Dr Charles Douglas
Honorary Senior Lecturer
School of Medicine and Public Health (Clinical Ethics and Health Law)
- Email:charles.douglas@newcastle.edu.au
- Phone:0400 390 748
Career Summary
Biography
Dr. Charles Douglas is a cancer surgeon and an academic in the fields of medicine, medical law, ethics and philosophy.
Dr. Douglas originally studied mathematics and physics at the University of Adelaide, and worked as a high school physics teacher, before commencing medical training at the University of Newcastle in 1985. He completed the Bachelor of Medical Science in transplantation immunology with first class honours in 1988 and the Bachelor of Medicine with honours in 1990.
Dr. Douglas then undertook post-graduate training in general surgery, taking a break from this in 1999 to do a year of research in ethics (relating to surgery). Soon after completion of his surgical training, an opportunity arose to take an academic position at the University of Newcastle as a Lecturer in Clinical Ethics and Health Law. He has continued in this role while developing his surgical expertise in the areas of breast cancer and melanoma surgery. He now works as a consultant surgeon at the Breast Centre, Gateshead, and at the Newcastle Melanoma Unit, and as a VMO surgeon at the Calvary Mater and Lake Macquarie Private Hospitals. In 2008 he was promoted to Senior Lecturer at the University of Newcastle and from 2010-2015 he was the Director of the Newcastle Melanoma Unit.
In 2017 Dr. Douglas commenced a law degree (Juris Doctor, University of Newcastle). He completed this in 2021 and was awarded the College Medal (College of Human and Social Futures), awarded to a graduate who displays outstanding ability.
In 2023 Dr. Douglas is working full time as surgeon, exploring his future career opportunities in law and academia.
Research
Dr. Douglas has a wide range of research interests in ethics, clinical decision making, basic science and surgery and he has published more than 30 peer-reviewed papers in these fields. He was awarded his PhD (on medical law and end-of-life decision making) in 2012. He was holder of a Royal Australasian College of Surgeons Research Scholarship in 1999 and a Fellowship of the Federation of European Cancer Societies in 2003. He was the winner of the inaugural General Surgeons Australia Best Paper Prize for his work on the ultrasound diagnosis of appendicitis and the winner of the Sir Edward Hughes Memorial Research Prize for the same project (in 1999). He was shortlisted again for the Sir Edward Hughes Memorial Research Prize for his work on surgeons attitudes to euthanasia (2000). He is the winner of the Ethel and Olive Hewitt Medical Research Scholarship in 2001. He won two ECR grants relating to his work on interviews with palliative care physicians regarding the use of palliative sedation at the end of life in 2007 and 2009. His more recent research interests have been on various aspects of informed consent.
Former Teaching and Administrative Roles
Until his retirement in 2020 Dr. Douglas was the Discipline Lead for Ethics and Health Law and the theme lead for Professional Development in the new MD curriculum of the Joint Medical Program at the University of Newcastle / University of New England. He carried a substantial face to face teaching load in clinical ethics and health law across the program. He was also the Program Convenor for the outgoing Bachelor of Medicine program of the Joint Medical Program from 2019-2020 and was intimately involved in remodelling the curriculum during the COVID-19 crisis of 2020. He was the Student Academic Conduct Officer of the School of Medicine and Public Health. Dr. Douglas served on a number of University committees and also sat on the Clinical Advisory Panel of the Calvary Mater Hospital Newcastle during the early phases of the COVID-19 crisis.
Qualifications
- Bachelor of Medicine (Honours), University of Newcastle
- Bachelor of Science, University of Adelaide
- Bachelor of Medical Science (Honours), University of Newcastle
Keywords
- Breast cancer
- Breast surgery
- Clinical decision making
- Clinical ethics
- End-of-life decision-making
- Ethics
- Health Law
- Informed consent
- Moral philosophy
- Oncology
- Surgery
Professional Experience
Academic appointment
Dates | Title | Organisation / Department |
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Fellow - Royal Australasian College of Surgeons | Royal Australasian College of Surgeons (RACS) Australia |
Professional appointment
Dates | Title | Organisation / Department |
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1/8/2006 - | Visiting Medical Officer | Newcastle Mater Hospital Surgery Australia |
Awards
Research Award
Year | Award |
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1999 |
Sir Edwin Hughes Memorial Research Prize Royal Australasian College of Surgeons |
Publications
For publications that are currently unpublished or in-press, details are shown in italics.
