Field of Research (FoR)
Dr Magnolia Cardona has a background in Medicine from Latin America with Australian postgraduate qualifications in Public Health (MPH) and Applied Epidemiology (PhD and Grad Dipl Appl Epidemiology). She has worked with international aid agencies in Europe and Africa, at State Health Departments and Universities in Australia, and has eight years experience teaching at the Master's level. Her research interests are health services...view more
Dr Magnolia Cardona has a background in Medicine from Latin America with Australian postgraduate qualifications in Public Health (MPH) and Applied Epidemiology (PhD and Grad Dipl Appl Epidemiology). She has worked with international aid agencies in Europe and Africa, at State Health Departments and Universities in Australia, and has eight years experience teaching at the Master's level. Her research interests are health services research, health program evaluation, patient safety, end-of-life care, chronic disease prevention (diabetes, cardiovascular disease, cancer), international health, pharmacoepidemiology and evidence-based health policy.
At The Simpson Centre for Health Services Research she is currently leading a program of research to improve end-of-life care for patients, families and health professionals (https://newsroom.unsw.edu.au/news/health/sense-ending). Central to this is the development, implementation and validation of a checklist for identifying terminal patients and facilitating doctor's conversations with patients and families about end-of-life care preferences. See CriSTAL project page, available at:
Another research initiative which recently attracted international media attention was a review of unnecesary treatments in hospitals at the end of life. The global publicity indicated that these sensitive topics apply across cultures and highlighted the willingness of clinicians and service managers to address them in several health systems.
Our research program supports Dying to Know Day, a time to bring conversations on the importance of stating your last wishes before it is too late.
In consultation with doctors, nurses and health service managers she has also designed the evaluation of an initiative to provide a safer environment in acute hospitals through the introduction of continuous monitoring of vital signs among patients admitted to general wards: See the Vigilance with Vital Signs project (VVS) page. The ultimate goal is to prevent unplanned admissions to intensive care and reduce avoidable in-hospital deaths.
Publications by this person
END-OF-LIFE (EOL) RESEARCH
RECENT PEER-REVIEWED ARTICLES
Cardona M, Lewis E, Turner RM, Alkhouri H, Asha S, Mackenzie J, et al. Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments: Protocol for a multi-centre cohort study. Archives of Gerontology and Geriatrics, 2018; 76:169-174.
Cardona-Morrell M, Lewis E, Suman S, Haywood C, Williams M, Brousseau AB, Greenaway S, Hillman K, Dent E. Narrative review. Recognising older frail patients near the end of life: What next? European Journal of Internal Medicine 2017:;45:84-90.
Williams M, Cardona-Morrell M, Stevens P, Bey J, Glasgow ME. Timing of palliative care team referrals for inpatients receiving rapid response services: A retrospective pilot study in a US hospital. International Jnl Nursing Studies 2017; 71:147-153. http://www.sciencedirect.com/science/article/pii/S0020748917301694?via%3Dihub
Lewis E, Kristensen M, O'Sullivan M, Eakman A, Skjot-Arkil H, Nygaard H, Cardona-Morrell M. Challenges of measuring frailty in emergency departments and proposed solutions. Innovations in Aging, 2017; 1 (Suppl_1):383. https://academic.oup.com/innovateage/article/1/suppl_1/383/3898231
Cardona-Morrell M, Kim JCH, Turner RM, Brabrand M, Gallego-Luxan B, Hillman K. What is inappropriate hospital use near the end of life? A systematic review. European Journal of Internal Medicine, 2017. S0953-6205(17)30162-0. https://www.ncbi.nlm.nih.gov/pubmed/28502866
Cardona-Morrell M, Kim JCH, Anstey M, Mitchell I, Hillman K. Non- beneficial treatments in hospital at the end of life – A systematic review on extent of the problem. International Journal for Quality in Helathcare, 2016 http://intqhc.oxfordjournals.org/content/early/2016/06/16/intqhc.mzw060
Hillman KM, Cardona-Morrell M. The ten barriers to appropriate management of patients at the end of their life. Intensive Care Med. 2015;41(9):1700-2
Cardona-Morrell M and Hillman K. Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL). BMJ Support Palliat Care 2015;5:78-90. http://spcare.bmj.com/content/5/1/78.full.pdf+html
Lewis E, Cardona-Morrell M, Ong KY, Trankle S, Hillman K. Evidence still insufficient for advance care documentation leading to timely engagement of healthcare professionals in end-of-life discussions: A systematic review. Palliative Medicine, 2016 http://pmj.sagepub.com/content/early/2016/03/07/0269216316637239.abstract
Cardona-Morrell M, Benfatti-Olivato G, Jansen J, Turner RM, Fajardo-Pulido D, Hillman K. A systematic review of effectiveness of decision aids to assist patients and healthcare providers at the end of life. Patient Education and Counseling, 2016 http://www.sciencedirect.com/science/article/pii/S0738399116304578
Cardona-Morrell M, Chapman A, Turner R, Lewis E, Gallego-Luxan B, Parr M, Hillman K. Pre-existing risk factors for in-hospital death among patients requiring a Rapid Response System call: a case-control study. Resuscitation, 2016. http://www.resuscitationjournal.com/article/S0300-9572(16)30502-0/abstract
Dent E, Hoogendijk E, Cardona-Morrell M, Hillman K. Frailty in Emergency Departments. The Lancet, 2016;387(10017), 434.
