care.

Intersectoral exposure and/or international mobility

(e.g. secondments to/collaboration with partner organizations)

The PhD candidate would be encouraged to apply for the annual School of Nursing and Midwifery Marcia Mackie Studentship to undertake an exchange program to aid collaboration with Dr Kaasalainen. During these visits it is envisaged the PhD candidate would work closely with Dr Kaasalainen to facilitate learning between different cultures and contexts. It will also help the PhD candidate to establish a professional network for their future career in palliative care research. The PhD candidate will join existing monthly meetings via teleconference between QUB and Dr Kaasalainen for discussions on ongoing collaborative research between the two institutions.

Describe briefly the international profile of the partner

Dr. Sharon Kaasalainen is currently an Associate Professor in the School of Nursing, Associate Member of the Department of Family Medicine at McMaster University and an Honorary Professor with the School of Nursing and Midwifery at Queen’s University Belfast. She completed a Canadian Health Services Research Foundation postdoctoral fellowship and held an Ontario Ministry of Health and Long Term Care Career Scientist award from 2009-2013. Her research program is focused on improving the quality of life for people living in long term care (LTC) homes. She is currently Co-PI on a TVN-funded Strategic Impact Grant, “Improving Palliative Care in Long Term Care Homes Using a Participatory Action Approach”. Other areas of interest include examining the role of nurse practitioners in LTC and improving quality of palliative care in rural communities and LTC homes.

Training that will be provided through the research project itself

The School of Nursing and Midwifery at Queen’s University provides a comprehensive suite of training for postgraduate research students. This will include two Master’s level modules on qualitative and quantitative methods. Additionally, PhD candidates attend a fortnightly series of methodological master classes given by School research staff, and a fortnightly PhD student journal club aimed at developing critical thinking throughout tenure as a student. Regular research seminars by international academics will include experts on cancer and supportive care.

Examples of additional training in non-research transferable skills

The PhD candidate will be exposed to seminars delivered by the School of Nursing and Midwifery that will provide training in:  time management; entrepreneurial activity; self-awareness and the ability to identify own training needs; management (organisational skills, time and project management); personal effectiveness (open-mindedness, self-discipline); communication skills, networking and team working skills; and career management.

Expected dissemination of results: peer-reviewed journals, seminars, workshop and conferences at European/international level

(e.g. public talks, visits to schools, open days, QUB impact showcase)

Dissemination will take place locally, nationally and internationally. Locally though presentations to health care professionals and lay carer groups who provide care for these clients. Nationally and internationally dissemination will be though presentation at international conferences, such as the European Association of Palliative Care International Conference. Furthermore publications will be submitted to high quality peer revised journals, including open access journals such as BMC Palliative Care.

Expected impact activities

(e.g. public talks, visits to schools, open days, QUB impact showcase)

This research will be showcased at annual School of Nursing and Midwifery open days. The School also has close liaison with secondary schools and health Trusts and this research will feature in the annual road shows to both groups. Furthermore, it is expected that the PhD candidate will apply for the annual Marcia Mackie Travel Studentship and provide public lectures in the collaborating institution.