Journal article (39 outputs)
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2021 |
Shepherd J, Waller A, Sanson-Fisher R, Zdenkowski N, Douglas C, Clark K, 'Oncology patients' and oncology nurses' views on palliative chemotherapy: A cross-sectional comparison', COLLEGIAN, 28 521-527 (2021) [C1]
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2020 |
Younger CWE, Douglas C, Warren-Forward H, 'Informed consent guidelines for ionising radiation examinations: A Delphi study', Radiography, 26 63-70 (2020) [C1] Introduction: Informed consent for ionising radiation medical imaging examinations is currently undertaken inconsistently in Australian radiographic practice. There is no uniform ... [more] Introduction: Informed consent for ionising radiation medical imaging examinations is currently undertaken inconsistently in Australian radiographic practice. There is no uniform informed consent process, and opinions vary about how it should be undertaken, and by whom, if indeed it needs to be undertaken at all. To ensure that patients¿ rights are maintained, the informed consent process must be consistent, proactive in the provision of information, and must empower the patient to formulate and ask questions about their care, and to make voluntary decisions. Methods: The Delphi technique utilises a group of experts whose individual responses are used to create a collective consensus on a process. This ten-expert (five radiographer, five radiologist) Delphi study examined a basic modelling of the process of informed consent for ionising radiation medical imaging examinations and made recommendations for an ideal process. Results: A series of consensus statements were developed, seeking to rectify areas of the process that were inconsistent, unclear, or ethically unsound. These statements were then considered alongside current codes of professional practice, and Australian law on the duty of disclosure. A model of the ideal process was then developed using these consensus statements and adhering to codes of practice. Conclusion: The final process model has a continuity of care and a continuity of information provision. The model eliminates the radiographer as a delegatee, and emphasises physician involvement. The referrer and the radiologist have a shared responsibility of providing risk disclosure information. Implications for Practice: For a non-pregnant adult, the ionising radiation dose from conventional radiography is considered insignificant, and does not require risk disclosure, ameliorating the time commitment needed for the process.
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2019 |
Mackenzie J, Douglas C, 'Gynecomastia or rare malignancy? A young man with an unremarkable history proves to have adenoid cystic carcinoma of the breast', BREAST JOURNAL, 26 502-504 (2019)
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2019 |
Younger CWE, Wagner MJ, Douglas C, Warren-Forward H, 'Describing ionising radiation risk in the clinical setting: A systematic review', Radiography, 25 83-90 (2019) [C1] Introduction: Meaningfully explaining the risk of an ionising radiation examination is a challenging undertaking. Patients must contextualise the risk against the expected benefit... [more] Introduction: Meaningfully explaining the risk of an ionising radiation examination is a challenging undertaking. Patients must contextualise the risk against the expected benefit of the imaging examination, often in a situation of heightened emotion. This systematic review seeks to explore the literature to identify what techniques are advocated for disclosing the risk to patients of ionising radiation from clinical medical imaging examinations. Methods: A systematic review of peer-reviewed literature was undertaken. Electronic databases were searched to identify peer-reviewed, full-text articles published in English from 1990. Original articles discussing techniques for disclosing ionising radiation risks in the clinical setting were included. The reference lists of the included articles were searched for unpublished articles and reports of use. Results: Sixteen papers out of 5959 unique titles met the inclusion criteria. The data was extracted independently by two researchers and assessed for quality using the Joanna Briggs Institute critical appraisal tools. Conclusion: The two most commonly cited techniques for disclosing ionising radiation risk is to compare risk to the risk of common life events, and to describe risk as an additive risk to the baseline risk of cancer. The most commonly cited communication strategy was a graphical representation of the data, but simple language is also advocated. The use of a pictograph represents a technique which satisfied the advocated techniques of most articles.
