Amara Nwosu

MBCHB FRCP PhD CF SFHEA


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New! Special Interest Forum in Technology and Digital Innovation in palliative care

We invite you to express interest in joining a new Special Interest Forum (SIF) in Technology and Digital Innovation in palliative care, which will be coordinated by the Association for Palliative Medicine of Great Britain and Ireland (APM – www.apmonline.org).

This SIF is open for members and non APM members (see below). If you are interested in being involved, please contact the APM office at office@compleat-online.co.uk expressing your interest.

Advancing digital technologies are impacting all areas of healthcare and it is clear these tools will play an increasingly significant role in the future of healthcare delivery, including within the fields of palliative and end of life care. Digital technologies include all aspects of telehealth, artificial intelligence, virtual reality, remote monitoring using apps or wearable devices, as well as electronic records and prescribing systems. The benefits of incorporating technologies to support a patient’s palliative care journey range from enhanced quality and coordination of care, improved symptom management, remote monitoring and improved communication.

In this rapidly changing landscape, it is important that as clinicians we are aware of the opportunities that different digital technologies may offer, both to improve healthcare and to support professionals. This special interest forum is open to any APM members who have an interest in, or current involvement in the application of digital technologies in palliative care.

The aims and objectives of the group will be agreed in detail at the convening meeting, but we hope the group will enable dissemination and implementation of digital innovation, connect members to leverage their skills and experiences for the benefit of the wider healthcare system and each other, and facilitate member networking to enable support and professional development in digital health and enable members to utilise the collective expertise within the group.

We encourage all members of the SIF to be a member of the APM. This SIF will be open to non APM members who have legitimate reason to be involved, e.g. technologists, social scientists etc. Please contact us if you, or your colleagues, are in other fields who may wish to be involved in this SIF.

If you are interested in being involved, please contact the APM office at office@compleat-online.co.uk expressing your interest.

Co-chairs of the Special Interest Forum (SIF) in Technology and Digital Innovation in palliative care

Dr Amara Nwosu, Senior Clinical Lecturer in Palliative Medicine, Lancaster Medical School and Consultant at Royal Liverpool University Hospital, Churchill Fellow 2020, Research Lead of Marie Curie Hospice Liverpool and Technology Editor Palliative Medicine.

Dr Suzanne Ford-Dunn, Consultant in Palliative Medicine, University Hospitals Sussex NHS Foundation Trust and current Topol Digital Fellow


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Completion of my Churchill Fellowship report: Advancing Palliative Care: Artificial Intelligence and Design Insights from the USA and the Netherlands

I am delighted to share the report from my Churchill Fellowship which has been published online today. In 2023 I travelled to the USA and the Netherlands to research applications of artificial intelligence in palliative care.

Title

Advancing Palliative Care: Artificial Intelligence & Design Insights from the USA and the Netherlands

In addition to my written report, I have also made a YouTube video and podcast. I also include my keynote talk from 2023 Hospice UK conference.

Report

https://churchillfellowship.org/ideas-experts/ideas-library/advancing-palliative-care-ai-and-design-insights-from-the-usa-and-the-netherlands/?fbclid=IwZXh0bgNhZW0CMTAAAR0gMHiUNrGHjtO_-Mw-GO-pqj_-Q46wym3EXsHqIQ2Y4NRTkA10MLwYhX0_aem_FuWfM5HHGrrhFxULAI5krA

Video

Podcast

Keynote talk


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New paper: Palliative care healthcare professionals’ experiences of managing digital legacy as part of advance care planning for people receiving palliative care

I am delighted to be a co-author on a paper, published in the Palliative Medicine journal, which explores how we support people to manage their digital legacy after death.

In this paper Sarah Stanley , and collegaues, used a constructivist grounded theory approach, and semi-structured interviews, to understand healthcare professionals’ (working in a hospice) experiences of managing digital legacy.

The results demonstrated the following:

  • Palliative care healthcare professionals believe that managing digital belongings is as important as managing physical belongings.
  • Palliative care healthcare professionals require education to improve their knowledge and understanding of digital legacy.
  • Digital legacy should become part of advance care planning conversations.

The paper is freely available (open access) from the link below and is Editor’s choice article of Palliative Medicine for October 2023.

Stanley S, Higginbotham K, Finucane A, Nwosu AC. A grounded theory study exploring palliative care healthcare professionals’ experiences of managing digital legacy as part of advance care planning for people receiving palliative care. Palliative Medicine. 2023;0(0). doi:10.1177/02692163231194198


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Telehealth requires improved evidence to achieve its full potential in palliative care

I have written an Editorial for the Palliative Medicine journal about the unrealised potential of palliative care telehealth. In the Editorial, I discuss the opportunities and challenges associated with telehealth; I also describe the next steps needed for research to evaluate palliative care telehealth.

