Joanne Droney

National Health Service | NHS

Purpose To evaluate the use, acceptability, and experience of a seven-item palliative care referral screening tool in an outpatient oncology setting. Methods A two-phase convergent parallel mixed-methods study. Patient participants who met any of the “Royal Marsden Triggers Tool” criteria were compared with those who did not in terms of demographi...

Purpose of review The impacts of early palliative care for patients with advanced cancer are well described. This has led to endorsement of early palliative care, alongside cancer treatment, by leading cancer organisations. The aim of this review is to consider how best to adopt and integrate the learning from studies of early palliative care into...

Palliative care, an integral component of supportive oncology, enhances the quality of life for patients living with cancer. Whilst palliative care has historically been synonymous with the provision of care at the end of life, it is increasingly playing a role earlier in a patient’s cancer journey; frequently in conjunction with administration of...

Background Advance care planning (ACP) was encouraged by policymakers throughout the COVID-19 pandemic. Little is known about use of ACP during this time. Aim To compare use of ACP before and during the COVID-19 pandemic. Design & setting Retrospective, observational cohort study, comparing the creation, use and content of Electronic Palliative C...

Purpose: To evaluate the use, acceptability, and experience of a seven-item palliative care referral screening tool in an outpatient oncology setting. Methods: Atwo-phase convergent parallel mixed methods study. Patient participants who met any of the “Royal Marsden Triggers Tool” criteria were compared with those who did not in terms of demographi...

Enhanced supportive care is a care model providing earlier access to multiprofessional, coordinated care for patients from the point of cancer diagnosis. As a proactive model of care, it stands as a contrast to providing access to a multidisciplinary team once a patient has hit a crisis point, or when their prognosis has become sufficiently poor th...

Background Patient centred outcome measures (PCOMs) support proactive symptom assessment and patient-centred care. This quality improvement project (QIP) aimed to address engagement with, and accuracy of inpatient palliative care PCOM data in a specialist cancer centre. Methods Routine recording of PCOM data for inpatients was introduced in 2017 i...

Background People living with severe mental illness (SMI) face significant health inequalities, including in palliative care. Advance Care Planning (ACP) is widely recommended by palliative care experts and could reduce inequalities. However, implementing ACP with this group is challenging. Electronic Palliative Care Coordination Systems such as Co...

Background People living with severe mental illness (SMI) face significant health inequalities, including in palliative care. Advance Care Planning (ACP) is widely recommended by palliative care experts and could reduce inequalities. However, implementing ACP with this group is challenging. Electronic Palliative Care Coordination Systems such as Co...

Increased advance care planning was endorsed at the start of the Coronavirus disease 2019 (COVID-19) pandemic with the aim of optimizing end-of-life care. This retrospective observational cohort study explores the impact of advanced care planning on place of death. 21,962 records from patients who died during the first year of the pandemic and who...

Palliative care is a holistic approach to the care of patients living with advanced illness. For older patients, palliative care integrates with and complements geriatric care especially for those with multi-morbidity and complex physical and psychosocial needs.The use of drugs to alleviate symptoms in older patients is based on the principles of (...

Background At the beginning on the COVID-19 pandemic, advance care planning (ACP) was widely encouraged and endorsed for adults with serious illness to ensure their treatment and care preferences would be honoured, including location of death, often considered a surrogate quality indicator for end-of-life care. Coordinate My Care (CMC) represents t...

Background Mortality forecasts associated with COVID-19 stressed a need to prepare adults with advanced disease for possible severe illness and engage with Advance Care Planning (ACP). We aimed to examine ACP engagement and activity during the COVID-19 pandemic. Methods A retrospective cohort study, comparing the creation, content and use of Coord...

Background Consideration and documentation of where individual patients want to die is an important component of advance care planning and helps facilitate care aligned with patients’ wishes. Aim To examine factors associated with recording a preferred place of death in Coordinate My Care, a large Electronic Palliative Care Coordination System in...

Background Despite minimal evidence regarding utility, and no national guidelines, MDTMs are embedded within palliative care. However they are costly so efficiency must be maximised (De Leso et al, 2013).² The function of MDTMs includes coordinating care for complex patients (Borgstrom et al, 2021).¹ This project aimed to review completeness of loc...

Background The consideration, recording and sharing of where individual patients would prefer to die are core elements of advance care planning and help ensure care is in keeping with patients’ wishes. Aim To explore the factors associated with recording a preferred place of death in Coordinate My Care, a large Electronic Palliative Care Coordinat...