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2019 |
Younger CWE, Moran S, Douglas C, Warren-Forward H, 'Barriers and pathways to informed consent for ionising radiation imaging examinations: A qualitative study', Radiography, 25 e88-e94 (2019) [C1] Introduction: Informed consent for ionising radiation medical imaging examinations represents a recent change to medical imaging practice. This practice has not had a definitive a... [more] Introduction: Informed consent for ionising radiation medical imaging examinations represents a recent change to medical imaging practice. This practice has not had a definitive and authoritative integration into clinical practice, and lack of direction has caused many health care professionals to be unsure of an appropriate consent methodology. Consent practices have been undertaken inconsistently and sometimes poorly. This research sought to investigate what barriers exist to meaningful informed consent, and what pathways are suggested to overcome these barriers. These views are then discussed in the context of practical health care consent practices. Methods: A semi-structured interview explored the views of radiographers and radiologists on the practice of disclosing the ionising radiation risk of a clinical medical imaging examination. Qualitative data was analysed using a nominal method of quantitative transformation. Responses were reviewed, and a set of definitive themes constructed. Participants considered the influences, logistics and barriers to the informed consent process. Participants were then asked what pathways might be developed that would improve the process. Results: Twenty-one (21) radiographer participants and nine (9) radiologists were interviewed. The barriers to consent identified issues of time constraints, lack of a unified message, and patient presentations. Pathways suggested included limiting the scope of the consent practice, sharing the consent responsibility, and formulation of definitive consent guidelines. Conclusion: A unified, definitive series of guidelines for informed consent for ionising radiation examinations would alleviate many of the identified barriers. Having the consent process consistently begin with the referring doctor would facilitate more meaningful consent.
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2019 |
Zdenkowski N, Butow P, Spillane A, Douglas C, Snook K, Jones M, et al., 'Patient-reported outcomes with neoadjuvant vs adjuvant systemic therapy for operable breast cancer', Breast, 46 25-31 (2019) [C1] Background: Neoadjuvant systemic therapy (NAST)is used for large operable or highly proliferative breast cancers. It is not known whether psychological outcomes differ according t... [more] Background: Neoadjuvant systemic therapy (NAST)is used for large operable or highly proliferative breast cancers. It is not known whether psychological outcomes differ according to the treatment sequence (chemotherapy or surgery first)or tumour response. Methods: This was a planned analysis of a multi-institutional single arm longitudinal study of patients considering NAST for operable breast cancer. Participants completed patient reported outcome questionnaires before and after the decision about NAST, between chemotherapy and surgery, and 12 months after diagnosis. Results: Fifty-nine women enrolled. Fourteen of 51 (28%)who received NAST experienced pathological complete response (pCR). Patients who had surgery first (n = 7)had higher baseline anxiety, and a greater decrease in anxiety at 12 months follow up, compared with patients who received NAST (n = 50)(a decrease from baseline of 34 pts vs 17 points; p = 0.033). Distress declined at a similar rate in surgery first and NAST groups. Mean satisfaction with decision score post-decision was significantly lower in the adjuvant group compared with NAST (22 vs 26, p = 0.02). No differences were seen between patients with pCR vs residual cancer in: distress, anxiety, satisfaction with decision, fear of progression, and decision regret. Conclusion: Most patients in this study proceeded with NAST when their surgeon offered it as an option. This exploratory analysis suggests that patients who chose surgery first tended to be more anxious, and had lower satisfaction with their decision, than those who had NAST. In patients who had NAST, lack of pCR does not appear to correlate with adverse psychological outcomes.
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2018 |
Waller A, Hall A, Sanson-Fisher R, Zdenkowski N, Douglas C, Walsh J, 'Do medical oncology patients and their support persons agree about end-of-life issues?', Internal Medicine Journal, 48 60-66 (2018) [C1] Background: The perceptions of those called on to make decisions on behalf of patients who lack capacity at the end of life must accurately reflect patient preferences. Aims: To e... [more] Background: The perceptions of those called on to make decisions on behalf of patients who lack capacity at the end of life must accurately reflect patient preferences. Aims: To establish the extent to which the views of medical oncology outpatients are understood by their support persons, specifically with regards to (i) preferred type and location of end-of-life care, (ii) preferred level of involvement in end-of-life decision-making and (iii) whether the patient has completed an advance care plan or appointed an enduring guardian. Methods: Adults with a confirmed cancer diagnosis and their nominated support persons were approached between September 2015 and January 2016 in the waiting room of an Australian tertiary referral clinic. Consenting participants completed a pen-and-paper survey. Nominated support persons answered the same questions from the patient¿s perspective. Results: In total, 208 participants (39% of eligible dyads) participated. Observed agreement across the five outcomes ranged from 54% to 84%. Kappa values for concordance between patient¿support person responses were fair to moderate (0.24¿0.47) for enduring guardian, decision-making, advance care plan and care location outcomes. A slight level of concordance (k = 0.15; 95% confidence interval: -0.02, 0.32) was found for the type of care outcome. Conclusion: Relying on support persons¿ views does not guarantee that patients¿ actual preferences will be followed. Strategies that make patient preferences known to healthcare providers and support persons while they still have the capacity to do so is a critical next step in improving quality cancer care.
