Decision-Making for People with Advanced Illness in Palliative Care

Applications are invited for four (4) full-time PhD Studentships funded by an interdisciplinary Trinity Research Doctorate Group-based Award.

The four successful applicants will be recruited on four distinct projects within a programme focused on Decision-Making for People with Advanced Illness in Palliative Care. The programme investigates key evolving challenges in palliative care including clinical decision-making in the management of symptoms for patients, and patient-family caregiver relations in decision-making for patient care. The programme also researches legislative and ethical aspects of shared decision-making for people with advanced illness in palliative care.

Each of the PhD studentships will be 4 years in duration. Funding for each of the successful PhD applicants comprises an annual stipend of €25,000 with full exemption of tuition/academic fees (EU and non-EU).

Why focus on decision-making in palliative care?

Palliative care is an interdisciplinary care approach to enhance quality of life and alleviate symptom distress for people living with life-limiting illness and their families. Decision-making in palliative care is complex, particularly in cases of advanced illness. Whilst some patients make decisions about care on their own, many make decisions with their family. Others may even delegate decision-making to their family.

Healthcare professionals in palliative care are tasked with advising patients about treatment options and supportive care. They also operate within ethical and legislative frameworks that directly impact how they facilitate patient decision-making. Shared decision-making is a process of integrating best available evidence, healthcare professional opinion, and patients’ values and preferences. In palliative care, shared decision-making is often understood as a process that includes family.

Population ageing, together with the growing prevalence of life-limiting illness, means that the need for palliative care worldwide will grow exponentially this century. In Ireland alone, the prevalence of palliative care need is predicted to double in the next 30 years. It is important that decision-making processes in palliative care adapt to this changing landscape and in line with legislation and ethics of care that impact on patient autonomy and shared decision-making.

This research programme will answer the following inter-connected questions:

1. How are patients’ preferences for and choices about care influenced by their family caregiver(s)?
2. How do healthcare professionals decide about the management of patient symptoms including patient distress?
3. How does the legislative framework ‘Assisted Decision-Making (Capacity) Act’ in Ireland impact on patient autonomy and shared decision-making?
4. What are key ethical considerations for patients, their family caregivers, and healthcare professionals in shared decision-making for patient treatment and care?

The four individual PhD studies will comprise the following:

PhD 1 – A study focused on relationship factors between the patient with advanced illness and family caregiver in palliative care that impact on patient preferences for and choices about care. The study will investigate why some patients involve family caregivers in decision-making and others do not.

This PhD study aligns best with applicants from one or more of the following backgrounds: health or social psychology; allied health (professional); health services research; social sciences; social work; population health research.

This PhD will involve qualitative and quantitative methods.

For direct inquiries about the specifics of this study, please contact:

Dr Geraldine Foley, email: foleyg3@tcd.ie  

PhD 2 – A study focused on healthcare professional decision-making in the medical treatment of patient symptoms before and during end-of-life care. The study will decipher how healthcare professionals assess patients with capacity and those with impaired capacity, and what influences practices for medical treatment in these contexts.

This PhD aligns best with applicants from one or more of the following backgrounds: pharmacy; medicine; population health research; allied health (professional).

This PhD will involve quantitative and qualitative methods.

For direct inquiries about the specifics of this study, please contact:

Dr Cathal Cadogan, email: cathal.cadogan@tcd.ie

PhD 3 – A study focused on the impact of the Assisted Decision-Making (Capacity) Act in

Ireland on patient autonomy and shared decision-making in palliative care. This PhD will involve doctrinal legal analysis of case law, statute law and commentary, as well as empirical research using qualitative methods. Prior experience of qualitative methods is not essential.

This PhD study requires the applicant to have a Law degree.

For direct inquiries about the specifics of this study, please contact:

Dr Andrea Mulligan, email: mulliga3@tcd.ie & Dr Geraldine Foley, email: foleyg3@tcd.ie

PhD 4 – A study focused on ethical dimensions of shared decision-making for patients with advanced illness, family caregivers, and healthcare professionals in palliative care. The study will compare the patient, family caregiver, and healthcare professional perspective and decipher how their perspectives impact on how they approach decision-making about treatment and care.

This PhD study aligns best with applicants from one or more of the following backgrounds: medical ethics; ethics; social sciences; health research; or cognate fields.

This PhD will involve primarily qualitative methods.

For direct inquiries about the specifics of this study, please contact:

Professor Linda Hogan, email: lhogan2@tcd.ie & Dr Geraldine Foley, email: foleyg3@tcd.ie

Each successful applicant will deliver/work on their own PhD project but also engage collaboratively with one another as part of the overall programme of work. All PhD students will have opportunities to complete taught modules that are offered across college to fulfil the requirements of the structured TCD PhD programme. The Lead Primary Investigator for this interdisciplinary Trinity Research Doctorate Group-based Award is Dr Geraldine Foley and Co-Primary Investigators are Dr Cathal Cadogan, Dr Andrea Mulligan, Professor Linda Hogan, Dr Emer Guinan, Professor Andrew Davies, and Professor Cathal Walsh.

Each of the successful applicants will be supervised by a principal supervisor in conjunction with co-supervisors and they will be registered in the school of their principal supervisor. The PhD studies will include Public and Patient Involvement (PPI) and collaborate with researchers beyond Trinity College Dublin.

Qualifications and skills of applicants (essential and desirable)

All applicants must meet Trinity College Dublin requirements for a PhD by research which are detailed in https://www.tcd.ie/courses/postgraduate/how-to-apply/entry-requirements/. They should have achieved a 2.1 or above in their primary degree. In addition, a prior postgraduate degree at master level (e.g., Masters by research or Taught Masters) is desirable. Successful candidates will have a strong academic background and demonstrate full commitment to PhD research.

Essential skills and experience

• Experience of conducting qualitative and/or quantitative research (PhDs 1,2,4)
• Experience of conducting theoretical legal research (PhD 3)
• Excellent English language writing skills.
• Excellent verbal communication skills.
• Strong organisational skills and the ability to set and adhere to research goals.
• Ability to keep to timelines and meet deadlines.
• Ability to work in an independent manner with supervision and as a team.

Desirable skills and experience

• Evidence of previous research dissemination (e.g., conference papers/presentations, journal articles, published abstracts, etc) from a prior postgraduate degree.
• Prior experience of conducting research in life-limiting illness.
• Understanding of the complexities and range of skills relevant to the conduct of research for people with life-limiting illness.

PhD student registration at TCD occurs in September and March of the academic year. All successful applicants must be registered on the PhD register by September 2024 or by the very latest March 2025.

Application Procedure

Applicants should submit the following by email to the primary investigator(s) listed beside the PhD studentship they are applying for (please see table below) The subject line in the email should read: ‘Application to TRDA Group – Palliative Care’.

1. A full Curriculum Vitae (including the names and contact details of two academic referees). Please include in the CV any research outputs in which the applicant is named author (e.g., conference presentation/papers, journal articles, published abstracts, etc).

1. A Cover Letter (no longer than 2 A4 pages) outlining:                                                                                           (a) The applicant’s profile and skills relevant and/or transferrable to the PhD they are applying for.                       (b) A statement of motivation to pursue the PhD.

Please submit applications by Friday 26^th July 2024, 5.00PM (Irish Standard Mean Time)

Applicants are encouraged to contact the primary investigator(s) listed beside the PhD studentship they are intending to apply for so that they have an opportunity to ask questions about the specifics of the PhD study. 

Please direct general inquiries about the programme to Dr Geraldine Foley.

Email: foleyg3@tcd.ie