Cardona-Morrell M, Prgomet M, Turner RM, Nicholson M, Hillman K. Effectiveness of continuous or intermittent vital signs monitoring in preventing adverse events on general wards: A systematic review and meta-analysis. International Journal of Clinical Practice, 2016 http://onlinelibrary.wiley.com/doi/10.1111/ijcp.12846/abstract
Prgomet M, Cardona-Morrell M, Nicholson M, Lake R, LongJ, Westbrook J, Braithwaite J, Hillman K. Vital signs monitoring on general wards: clinical staff perceptions of current practices and the planned introduction of continuous monitoring technology. International Journal for Quality in Helathcare, 2016. http://intqhc.oxfordjournals.org/content/early/2016/06/17/intqhc.mzw062
Cardona-Morrell M, Prgomet M, Lake R, Nicholson M, Long J, Harrison R, Westbrook J, Braithwaite J, Hillman K. Vital signs monitoring and nurse-patient interaction: An observational study of hospital practice. International Journal of Nursing Studies, Dec 2015.DOI: http://dx.doi.org/10.1016/j.ijnurstu.2015.12.007
Cardona-Morrell M, Nicholson M, Hillman K. Vital Signs: From Monitoring to Prevention of Deterioration in General Wards. In: Annual Update in Intensive Care and Emergency Medicine 2015 Volume 2015, pp 533-545. http://link.springer.com/chapter/10.1007%2F978-3-319-13761-2_39
Cardona-Morrell M and Hillman K. Dying Safely. Chapter 27 In: Textbook of Rapid Response Systems. Concept and Implementation. DeVita, Michael A., Hillman, Ken, Bellomo, Rinaldo (Eds.) 3rd Edition, 2017. p288-299.
Cardona-Morrell M, Zimlichman E, Taenzer A. Continuous monitoring for early detection of deterioration on general care units. Chapter 26 In: Textbook of Rapid Response Systems. Concept and Implementation. DeVita, Michael A., Hillman, Ken, Bellomo, Rinaldo (Eds.) 3rd Edition, 2017, pp. 277-287.
Recently submitted articles under review
4. Cardona M, Lewis E, Alkhouri H, Williamson M, Hillman K. Who benefits from aggressive Rapid Response System treatments near the end of life? A retrospective cohort study.
Journal: The Joint Commission Journal on Quality and Patient Safety, 2018. [Under review].