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2018 |
Younger CWE, Douglas C, Warren-Forward H, 'Ionising radiation risk disclosure: When should radiographers assume a duty to inform?', Radiography, 24 146-150 (2018) [C1] Introduction: Autonomy is a fundamental patient right for ethical practice, and informed consent is the mechanism by which health care professionals ensure this right has been res... [more] Introduction: Autonomy is a fundamental patient right for ethical practice, and informed consent is the mechanism by which health care professionals ensure this right has been respected. The ethical notion of informed consent has evolved alongside legal developments. Under Australian law, a provider who fails to disclose risk may be found to be in breach of a duty of disclosure, potentially facing legal consequences if the patient experiences harm that is attributable to an undisclosed risk. These consequences may include the common law tort of negligence. Ionising radiation, in the form of a medical imaging examination, has the potential to cause harm. However, stochastic effects cannot be attributable to a specific ionising radiation event. What then is the role of the Australian medical imaging service provider in disclosing ionising radiation risk? Methods: The ethical and legal principles of informed consent, and the duty of information provision to the patient are investigated. These general principles are then applied to the specific and unusual case of ionising radiation, and what responsibilities apply to the medical imaging provider. Finally, the legal, professional and ethical duties of the radiographer to disclose information to their patients are investigated. Results: Australian law is unclear as to whether a radiographer has a common law responsibility to disclose radiation risk. There is ambiguity as to whether stochastic ionising radiation risk could be considered a legal disclosure responsibility. Conclusion: While it is unlikely that not disclosing risk will have medicolegal consequences, doing so represents sound ethical practice.
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2018 |
Donovan LC, Douglas CD, Van Helden D, 'Wound tension and 'closability' with keystone flaps, V-Y flaps and primary closure: a study in fresh-frozen cadavers.', Widespread white matter microstructural differences in schizophrenia across 4322 individuals: results from the ENIGMA Schizophrenia DTI Working Group., 88 486-490 (2018) [C1]
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2018 |
Waller A, Douglas C, Sanson-Fisher R, Zdenkowski N, Pearce A, Evans T, Walsh J, 'Dances with denial: Have medical oncology outpatients conveyed their end-of-life wishes and do they want to?', JNCCN Journal of the National Comprehensive Cancer Network, 16 498-505 (2018) [C1] Objectives: This study surveyed a sample of medical oncology outpatients to determine (1) the proportion who have already discussed and documented their end-of-life (EOL) wishes; ... [more] Objectives: This study surveyed a sample of medical oncology outpatients to determine (1) the proportion who have already discussed and documented their end-of-life (EOL) wishes; (2) when and with whom they would prefer to convey their EOL wishes; (3) the EOL issues they would want to discuss; and (4) the association between perceived cancer status and advance care planning (ACP) participation. Methods: Adult medical oncology outpatients were approached in the waiting room of an Australian tertiary treatment center. Consenting participants completed a pen-and-paper survey assessing participation in ACP, preferences for conveying EOL wishes, timing of EOL discussions, and EOL issues they want to be asked about. Results: A total of 203 patients returned the survey (47% of eligible). EOL discussions occurred more frequently with support persons (47%) than with doctors (7%). Only 14% had recorded their wishes, and 45% had appointed an enduring guardian. Those who perceived their cancer as incurable were more likely to have participated in ACP. If facing EOL, patients indicated that they would want family involved in discussions (85%), to be able to write down EOL wishes (82%), and to appoint enduring guardians (91%). Many (45%) preferred the first discussion to happen when their disease became incurable. Slightly less than one-third thought discussions regarding EOL should be patient-initiated. Most agreed doctors should ask about preferred decision-making involvement (92%), how important it is that pain is managed well (95%), and how important it is to remain conscious (82%). Fewer (55%) wanted to be asked about the importance of care extending life. Conclusions: Many patients would like to have discussions regarding EOL care with their doctor and involve their support persons in this process. Only a small percentage of respondents had discussed EOL care with their doctors, recorded their wishes, or appointed an enduring guardian. The first step requires clinicians to ask whether an individual patient wishes to discuss EOL issues, in what format, and at what level of detail.
