Exploring patients’ advance care planning needs during the annual 75+ health assessment: survey of Australian GPs’ views and current practice

The 75+ health assessment has been identified as a suitable trigger to introduce advance care planning (ACP) to general practice patients. Australian general practitioners (GPs) were surveyed to explore their perceptions, attitudes and practices in introducing ACP during 75+ health assessments. Methods. A cross-sectional postal survey of Australian GPs covering their personal, professional and workplace characteristics, their current practice regarding ACP within a 75+ health assessment, and their attitude towards ACP. Multivariate logistic regression was used to analyse the factors associated with routinely discussing ACP as part of the 75+ health assessment. Results. A total of 185 (19.2%) out of 964 eligible GPs returned a completed survey. Most GPs reported that patients interested in ACP were supported by the GPs or the practice nurse. Two factors, (1) attitude that ACP is an essential component of the 75+ health assessment, and (2) regional or rural location of the practice, had a statistically and clinically significant association with the GP’s self-reported discussion of ACP during 75+ health assessments. Conclusions. GPs showed a high level of support and involvement in discussing ACP during 75+ health assessments. ACP support during 75+ health assessments was often provided directly by the GP or via the practice nurse. Given the international evidence that ACP training programs improve skills and knowledge, and foster positive attitudes towards ACP, there is an important need to continue funding ACP training programs for GPs and practice nurse

Preliminary development and psychometric evaluation of an unmet needs measure for adolescents and young adults with cancer: the Cancer Needs Questionnaire - Young People (CNQ-YP)

<p>Abstract</p> <p>Background</p> <p>Adolescents and young adult (AYA) cancer survivors may have unique physical, psychological and social needs due to their cancer occurring at a critical phase of development. The aim of this study was to develop a psychometrically rigorous measure of unmet need to capture the specific needs of this group.</p> <p>Methods</p> <p>Items were developed following a comprehensive literature review, focus groups with AYAs, and feedback from health care providers, researchers and other professionals. The measure was pilot tested with 32 AYA cancer survivors recruited through a state-based cancer registry to establish face and content validity. A main sample of 139 AYA cancer patients and survivors were recruited through seven treatment centres and invited to complete the questionnaire. To establish test-retest reliability, a sub-sample of 34 participants completed the measure a second time. Exploratory factor analysis was performed and the measure was assessed for internal consistency, discriminative validity, potential responsiveness and acceptability.</p> <p>Results</p> <p>The Cancer Needs Questionnaire - Young People (CNQ-YP) has established face and content validity, and acceptability. The final measure has 70 items and six factors: Treatment Environment and Care (33 items); Feelings and Relationships (14 items); Daily Life (12 items); Information and Activities (5 items); Education (3 items); and Work (3 items). All domains achieved Cronbach's alpha values greater than 0.80. Item-to-item test-retest reliability was also high, with all but four items reaching weighted kappa values above 0.60.</p> <p>Conclusions</p> <p>The CNQ-YP is the first multi-dimensional measure of unmet need which has been developed specifically for AYA cancer patients and survivors. The measure displays a strong factor structure, and excellent internal consistency and test-retest reliability. However, the small sample size has implications for the reliability of the statistical analyses undertaken, particularly the exploratory factor analysis. Future studies with a larger sample are recommended to confirm the factor structure of the measure. Longitudinal studies to establish responsiveness and predictive validity should also be undertaken.</p

Effectiveness of interventions utilising telephone follow up in reducing hospital readmission within 30 days for individuals with chronic disease: a systematic review

Background: Rates of readmission to hospital within 30 days are highest amongst those with chronic diseases. Effective interventions to reduce unplanned readmissions are needed. Providing support to patients with chronic disease via telephone may help prevent unnecessary readmission. This systematic review aimed to determine the methodological quality and effectiveness of interventions utilising telephone follow up (TFU) alone or in combination with other components in reducing readmission within 30 days amongst patients with cardiovascular disease, chronic respiratory disease and diabetes. Methods: A systematic search of MEDLINE, the Cochrane Library and EMBASE were conducted for articles published from database inception to 19th May 2015. Interventions which included TFU alone, or in combination with other components, amongst patients with chronic disease, reported 30 day readmission outcomes and met Effective Practice and Organisation of Care design criteria were included. The titles and abstracts of all identified articles were initially assessed for relevance and rejected on initial screening by one author. Full text articles were assessed against inclusion criteria by two authors with discrepancies resolved through discussion. Results: Ten studies were identified, of which five were effective in reducing readmissions within 30 days. Overall, the methodological quality of included studies was poor. All identified studies combined TFU with other intervention components. Interventions that were effective included three studies which provided TFU in addition to pre-discharge support; and two studies which provided TFU with both pre- and post-discharge support which included education, discharge planning, physical therapy and dietary consults, medication assessment, home visits and a resident curriculum. There was no evidence that TFU and telemedicine or TFU and post-discharge interventions was effective, however, only one to two studies examined each of these types of interventions. Conclusions: Evidence is inconclusive for the effectiveness of interventions utilising TFU alone or in combination with other components in reducing readmissions within 30 days in patients with chronic disease. High methodological quality studies examining the effectiveness of TFU in a standardised way are needed. There is also potential importance in focusing interventions on enhancing provider skills in patient education, transitional care and conducting TFU