Background The provision of high-quality person-centred specialist palliative care requires effective mechanisms to ensure timely input of services. The time between referral and initial review is a marker of efficient service functioning.The aim of this project was to audit compliance against the local standard that ‘patients referred to the hospi...

Background Approximately thirty thousand people in Scotland are diagnosed with cancer annually, of whom a third live less than one year. The timing, nature and value of hospital-based healthcare for patients with advanced cancer are not well understood. The study's aim was to describe the timing and nature of hospital-based healthcare use and assoc...

Objectives There have been many models of providing oncology and palliative care to hospitals. Many patients will use the hospital non-electively or semielectively, and a large proportion are likely to be in the last years of life. We describe our multidisciplinary service to treatable but not curable cancer patients at University Hospitals Sussex....

Background Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life. Methods We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and...

Background Approximately thirty thousand people in Scotland are diagnosed with cancer annually, of whom a third live less than one year. The timing, nature and value of hospital-based healthcare for patients with advanced cancer are not well understood. The aim of this study was to describe patterns of hospital-based healthcare use and associated c...

Introduction Palliative care within intensive care units (ICU) benefits decision-making, symptom control, and end-of-life care. It has been shown to reduce the length of ICU stay and the use of non-beneficial and unwanted life-sustaining therapies. However, it is often initiated late or not at all. There is increasing evidence to support screening...

Background Haemato-oncology patients are likely to be referred later to palliative care than patients with solid tumours, despite experiencing similar symptom burden. Patients prior to stem cell transplant may benefit from symptom control, advance care planning and shared decision-making, and previous studies have demonstrated feasibility and benef...

Background Palliative Medicine is increasingly developing as an evidence-based specialty. However, research experience during training is not uniform for all disciplines involved. In a tertiary referral Cancer centre, palliative care clinical staff (N=30) reported a lack of confidence in the language and understanding of research and critical appra...

Background Mortality predictions as the COVID-19 pandemic began highlighted a need to prepare adults for possible severe illness, encouraging engagement with Advance Care Planning (ACP). Aim To explore ACP activity and engagement during the COVID-19 pandemic. Methods A retrospective cohort study, comparing the creation, content and use of Coordin...

Background Anticipated severe illness at the start of the COVID-19 pandemic bought increased endorsement, awareness and provision of advance care planning in adults with serious illness. Place of death is often considered a surrogate quality indicator for end-of-life care. Aim To examine the impact of advance care planning on place of death for pa...

Background High quality patient and public involvement and engagement (PPIE) ensures that research is effective, representative, and focused on patients’ needs. Aims To describe PPIE activities in a palliative care study. Methods The six UK Standards for Public Involvement in Research were used to evaluate PPIE activity in a single site mixed-met...

Introduction Patient and Public involvement (PPI) is essential to ensure research is relevant, patient-focused and of high quality. Social distancing recommendations during the COVID-19 pandemic affected how PPI members engaged with research teams. Aims To describe and evaluate PPI in a retrospective study evaluating 73,675 advance care planning r...

Introduction Background: High quality patient and public involvement and engagement (PPIE) ensures that research is effective, representative, and focused on patients’ needs. Aims To describe PPIE activities and their impact in a palliative care study. Method The six UK Standards for Public Involvement in Research were used to evaluate PPIE activ...

Despite a wealth of research regarding COVID-19, little evidence exists about cancer patients’ specific needs and experiences at end-of-life. This study retrospectively describes the care of 34 hospitalised cancer patients dying with COVID-19. The palliative care needs of patients were described. The main domains of end-of-life care service provisi...

Coronavirus disease 2019 (COVID-19) antiviral response in a pan-tumor immune monitoring (CAPTURE) ( NCT03226886 ) is a prospective cohort study of COVID-19 immunity in patients with cancer. Here we evaluated 585 patients following administration of two doses of BNT162b2 or AZD1222 vaccines, administered 12 weeks apart. Seroconversion rates after tw...

Patients with cancer have higher COVID-19 morbidity and mortality. Here we present the prospective CAPTURE study, integrating longitudinal immune profiling with clinical annotation. Of 357 patients with cancer, 118 were SARS-CoV-2 positive, 94 were symptomatic and 2 died of COVID-19. In this cohort, 83% patients had S1-reactive antibodies and 82% h...