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2018 |
Younger CWE, Douglas C, Warren-Forward H, 'Medical imaging and informed consent Can radiographers and patients agree upon a realistic best practice?', Radiography, 24 204-210 (2018) [C1] Introduction: For radiographers, gaining informed consent with our patients represents a challenging undertaking. Reconciling the need to gain meaningful consent with time pressur... [more] Introduction: For radiographers, gaining informed consent with our patients represents a challenging undertaking. Reconciling the need to gain meaningful consent with time pressures represents one challenge, as does differing expectations of how risk communication should be undertaken. Different methods and thresholds of risk disclosure are considered, with the aim of finding a realistic best practice. Methods: A cross-sectional study of radiographers and members of the public was undertaken. Participants were asked their preferences for how they would like to receive ionising radiation risk information. This included the health care professional(s) most suited to provide the information, the media through which the information was delivered, and the technique for delivering the information. In addition, participants were asked to consider hypothetical scenarios in which they were a patient receiving an ionising radiation examination, and to give the threshold of ionising radiation cancer risk which they would consider material. These scenarios considered variations in the cancer-onset time, and the accuracy of the test. Results: One hundred and twenty-one (121) radiographer participants and one hundred and seventy two (172) members of the public met the inclusion criteria and completed the survey. There was strong agreement in the most appropriate media, and person, to disclose risk, as well as what represents a significant risk. There was considerable agreement in risk delivery technique. However, some of the agreed-upon strategies may be challenging to achieve in clinical practice. Conclusion: Radiographers and patients fundamentally agree upon risk communication strategies, but implementing some strategies may prove clinically challenging.
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2018 |
Zdenkowski N, Butow P, Spillane A, Douglas C, Snook K, Jones M, et al., 'Single-arm longitudinal study to evaluate a decision aid for women offered Neoadjuvant systemic therapy for operable breast cancer', JNCCN Journal of the National Comprehensive Cancer Network, 16 378-385 (2018) [C1] Background: Neoadjuvant systemic therapy (NAST) is an increasingly used treatment option for women with large operable or highly proliferative breast cancer. With equivalent survi... [more] Background: Neoadjuvant systemic therapy (NAST) is an increasingly used treatment option for women with large operable or highly proliferative breast cancer. With equivalent survival outcomes between NAST and up-front surgery, the situation-specific preference-sensitive nature of the decision makes it suitable for a decision aid (DA). This study aimed to develop and evaluate a DA for this population. Methods: A DA booklet was developed according to international standards, including information about adjuvant and neoadjuvant treatment, outcome probabilities, and a values clarification exercise. Eligible women, considered by investigators as candidates for NAST, were enrolled in a multi-institutional, single-arm, longitudinal study. Patient-reported outcome measure questionnaires were completed pre- and post-DA, between chemotherapy and surgery, and at 12 months. Outcomes were feasibility (percentage of eligible patients accessing the DA); acceptability to patients (percentage who would recommend it to others) and clinicians (percentage who would use the DA in routine practice); and decision-related outcomes. Results: From 77 eligible women, 59 were enrolled, of whom 47 (79.7%; 95% CI, 69.4-89.9) reported having read the DA; 51 completed the first post-DA questionnaire. Of these 51, 41 participants (80.4%; 95% CI, 69.5-91.3) found the DA useful for their decision about NAST. Of 18 responding investigators, 16 (88.9%; 95% CI, 74.4-103.4) indicated they would continue to use the DA in routine practice. Post-DA, decisional conflict decreased significantly (P<.01); anxiety and distress decreased significantly; and 86.3% (95% CI, 73.7-94.3) achieved at least as much decisional control as they desired. Conclusions: This DA was feasible and acceptable to patients and clinicians, and improvement in decision-related outcomes was demonstrated when used in combination with clinical consultations. This DA could safely be implemented into routine practice for women considering NAST for operable breast cancer.
