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The Dunhill Medical Trust – Saunders PhD Programme Integrating rehabilitation and palliative care to optimise function for older people

The Dunhill Medical Trust – Saunders PhD Programme Integrating rehabilitation and palliative care to optimise function for older people

The Cicely Saunders Institute at King’s College London invites applications to a PhD programme on palliative care and rehabilitation funded by The Dunhill Medical Trust and Cicely Saunders International.

This programme focuses on palliative care and rehabilitation. The novel research to be undertaken as part of doctoral studies is shaped by the priorities of older people and their families, and is aligned to future health and social care challenges.

Our potential projects fall under two broad areas: 1) optimising mobility and social participation, including economic evaluation; and 2) management of restricting or limiting symptoms, especially breathlessness. Involvement of people with lived experience will be ensured throughout all projects, providing advice and guidance on study design, research processes, and interpretation of findings.

Successful candidates will join a multidisciplinary cohort of students funded under this programme and will be exposed to outstanding training and development opportunities. Three studentships are available focusing on the projects listed below. Students are expected to start in October 2024 and will complete within 3 years full-time equivalent.

Award value

The studentships cover:

  • UK fees only, with one opportunity to cover overseas fees
  • An annual stipend at the UKRI rate (£20,622 per year for 2023/24)
  • Conference attendance and travel fees (£1,500)
  • Training costs (£1,400)
  • Research costs to cover computing costs, patient and public involvement, and publication open access fees.

Entry requirements

Entry: Proposed October 2024

  • Bachelor’s degree with 2:1 honours in a relevant subject.
  • English language band: D

How to apply

Application closing date: Monday 10th June 2024

To be considered for the studentship, candidates must apply via the King’s Apply online application system.

Candidates shall submit a CV and research proposal statement (two-pages maximum) detailing their research experience, interest in the studentship, and their most preferred project(s) from the list ranked 1-3.

Interviews are expected to take place online early in July.

Prior to making a formal application, we encourage applicants to make contact with their potential project supervisors.

Support for Postgraduate Research Students within the programme and Faculty of Nursing, Midwifery & Palliative Care

  • A model of 2-3 supervisors improves access to clinical and methodological expertise.
  • Core research methods training modules include Advanced Quantitative Research Methods; Advanced Qualitative Research Methods; Evidence Based Decision Making in Healthcare; Research Methods and Statistics; and Epidemiology.
  • Our Nightingale-Saunders Clinical Trials & Epidemiology Unit offers an advanced level of expertise on quantitative topics of which students can avail.
  • Our PhD students have access to a wide range of supplementary courses and activities, including workshops, symposia and funding offered by Centre of Doctoral Studies, the Health Sciences Doctoral Training Centre and the London Interdisciplinary Social Science Doctoral Training Partnership.
  • The Faculty runs three Journal Clubs (for Nursing & Midwifery, Mental Health and the Cicely Saunders Institute of Palliative Care respectively) and students have an opportunity to participate in fortnightly research seminar programmes delivered by one of the research divisions.

Contact details

For more information regarding this PhD programme opportunity, please email Professor Matthew Maddocks (matthew.maddocks@kcl.ac.uk) and copy Ryana Dhali (ryana.dhali@kcl.ac.uk).

For more information on the projects, please email the named supervisors.

Theme 1: Optimising mobility and social participation

Project 1: Co-production and pilot testing of an intervention to support older people living with dementia in care homes to use a voice-controlled assistant devices to reduce their feeling of loneliness and social isolation.
Supervisors: Professor Ruth Harris (ruth.harris@kcl.ac.uk) and Dr Joanne Fitzpatrick (joanne.fitzpatrick@kcl.ac.uk)

Social isolation and loneliness pose significant challenges for individuals with dementia in care homes, an issue accentuated by the COVID-19 pandemic. Despite eased restrictions, limited contact with relatives persists, a critical concern given the relatively short life expectancy in care homes. Social isolation and loneliness in older people living with dementia have been associated with depression, worsening of cognitive function, and loss of physical function; therefore, there is a need to identify interventions that can reduce social isolation and loneliness, and enhance quality of life. Several countries, including the UK, have appointed a Minister for Loneliness to focus on reducing the stigma of loneliness and addressing relationships and loneliness in policy-making and societal action.

