Brian Le

Brian Le
The Royal Melbourne Hospital | RMH · Department of Palliative Care

MBBS(Hons), MPH, FRACP, FAChPM

About

122
Publications
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894
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Publications

Publications (122)
Article
Background: Recruitment of participants for clinical trials remains a key consideration for investigators. This is particularly relevant in palliative care, where practitioners are sometimes reluctant to refer patients for consideration of enrolment. Reasons for this reluctance range from concerns about excessive burden to patients, through to deba...
Article
Context : Guidelines exist to direct end-of-life symptom management in COVID-19 patients. However, the real-world symptom patterns, and degree of concordance with guidelines on medication use, and palliative care involvement has received limited attention. Objectives : To describe the evolution of COVID-19 symptoms, medication used to alleviate th...
Article
Background: COVID-19 has led to challenges in providing effective and timely communication in healthcare. Services have been required to adapt and evolve as successful communication remains core to high quality patient-centred care. Aim: This study aims to describe the communication between admitted patients, their families and clinicians (medic...
Article
Full-text available
Background People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deli...
Article
Full-text available
Introduction: Management of neuropathic cancer pain (NCP) refractory to regular opioids remains an important challenge. The efficacy of pregabalin for NCP except chemotherapy-induced peripheral neuropathy (CIPN) has already been confirmed in two randomised controlled trials (RCTs) compared with placebo. Duloxetine offers the potential of analgesia...
Article
Background Chronic heart failure has a high mortality and early provision of palliative care supports complex decision-making and improves quality of life. Aim To explore whether and when a palliative approach was adopted during the last 12 months of life in patients who experienced an in-hospital death from heart failure. Design Retrospective me...
Article
In Australia, cancer is the second leading cause of death in adolescents and young adults (AYA). In an audit of 76 AYA decedents known to a comprehensive cancer center, most were male (63%), and most had a parent as primary carer (78%). Median age at diagnosis was 21 years (range: 15–27). Median time from diagnosis to first palliative care consulta...
Article
Clinical trials are a key component of expanding the evidence base in palliative care. A key strategic objective of the Victorian Comprehensive Cancer Centre (VCCC), a multisite cancer center alliance, was to increase palliative care clinical trial expertise. The palliative care services within the VCCC alliance presented substantial trial developm...
Preprint
Full-text available
Background Access to palliative and end-of-life care for people with dementia living in nursing homes is suboptimal. Nursing home staff require training in palliative care for dementia to equip them with knowledge and skills to deliver high quality care. Objective The primary aim was to evaluate the effectiveness of a simulation training interventi...
Article
Use of medical device technologies for diabetes mellitus, including continuous glucose monitoring devices, is becoming more frequently encountered in end-of-life care. Good communication is paramount to determine patient and carer preferences for if, when, and how blood glucose monitoring should occur in the end-of-life setting. We present two diff...
Poster
Full-text available
The poster describes palliative care referral and end of life patterns for a cohort of adolescent and young adult decedents known to a comprehensive cancer centre.
Article
Regulatory changes now permit the availability and prescribing of medicinal cannabis in Australia. Public awareness and patient interest are high. Using a co-design approach involving cancer patients, carers and oncology and palliative care clinicians, two information resources were developed to provide readily available sources of important inform...
Article
Full-text available
Background Current international consensus is that ‘early’ referral to palliative care services improves cancer patient and family carer outcomes. In practice, however, these referrals are not routine. An approach which directly addresses identified barriers to early integration of palliative care is required. This protocol details a trial of a sta...
Article
Background Advance care planning (ACP) is important, however ethnic minorities have half the completion rates in the United States compared to Caucasian counterparts, and in Australia only 3.5% of advance directives were completed by those overseas-born.Educational intervention improves ACP knowledge and subsequent uptake. We evaluated immediate an...
Article
Full-text available
Opioids such as oxycodone are recommended in the management of moderate‐to‐severe, chronic cancer pain. All opioids can potentially cause constipation, which may be a significant barrier to their use. Multiple randomised clinical trials have shown that the use of naloxone as a peripherally acting mu‐opioid receptor antagonist, in combination with o...
Article
Background Descriptions of symptoms and medication use at end‐of‐life in COVID‐19 are limited to small cross‐sectional studies, with no Australian longitudinal data. Aims To describe end‐of‐life symptoms and care needs of people dying of COVID‐19. Methods This retrospective cohort study included consecutive admitted patients who died at a Victori...
Article
