Current Research Projects

Together with the team at Helen and Douglas House the department is actively exploring how to best provide palliative care to patients who are reaching their eighteenth birthday and moving from paediatric to adult services.  This work involves quality improvement work focused on the service design as well as qualitative research to explore staff, patient and family experience and expectations.  Current research threads include exploring after death and bereavement care. 

Poster: Jones, J., Carey, M., Nohavicka, L. and Bradley, V., 2025. 187 How to help young people transition from paediatric to adult palliative care services in Oxfordshire: our experiences and lessons learned. BMJ Supportive & Palliative Care, 15(Suppl 2), pp.A79-A79. 

https://doi.org/10.1136/spcare-2025-PCC.205

The team at Oxford have convened and co-lead a national group of specialists from Neurology, Palliative Care, General Practice, Psychiatry and Psychology as well as patient advocates to try to develop practical guidelines for the care of patients dying from this rare but devastating group of diseases.  This has involved a large literature review to explore the existing evidence, and then development of a Delphi style group to co-produce guidelines. The guidelines are currently being written.

Hogg, R., Centola, J., Durley, K., Chin, C.A., Quibell, R., Spriggs, H., Carey, M., Bajorek, T., Miller, M., Bradley, V. and Pal, S., 2024. Prion disease: clinical pathway development for the terminally ill. BMJ Supportive & Palliative Care, 14(e1), pp.e326-e327. 

https://doi.org/10.1136/spcare-2022-003877

Hogg, R., Centola, J., McDermott, E.A., Mastaglio, F., Grundy, A., Awe, T., Carey, M., Miller, M., Chin, C.A., Quibell, R. and Bajorek, T., 2024. Prion diseases motor and neuropsychiatric symptom cluster pharmacotherapy: structured scoping review. BMJ Supportive & Palliative Care, 14(e3), pp.e2397-e2410. 

https://doi.org/10.1136/spcare-2024-005027

Recognising that patients with metastatic bone disease currently receive a fragmented and poorly coordinated service, the team in Oxford has created a novel, world-first holistic service, reviewing patients virtually on a weekly basis. The Palliative Care team leads a multidisciplinary team comprising Oncologists, Surgeons, Anaesthetists, Radiologists, Psychiatrists, Nurses, and Physiotherapists. The service is designed to improve equitable access and deliver well-evidenced care for these patients.

Global Spine Congress 28-31 May 2025

Please check the Global Spine Congress 2025 website for updates.

https://www.globalspinecongress.org/index.php/abstracts/abstract-results

1/5

Accepted at the Global Spine Congress (May 28-31, 2025, Rio de Janeiro, Brazil) for an oral presentation that Dr Bradley will deliver.

Abstract PDF (Global Spine Congress 2025 1/5)

The OxMINT pathway. A novel service for the rapid referral assessment and treatment of metastatic spinal patients in Oxford. The design and implementation of the patient pathway and the multidisciplinary team meeting and comparison with other international models.

Georgios Zilidis, Clare Jacobs, Gerard Mawhinney, Jeremy Reynolds, Yaron Berkowitz, Emma Kenney-Herbert, Ather Siddiqi, James Teh, Basavaraj Chari, Martin Gillies, Tim McCormick, Ami Sabharwal, Stana Bojanic, Hayley Jones, Alex Anderson, Claire Worrall, Niamh Louwman, Harriet Dent, Mariam Latif, Tomasz Bajorek, Victoria Bradley, Nicolas Beresford-Cleary. 

2/5

Accepted at the Global Spine Congress (May 28-31, 2025, Rio de Janeiro, Brazil)

Abstract PDF (Global Spine Congress 2025 2/5)

Early data from the OxMINT project a novel multidisciplinary service model for managing metastatic bone disease.

Georgios Zilidis, Clare Jacobs, Gerard Mawhinney, Jeremy Reynolds, Yaron Berkowitz, Emma
Kenney-Herbert, Ather Siddiqi, James Teh, Basavaraj Chari, Martin Gillies, Tim McCormick, Ami
Sabharwal, Stana Bojanic, Hayley Jones, Alex Anderson, Claire Worrall, Niamh Louwman,
Harriet Dent, Mariam Latif, Tomasz Bajorek, Victoria Bradley, Nicolas Beresford-Cleary.

3/5

Accepted at the Global Spine Congress (May 28-31, 2025, Rio de Janeiro, Brazil)

Abstract PDF (Global Spine Congress 2025 3/5)

The OxMINT Effect; Understanding how good clinical decisions are made in novel clinical teams, an ethnographic study.

