Timely Application of Palliative Care by Enhancing Prognostic Accuracy

PhD opportunity (read about the conditions and procedures here)  

Promotor
M. van den Beuken – van Everdingen

About the supervisors
M. van den Beuken – van Everdingen is internist and professor of Palliative Medicine. She obtained a doctorate with a dissertation on ‘Symptoms in patients with cancer’. She is co-founder and head of the expertise center for palliative care at Maastricht UMC+, head of the Dutch advisory board for palliative care and of the ‘working group Care’ of the Dutch expert centers, member of several guideline committees and member of the ‘working group Palliative care’ of the Dutch oncology society and the Dutch society of internists. F. Magdelijns is internist and elderly care physician. She obtained a doctorate with a thesis titled ‘Health-care-related adverse events leading to (re)hospitalization.’ D. Jansen is assistant professor and elderly care physician and palliative care physician. She obtained her PhD on ‘palliative care needs of patients with advanced chronic organ failure’ Cum Laude. M. Theunissen is clinical epidemiologist and senior researcher, experienced in research on pain and perioperative medicine. He obtained a doctorate with a thesis titled ‘Understanding factors affecting postoperative Quality of Life’.

About the research group
The studentship will be embedded within the team of prof. dr. M. van den Beuken – van Everdingen. The research activities are focused on three points of interest: pain, dyspnoea, and advanced care planning. Pain research is mainly focused on oncological pain, while dyspnoea research addresses patients with chronic organ failure and COPD. Early involvement of a palliative care team is the third spearhead within the research activities: research on advanced care planning has overlap with the dyspnoea research, but also focuses at patients with legal incapability.

Work field of the proposed project:
palliative care

Estimated duration:
2 years

Scientific background
Most research on advanced care planning is still relatively new and evidence on timely application of interventions across different palliative patient populations is limited. In Dutch hospitals, patients are not structurally identified as patients who could benefit from palliative care. Therefore, no structural symptom assessment is performed, underestimating the actual symptom burden. Proactive consultation of a palliative care team might result in an improvement of the symptom burden. However, for proactive participation of a palliative care team, valid and reliable diagnostic and prognostic tools are essential. This led to the following research question:

Main research question, sub questions and aim(s):
The main question of this project is whether proactive consultation of a palliative care team results in an improvement of the symptom burden of palliative patients. Another question is if and how the care processes will change as a result of the proactive consultations. Finally, the question is which prognostic and diagnostic instruments are available for the assessment of the palliative status of patients and how the use of these instruments is experienced by nurses and doctors

Research design and methods:
Literature review on diagnostic and prognostic instruments; Intervention study with baseline measurement among palliatively marked (by the Surprise Question) elderly and follow-up measurement among palliatively marked elderly who received additional care by the palliative care team; Qualitative research, consisting of a focus group interview with nurses and physicians. Predictive validation study (1year survival) on the Surprise Question and the Radboud indicatoren voor palliatieve zorg. Research activities:
Perform a systematic literature review; Data collection concerning follow-up of palliative care team advices; Finalize (statistical) analyses on interviews, follow-up of palliative care team advices, and validation study of the Surprise Question and Radboud indicators; writing of scientific publications.

Expected results:
This PhD project aims to provide definite answers on the added value of proactive palliative care for patients with a life expectancy <1 year. Also this project aims to reveal the experience of nurses and doctors with the use of the Surprise Question and the Utrecht Symptom Diary. Finally, the results will be used to update existing evidence on diagnostic and prognostic instruments with regard to palliative care.

Competences the applicant needs to have or acquire for the project:
MSc in Medicine or General health science and fluency in Dutch and English

Internal contact:
M. van den Beuken – van Everdingen, m.vanden.beuken@mumc.nl