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Magnolia Cardona

Magnolia Cardona
Bond University Institute for Evidence Based Healthcare

PhD, MPH, MB.BS, Grad Dip ApplEpid
Interested in research translation collaborations in routine healthcare, with a focus on older adults.

About

117
Publications
18,608
Reads
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2,795
Citations
Citations since 2016
89 Research Items
2160 Citations
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Introduction
A/Prof Magnolia Cardona leads a program on research to reduce low-value care and non-beneficial interventions in older people, particularly in their last year of life. Her work spans acute hospital care, general practice and residential aged care, with investigations on perceptions by clinicians and consumers, and data analysis of routine data collections to identify and measure the extent of the problem and research on effective interventions to reduce it.
Additional affiliations
July 2018 - present
Bond University
Position
  • Professor (Associate)
September 2013 - June 2018
UNSW Sydney
Position
  • Senior Researcher
February 2011 - August 2013
NPS
Position
  • Epidemiologist

Publications

Publications (117)
Article
Purpose To investigate the extent of objective ‘non-beneficial treatments (NBTs)’ (too much) anytime in the last 6 months of life in routine hospital care. Data sources English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995–April 2015). Study selection All study types assessing objective...
Article
Background: Many patients near the end of life are subject to rapid response system (RRS) calls. A study was conducted in a large Sydney teaching hospital to identify a cutoff point that defines nonbeneficial treatment for older hospital patients receiving an RRS call, describe interventions administered, and measure the cost of hospitalization....
Article
Search AJGP > 2020 > November > Near end of life status in older patients from routine general practice data RESEARCH Volume 49, Issue 11, November 2020 It is feasible to flag ‘near end-of-life’ status in older patients from routine general practice data Magnolia Cardona Margaret Williamson Mark Jones Danielle Ní Chróinín John Gullotta Ken Hillman...
Article
After a loved one’s death, families often go to their GP for explanations on cause of death, queries on whether the death could have been prevented, and reassurance that the symptoms and moods experienced during their grief are normal. Some may consult with their doctor for symptom management if their grief is prolonged. However, while we receive...
Article
Full-text available
Background Hospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people’s preferences, and improve the use of healthcare resources. The Inter...
Article
Full-text available
Introduction Low-value care can lead to patient harm, misdirected clinician time and wastage of finite healthcare resources. Despite worldwide endeavours, deimplementing low-value care has proved challenging. Multifaceted, context and barrier-specific interventions are essential for successful deimplementation. The aim of this literature review is...
Article
Full-text available
Purpose: Frailty is a prevalent condition in older adults. Identification of frailty using an electronic Frailty Index (eFI) has been successfully implemented across general practices in the United Kingdom. However, in Australia, the eFI remains understudied. Therefore, we aimed to (i) examine the feasibility of deriving an eFI from Australian gene...
Article
Full-text available
This commentary raises awareness of how creative health professionals and technology gurus can be in innovating to enable advance care planning in the middle of social restrictions. https://insightplus.mja.com.au/2022/42/planning-for-a-good-death-covid-19-lessons-learned/
Preprint
Full-text available
International students, particularly those from non-English speaking countries seeking admission to higher degree by research in Anglophone universities face multiple challenges in understanding the educational system rules, and socially adapting to the host country. Through a targeted literature search we identified barriers and facilitators to th...
Preprint
Full-text available
Abstract This rapid review of quantitative and qualitative publications of any design indexed in PUBMED between January 2020-April 2021 investigates barriers and enablers of advance care planning (ACP) worldwide in the early stages of the life-threatening COVID-19 pandemic. Seventy-four papers were included: 35 primary research studies (cohorts, re...
Article
Full-text available
Thromboembolic events are a common risk in adults with atrial fibrillation, those with previous cerebrovascular accidents and undergoing emergency or elective surgeries. The widespread availability of antithrombotic agents and differing guidelines contribute to practice variations and increased risk of complications and deaths. The objective of thi...
Article
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Ensuring continuity of care for patients with major depressive disorders poses multiple challenges. We conducted a systematic review and meta-analysis of randomised controlled trials comparing real-time telehealth to face-to-face therapy for individuals with depression. We searched Medline, Embase, and Cochrane Central (to November 2020), conducted...
Article
Full-text available
Purpose: Many people with chronic obstructive pulmonary disease (COPD) feel overburdened with the treatment and management of their illness. Although research has begun to shed light on how COPD patients experience treatment burden, most of what we know is limited to personal experiences of patients. The aim of this study is to identify and priori...