Ellana Slade, Georgios Zilidis, Clare Jacobs, Gerard Mawhinney, Jeremy Reynolds, Yaron Berkowitz, Emma
Kenney-Herbert, Ather Siddiqi, James Teh, Basavaraj Chari, Martin Gillies, Tim McCormick, Ami
Sabharwal, Stana Bojanic, Hayley Jones, Alex Anderson, Claire Worrall, Niamh Louwman,
Harriet Dent, Mariam Latif, Tomasz Bajorek, Mehrunisha Suleman, Victoria Bradley, Nicolas
Beresford-Cleary.

4/5

Accepted at the Global Spine Congress (May 28-31, 2025, Rio de Janeiro, Brazil)

Abstract PDF (Global Spine Congress 2025 4/5)

The OxMINT score. A novel scoring system to guide clinicians on the choice of intervention between best supportive care, spinal surgery, interventional radiological procedures and anaesthetic interventions in metastatic spinal disease developed using AI systems.

Georgios Zilidis, Clare Jacobs, Gerard Mawhinney, Jeremy Reynolds, Yaron Berkowitz, Emma
Kenney-Herbert, Ather Siddiqi, James Teh, Basavaraj Chari, Martin Gillies, Tim McCormick, Ami
Sabharwal, Stana Bojanic, Hayley Jones, Alex Anderson, Claire Worrall, Niamh Louwman,
Harriet Dent, Mariam Latif, Tomasz Bajorek, Victoria Bradley, Nicolas Beresford-Cleary

5/5

Accepted at the Global Spine Congress (May 28-31, 2025, Rio de Janeiro, Brazil)

Abstract PDF (Global Spine Congress 2025 5/5)

The OxMINT metastatic spine tumour checklist.

Georgios Zilidis, Clare Jacobs, Gerard Mawhinney, Jeremy Reynolds, Yaron Berkowitz, Emma
Kenney-Herbert, Ather Siddiqi, James Teh, Basavaraj Chari, Martin Gillies, Tim McCormick, Ami
Sabharwal, Stana Bojanic, Hayley Jones, Alex Anderson, Claire Worrall, Niamh Louwman,
Harriet Dent, Mariam Latif, Tomasz Bajorek, Victoria Bradley, Nicolas Beresford-Cleary

European Conference on Interventional Oncology 2025 (April 13-16 2025, Rotterdam, The Netherlands)

The abstract will be published shortly in the ECIO book of abstracts: https://www.cvironline.org/read/cirse-book-of-abstracts/

Innovative Multidisciplinary Approach to Managing Symptomatic Metastatic Bone Disease: The Oxford Metastatic Intervention Team (OxMINT) Experience.

Zilidis G, Jacobs C, Mawhinney G, Reynolds J, Berkowitz Y, Kenney-Herbert E, Siddiqi A, Teh J, Chari B, Gillies M, Mccormick T, Sabharwal A, Bojanic S, Jones H, Anderson A, Louwman N, Dent H, Stirling E, Latif M, Bajorek T, Nicolas B, Bradley V

This project offers an historical narrative of the RIPEL initiative, exploring how the service evolved through stakeholder insight, adaptive leadership, and real-time problem-solving. It highlights the human, relational, and ethical dimensions of delivering integrated palliative care in a complex system.

Published Abstract: Opioid prescribing and opioid-induced neurotoxicity in the palliative care setting: a single-centre observational study.

https://doi.org/10.1136/spcare-2025-PCC.180

Opioid-induced neurotoxicity in the palliative care population: a rapid review of the current evidence.

The Delphi study of palliative care doctors’ understanding and management of OIN is currently underway, with involvement from Dr Jac Jones.

Dr Hedges has conducted local reviews (unpublished) of opioid reduction as main management of OIN and of low-dose opioid management at end of life.

Exploring end of life care in the context of infectious diseases in Vietnam: A social science study using multiple methods.

Understanding the ethical and socio-cultural aspects of hospital discharge at the end of life.

Predicting 90-day mortality for targeting proactive palliative care in older hospital patients: validation of the CRiSTAL score and a streamlined e-CRiSTAL score (Sarah T Pendlebury, Dimitrios Gratsias, Mary Miller)

The CRiSTAL score reliably identified those at high short-term risk of death but required manual collection by trained researchers in OUH. In contrast, the e-CRiSTAL score performed similarly using only routinely collected EPR data and could help target proactive palliative care in hospital.

The manuscript is in the final stages of preparation for publication.

To routinely measure quality of care within palliative care – two national systems of benchmarking. (Mary Miller, Maria Schelin)

The aim of this paper is to provide guidance for countries/regions/healthcare providers that wish to start or develop palliative care benchmarking. We will describe the two current national approaches, Swedish Palliative Registry of Care and National Audit of Care at the End of Life, specifying and comparing advantages and disadvantages of both approaches.

