Andrew Wilcock - Academia.edu (original) (raw)

Papers by Andrew Wilcock

Journal of pain and symptom management, Jan 21, 2015

Measurement of dyspnea is important for clinical care and research. To characterize the relations... more Measurement of dyspnea is important for clinical care and research. To characterize the relationship between the 0-10 numerical rating scale (NRS) and four-level categorical verbal descriptor scale (VDS) for dyspnea assessment. This was a substudy of a double-blind, randomized controlled trial comparing palliative oxygen to room air for relief of refractory breathlessness in patients with life-limiting illness. Dyspnea was assessed with both a 0-10 NRS and a four-level categorical VDS over the one-week trial. NRS and VDS responses were analyzed in cross-section and longitudinally. Relationships between NRS and VDS responses were portrayed using descriptive statistics and visual representations. Two hundred twenty-six participants contributed responses. At baseline, "mild" and "moderate" levels of breathlessness were reported by 41.9% and 44.6% of participants, respectively. NRS scores demonstrated increasing mean and median levels for increasing VDS intensity, fr...

Journal of Pain and Symptom Management, 2014

The challenges of palliative care clinical trial recruitment are well documented. The aim of the ... more The challenges of palliative care clinical trial recruitment are well documented. The aim of the study was to review tested strategies to improve recruitment to trials of people with a range of conditions who may access palliative care services but are not explicitly stated to be "palliative." This was a systematic review with narrative description. The Cochrane, Embase, PubMed, PsycINFO, and CINAHL electronic databases were searched (English; January 2002 to February 2014) for quasi-experimental and randomized controlled trials (RCTs) testing the effect of recruitment strategies on accrual to clinical trials of people with organ failure and cancer. Titles, abstracts, and retrieved articles were screened by two researchers and categorized by recruitment challenge: 1) patients with reduced cognition, 2) those requiring emergency treatment, and 3) willingness of patients and clinical staff to contribute to trials. Of 549 articles identified, 15 were included. Thirteen reported RCTs and two papers reported three quasi-experimental studies. Five were cluster RCTs of recruiting sites/institutions. One was a randomized cluster, crossover, feasibility study. Seven studies recruited patients with cancer. Others included patients with dementia, stroke, cardiovascular disease, diabetes, frail elderly, and bereaved carers. Some interventions improved recruitment: memory aid, contact before arrival, cluster consent, "opt out" consent. Others either reduced recruitment (formal mental capacity assessment) or made no difference (advance research directive; a variety of educational, supportive, and advertising interventions). Successful strategies from other disciplines could be considered by palliative care researchers. Tailored, efficient, evidence-based strategies must be developed, acknowledging that strategies with face validity are not necessarily the most effective.

Handbook of Palliative Care, 2005

Respiratory symptoms are a common problem for patients with ad-vanced cancer, cardio-respiratory ... more Respiratory symptoms are a common problem for patients with ad-vanced cancer, cardio-respiratory and neurological disease. In their last year of life as many as 94% patients with chronic lung disease, 78% of those with lung cancer [1] and 50% of patients with heart dis-ease will ...

Palliative Medicine, 2013

The &... more The 'off-label' use of a drug beyond the specifications of its Marketing Authorization is widespread in palliative care.It is legal, but there are implications for prescribers, outlined by regulatory bodies such as the General Medical Council. A previous survey suggested that few doctors in palliative medicine always follow these recommendations. To obtain a contemporary view of how medical and non-medical independent prescribers adhere to current regulatory guidance. Selected doctor, nurse and all pharmacist members of www.palliativedrugs.com from the United Kingdom were invited to complete an online questionnaire. There were 332 respondents, a response rate of 9% based on number of e-mails delivered. Most worked within an inpatient hospice, although for nurses it was the community; there was a wide range of experience. Few respondents (15%) reported that their services operated a policy on providing information about off-label use. Most (65%) would always make a clear record of the drug prescribed, and this was highest for doctors, with 39%-73% always operating in line with the 'must do' aspects of General Medical Council guidance. This proportion was lower for nurse (42%-55%) and pharmacist (0%-30%) responders in part because their guidance is based on the previous, less pragmatic General Medical Council guidance. Examples given for off-label use, together with general comments, provided additional insight into respondents' practice. Compared to before and to nurse and pharmacist prescribers, doctors appear better able to adhere to their regulatory body guidance. Given that all the independent prescribers in palliative care can prescribe the same drugs, consistent regulatory guidance is required.

