Rae Thomas

Bond University · Institute for Evidence-Based Healthcare

Objective To identify healthcare professionals' knowledge, self‐reported use, and documentation of clinical decision aids (CDAs) in a large ED in Australia, to identify behavioural determinants influencing the use of CDAs, and healthcare professionals preferences for integrating CDAs into the electronic medical record (EMR) system. Methods Healthc...

Introduction: Consistent evidence shows pathology services are overused worldwide and that about one-third of testing is unnecessary. Audit and feedback (AF) is effective for improving care but few trials evaluating AF to reduce pathology test requesting in primary care have been conducted. The aim of this trial is to estimate the effectiveness of...

Background: Screening for asymptomatic health conditions is perceived as mostly beneficial, with possible harms receiving little attention. Aims: To quantify proximal and longer-term consequences for individuals receiving a diagnostic label following screening for an asymptomatic, non-cancer health condition. Method: Five electronic databases...

The primary objective of this trial is to estimate the effectiveness of audit and feedback for reducing requests for 10 commonly overused combinations of pathology tests by high-requesting Australian general practitioners (GPs) compared with no intervention control. This includes requests for any combination of 2 or 3 pathology tests for Iron Studi...

Objectives The treatment workload associated with end-stage kidney disease (ESKD) is high. The treatment burdens experienced by patients with ESKD are not well understood. In this study, we aimed to elucidate the most important areas of treatment burden for discussion in a clinical encounter from the perspectives of patients with ESKD and nephrolog...

Importance: Appropriate diagnosis of attention-deficit/hyperactivity disorder (ADHD) can improve some short-term outcomes in children and adolescents, but little is known about the association of a diagnosis with their quality of life (QOL). Objective: To compare QOL in adolescents with and without an ADHD diagnosis. Design, setting, and partic...

Objectives Organisations that develop clinical practice guidelines (CPGs) encourage involvement of patients and the publics in their development, however, there are no standard methodologies for doing so. To examine how CPGs report patient and public involvement (PPI), we conducted a scoping review of the evidence addressing the following four ques...

This study aimed to explore the impact of health literacy on psychosocial and behavioural outcomes for people who were not at high risk of cardiovascular disease receiving a hypothetical blood pressure reading of 135/85 mmHg. We performed a secondary analysis of data from a national sample of Australians aged 40 to 50 years (n = 1318) recruited onl...

Objectives: To develop a thematic framework for the range of consequences arising from a diagnostic label from an individual, family/caregiver, healthcare professional, and community perspective. Design: Systematic scoping review of qualitative studies. Search Strategy: We searched PubMed, Embase, PsycINFO, Cochrane, and CINAHL for primary studies...

This paper examines the efficacy of a universally-offered parenting program, Tuning in to Toddlers (TOTS), that aims to improve parent emotion socialization, reduce parent and toddler stress and improve social, emotional, and behavioral functioning in toddlers. Three hundred parents of an 18–36 month old toddler were cluster randomized into interve...

Rationale The public should be informed about overtesting and overdiagnosis. Diverse qualitative studies have examined public understandings of this information. A synthesis was needed to systematise the body of evidence and yield new, generalisable insights. Aim Synthesise data from qualitative studies exploring patient and public understanding o...

Background Current guidelines recommend that patients attending general practice should be screened for excess weight, and provided with weight management advice. Objective This study sought to elicit the views of people with overweight and obesity about the role of GPs in initiating conversations about weight management. Methods Participants wit...

Importance Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-c...

Background Recent US guidelines lowered the threshold for diagnosing hypertension while other international guidelines use alternative/no labels for the same group (blood pressure [BP], <140/90 mm Hg). We investigated potential benefits and harms of hypertension and high-normal BP labels, compared with control, among people at lower risk of cardiov...

Objective Public cooperation to practise preventive health behaviours is essential to manage the transmission of infectious diseases such as COVID-19. We aimed to investigate beliefs about COVID-19 diagnosis, transmission and prevention that have the potential to impact the uptake of recommended public health strategies. Design An online cross-sec...