Background The Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool is a novel, evidence-based tool by which specialist palliative care services can manage waiting lists and workflow by prioritising access to care for those patients with the most pressing needs in an equitable, efficient and transparent manner. Aim This study aime...
Article
Background Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications. Aims To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (pri...
Article
Context: Patients with advanced chronic obstructive pulmonary disease (COPD) can develop increasing breathlessness, which can persist despite optimal medical management-refractory breathlessness. Management can be challenging for all clinicians and requires a broad approach that includes optimization of disease directed therapies, non-pharmacologi...
Article
Background The need for healthcare workers (HCWs) to have skills and knowledge in non-cancer palliative care has been recognised. Simulation is increasingly being used for palliative care training, offering participants the opportunity to learn in a realistic environment and fully interactive way. Objective The aim of this systematic review was to...
Article
Following legislative changes in the availability and prescribing of medicinal cannabis in Australia, we sought to understand prospectively the nature of information seeking and requests for medicinal cannabis in consultations between palliative care clinicians and patients with cancer. The 104 discussions were overwhelmingly initiated by patients...
Article
The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a F...
Article
Full-text available
Objective: The cancer care coordinator (CCC) role has become a priority in providing coordinated, patient-centered, supported care for patients, and their families experiencing cancer. The CCC role exists with heterogeneity across tumor streams, clinical disciplines, and institutions. This study explored CCCs perceptions and experiences of their r...
Article
Context: Evidence-based resource allocation is receiving increasing attention as we strive for equity, transparency, and cost-effectiveness across health care. In the context of finite resources, which of our patients with terminal illness should be prioritized for urgent palliative care? Objectives: To develop the scoring system for the novel R...
Article
Full-text available
Background Current international consensus is that ‘early’ referral to palliative care services improves cancer patient and family carer outcomes; however, in practice, these referrals are not routine. Uncertainty about the ‘best time’ to refer has been highlighted as contributing to care variation. Previous work has identified clear disease-specif...
Article
This case study describes the involvement of a patient representative on a palliative care committee and outlines some of the issues that arose as her health deteriorated. A summary of the increasing involvement of patient representation within health care governance is provided, and some of the challenges raised by the case, many of which may be r...
Article
Transdermal buprenorphine (TDB) has demonstrated effectiveness in treating a range of chronic pain conditions, including cancer pain, nociceptive pain, and neuropathic pain and has a favorable safety profile. Worldwide, clinical experience of its use is relatively limited. There is considerable misunderstanding about the pharmacology, mechanism of...
Article
Objective:: This article sought to explore ethical issues associated with prioritization decisions in palliative care. Methods:: As part of a broader series of studies of triage in palliative care, this qualitative substudy was conducted via semi-structured focus groups and individual interviews. Transcripts were subjected to thematic analysis....
Article
Rapid change, treatment responsiveness, and prognostication difficulties present challenges for palliative care integration for hematology patients. This Australian study aimed to document end-of-life hospital care for patients with non-Hodgkin lymphoma (NHL) to consider opportunities for palliative care integration. A retrospective population coho...
Article
Background There is increasing recognition that patients with non-malignant diseases have comparable physical and psychosocial symptom burden to patients with cancer. There is currently limited data directly comparing symptom burden between these patient groups. Objective To investigate differences in symptom burden between patients with malignant...
Article
Full-text available
Introduction Delirium is a significant medical complication for hospitalised patients. Up to one-third of delirium episodes are preventable in older inpatients through non-pharmacological strategies that support essential human needs, such as physical and cognitive activity, sleep, hydration, vision and hearing. We hypothesised that a multicomponen...
Article
Full-text available
Background The Advanced Lung Disease Service is a unique, new model of integrated respiratory and palliative care, which aims to address the unmet needs of patients with advanced, non-malignant, respiratory diseases. This study aimed to explore patients’ and carers’ experiences of integrated palliative care and identify valued aspects of care. Met...
Article
Objective As referrals to specialist palliative care (PC) grow in volume and diversity, an evidence-based triage method is needed to enable services to manage waiting lists in a transparent, efficient, and equitable manner. Discrete choice experiments (DCEs) have not to date been used among PC clinicians, but may serve as a rigorous and efficient m...
Article
Full-text available
Background:: Distressing and potentially life-threatening events, such as significant external bleeding, may occur in patients with a known terminal condition. These events are often referred to as catastrophic or crisis events. Pharmacological management varies and there is little evidence to guide practice. Aim:: The aim of this study was to e...