Palliative Medicine, 2004

A randomised controlled pilot study was carried out to examine the effects of adjunctive aromathe... more A randomised controlled pilot study was carried out to examine the effects of adjunctive aromatherapy massage on mood, quality of life and physical symptoms in patients with cancer attending a specialist unit. Participants were randomised to conventional day care alone or day care plus weekly aromatherapy massage using a standardised blend of oils for four weeks. At baseline and at weekly intervals, patients rated their mood, quality of life and the intensity and bother of two symptoms most important to them. Forty-six patients were recruited to the study. Due to a large number of withdrawals, only 11 of 23 (48%) patients in the aromatherapy group and 18 of 23 (78%) in the control group completed all four weeks. Mood, physical symptoms and quality of life improved in both groups. There was no statistically significant difference between groups in any of the outcome measures. Despite a lack of measurable benefit, all patients were satisfied with the aromatherapy and wished to continue. Whilst this pilot study has shown that a randomised controlled trial of complementary therapy is feasible, it has also identified several areas that would require further consideration when designing future studies, e.g., the recruitment and retention of appropriate numbers of patients and the outcome measures used.

Journal of Pain and Symptom Management, 2012

Therapeutic Reviews aim to provide essential independent information for health professionals abo... more Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

Journal of Pain and Symptom Management, 2002

Breakthrough pain in patients with cancer is common, often unpredictable, and can rapidly become ... more Breakthrough pain in patients with cancer is common, often unpredictable, and can rapidly become severe. Treatment using the oral administration of opioids is not optimal due to the slow onset of pain relief. Nasal administration of analgesics potentially offers more rapid pain relief. This study investigates the tolerability and efficacy of a novel morphine-chitosan formulation. Twenty episodes of breakthrough pain were observed in 14 patients with cancer who received 5-80 mg of nasal morphine-chitosan. Nasal symptoms, sedation, giddiness, nausea, and other volunteered symptoms, along with pain scores (pain intensity and pain relief), were recorded at baseline and at regular intervals up to 4 hours after administration, together with an overall satisfaction rating. The formulation was acceptable to patients, generally well tolerated, and had an onset of pain relief 5 minutes after dosing. This formulation warrants further study.

Journal of Pain and Symptom Management, 2012

Journal of Pain and Symptom Management, 2012

Therapeutic Reviews aim to provide essential independent information for health professionals abo... more Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

ABSTRACT Therapeutic Reviews aim to provide essential independent information for health professi... more ABSTRACT Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. The content is also available on www.palliativedrugs.com and will feature in future editions of the Hospice and Palliative Care Formulary USA and its British and Canadian counterparts. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

Journal of Pain and Symptom Management, 2015

Journal of Clinical Oncology, 2006

To cite this article: Agnelli G, Verso M. Management of venous thromboembolism in patients with c... more To cite this article: Agnelli G, Verso M. Management of venous thromboembolism in patients with cancer. J Thromb Haemost 2011; 9 (Suppl. 1): 316-324.

Current Opinion in Supportive and Palliative Care, 2009

To examine the recent literature with regards to methadone, prolongation of the QT interval, tors... more To examine the recent literature with regards to methadone, prolongation of the QT interval, torsade de pointes and the implications for palliative care clinicians. There is a disproportionate number of unexpected deaths seen in patients receiving methadone. Although many of these deaths are likely to be a result of respiratory depression, torsade de pointes may be a contributing factor. Guidelines have been developed to minimize the risk, but these are generally based on expert opinion because of a lack of robust evidence. Routine ECG screening is controversial, but most guidelines advise an ECG in the presence of one or more risk factors for QT interval prolongation. The safe use of methadone requires clinicians to be familiar with its pharmacology and to closely monitor patients to avoid an unintentional overdose. As a minimum, clinicians should be aware of the advice regarding prolonged QT in the Summary of Product Characteristics for methadone and the general advice regarding ECG monitoring. These can be given due consideration when balancing the benefits versus the risks of the use of methadone, taking the circumstances of the patient fully into account. Clinicians should also be aware of the potential significance of palpitation, syncope or seizure-like activity in a patient taking methadone.

Journal of Pain and Symptom Management, 2006

Supportive and Palliative Care

40% of patients with lung cancer are diagnosed following an emergency admission to hospital (DFEA... more 40% of patients with lung cancer are diagnosed following an emergency admission to hospital (DFEA), but little is known about this group. There are particular challenges in providing information in these circumstances. This paper reports preliminary qualitative findings from a mixed methods study seeking to describe the characteristics, needs and outcomes of patients with lung cancer DFEA admitted over one year to a University hospital. To explore patients' and carers' experiences of lung cancer DFEA, focusing on reports about information provision and needs. This study is in progress. Patients DFEA and their carers are invited to participate in a qualitative interview following completion of the Charlson co-morbidities index; Sheffield Profile for Assessment and Referral to Care holistic needs questionnaire and a modified 2012 National Cancer Patient Experiences Survey. Interviews usually take place following hospital discharge. Data are analysed using a grounded theory app...