CAPTURE (NCT03226886) is a prospective cohort study of COVID-19 immunity in patients with cancer. Here we evaluated 585 patients following administration of two doses of BNT162b2 or AZD1222 vaccines, administered 12 weeks apart. Seroconversion rates after two doses were 85% and 59% in patients with solid and hematological malignancies, respectively...

Patients with cancer have higher COVID-19 morbidity and mortality. Here we present the prospective CAPTURE study (NCT03226886) integrating longitudinal immune profiling with clinical annotation. Of 357 patients with cancer, 118 were SARS-CoV-2-positive, 94 were symptomatic and 2 patients died of COVID-19. In this cohort, 83% patients had S1-reactiv...

Background As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and e...

e18769 Background: Delivery of high quality cancer care is associated with rising costs, both in earlier stages of the illness trajectory and at the end of life. A significant portion of the costs and health care utilisation occurs in the last year of life. Most publications to date have focused on costs in hospital. Little is known about the costs...

e18732 Background: Approximately thirty thousand people in Scotland are diagnosed with cancer each year, of whom 10,000 live less than one year. Hospital is the most common place of death for people with cancer, despite most expressing a preference for community-based care. There is inadequate understanding of the nature and value of hospital-based...

Introduction Palliative care within Intensive Care Units (ICU) benefits decision making, symptom control and end-of-life care. It has shown to reduce length of ICU stay and the use of non-beneficial and unwanted life-sustaining therapies. However, it is often initiated late or not at all. There is increasing evidence behind screening ICU patients u...

Background Qualitative focus group research traditionally involves participants meeting face-to-face- in small groups to allow for participant interaction. The Covid-19 pandemic has prevented such meetings. Consequently, research has moved to holding online meetings using videoconferencing software. We discuss the advantages and challenges of runni...

Background Earlier referral to palliative care is increasingly being utilised in solid tumour oncology to improve quality of life and symptom control. Patients with haematological malignancies have similar symptom burden but are frequently referred later to palliative care. We recently established an integrated early palliative care service for pat...

Background The COVID-19 pandemic has seen a wealth of research examining the features of the disease. While large multicentre studies have detailed the implications of a cancer diagnosis and systemic anti-cancer therapy on mortality, little has been published regarding the end-of-life experiences for cancer patients dying COVID-19. Aims To review...

Background People who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain. Objectives To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life. Methods Retrospective whole-population secondary care administ...

Cancer deaths are increasing each year. If end-of-life care is to be improved and sustainable, a culture change is required: a culture change that changes crisis care to planned care. Advance care planning (ACP) improves care and decreases unnecessary hospital admissions and thus costs. Changing a culture requires training and technology. Clinician...

There is a pressing need to characterise the nature, extent and duration of immune response to SARS-CoV-2 in cancer patients and inform risk-reduction strategies and preserve cancer outcomes. CAPTURE is a prospective, longitudinal cohort study of cancer patients and healthcare workers (HCWs) integrating longitudinal immune profiling and clinical an...

Place of death is an important outcome of end-of-life care. Many people do not have the opportunity to express their wishes and die in their preferred place of death. Advance care planning (ACP) involves discussion, decisions and documentation about how an individual contemplates their future death. Recording end-of-life preferences gives patients...

Objectives To analyse healthcare utilisation and costs in the last year of life in England, and to study variation by cause of death, region of patient residence and socioeconomic status. Methods This is a retrospective cohort study. Individuals aged 60 years and over (N=108 510) who died in England between 2010 and 2017 were included in the study...

BACKGROUND: COVID-19 has forced oncology professionals globally to face both personal and professional challenges. The impact of COVID-19 pandemic on wellbeing and burnout has the potential for serious negative consequences on work and home life as well as patient care both in the immediate and longer term. It is fundamental to understand factors i...

Background People who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain. Objectives To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life. Methods Retrospective whole-population secondary care administ...

Purpose To examine the use of Normalisation Process Theory (NPT) to establish if, and in what ways, the AMBER care bundle can be successfully normalised into acute hospital practice, and to identify necessary modifications to optimise its implementation. Method Multi-method process evaluation embedded within a mixed-method feasibility cluster rand...

Purpose Benefits of early palliative referral in oncology are well documented. Palliative care referral “triggers” may help identify patients for referral. Many triggers have been proposed, but are not commonly used. This study reviewed the timing of palliative care involvement for patients in a tertiary referral oncology hospital, and whether the...

e24007 Background: Place of death is an important indicator of quality of end-of-life care (EOLC). Most patients do not want to die in hospital and hospital deaths are costly to healthcare organisations. Advance care planning (ACP) includes discussions about where patients want to die. Cancer patients often have a distinct illness trajectory with a...