Article
Objectives To describe health service use, symptom and survival characteristics in mPCA in order to outline usual care practices and identify future opportunities to improve the quality of care in this patient group. Patients and methods This population cohort study, conducted in Victoria, Australia, used 10 years (2000‐10) of linked hospital disc...
Poster
Full-text available
Distressing and potentially life-threatening events, such as significant external bleeding, may occur in patients with a known terminal condition. Pharmacological management varies and there is little evidence to guide practice. The objective of this study was to explore Australian and New Zealand palliative medicine doctors' approaches to pre-empt...
Article
Background: Palliative care services face the challenge of a workload increasing in volume and diversity. An evidence-based triage method to assess urgency of palliative care needs is required to ensure equitable, efficient and transparent allocation of specialist resources when managing waiting lists. Aim: As the initial stage of a mixed-method...
Article
Context: Increasing emphases are being placed upon early integration of palliative care for patients with advanced cancers, yet barriers to implementation in clinical practice remain. Criteria to standardise referral have been endorsed, but their application are yet to be tested at the population level. Objectives: This study sought to: 1) estab...
Article
Full-text available
The unaddressed palliative care needs of patients with advanced, nonmalignant, lung disease highlight the urgent requirement for new models of care. This study describes a new integrated respiratory and palliative care service and examines outcomes from this service. The Advanced Lung Disease Service (ALDS) is a long-term, multidisciplinary, integr...
Chapter
There have been significant advances in the prevention and management of stroke over the last few decades. Despite these important developments, stroke, both in the acute and chronic phases, remains a major cause of morbidity and mortality. The value of integrating palliative care principles and practices into stroke care management is being increa...
Article
Background and objective Many patients with advanced COPD experience refractory breathlessness and individualized breathlessness interventions may improve management of this complex symptom. The aims of this study were to develop, implement and assess the efficacy of a breathlessness intervention for patients with COPD and refractory breathlessness...
Article
Full-text available
Treatment of cancer pain is generally based on the three-step World Health Organization (WHO) pain relief ladder, which utilizes a sequential approach with drugs of increasing potency. Goals of pain management include optimization of analgesia, optimization of activities of daily living, minimization of adverse effects, and avoidance of aberrant dr...
Article
Aims: To understand Australian junior doctors' knowledge and attitudes regarding the management of refractory breathlessness and the role of opioids in COPD. Methods: All junior doctors undertaking basic training in internal medicine in Victoria were invited to complete an online survey. Knowledge, willingness, and experience prescribing opioids...
Article
Background: Patients with advanced cancer often desire home-based care, placing general practitioners (GPs) at the centre of complex clinical situations. The objective of this article was to determine GPs' needs when providing home-based palliative care in collaboration with existing palliative care services. Methods: A survey of GPs was conduct...
Article
Full-text available
Importance: Antipsychotics are widely used for distressing symptoms of delirium, but efficacy has not been established in placebo-controlled trials in palliative care. Objective: To determine efficacy of risperidone or haloperidol relative to placebo in relieving target symptoms of delirium associated with distress among patients receiving palli...
Article
Full-text available
Background: Nurse practitioners (NP) are relatively new in Australia with national registration achieved in 2010. Most NP-related literature is about establishing models and scope of practice. This paper reports on the establishment and 12-month evaluation of an NP model of care, between inpatient and community palliative care services, developed...
Article
Refractory breathlessness is common, and undertreated, in patients with advanced COPD. At times of dyspnoea crisis, patients and carers can be overwhelmed and may underutilise active dyspnoea management strategies, including opioids. Aim: To assess if written individualised Breathlessness Plans (BP) improve dyspnoea self-management. Methods: Eligib...
Article
The unaddressed palliative care needs of patients with advanced lung disease highlight the urgent requirement for new models of care. The Advanced Lung Disease Service (ALDS) represents such a model, whereby patients with severe, non-malignant respiratory disease receive multidisciplinary specialist clinic review, and telephone and domiciliary nurs...
Article
Full-text available
Background: Palliative care focuses on supporting patients diagnosed with advanced, incurable disease; it is 'family centered', with the patient and their family (the unit of care) being core to all its endeavours. However, approximately 30-50 % of carers experience psychological distress which is typically under recognised and consequently not ad...
Article
Corticosteroids are commonly used as co-analgesics with opioids for cancer pain, however limited quality data exists supporting their efficacy for this purpose. Further, little is known about individual prescribing practices. The current study surveyed members of the Australian New Zealand Society of Palliative Medicine about their use of corticost...