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Academic

Dr Jonathan Koffman

Reader in Palliative Care & MSc Course Director

Phone: 0207 848 5590
Fax: 0207 848 5517
Email: jonathan.koffman@kcl.ac.uk
Address: King’s College London
Cicely Saunders Institute
Department of Palliative Care, Policy & Rehabilitation
Denmark Hill
London SE5 9PJ


Research

Social disadvantage and social exclusion at the end of life; black, Asian and minority ethnic (BAME) groups, illness and symptoms attributions; religion and spirituality; quality improvement; mixed methods and qualitative research; phenomenological approaches to illness; the philosophy of palliative care.

Biography

Jonathan has a BSc in Social Administration and an MSc in Sociology with Special Reference to Medicine. His PhD from King's College London explored the experience of living with, and dying from, advanced cancer among black Caribbean and white patients living in south east London. Prior to coming to King's, Jonathan worked for the National Health Service (NHS) as a public health specialist, involved in implementing the reforms of the early 1990s. He is now a Reader in Palliative Care and Course Co-ordinator for the inter-professional Postgraduate Certificate, Diploma and MSc in Palliative Care. His research interests include clinical trials and specifically designing and evaluating complex interventions, mixed methods research, social exclusion, and communications training. Jonathan received the King's Award for Excellence in Teaching in 2007.

Key Leadership Roles

Jonathan assumes overall responsibility for co-ordinating the inter-professional MSc in Palliative Care and has a direct role in the management of five out of eight core and optional modules within the programme.

Jonathan is also sub Dean for Postgraduate Teaching in the School of Medicine. He is Chair of the Postgraduate Teaching Committee in the School of Medicine, King’s College London.

He assumes responsibility for the management, governance and quality assurance of over 30 postgraduate programmes in the School of Medicine that include the MSc in Medical Engineering and Physics, Masters in Public Health, MSc in Dermatology and MSc Advanced Paediatrics.

Selected Publications
  • Koffman J, Morgan M, Edmonds P, Speck P, Siegert R, Higginson I.J. Meanings of happiness among two ethnic groups living with advanced cancer in south London: A qualitative study. Psycho-Oncology 2013;22:1096-1103.
  • Bajwah S, Ross J.R, Peacock J, Higginson I.J., Wells A.U, Patel A.S., KOFFMAN J, Riley J. Interventions to improve symptoms and quality of life of patients with fibrotic interstitial lung disease: a systematic review of the literature Thorax 2012. doi:10.1136/thoraxjnl-2012-202040.
  • Koffman J, Morgan M, Edmonds P, Speck P, Higginson I.J. ‘The greatest thing in the world is the family’: The meaning of social support among Black Caribbean and White British patients living with advanced cancer. Psycho-Oncology 2011: DOI: 10.1002/pon.1912.
  • Koffman J, Goddard C. Is the experience of cancer-related pain shaped by ethnicity or cultural background? European Journal of Palliative Care 2011:18: 130-135.
  • Koffman J, Higginson IJ, Hall S, Riley J, McCrone P, Gomes B. Bereaved relatives' views about participating in cancer research. Palliative Medicine 2011. DOI: 10.1177/0269216311405091.
  • Coleman-Brueckheimer K, Spitzer J, Koffman J. Involvement of Rabbinic and communal authorities in decision-making by haredi Jews with breast cancer: an interpretative phenomenological analysis. Social Science & Medicine 2009;68(2):323-33
  • Koffman J, Morgan M, Edmonds P, Speck P, Higginson I.J Vulnerability in palliative care research: findings from a qualitative study of Black Caribbean and White British patients with advanced cancer, Journal of Medical Ethics 2009;35;440-444.
  • Koffman J, Morgan M, Edmonds P, Speck P, Higginson I.J. Cultural meanings of pain: a qualitative study of Black Caribbean and White British patients with advanced cancer, Palliative Medicine 2008;22:349-359.
  • Koffman J, Morgan M, Edmonds P, Speck P, Higginson I.J. "I know he controls cancer" The meanings of religion among Black Caribbean and White British patients with advanced cancer, Social Science & Medicine 2008;67:780-789.
  • KOFFMAN J, Burke G. Dias A. Byrne J. Gonzales J & Daniels C. Demographic factors and awareness of palliative care and related services, Palliative Medicine 2007;21:145-153.
Teaching

MSc in Palliative Care:

  • Research Methods and Statistics (core module), Biology and Management of Symptoms (core module); Psychosocial, Cultural, Ethical and Spiritual Issues (core module); Advanced Psychosocial, Ethical and Spiritual issues(optional module); Service Organisation and Policy (core module); Service Development and Management (optional module)

MSc in Advanced Paediatrics:

  • Research Methods and Statistics

IAT PG Cert in Applied Research Methods:

