Dr Stephen Barclay
BA, MD, BM (Oxon), BCh (Oxon), MSc (Lond).
Bye-Fellow; Director of Studies in Medicine
Director of Studies in Clinical Medicine; Senior Lecturer in Palliative Care and General Practice
Stephen’s pre-clinical training was in Cambridge and his clinical training in Oxford. He continues to work clinically in both General Practice and Palliative Care and was appointed as Honorary Consultant Physician in Palliative Medicine in 1996.
His 2005 MD thesis from the University of Cambridge “General Practitioner provision of Palliative Care in the United Kingdom” was awarded the Clinical School Ralph Noble prize. In 2011 he was appointed HEFCE Clinical Senior Lecturer in General Practice and Palliative Care in the Department of Public Health and Primary Care, with an office in the Institute of Public Health on the Addenbrooke’s site.
He leads a research group that focuses on Palliative and End of Life Care in Primary Care, with a particular interest in General Practitioner and District Nurse provision of care, end of life care conversations in cancer and non-cancer illness, decision-making concerning treatment cessation in advanced disease and medical student education in Palliative Care.
In 2002 he was appointed Clinical Medical School Specialty Director for Palliative Care. Since then h has overseen considerable expansion of the curricular time allocated to Palliative Care, which is now also regularly examined in Finals exams. He co-leads the Undergraduate Education Forum of the Association for Palliative Medicine and led to 2014 revision of the national curriculum for medical student teaching in Palliative Care.
In October 2014 he was elected to a Bye-Fellowship and appointed Co-Director of Studies for Clinical Medicine at Emma, a role that he shares with Prof David Lomas.
- Appointed Specialty Director for Palliative Care teaching in the Clinical Medical School in 2002.
- Awarded University Pilkington Prize for excellence in teaching, June 2015
- Developed the curriculum, from an initial 1.0 days in the three year clinical course to the current 10.5 days, securing funding for two Associate Speciality Directors and developed a regional faculty team of some 45 teachers
- Leading the development of a revised Palliative Care curriculum for the new Clinical School curriculum.
- Member of the Medical School Fitness to Practice Committee.
- Final MB examiner
- Fellow of the Higher Education Academy
- Co-Chair of UK Association for Palliative Medicine Special Interest Forum for undergraduate medical education, leading annual national conferences.
- Led the 2014 revision of the UK Association for Palliative Medicine curriculum for undergraduate medical education
- Lead research in medical student education in Palliative Care: 7 papers published to date.
Current Research Programme
1) CAPE study: Care Pathways at the End of Life. Funder: NIHR Research for Patient Benefit
A collaboration with GP practices and Community Nursing services across East Anglia. Through retrospective clinical records review of 400 deaths from 20 GP practices, clinical focus groups and interviews with bereaved carers, this study seeks to:
a) Characterise the patterns of care need of people approaching the end of life in the community, mapping their current pathways of care provision and place of death.
b) Investigate the health costs of the identified care pathways and place of death
c) Develop a “toolkit” for Primary Care Teams to review care and better align patient needs to care provision.
Field work currently underway
2) PACE study – patients’ Plans And Care Expectations. Funder: Macmillan Cancer Support.
Collaboration with GPs, Nurse Specialists across East Anglia, and hospital colleagues in Addenbrooke’s, Papworth and Peterborough hospitals.
An investigation of the existence and nature of the transitions to Palliative and End of Life Care in two contrasting illnesses; incurable lung cancer and severe COPD. Qualitative interviews investigated the views of patients, their lay carers and health professionals concerning the appropriateness of a Palliative Care approach and conversations concerning the End of Life.
Field work complete. Data analysis and paper writing underway.
3) ACE: Hospital admissions at the end of life. Funder: NIHR CLAHRC.
Collaboration with Ambulance Trust, Out of Hours GP service, Addenbrooke’s and Peterborough Hospitals.
A reduction in the number of people dying in hospital is one of the key aims and quality markers for both the National NHS and local End of Life Care Strategies. This study investigates the reasons why patients with cancer, Chronic Obstructive Pulmonary Disease and dementia are admitted to hospital close to the end of life and details their experiences of care once in hospital.