Conference Paper
Objectives To explore how the COVID-19 pandemic impacted communication around Advanced Care Planning (ACP). We sought to identify the barriers and enablers of ACP communication given the global crisis involving a previously-unknown, serious infection potentially leading to a surge in overtreatment. Methods We adopted the WHO recommendation of usin...
Article
Full-text available
Objectives The COVID-19 pandemic has highlighted the importance of access to telehealth as an alternative model of service during social restrictions and for urban and remote communities alike. This study aimed to elucidate whether First Nations and culturally and linguistically diverse (CALD) patients also benefited from the resource before or dur...
Article
Full-text available
Objective: We conducted a systematic review and meta-analysis of randomized controlled trials comparing real-time telehealth (video, phone) with face-to-face therapy delivery to individuals with posttraumatic stress disorder (PTSD), by primary or allied health care practitioners. Data Sources: We searched MEDLINE, Embase, CINAHL, and Cochrane Cent...
Article
Full-text available
Background: People with hematological malignancies can deteriorate rapidly to a terminal event and have variable levels of engagement when transitioning to palliative and end-of-life care. Objectives: To describe end-of-life care values and preferences of people with hematological malignancies and explore whether these align with hematology clinici...
Article
Objective: Understanding the longitudinal patient experience outcomes following major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma center. This process evaluation examined what factors promoted or impeded the progra...
Article
Full-text available
Background Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. Objective This study aims to conduct a robus...
Preprint
Full-text available
Background To develop an electronic resource, called Communicating Health Alternatives Tool (CHAT) that was compatible with hospital medical records software to facilitate preliminary patient-centered decision-making across health settings for frail older adults with progressive chronic disease. Methods Mixed methods including literature review; u...
Preprint
Full-text available
Background: Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. Objective: Conduct robust evidence synthesi...
Article
Objectives: To examine the modalities and clinical and non-clinical effectiveness of telehealth services available to people from Indigenous and culturally and linguistically diverse backgrounds (CALD). Materials and methods: A scoping review of peer-reviewed publications (2000-2021) on the effectiveness of telehealth interventions for Indigenou...
Article
Full-text available
Background Overtreatment in advanced age i.e. aggressive interventions that do not improve survival and are potentially harmful, can impair quality of care near the end of life (EOL). As healthcare provider perspectives on care quality may differ from that of service users, the aim of this study was to explore the views of older patients near EOL o...
Article
Introduction Worldwide, it is estimated that 264 million people meet the diagnostic criteria for anxiety conditions. Effective treatment regimens consist of cognitive and behavioural therapies. During the COVID-19 pandemic, treatment delivery relied heavily on telemedicine technologies which enabled remote consultation with patients via phone or vi...
Article
Purpose This scoping review sought to identify objective factors to assist clinicians and policy-makers in making consistent, objective and ethically sound decisions about resource allocation when healthcare rationing is inevitable. Materials and methods Review of guidelines and tools used in ICUs, hospital wards and emergency departments on how t...
Article
Full-text available
Background: Indigenous populations experience high rates of age-related illness when compared to their non-Indigenous counterparts. Frailty is a challenging expression of aging and an important public health priority. The purpose of this review was to map what the existing literature reports around frailty in Indigenous populations and to highlight...
Article
Full-text available
Introduction: The decision to deprescribe medications used for both disease prevention and symptom control (dual-purpose medications or DPMs) is often challenging for clinicians. We aim to establish the impact of deprescribing DPMs on patient-related outcomes for older adults near end-of-life (EOL). Methods: This systematic review was conducted a...
Article
Full-text available
The concepts and elements determining quality of care at the End of Life may vary across professional groups but there is consensus that high-quality care at the End of Life is beneficial for the patient, families, health systems and society at large. This scoping review aimed to elucidate gaps in the delivery of this specific type of care in older...
Preprint
Full-text available
Background: Survival rates following major trauma are increasing. Understanding the longitudinal outcomes of major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma centre. This evaluation was conducted to examine what fa...
Article
Background This scoping review aimed to investigate the presence of discordance or concordance in the perceptions of end-of-life (EOL) care quality between consumers (i.e. patients aged over 60 in their last years of life and/or their informal caregivers) and clinicians, to inform further improvements in end-of-life care service delivery.MethodsA s...
Preprint
BACKGROUND Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. OBJECTIVE This study aims to conduct a robus...
Article
Full-text available
We aimed to identify the level of prognostic disclosure, type of prognostic information and delivery format of prognostic communication that older adults diagnosed with a life-limiting illness or caregivers prefer to receive. We developed and pilot tested an open-ended survey to 15 older patients and caregivers who had experience in health services...
