IMPACCT PhD project opportunities

Proactive planning to manage existing symptoms and potential symptoms is an important part of palliative care and is also essential when planning for care in the last days and hours of life.

This doctoral project will explore approaches to inform optimal prescription, assessment to underpin the decision to administer, and the follow-up to assess benefits and harms.

Supervisors: Professor Meera Agar and co-supervisors.

The most common outcomes used to evaluate interventions in palliative care clinical trials are symptoms and quality of life. These outcomes should ideally be self-reported by the person with palliative care needs themselves to capture direct experience. However, people with palliative care needs sometimes have cognitive impairments from disease and treatment that interfere with their ability to self-report. These often worsen over time as people approach the end of life. In these cases, it may be necessary for family members or clinicians to ‘proxy’ report symptoms and quality of life instead of the person with palliative care needs.

This project will combine qualitative and quantitative methods to develop guidance for families and clinicians on how to approach proxy reporting as well as inform analysis and interpretation by clinical trialists. The project will be supervised by researchers from both IMPACCT and the University of Tasmania. The resulting guidance will make an important methodological contribution to the field of palliative care research.

Supervisors: Dr Tim Luckett and Dr Jessica Roydhouse

This project will focus on the experiences of unpaid carers who have provided support for a friend or family member with a life-limiting disease. Qualitative methods will feature to enable a nuanced exploration of the impact of unpaid caring on carers’ psychosocial, physical and financial wellbeing.

Supervisors: Associate Professor Michelle DiGiacomo  and co-supervisors.

Older Australians living with cancer and complex co-morbidities experience symptom burden, limited mobility, and increased physical burden as well as social isolation.

In 2017, 1 in 7 Australians were aged ³ 65 (3.8 million; 15% of the total population). By 2057, the number of older people is expected to grow to 8.8 million (22%); by 2097, to 12.8 million (25%). In 2017, approximately 78,688 new cancer diagnoses were in people aged ³ 65; 7% of all Australians aged ³ 75 had a cancer diagnosis within the previous 5 years (2012 data); over 80% of cancer deaths will occur among those aged ³ 60.

Timely assessment and recognition of the needs of older people with cancer during routine clinical consultations where hearing loss and cognitive issues can be a barrier to effective communication are critical to providing optimal patient-centred care.

This project will develop an age-friendly clinical communication model to facilitate a more systematic assessment of the needs of older people living with cancer and their families to enable appropriate care, minimise burden, and improve quality of life.

This project is inter-disciplinary, intersecting palliative, supportive, geriatric and aged care. The project is suitable for students with health and/or behavioural science background.

Supervisors and co-supervisors Dr Slavica Kochovska,  Professor Meera Agar, Professor Deborah Parker, including support Professor David Currow and Associate Professor Michelle DiGiacomo.

Meta-syntheses were developed as a more recent qualitative analogy to systematic reviews of quantitative research. However, differences in the underlying epistemologies of qualitative versus quantitative research arguably means that meta-syntheses should generate new knowledge rather than merely summarise previous findings.

While quality appraisal checklists for meta-syntheses are now available, there is no ‘gold standard’ in the way there is for systematic reviews of quantitative research. Instead, further development work is needed on the optimal definition of ‘data’, methods for synthesis, and quality appraisal of primary studies.

The proposed project will explore these methodological questions and propose advances to guide future meta-syntheses.

Supervisors: Dr Tim Luckett and co-supervisors.

Currently, clinical trials measure benefits separately from adverse effects and struggle to integrate in a way that measures net benefit. This is especially important for trials of treatments for people with life-limiting illness because of the time-limited window and scope for benefits, which rarely include survival gains.

The proposed project would involve:

1. a systematic review of current approaches to measuring net benefit in clinical trials
2. secondary analysis of previously-collected clinical trial data to explore relationships between measures and generate ideas for new methods, and
3. prospective development and pilot testing of a new method to measure net benefit.

Supervisors: Dr Tim Luckett and co-supervisors.

Appropriate care of older people with cancer requires an interdisciplinary approach, considering comorbidities, geriatric syndromes and psychosocial-economic issues. This project will explore care for the older person with cancer across the cancer trajectory with several choices of topic and methodological approaches available.

Supervisors: Professor Meera Agar and co-supervisors.

Guidelines are available to support the management of symptoms such as pain, breathlessness, nausea, and fatigue. But these tend to treat symptoms separately and overlook the fact that people with chronic life-limiting illness commonly present with multiple symptoms. Best practice determines that symptom management should occur within a self-management framework that empowers patients to become ‘expert’ members of their own healthcare team.

The proposed project will develop a model for self-managing co-presenting symptoms in a way that prioritises foci for intervention and coordinates strategies to optimise effectiveness and reduce unwanted interactions. The project will take a mixed methods approach, including both qualitative and quantitative components to develop and pilot the model.

Supervisors: Dr Tim Luckett and co-supervisors.

Cachexia is a wasting disorder that causes extreme involuntary weight and muscle loss. It is considered one of the most distressing aspects of cancer affecting as many as 80% of people with advanced cancer and directly contributes to nearly 1 in 3 of all cancer deaths. Despite the high prevalence, cachexia is still largely overlooked by clinicians, and rarely identified and treated at early stages.

This research project proposes to address an unmet need by providing clear, accessible, and evidence-based guidance about the likelihood of developing cachexia at early stages to help people with cancer to receive timely access to care.

This project is inter-disciplinary, intersecting health care and information science. The project is suitable for students with health and/or health informatics background.

Supervisors: Dr Mariana Sousa, Professor David Currow, A/Prof Asif Gill, and support from co-supervisors Dr Rayan Saleh Moussa and Dr Slavica Kochovska.

Malignant bowel obstruction is a highly distressing complication of cancer. Management of bowel obstruction ranges from surgical procedures or stenting to the  placement of nasogastric tube drainage and intravenous fluids in the inoperable setting. For those for whom the bowel obstruction is irreversible, medication management aims to reduce symptoms and allow the person to remain at home if this is their wish.

This project will consider the resource and health service use for the various ‘patient journeys’ within the management options for malignant bowel obstruction and consider implications for service models and policy.

Supervisors: Professor Meera Agar and co-supervisors.

Informal caregivers play an important role in delivering care and often notice the first signs of delirium in people with chronic conditions, older people, and those with palliative diagnoses.

This project aims to understand the experience of family caregivers and develop approaches to involve them in delirium prevention and care

Supervisors: Professor Meera Agar and co-supervisors.