Decision-Making for People with Advanced Illness in Palliative Care
Abstract
Palliative care is an interdisciplinary care approach to enhance quality of life and alleviate distress for people living with life-limiting conditions and their families. Patient, family caregiver, and healthcare professional decision-making in the management of patient care is complex, particularly in cases of advanced illness. Healthcare professionals in palliative care advise patients about treatment options and supportive care. Patients make decisions about care with healthcare professionals, but many patients also make decisions with their family. This project addresses key evolving challenges in palliative care including clinical decision-making processes in the management of symptoms for patients with advanced illness, and patient-family caregiver relations in decision-making for patient care. These challenges will be investigated in the context of legislative and ethical dimensions of shared decision-making for people with advanced illness.
The project involves interdisciplinary investigation among researchers from allied health, palliative medicine, Law, cancer survivorship, ethics, biostatistics, psychology, and social sciences. Four inter-related PhD works focus the project to identify how healthcare professionals decide about treating patient symptoms including pain and distress; explain how family caregivers influence patients’ decision-making about their care; decipher key ethical considerations for patients, family caregivers and healthcare professionals in shared decision-making for patient care; and examine the impact of the Assisted Decision Making (Capacity) Act in Ireland for patient autonomy and shared decision-making in palliative care. The project incorporates public and patient involvement from design to dissemination.
Teaching and learning for the PhD students will be interdisciplinary in scientific approach, enhanced by investigator co-supervision and by collaboration with interdisciplinary partners beyond Trinity College. Outcomes and experiences in palliative care research are known to be gendered. All procedures from design to dissemination will address gender bias across the project. The project will attract both national and international PhD applicants which will support not only cross-cultural learning and diversity between PhD students, but also the primary investigators’ learning in these contexts.
The project will achieve Trinity’s cross-cutting ambitions of conducting quality research with impact and facilitating next-generation learning. A key output from the project will be an interdisciplinary framework from which to critically examine shared decision-making in palliative care. A primary outcome of the award will be a blueprint for future interdisciplinary doctoral research in shared decision-making in life-limiting illness. The award will leverage the investigators’ ability to develop and lead consortia for large-scale funding including Horizon Europe focused on novel solutions for people with severe and advanced illness.
Wandering Books
Abstract
For over a millennium, before paper became widely available and printing was introduced to Europe in the fteenth century, knowledge circulated and was preserved primarily on animal skin, handwritten, in manuscripts like the Book of Kells. Today, manuscripts are the key sources for cultural, social, intellectual, literary and linguistic history of the Middle Ages, a formative period of human history. As well as being repositories of language and text, manuscripts are simultaneously material objects that preserve ancient DNA which offers information about the biological past that may be key to contemporary issues of agricultural sustainability.
Central to utilising the various kinds of evidence manuscripts offer are a better understanding of how existing disciplinary techniques interact to determine where particular manuscripts were made and the innovation of new methodologies. No single discipline can adequately address this challenge. Wandering Books therefore brings together a geneticist (Bradley), a manuscript specialist (Volmering), an intellectual historian (Warntjes) and a historical linguist (Faulkner) to supervise between them four PhDs taking distinct methodological approaches to the same corpus of manuscripts deriving from early medieval Britain and Ireland: one hunting the animals whose skins made the manuscripts, one tracing the techniques used to assemble the skins into a book and write it, another tracking the texts it contains as they diffused across Europe, and a fourth listening for the languages the manuscript contains.
Wandering Books will articulate a new understanding of the relationship between existing methods for dating medieval manuscripts and introduce innovative new approaches, which, through the new localisations they propose, will revolutionise our understanding of the medieval textual record, and key questions of intellectual, cultural, social, linguistic and biological history. These findings will be shared through a rich set of public engagement activities, delivered through the new Long-Room-Hub-based Trinity Centre for the Book. The project will therefore significantly help Trinity achieve goals 5 and 8 of its strategic plan by addressing UN SDGs around quality education, sustainable cities and communities and life on land, and enhancing a sense of community.
Trinity is the obvious place for this project to coalesce. The Book of Kells is of massive economic importance to Trinity (c. €12m per annum), with College’s symbolic capital in the area already significantly enhanced by the manuscript-focused M. Phil in Medieval Studies and new Centre for the Book. With Wandering Books, Trinity will become a global player in early medieval manuscript studies.
Health and transport in an AI era
Abstract
We are currently at the dawn of the artificial intelligence (AI) era and are facing a sustainability challenge. There is a large degree of uncertainly and trepidation in society about what changes may come next but one thing we do know is that transport is changing. Recent years have seen a significant increase in the number of electric vehicles on our roads, advances in driver assist technology, and recently there was a court case related to autonomous car driving which made national headlines.
The pros and cons of transport changes have been examined by various stakeholder groups and health implications, both positive and negative, have been suggested, however there is a lack of real diversity in the voices being heard. For example, driver assist technology and increasingly autonomous vehicles could certainly help the average person who currently owns a car, however their greatest use is arguably to serve those who currently struggle to drive. We know that there is a great need to increase active and public transport use, but this needs to be done with a universal design approach so that populations such as older adults and disabled people can easily benefit from these changes.
This project will examine health considerations related to the modernisation of transport for both disabled people and older adults. Specifically, we will examine the advantages and disadvantages of driver assist technology from the perspective of older adults and disabled adults. The legal implications associated with using increasingly autonomous vehicles will be examined as well as how changes in our built environment related to the modernisation of transport can lead to health benefits in our communities. This work will be carried out with partners from government, patient representatives and other relevant stakeholders. As well as writing academic papers, our group will work with our non-academic partners to produce reports and other outputs which are relevant to them.
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