Background Clinical trials demonstrate that early referral to specialist palliative care improves patient outcomes in terms of quality of life and symptom control. This qualitative research study is part of a mixed methods evaluation of a novel early integrated Palliative Care (‘Triggers’) service for cancer patients. The Triggers service involves...

Background Clinician’s estimation of patient survival can influence decisions regarding treatment, enable patients to make plans, improve quality of life and increase meeting preferred place of care and death. The two survival predictors frequently used are temporal and probabilistic. Temporal-the patient is predicted to live a certain amount of ti...

Background Trials have proved the benefits of early Palliative Care involvement in Oncology care, such as improved quality of life, better understanding of disease and better symptom control. Based on these we have introduced a new model of Integrated Palliative Care at the Royal Marsden - the ‘Triggers’ service since March 2017. It involves the us...

Background International consensus supports early integration of SPC in oncological disease. Haematological malignancies differ in nature from solid site tumours. Remitting and relapsing trajectories, late salvage treatments, and divergent outcomes make for difficult prognostication and traditional markers of ‘good’ end of life care may not transla...

Background: The AMBER (Assessment, Management, Best Practice, Engagement, Recovery Uncertain) care bundle is a complex intervention used in UK hospitals to support patients with uncertain recovery. However, it has yet to be evaluated in a randomised controlled trial (RCT) to identify potential benefits or harms. The aim of this trial was to invest...

Background: The AMBER (Assessment; Management; Best practice; Engagement; Recovery uncertain) care bundle is a complex intervention used in UK hospitals to support patients with uncertain recovery. However, it has yet to be evaluated in a randomised controlled trial (RCT) to identify potential benefits or harms. Aim: To investigate the feasibility...

Background: Critical care and palliative care professionals treat and support seriously ill patients on a daily basis, and the possibility of burnout may be high. The consequences of burnout can include moral injury and distress, and compassion fatigue, which are detrimental to both care and staff. Aims and objectives: To explore the incidence o...

Background The AMBER (Assessment; Management; Best practice; Engagement; Recovery uncertain) care bundle is a complex intervention used in UK hospitals to support patients with uncertain recovery. However, it has yet to be evaluated in a randomised controlled trial (RCT) to identify potential benefits or harms. Aim To investigate the feasibility of...

Background Schwartz Rounds (SR) aim to provide a structured forum for staff to discuss the psychosocial and emotional issues of work in healthcare. Patient safety is linked with staff wellbeing, with potential associations between burnout and medical mistakes, and possible impact on effective organisational response to change. These issues are part...

Background Early palliative care is recognised as an effective service for patients living with cancer. A new integrated palliative care service was developed in the outpatient clinics in September 2016. The palliative care needs of patients were assessed using the validated Integrated Palliative Outcome Scale (IPOS). 80% of patients reviewed throu...

Background Global leading cancer organisations recommend that palliative care should be available to all patients, regardless of stage of disease. We established a novel Integrated Palliative Care service (‘Triggers’ Service) for lung cancer outpatients. New patients are screened by oncologists using a brief palliative care referral ‘Triggers’ tool...

Background: dying in one's preferred place is a quality marker for end-of-life care. Little is known about preferred place of death, or the factors associated with achieving this, for people with dementia. Aims: to understand preferences for place of death among people with dementia; to identify factors associated with achieving these preference...

Objectives The aim of this evaluation is to describe the components and results of urgent care planning in Coordinate My Care (CMC), a digital clinical service for patients with life-limiting illness, for use if a patient is unable to make or express choices. Ceiling of treatment (CoT) plans were created detailing where the patient would like to re...

Background The Royal Marsden NHS Foundation Trust is a tertiary referral cancer centre. The Symptom control and palliative care team have opioid prescribing guidelines. There are specific guidelines for Alfentanil given that it is an infrequently prescribed drug on the inpatient wards, to reduce the risk of error. We carried out a retrospective re-...

Background Benefits of early palliative care (PC) referral for oncology patients are well-documented. The development of PC referral ‘Triggers’ may help identify which patients should be referred. A number of ‘Triggers’ have been proposed, but are currently not commonly used in clinical practice. This project aimed to evaluate a number of published...