BMJ supportive & palliative care, 2015

Journal of pain and symptom management, 1998

Journal of pain and symptom management, Jan 21, 2015

Measurement of dyspnea is important for clinical care and research. To characterize the relations... more Measurement of dyspnea is important for clinical care and research. To characterize the relationship between the 0-10 numerical rating scale (NRS) and four-level categorical verbal descriptor scale (VDS) for dyspnea assessment. This was a substudy of a double-blind, randomized controlled trial comparing palliative oxygen to room air for relief of refractory breathlessness in patients with life-limiting illness. Dyspnea was assessed with both a 0-10 NRS and a four-level categorical VDS over the one-week trial. NRS and VDS responses were analyzed in cross-section and longitudinally. Relationships between NRS and VDS responses were portrayed using descriptive statistics and visual representations. Two hundred twenty-six participants contributed responses. At baseline, "mild" and "moderate" levels of breathlessness were reported by 41.9% and 44.6% of participants, respectively. NRS scores demonstrated increasing mean and median levels for increasing VDS intensity, fr...

Journal of Pain and Symptom Management, 2014

The challenges of palliative care clinical trial recruitment are well documented. The aim of the ... more The challenges of palliative care clinical trial recruitment are well documented. The aim of the study was to review tested strategies to improve recruitment to trials of people with a range of conditions who may access palliative care services but are not explicitly stated to be "palliative." This was a systematic review with narrative description. The Cochrane, Embase, PubMed, PsycINFO, and CINAHL electronic databases were searched (English; January 2002 to February 2014) for quasi-experimental and randomized controlled trials (RCTs) testing the effect of recruitment strategies on accrual to clinical trials of people with organ failure and cancer. Titles, abstracts, and retrieved articles were screened by two researchers and categorized by recruitment challenge: 1) patients with reduced cognition, 2) those requiring emergency treatment, and 3) willingness of patients and clinical staff to contribute to trials. Of 549 articles identified, 15 were included. Thirteen reported RCTs and two papers reported three quasi-experimental studies. Five were cluster RCTs of recruiting sites/institutions. One was a randomized cluster, crossover, feasibility study. Seven studies recruited patients with cancer. Others included patients with dementia, stroke, cardiovascular disease, diabetes, frail elderly, and bereaved carers. Some interventions improved recruitment: memory aid, contact before arrival, cluster consent, "opt out" consent. Others either reduced recruitment (formal mental capacity assessment) or made no difference (advance research directive; a variety of educational, supportive, and advertising interventions). Successful strategies from other disciplines could be considered by palliative care researchers. Tailored, efficient, evidence-based strategies must be developed, acknowledging that strategies with face validity are not necessarily the most effective.

Handbook of Palliative Care, 2005

Respiratory symptoms are a common problem for patients with ad-vanced cancer, cardio-respiratory ... more Respiratory symptoms are a common problem for patients with ad-vanced cancer, cardio-respiratory and neurological disease. In their last year of life as many as 94% patients with chronic lung disease, 78% of those with lung cancer [1] and 50% of patients with heart dis-ease will ...

Palliative Medicine, 2013

The &... more The 'off-label' use of a drug beyond the specifications of its Marketing Authorization is widespread in palliative care.It is legal, but there are implications for prescribers, outlined by regulatory bodies such as the General Medical Council. A previous survey suggested that few doctors in palliative medicine always follow these recommendations. To obtain a contemporary view of how medical and non-medical independent prescribers adhere to current regulatory guidance. Selected doctor, nurse and all pharmacist members of www.palliativedrugs.com from the United Kingdom were invited to complete an online questionnaire. There were 332 respondents, a response rate of 9% based on number of e-mails delivered. Most worked within an inpatient hospice, although for nurses it was the community; there was a wide range of experience. Few respondents (15%) reported that their services operated a policy on providing information about off-label use. Most (65%) would always make a clear record of the drug prescribed, and this was highest for doctors, with 39%-73% always operating in line with the 'must do' aspects of General Medical Council guidance. This proportion was lower for nurse (42%-55%) and pharmacist (0%-30%) responders in part because their guidance is based on the previous, less pragmatic General Medical Council guidance. Examples given for off-label use, together with general comments, provided additional insight into respondents' practice. Compared to before and to nurse and pharmacist prescribers, doctors appear better able to adhere to their regulatory body guidance. Given that all the independent prescribers in palliative care can prescribe the same drugs, consistent regulatory guidance is required.

