2020 NIHR ACF PES Leeds Older People and Complex Health Needs
2020 NIHR Academic Clinical Fellowship in Priority Research Themes
HEE Local Office: Yorkshire and Humber
Medical School: University of Leeds
Research Theme: Complex Needs in Age-Related and Chronic Disease
Specialty Options: Palliative Medicine or Vascular Surgery
Plain English Summary
This NIHR Academic Clinical Fellow (ACF) will address the unmet need around the palliative care management of patients with either Critical limb ischemia (CLI) which incorporates night time rest pain, ulceration and gangrene or large Abdominal Aortic Aneurysms (AAA) where the patient is deemed unsuitable for either open or endovascular repair.
Patients with this condition are often older, frail with multiple comorbidities and so decisions regarding intervention or conservative management are finely balanced. In critical limb ischaemia pain is common resulting from a mixture of inflammatory and neuropathic mechanisms and sometimes poorly responsive to conventional analgesia. Mortality rates remain high while quality of life and outcomes for many patients with critical limb ischaemia are worse than that of most cancers.
In AAA, the major issues for patients are the acceptance of the diagnosis and that they may die from the AAA or another disease, and that the goal is about good quality of life and living in their own home. Discussion has to be had with family members about the ‘what if’ scenario of rupture and where the patient wished to be managed either at home or in the hospital if this happened.
Palliative care consultations occur (if at all) when death is imminent, reflecting poor quality end-of-life care. There is considerable scope for research to improve palliative care in surgical practice, and more specifically to guide practice and care of patients with critical limb ischaemia and AAA. Important research topics include supporting decision-making, determining outcomes that matter to patients, pain management (particularly in patients managed conservatively) and in supporting earlier integration of palliative care within overall surgical management plans.
The ACF will build on the existing research strengths in Leeds in vascular surgery and palliative medicine in this novel collaboration, which supports the priority theme of older people and complex health needs. The vibrant research environment within these two specialties and the overall NIHR Integrated Academic Training programme at Leeds offers an opportunity for the ACF to lead preparatory research work and publish peer-reviewed papers to support a highly competitive PhD Fellowship application.
Design and Methods: We have access to the local National Vascular Registry for patients with CLI and AAA and the initial work will be based around the scale of the problem in term of comorbidities, frailty and survival. Methodologically, there are international strengths in data linkage and analysis (working with MRC funded Leeds Institute of Data Analytics, University of Leeds), community based randomised clinical trials of complex interventions (working with Leeds Institute for Clinical Trials Research, University of Leeds), systematic reviews, health economics, behavioural change and implementation science.
We have developed a Patient and Public Involvement (PPI) group on frailty and we have expertise in collaboration with a dedicated geriatrician in the assessment of Frailty and Cognitive Impairment. Based upon this PPI work we will develop further PPI groups around CLI and AAA which will involve Vascular Surgeons and Palliative Care Medicine.
Academic leads: Professor Michael Bennett (Palliative Medicine), Professor Julian Scott (Vascular Surgery)