Amara Nwosu

MBCHB FRCP PhD


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Implantable cardioverter defibrillator (ICD) deactivation in palliative care – a case involving best interest decisions for someone lacking capacity at the end of life

The use of implantable cardioverter-defibrillators (ICD) has increased due to benefits of preventing death from cardiac arrhythmia. However, the increasing use of ICDs has created new challenges for how to proactively manage deactivation of these devices in people who are dying, especially for those who lack capacity to make decisions about their care. The aim of this case report is to discuss the challenges of planning for deactivation of an ICD for a patient who lacked capacity at the end of life.


In this case report (published on AMRC Open Research) we describe the challenges of managing ICD deactivation in a dying patient with fluctuating capacity who had previously expressed a wish for the ICD to remain active. Although it is preferable to use advance care planning (ACP), to provide care in-line with patient-identified care preferences, we demonstrate how a best interest process can be used to make decisions about ICD deactivation at the end of life.

More information can be found in our case report here:

https://amrcopenresearch.org/articles/3-4

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The use of advance consent to enable hydration assessments, for research, at the end of life

As the need for palliative care increases, it is essential for research opportunities to be offered to patients with palliative care needs to ensure patients can receive evidence-based treatments and services to improve care. Although it is recognised that palliative, and in particular end of life, research can be both methodically and ethically challenging it is important to note that palliative patients are keen to be involved with research.
Over the past three years, patients in Marie Curie Hospice Liverpool have been recruited to a research study evaluating hydration, where advance consent methodology is used to facilitate participation at the end of life. In this study, participants provided ‘advanced consent’ to receive research assessments, in anticipation of the deterioration of their health and loss of the ability to provide consent to ongoing research participation. During this process, recruiting participants will nominate a consultee (who can be any family member, friend or healthcare professional), who is contacted by the researcher prior to completion of research assessments. Participants will generally choose a caregiver or friend to act as a personal consultee; however, there may be some instances where a healthcare professional is chosen.
In this, we share our experiences using advanced consent methodology and a healthcare professional acting as a consultee, to facilitate research assessments in a patient who was lacking capacity at the end of life.

More information can be found in our case report here:

Stanley S and Nwosu AC. Case Report: The use of advanced consent methodology and healthcare professional consultee to facilitate research participation in dying patients [version 1; peer review: awaiting peer review]. AMRC Open Res 2021, 3:3 (https://doi.org/10.12688/amrcopenres.12961.1)


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Palliative Medicine Podcasts

Podcasts offer a fantastic way to learn about palliative medicine on the go. I’m delighted to be the Technology Editor of ‘Palliative Medicine’, the world’s most highly rated palliative care journal. Listen to our amazing podcast series , where talented authors share their important findings in their own words. We have many exciting and interesting podcasts coming up with over 60 podcasts in our back catalogue!

The podcasts are available from most places which curate podcasts. This includes Apple podcasts, Google podcasts, Stitcher, BeyondPod, Pocketcasts and more.

Podcasts can be recorded for FREE by authors of papers published in Palliative Medicine, or those who have had articles accepted for piblication. If you wish to record a podcast please contact me here:

Palliative Medicine podcast link (webpage)

Palliative Medicine Apple Podcasts


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Improving Palliative Care Through Digital Health Technology

I’m delighted to write a geust blog for BMJ Supportive and Palliative Care about how palliative care care be improved through use of digital health technology. I also reflect on how this presents an opportunity to learn from the COVID19 pandemic. Specifically, I reference an article by Clabburn and colleagues, which describes the novel use of ‘Ivy Street’, a Virtual Learning Environment to support palliative and end of life care education. 

Read my guest blog here:

Improving Palliative Care Through Digital Health Technology


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Palliative Care, Architecture and Design symposium (PADS): 2nd conference coming soon

Funding has been secured to deliver the 2nd Palliative Care, Architecture and Design Symposium (PADS) in 2020. Engage (University of Liverpool) has agreed to fund the event which will bring together researchers from different backgrounds to develop research methodology, to explore how architecture, design and technology can improve quality of life for people with palliative care needs. The event follows the overwhelming success of the first symposium which took place in November 2018.

Further information will follow. Information of the inaugral PADS conference can be found through the following links:

Presentations from PADS 2018

Overview of PADS event in the European Association for Palliative Care Blog


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Technology in Palliative Care Study Consensus Meeting Completed

The Technology in Palliative Care (TIP) study consensus meeting was completed successfully on Friday 6th September, in the University of Liverpool. The TIP study (funded by Liverpool Clinical Commissing Group) aims to identify the research priorities for digital health in palliative care. The consensus meeting was attended by 12 experts, and followed two international Delphi rounds which were completed earlier this year.

The consensus meeting will be followed by a Patient and Public Engagement event (funded by Wellcome Trust, University of Liverpool Health and Life Sciences PPE scheme) which will take place in Marie Curie Hospice Liverpool on the 27th of September.

Following this event, the final report will be written and the agreed priorities will be submitted for publication in a peer reviewed journal and widely disseminated.

For more information about the TIP study please contact Dr Amara Nwosu through the contact section of this website.

Infographic vector created by studiogstock – www.freepik.com


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Robotic technology for palliative and supportive care: Strengths, weaknesses, opportunities and threats

How could robots help us at the end of life? Check out this open access article I published with some great co-authors.

https://journals.sagepub.com/doi/full/10.1177/0269216319857628

What is already known about the topic?

  • Medical robots have mainly been used to support surgical procedures and for a variety of assistive uses in dementia and elderly care.
  • There has been limited debate about the potential opportunities and risks of robotics in other areas of palliative, supportive and end-of-life care.

What this paper adds?

  • The potential opportunities of robotics in palliative, supportive and end-of-life care include a number of assistive, therapeutic, social and educational uses.
  • There is concern that robots will exacerbate healthcare inequalities, disrupt the workforce and reduce face-to-face human interaction.

Implications for practice, theory or policy

  • Future work should evaluate the health-related, economic, societal and ethical implications of using robotic technology in palliative, supportive and end-of-life care.
  • There is a need for collaborative research to establish use-cases and policy recommendations to guide the appropriate use of robots for people with serious illness.

CLICK below to access the artilce

Nwosu AC, Sturgeon B, McGlinchey T, Goodwin CDG, Behera A, Mason S, Stanley S, Payne TR. Robotic technology for palliative and supportive care: strengths, weaknesses, opportunities and threats. Palliative Medicine 2019.


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Bioelectrical impedance vector analysis (BIVA) as a method to compare body composition differences according to cancer stage and type – ScienceDirect

I’m delighted to announce my latest publication. This article describes the potential to use Bioelectrical Impedance Vector Analysis (BIVA – a non-invasive body composition assessment tool) to evaluate body composition differences between cancer groups. This is the first paper in the academic literature to report how BIVA using a z-score methodology, can study body composition, according to cancer type, stage, gender and ethnicity.

The open access paper can be found completely free through the link below:

https://www.sciencedirect.com/science/article/pii/S2405457718304066


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Robots at home event – University of Liverpool 08/03/2019

I had a great time presenting my work on robotics in palliative care at the Robots @ Home event in the University of Liverpool. I discussed the strengths, weaknesses, opportunities and threats of robotic technology in relation to palliative care supportive care. I’m happy to discuss the next steps of my work and collaboration potential. Feel free to contact me.