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2018 |
Waller A, Sanson-Fisher R, Zdenkowski N, Douglas C, Hall A, Walsh J, 'The right place at the right time: Medical oncology outpatients' perceptions of location of end-of-life care', JNCCN Journal of the National Comprehensive Cancer Network, 16 35-41 (2018) [C1] Background: Helping people achieve their preferred location of care is an important indicator of quality end-of-life (EOL) care. Using a sample of Australian medical oncology outp... [more] Background: Helping people achieve their preferred location of care is an important indicator of quality end-of-life (EOL) care. Using a sample of Australian medical oncology outpatients, this study examined (1) their preferred location of EOL care; (2) their perceived benefits and worries of receiving care in that location; (3) the percentage who had discussed preferences with their doctor and/or support person; and (4) whether they wanted their doctor to ask them where they wanted to die. Methods: Adults with a confirmed diagnosis of cancer were approached between September 2015 and January 2016 in the waiting room of an Australian oncology outpatient clinic. Consenting participants completed a home-based pen-and-paper survey indicating preferred location of care, perceived benefits and worries of that location, whether they had discussed preferences with their doctors, and whether they were willing to be asked about their preferences. Results: A total of 203 patients returned the survey (47% of those eligible). Less than half preferred to be cared for at home (47%), 34% preferred a hospice/palliative care unit, and 19% preferred the hospital. Common benefits and worries associated with locations included perceived burden on others, familiarity of environment, availability of expert medical care, symptom management, and likelihood of having wishes respected. More patients had discussed preferences with their support persons (41%) than doctors (7%). Most wanted a doctor to ask them about preferred location of care (87%) and thought it was important to die in the location of their choice (93%). Conclusions: Patients were willing to have clinicians to ask them where they wanted to die, although few had discussed their preferences with doctors. Although home was the most preferred location for many patients, the overall variation suggests that clinicians should adopt a systematic approach to eliciting patient preferences.
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2016 |
Zdenkowski N, Butow P, Mann GB, Fewster S, Beckmore C, Isaacs R, et al., 'A survey of Australian and New Zealand clinical practice with neoadjuvant systemic therapy for breast cancer', Internal Medicine Journal, 46 677-683 (2016) [C1] Background: Neoadjuvant systemic therapy (NAST) has become an established treatment option for women with operable breast cancer. Aim: We aimed to better understand NAST treatment... [more] Background: Neoadjuvant systemic therapy (NAST) has become an established treatment option for women with operable breast cancer. Aim: We aimed to better understand NAST treatment patterns, barriers and facilitators in Australia and New Zealand. Methods: We undertook a cross-sectional survey of the current clinical practice of Australian and New Zealand breast cancer specialists. Questions included referral patterns for NAST, patient selection, logistics, decision making and barriers. Results: Of 207 respondents, 162 (78%) reported routinely offering NAST to selected patients with operable breast cancer (median 9% of patients offered NAST). Specialty, location, practice type, gender or years of experience did not predict for offering NAST. In all, 45 and 58% wanted to increase the number of patients who receive NAST in routine care and in clinical trials respectively. Facilitators included the multidisciplinary team meeting and access to NAST clinical trials. Specialist-reported patient barriers included: patient desire for immediate surgery (63% rated as important/very important); lack of awareness of NAST (50%); concern about progression (43%) and disinterest in downstaging (32%). Forty-three per cent of participants experienced system-related barriers to the use of NAST, including other clinicians' lack of interest (27%); lack of clinical trials (24%) and unacceptable wait for a medical oncology appointment (37%). Conclusion: This group of Australian and New Zealand clinicians are interested in NAST for operable breast cancer in routine care and clinical trials. Patient- and system-related barriers that prevent the optimal uptake of this treatment approach will need to be systematically addressed if NAST is to become a more common approach.
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2015 |
Zdenkowski N, Butow P, Mann B, Fewster S, Douglas C, Boyle FM, 'Decisions about neoadjuvant systemic therapy for breast cancer: A survey of Australian and New Zealand specialists', ANZ Journal of Surgery, 85 797-798 (2015) [C3]
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2014 |
Douglas C, 'Moral concerns with sedation at the end of life', Journal of Medical Ethics, 40 241 (2014) [C3]
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2014 |
Douglas CD, Kerridge IH, Ankeny RA, 'Double meanings will not save the principle of double effect', Journal of Medicine and Philosophy (United Kingdom), 39 304-316 (2014) [C1] In an article somewhat ironically entitled "Disambiguating Clinical Intentions," Lynn Jansen promotes an idea that should be bewildering to anyone familiar with the lite... [more] In an article somewhat ironically entitled "Disambiguating Clinical Intentions," Lynn Jansen promotes an idea that should be bewildering to anyone familiar with the literature on the intention/foresight distinction. According to Jansen, "intention" has two commonsense meanings, one of which is equivalent to "foresight." Consequently, questions about intention are "infected" with ambiguity-people cannot tell what they mean and do not know how to answer them. This hypothesis is unsupported by evidence, but Jansen states it as if it were accepted fact. In this reply, we make explicit the multiple misrepresentations she has employed to make her hypothesis seem plausible. We also point out the ways in which it defies common sense. In particular, Jansen applies her thesis only to recent empirical research on the intentions of doctors, totally ignoring the widespread confusion that her assertion would imply in everyday life, in law, and indeed in religious and philosophical writings concerning the intention/foresight distinction and the Principle of Double Effect. © 2014 The Author.
