Janet Hardy

Outcome measures in palliative care - time for a paradigm shift?Wednesday 29 October, 4.00pm

All fields of medicine are all under increasing pressure to measure the benefit of the service they provide and to date the evidence that palliative care improves patient outcomes is relatively limited. Most of the outcome measures used to date are patient focused e.g. they measure serial pain scores or dyspnoea control. They can be influenced by many factors other than clinical management. Moreover, it is possible to get a good outcome despite a poor process. Palliative care patients by definition have progressive disease with inevitable worsening of their symptoms over time. Part of our practice is to react to this changing symptomatology. Process quality indicators measure how we respond to needs and/or uncontrolled symptoms. This is a health care professional centred approach rather than a patient centred approach and can highlight specific actions to improve care. Perhaps it is time to re-think how we measure the benefit of palliative care.

Morphine in the 21st century - an outdated concept?
Thursday 30 October, 8.30am

Consistent with developments in modern medicine, we have available a large number of new opioids and opioids of different formulations. Opioids can be delivered by a number of different routes as infrequently as every 7 days or every few hours depending on the patient's needs and circumstances. We know which opioids are best suited to patients with renal or liver impairment and which are more likely to be tolerated in the elderly. We are beginning to understand how an individual's genetic makeup might determine how they tolerate individual drugs and whether or not they are likely to get benefit from them. Despite all this knowledge, is there any evidence to suggest that any analgesic is better than morphine, a drug that was first introduced into clinical practice more than 200 years ago?

Background bio;
Janet graduated from Auckland Medical School and trained in medical oncology at Auckland Hospital. She was appointed Head of the Department of Palliative Medicine at the Royal Marsden Hospital in London in 1991.

In 2003, she returned to Australasia and is now the Director of Palliative Medicine for the Mater Health Services and is the Clinical Research Programme Leader for the Centre for Palliative Care Research and Education in Brisbane.

Her appointment as clinical program leader for Palliative Care Research at the MMRI has allowed her to pursue her varied research interests.

In 2005, she was awarded a personal chair from the University of Queensland, School of Medicine. As chair of the Trials Management Committee for the Palliative Care Clinical Studies Collaborative (PaCCSC), she has a lead role in the development of this national research collaborative.