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ABSTRACT: Background:Clinicians and patients find prognosis and end-of-life care discussions challenging. Misunderstanding one's prognosis can contribute to poor decision-making and end-of-life quality of life. A question prompt list (booklet of questions patients can ask clinicians) targeting these issues may help overcome communication barriers. None exists for end-of-life discussions outside the palliative care setting.Aim:To develop/pilot a question prompt list facilitating discussion/planning of end-of-life care for oncology patients with advanced cancer from Australia and the United States and to explore acceptability, perceived benefits/challenges of using the question prompt list, suggestions for improvements and the necessity of country-specific adaptations.Design:An expert panel developed a question prompt list targeting prognosis and end-of-life issues. Australian/US semi-structured interviews and one focus group elicited feedback about the question prompt list. Transcribed data were analysed using qualitative methods.Setting/participants:Thirty-four patients with advanced cancer (15 Australian/19 US) and 13 health professionals treating such patients (7 Australian/6 US) from two Australian and one US cancer centre participated.Results:Most endorsed the entire question prompt list, though a minority queried the utility/appropriateness of some questions. Analysis identified four global themes: (1) reinforcement of known benefits of question prompt lists, (2) appraisal of content and suggestions for further developments, (3) perceived benefits and challenges in using the question prompt list and (4) contrasts in Australian/US feedback. These contrasts necessitated distinct Australian/US final versions of the question prompt list.Conclusions:Participants endorsed the question prompt list as acceptable and useful. Feedback resulted in two distinct versions of the question prompt list, accommodating differences between Australian and US approaches to end-of-life discussions, highlighting the appropriateness of tailoring communication aides to individual populations.
Palliative Medicine 04/2013; · 2.38 Impact Factor
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Rachel F Dear,
Alexandra L Barratt,
Alison Evans,
John Simes,
John Newsom,
Dan Kent,
Sally Crossing,
Catherine Holliday,
Eva Segelov,
George Hruby, Martin Hn Tattersall
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ABSTRACT: To identify gaps in colorectal cancer clinical trials research in Australia and to suggest and prioritise trials to fill those gaps.
Retrospective review of colorectal cancer trial activity from 1 January 2005 to 1 July 2011 in Australia and internationally, followed by a consensus meeting of consumers, health care professionals, researchers and funding agencies.
Proportion of Phase III and randomised clinical trials in the areas of prevention, screening, surgery, adjuvant therapy, advanced disease and behavioural interventions, and priority areas of research identified by participants at the consensus meeting.
The registry search identified 76 colorectal cancer clinical trials (all phases) registered in Australia from 1 January 2005 to 1 July 2011, of which 51 were Phase III or randomised, and 323 Phase III and randomised trials registered worldwide. In Australia, most trials were in advanced colorectal cancer (32), screening (10), and behavioural interventions (9). Worldwide, most Phase III or randomised trials were in advanced disease (94, 29.1%), surgery (64, 19.8%), behavioural interventions (38, 11.8%), and screening (30, 9.3%). At the consensus meeting, all participant groups emphasised the need for research in secondary prevention, screening, individualised treatments and follow-up care after treatment for colorectal cancer.
There is a mismatch between the high proportion of registered trials in advanced colorectal cancer and the areas of priority identified. The development of specific trials in these priority areas depends on the availability of funding and the existence of plausible interventions likely to improve patient outcomes.