Field work currently underway. One paper published to date.
4) “Prepared to Share?” Data sharing in End of Life Care. Funder: NIHR CLAHRC.
A collaboration with GP practices across Cambridgeshire and the Cambridgeshire and Peterborough Clinical Commissioning Group
A study of the attitudes and experiences of GPs, Practice Managers, patients and lay carers towards data sharing in general and in End of Life Care in particular. GP and Practice Manager survey and qualitative interview study of health professionals, patients at lay carers.
Field work currently underway
5) “Future Care Study”: Decision-making concerning feeding and drinking interventions for people with progressive neurological disease at risk of losing decision-making capacity. Funder: Dunhill Medical Trust.
A three-year study comprising:
- IPSOS MORI public opinion survey of 1000 members of the public
- Qualitative interview study of patients, lay carers and community health care professionals
- Focus group study to develop guidelines for clinical practice
Field-work currently underway
6) Medical student training in Palliative Care.
Arising out of my teaching post within the University of Cambridge School of Clinical Medicine, four related research studies are underway:
a) A cross-sectional and longitudinal study of medical students' attitudes towards end of life care during their medical course.
b) A cross-sectional and longitudinal cohort study of medical students' general anxiety and death anxiety during their medical course.
c) A study of medical students’ experience of close personal bereavement before and during their course.
d) Analysis of final year students' reflective portfolio items written after they meet patients approaching the end of life in their senior GP attachment and in their senior medicine / surgery.
Seven papers published from this strand of work
7) “Design for Care” collaborative. Funders Marie Curie Cancer Care and Macmillan Cancer Support.
I host this national collaborative group that was established in early 2015 and aims to redesign community palliative care services through a process of experience based design.
Collaborative commenced March 2015 with national conference of 40 experts held at Madingley Hall, Cambridge.
Thiemann P, Quince T, Benson J, Wood D, Barclay S. (2015). “Medical students’ death anxiety: severity and association with psychological health and attitudes toward palliative care”. Journal of Pain and Symptom Management; paper in press.
Spathis A, Booth S, Grove S, Hatcher H, Kuhn I, Barclay S. (2015) “Teenage and young adult cancer-related fatigue is prevalent, distressing and neglected: it is time to intervene.” A systematic literature review and narrative synthesis. Journal of Adolescent and Young Adult Oncology: 4(1): 3 – 17.
Dzeng E, Colaianni A, Chander G, Smith T, Roland M, Kelly M, Barclay S, Levine D (2015). “Institutional policies’ influence on Do Not Resuscitate decision-making at the end of life” JAMA Internal Medicine; Published online April 6 2015
Barclay S, Whyte R, Thiemann P, Benson J, Wood D, Parker R, Quince T (2014). “An important but stressful part of my future work”. Medical students’ attitudes to End of Life Care throughout their course. Journal of Pain and Symptom Management: 49 (2): 231 – 242.
Barclay S, Froggatt K, Crang C, Mathie E, Handley M, Iliffe S, Manthorpe J, Gage H, Goodman C. (2014) “Living in uncertain times: trajectories to death in residential care homes”. British Journal of General Practice: 64 (626); 576 – 583.
Mason B, Epiphaniou E, Murray S, Nanton V, Donaldson A, Shipman C, Daveson B, Harding R, Higginson I, Munday D, Barclay S, Dale J, Kendall M, Worth A, Boyd K. (2014) “My body’s falling apart.” Understanding the experiences of patients with advanced multimorbidity to improve care: serial interviews with patients and carers. BMJ Supportive and Palliative Care; published online May 2014. doi:10.1136/bmjspcare-2013-000639
Clarke G, Galbraith S, Woodward J, Holland A, Barclay S (2014). “Should they have a Percutaneous Endoscopic Gastrostomy? The importance of assessing decision-making capacity and the central role of a multidisciplinary team”. Clinical Medicine: 14 (3): 245 - 249
Daveson B, Harding R, Shipman C, Mason B, Epiphaniou E, Higginson I, Ellis-Smith C, Henson L, Munday D, Nanton V, Dale J, Boyd K, Worth A, Barclay S, Donaldson, Murray S. (2014). “The Real-World Problem of Care Coordination: A Longitudinal Qualitative Study with Patients Living with Advanced Progressive Illness and Their Unpaid Caregivers". PLoS ONE 9(5): e95523. doi: 10.1371/journal.pone.0095523
Fritz Z, Barclay S (2014). “Patients’ resuscitation preferences in context: lessons from POLST”. Resuscitation; 85 (4): 444 -5.
