Tag Archives: Research Grants

Unscheduled care attendance by people with advanced cancer is significantly greater than previously estimated

A new paper studies the use of any NHS unscheduled care for people with advanced cancer, where previous papers have only focused on A&E. Initial funding for this research was provided by PATCH.

The study finds that the majority of unscheduled care given to people who die from cancer is GPOOH (GP Out-of Hours). Common causes for visits are pain and palliative care. Previous studies based on only A&E (accident and emergency) visits have led to an underestimation of the frequency of unscheduled care use.

One significant finding is that frequent users made up a small proportion of the cohort, but accounted for more than half of the visits.

This concentration of unscheduled care use at the end of life and among a small number of users implies that any unscheduled care use should trigger in-hours care review and anticipatory care planning[1].

The study is based on a dataset of 2443 people who died from cancer in Tayside, Scotland, during 2012-2015.

PATCH provided initial funding to Sarah Mills for data extraction and storage.

I am delighted to share with the PATCH community the publication of my research into use of unscheduled care by people who die from cancer.  This work was only possible through having received a PATCH Scotland grant, which enabled me to pay for the creation of the computer programme that enabled the extraction of general practice out-of-hours clinical information.  This enabled the creation of the first general practice out-of-hours dataset, which is still the most detailed of its kind.  This work is the first overview of all unscheduled care (GP out-of-hours and A&E combined).  Because of the funding I received from PATCH I was able to successfully apply for and obtain a PhD Fellowship through the Chief Scientist’s Office, which will enable me to take this work further while pursuing a higher degree.  I am forever indebted to PATCH for supporting me at such a pivotal point in my career and hope that my future work is a credit to them and to the PATCH funders and community.

Dr Sarah Mills

At PATCH, we extend our deepest gratitude to Sarah and her fellow researchers. Their thorough research grants us all a better understanding of the situation, and gives a solid foundation for their suggestions of anticipatory care planning, improved community support, and streamlined care pathways. As the paper indicates, these methods can help ensure unscheduled care attendances only happen when appropriate and unavoidable.

References and Footnotes

  1. Sarah Mills, Deans Buchanan, Bruce Guthrie, Peter Donnan and Blair Smith (2019) "Factors affecting use of unscheduled care for people with advanced cancer: a retrospective cohort study in Scotland", British Journal of General Practice, 69 (689): e860-e868 (Accessed online 09/12/2019).

PATCH funded research presentation is well-received at the WONCA Europe conference 2016

PATCH funded Dr Sarah Mills to attend the WONCA Europe conference 2016, where she gave four presentations regarding her research into unscheduled care and cancer.

Dr Sarah Mills SCREDS Lecturer in General Practice, Tayside Scotland, was funded by PATCH to present her research at the WONCA Europe international conference of primary care physicians in Denmark in June.

The World Organization of Family Doctors (WONCA) is a not-for-profit organization and was founded in 1972 by member organizations in 18 countries. WONCA now has 118 Member Organizations in 131 countries and territories with membership of about 500,000 family doctors and more than 90 per cent of the world’s population. [1]

Dr Mills’ research can potentially:

  • identify factors associated with unscheduled care use.
  • Suggest clinical and service provision changes to improve the patient journey in patients with terminal cancer.
  • Ensure quick access to pain and symptom control.

Following is a report from Dr Mills following her series of presentations that she gave at the conference.

WONCA 2016 Conference Report

Dr Sarah Mills, SCREDS Lecturer in General Practice, Tayside

I attended the WONCA Europe conference from 15th to 18th June in Copenhagen, Denmark. This was an international research meeting for General Practitioners from around the world to present their research to a primary care audience. It was a fantastic opportunity to network with GPs from different cultural, socioeconomic and political backgrounds and to present the research I have been working on to a diverse audience.

Dr Sarah Mills at WONCA Europe 2016

Dr Sarah Mills at WONCA Europe 2016

I was fortunate enough to be selected to give four presentations at the WONCA conference, which was among the highest number of presentations given to any individual speaker at the conference. I presented two ePosters, which were a one-slide 5 minute oral presentation. The titles for these were ‘Use of Unscheduled Care in both GP Out-of-Hours and Accident & Emergency departments by Patients with Terminal Cancer’ and ‘Consultation Outcomes And Analgesic Prescribing In A&E For Patients With Terminal Cancer’. This was an interesting presentation method which I had not tried before. It allowed me to take small aspects of my research and present them in a snapshot fashion to an intimate audience with similar research interests. The way the ePoster sessions worked meant that researchers were able to target attending sessions that reflected their clinical interests. It was excellent practice to be able to put across research findings in such a time-focused way, and really helped me distill the message behind my research. The presentations were well received and there were a large volume of questions afterwards. I was also asked to give two oral presentations, which were 15 minutes long and which were given in lecture theatres. The titles of these talks were ‘Use of Emergency Care by Patients with Cancer’ and ‘Pain-related Emergency Care Presentations by Patients with Terminal Cancer’. This gave me the opportunity to present aspects of my research in greater depth. I was again very pleased with the audience reaction – I had a lot of questions and had researchers come to speak to me afterwards. I made a number of excellent contacts with potentials for future collaborations. I recorded all the questions I was asked and will use them to inform and develop the discussion and analysis elements of my research in order to ensure it targets the information, service and research needs within this niche of primary care.