3. Cardona M, Shanmugam S, Psirides A, Anstey M, Hillman K. A review of patient and family perspectives on inappropriateness of intensive care treatments at the end of life. BMJ Medical Ethics, 2018 [Under review]
2. Cardona M, Williamson M, Elliott J, Aichinger R, Ferguson R, Stokes N, Emery J, Gunn J. Results form the Australian Prescribing Data in General Practice Demonstration Project: A cluster randomized controlled trial. British Journal of General Practice, 2018 [Under Review]
1. Cardona-Morrell M, Lewis E, Kristensen MR, Skjøt-Arkil H, Ekmann A, Nygaard H, et al. Efficacy of the CriSTAL tool for prediction of short-term mortality in elderly people presenting at Emergency Departments in Denmark and Australia: a prospective validation study. Annals of Emergency Medicine, 2018. [Under review]
END-OF-LIFE CONFERENCE PRESENTATIONS
Cardona-Morrell M and McCarthy S. End of life in the emergency department. Identifying the best way forward. Workshop session in Sydney: Australasian College of Emergency Medicine Annual Scientific meeting., November 2017.
Cardona-Morrell M, Kim J, Lewis E, Turner R, Alkhouri H, McCarthy S, Williamson M, Greenaway S, Hillman K. Clinical futility at the end of life: how significant is the problem, who drives it and how to minimise it? Adelaide: Australian Palliative Care Conference, September 2017.
Cardona-Morrell M, Yap S-J, Lewis E, & Hillman K. Choosing your surgical candidates wisely. Sydney: Vascular Focus Conference, June 2017.
Cardona-Morrell M, Lewis E, Alkhouri H, Turner RM, Nicholson M, Middleton P, Nagaraj G, Wiltshire J, and Hillman K. The Goals of Care: a new model of service for the dying older patient presenting at emergency services. Sydney: Ingham Institute for Applied Medical Research Showcase, June 2017.
Cardona-Morrell M, Lewis E, Hillman. Early identification and decision-making of frail elderly at the end of life: What next? Crawley, UK: Kent Surrey Sussex Academic Health Network Roadshow, 24 January 2017.
Cardona-Morrell M, Lewis E, Alkhouri H, Turner R, McCarthy S, and Hillman K. The challenges of translational end-of-life research in the ED and beyond. Australasian College of Emergency Medicine. Queenstown, New Zealand: Annual Scientific Meeting, December 2016.
Cardona-Morrell M, Lewis E, Hillman K. Practicalities of measuring frailty in emergency departments. Annual Aged Care and Rehabilitation Conference, Liverpool Hospital, Sydney, 13 December, 2016.
Cardona-Morrell M, Lewis E, Nicholson M, Hanly L, Chapman A, Kim J, Trankle S, Turner R, Ong K, Shanmugan S, Alkhouri H, Asha S, Perkins M, Holdgate A, Suri S,Winoto L, Harrison R, Benfatti-Olivato G, Zammit A, and Hillman K. Challenges of research on sensitive topics: the end-of-life experience. Sydney: Ingham Institute for Applied Medical Research Showcase, November 2016.
Cardona-Morrell M, Lewis E, Hillman K. Identifying and managing the frail elderly to prevent non-beneficial hospital treatments. Sydney Institute of Palliative Medicine Annual Symposium . Invited oral presentation, Sydney, 23rd September 2016.
Cardona-Morrell M, Lewis E, Hillman K. Non-beneficial treatments at the end of life: extent, causes, potential solutions and future research. Emergency Care Institute Leadership Forum. Invited oral presentation, Sydney, 5th August 2016.
Cardona-Morrell M, Lewis E, Hillman K, et al. Improving the end-of-life experience: from identification to response. International Rapid Response Systems Conference. Oral presentation, Melbourne, 2nd May 2016
Cardona-Morrell M. Clinical Staff and Public acceptability of a tool to estimate risk of death. National Health Roundtable on End-of-Life Improvement. Invited oral presentation, Sydney, 6th April, 2016.
Cardona-Morrell M. Towards a National Consensus Statement on best practice for patient safety at the end of life. National Health Roundtable on End-of-Life Improvement. Invited oral presentation, Sydney, Australia. 6th April 2016
Cardona-Morrell M, Lewis E, Nicholson M, Alkhouri H, McCarthy S, Hanly L, Samperi S, Ashton A, Shantiban S, Trankle S, Hillman K. Recruiting the hard-to-reach groups for research in real-life settings: The CriSTAL Program. Emergency Care Institute Annual Symposium. Poster, Sydney, Nov 2015
Cardona-Morrell M, Lewis E, Nicholson M, Shanmugam S, Hanly L, Hillman K. Public and clinician’s readiness to discuss end of life: moving from knowledge to action. Ingham Institute Research Showcase. Oral presentation, Sydney, Nov 2015
Cardona-Morrell M, Turner R, Chapman A, Werner M, Parr M, Hillman K. Futility at the end-of-life: where do we draw the line for hospital admissions and RRS attendances? Oral presentation for the ANZICS conference. Gold Coast (QLD) 2015.