Background: The majority of small papillary thyroid cancers (sPTCs) are treated surgically, rather than by active surveillance. Patient and clinician preference for surgery may be partially driven by the use of cancer terminology. Some experts propose that changing terminology would better communicate the indolent nature of sPTCs and improve uptake...

Objectives We examined the effect of ‘labels’ versus ‘descriptions’ across four asymptomatic health conditions: pre-diabetes, pre-hypertension, mild hyperlipidaemia, and chronic kidney disease stage 3A, on participants’ intentions to pursue further tests. There were four secondary objectives: 1) assessing confidence and satisfaction in their intent...

Background: Timely and effective contact tracing is an essential public health measure for curbing the transmission of COVID-19. App-based contact tracing has the potential to optimize the resources of overstretched public health departments. However, its efficiency is dependent on widespread adoption. Objective: This study aimed to investigate th...

Introduction: When health conditions are labelled it is often to classify and communicate a set of symptoms. While diagnostic labelling can provide explanation for an individual's symptoms, it can also impact how individuals and others view those symptoms. Despite existing research regarding the effects of labelling health conditions, a synthesis...

Introduction: Clinical practice guidelines (CPGs) are intended to optimise patient care by recommending care pathways based on the best available research evidence and practice experience. Patient and public involvement (PPI) in healthcare is recommended based on the expectation that it will improve the quality and relevance of outcomes. There is...

BACKGROUND Timely and effective contact tracing is an essential public health role to curb the transmission of COVID-19. App-based contact tracing has the potential to optimise the resources of overstretched public health departments. However, its efficiency is dependent on wide-spread adoption. OBJECTIVE We aimed to identify the proportion of peo...

Habit-based interventions are a novel and emerging strategy to help reduce excess weight in individuals with overweight or obesity. This systematic review and meta-analysis aims to determine the efficacy of habit-based interventions on weight loss. We identified potential studies through electronic searches in February 2019. Included studies were r...

Objective: Public cooperation to practice preventive health behaviours is essential to manage the transmission of infectious diseases such as COVID-19. We aimed to investigate beliefs about COVID-19 diagnosis, transmission and prevention that have the potential to impact the uptake of recommended public health strategies. Design: An online cross-se...

Introduction Examining patient and public understanding of overtesting and overdiagnosis (OverTD) is vital for reducing the burden of OverTD. Studies from disparate contexts, disciplines and focusing on disparate healthcare issues have examined patient and public understanding of OverTD. A synthesis is needed to bring this literature together, exam...

Background Timely and effective contact tracing is an essential public health role to curb the transmission of COVID-19. App-based contact tracing has the potential to optimise the resources of overstretched public health departments. However, it’s efficiency is dependent on wide-spread adoption. We aimed to identify the proportion of people who ha...

Background: There is no international diagnostic agreement for gestational diabetes mellitus (GDM). In 2014, Australia adopted a new definition and testing procedure. Since then, significantly more women have been diagnosed with GDM but with little difference in health outcomes. We explored the priorities and preferences of women potentially impac...

Background: Gestational diabetes mellitus (GDM) - a transitory form of diabetes induced by pregnancy - has potentially important short and long-term health consequences for both the mother and her baby. There is no globally agreed definition of GDM, but definition changes have increased the incidence in some countries in recent years, with some re...

Objectives The objective of this study is to use a recently developed framework of questions to systematically determine if the existing literature indicates a potential for overdiagnosis and overtreatment in ADHD. We hypothesize that ADHD fulfils the pre-determined criteria for overdiagnosis. A secondary aim of the study will be to examine and hig...

Changing disease or health risk definitions and labels where there is a case for no or little net benefit and significant harm, has the potential to affect millions of people worldwide. It appears, on the surface, to be a comparatively sustainable intervention to mitigate overdiagnosis and overtreatment, requiring only a one-off policy change. In p...

Objectives Women diagnosed with gestational diabetes mellitus (GDM) are potentially at increased risk for physical complications such as increased rates of caesarean sections, large babies, and babies with shoulder dystocia and low blood sugar. Diagnosis may offer opportunities to change behaviours yet emotional harms such as high levels of anxiety...