Dr Sarah Mills giving a presentation at WONCA Europe 2016

Dr Sarah Mills giving a presentation at WONCA Europe 2016

The conference was also an excellent chance to network with other UK-based researchers; the UK had the fifth largest delegation there and it was useful to be able to compare fields of interest with other British colleagues, with a view to future collaborations and input.

It was so gratifying to see how well received my research was and to get to discuss the challenges of unscheduled care use in patients with terminal cancer with other primary care colleagues from around the world. It has given me many new angles and perspectives on how this research can influence policy, and will help to make my research more robust, well-rounded and real-world applicable.

Without outside sponsorship I would not have been able to attend this conference and I am very grateful to have had this fantastic opportunity.

Further information

References and Footnotes

  1. WONCA. (2016). Global Family Doctor - WONCA online - WONCA in brief [Accessed: 02 September 2016].

PATCH-sponsored research into unscheduled care and cancer – a huge amount of progress

A first year report on PATCH funded research into patients with advanced cancer who are seen urgently at A+E and GP Out-of-Hours services because of pain.

There continue to be many reports of patients with advanced cancer who are seen out of hours because of pain. Many of these patients are seen in Accident and Emergency Departments and may need to be admitted to hospital.

Dr Sarah Mills SCREDS Lecturer in General Practice, Tayside Scotland is working collaboratively with the Departments of Palliative and Supportive Care and Oncology, Ninewells Hospital, Dundee to study this is depth.

Sarah Mills (3rd from left) with the Chronic Pain research team in the Population Health Sciences department.

Sarah Mills (3rd from left) with the Chronic Pain research team in the Population Health Sciences department.

Dr Mills has just recently been awarded a Fellowship to continue this work which she is developing towards her MD. She is delighted to have been funded by PATCH to present this research at the WONCA Europe international conference of primary care physicians in Denmark this July.

First year report into PATCH funded research into patients with advanced cancer who are seen urgently at A+E because of pain

Dr Sarah Mills, SCREDS Lecturer in General Practice, Tayside

The last year has seen a huge amount of progress with the PATCH-sponsored research into unscheduled care and cancer.

First, it was necessary to define a cohort of patients whom we could study, namely those patients in Tayside who have died from cancer in a three-year period, from 2011-2014. The cohort was identified using General Register Office ‘Cause of Death’ Data. Routinely collected clinical data from all unscheduled care during their last year of life was collected and linked to demographic and prescribing datasets using patient Community Health Index (CHI) numbers. The CHI is a unique patient identification number used in all clinical encounters in both general practice and hospital services.

The A&E data has given us a wealth of information, including the percentage of patients with cancer who use A&E, the frequency with which they attend, their reasons for attendance and when they attend relative to their date of diagnosis and date of death. We have defined 197 clinical reasons for why patients present to A&E and have examined the most common reasons for seeking emergency care. We are in the process of convening a group of experts in order to decide which presentations are directly pain-related and cancer-related. We have looked at ways in which patients present, whether they are accompanied by family and friends, what medications they are given and whether they are admitted, discharged or transferred. By mapping these trends over time we can also see how these patterns change in the few weeks before death.

Comparing GP Out Of Hours and A&E data has shown that patients with cancer present frequently to unscheduled care and that such presentations become more common in the weeks before death often due to uncontrolled pain. Initial analyses have demonstrated vital information about how, why, when and where patients with cancer access unscheduled care services. This research can potentially identify factors associated with unscheduled care use, suggest clinical and service provision changes to improve the patient journey in patients with terminal cancer and ensure quick access to pain and symptom control.

The preliminary findings of this research have been presented at the Scottish Pain Research Community Annual Conference (SPaRC) and the University of Dundee College Research Symposium. At both occasions the research has been very well received and PATCH has been credited for the research funding.

PATCH funds its first research project

PATCH is part-funding a research project examining what painkillers patients with advanced cancer had been prescribed before being admitted as an emergency or seen "out of hours".

The research project is being conducted in Tayside, Scotland and is a retrospective study that aims to see how relevant pain management is to patients who require “out of hours” (OOH) medical attention

Recent research suggests that uncontrolled pain in such patients may be the presenting complaint in up to 30% of unscheduled GP attendances and 25% of Accident and Emergency (A&E) attendances. (Aprile, 2013; Adam, 2014).

Data will be examined from patients identified as having an established diagnosis of cancer and being in the last 12 months of life. It will document which pain-killers are prescribed and how they are prescribed, to see if there is an association between prescribing practices such as the provision of breakthrough medication or the use of adjuvant treatment, and unscheduled or OOH care.

This research will provide an observational analysis of how pain is managed in those patients who seek help through the use of unscheduled care, and although this study looks at patients with cancer, it is hoped the results will be relevant to patients with advanced illness where the underlying cause is not cancer.

Dr Sarah Mills, SCREDS lecturer in Primary Care in Tayside, who is carrying out the research in collaboration with Professor Blair Smith and Dr Deans Buchanan said  “I’d like to thank PATCH Scotland and all their donors and contributors for this award. The PATCH funding will allow this project to begin immediately and will maximise our window for data collection  It will be a pleasure to work with PATCH to characterise why patients with terminal cancer access unscheduled care, particularly for pain-related presentations, in order to develop a better understanding of ways of improving the care they receive.”

Further information