Perrels A, Fleming J, Zhao J, Barclay S, Farquhar M, Buiting H, Brayne C and Cambridge City over-75s Cohort (CC75C) study collaboration (2013). “Place of death and end-of-life transitions experienced by very old people of different cognitive status. Retrospective analysis of a population-based cohort aged 85 and older”. Palliative Medicine: 28 (3); 220 - 233.
Sharp T, Moran E, Kuhn I, Barclay S. (2013) “Do the elderly have a voice? End of life care discussions with frail & elderly individuals: a systematic literature review & narrative synthesis”. British Journal of General Practice: 63; 657 – 668.
Knights D, Wood D, Barclay S. (2013) “The Liverpool Care Pathway for the Dying: what went wrong?” British Journal of General Practice: 63; 509 – 510.
Badrakalimuthu R, Barclay S. (2013) “Do people with dementia die at their preferred location of death? A systematic literature review and narrative synthesis”. Age and Ageing: 43 (1); 13 – 19.
Corrie P, Moody M, Armstrong G, Nolasco S, Lao-Sirieix S, Bavister L, Prevost T, Parker T, Sabes-Figuera R, McCrone P, Balsdon H, McKinnon K, Hounsell A, O'Sullivan B, Barclay S. (2013). “Is community treatment best? A randomised trial comparing delivery of cancer treatment in the hospital, home and GP surgery” British Journal of Cancer: (109); 1549-1555.
Mason B, Epiphaniou E, Nanton V, Donaldson A, Shipman C, Daveson B, Harding R, Higginson I, Munday D, Barclay S, Boyd K, Dale J, Kendall M, Worth A, Murray S. (2013) “Coordination of care for people with advanced progressive conditions: a multi-site prospective study”. British Journal of General Practice: 63; 421 – 422.
Bamber A, Quince T, Barclay S, Siklos P, Clark J, Wood D. (2013) “Medical student attitudes to the autopsy and its utility in medical education. A qualitative phenomenological study at one UK medical school”. Anatomical Sciences Education:7(2); 87 – 96.
Handley M, Goodman C, Froggatt K, Mathie E, Gage H, Manthorpe J, Barclay S, Crang C, Iliffe S (2013). “Living and dying: Responsibility for end of life care in care homes without on-site nursing provision: a prospective study” Health and Social Care in the Community; 22(1): 22 - 29.
Clarke G, Harrison K, Holland A, Kuhn I, Barclay S. (2013) “How are treatment decisions made about artificial nutrition for individuals at risk of lacking capacity? A systematic review and qualitative synthesis”. PLOS ONE: 8(4): e61475.
Morris Z, Fyfe M, Momen N, Hoare S, Barclay S. (2013) “Understanding hospital admissions close to the end of life (ACE) study”. BMC Health Services Research: 13; 89.
Whyte R, Quince T, Benson J, Wood D, Barclay S. (2013) “Medical students’ experience of personal loss: incidence and implications”. BMC Medical Education: 13; 36.
Kendall M, Mason B, Murray S, Momen N, Barclay S, et al (2013) “Pro-active cancer care in primary care: a feasibility study” Family Practice: 30(3); 302 – 312.
Momen N, Kendall M, Barclay S, Murray S. (2013) “Using timelines to depict patient journeys: a development for research methods and clinical care review.” Primary Health Care Research and Development: 14(4); 403 – 408
Stone P, Gwilliam B, Keeley V, Todd C, Kelly L, Barclay S (2013) “Factors affecting recruitment to an observational multicentre palliative care study”. BMJ Supportive and Palliative Care: 3; 318 - 323.