On the evening of October 25, Professor Kevin Brazil, Professor of Palliative Care, gave a Professional lecture in the Council Chamber, Lanyon Building, QUB. The title ‘Addressing inequality suffered by the frail and the dying: unfinished business’ .

The COVID-19 pandemic exposed and amplified the magnitude of inequality in society. Systems that care for frail and dying replicate and reinforce witnessed inequality in society. Individual experiences of frailty and dying is determined by multiple factors such as access to, and trust in, healthcare services, relationships, poverty, ethnicity, education and geography. These factors interact with each other to shape experiences for people nearing the end of life.

Reducing inequalities in health care for people nearing the end of life is a matter of social justice and evidence based planning for improved population health and service development. Implementation science is an evolving field which has the purpose to create a bridge between research evidence and the real-world settings of service delivery. It is increasingly being viewed as having the potential to advance health care equity. This potential is accomplished by examining what is being delivered, for whom, under what conditions; and how delivery should be tailored to best meet the needs of the focus population. In this fashion implementation science offers a method to develop and assess disparity-reducing service implementation strategies. A review of the role of implementation science to reduce health care disparities generates several considerations to enhance disparity research for the frail and dying; a) what is the research question and who is asking it; b) design interventions with implementation in mind; c) use pragmatic research designs; c) adaptation of an intervention to suit context is important; d) acknowledge the limitations of health care systems.

Below are a selection of Professor Brazil's Publications:

Bavelaar Visser, M, Walshe C, Preston N, Kaasalainen S, Sussman T, Cornally N, Hartigan,I, Loucka M, di Giulio P, Brazil K., Achterberg, W. P. & van der Steen J. T The impact of the mySupport advance care planning intervention on family caregivers' perceptions of decision-making and care for nursing home residents with dementia: pretest-posttest study in six countries. 01 Mar 2023, In: Age and Ageing. 52, 3.

Bavelaar L, McCann A, Cornally N, Hartigan I, Kaasalainen S, Vankova, H, Di Giuli P, Volicer,L, Arcand M, van der Steen J. T. & Brazil K mySupport study Group. Guidance for family about comfort care in dementia: a comparison of an educational booklet adopted in six jurisdictions over a 15 year timespan. BMC Palliative Care 21, 76 (2022). 

Brazil, K., Cardwell, C., Carter, G. Clarke M, Corry D. A. S, Fahey T, Gillespie P, Hobbins, A, McGlade K, O’Halloran P, O’Neill N, Wallace E. & Doyle F. Anticipatory care planning for community-dwelling older adults at risk of functional decline: a feasibility cluster randomized controlled trial. BMC Geriatr 22, 452 (2022). 

Corry D. A. S, Doherty J, Carter G, Doyle F, Fahey T, O'Halloran P, McGlade K, Wallace E. & Brazil K. Acceptability of a nurse-led, person-centred, anticipatory care planning intervention for older people at risk of functional decline: A qualitative study. 20 May 2021, PLoS ONE. 16, 5, 30 p., e0251978.

Brazil K, Carter G, Cardwell C, Clarke M, Hudson P, Froggatt K, McLaughlin D, Passmore P, Kernohan WG. Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial. Palliative Medicine. 2017 July 1:269216317722413. doi: 10.1177/0269216317722413.