Conference Paper
Sarah Younan1; Magnolia Cardona2; Danielle Ni Chroinin1 1South Western Sydney Clinical School, UNSW; 2Institute for Evidence-based Healthcare, Bond University Aims: Amidst COVID-19, where older persons bear significant mortality and morbidity, ACP has been highlighted. We sought to explore lessons learned in relation to ACP in this pandemic, in pa...
Article
Unquestionably this pandemic is teaching health clinicians and the public in general, many lessons about protective behaviors, generosity, compassion and what is required to preserve public health. For people who, because of the pandemic, have lost their autonomy, their right to freely see family, and their choice for place of death, we would recom...
Article
Full-text available
Background Clinicians’ delays to identify risk of death and communicate it to patients nearing the end of life contribute to health-related harm in health services worldwide. This study sought to ascertain doctors, nurses and senior members of the public’s perceptions of the routine use of a screening tool to predict risk of death for older people....
Book
Full-text available
This book deals with what we want for ourselves and our loved ones, ‘when the time comes’. Jointly written, collected and curated by a doctor and nurse working in end-of-life care, this collection of personal experiences (of families and healthcare professionals) throws light on social, cultural and individual influences on what is expected but not...
Article
Background: Knowing the prevalence of true asymptomatic coronavirus disease 2019 (COVID-19) cases is critical for designing mitigation measures against the pandemic. We aimed to synthesize all available research on asymptomatic cases and transmission rates. Methods: We searched PubMed, Embase, Cochrane COVID-19 trials, and Europe PMC for primary...
Article
Introduction Polypharmacy is prevalent in hospitals and deprescribing strategies for older people are strongly promoted. However, evidence of their feasibility and sustainability among patients receiving end of life care is lacking. The objective of this review was to ascertain effectiveness and post-discharge sustainability of hospital-initiated d...
Article
Full-text available
OBJECTIVE: This study aimed to determine the predictive accuracy of the modified clinical prognostic tool Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL) to predict 30-day and 90-day mortality in older patients undergoing urgent abdominal surgery. BACKGROUND: Anticipating the mid-term mortality of older patients under...
Preprint
Full-text available
As the world struggles with the COVID-19 pandemic, health service demands have increased to a point where healthcare resources may prove inadequate to meet demand. Guidelines and tools on how to best allocate intensive care beds and ventilators developed during previous epidemics can assist clinicians and policy-makers to make consistent, objective...
Article
Full-text available
The patient and family perspective on the appropriateness of intensive care unit (ICU) treatments involves preferences, values and social constructs beyond medical criteria. The clinician's perception of inappropriateness is more reliant on clinical judgment. Earlier consultation with families before ICU admission and patient education on the outco...
Article
Full-text available
Background: The prevalence of true asymptomatic COVID-19 cases is critical to policy makers considering the effectiveness of mitigation measures against the SARS-CoV-2 pandemic. We aimed to synthesize all available research on the asymptomatic rates and transmission rates where possible. Methods: We searched PubMed, Embase, Cochrane COVID-19 trials...
Article
Full-text available
Residents of Aged Care Facilities (RACF) experience burdensome hospital transfers in the last year of life, which may lead to aggressive and potentially inappropriate hospital treatments. Anticipating these transfers by identifying risk factors could encourage end-of-life discussions that may change decisions to transfer. The aim was to examine the...
Article
Full-text available
Background: Hospitalisation rates for the older population have been increasing with end-of-life care becoming a more medicalised and costly experience. There is evidence that some of these patients received non-beneficial treatment during their final hospitalisation with a third of the non-beneficial treatment duration spent in intensive care uni...
Article
The COVID-19 global emergency has brought about unexpected changes in the format and quality of undergraduate medical education in a short period of time. The impact of remote delivery on medical students learning, satisfaction, confidence, social relationships, communications and emotional wellbeing has been significant. The lack of direct patient...
Article
The large scale and rapid spread of the current COVID-19 pandemic has changed the way hospitals and other health services operate. Opportunities for patient-centered decision-making at the end of life are being jeopardized by a scarcity of health system resources. In response, the traditional doctor-initiated advanced care planning (ACP) for critic...
Preprint
Full-text available
Background: Knowing the prevalence of true asymptomatic coronavirus disease 2019 (COVID-19) cases is critical for designing mitigation measures against the pandemic. We aimed to synthesize all available research on asymptomatic cases and transmission rates. Methods: We searched PubMed, Embase, Cochrane COVID-19 trials, and Europe PMC for primary st...