Background There is growing evidence to support the benefits of early integrated palliative care (PC) for patients with advanced cancer. Within a tertiary referral cancer centre we started a new Integrated Symptom Control and PC service. The aim of this service is to proactively identify patients who would benefit from PC review and to offer earlie...

Background The Palliative Care (PC) Multidisciplinary Team (MDT) in a tertiary referral oncology hospital meets weekly across two sites. All new referrals and all inpatients under the PC team are discussed. In June 2016 an electronic MDT (eMDT) proforma was developed to record data including performance status, phase of illness, estimated prognosis...

Background Fewer than half of patients opt to die in hospital, yet this remains the most common place of death in England. Coordinate My Care (CMC) is London’s Electronic Palliative Care Coordination Service. Previous analysis has shown that individuals with a ‘do not resuscitate’ order shared through CMC are 76% more likely to die in a place of th...

Background Patients with life-limiting disease often do not achieve their preferred place of care and death. The Hospital2Home service (H2H) has been created to enable patients whose treatment has moved to palliation only, to leave hospital and safely achieve their priorities and preferences. The H2H service is facilitated by a team of palliative c...

Aims Primary aim: Assess compliance with national standards for completion of death certificates within 1 working day. Secondary aim: Evaluate speed and form of communication of death to GP. Background It is understood that effective and prompt communication to GPs facilitates provision of bereavement support to relatives after a death. Delayed pa...

Background: Polymorphisms in the opioid receptor genes may affect the pharmacodynamics (PD) of oxycodone and be part of the reason behind the diversity in clinical response. The aim of the analysis was to model the exposure-response profile of oxycodone for three different pain variables and search for genetic covariates. Model simulations were us...

There have been few studies that have evaluated the quality of end-of-life care (EOLC) for cancer patients in the ICU. The aim of this study was to explore the quality of transition to EOLC for cancer patients in ICU. The study was undertaken on medical patients admitted to a specialist cancer hospital ICU over 6 months. Quantitative and qualitativ...

Human experimental pain studies are of value to study basic pain mechanisms under controlled conditions. The aim of this study was to investigate if genetic variation across selected mu-, kappa- and delta-opioid receptor genes (OPRM1, OPRK1and OPRD1 respectively) influenced analgesic response to oxycodone in healthy volunteers. Experimental multi-m...

points An individual’s response to opioids is influenced by a complex combination of genetic, molecular and phenotypic factors. Intra- and inter-individual variations in response to mu opioids have led to the suggestion that mu-opioid receptor subtypes exist. Scientists have now proven that mu-opioid receptor subtypes exist and that they occur thro...

Context: There is wide interindividual variation in response to morphine for cancer-related pain; 30% of patients do not have a good therapeutic outcome. Alternative opioids such as oxycodone are increasingly being used, and opioid switching has become common clinical practice. Objectives: To compare clinical response to oral morphine vs. oral o...

Morphine is recommended firstline for the treatment of moderate to severe cancer-related pain in worldwide and national guidelines. Other strong opioids i.e. oxycodone are available and are appropriate for use in certain cases. Some patients do not respond to morphine due to poor analgesia or side effects. In these cases an opioid switch to oxycodo...

Pain is a ubiquitous yet highly variable experience. The psychophysiological and genetic factors responsible for this variability remain unresolved. We hypothesised the existence of distinct human pain clusters (PCs) comprising of distinct psychophysiological and genetic profiles coupled with differences in perception and brain processing of pain....

Background Pain tolerance is subject to considerable inter-individual variation, which may be influenced by a number of genetic and non-genetic factors. The mu, delta and kappa opioid receptors play a role in pain perception and are thought to mediate different pain modalities. The aim of this study was to explore associations between pain threshol...

To present a statistical model for defining interindividual variation in response to morphine and to use this model in a preliminary hypothesis-generating multivariate genetic association study. Two hundred and sixty-four cancer patients taking oral morphine were included in a prospective observational study. Pain and morphine side-effect scores we...

Context: Morphine is the opioid of choice for cancer-related pain, but for many patients the benefits of morphine are outweighed by its side effect profile. Morphine is metabolized to morphine-3-glucuronide and morphine-6-glucuronide; however, little is known about the contribution of these metabolites to analgesia and morphine-related side effect...

There are now several strong opioids available to choose from for the relief of moderate to severe pain. On a population level, there is no difference in terms of analgesic efficacy or adverse reactions between these drugs; however, on an individual level there is marked variation in response to a given opioid. The genetic influences to this variat...