Cardona-Morrell M and Hillman K. Enhancing prognostic certainty to improve the EOL experience for patients, families and healthcare providers. Oral presentation for the National End-of-Life Improvement Group Health Round Table. Brisbane (QLD) 2015
Cardona-Morrell M, Chapman A, Werner M, Turner R, Lewis E, Parr M, Hillman K. Retrospective Validation of the CriSTAL checklist to predict in-hospital death for patients requiring a Rapid Response call. Oral poster for the International Rapid Response Systems Conference. Amsterdam (NL) 2015
Cardona-Morrell M and Nicholson M. Continuous monitoring of vital signs for earlier detection and management: Pre-implementation issues of the Vigilance with Vital Signs. Deteriorating Patient Conference, Melbourne, (VIC), 2014
Cardona-Morrell M and Hillman K. Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL) . Rapid Response Systems Conference, Miami, USA, 2014.
RESEARCH COVERED IN THE MEDIA
Clinical Futility - September 2017
Too much medicine at the end of life: https://croakey.org/please-dont-let-this-happen-to-me-too-much-medicine-at-the-end-of-life/
Advance Care planning - May 2017
Impact of ACP on clinician's conversations with patients: https://eapcnet.wordpress.com/2017/08/23/palliative-medicine-paper-of-the-year-award-helping-clinicians-engage-in-end-of-life-discussions-with-older-dying-patients/
UK Tour encouraging end-of-life care discussions - January 2017
Kent-Surrey-Sussex Academic Health Science Network (page 8): http://www.kssahsn.net/what-we-do/publications-and-resources/innovate/Documents/Innovate%20issue%209_WEB_Spreads%20-%20final.pdf
Non-beneficial treatments at the end of life - June 2016
Studio appearance on Australian Broadcasting Corporation (ABC) television (Morning News); interviews for ABC Radio National, Perth, Newcastle, Sydney, Adelaide, Cairns Post; SBS.com, Skynews, interviews for print media including The Australian, Sydney Morning Herald, The QLD Courier, The Leader at Sutherland Shire, Byron Bay Echonet Daily, Medical Observer, Australian Doctor, The Conversation; extensive international print media coverage reporting by the London Telegraph, The Independent, UK Mirror, Daily Mail, extensive web-based by Science Daily (US), AgedCare Insite, Econo-Times, UK HomeCare.co, New Zealand’s Listener magazine, inews.co.UK, US CoxHealth Daily, US HealthBanks Houston, US AHMC, WebMD, China News, China.org, Medline Plus, consumer.healthday.com, newsy-today.com, eurekalert.org, 6minutes.com.au, Africa’s Medical Digest (Medical Brief).
CriSTAL clinical prediction tool - January 2015
Studio appearance on Australian Broadcasting Corporation (ABC) television (News at Midday); interviews for ABC Radio and Radio New Zealand; interviews for print media including The Guardian Australia, Sydney Morning Herald, Medical Observer, Australian Doctor; extensive international print media coverage reporting research into developing instrument to identify dying elderly patients in hospital (CriSTAL), including by the London Telegraph, The Independent, Daily Mail, Florida News Times; extensive web-based reportage of the CriSTAL project, including by Science Daily (US), MedScape (Australia), Biothethics Research Library (Georgetown University), Huffington Post (US), Newser (US), SeniorAU (Senior Australian News and Research), Medical Futility Blog (Australia), Pulse+IT (Australasia’s eHealth IT Magazine), HNGN (Headlines and Global News, US), MedicalXpress (US), IBTimes (UK), My Informs (UK), UK Today 24 hours, UK News Real Time, EurekaAlert! Science News (American Association for the Advancement of Science), Health Canal News (US).