Background: Widening definitions of health conditions have the potential to affect millions of people and should only occur when there is strong evidence of benefit. In the last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5 Committee changed the Attention Deficit Hyperactivity Disorder (ADHD) age of onset cr...

Introduction Worldwide, attention deficit hyperactivity disorder (ADHD) diagnosis rates in children and adolescents have been increasing consistently over the past decades, fuelling a debate about the underlying reasons for this trend. While many hypothesise that a substantial number of these additional cases are overdiagnosed, to date there has be...

Aims: To assess the completeness of reporting of group-based education interventions for the management of type 2 diabetes. Methods: A previous systematic review of group-based education programmes for adults with type 2 diabetes identified eligible intervention studies. Data were extracted and assessed using the Template for Intervention Descri...

Abstract Background Healthcare professionals are recommended to use evidence-based practice (EBP) principles to update and improve clinical practice. Well-designed educational initiatives, together with practice and feedback opportunities can improve individuals’ EBP knowledge, skills and attitudes. Methods A concurrent mixed methods assessment was...

Background: Parenting a toddler is a challenging experience for many parents with times of emotional dysregulation in both parent and child. Parenting interventions may be useful for parents to improve their ability to regulate emotions and respond to children’s emotions in a way that assists the child to understand and regulate emotions (emotion c...

Background Public participation in health policy decision making is thought to improve the quality of the decisions and enhance their legitimacy. Citizen/Community Juries (CJs) are a form of public participation that aims to elicit an informed community perspective on controversial topics. Reporting standards for CJ processes have already been prop...

Background Case‐finding for dementia is practised by general practitioners (GPs) in Australia but without an awareness of community preferences. We explored the values and preferences of informed community members around case‐finding for dementia in Australian general practice. Design, setting and participants A before and after, mixed‐methods stu...

Objectives: The objective of this study was to determine whether habit-based interventions are clinically beneficial in achieving long-term (12-month) weight loss maintenance and explore whether making new habits or breaking old habits is more effective. Methods: Volunteer community members aged 18-75 years who had overweight or obesity (BMI ≥ 2...

Background Structured journal clubs are a widely used tool to promote evidence-based practice in health professionals, however some journal clubs (JC) are more effectively sustained than others. To date, little research has provided insights into factors which may influence sustainability of JCs within health care settings. As part of a larger rand...

Objectives Widening disease definitions is a major driver of overdiagnosis. In response, the Preventing Overdiagnosis working group of the Guidelines International Network developed a checklist to provide guidance on issues to consider when modifying disease definitions. This checklist recommends panels outline definition changes and the trigger fo...

Objectives Negative consequences of medical labelling have been reported in research literature¹ and differences in an individual’s intention to undertake further testing have been shown in studies that randomly assigned participants to labelled and unlabeled hypothetical medical scenarios.² When given information about overdiagnosis of polycystic...

Background: Journal clubs (JC) may increase clinicians' evidence-based practice (EBP) skills and facilitate evidence uptake in clinical practice, however there is a lack of research into their effectiveness in allied health. We investigated the effectiveness of a structured JC that is Tailored According to Research Evidence And Theory (TREAT) in i...

Objectives Habit-based weight-loss interventions have shown clinically important weight loss and weight-loss maintenance. Understanding why habit-based interventions work is therefore of great value, but there is little qualitative evidence about the experiences of participants in such programmes. We explored the perspectives of individuals who com...

Context: Parent-child interaction therapy (PCIT) is effective at reducing children's externalizing behavior. However, modifications are often made to PCIT, and it is not known whether these impact effectiveness. Objective: To systematically review and meta-analyze the effects of PCIT on child externalizing behaviors, considering modifications, s...

Group-based education has the potential to substantially improve the outcomes of individuals with type 2 diabetes mellitus (T2DM) and reduce the enormous burden that chronic diseases place on healthcare systems worldwide. Despite this proven effectiveness, the utilisation of group services for the management of T2DM by Australian dietitians is surp...

Objective: The objective of this study was to explore the experiences of individuals who participated in a group-based education program, including their motivators in relation to their diabetes management, and the perceived impact of group interactions on participants' experiences and motivation for self-management. Understanding individuals diag...

