Amara Nwosu

MBCHB FRCP PhD


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Development of ‘use-cases’ for a digital palliative care bereavement service [new study for 2022]

We are delighted that our research funding application to develop ‘use cases’ for digital palliative care bereavement service was successful. The project will be funded by Liverpool Clinical Commissioning Group and is part of the Research Capability Funding stream.

We will aim to conduct the study in 2022. The lay summary is below.

Please contact me on Twitter @amaranwosu for further information:

Lay Summary

Grief, bereavement and the need for bereavement services

Grief is a natural process, in which many people will cope with help from their friends and family. However, many people will need professional help.1-3 People who are bereaved are more likely to have problems with their mental health and wellbeing. 4-6 These problems can affect many people in society.7-9 Therefore, good bereavement care is important to ensure that people get the support they need when they are grieving.3

Challenges facing bereavement services

There are many challenges to delivering bereavement care, these include:

  • There is not enough resources to meet current demand.10 
  • Some people may not easily receive support because they live in an area where there are few services.11 
  • Some people struggle to find time to receive support during working hours due to their other commitments.
  • The COVID-19 pandemic has increased demand and has made it difficult for people to access services.3 2 
  • Palliative care need is increasing and is expected to increase by 42% in 2040, this will also increase need for bereavement support.12

Can digital bereavement services help more people receive support?

It is possible technology can be used to help more people to access bereavement support.13 However, it is important we carefully design these systems so they work properly.

In this project we will create the ‘blueprint’ needed to design a new digital bereavement serviceIn this study we will interview staff and caregivers about bereavement support, to understand what a digital bereavement service should look like. We will use this information to design the ‘blueprint’ which is needed to design a new digital bereavement support service. In computer science this ‘blueprint’ is called a ‘use-case’.14 15 We will partner with computer developers to design ‘use-cases’ which we can then use to build a digital bereavement service. After this study we will do more research to test whether the new digital bereavement service is helping more people to get the support they need.

References

1. Aoun SM, Breen LJ, Howting DA, et al. Who needs bereavement support? A population based survey of bereavement risk and support need. PloS one 2015;10(3):e0121101.

2. Pattison NA, White C, Lone NI. Bereavement in critical care: A narrative review and practice exploration of current provision of support services and future challenges. Journal of the Intensive Care Society 2020:1751143720928898.

3. Harrop E, Selman L, Farnell D, et al. 6 End of life and bereavement experiences during the COVID-19 pandemic: Interim results from a national survey of bereaved people. BMJ Supportive & Palliative Care 2021;11:A3-A3.

4. Guldin M-B, Vedsted P, Zachariae R, et al. Complicated grief and need for professional support in family caregivers of cancer patients in palliative care: a longitudinal cohort study. Supportive care in cancer 2012;20(8):1679-85.

5. Wittouck C, Van Autreve S, De Jaegere E, et al. The prevention and treatment of complicated grief: A meta-analysis. Clinical psychology review 2011;31(1):69-78.

6. Stroebe M, Schut H, Stroebe W. Health outcomes of bereavement. The Lancet 2007;370(9603):1960-73.

7. Birrell J, Corden A, Macduff C, et al. Socio-economic costs of bereavement in Scotland: main study report. 2013

8. van den Berg GJ, Lundborg P, Vikström J. The economics of grief. The Economic Journal 2017;127(604):1794-832.

9. Genevro J, Miller T. The emotional and economic costs of bereavement in health care settings. Psychologica Belgica 2010;50(1-2)

10. Harrop EJ, Goss S, Farnell DJ, et al. Support needs and barriers to accessing support: Baseline results of a mixed-methods national survey of people bereaved during the COVID-19 pandemic. medRxiv 2021

11. Wakefield D, Fleming E, Howorth K, et al. Inequalities in awareness and availability of bereavement services in north-east England. BMJ Supportive & Palliative Care 2020

12. Etkind SN, Bone AE, Gomes B, et al. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Medicine 2017;15(1):102. doi: 10.1186/s12916-017-0860-2

13. Morris SE, Ryan AK. Bereavement via Zoom during COVID-19. Journal of psychosocial oncology 2021:1-4.

14. Cockburn A. Writing Effective Use Cases. https://books.google.co.uk/books?id=TUZsAQAAQBAJ: Addison-Wesley 2001.15. Clausen M, Apel R, Dorchain M, et al. Use Case methodology: A progress report. Energy Informatics 2018;1(1):273-83.

15. Clausen M, Apel R, Dorchain M, et al. Use Case methodology: A progress report. Energy Informatics 2018;1(1):273-83.


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Digital health priorities for palliative care research

We have deposited our paper “Technology in Palliative Care (TIP): the identification of digital priorities for palliative care research using a modified Delphi method” on the medRxiv preprint server (ahead for formal peer reviewed publication)

The aim of this study was to identify research priority areas for digital health in palliative care.

This is first study to identify digital health research priorities for palliative care and provides guidance for researchers, funders and policy makers to consider areas for future research and development. 