Palliative Medicine, 2004

A randomised controlled pilot study was carried out to examine the effects of adjunctive aromathe... more A randomised controlled pilot study was carried out to examine the effects of adjunctive aromatherapy massage on mood, quality of life and physical symptoms in patients with cancer attending a specialist unit. Participants were randomised to conventional day care alone or day care plus weekly aromatherapy massage using a standardised blend of oils for four weeks. At baseline and at weekly intervals, patients rated their mood, quality of life and the intensity and bother of two symptoms most important to them. Forty-six patients were recruited to the study. Due to a large number of withdrawals, only 11 of 23 (48%) patients in the aromatherapy group and 18 of 23 (78%) in the control group completed all four weeks. Mood, physical symptoms and quality of life improved in both groups. There was no statistically significant difference between groups in any of the outcome measures. Despite a lack of measurable benefit, all patients were satisfied with the aromatherapy and wished to continue. Whilst this pilot study has shown that a randomised controlled trial of complementary therapy is feasible, it has also identified several areas that would require further consideration when designing future studies, e.g., the recruitment and retention of appropriate numbers of patients and the outcome measures used.

Journal of Pain and Symptom Management, 2012

Therapeutic Reviews aim to provide essential independent information for health professionals abo... more Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

Journal of Pain and Symptom Management, 2002

Breakthrough pain in patients with cancer is common, often unpredictable, and can rapidly become ... more Breakthrough pain in patients with cancer is common, often unpredictable, and can rapidly become severe. Treatment using the oral administration of opioids is not optimal due to the slow onset of pain relief. Nasal administration of analgesics potentially offers more rapid pain relief. This study investigates the tolerability and efficacy of a novel morphine-chitosan formulation. Twenty episodes of breakthrough pain were observed in 14 patients with cancer who received 5-80 mg of nasal morphine-chitosan. Nasal symptoms, sedation, giddiness, nausea, and other volunteered symptoms, along with pain scores (pain intensity and pain relief), were recorded at baseline and at regular intervals up to 4 hours after administration, together with an overall satisfaction rating. The formulation was acceptable to patients, generally well tolerated, and had an onset of pain relief 5 minutes after dosing. This formulation warrants further study.

Journal of Pain and Symptom Management, 2012

Journal of Pain and Symptom Management, 2012

Therapeutic Reviews aim to provide essential independent information for health professionals abo... more Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

ABSTRACT Therapeutic Reviews aim to provide essential independent information for health professi... more ABSTRACT Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. The content is also available on www.palliativedrugs.com and will feature in future editions of the Hospice and Palliative Care Formulary USA and its British and Canadian counterparts. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

Journal of Pain and Symptom Management, 2015

Journal of Clinical Oncology, 2006

To cite this article: Agnelli G, Verso M. Management of venous thromboembolism in patients with c... more To cite this article: Agnelli G, Verso M. Management of venous thromboembolism in patients with cancer. J Thromb Haemost 2011; 9 (Suppl. 1): 316-324.

Current Opinion in Supportive and Palliative Care, 2009

To examine the recent literature with regards to methadone, prolongation of the QT interval, tors... more To examine the recent literature with regards to methadone, prolongation of the QT interval, torsade de pointes and the implications for palliative care clinicians. There is a disproportionate number of unexpected deaths seen in patients receiving methadone. Although many of these deaths are likely to be a result of respiratory depression, torsade de pointes may be a contributing factor. Guidelines have been developed to minimize the risk, but these are generally based on expert opinion because of a lack of robust evidence. Routine ECG screening is controversial, but most guidelines advise an ECG in the presence of one or more risk factors for QT interval prolongation. The safe use of methadone requires clinicians to be familiar with its pharmacology and to closely monitor patients to avoid an unintentional overdose. As a minimum, clinicians should be aware of the advice regarding prolonged QT in the Summary of Product Characteristics for methadone and the general advice regarding ECG monitoring. These can be given due consideration when balancing the benefits versus the risks of the use of methadone, taking the circumstances of the patient fully into account. Clinicians should also be aware of the potential significance of palpitation, syncope or seizure-like activity in a patient taking methadone.

Journal of Pain and Symptom Management, 2006

Supportive and Palliative Care

40% of patients with lung cancer are diagnosed following an emergency admission to hospital (DFEA... more 40% of patients with lung cancer are diagnosed following an emergency admission to hospital (DFEA), but little is known about this group. There are particular challenges in providing information in these circumstances. This paper reports preliminary qualitative findings from a mixed methods study seeking to describe the characteristics, needs and outcomes of patients with lung cancer DFEA admitted over one year to a University hospital. To explore patients' and carers' experiences of lung cancer DFEA, focusing on reports about information provision and needs. This study is in progress. Patients DFEA and their carers are invited to participate in a qualitative interview following completion of the Charlson co-morbidities index; Sheffield Profile for Assessment and Referral to Care holistic needs questionnaire and a modified 2012 National Cancer Patient Experiences Survey. Interviews usually take place following hospital discharge. Data are analysed using a grounded theory app...

BMJ supportive & palliative care, 2015

Journal of pain and symptom management, 1998