I have also recorded a podcast to summarise the Ediorial. The article and podcast are freely available from the links below:

Click here to access the published Editorial

Click here to access the podcast


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Marie Curie Hospice Liverpool win the ‘Culture for Innovation Award’ at the North West Coast Research and Innovation Awards 2023

We are delighted to announce that Marie Curie Hospice Liverpool, in partnership with the Inclusionaries Lab, has won a prestigious award at an event recognising the best innovators and researchers in health and care in Cheshire, Merseyside, Lancashire and South Cumbria.

The North West Coast Research and Innovation Awards is the only health awards event for the region, run by three NHS bodies focussed on research and innovation. The Culture for Innovation Award was presented to Marie Curie Hospice Liverpool (in partnership with the Inclusionaries Lab, University of Liverpool) in recognition of the innovative ‘Designer in Residence’ project, which involves hosting a designer (Andrew Tibbles) in Marie Hospice Liverpool for a year, to research how design methods can improve future palliative care. This project has resulted in the opening of a temporary Research Hub in the clinical area of Marie Curie Hospice Liverpool, the creation of a prototype phone installation to capture people’s experiences of hospice care, and the development of future work to explore how design can support future digital legacy research.

Marie Curie Hospice Liverpool win the CULTURE FOR INNOVATION Award. North West Coast Research and Innovation Award 2023 at The Spine Liverpool.

Left to right: Dr Laura Chapman (Medical Director and Consultant in Palliative Care, Marie Curie Hospice Liverpool), Sarah Stanley (Research Nurse, Marie Curie Hospice Liverpool), Dr Amara Nwosu (Senior Clinical Lecture in Palliative Care, Lancaster University; Honorary Consultant in Palliative Care, Liverpool University Hospitals NHS Foundation Trust; Research Lead, Marie Curie Hospice Liverpool), Andrew Tibbles (PhD Design student, the Inclusionaries LabUniversity of Liverpool), Hayley Hawkins (Deputy Head of Operations, Marie Curie Hospice Liverpool).


Commenting on the award, Dr Amara Nwosu (Senior Clinical Lecture in Palliative Care, Lancaster University; Honorary Consultant in Palliative Care, Liverpool University Hospitals NHS Foundation Trust; Research Lead, Marie Curie Hospice Liverpool) said “We are delighted to be the first palliative care winner of an award from North West Coast Research and Innovation Awards. Palliative care is an essential component to effective healthcare systems; we are proud that our innovative work to use design methods to shape palliative care services has been acknowledged through this wonderful award”.

Hosted by the Innovation AgencyClinical Research Network North West Coast (CRN NWC); and Applied Research Collaboration North West Coast (ARC NWC) the event attracted around 180 entries, of whom 36 were shortlisted in 12 categories. 

Special guest Professor Sir Stephen Powis, Medical Director of the NHS, said: “Every challenge we face is an opportunity to learn, collaborate and embrace new approaches to deliver improvements in the services we provide, for the benefit of patients, staff and the wider NHS. 

“As the NHS looks forward to its 75th birthday on 5th July, it is a good time to reflect on its journey and on the incredible research and innovation milestones that have transformed patient outcomes and that will help to build an NHS that is fit for the future.” 

The event took place at The Royal College of Physicians, The Spine in Liverpool, hosted by BBC TV North West and Breakfast presenter Roger Johnson. The full list of winners is below; to find out more about their entries, visit www.nwcawards.co.uk.  

WINNERS 2023

Culture for Innovation Award: Marie Curie Hospice Liverpool

Innovation in Workforce Development Award: Health Education England NW; Lancashire and South Cumbria NHS Foundation Trust; University of Central Lancashire

Patient Safety and Care Improvement Award: Liverpool University Hospitals NHS Foundation Trust and Innovation Agency

Research Student of the Year Award: Piotr Teodorowski, University of Liverpool

Ruth Young Award for Research Implementation: Liverpool Heart and Chest Hospital NHS Foundation Trust

Outstanding Contribution to Patient and Public Involvement Award: Lancaster University

Research Delivery Team of the Year Award: Warrington and Halton Teaching Hospitals NHS Foundation Trust

Research Collaboration of the Year Award: Marine Lake Medical Practice and Wirral University Teaching Hospital NHS Foundation Trust

Primary Care and/or Community Research Team of the Year Award: Lancaster Medical Practice

Unsung Hero: NHS 75th Anniversary Award: Sue Smith of One Wirral CIC

Tackling Health Inequalities Award: Liverpool John Moores University; University of Liverpool; Edge Hill University

Sustainability Award: Liverpool University Hospitals NHS Foundation Trust, Broadgreen University Hospital


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My Churchill Fellowship begins!

