Critical issues in prescribing at end of life: An interview with Lucas Morin, PhD, joint winner of the 2020 EAPC Early Researcher Award

Highlights of every European Association for Palliative Care (EAPC) Congress are the EAPC Researcher Awards. Awarded jointly by the EAPC and the EAPC Research Network (RN), these awards recognise and support the work of scientists and clinicians in the field of palliative care who make an outstanding contribution to research and clinical practice.  

Lucas Morin, PhD, is an epidemiologist at the Clinical Investigation Unit of the University Hospital of Besançon, France. He is also an affiliated researcher at the Department of Medical Epidemiology and Biostatistics at Karolinksa Institutet in Stockholm, Sweden. Here we talk to Lucas about his work as an epidemiologistand the research that has led to his receiving the Joint EAPC Early Researcher Award for 2020. You can also view a presentation from Lucas – one of the many on-demand presentations now available to view on the congress platform…


Lucas Morin.

Can you tell us briefly about the research that has led to your winning this award and some of the main findings?

 LM: In a nutshell, I use routinely collected administrative and healthcare data (e.g. hospital electronic records) to study the utilisation patterns, the effectiveness and the safety of drug treatments among people with serious illness and/or limited life expectancy.

My PhD thesis was about the burden of medications among older people who are nearing the end of life. This topic has come under quite intense scrutiny over the past few years, because it appears that older people with serious illness and poor prognosis may be prescribed drugs that may do more harm than good, or continue to receive treatments that have little chance of achieving their benefit during the patient’s remaining lifetime.

I found that the number of prescribed drugs increases markedly throughout the last months of life, fuelled not only by the initiation of symptomatic drugs to ensure comfort but also by the frequent continuation of preventive and disease-oriented treatments. Interestingly (and contrary to my initial hypothesis), older people who followed unpredictable end-of-life trajectories were not the ones driving this observed increase in polypharmacy and in the continuation of preventive drugs. For instance, people who die with solid cancer (a set of diseases most often characterised by a very poor prognosis and a clinically discernible terminal phase) often keep receiving drugs for the long-term management of chronic comorbidities until the very end of life. This suggests that there is indeed some room for deprescribing. To help with that process – given the lack of robust evidence from clinical trials and well-designed observational studies – we developed a set of clinically-driven, consensus-based criteria to identify drugs considered ‘often adequate’, ‘questionable’, and ‘often inadequate’ for use in older persons aged ≥75 years with a life expectancy of three months or less.

We hope that these criteria can provide some guidance to rationalise drug prescribing near the end of life, and serve as a reminder that good prescribing is not only about knowing when to start treating patients, but also about knowing when to stop and when not to start these treatments in the first place.

It is important to remember that deprescribing is not about denying patients access to treatments that would be beneficial for them. On the contrary… Deprescribing is about using the right treatments for the right patients at the right time, avoiding harmful side effects, maintaining the best possible quality of life despite the progression of the disease, and minimising the disruptive impact of medicine on the patient’s everyday life.

What will you be doing in the future? Will you continue in research? 

LM: yes, I will continue doing research. I received a large research grant in France to lead a multidisciplinary study looking at the impact of overtreatment on older cancer patients’ health outcomes and quality of life. It’s an exciting project and it will involve a lot of collaboration with clinicians, which I am very much looking forward to!

Which qualities do you think are the most important in a researcher? And what advice would you give to other young researchers?

LM: Rather than giving advice (which is not really my place), I’ll tell you what lessons I personally learned over the past few years. The first one is that research can be very tedious and unrewarding at times. When that happens, it is essential to remember why you are doing this work and to have a few trustworthy colleagues who remind you of that.

The second lesson is that it’s very easy to get caught up in abstract considerations and lose track of the clinical reality hidden behind the data. Reading about chronic pain and dyspnea is one thing, meeting people with terminal lung cancer is something entirely different. Listening to a scientific presentation about hospice care is not the same as going to an actual hospice, meeting patients and talking with staff members. Thinking and writing about grief is not the same as spending a couple hours interviewing people who lost a loved one. Reading papers and listening to presentations are obviously an important part of our work, but there is only so much one can learn without a tangible experience of what the research is about.