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2014 |
Douglas C, Morris O, Donovan L, 'The keystone flap: Is your 'unclosable' wound really unclosable?', ANZ Journal of Surgery, 84 496-497 (2014) [C3]
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2013 |
Douglas CD, Kerridge IH, Ankeny RA, 'NARRATIVES OF 'TERMINAL SEDATION', AND THE IMPORTANCE OF THE INTENTION-FORESIGHT DISTINCTION IN PALLIATIVE CARE PRACTICE', BIOETHICS, 27 1-11 (2013) [C1]
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2013 |
Douglas CD, Low NCK, Seitz MJ, 'The Keystone Flap: Not an Advance, Just a Stretch', ANNALS OF SURGICAL ONCOLOGY, 20 973-980 (2013) [C1]
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2013 |
Douglas C, Morris O, 'The 'keystone concept': time for some science', ANZ Journal of Surgery, 83 498-499 (2013) [C3]
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2013 |
Douglas C, Proudfoot E, 'Nudging and the Complicated Real Life of Informed Consent ', The American Journal of Bioethics, 13 16-17 (2013) [C2]
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2012 |
Papeix G, Zardawi IM-A, Douglas CD, Clark DA, Braye SG, 'The accuracy of the 'triple test' in the diagnosis of papillary lesions of the breast', Acta Cytologica, 56 41-46 (2012) [C1]
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2012 | Douglas CD, Jansen M, Kerridge I, 'The devil is in the detail: Best practice, or catholic practice?', American Journal of Bioethics, 12 38-39 (2012) [C3] | ||||||||||
2011 |
Harwood RC, Douglas CD, Clark D, 'Decision aids for breast and nodal surgery in patients with early breast cancer: Development and a pilot study', Asia-Pacific Journal of Clinical Oncology, 7 114-122 (2011) [C1]
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2009 |
Douglas CD, 'End-of-life decisions and moral psychology: Killing, letting die, intention and foresight', Journal of Bioethical Inquiry, 6 337-347 (2009) [C1]
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2008 |
Douglas CD, Kerridge I, Ankeny R, 'Managing intentions: The end-of-life administration of analgesics and sedatives, and the possibility of slow euthanasia', Bioethics, 22 388-396 (2008) [C1]
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2007 |
Douglas CD, McPhee JR, 'Informed consent: A review of the ethical and legal basis for medical decision-making for the competent patient', ANZ Journal of Surgery, 77 521-522 (2007) [C1]
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2004 |
Winn RD, Laura S, Douglas C, Davidson PM, Gani JS, 'Protocol-Based approach to suspected appendicitis, incorporating the alvarado score and outpatient antibiotics', ANZ Journal of Surgery, 74 324-329 (2004) [C1]
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2001 |
Douglas C, Kerridge I, McPhee J, Parkinson L, Spigelman AD, Rainbird K, 'The intention to hasten death: a survey of attitudes and prctices of surgeons in Australia', Medical Journal of Australia, 175 511-515 (2001) [C1]
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2000 |
Douglas CD, MacPherson NE, Davidson P, Gani JS, 'Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score', British Medical Journal, 321 919 (2000) [C1]
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Conference (5 outputs)
Year | Citation | Altmetrics | Link | |||||
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2018 |
Younger C, Douglas C, Warren-Forward H, 'Communication of risk Do our views match those of our patient?', Communication of risk Do our views match those of our patient?, Canberra, Australia (2018)
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2018 |
Younger C, Douglas C, Warren-Forward H, 'Informed consent in medical radiation science', Canberra, Australia (2018)
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2018 |
Waller A, Sanson-Fisher R, Zdenkowski N, Douglas C, Pearce A, Hall A, Evans T, 'Are Medical Oncology Outpatients Conveying their End-of-Life Wishes and Do They Want to?', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2018)
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Grants and Funding
Summary
Number of grants | 5 |
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Total funding | $430,067 |
Click on a grant title below to expand the full details for that specific grant.