Improving adherence to colorectal cancer surveillance guidelines: results of a randomised controlled trial

BACKGROUND: Colorectal cancer (CRC) survivors are at increased risk of developing the disease again. Surveillance guidelines are aimed at maximising the early detection of recurring or new cancers and pre-cancerous polyps. The frequency and type of surveillance recommended depends on the type of treatment for the initial CRC, the extent of colonoscopic investigation prior to treatment and the results of previous surveillance tests. This paper aimed to test the effect of a paper–based educational intervention to improve adherence to colonoscopy following treatment for colorectal cancer. METHODS: People with a diagnosis of colorectal cancer within the last 10 months, aged ≥18 and English speaking were recruited through a population-based cancer registry in Australia. Participants were randomly allocated to either the intervention or control. Participants completed an interview at baseline. Self-reported participation in colonoscopy was obtained at 12 month followup by survey. Those allocated to the control received a generic pamphlet on colorectal cancer treatment; while intervention participants received a letter which provided specific information about guideline recommendations for surveillance colonoscopy. Rates of guideline adherence were compared between groups. The guideline recommendations for the timing of surveillance colonoscopy changed part way through the study. This change occurred after all intervention materials had been sent, but prior to all participants completing the 12 month follow up. Post hoc analyses were conducted to assess adherence to the new guidelines. RESULTS: Of the 767 participants, 604 (79%) had had surgery, had stage I – III disease and completed the baseline interview within 12 months of diagnosis (intervention = 305; control = 299). There was no significant difference between those adherent to surveillance colonoscopy guidelines, in the control (67, 27%) and intervention groups (80, 31%) at followup (difference = 4.3% (95%CI:-3.7%, 12%), χ2(1df) = 1.09, P = 0.296). Overall, 246 (49%) participants were adherent to the new guidelines, compared to 147 (29%) adherent to the old guidelines. CONCLUSIONS: Results indicate the paper-based educational intervention is not effective in improving adherence to colorectal cancer surveillance guidelines for colonoscopy.This research was supported by a National Health and Medical Research Council grant (Grant ID 510776), a Strategic Research Partnership Grant from Cancer Council NSW to the Newcastle Cancer Control Collaborative (New- 3C), and infrastructure funding from the Hunter Medical Research Institute. Dr. Mariko Carey is supported by a NHMRC TRIP Fellowshi

Are Australian general practice patients appropriately screened for colorectal cancer? A cross-sectional study.

BackgroundAustralia has one of the highest rates of colorectal cancer (CRC) in the world. Data from the National Bowel Cancer Screening Program (NBCSP) suggests that only one third of Australians eligible for CRC screening are up-to-date with CRC screening; however screening occurring outside the program is not captured.AimsThis study examines the self-reported CRC screening practices of general practice patients, and the factors associated with being under-screened for CRC.Methods A cross-sectional study conducted in five general practice clinics in NSW from 2015-2017. Participants were aged 50–75 and at average risk of CRC. Participants reported whether they had a faecal occult blood test (FOBT) in the past two years, including the source of FOBT; and whether they had a colonoscopy in the past five years and the reason for colonoscopy.Results Forty-nine per cent of participants completed a FOBT in the past two years. Of these, 62 per cent sourced their FOBT from the NBCSP and 25 per cent from their general practitioner. Thirty-seven per cent of participants reported colonoscopy in the past five years. Of these, 29 per cent received potentially inappropriate colonoscopy. Thirty-two per cent of the samples were classified as under-screened. Older adults were less likely to be under-screened.ConclusionCRC screening rates were higher than those reported by the NBCSP, however a significant proportion of participants remain under-screened. Over one-quarter of participants reporting colonoscopy in the past five years may have undergone unnecessary colonoscopy. These findings indicate that more needs to be done at a general practice level to facilitate risk-appropriate CRC screening

Monitoring stormwater contaminants in the Puget Sound nearshore: an active biomonitoring tool using transplanted mussels (Mytilus trossulus)