The Medical journal of Australia 11/2012; 197(9):507-11. · 2.81 Impact Factor
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ABSTRACT: BACKGROUND: We developed a novel individualised training program regarding end-of-life communication, designed to be time effective for busy junior-doctors working in hospital settings. AIM: We aimed to pilot this brief individualised training program with junior-doctors to explore its acceptability, feasibility and effect on the doctors' confidence, communication skills, attitudes towards psychosocial care and burnout. DESIGN: The content of the training intervention was informed by a systematic literature review and evidence-based clinical practice guidelines regarding end-of-life communication. The intervention was based on sound educational principles and involved three one-hour teaching sessions over a three-week period, including two individual sessions with an expert facilitator and simulated patient/caregiver. In addition, participants received written and audiovisual take-home learning materials.Participants were videotaped consulting with a simulated patient/caregiver pre/post training to assess the impact of the course on their communication behaviours. Participants completed de-identified questionnaires pre/post training, including self-assessed confidence, attitudes to psychosocial care, and the Maslach Burnout inventory. PARTICIPANTS: Participants included 22 junior-doctors from a large teaching hospital in Sydney, Australia. RESULTS: All participants reported that the training was useful, had been helpful for their communication with patients and that they would recommend the training to others. Significant improvements were found in participants' communication skills (in seven out of 21 specific and all three global communication behaviours assessed, range P=0.02 to <0.001), confidence in communicating about relevant topics (P<0.001), attitudes towards psychosocial care (P=0.03) and sense of personal accomplishment (P=0.043). There were no overall differences in participants' burnout levels. CONCLUSION: This intervention shows promise and warrants further formal evaluation.
Palliative Medicine 06/2012; · 2.38 Impact Factor
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ABSTRACT: The Australian Cancer Trials website (ACTO) was publicly launched in 2010 to help people search for cancer clinical trials recruiting in Australia, provide information about clinical trials and assist with doctor-patient communication about trials. We describe consumer involvement in the design and development of ACTO and report our preliminary patient evaluation of the website.
Consumers, led by Cancer Voices NSW, provided the impetus to develop the website. Consumer representative groups were consulted by the research team during the design and development of ACTO which combines a search engine, trial details, general information about trial participation and question prompt lists. Website use was analysed. A patient evaluation questionnaire was completed at one hospital, one week after exposure to the website.
ACTO's main features and content reflect consumer input. In February 2011, it covered 1, 042 cancer trials. Since ACTO's public launch in November 2010, until the end of February 2011, the website has had 2, 549 new visits and generated 17, 833 page views. In a sub-study of 47 patient users, 89% found the website helpful for learning about clinical trials and all respondents thought patients should have access to ACTO.
The development of ACTO is an example of consumers working with doctors, researchers and policy makers to improve the information available to people whose lives are affected by cancer and to help them participate in their treatment decisions, including consideration of clinical trial enrolment. Consumer input has ensured that the website is informative, targets consumer priorities and is user-friendly. ACTO serves as a model for other health conditions.
Health Research Policy and Systems 06/2011; 9:30. · 1.38 Impact Factor
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Martin H N Tattersall
Asia-Pacific Journal of Clinical Oncology 03/2011; 7(1):1-3. · 0.58 Impact Factor
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ABSTRACT: To understand the factors associated with oncologists' work preferences to help future workforce planning.
In May 2008 a questionnaire was e-mailed to members of the Medical Oncology Group of Australia, Fellowship of Radiation Oncologists and the New Zealand Association of Cancer Specialists. Univariate and multivariate analysis were used to determine if gender, age, specialist status or specialty were associated with the intention to work full time or part time or consider weekend or evening work, and with the level of satisfaction with current working hours.
In total, 205 medical and radiation oncologists and trainees responded. Overall 77 (38%) oncologists intended to work part time. There was strong evidence (P<0.0001) that women were more likely than men to want to work part time (OR 4.18, 95% CI, 2.12-8.22). Overall 52% of oncologists were not prepared to work on weekends. Women were less willing to consider working on weekends than men (P=0.02, OR 0.48, 95% CI 0.26-0.89). A total of 58% of oncologists felt they were working more than their ideal working hours. There was evidence (P<0.0001) that this was independently associated with oncology specialty; medical oncologists had twice the odds of feeling dissatisfied with their working hours compared with radiation oncologists (OR 2.18, 95% CI 1.20-3.94).
Female gender was the most important factor associated with wanting to work part time. This should be considered when planning the oncology workforce, particularly because an increasing number of oncologists are women.
Asia-Pacific Journal of Clinical Oncology 03/2011; 7(1):56-64. · 0.58 Impact Factor