Voice-controlled assistant devices (e.g., Alexa/Echo Show) have been identified as potential interventions to foster connection and diminish isolation (Welch et al. 2023). However, research is needed to investigate how best to support people living with dementia to use these devices effectively. This proposed PhD study aims to develop an intervention to support people living with dementia in care homes to use a voice-controlled device and to determine its effectiveness in reducing social isolation and loneliness. This mixed-methods study comprises 4 phases: a systematic review of evidence for using voice-controlled assistant devices with people living with dementia in care homes; 50 hours of non-participant observation using behavioural mapping to explore how much time residents living with dementia in care homes spend alone; in-depth interviews with 10 residents living with dementia, 10 family members, 10 staff and the manager at one large care home; and co-production of an intervention to support older people living with dementia in a care home to use a smart speaker device. A single-arm pilot study will assess the preliminary efficacy of this intervention in preparation for future evaluation through a full trial.

Project 2: Economic evaluation of interventions to improve functional independence for older adults.
Supervisor: Dr Peter May (peter.d.may@kcl.ac.uk)

Health and social care costs increase on average as people age. Among the most important determinants of costs are functional limitations and advanced illness. Interventions that can slow or reverse functional decline promise significant potential value to health systems and society through improved quality of life for patients and a reduced need for care. However, economic evidence on interventions to improve functional independence for older adults with palliative care needs is relatively sparse.

This project aims to generate high-quality economic evidence to inform resource allocation, decision-making, and commissioning in rehabilitation services for older adults. You will have access to training in advanced health economic evaluation methods (e.g. decision modelling, econometrics) as well as complementary research skills (e.g. literature reviews, PPI engagement) and wider professional skills (e.g. project management, communication). You will join an interdisciplinary network of academics in economics, rehabilitation, palliative care, policy, and big data. With support from your supervisors, you will: finalise your thesis research questions; match these questions to study design, primary and secondary data collection, and evaluative methods; and disseminate your findings to diverse stakeholders, including policymakers, patients and families, academics, and clinicians.

This PhD project will produce new knowledge and understanding on when and how rehabilitation approaches provide good value to patients, their families, the health system, and society, and will equip the student for a research career in the economics of care for older adults.

Project 3: Palliative rehabilitation for people with dementia to maximise and enable participation in meaningful activities.
Supervisor: Dr Clare Ellis-Smith (alexandra.c.ellis-smith@kcl.ac.uk)

People with dementia prioritise comfort and opportunities to engage in activities that are important to them. Palliative care and rehabilitation are both person-centred approaches to improving quality of life through maximising comfort, function, and participation. However, those with dementia, particularly those with advancing dementia, are often denied such interventions, resulting in distress and reduced quality of life.

This is an exciting opportunity to address the neglected area of palliative rehabilitation for people with dementia. The aim of the study is to develop and conduct a preliminary evaluation of a person-centred palliative rehabilitation intervention for people with dementia. Intervention development will comprise a systematic review of the evidence to construct the underpinning theory of how the intervention may work. This is followed by co-design workshops to develop the intervention with those living with dementia, family carers, and health and social care practitioners who work with people with dementia. Finally, the intervention will be evaluated in a mixed-methods feasibility study. The intention of the feasibility study is to further develop the underpinning theory with an understanding of how it can be implemented into care and how it works to benefit those with dementia and their family carers.