  • Research Methods and Statistics
Current PHD Students
  • Dr Sabrina Bajwah (King’s College London)
  • Dr Nicolas Gough (Imperial College)
  • Dr Clare Smith (Imperial College)
Selected Grants
  • Modernisation Initiative. The AMBER Care Bundle in the hospital: does it improve the experience of patient and family care at the end of life? A pilot study. Koffman J, Carey I, Hooper A, Wei G, Hall S, Higginson I.J. £75,447 (2012-2012).
  • MS Society. Preferences for care and knowledge among people severely affected by MS and their caregivers: does ethnicity make a difference? Koffman J, Higginson I.J. Jackson D, Silber E, McCrone P, Burman R. £106,709 (2010-2012).
  • Cicely Saunders International/Samuel Sebba Trust. Samuel Sebba Scholarships for Palliative Care. Koffman J, Higginson I.J £45,000 (2010-2013).
  • King’s Fund. Evaluation of NHS Direct telephone helpline for patients with advanced disease and their families. Koffman J. Shipman C. £20,000. (2007-2008).
  • Special Trustees for St Thomas’ Hospital & Special Trustees of Guy’s Hospital, Culture, cancer and meaning: a comparative account of the effects of advanced disease in the black Caribbean and white populations in inner London. Koffman J. Higginson I.J., Morgan M, Edmonds P. 30 months, £78,300. (2001-2003).
Critical Impact

World-wide, globalization has brought with it an unprecedented increase in the numbers of persons who have migrated to developed countries. The total number of international migrants has increased over the last 10 years from an estimated 150 million in 2000 to 214 million persons today: approximately 72.1 million of these immigrants arrived in Europe, a tripling of the immigrant populations in these regions compared to twenty years earlier . This trend is expected to continue. According to the 2001 and 2011 UK Censuses, in the past 20 years the entire UK has become increasingly ethnically diverse. This was especially true in England where both the numbers and proportions of people from BAME groups (all ethnic groups other than White British) have increased; in 2011 they represented a fifth of the population. The relationship between those from BAME groups and age is important; there have been substantial increases in the number of older people from BAME groups. This being particularly marked among the Black Caribbean community of whom 10.6% are aged 65 years and over. They are now more likely to experience advanced disease which include cancer. Pain is the most common and often the most distressing symptom associated with cancer, with a prevalence of over 90% in the more advanced stages of the disease.

Meanings, which are shaped by culture, have been shown to influence attitudes and responses to symptoms which include pain. No research, however, has explored the relationship between cancer pain and culture in the UK, a greater understanding of which may lead to better assessment and management of this symptom. JK in collaboration with colleagues conducted a novel in-depth study among Black Caribbean and White British people living with and dying from cancer to explore illness and symptom attributions, and how they coped with their illness as it progressed. We identified important culturally shaped pain attributions that were specific to Black Caribbean patients; these included pain as a ‘test of faith’ which referred to confirmation and strengthening of religious belief, and pain as a ‘punishment’ that was associated with wrongdoing. These meanings, strong influenced by a deeply-embedded religious belief system [6] influenced the extent to which patients were able to accommodate their profound distress, and were also related to notions happiness, a central component of quality of life.

What difference did it make?
Definitions of palliative care refer to importance of impeccable assessment. However, health care professionals have been criticised for patronising patients by ignoring their ‘illness narratives’ or the meanings that govern how they comprehend and accommodate their illness . Our study demonstrates that the position of patient-centred narrative, which may be culturally patterned, should be elevated in the clinical encounter to arrive at a more complete picture of a clinical problem, and to assist in resolving problems of diagnosis and treatment. This is particularly true for those patients from diverse communities where responses to pain may seem inappropriate and even anti-therapeutic from what is considered typical or usual.

How can we demonstrate impact?
In 2011, this important new evidence was incorporated into the Oxford Advanced Courses in Pain and Symptom Management; the advanced course in pain and symptom management is considered to be a flagship educational event for senior medical, nursing and pharmacy staff involved in palliative and end of life care: http://www.sobell-house.org.uk/Past%20Topics.aspx

These findings were also incorporated within the training of members of the British Pain Society.

The reputation of the Cicely Saunders Institute in relation to its extensive portfolio of work on ethnicity and social diversity has led to the commissioning by Public Health England and Marie Curie to examine the demographic profile of BAME population in the UK and to appraise evidence on the current state of palliative and end-of-life care provision. This findings of this report were discussed in April 2013 by Dr Jonathan koffman and Natalia Calazani in detail at meeting of providers of palliative and end of life care, commissioners and researchers in: http://www.endoflifecare-intelligence.org.uk/events/

Most recently, (13 May 2013), Dr Jonathan Koffman debated the importance of examining culture and incorporating this into patient-centred narrative into end-of-life clinical encounters on BBC Radio 3’s ‘Nightwaves’.

International Links

Course Director: MSc, Postgraduate Diploma and Certificate in Palliative Care

Course Background: All three courses are run in collaboration with St. Christopher’s Hospice, London. They draw on the research, teaching expertise and international reputations of health and social care professionals from both institutions as well as nationally.

Since the course’s inception students have reported added value in learning alongside other professions, particularly with regard to lateral thinking, questioning preconceived ideas, and improved communication opportunities. Nearly a third of students who have successfully completed the MSc are from outside the United Kingdom. These countries include the USA, Germany, Italy, Switzerland, Taiwan, Japan, Iceland and India to mention only a few. We are convinced that the different working experiences and cultures these students bring with them enhance the educational experience of all the courses offered.

International conferences:

  • Koffman J. Higginson IJ. A systematic review of race, ethnicity and culture as variables in palliative care research 3rd European Association of Palliative Care, Aachen, Germany, April 2005Koffman J, Dias A, Raval B, Burke G, Daniels C. Factors associated with understanding palliative care and related services: results from a survey of oncology out-patients, 4th Research Forum for the European Association of Palliative Care, Venice, May 2006.
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