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Academic

Dr Fliss E M Murtagh

Reader and Consultant in Palliative Medicine

Dr Fliss MurtaghPhone: 0207 848 5587
Fax: 0207 848 5517
Email: fliss.murtagh@kcl.ac.uk
Researcher ID: http://www.researcherid.com/rid/C-3216-2009


Research

Palliative care; end of life care; end stage kidney disease; renal palliative care; non-cancer palliative care; complexity and casemix; costs and cost-effectiveness of palliative and end of life care: research ethics, outcome measures and tool validation.

Biography

Fliss qualified in medicine in the UK in 1986. She initially trained in General Practice, and worked as a General Practitioner from 1992 – 2000, then undertook specialist training in palliative medicine between 2000 and 2004. She went on to undertake a PhD at King’s College London, on ‘Improving the quality of care of patients with Stage 5 Chronic Kidney Disease’ in the Department of Palliative Care, Policy & Rehabilitation at King’s College London. She then gained a HEFCE Clinical Senior Lectureship – one of the first nationally in Palliative Care. She is based at King’s College London and King’s College Hospital. Fliss has recently been named a Fellow of the Royal College of Physicians in London and she recieved the academic title of Reader in Palliative Care in September 2014.

She has published on the palliative and end-of-life care needs of renal patients, including on symptoms, withdrawal from dialysis, survival, and use of opioids. Fliss has a keen interest in longitudinal study, including methodological development, and symptom and functional trajectories in the last year of life. She led analytical modelling work commissioned for the Palliative Care Funding Review, and is currently working on evaluating complexity in palliative care, and mapping needs, service provision, and outcomes. She is co-leading a 5 year national research project (the NIHR-funded C-CHANGE project) to take forward recommendations from the Funding Review, and in particular, to validate a casemix classification for palliative care, and test the effectiveness and cost-effectiveness of different models of palliative care.

Key Leadership Roles
  • Lead for the NIHR funded Programme Grant for Applied Research (the C-CHANGE project)
  • MSc in Palliative Care - Internal Examiner and module coordinator (Core and Advanced Symptom management modules)Postgraduate PhD Research Coordinator for Palliative CareTreasurer and Academic Board liaison for the Palliative Care Section Council of the Royal Society of MedicineChair of Integration and Coordination Committee for the Cicely Saunders Institute
  • Postgraduate PhD Research Coordinator for Palliative Care
  • Treasurer and Academic Board liaison for the Palliative Care Section Council of the Royal Society of Medicine
  • Chair of Integration and Coordination Committee for the Cicely Saunders Institute
Selected Publications
  • Murtagh FEM, Bausewein C, Verne J, Groeneveld EI, Kaloki Y, Higginson IJ. "How many people need palliative care? A study developing and comparing methods for population-based estimates." Palliative Medicine, 2013 May 21. [Epub ahead of print]. PMID: 23695827
  • Murtagh FEM, Groeneveld EI, Kaloki Y, Calanzani N, Bausewein C, Higginson IJ. Capturing activity, costs and outcomes: The challenges to be overcome for successful economic evaluation in palliative care. Progress in Palliative Care. 2013. http://dx.doi.org/10.1179/1743291X12Y.0000000046
  • Murtagh FEM, Sheerin N, Addington-Hall J, Higginson IJ. Trajectories of illness in Stage 5 Chronic Kidney Disease: a longitudinal study of patients’ symptoms and concerns in the last year of life. Clinical Journal of the American Society of Nephrology, 2011, Jun 16.(1) Epress advance publication.
  • Murtagh FEM, Addington-Hall JM, Higginson IJ. End-stage renal disease: a new trajectory of functional decline in the last year of life. Journal of the American Geriatrics Society, 2011; 59:304-8.
  • Murtagh FEM, Addington-Hall J, Edmonds PM, Donohoe P, Carey I, Jenkins KJ, Higginson IJ. Symptoms in the month before death for Stage 5 Chronic Kidney Disease patients managed without dialysis. Journal of Pain and Symptom Management 2010 doi:10.1016/j.jpainsymman.2010.01.021
  • Murtagh, F. E. M., Marsh, J. E., Donohoe, P., Ekbal, N. J., Harris, F. E. & Sheerin, N. S. Dialysis or not? A comparative survival study of patients over 75 years of age with chronic kidney disease stage. Nephrology, Dialysis, Transplantation May 2008. 23, 5, p. 1769 – 1769.
  • Murtagh, F. E. M., Addington-Hall, J. & Higginson, I. J. The prevalence of symptoms in end-stage renal disease: A systematic review. Advances in Chronic Kidney Disease Jan-2007.14, 1, p. 82 – 99.
Teaching
  • PhD supervision at King’s College London – since Oct 2009.
  • Undergraduate medical student teaching.
  • MSc Palliative Care at King’s College London – module lead for 2 week symptom modules x 2 (2009-current), personal tutor (2004-present), supervisor for research projects (2005-present), and Internal Examiner (2006-present). Didactic and group-led teaching for taught components (subjects including Communication, Complexity and Costs, Research Ethics, Clinical Ethics, Renal Palliative Care, Evidence-Based Medicine, Clinical Pathways, Developing Guidelines).
  • MSc Palliative Care at University of Kent in Canterbury – External Examiner (2012-present), External Reviewer (2006-present).
  • Teaching in the nephrology field – teaching and presentations on Renal Palliative Care and related topics for renal specialist nurses, nephrology specialist registrars, nephrology multi-disciplinary teams, and nephrologists (2006 – current). Co-leader of the two day Renal Supportive Care course (the only national training course on renal palliative care in the UK) (2010, 2011, 2012, 2013).
Current PHD Students Selected Grants
  • NIHR Programme Grant. C-CHANGE: Delivering quality and cost-effective care across the range of complexity for those with advanced conditions in the last year of life. Murtagh, Higginson, Turner-Stokes, Bausewein, McCrone, Gao, Eagar et al. £1,968,973. (2013-18)
  • Guys & St Thomas Charity. OACC – Outcomes, Assessment and Complexity Collaborative. Higginson, Murtagh, Daveson. £467,010. (2013-15)
  • Department of Health, Palliative Care Funding Review. Analytical modelling work – developing casemix and modelling resource use in palliative care. Murtagh, Bausewein, Verne, Lacey, McCrone, Turner-Stokes and Higginson. £123,976. (2011)
  • Department of Health, NHS Kidney Care. The ARC project across King’s Health Partners. A national test site to develop services for patients with advanced kidney disease approaching last year of life. Murtagh et al. £159,935 (2010-11)
  • NIHR Service Development and Organisation Programme grant: Understanding place of death for patients with non malignant conditions – a systematic literature review. Murtagh, Higginson, Bausewein, Gysels, Banerjee, Murray, Johnson, Shipman and Gomes. £123,733 (2009-2010)
Critical Impact