Project 4: A biopsychosocial approach to functional decline in older people
Supervisor: Dr Lisa Jane Brighton (lisa.brighton@kcl.ac.uk) and Professor Matthew Maddocks (matthew.maddocks@kcl.ac.uk)

As people age, illness(es) and accompanying symptoms (e.g. pain, fatigue, breathlessness) can contribute to functional decline, loss of ability to undertake necessary or desired tasks, which is a common source of suffering for patients and families. While previous work has identified several predictors of functional decline in older people, an integrated approach considering the role of mental and social health in functional decline, alongside physical health, is lacking. Moreover, little is known about how these factors work together over time to form different trajectories of functional loss.

This project aims to develop a biopsychosocial approach to supporting older people at risk of functional loss, using a mixed-methods approach. It will determine trajectories of functional decline in older people, and the role of key physical, psychological, and social factors (e.g. symptoms, mental health, social participation), using existing population-based data. It will also use qualitative interviews with older people experiencing functional loss to understand their experiences of functional decline, and explore their priorities, needs and preferences for support. These data will be used as the basis for developing a biopsychosocial approach to supporting older people at risk of functional loss, collaboratively with stakeholders with relevant personal and professional experience.

This exciting project offers the opportunity to develop skills in both quantitative and qualitative approaches, and work with stakeholders to ensure clinical utility of findings. There is also scope for this project to focus on groups of older people at particular risk of frailty (e.g. people with multiple long-term conditions, people experiencing socio-economic deprivation), in line with the interests of the student.

Project 5: Reducing outdoor falls in the last years of life.
Supervisor: Dr Joanne Bayly (joanne.bayly@kcl.ac.uk) and Professor Matthew Maddocks (matthew.maddocks@kcl.ac.uk)

As societies grapple with increasing aged and multimorbid populations, assistive mobility devices could transform lives for millions affected by advanced illness and disability towards end of life. Outdoor falls and fear of falling cause injury, death, deconditioning and a ‘shrinking world’ for people with serious illness, at major societal cost. Poor design features of existing mobility devices cause poor uptake, stigma, and may even increase falls risk.

This intervention development study aims to improve the acceptability and uptake of assistive devices to support outdoor mobility for older people living with advanced illness.

The methods are informed by MRC guidance on complex intervention development. In phase one, a concurrent mixed methods study will incorporate: 1) an interview study to explore perceptions of current assistive devices, factors affecting uptake behaviour, and design needs and preferences and 2) a mixed methods systematic review of quantitative and qualitative empirical studies. Findings from phase one will inform phase two: 1) co-design of a model intervention to improve uptake and safety in use of assistive devices supporting outdoor mobility in people with advanced illness; 2) randomised controlled feasibility trial of the model intervention in palliative care settings. There will be involvement of people with lived experience throughout the project, providing advice and guidance on study design, research processes and interpretation of findings.

Theme 2: Management of restricting/limiting symptoms

Project 1: I-Breathe: Development of a personalised and responsive telehealth prototype promoting Independence and self-efficacy for Breathless patients at home.
Supervisors: Dr Sabrina Bajwah (sabrina.bajwah@kcl.ac.uk), Dr Crina-Daniela Grosan (crina.grosan@kcl.ac.uk), and Dr Joanna Davies (joannamariedavies@kcl.ac.uk)

Breathlessness is a common and distressing symptom in many advanced chronic diseases, causing considerable disability, anxiety, and social isolation. A lack of control leaves patients feeling frightened and vulnerable and often results in crisis help-seeking.

The aim of this project is to develop and evaluate the use of AI techniques in delivering a personalised and responsive Breathlessness Support Service through a 2-way digital e-platform (I-Breathe) to promote independence, self-efficacy, and control of breathlessness at home.

The method will include adaptation of the existing face-to-face and internet-based Breathlessness Support Service for delivery via aTouchAwayTM app. Development and validation of a new AI model to support transformation of the service into a 2-way digital platform that will include vital sign monitoring (e.g. oxygen saturations), early identification, and tailored and timely intervention. This trail-blazing PhD will make breathlessness management more equitable, data-driven, anticipatory, targeted, personalised, and responsive to each individual patient’s changing needs. This intervention will harness the latest technology to empower patients and families, helping to support their functional independence and reducing pressure on health and social care. If successful, this intervention could be adapted across multiple systems and implemented globally.