Stormwater delivers a diverse range of contaminants to receiving waters including Puget Sound. Monitoring stormwater pollutants and their effects on biota is critical to informing best management practices aimed at recovering Puget Sound health. In the winter of 2012/13, the Washington Department of Fish and Wildlife’s Toxics-focused Biological Observation System (TBiOS) team conducted a pilot study using transplanted mussels to characterize the extent and magnitude of contamination in nearshore biota of Puget Sound. Mussels are now a key TBiOS indicator organism for tracking contaminants in the nearshore, and the Stormwater Action Monitoring (SAM) program has adopted mussels for nearshore stormwater monitoring as well. SAM now serves as the primary funder of nearshore mussel monitoring in Puget Sound and the first two SAM mussel monitoring surveys were conducted during the winters of 2015/16 and 2017/18, with future surveys planned on a biennial basis. These mussel surveys utilized native bay mussels (Mytilus trossulus) from a local aquaculture source that were transplanted into anti-predator cages to locations along the Puget Sound shoreline. Monitoring sites covered a broad range of upland land-use types, from rural to highly urban, and concentrations of organic contaminants and metals were measured in the mussels after a two to three-month winter deployment period. Data from the first two years of mussel surveys (2012/13, 2015/16) indicates polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) were the most abundant organic contaminants of those tested in the nearshore. Concentrations of both contaminants were significantly higher in the most urbanized areas and were positively correlated with impervious surface in upland watersheds adjacent to the nearshore. Patterns of PAHs (i.e. PAH fingerprints) in mussels from different locations demonstrate how mussels might be useful as indicators of sources for this particular class of stormwater contaminants in Puget Sound

Frequent avoidable admissions amongst Aboriginal and non-Aboriginal people with chronic conditions in New South Wales, Australia: a historical cohort study

Background: Aboriginal and Torres Strait Islander people have high rates of avoidable hospital admissions for chronic conditions, however little is known about the frequency of avoidable admissions for this population. This study examined trends in avoidable admissions among Aboriginal and non-Aboriginal people with chronic conditions in New South Wales (NSW), Australia. Methods: A historical cohort analysis using de-identified linked administrative data of Aboriginal patients and an equal number of randomly sampled non-Aboriginal patients between 2005/06 to 2013/14. Eligible patients were admitted to a NSW public hospital and who had one or more of the following ambulatory care sensitive chronic conditions as a principal diagnosis: diabetic complications, asthma, angina, hypertension, congestive heart failure and/or chronic obstructive pulmonary disease. The primary outcomes were the number of avoidable admissions for an individual in each financial year, and whether an individual had three or more admissions compared with one to two avoidable admissions in each financial year. Poisson and logistic regression models and a test for differences in yearly trends were used to assess the frequency of avoidable admissions over time, adjusting for sociodemographic variables and restricted to those aged ≤75 years. Results: Once eligibility criteria had been applied, there were 27,467 avoidable admissions corresponding to 19,025 patients between 2005/06 to 2013/14 (71.2% Aboriginal; 28.8% non-Aboriginal). Aboriginal patients were 15% more likely than non-Aboriginal patients to have a higher number of avoidable admissions per financial year (IRR = 1.15; 95% CI: 1.11, 1.20). Aboriginal patients were almost twice as likely as non-Aboriginal patients to experience three or more avoidable admissions per financial year (OR = 1.90; 95% CI = 1.60, 2.26). There were no significant differences between Aboriginal and non-Aboriginal people in yearly trends for either the number of avoidable admissions, or whether or not an individual experienced three or more avoidable admissions per financial year (p = 0.859; 0.860 respectively). Conclusion: Aboriginal people were significantly more likely to experience frequent avoidable admissions over a nine-year period compared to non-Aboriginal people. These high rates reflect the need for further research into which interventions are able to successfully reduce avoidable admissions among Aboriginal people, and the importance of culturally appropriate community health care

Protocol of a multi-centre randomised controlled trial of a web-based information intervention with nurse-delivered telephone support for haematological cancer patients and their support persons