Vita P, Cardona-Morrell M, Bauman A, et al. Type 2 diabetes prevention in the community: 12-month outcomes from the Sydney Diabetes Prevention Program. Diabetes Research and CLinical Practice. 2015. http://www.diabetesresearchclinicalpractice.com/article/S0168-8227%2815%2900470-2/abstract
Hieu T Trinh, Phuong H. Hoang, Cardona-Morrell M, et al. Antibiotic therapy for inpatients with community acquired pneumonia in a developing country. Pharmacoepidemiol Drug Saf. 2015.Feb 19;24(2):129-36
O’Hara N, Bauman A, Eakin E, King L, Haas M, Allman-Farinelli M, Owen N, Cardona-Morrell M, Farrell L, Milat A, and Phongsavan P. Evaluation framework for translational research: Case study of Australia’s Get Healthy Information and Coaching Service. Health Promotion Practice 2013;14 (3): 380-389. http://hpp.sagepub.com/content/14/3/380.abstract
Williamson M, Cardona-Morrell M, Elliott J, Reeve J, Stocks N, Emery J, Mackson J, and Gunn J. Prescribing Data in General Practice Demonstration (PDGPD) Project - A cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension. BMC Health Services Research 2012;12:273. http://www.biomedcentral.com/1472-6963/12/273
Cardona-Morrell M, Rychetnik L, Morrell SL, Espinel PT, and Bauman A. Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis. BMC Public Health 2010;10:653. http://www.biomedcentral.com/1471-2458/10/653
Colagiuri S, Vita P, Cardona-Morrell M, Singh MF, Farrell L, Milat A, Haas M, and Bauman A. The Sydney Diabetes Prevention Program: a community-based translational study. BMC Public Health 2010;10:328. http://www.biomedcentral.com/1471-2458/10/328
Cardona M, Joshi R, Ivers RQ, Iyengar S, Chow CK, Colman S, Ramakrishna G, Dandona R, Stevenson MR, and Neal BC. The burden of fatal and non-fatal injury in rural India. Inj Prev 2008;14:232–237. http://www.ncbi.nlm.nih.gov/pubmed/18676781
Cardona M, Joshi R, and on behalf of the roundtable participants at the 36th Conference of the Asia-Pacific Academic Consortium of Public Health. The challenges of research in low-income settings. Critical Public Health 2007;17:81–89. http://www.ingentaconnect.com/content/routledg/ccph/2007/00000017/00000001/art00008
Chow C, Cardona M, Raju PK, Iyengar S, Sukumar A, Raju R, Colman S, Madhav P, Raju R, Reddy KS, Celermajer D, and Neal B. Cardiovascular disease and risk factors among 345 adults in rural India–the Andhra Pradesh Rural Health Initiative. Int J Cardiol 2007;116:180–185. http://www.sciencedirect.com/science/article/pii/S0167527306004438
Chow C, Raju P, Raju R, Reddy K, Cardona M, Celermajer D, and Neal B. The prevalence and management of diabetes in rural India. Diabetes Care 2006;29:1717–1718. http://care.diabetesjournals.org/content/29/7/1717.1.full
Joshi R, Cardona M, Iyengar S, Sukumar A, Raju CR, Raju KR, Raju K, Reddy KS, Lopez A, and Neal B. Chronic diseases now a leading cause of death in rural India–mortality data from the Andhra Pradesh Rural Health Initiative. Int J Epidemiol 2006;35:1522–1529. http://ije.oxfordjournals.org/content/35/6/1522.long
OTHER CONFERENCE PAPERS
Cardona-Morrell M, Williamson M, and Elliott Jet al. Impact evaluation of a prescribing improvement intervention for cardiovascular disease management in Australian general practice (2009-11). RACGP Annual Conference (GP12), Gold Coast (Queensland), 2012.
Cardona-Morrell M,Williamson M, Klein L, and Gillies M. GP adherence to practice guidelines for Type 2 diabetes first-line therapy. National Medicines Symposium, Sydney, 2012.
Cardona-Morrell M, Williamson M, and Elliott J. Impact evaluation of a prescribing improvement intervention for cardiovascular disease management in Australian general practice (preliminary results). European Drug Utilisation Research Group meeting. Antwerp, Belgium, 2011.