The third lesson I learned is that writing academic articles is incredibly difficult. Not just for me or you, but for everyone. It takes a lot of hard work, no matter how clever and talented you may be. However, one little trick I came up with to avoid catastrophes is to always start with the detailed outline of the manuscript and to get all the co-authors to agree on it before I move on to the writing part. By doing so, I make sure that everyone is on the same page regarding the key components of the paper and the logical reasoning behind it. It goes a long way!

Finally, an important lesson for young researchers is to learn how to stand up for their own ideas and opinions in an effective manner. In my experience, many unnecessarily heated and pointless discussions arise when there is a confusion between disagreeing and being in conflict (“I disagree with what you said” is not the same as “I disagree with you”), between disagreeing and misunderstanding (some people say “I disagree with what you said” when what they mean is, in fact, “I am not sure I understand what you said”), or between disagreeing about the facts and disagreeing about the interpretation of these facts (“I don’t think you’re right” and “I don’t share your views” are two different things). Although this can definitely be true for more senior researchers, I’ve found that it is quite common among PhD students and that it sometimes prevents them from getting their ideas across.

How do you see your role (and palliative care researchers in general) linked to that of clinicians?

LM: I’m keeping it simple: the goal of clinicians is to provide excellent patient care; my goal as a clinical epidemiologist is to help them provide even better care. All my research projects are driven by questions from and discussions with clinicians, not only palliative care physicians and nurses but also oncologists, geriatricians, GPs (general practitioners), etc. Without their input, the whole thing would fall apart like a house of cards!

What does winning the EAPC Early Researcher Award mean to you?  

LM: I’m very excited and honoured to receive this important award from the EAPC. I have been involved in the palliative care research community for a few years now, and it means a lot that my peers find my work interesting and useful.

When Joachim Cohen (2010) and Lieve Van den Block (2014) won this award and gave their lectures, I remember thinking “Wow, they are advancing the field, aren’t they?” Now, I’m here and it’s my turn to try convincing younger researchers and clinicians that research is indeed essential to improve the lives of people with serious illness. 


Links


MORE EAPC RESEARCHER AWARDS AT #EAPC2020

We’ve much to celebrate at the EAPC World Research Congress Online. On top of some of the latest research presentations and posters from some of the world’s leading palliative care researchers you’ll discover exibitions, more awards, prizes, a Science Slam, Yoga and much else… And, of course, we have the prestigious annual EAPC Researcher Awards. Lucas Morin is one of three of this year’s winners. Look out for interviews with Melissa Bloomer PhD, winner of the 2020 EAPC Post-doctoral Award, and Dr Eva Katharina Schildmann, Joint Early Researcher Award winner, which will be published on the blog live from the EAPC World Research Congress Online on 8 and 9 October. Their presentations are among masses of on-demand content that registered delegates can now view on the congress platform and will be followed by a live panel discussion on 8 October at 10am CET. Check the live interactive programme here. View Melissa and Eva’s presentations now and submit your questions for their live panel discussion, or use the Q&A feature on Zoom during the live session. And it’s still not too late to register.

Important message: Registered delegates can now enter congress platform to view on-demand content
An automatically generated email has been sent to all registered delegates with their unique login to access the congress platform with the subject heading: ‘Admin User (via EAPC)’. If you’re registered and have not received the email, please check your Spam folder, or email info@eapcnet.eu

This entry was posted in 11th EAPC World Research Congress Online, EAPC Researcher Awards, EAPC World Research Congresses, RESEARCH and tagged , . Bookmark the permalink.

1 Response to Critical issues in prescribing at end of life: An interview with Lucas Morin, PhD, joint winner of the 2020 EAPC Early Researcher Award

  1. Silva Dakessian Sailian says:

    Inspirational !

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.