Our Palliative Care champion

One of the most recognisable names in palliative care research in Australia, Professor Meera Agar has been working in the field for almost 20 years. Her commitment to ensuring the person is front and centre of all healthcare has led to significant improvements in person-centred palliative care.

Why did you choose to go into palliative care?

I was always interested in holistic care, particularly in the care of older people and people with cancer. Palliative care brought together these interests. It was an emerging speciality at the time I started my training, so I’ve been part of framing what palliative care in the Australian context looks like now and in the future.

You have played an instrumental role in the establishment of home-based palliative care in Australia. Why is it so important?

I believe if we are to optimise people’s healthcare, we should have models of care where we go to the person rather than rely on the sick person coming to hospital. It doesn’t make sense to have people with cancer or other serious illnesses sitting in an outpatient department or going to multiple appointments when they feel unwell. I believe there are better ways to get healthcare to them and that is by making the health professionals the mobile part of the equation and not the person living with cancer or serious illness.

It is also a privilege to provide care in someone’s home. You see them as a person first and their clinical issues second whereas the hospital setting removes their identity and who they are as a person.

As Chair of SPHERE’s Palliative Care CAG, how do you think SPHERE contributes to research in palliative care?

Research in palliative care continues to grow. The pioneers of palliative care were focused on developing clinical services, developing the funding models and advocating for the workforce to provide palliative care whilst also challenging previous clinical care models that didn’t put the person at the centre of care. More recently, we have turned to undertake research to also contribute to improving care. What SPHERE has done is provided an opportunity to bring together clinicians, consumers and researchers to look at how we can use research to improve care. Being a smaller specialty, we’ve been able to do a lot of networking and sharing our time, energy and resources so we can do great things together rather than in isolation.

You led a world-first clinical trial of antipsychotics in delirium. Tell us about the clinical trial and what were the outcomes?

Delirium is a critical condition affecting one in five people in hospital. If you are in palliative care, the risk is even higher. From my clinical experience I know how important it is for a person with a palliative diagnosis to be mentally aware and able to interact with loved ones because communication is such a critical part of maintaining meaning. Having an acute issue such as delirium impairs your cognition and clouds your consciousness. For this reason, delirium was an area where we knew we needed to improve clinical care.

There was a lot of work in other areas of health such as geriatrics which was focusing on reducing use of medications and increasing focus on use of non-medication measures to help people prevent symptoms of delirium and improve recovery. However, there is a tension between keeping people mentally aware and trying to reduce their distressing symptoms such as hallucinations and restlessness. So, we wanted to test whether anti-psychotics had a role in delirium in people with more advanced disease.

The trial was aligned with SPHERE philosophy to bring together the lens of experts well outside our own clinical ‘silo’. We worked closely with geriatricians, aged care psychiatrists, nurses, pharmacologists to articulate the research question specific to palliative care and also how learnings from other specialties could help us. Our study found that focusing on nonmedication approaches are also critical in palliative care.

What are your biggest areas of focus?

The biggest focus in my clinical trials has been around the impacts of advanced illness on the brain, with my initial work in delirium. This led me to a focus on geriatric oncology given that older people with cancer are particularly vulnerable in terms of cognitive issues. The focus has been looking at models of care and how we can assess to meet the broader needs of older people who have cancer and make sure we are putting in multidimensional care plans to improve their clinical outcomes.

The other area we have been interested in is to improve the management of symptoms for people with malignant brain tumours particularly looking at raised intracranial pressure and if we can reduce the need to use high doses of a medication (corticosteroids) which are currently used to manage this and have significant side effects. This focus came directly from people who had experience of living with brain cancer and the importance of reducing side effects.

Describe your typical week

I’m fortunate that I have the capacity to continue to do clinical work for part of my week which is primarily at Liverpool Hospital Cancer Centre. The rest of my week is spread between mentorship and capacity building Early Career Researchers including supervising PhD Students and Post doctoral research fellows, and leading my own research projects. Part of that involves trying to improve the infrastructure needed to conduct palliative care research at scale and support those systems within our clinical services.

What is the best part of your job?

The best part of my job is mentoring early career researchers. It has been really wonderful to see palliative care develop in Australia so that we now provide world-leading palliative care services. It is exciting to mentor the next generation of people from all disciplines who are taking on research into palliative care and who are really tackling some challenging aspects of healthcare and already making a difference.

What is your greatest professional achievement?

The establishment of the 14th Cancer Collaborative Clinical Trial group focused on cancer symptoms. Australia has been a world-first in ensuring that supportive care and symptom questions are equally part of the clinical trials landscape.

What do you do in your free time?

I have two other interests outside of research and clinical practice. The first is gardening. During COVID I did a permaculture course, so my goal is to have an urban farm in the middle of Sydney which I acknowledge is tricky to achieve. I also love to knit using complicated patterns and different colours.

Prof Agar is a Fellow of the Royal Australasian College of Physicians, Fellow of the Australasian Chapter of Palliative Medicine and clinician scientist. She holds a Masters in Palliative Care.