Cardona-Morrell M, Williamson M, Klein L, and Gillies M. Using PBS data to evaluate GP adherence to practice guidelines for first-line management of diabetes over 5 years. Primary Healthcare Research Conference, Brisbane, 2011.
Cardona-Morrell M, Fiatarone-Singh M, Bauman A, Vita P, Farrell L, MiIlat A, and Colagiuri S. Who attends diabetes prevention programs? Experience from the Sydney DPP. Diabetes Epidemiology Group meeting, Dresden, Germany, 2010.
Cardona-Morrell M and Morrell S. Prevalence and risk factors for type 2 diabetes in migrants from non-English speaking backgrounds participating in The 45&Up Cohort Study. Diabetes Epidemiology Group meeting, Dresden, Germany, 2010.
Agency for Clinical Innovation (Principal investigator) $85,330 for 2017-2018 project decision aid innovation for hospitals and nursing homes
HCF Foundation (Principal investigator) $82,000 for 2018 project Optimising advance care planning in general practice
UNSW Research Infrastructure Scheme (Associate investigator) $357,000 for 2018-2019 initiatives on mobile health applications led by Graduate School of Biomedical Engineering
HCF Foundation (Associate investigator) $150,000 for 2017-2018 to develop and evaluate a new model of service for frail elderly patients in the emergency department
- Nominated for UNSW Vice-Chancellor and President’s Award (November 2017)
- Finalist, NSW Health Statewide Awards for Innovation in Research, CriSTAL clinical prediction tool to encourage advance care planning. New South Wales Health Ministry (October 2017)
- Winner. Quality Award for Patient Safety, September 2017. South Western Sydney Local Health District for program of work on Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL).
- Paper of the Year Award, By Palliative Medicine. Madrid, May 2017. https://eapcnet.wordpress.com/2017/08/23/palliative-medicine-paper-of-the-year-award-helping-clinicians-engage-in-end-of-life-discussions-with-older-dying-patients/
- Finalist, Annual Hub Prize, 2016. South West Sydney Research consortium A program of research to investigate patient priorities and improve the end of life experience for frail elderly people in and out of hospitals.
- Winner. Best poster on Communications: Missed Opportunities to identify the dying patient. European Association of Palliative Care Congress, Madrid, Spain, 2017
- Winner. Best Conference oral poster: Development of the CriSTAL tool -International Rapid Response Systems Conference, Miami, USA, 2014
My Research Supervision
Areas of supervision
End-of-life improvement in hospitals, nursing homes or general practice; Geriatric Medicine translational projects
==>Sample candidates projects supervised to completion/publication:
Diagnosing dying is relatively straightforward when symptoms are evident within the last few days or hours of death. Diagnosing the dying several months or weeks before the final event is more complex and doctors generally feel uncertain about prognosis. Failure to recognise chronically ill elderly patients who are naturally and normally dying delays appropriate decision-making on limitations of treatment, and the planning of comfort care. This leads to intensive treatments to prolong life and even to resuscitation attempts, which can cause more harm than good.…
This online survey of nurses and doctors dealing with elderley people approaching the end of their lives has the following objectives:
• To assess the level of exposure to and confidence in initiating end-of-life conversations
• To identify barriers for initiating the sensitive end-of-life conversation
• To identify factors influencing the level of confidence in facing end-of-life discussions
• To propose strategies for addressing these barriers in line with the training needs and wants of the target group
The survey is a unique opportunity for…
SURVEY OF OLDER PEOPLE ON END-OF-LIFE PERCEPTIONS AND PREFERENCES
The Public consultation with older consumers commenced in 2015 with a survey of members of the public aged 60 years and over, to understand their perceptions of end-of-life, care preferences, preferred place of death and attitides towards doctors predicting risk of death.
The goal was to identify current perceptions and potential points for interventions.
a) To characterise public perception of…
The Vigilance with Vital Signs initiative aimed to establish a system for early identification of deteriorating patients through the continuous use of a portable electronic monitor of vital signs to prevent unexpected serious events and trigger a response that can enhance clinician’s decision-making. The project is conducted in two general wards of a NSW teaching hospital.
The device was to be gradually introduced and progressively evaluated in four phases:
- The first phase aims to assess the acceptance and…