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Current Research Projects

Palliative Care Economics (PaCE)

The Palliative Care Economics (PaCE) research group at Trinity College Dublin is among the most active in the field worldwide.

In the context of rising costs and poor outcomes associated with serious illness, we work with clinicians, policymakers and other social scientists to generate high-quality evidence on what care and interventions should be provided to and prioritised for which groups of patients. 

Our current research programme covers studies in Ireland, England, the United States, Jordan, and elsewhere.  We welcome collaboration with other investigators and centres interested in questions that relate to the quality, cost-effectiveness and appropriateness of care for people with serious and life-limiting illness.

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Mapping the Pathways to Universal Health Care in Ireland

Mapping the Pathways to Universal Health Care in Ireland is a three-year Health Research Board research project. Dr Steve Thomas is the principal investigator on the project, along with Prof Charles Normand, Dr Sarah Barry and Dr Sara Burke. 

The project is a collaboration between the Centre for Health Policy and Management, TCD and staff from the Health Systems Strengthening Offices of WHO Europe and the European Observatory. 

The research project aims to provide an excellent evidence base that will inform the strategic direction and implementation of universal health care in Ireland. There are three components to the research project:

1) Assessing the gap between current Irish health system performance and universal health care, using and adapting WHO concepts.
2) Evaluating the strengths and weaknesses of different models of universal health care and assessing their feasibility of implementation within the current context according to key criteria such as affordability, human resources and complexity of design.
3) Assessing the organisational challenges of moving to universal health care by reviewing the experience of other countries and exploring the current capacity and constraints facing decision makers throughout the system.

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INCA: Interaction Analytics for Automatic Assessment of Communication Quality in Primary Care

At the core of health care is the relationship between clinician and patient. Clinical communication skills play a key role in accurate diagnosis, effective treatment, and motivating patients to adopt healthier lifestyles. Poor communication imposes avoidable costs of billions of euros across Europe each year. There is urgent need for better tools to assess clinical communication skills.
The INCA project leverages cutting edge techniques in signal processing and computational linguistics to analyse key features of clinicians' communication styles. INCA uses audiovisual recordings of interactions with patients, in real life settings and in role plays, to train machine learning algorithms to parameterise features such as: 

  • Turn-taking: how often a patient speaks, how long before a patient is interrupted
  • Prosodic features such as pitch, pace, related to intonation and perceptions of empathy
  • Use of medical terminology
  • Repetition of key concepts as an indicator of shared understanding
  • Body language

The project is funded by a three year Health Research Award grant from the Health Research Board (2016 – 2019). The Principal Investigator is Professor Charles Normand. He works with Centre colleague Dr Padhraig Ryan and a Trinity College Dublin team spanning the School of Medicine, the School of Computer Science and Statistics, together with strong input from the University of Edinburgh and Dartmouth College. Padhraig's role is in content analysis - he conducts sentiment analysis, produces algorithms to quantify repetition of key concepts and effectiveness of knowledge transfer during emergency responses, and evaluates clustering algorithms that characterise the nature of each interaction. This project seeks to enhance the scalability and affordability of quality assessment, and to create actionable knowledge for improved care and value.

PI: Prof. Charles Normand
Project Co-ordinator Dr. Padhraig Ryan

Appropriate Care in the Appropriate Setting:
The Impact of the Health Service Executive Transformation Programme on Utilisation,
Patient Experience, Safety and Outcome in Urgent and Emergency Care

Aims of the Programme

The overarching aim of this programme is to describe and evaluate the development and performance of different EUCS (Emergency and Urgent Care Systems) models in Ireland. There are four objectives:

  1. To identify geographical networks of emergency and urgent care in Ireland and describe the model of EUCS configuration planned/implemented in each region.
  2. To analyse the process by which plans for EUCS reconfiguration were developed with a specific focus on the use of evidence and the roles of different internal and external stakeholders.
  3. To analyse the relationship between different EUCS models of governance and provision, and system-level indicators of activity, process and clinical outcome.
  4. To develop, implement and test a comprehensive evaluation framework for EUCS.

PI: Prof John Browne, Epidemiology and Public Health, UCC
Centre Co-PI: Dr Steve Thomas
Centre Researcher: Dr Bridget Kane

 

CERVIVA - Cervical cancer and HPV-related disease prevention

CERVIVA  (www.cerviva.ie) is a multidisciplinary research consortium with components drawing from the fields of health psychology, epidemiology, health economics and molecular medicine. CERVIVA's initial research focus was on cervical cancer prevention through screening, but this has broadened in recent years to encompass the prevention of other diseases caused by the human papillomavirus (HPV).  

CERVIVA is led by Principal Investigators Professor John O'Leary and Assistant Professor Cara Martin, both of whom hold positions at the Coombe Women and Infants University Hospital and Trinity College Dublin. Professor Charles Normand of the Centre for Health Policy and Management is the Principal Investigator on the health economics component of CERVIVA's research programme. He works with Dr James O'Mahony, a health economist investigating the cost-effectiveness of alternative HPV-associated cancer prevention strategies.  