Major contribution to the Palliative Care Funding Review (2011), and currently member of the working group for the Palliative Care Funding Pilots (2012-14).

The Advanced Renal Care Project saw the creation of a supportive and palliative register for those approaching the last months of life, a training programme for renal staff, and a toolkit of symptom guidelines, detailed end of life care plans and model advance care plans. Recommendations from this project have been adopted nationally (NHS Kidney Care. Getting it right: End of life care in advanced kidney disease. London, UK: Department of Health, 2012), were launched at a national conference at the King’s Fund in July 2012, and have positively improved clinical practice.

The renal version of the Palliative Care outcome Scale (POS-s renal) which we had previously developed (Murphy EL, Murtagh FE, et al. Understanding symptoms in patients with advanced chronic kidney disease managed without dialysis: use of a short patient-completed assessment tool. Nephron Clin Pract. 2009;111(1):c74-80), has been used to help identify patients with advanced kidney disease needing palliative care intervention, has been adopted into routine practice at King’s and Guy’s renal unit for the dialysis population, and is being used by a variety of renal units, both in England and abroad.

International Links
  • Renal palliative care links to USA, Australia, Europe (and Workgroup leader for KDIGO Consensus on Renal Supportive Care conference in Dec 2013)
  • IPOS validation work in conjunction with Professor Bausewein, University of Munich, Germany.

Renal palliative care

Fliss co-organises the annual two-day international conference on Supportive Care for the Renal Patient. This highly-regarded renal palliative care course uses a mixture of lectures and small group case discussions to explore palliative and end of life care for patients with renal disease. It is multi-professional, is held annually, and promotes:

 i) better communication between patients, families, and professionals

 ii) improved management for renal patients with end stage disease approaching end of life

ii) wider dissemination of emerging research evidence

Numbers are limited, so please apply early (next available Sept 2015, see https://www.regonline.co.uk for booking).

Complexity, Case-mix, and Outcomes:

Fliss has presented in diverse national and international conferences on complexity, case-mix and outcomes. Forthcoming presentations are at:

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