Researcher

Dr Magnolia Cardona-Morrell

Field of Research (FoR)

Biography

Dr Magnolia Cardona-Morrell 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-Morrell 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:

https://swscs.med.unsw.edu.au/project/validation-cristal-criteria-screening-and-triaging-appropriate-alternative-care

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.

http://newsroom.unsw.edu.au/news/health/global-analysis-finds-unnecessary-end-life-treatment-widespread

http://theconversation.com/doctors-still-provide-too-many-dying-patients-with-needless-treatment-61091

https://croakey.org/please-dont-let-this-happen-to-me-too-much-medicine-at-the-end-of-life/

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.

  https://newsroom.unsw.edu.au/news/health/day-voice-your-dying-preferences

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-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 [In Press].

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

 

BOOK CHAPTERS

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. 

END-OF-LIFE CONFERENCE PRESENTATIONS

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).

 

OTHER RESEARCH

PEER-REVIEWED ARTICLES

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.


My Grants

Agency for Clinical Innovation (Principal investigator) $85,330 for 20-17-2018 decision aid innovation for hospitals and nursing homes

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


My Awards


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:

Margaret Nicholson  (ICU Nurse Practitioner 2015)
- Vital signs monitoring and nurse-patient interaction: An observational study of hospital practice.  Published in the
International Journal of Nursing Studies, 2016.
- Vital signs - from monitoring to prevention of deterioration in general wards.  Published book chapter, Intensive Care and
Emergency Medicine textbook, 2015.
- Effectiveness of continuous or intermittent vital signs monitoring in preventing adverse events on general wards: a
systematic review and meta-analysis . Published in International Journal Of Clinical Practice, 2016.
Ong KY Jie  (Medical student 2015)
- Evidence still insufficient for advance care documentation leading to timely engagement of healthcare professionals in
end-of-life discussions: A systematic review.  Published in Palliative Medicine, 2016.
James CH Kim  (Medical Student 2015)
- Non-beneficial treatments at the end of life: A systematic Review.  Published in International Journal for Quality in Health
Care, 2016.
- What is inappropriate hospital use for elderly people near the end of life? a systematic review.  Published in the European
Journal of Internal Medicine, 2017.
Gustavo Benfatti-Olivato  (Medical Student 2015)
- Effectiveness of decision aids to assist patients and healthcare providers at the end of life. A systematic Review.  Article
Published in Patient Education and Counseling journal 2016.
Amanda Chapman  (ICU Nurse)
- Pre-existing risk factors for in-hospital death among older patients could be used to initiate end-of-life discussions rather
than Rapid Response System calls: a case-control study  Published in Resuscitation, 2016.
 - Who benefits from aggressive treatments at the end-of-life: a retrospective cohort study of rapid response call recipients
 Article submitted to Resuscitation, 2017.
Laura Hanly  (Surgical Recovery Nurse)
- Dissonance on perceptions of end-of-life needs between health service users and healthcare providers: quantitative
cross-sectional surveys.  To be submitted, 2017.
Shantiban Shanmugam  (Medical Student 2015)
- A review of patient and family perceived appropriateness of intensive care treatments at the end of life . Article submitted
to Journals of Gerontology series B: Social Sciences, 2016.
MarcellaWilliams  (Palliative Care Nurse, USA)
- Are more timely referrals to palliative care feasible? A case-control study in a magnet-status hospital  Article submitted
to International Journal Nursing Studies, 2017.
Ian Wee (Medical Student 2017, Sydney)
-Review on the influence of clinicians' values impacting on decision-making at the end of older patients' life
View less

Location

The Simpson Centre for Health Services Research (UNSW) and South Western Sydney Clinical School

Contact

+61 2 8738 9373

Research Activities