James' role with CERVIVA primarily concerns the simulation modelling of the cost-effectiveness of cervical cancer screening. The objective of which is to determine what novel screening tests offer the most appropriate balance of improved screening effectiveness to women and costs to the health system. This research relates both to current screening technologies of cervical cytology and HPV testing and to a new generation of potential testing technologies including p16(INK4a) dual staining and HPV mRNA testing. James is also considering the potential for a candidate screening test for head and neck cancer to be cost-effective, given what is currently known about the incidence of HPV-positive cancers and their health burden.  

The need for an ongoing research effort on HPV-associated disease stems from Ireland's relatively high incidence of cervical cancer and the emerging threat of HPV-positive head and neck cancer. Ireland had lagged behind other countries in establishing an organised, population based national screening programme. Accordingly, screening coverage and consequent disease prevention had been less complete than that achieved in other countries. While Ireland has now achieved good screening coverage there remain challenges in deciding what novel screening tests to apply within CervicalCheck. Similarly, although HPV vaccination has been offered in Ireland since 2009, there is an emerging problem of incomplete vaccination coverage due to unfounded fears of adverse effects of the vaccine. Over the past decade there has been growing recognition of the role of HPV as a cause of head and neck cancer. CERVIVA recently extended its research programme to investigate if the success of cervical cancer prevention through screening can be replicated using analogous testing technologies in head and neck cancer.

PI: Prof Charles Normand
Centre Researcher Dr James O'Mahony

The Irish Longitudinal Study of Aging (TILDA)

The Irish LongituDinal Study on Ageing (TILDA) is a large-scale, nationally representative, longitudinal study on ageing in Ireland, the overarching aim of which is to make Ireland the best place in the world to grow old.

TILDA collects information on all aspects of health, economic and social circumstances from people aged 50 and over in a series of data collection waves once every two years. TILDA is unique amongst longitudinal studies in the breadth of physical, mental health and cognitive measures collected. This data, together with the extensive social and economic data, makes TILDA one of the most comprehensive research studies of its kind both in Europe and internationally.

The study is a multidisciplinary project supported and guided by a cross-institutional team of experts from the Dundalk Institute of Technology, the Economic and Social Research Institute, the National University of Ireland Galway, Queen’s University Belfast, the Royal College of Surgeons in Ireland, Trinity College Dublin, University College Cork, University College Dublin and the Waterford Institute of Technology.
Funding has been provided by Irish Life, the Atlantic Philanthropies and the Department of Health.

Principal Investigator: Prof Rose-Anne Kenny
Co-PI:Professor Charles Normand

For more information:  https://www.tcd.ie/tilda/

Project BuildCARE

This project is a collaboration with King's College London and is funded through the Atlantic Philanthropies by Cecily Saunders International.

The purpose of this grant is to build capacity in the field of palliative care by supporting the creation of PhD Studentship and Faculty Scholarship Programmes and the expansion of a unique Research Study. This Project seeks to create a 'sea change' in the way palliative and end of life care is regarded, implemented and prioritised internationally. It is envisaged that the activities undertaken will substantially enhance the practice of palliative and end of life care by helping to build a long term and sustainable capacity. They will improve access, empower patients and families and result in better care for millions of patients and their families worldwide.

PI: Prof Irene Higginson (KCL)
Trinity lead: Prof Charles Normand
Trinity Researchers: Dr Katy Tobin and Bridget Johnston

Development of a Predictive Model for the Treatment of Edentulous Patients

Complete loss of natural teeth (edentulism) is a chronic disabling condition that impacts on an individual’s health, self-perception and social interaction. Edentulism is common in the Irish population, occurring in 40.9% of those over 65 years, with a higher prevalence in people holding medical cards and those in poorer general health. Despite the fact that edentulous people present with a wide range of functional and psychological needs, which may require different levels of intervention, there is no systematic approach to their diagnosis and treatment. The lack of data supporting patient-appropriate treatment means that many individuals do not receive  treatment suited to their needs and health service providers have no way to rationally plan services for this population. While advanced, implant-based, treatment for edentulism is reported to be very successful, there is also evidence that many patients neither need nor want this level of intervention. We hypothesise that a set of baseline clinical and patient-reported measures will be predictive of patient treatment outcomes. We aim to use patient-based data to develop a standardised clinical diagnostic tool that will predict the most appropriate treatment for an edentulous individual. The objectives of this project are first, to identify the key needs of edentulous people using qualitative methodology, purposive sampling and semi-structured interviews ; these needs will be used to produce a condition-specific  subjective health status measure, mapped to a taxonomy for quality of life.   Second, we will investigate edentulous individuals before and after conventional, then complex treatment to find the baseline characteristics of patients who achieve success with the different treatments. Third, we will measure the health gain and cost of conventional and complex treatments. This information will form the basis for more equal access to care and efficient use of health resources at primary and multidisciplinary care levels.