The manuscript is with co-authors for comment, prior to finalising the paper for publication.

Poster Presented at Palliative Care Congress, 20-21 March 2025, Belfast

https://doi.org/10.1136/spcare-2025-PCC.88

Prolonged disorders of consciousness: Practice described by palliative and rehabilitation physicians

Miller M., Harrison T., Barrie S., Pick A., Prolonged disorders of consciousness: practice described by palliative and rehabilitation physicians. BMJ Supportive & Palliative Care 15 (Suppl 2), 2025, Poster69

Paper currently in preparation for publication.

The Rapid Intervention for Palliative and End of Life care project (RIPEL) at Oxford University Hospitals NHS Foundation Trust (OUH) is designed to provide ‘enhanced palliative care and support for adults with advanced life-limiting illness’, including a hospital rapid response (HRR) which facilitates the rapid discharge and continuing support for patients who are dying and have expressed a wish to go home.

Data were extracted from the electronic patient records (EPR) of 1008 inpatients who died in OUH in April 2023, July 2023, October 2023, and January 2024, and anonymised where necessary. Patient records flagged as potential missed opportunities for HRR referral were revisited for in-depth journey-mapping, and univariate statistical analysis was used to evaluate equity of referral.

Only 5 patients were identified as potential missed opportunities from their clinical notes, and there are no consistent factors among these patients such as ward or demographic characteristics which differ from the HRR-referred patients – so no particular areas for improved HRR access were identified from this group. However, the statistical analysis identified several areas where learning around RIPEL services and improved referral may be beneficial, for example with regards to older patients and patients in intensive care or stroke wards; though the extent to which differential referral is based on differential clinical needs (as opposed to systematic bias) is difficult to quantify. Overall, these results provide reassurance that few clear opportunities for better care have been missed; but more explicit conversations and documentation around preferred place of death would likely reveal more opportunities for better care for people at the end of life.

I am undertaking a qualitative research project studying what patients would like to know about dialysis withdrawal.

I have conducted 6 semi-structured interviews with patients on haemodialysis, known to the renal supportive care team. Interviews were transcribed and underwent thematic analysis by 3 independent reviewers. The main themes identified were that patients want more information, they want to know timelines for their illness and they want to know what symptoms they would experience if they chose to withdraw from dialysis. Patients also discussed who they would consult for further information and who they would involve in decision making.

Whilst not specifically related to the research question, all patients discussed their experience on dialysis and how dialysis resulted in exhaustion, pain as well as the limitations it posed on their life.

I will create a poster which I plan to present at both the Palliative Care Congress 2026 and the UK Kidney Association Week in 2026.

RIPEL project staff evaluation: 

Managing a mixed-methods evaluation of the Rapid Intervention for Palliative and End of Life Care (RIPEL) project, using qualitative interviews and an online survey to explore how staff across services experienced the implementation, impact, and ongoing delivery of the model.

Neuropalliative education study:

Contributing to a mixed-methods educational study evaluating a new teaching session for medical students. This includes ethnographic observation, student feedback, and interviews to explore learning, confidence, and engagement with palliative care in neurological conditions.

Homelessness outreach evaluation:

Conducting an ethnographic longitudinal evaluation as part of a homelessness outreach project. This work focuses on the experiences of a seconded Clinical Nurse Specialist (CNS) working to improve access to palliative and end-of-life care for people experiencing homelessness. It explores professional experiences, system navigation, and interagency working.

Optimising the Virtual Hospice:

Participating in a 14-month NIHR Programme Development Grant focused on improving virtual hospice services. Working as part of a multidisciplinary team, responsibilities include supporting the design and delivery of qualitative research, engaging with partner sites and stakeholders, and contributing to the development of outcome measures related to quality improvement, patient experience, and health economics.

The department is currently piloting an approach to PPIE based on a pool model to allow participants to opt into projects as their health and caring needs change over time. Thus far, it has permitted flexible involvement of PPIE participants on a wide variety of short-term and longer projects and raised the profile and availability of PPIE input into departmental research and service improvement work.

Dr Satullo is currently evaluating a yearlong project seconding a clinical nurse specialist to work at and alongside frontline homelessness staff to facilitate early palliative care referrals.

This project has been informed by focus groups conducted with those on the homeless pathway to determine their wants and needs at end of life. An integral part of the project has been the involvement of a Volunteer Community Lead from the Lived Experience Advisory Forum. This work is funded by St James Place Charitable Foundation Trust and Sobell House Hospice Charity.

We continually analyse our patients compared to the relevant population in our catchment area to determine potential gaps in access. A recent geographic analysis comparing community patient deaths to those on the death register by postcode revealed neighbourhood variation in palliative care involvement. Key informant interviews are now being conducted to identify appropriate improvement projects.