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Trial registered on ANZCTR
Registration number
ACTRN12609000599279
Ethics application status
Approved
Date submitted
15/07/2009
Date registered
20/07/2009
Date last updated
9/12/2013
Type of registration
Prospectively registered
Titles & IDs
Public title
A prospective observational study - understanding the burden of adverse drug reactions and their impact on symptoms at end of life
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Scientific title
A prospective observational study - understanding the burden of adverse drug reactions and their impact on symptoms at end of life in palliative care patients.
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Secondary ID [1]
283724
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Prospective phase 4 study, 009
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Palliative care admissions
237259
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Condition category
Condition code
Other
239578
239578
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0
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Conditions of unknown or disputed aetiology (such as chronic fatigue syndrome/myalgic encephalomyelitis)
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Intervention/exposure
Study type
Observational
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Patient registry
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
All people admitted to participating palliative care units will be asked to provide access to their case notes for collection of admission data. This data will include information about their symptoms on admission, any medications they are taking at the time of admission, and any investigations undetaken, this will all be collected from the admission case notes. An assessment of possible adverse drug reactions will be made based on this data. All people admitted to participating palliative care services over the 3 month study period will be asked to participate. A single set of data will be collected.
In addition, a subset of patients will be asked to participate in an interview to ask further questions about their symptoms, the impact of these symtpoms, medications being taken, any problems or side effects experienced, and their beliefs about medicines. These participants will be asked to allow a single interview, weekly completion of a simple prompt diary each week, and telephone calls each week until end February 2010.
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Intervention code [1]
236944
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Not applicable
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Comparator / control treatment
Not applicable
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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To evaluate the prevalence, clinical characteristics and avoidability of advere drug reactions (ADR)-related referrals to palliative care services and ADRs that occur in a cohort of palliative patients longitudinally.
The Naranjo scale will be used to assess probability of an ADR.
Causality and classification will be assessed using the Scale by Edwards and Aronson (Lancet 2000).
Severity of the ADR will be assessed using the World Health Organisation Adverse Reaction Terminology (WHO-ART).
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Assessment method [1]
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Timepoint [1]
238375
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Admission to palliative care
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Secondary outcome [1]
244820
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To compare patient reported adverse drug reaction and those recorded in the clinical record through patient interview
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Assessment method [1]
244820
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Timepoint [1]
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Admission and weekly follow-up for up to 12 weeks or until end February 2010
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Secondary outcome [2]
244821
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To describe how adverse drug reactions impact on patient well being and ability to manage their affairs using a symptom assessment and impact tool
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Assessment method [2]
244821
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Timepoint [2]
244821
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Admission and weekly follow-up for up to 12 weeks or until end February 2010
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Secondary outcome [3]
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To describe the patient?s beliefs about the necessity of the prescribed medication for managing their symptoms and concerns about the potential adverse effects of taking the medicine using the Beliefs about Medicines questionnaire.
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Assessment method [3]
244822
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Timepoint [3]
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Admission and weekly follow-up for up to 12 weeks or until end February 2010
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Secondary outcome [4]
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To characterize the potential burden of adverse drug reactions in this setting of multiple concomitant medications and the risk for the prescribing cascade to manage adverse drug reactions. Medication histories from the patient who consent to interview will be utilized.
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Assessment method [4]
244823
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Timepoint [4]
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Admission and weekly follow-up for up to 12 weeks or until end February 2010
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Eligibility
Key inclusion criteria
All patients consecutively referred to inpatient care at the Phase IV Palliative Care services for the first time and where the referral was either:
1. for direct care with admission to the inpatient unit
2. under the care of another medical specialty, and the service acted in a consultative arrangement, or
3. where care was transferred from another medical specialty to the palliative care service for ongoing management.
Between 1 September to 30 November 2009
4. and who provide informed consent
Patient Interview subset
In addition to above
1. Patients 18 years or older who give informed consent for interviews
2.Australian modified Karnofsky Performance Status (AKPS) is =60 at the time of referral.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Patient unable to give consent or for whom it was deemed inappropriate by the Palliative care team to participate in the interview.
2. All patients transferred to other specialty unit within 24 hours of admission to the palliative care service.
3. The patient, their family or the Palliative Care team can withdraw the patient at any time from the study.
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
30/10/2009
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Actual
15/12/2009
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Date of last participant enrolment
Anticipated
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Actual
31/03/2010
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
120
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW,QLD
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Recruitment hospital [1]
1841
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Royal North Shore Hospital - St Leonards
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Recruitment hospital [2]
1842
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Greenwich Hospital - Greenwich
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Recruitment hospital [3]
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Nambour General Hospital - Nambour
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Recruitment postcode(s) [1]
7627
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2065 - Greenwich
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Recruitment postcode(s) [2]
7628
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2065 - St Leonards
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Recruitment postcode(s) [3]
7629
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4560 - Nambour
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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Australian Government Department of Health and Ageing
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Address [1]
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GPO Box 9848
Canberra
ACT 2601
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Country [1]
237334
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Australia
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Primary sponsor type
University
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Name
Flinders University
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Address
Flinders Drive
Bedford Park
SA 5042
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
236841
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Address [1]
236841
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Country [1]
236841
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
239446
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Northern Sydney Central Coast Health Human Research Ethics Committee
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Ethics committee address [1]
239446
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Level 2, Building 51 Royal North Shore Hospital St Leonards NSW 2065
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Ethics committee country [1]
239446
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Australia
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Date submitted for ethics approval [1]
239446
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15/07/2009
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Approval date [1]
239446
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07/12/2009
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Ethics approval number [1]
239446
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Not available
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Summary
Brief summary
There is a need to quantify the extent and severity of adverse drug reactions in palliative care to inform intervention strategies to reduce the burden of harm and pharmacovigilance as new drug therapies are introduced for the management of symptoms at end of life. This study will review the case notes of all patients admitted to participating palliative care units over a 3 month period, and then to seek permission to interview 30 participants from each site for symptoms, the burden of the symptoms, medications and health service use from the time of admission until death or end of study in February 2010. 1. To analyse the contribution of adverse drug reactions to referrals to Palliative Care Services 2. To determine the nature and frequency of adverse drug reactions in patients referred to palliative care services 3. To explore the relationship between adverse drug reactions and common symptoms experienced in palliative care 4. To undertake patient interview to determine their experience of adverse drug reactions and their perception of the impact of adverse drug reactions. To describe the resource utilisation of those patients in the subset of patients interviewed with the symptoms and index medicines of interest who experience an adverse drug reaction.
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Trial website
None
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Trial related presentations / publications
In progess.
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Debra Rowett
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Address
29902
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Service Director Drug and Therapeutic Information Service (DATIS) Repatriation General Hospital Daws Road DAW PARK SA 5041
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Country
29902
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Australia
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Phone
29902
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+61 8 8275 1179
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Fax
29902
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Email
29902
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[email protected]
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Contact person for public queries
Name
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Belinda Fazekas
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Address
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Palliative Care Clinical Studies Collaborative
Flinders University
700 Goodwood Road
Daw Park
SA 5041
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Country
13149
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Australia
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Phone
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+61 8 8275 1396
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Debra Rowett
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Address
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Service Director
Drug and Therapeutic Information Service (DATIS)
Repatriation General Hospital
Daws Road
DAW PARK SA 5041
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Country
4077
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Australia
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Phone
4077
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+61 8 8275 1179
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Fax
4077
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Email
4077
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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