PI: Prof Brian O’Connell (Dental Science)
Co-PI: Prof Charles Normand      
Research Assistant: Bridget Johnston

Living and Dying with Amyotrophic Lateral Sclerosis: A Population based Analysis of Palliative Needs,
Services and Outcomes in Non-malignant Terminal Illness

HRB Interdisciplinary Capacity Enhancement Award

A consortium led by Professor Orla Hardiman, Consultant Neurologist, Clinical Professor of Neurology ,  has received a HRB Capacity Enhancement Award for the programme entitled: 
Living and Dying with Amyotrophic Lateral Sclerosis: A Population based Analysis of Palliative Needs, Services and Outcomes in Non-malignant Terminal Illness. 
Members of the Consortium include  Prof.Charles Normand (TCD Health Policy Unit),  Prof.Virpi Timonen (TCD Social work & Social Policy),  Prof.Ivan Perry (UCC Population Health),  Prof.Anthony Staines (DCU Health Systems) and Dr.Regina McQuillan (St.Francis Hospice). The research programme will be organised in three specific and interlinked work packages relating to Amyotrophic Lateral Scerosis, spanning clinical, epidemiological and health services research including health economics.  The completed project will provide a best practice framework for future management of neurodegenerative disease, including an embedded rating scale that will trigger specialist palliative intervention in accordance with recent Irish health policy.

PI: Prof Orla Hardiman
Co-PI: Prof Charles Normand
Post-doctoral researcher: Dr Katy Tobin

All-Ireland Institute of Hospice and Palliative Care (AIIHPC) Structured Research Network (SRN) Funding

On behalf of Our Lady’s Hospice, AIIHPC have confirmed the award of funding from the Health Research Board (HRB) for the establishment of a single Structured Research Network (SRN). The two participating Lead Collaborating Institutions are University College Dublin (UCD) and Trinity College Dublin (TCD). The overseeing organisation will be AIIHPC.
 
The Network will initially consist of two Research Strands. Professor Charles Normand is the Lead Principal Investigator for Research Strand 2: Measurement and Evaluation (MES). It is envisaged that the Network will offer the all-Island palliative care research community significant opportunities to create and engage in excellent and innovative research projects that will occur within a supportive and collaborative environment and that will ultimately advance understanding of AIIHPC’s research agenda. A significant set of Network activities will include research capacity building, dissemination and knowledge transfer, policy engagement, development of new areas of research and other areas of work aligned to AIIHPC’s strategic objectives. A Network Committee will be established to oversee the operational and financial management of the overall Network.

Strand 1: ‘PATHWAYS TOWARD SOCIAL JUSTICE: UNDERSTANDING EQUALITY AND INCLUSION IN PALLIATIVE CARE’ led by Prof. Phil Larkin, Associate Professor of Clinical Nursing (Palliative Care), University College Dublin.

The Social Justice Strand (SJS) is based on the premise that inequality exists in relation to palliative and hospice care access and service delivery across the island of Ireland for certain groups of people. This strand will examine the experience of inequality towards and through hospice and palliative care service delivery across the island of Ireland as reported by individuals, their families and the health and social care workers who support them. It will utilise generated evidence to develop best practice approaches which strengthen relationships and facilitate greater awareness of the hospice and palliative care needs of people currently excluded by virtue of misunderstanding, diminished recognition and/or prejudice.

Strand 2: ‘MEASUREMENT AND EVALUATION OF OUTCOMES FOR PALLIATIVE CARE’ led by Prof. Charles Normand, Edward Kennedy Professor of Health Policy and Management, Trinity College, Dublin.

The Measurement and Evaluation Strand (MES) will explore methodological development for palliative care research with a focus on measurement of needs, measurement of impact and evaluation of service priority and delivery. MES will develop better understanding on how best to elicit preferences and views for service users and families and will support the development of measurement tools for palliative care research. This strand will utilise evidence to examine how best to disseminate complex findings in palliative care research. The MES team shares the social justice perspective of SJS, that access to care should depend on needs and not circumstance.

For more information: www.aiihpc.org

CARDI launch 

Photo CARDI launch                
Caption: TCD lead authors Dr Maev-Ann Wren and Prof Charles Normand with Prof Davis Coakley and Prof Bob Stout, co-chairs of CARDI at the launch of the CARDI funded report Towards the Development of a Predictive Model of Long-Term Care Demand for Northern Ireland and the Republic of Ireland

AIIHPC launch

Photo AIIHPC launch
Caption: Pictured at the launch of the AIIHPC – Mo Flynn, Phil Larkin, Charles Normand, Joan Regan, Edwin Poots,  Max Watson and Judith Hill