Research Proposal
Full-text available
This article now published at https://pubmed.ncbi.nlm.nih.gov/34707802/ This systematic review will investigate the impact on patient-related outcomes of deprescribing dual-purpose medicines (for prevention and symptom management) among older people (>=65 years) deemed to be at the end of life, defined as the last 12 months. All healthcare setting...
Research Proposal
This study will work with clinical teams in three acute hospitals to trial a feedback loop approach to promoting appropriate care and treatment for elderly patients at the end-of-life. The primary objectives are 1) to determine the impact and resource use and costs of a tailored clinical team feedback loop intervention on patient outcomes related t...
Article
Background: General practitioners' (GPs) play a central role in facilitating end-of-life discussions with older patients nearing the end-of-life. However, prognostic uncertainty of time to death is one important barrier to initiation of these discussions. Objective: To explore GPs' perceptions of the feasibility and acceptability of a risk predi...
Article
Full-text available
There’s a need to better balance clinicians’ evidence-based bias and older patients’ value-based preferences in shared decision-making, write a collaborative of researchers and advocates from Queensland and New South Wales.
Preprint
Full-text available
Research question: In older hospitalised patients near the end of life, which deprescribing interventions result in sustained deprescribing? Older people with multiple comorbidities in their last year of life may be on multiple non-essential medicines(McNeil, Kamal et al. 2016) that could impair quality of life through discomfort, adverse events (e...
Article
Full-text available
Background: The prevalence of true asymptomatic COVID-19 cases is critical to policy makers considering the effectiveness of mitigation measures against the SARS-CoV-2 pandemic. We aimed to synthesize all available research on the asymptomatic rates and transmission rates where possible. Methods: We searched PubMed, Embase, Cochrane COVID-19 trials...
Conference Paper
Full-text available
Objectives: To generate evidence for extent of and determinants of overtreatment of older people (60+ years) in hospitals and identify possible solutions. Methods: We conducted four systematic reviews on the following topics: 1) Definitions and magnitude of non-beneficial treatments in the last six months of life. 2) Type and extent of inappropria...
Conference Paper
Full-text available
The concepts of overdiagnosis and overtreatment are now emerging more often in the medical literature as awareness of their implications for psychosocial burden and unsustainable cost become clearer. Researchers now have more tools to investigate these widespread low-value care practices in hospitals, primary care and residential aged care. We aim...
Conference Paper
Full-text available
https://osf.io/pz2ch/ Background Initiation of discussions on patient’s end of life (EOL) care preferences are often delayed by clinicians due to prognostic uncertainty. We aimed to 1) enhance clinician confidence by identifying objective risk flags for ‘near EOL’; and 2) understand the barriers and facilitators to the use of a risk prediction che...
Conference Paper
Full-text available
https://osf.io/y82pq/ Background/objectives Decision-making on treatment options for older patients near the end of life do not often achieve minimum information requirements and often overlook personal priorities. We developed a decision support prototype to fill these gaps. Methods Master’s program candidates and nurses searched for evidence of...
Article
Full-text available
The often default process of ‘decisions made about me without me’ is only slowly changing. Empowering seniors and their families to challenge clinicians and ask about treatment burdens and realistic expectations, as well as encouraging open and honest conversation about dying, will only improve the care they receive.
Preprint
Full-text available
Aim To understand patient/family perspective of inappropriate intensive care unit (ICU) admissions and treatment. Methods Rapid literature review of English language articles published between 2001 and 2017 in Medline or PsycInfo. Results Thirteen articles covering 6,194 elderly patients or surrogate decision-makers from four countries were eligibl...
Conference Paper
Full-text available
157 - Shared decision making near the end of life: review of gaps and practical challenges of developing an electronic decision aid prototype . Background The preparedness of older patients and their families for poor prognostic news and care planning for near end of life (EOL) depends on personal, clinical and social factors. We investigated dec...
Article
Full-text available
The medicalisation of dying from natural causes: Unacceptable to patients, low-value for the health system. This article summarises findings from our research of the past five years and emphasises that doing more near the end of life is not necessarily ethical or better for patients or their caregivers, and it is unsustainable for the health syste...
Presentation
Full-text available
Initiating end-of-life discussions with patients is often delayed or avoided altogether by healthcare practitioners even in light of imminent death. This continues despite the availability of guidelines and conceptual frameworks on how to communicate prognoses at end-of-life. We elicited healthcare practitioners’ exposure to and confidence in end-o...