20141 grants / $260,564
Who decides and at what cost? Comparing patient, surrogate and oncologist perspectives on end of life care$260,564
Funding body: NHMRC (National Health & Medical Research Council)
Funding body | NHMRC (National Health & Medical Research Council) |
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Project Team | Laureate Professor Robert Sanson-Fisher, Emeritus Professor Neil Rees, Ms Gill Batt, Doctor Charles Douglas, Professor Ian Olver, Doctor Nick Zdenkowski, Conjoint Professor Frans Henskens |
Scheme | Partnership Projects |
Role | Investigator |
Funding Start | 2014 |
Funding Finish | 2017 |
GNo | G1300011 |
Type Of Funding | Aust Competitive - Commonwealth |
Category | 1CS |
UON | Y |
20132 grants / $150,303
Who decides and at what cost? Comparing patient, surrogate and oncologist perspectives on end of life care$130,303
Funding body: Cancer Council NSW
Funding body | Cancer Council NSW |
---|---|
Project Team | Laureate Professor Robert Sanson-Fisher, Emeritus Professor Neil Rees, Ms Gill Batt, Doctor Charles Douglas, Professor Ian Olver, Doctor Nick Zdenkowski, Doctor Scott Twaddell, Conjoint Professor Frans Henskens |
Scheme | Partnership Projects Partner Funding |
Role | Investigator |
Funding Start | 2013 |
Funding Finish | 2016 |
GNo | G1300851 |
Type Of Funding | Grant - Aust Non Government |
Category | 3AFG |
UON | Y |
Reducing psychosocial burden among women diagnosed with breast cancer and their support persons: A randomised controlled trial of a web-based intervention.$20,000
Funding body: Hunter Medical Research Institute
Funding body | Hunter Medical Research Institute |
---|---|
Project Team | Laureate Professor Robert Sanson-Fisher, Doctor Charles Douglas, Doctor Jamie Bryant, Professor Mariko Carey, Conjoint Professor Frans Henskens |
Scheme | Near Miss |
Role | Investigator |
Funding Start | 2013 |
Funding Finish | 2013 |
GNo | G1300705 |
Type Of Funding | Grant - Aust Non Government |
Category | 3AFG |
UON | Y |
20091 grants / $9,600
A qualitative study of terminal sedation in end-of-life care, involving in-depth interviews with health care providers in palliative care$9,600
Funding body: University of Newcastle
Funding body | University of Newcastle |
---|---|
Project Team | Doctor Charles Douglas |
Scheme | Early Career Researcher Grant |
Role | Lead |
Funding Start | 2009 |
Funding Finish | 2009 |
GNo | G0190227 |
Type Of Funding | Internal |
Category | INTE |
UON | Y |
20071 grants / $9,600
A qualitative study of terminal sedation in end-of-life care, involving in-depth interviews with health care providers in palliative care$9,600
Funding body: University of Newcastle
Funding body | University of Newcastle |
---|---|
Project Team | Doctor Charles Douglas |
Scheme | Early Career Researcher Grant |
Role | Lead |
Funding Start | 2007 |
Funding Finish | 2007 |
GNo | G0187405 |
Type Of Funding | Internal |
Category | INTE |
UON | Y |
Research Supervision
Number of supervisions
Current Supervision
Commenced | Level of Study | Research Title | Program | Supervisor Type |
---|---|---|---|---|
2007 | Honours | Informed consent and the management of probably benign breast lesions | Medical Science, University of Newcastle | Principal Supervisor |
2007 | Honours | Informed consent and management of probably benign breast lesions | Medical Science, University of Newcastle | Principal Supervisor |
Past Supervision
Year | Level of Study | Research Title | Program | Supervisor Type |
---|---|---|---|---|
2020 | PhD | Informed Consent for Clinical Examinations involving Ionising Radiation | PhD (Medical Radiation Sc), College of Health, Medicine and Wellbeing, The University of Newcastle | Co-Supervisor |
1999 | Honours | Ultrasound diagnosis of appendicitis | Accounting, University of Newcastle | Co-Supervisor |
1998 | Honours | Ultrasound diagnosis of appendicitis - randomised controlled trial | Medical Science, University of Newcastle | Co-Supervisor |
Dr Charles Douglas
Position
Honorary Senior Lecturer
School of Medicine and Public Health
College of Health, Medicine and Wellbeing
Focus area
Clinical Ethics and Health Law
Contact Details
charles.douglas@newcastle.edu.au | |
Phone | 0400 390 748 |
Office
Room | BB107 |
---|---|
Building | Bowman Building |
Location | Callaghan University Drive Callaghan, NSW 2308 Australia |