One of the many highlights from last week’s 12th World Research Congress Online was the EAPC Researcher Awards. Awarded jointly by the EAPC and the EAPC Research Network, 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. Today we are delighted to hear from the joint winner of the #EAPC2022 EAPC Post-Doctoral Award, Dr. Peter May. Peter is a Research Assistant Professor in Health Economics at Trinity College Dublin in Ireland.
Thank you for being interviewed for the EAPC blog! Can you tell me what was your inspiration for a career in palliative care?
I started in palliative care by chance. After an undergrad degree in economics and an MSc in public policy, I worked for a few years in very wide-ranging research roles: transport, education, sport and others. Then in 2010 Trinity College Dublin wanted a researcher for policy analysis and literature reviews in ‘palliative and end-of-life care’. I had the methods skills but had never heard of palliative care – I began my interview prep by reading the Wikipedia article.
But once I got the job, inspiration was in abundant supply. It very quickly became apparent that this is a uniquely challenging and rewarding field, with not nearly enough research activity. For a pre-doctoral researcher in search of a focus, this was a heady mix: the promise of doing something new and intellectually adventurous, and making a difference by addressing unusually large, increasingly urgent evidence gaps.
Who have been your main influences?
I’ve since met and worked with countless wonderful people. My first manager at Trinity was Professor Geralyn Hynes. She has a mix of qualities that is perhaps particularly common in nurses: smart, industrious, protective of her team, and flintily sceptical in the face of those with too high an opinion of themselves. I learned a lot about palliative care, but also about following the evidence and not the agendas of others. My PhD and post-doc mentors were Professor Charles Normand, who more or less started the economics of palliative care as a field, and Professor R. Sean Morrison, who judiciously combines unstinting generosity with bad jokes about our respective football teams.
As I’ve become more established, I increasingly find inspiration outside academia in the ‘real’ world. It’s one thing to know in principle that we’re trying to improve experiences for people with serious illness and their families, but it’s quite another to grasp the full meaning of why that is so needed. The emergence of public patient involvement in research is critical in this regard because it can help us to augment economic knowledge with understanding. I am increasingly convinced that we must involve patient, carers and the public throughout the research cycle if we are to bridge the gap between theory and practice and ensure tangible benefits to those who benefit from palliative care services.
Can you tell us about the research that has led to your winning this award and some of the main findings?
Early economic studies of hospital palliative care (from c.2005-2015) typically removed the most clinically complex cases on an assumption that there were some people for whom no difference could be made. My PhD work showed that this was scientifically flawed and missed the importance of intervention timing: the earlier the palliative care involvement in an episode of care, the more cost-effective the intervention, all else being equal. Furthermore, once we’d incorporated timing into the model we found that palliative care had a larger effect on treatment choices for that complex, high-cost group – precisely the opposite of what was previously assumed.
My post-doctoral work extended that exploration of how treatment effect estimates vary by how many serious medical conditions (‘comorbidities’) an individual has. The resultant meta-analysis, published in JAMA Internal Medicine in 2018, attracted a lot of attention in research and beyond. It shows that palliative care is more cost-effective for people with high numbers of comorbidities, and as we move into an age of multimorbidity, these dynamics are crucial to understand, as well as potentially making intervention more attractive to those who commission services. As a Principal Investigator I am currently working with Irish policymakers to quantify future need and model the costs and outcomes under different policy choices.
In the future I aim to focus increasingly on frontier questions for the field. I am a member of the EAPC Task Force on Big Data, with a particular interest in quasi-experimental methods. I am engaged in new collaborations with clinicians in Ireland and internationally to compare approaches to outcome measurement and address the ‘QALY problem’. I have begun working with an international team to address the established lack of economic evidence in low and middle-income countries.
Let’s talk about life outside of palliative care – when you are not in work, where could we find you?
As a parent of young children, I am unfamiliar with the concept of ‘free time’ as such. At weekends my natural habitat is refereeing a chaotic game of cricket/football/hurling in the road outside our house.
Thank you for speaking with us today and letting us know more about your important research, and congratulations on your award!
To hear more about Peter’s work and his views on the importance of an economic evidence base in palliative care, look out for his forthcoming EAPC blog.
Links and resources
Read Peter May et al, Economics of Palliative Care for Hospitalized Adults With Serious Illness: A Meta-analysis. JAMA Internal Medicine, 2018.
About the author
Dr Peter May is a Research Assistant Professor at Trinity College Dublin in Ireland. He is a health economist with a focus on palliative and end-of-life care. Twitter: @petermay_tcd
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