We are looking for a creative and innovative individual with a clinical, computer science, or social science background, good knowledge of AI applications, and a strong commitment to improving patient care equitably.

Project 2: A partnership approach to strengthen integration of palliative care in community settings for adults with severe frailty and multimorbidity.
Supervisors: Professor Catherine Evans (catherine.evans@kcl.ac.uk) and Dr Anna Bone (anna.bone@kcl.ac.uk)

Palliative care improves patient and family outcomes and reduces pressure on the healthcare system by reducing unplanned hospital attendances. However, how best to deliver palliative care to frail older people in community settings is not well understood. With an ageing population and increasing number of deaths among older people projected for the next few decades, there is an urgent need for robust evidence in how to meet the needs of older people living in the community at home or in care homes.

This study aims to co-create and evaluate the feasibility of a community partnership approach for integrated person-centred palliative care for adults with severe frailty and multi-morbidity.

This is a mixed method study comprising three main components: 1) systematic review of service level interventions for palliative care. Findings construct an initial intervention programme theory; 2) co-creation of community partnership intervention for palliative care in care homes using consensus methods with practitioners from palliative care, community and primary care, and family carers of residents; 3) Feasibility evaluation of the intervention with process evaluation to explore mechanisms for integrated working, requirements for implementation, and potential efficacy.

Project 3: Improving care for older people with frailty using symptom self-management toolkits
Supervisors: Professors Matthew Maddocks (matthew.maddocks@kcl.ac.uk) and Irene Higginson (irene.higginson@kcl.ac.uk)

Population changes are leading to a growing number of older people in the community with complex needs and frailty. Best care should be promote self-management and empowerment, and focus on symptom experience across conditions.

This project aims to evaluate the impact of symptom self-management intervention for older people living with frailty in the community. It builds on our existing work to embed outcome measurement into routine practice, to provide decision support for prevalent symptoms.

We will work with stakeholders to adapt and develop existing resources for self-management of common symptoms including pain, breathlessness, weakness, fatigue and anxiety. The toolkit will include educational, practical tips, community resources and low-cost equipment.

We will then pilot the toolkit in a randomised trial with nested qualitative study, to understand changes in symptoms and concerns, disability and social participation. Specific efforts will be made to consider inequalities related to protected characteristics and socioeconomic status throughout the research cycle.

Project 4: Developing and testing an online self-management intervention for older adults living with chronic breathlessness (SELF-BREATHE_OP)
Supervisor: Dr Charles Reilly (charles.c.reilly@kcl.ac.uk) and Professor Matthew Maddocks (matthew.maddocks@kcl.ac.uk)

It is estimated that 95% of the UK population have Internet access. The COVID-19 pandemic has increased the acceptability, use, normalisation, and the value of the Internet for many individuals living with multimorbidity and / or chronic symptoms such as breathlessness. Older people living with multimorbidity, and chronic breathlessness are willing to use digital health interventions if given the opportunity.

SELF-BREATHE is a new online self-management intervention for individuals living with chronic breathlessness. SELF-BREATHE is acceptable and valued by patients as it provides support with both acute breathlessness crisis and breathlessness during activities of daily life. However, for some individuals, accessing digital health interventions such SELF-BREATHE can be a challenge due to multiple complex factors such as; low confidence, limited IT technical skills, no access to an internet enabled device e.g., smart phone, tablet, or computer, lack the intrinsic motivation to start online self-management programme such as SELF-BREATHE.

This project aims to co-develop and test a brief intervention to improve and support access to online health interventions older people, using a mixed methods approach. It will fully understanding both these barriers and potential enablers, using qualitative and quantitative methods, to inform the co-development of a brief intervention to empower people to access online digital health interventions.