Citizens’/community juries [CJs] engage members of the public in policy decision-making processes. CJs can be employed to develop policy responses to health problems that require the consideration of both community values and scientific evidence. Based on the principles of deliberative democracy, recent reviews indicate that findings from CJs have...

Aims: Patient education for the management of Type 2 diabetes can be delivered in various forms, with the goal of promoting and supporting positive self-management behaviours. This systematic review aimed to determine the effectiveness of group-based interventions compared with individual interventions or usual care for improving clinical, lifesty...

Background Overdiagnosis is considered a risk associated with the diagnosis of osteoporosis–as many people diagnosed won’t experience harm from the condition. As yet there’s little evidence on community understanding of overdiagnosis outside cancer- where it is an established risk of some screening programs–or effective ways to communicate about it...

This was the moderator guide used to guide the moderator/facilitator. (PDF)

This Explanatory Statement was given to focus group participants. (PDF)

This was the powerpoint presentation shown to participants, which included the discussion questions for the first hour and for the second hour, the video portions were embedded within it. (PPTX)

This is the transcript of the audio for the video presentations given to participants. (PDF)

Despite the significance placed on lifestyle interventions for obesity management, most weight loss is followed by weight regain. Psychological concepts of habitual behaviour and automaticity have been suggested as plausible explanations for this overwhelming lack of long-term weight loss success. Interventions that focus on changing an individual'...

Although many interventions for child externalizing behavior report promising outcomes for families, high attrition prior to program completion remains a problem. Many programs report dropout rates of 50% or higher. In this trial we sought to reduce attrition and improve outcomes by augmenting a well-known evidence-based intervention, Parent–Child...

Background Opportunities for community members to actively participate in policy development are increasing. Community/citizen's juries (CJs) are a deliberative democratic process aimed to illicit informed community perspectives on difficult topics. But how comprehensive these processes are reported in peer‐reviewed literature is unknown. Adequate...

Aim: The present study developed and evaluated a patient-centred, patient-directed, group-based education program for the management of type 2 diabetes mellitus. Methods: Two frameworks, the Medical Research Council (MRC) framework for developing and evaluating complex interventions and the RE-AIM framework were followed. Data to develop the int...

Objectives: To elicit the views of well informed community members on the ethical obligations of general practitioners regarding prostate-specific antigen (PSA) testing, and what should be required before a man undergoes a PSA test. Design and setting: Three community juries held at the University of Sydney over 6 months in 2014. Participants:...

Background and objective: Overdiagnosis and underdiagnosis of attention-deficit/hyperactivity disorder (ADHD) are widely debated, fueled by variations in prevalence estimates across countries, time, and broadening diagnostic criteria. We conducted a meta-analysis to: establish a benchmark pooled prevalence for ADHD; examine whether estimates have...

Self-determination theorists argue that parents can support or thwart their children's psychological needs for relatedness, autonomy, and competence. The first aim of this study was to develop a measure to assess six dimensions of parenting theoretically linked to meeting toddlers' needs. The second aim was to examine the associations of these dime...

Prostate-specific antigen (PSA) screening is controversial. A community jury allows presentation of complex information and may clarify how participants view screening after being well-informed. We examined whether participating in a community jury had an effect on men's knowledge about and their intention to participate in PSA screening. Random al...

Objectives: To determine how many children had health problems identified by the Healthy Kids Check (HKC) and whether this resulted in changes to clinical management. Design, setting and participants: A medical records audit from two Queensland general practices, identifying 557 files of children who undertook an HKC between January 2010 and May...

Cancer screening policies and programmes should take account of public values and concerns. This study sought to determine the priorities, values and concerns of men who were 'fully informed' about the benefits and harms of prostate-specific antigen (PSA) screening; and empirically examine the value of a community jury in eliciting public values on...

Conducting a screening program is one thing, communicating the results to individuals is another altogether. We believe effective communication to be the nexus of health decision-making. How you convey screening choices and results to parents, teachers, and children may have both positive and negative consequences to parental and teacher perception...