We identified 16 research priority areas for technology in palliative care, representing 8 themes of big data, mobile devices, telehealth, virtual reality, artificial intelligence, the smart home, biotechnology and digital legacy.  Our findings will support researchers, clinicians and policy makers to improve the evidence base in these areas, through further research and development. This work is timely and important, as global palliative care need is increasing but there is a lack of evidence of how digital health can be meaningfully used to support care needs of people with advanced illness.  Therefore, it is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely and safely and do not cause unintentional harm

The pre-print is freely available from the following link. Please note, that this has not been peer reviewed so should not yet be used to guide clinical practice.

Nwosu AC, McGlinchey T, Sanders J, Stanley S, Palfrey J, Lubbers P, Chapman L, Finucane A, Mason S. Technology in Palliative Care (TIP): the identification of digital priorities for palliative care research using a modified Delphi method. Medrxiv 2021. https://doi.org/10.1101/2021.06.24.21259307

health technology design, vector illustration eps10 graphic


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AmiPal Podcast: Renal Medicine and Palliative Care – Interview with Dr Hannah Sammut – episode 19

In this episode of AmiPal I talk with Dr Hannah Sammut (Renal Physician and Royal College of Physicians post-CCT fellow in Palliative Medicine) about the importance of palliative medicine and palliative care.

 

The prevalence of symptoms in end-stage renal disease: a systematic review. Murtagh FE et al. Adv Chronic Kidney Dis. 2007 Jan;14(1):82-99.
www.ncbi.nlm.nih.gov/pubmed/17200048

 

Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease?Carson RC et al.Clin J Am Soc Nephrol. 2009 Oct;4(10):1611-9. doi: 10.2215/CJN.00510109
www.ncbi.nlm.nih.gov/pubmed/19808244

 

AmiPal and it’s content is copyright of Dr Amara Nwosu, KingAmi Media 2016. www.amaranwosu.com

Music by Bensound
www.bensound.com/royalty-free-music


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AmiPal Podcast

Hello everyone

As of today the MyPal podcast has been rebranded as AmiPal!

The content is still the same. It’s the only episodic podcast series about Palliative Care, technology, research and innovation.

The weblink for the podcast is the same:

However, the podcast also has it’s own webpage, which is now another way to access content:

www.amipal.co.uk

Please stay posted to find out exciting developments for the content!

 


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Peer Led Learning In Palliative Care #8

Dr Amara Nwosu discusses his paper about peer-led learning as a mechanism to facilitate palliative care education in medical undergraduates.

Nwosu A, Mason S, Roberts A, Hugel H. Does peer-led education have a role in teaching medical students about palliative care? The evaluation of an examination question-writing task. The Clinical Teacher 2013;10(3):151-4
http://www.ncbi.nlm.nih.gov/pubmed/23656675

Peer learning pic

Copyright Dr Amara Nwosu, KingAmi media 2014. http://www.amaranwosu.com

Music by ‘Year of the Fiery Horse’ (YOTFH). Soundcloud link: https://soundcloud.com/year-of-the-fiery-horse


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The new MyPal podcast: technology, innovation and palliative care. Episode 1 now available.

This is the first episode of an exciting new project that I’m undertaking. This podcast blends discussion of technology, innovation, health, palliative care and research. This first episode provides an overview of the project and outlines what you can expect in the coming weeks.

MyPal is a podcast about technology, innovation and research relevant to Palliative Care. Come and join the conversation about these issues in a way you just might like.

Copyright Dr Amara Nwosu, KingAmi media 2014.www.amaranwosu.com

Original music is performed by ‘Year of the Fiery Horse’ (YOTFH). Soundcloud link: @year-of-the-fiery-horse


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Nanotechnology to diagnose and monitor cancer – can palliative care benefit? The Google X project

Google have entered into the health research arena. They aim to use technology to diagnose cancer early. I believe is exciting and should cause us to question how technology could be used in palliative care.

Computer science has arguably overtaken medicine as the newest academic discipline. Modern applications like the iPhone (only developed in 2007) have irreversibly changed the way we interact with technology on a daily basis. However, it is not common to hear about medics collaborating with computer scientists or undertaking computer science courses or research. This is in contrast with  other academic disciplines such as natural sciences, social sciences and psychology.

The ‘Google X’ project aims to avoid unnecessary deaths. In terms of cancer Google propose a diagnostic ‘smart pill’ that can be swallowed by an individual which. The pull would contain magnetised nanoparticles that would be released into the blood when swallowed. These particles would travel round the body looking for biomarkers, only to return (by action of their magnets) to a wearable device on the wrist to download the results. In addition to cancer Google indicate that other markers (such as sodium) could be monitored.

Google’s aim to reduce unnecessary deaths is admirable; however, should we also be asking how we can use computer science and concepts like nanotechnology to improve palliative care? Or, conversely, should high tech, high cost interventions be avoided at the end of life? This is interesting food for thought. What is certain is that technology and innovation will continue and the role this has in palliative care needs to be considered.

http://news.sciencemag.org/biology/2014/07/google-x-sets-out-define-healthy-human

http://online.wsj.com/articles/google-to-collect-data-to-define-healthy-human-1406246214