Hello, my name is Dr Amara Nwosu, I am a Senior Clinical Lecturer (Lancaster Medical School) and Honorary Consultant in Palliative Medicine (Liverpool University Hospitals NHS Foundation Trust and Marie Curie Hospice Liverpool). In 2020, I was awarded a Churchill Fellowship to visit the U.S.A and the Netherlands to research how technology, data and design can support healthcare for people who with serious illness. My Churchill Fellowship is supported my Marie Curie.

The Churchill Fellowship

The Churchill Fellowship is an overseas travelling fellowship to support UK citizens to travel the world in search of innovative solutions for today’s most pressing problems. The Churchill Fellowship was founded by public donation in 1965 as the living legacy of Sir Winston Churchill for the UK.

The aim of my Fellowship

I aim to research how technology, data and design can support healthcare for people who with serious illness. This is because the UK population is ageing and palliative care need will increase by 42% by 2040; demand for care wil be challenging for NHS to meet without innovation. Palliative care need in the UK has been exacerbated by the impact of the COVID-19 pandemic. When used well, digital health improves access to healthcare services; however, many barriers prevent meaningful use of these technologies in the UK. Through this Fellowship, I will travel to the Netherlands (Erasmus Medical Center, Rotterdam; Delft University of Technology (TU Delft), Delft and IKNL, locatie Utrecht) and the USA (Dana Farber Cancer Institute, Harvard University, Boston) to meet professionals from a variety of disciplines who are using applications of design, technology and data in palliative care that can benefit the UK.

My travels (eventually) begin!

The My trip has been delayed due to the COVID19 pandemic, but I have finially commenced my trip to the Netherlands in May 2023! Firstly, I visited the Nemo Science Museum in Amsterdam which housed a fantastic exhibition about death and dying. The section titled ‘Over de dood’ (About Death) takes people through a journey about people’s views and experiences of death and dying from different cultural perspectives. The exhibition uses a mix of text, images and lighting to provide a thoughtful and emotional experience about death and dying, from a societal and human persepctive rather than a medical one. I really loved the design of the exhibition, with its inclusion within a family science musuem but also located within the ‘Hoe word ik ouder’ (How will I age?) section of the musuem, which presented positive messages about aging.

Next stop is to visit Delft University of Technology (TU Delft), where I will deliver a seminar about my research and will meet designers and engineers to learn about their excellent work.

I will provide updates about my progress in further blogs and I will record a podcast to summarise the findings of my trip.

My Research interest

  • The evaluation of technology to support care for patients with advanced disease.

Examples of my interests for the fellowship

  • Telehealth
  • Architecture and design in healthcare / palliative care
  • Technology to support care in serious illness
  • Design in healthcare and palliative care
  • Digital legacy (e.g., how digital data is managed after death)
  • Virtual reality
  • Social robotics and healthcare / palliative care
  • Use of mobile devices, apps, wearable devices to support healthcare /palliative care

Selected publications

Nwosu AC, McGlinchey T, Sanders J, Stanley S, Palfrey J, Lubbers P, Chapman L, Finucane A, Mason S
Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study
JMIR Aging 2022;5(1):e32075

Nwosu AC, Mills M, Roughneen S, Stanley S, Chapman L, Mason SR. Virtual reality in specialist palliative care: a feasibility study to enable clinical practice adoption. BMJ Supportive & Palliative Care Published Online First: 17 February 2021. doi: 10.1136/bmjspcare-2020-002327


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Death, dying and the metaverse

On 08/09/2022 I delivered a talk called ‘Death, dying and the metaverse’, as part of the ‘International Collaborative for Best Care for the Dying Person’ webinar series. In this talk I reflect on my thoughts about how Web 3.0 technologies will affect how society will experience death and dying. I also discuss concepts such as digital legacy and digital immortality.

My talk starts at the 26 minute mark and is available from this link:

Death, dying and the metaverse talk – Dr Amara Nwosu

Photo by RODNAE Productions on Pexels.com


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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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How can technology be used to support communication in palliative care beyond the COVID19 pandemic?

Can we use technology better to support communication in palliative care?

  • We are looking for palliative care healthcare professionals to share their experience of using technology to communicate during the COVID19 pandemic.
  • The study is funded by Marie Curie is led by Sarah Stanley (research nurse at Marie Curie Liverpool Hospice). The study has ethical approval and is sponsored by Lancaster University.
  • We are seeking the opinions of Palliative Care healthcare professionals who have worked in the UK during the COVID19 pandemic. 
  • This a short electronic survey (takes roughly 10 -15 minutes to complete) can be completed from a smartphone, laptop or desktop computer.
  • We will identify how technology have been used in palliative care, been used to support communication during the COVID19 pandemic. 
  • We will use the outcomes of this work to inform policy, to identify how technologies can be used to improve palliative access beyond the COVID19 pandemic.

  All the participant information, consent form and survey can be assessed from the link below.

Click here to access the survey

health technology design, vector illustration eps10 graphic