BACKGROUND: High rates of anxiety, depression and unmet needs are evident amongst haematological cancer patients undergoing treatment and their Support Persons. Psychosocial distress may be minimised by ensuring that patients are sufficiently involved in decision making, provided with tailored information and adequate preparation for potentially threatening procedures. To date, there are no published studies evaluating interventions designed to reduce psychosocial distress and unmet needs specifically in patients with haematological cancers and their Support Persons. This study will examine whether access to a web-based information tool and nurse-delivered telephone support reduces depression, anxiety and unmet information needs for haematological cancer patients and their Support Persons. METHODS/DESIGN: A non-blinded, parallel-group, multi-centre randomised controlled trial will be conducted to compare the effectiveness of a web-based information tool and nurse-delivered telephone support with usual care. Participants will be recruited from the haematology inpatient wards of five hospitals in New South Wales, Australia. Patients diagnosed with acute myeloid leukaemia, acute lymphoblastic leukaemia, Burkitt’s lymphoma, Lymphoblastic lymphoma (B or T cell), or Diffuse Large B-Cell lymphoma and their Support Persons will be eligible to participate. Patients and their Support Persons will be randomised as dyads. Participants allocated to the intervention will receive access to a tailored web-based tool that provides accurate, up-to-date and personalised information about: cancer and its causes; treatment options including treatment procedures information; complementary and alternative medicine; and available support. Patients and Support Persons will complete self-report measures of anxiety, depression and unmet needs at 2, 4, 8 and 12 weeks post-recruitment. Patient and Support Person outcomes will be assessed independently. DISCUSSION: This study will assess whether providing information and support using web-based and telephone support address the major psychosocial challenges faced by haematological patients and their Support Persons. The approach, if found to be effective, has potential to improve psychosocial outcomes for haematological and other cancer patients, reduce the complexity and burden of meeting patients’ psychosocial needs for health care providers with high potential for translation into clinical practice. .The study is funded by Cancer Institute New South Wales (10/THS/2-14). This research was also supported by a Strategic Research Partnership grant provided by Cancer Council New South Wales to the Newcastle Cancer Control Collaborative, and infrastructure funding from the Hunter Medical Research Institute. Dr. Jamie Bryant is supported by an Australian Research Council Post-Doctoral Industry Fellowship. A/Prof Christine Paul is supported by an NHMRC Career Development Fellowship. Dr. Flora Tzelepis was supported by a Leukaemia Foundation of Australia and Cure Cancer Australia Foundation Post-Doctoral Research Fellowship

Agreement between patients' and radiation oncologists' cancer diagnosis and prognosis perceptions: A cross sectional study in Japan

This study assessed agreement between radiation oncologist- and cancer patient-reported perceptions about cancer diagnosis, time since diagnosis, treatment purpose, and whether life expectancy had been discussed; and described preferences for prognosis discussions. Adult cancer patients receiving radiotherapy at a Japanese hospital were invited to complete a touchscreen tablet survey. Patient survey responses were linked and comparisons made with a survey completed by their radiation oncologist. Among 146 cancer patient-oncologist dyads, there was almost perfect agreement on cancer diagnosis (ĸ = 0.88, 95% CI: 0.82–0.94), substantial agreement on time since diagnosis (ĸ = 0.70, 95% CI: 0.57–0.83) and moderate agreement on whether treatment goal was curative or palliative (ĸ = 0.44, 95% CI: 0.28–0.57; all p’s < 0.0001). Agreement about whether a life expectancy discussion had occurred was less than expected by chance (κ = -0.06, p = 0.9). Radiation oncologists reported that they had spoken to over two thirds of patients about this, whilst less than one third of patients stated that this discussion had occurred with their radiation oncologist. Over half of the patients who had not discussed life expectancy wanted to. Patients had variable preferences for whether they (80%), their radiation oncologist (78%) or their partner/family (52%) should decide whether they discuss their life expectancy. Although patient self-reported information about diagnosis and time since diagnosis appears to be reasonably accurate (compared with clinician-reported information), limitations of self-reported data about prognostic discussions were highlighted by poor agreement between patient- and clinician-reported information about whether prognostic discussions have occurred. Additional support is needed to improve prognosis communication and understanding in radiation oncology settings

Input of PBDE exposure in juvenile Chinook salmon along their out-migrant pathway through the Snohomish River, WA

Polybrominated diphenyl ether (PBDE) flame retardant inputs to Puget Sound may be impairing the health of juvenile Chinook salmon and reducing their early marine survival in the Salish Sea, possibly contributing to their decline and limiting their recovery. Previous studies have shown Chinook salmon outmigrating from the Snohomish River accumulate PBDEs at concentrations high enough to alter their immune response, increasing their susceptibility to naturally occurring diseases; however, the source of PBDEs is unknown. Our study objective was to determine where in the Snohomish River system migrating Chinook salmon are exposed to and accumulate PBDEs, and to assess the source so that corrective actions can be implemented. Levels of PBDEs and other persistent organic pollutants were measured in salmon from the upstream tributaries of the Snoqualmie and Skykomish regions, representing the cumulative exposure from all sources prior to entering the Snohomish River, and were compared to those in salmon from subsequent downstream regions of the mainstem to assess where salmon are exposed and the exposure source. Additionally, contaminant levels were measured in salmon sampled from distributary channels of the lower delta to evaluate the extent of PBDE exposure in the outmigrating Snohomish River population. Analyses of the contaminant and body burden data reveal that juvenile Chinook salmon are primarily exposed to and accumulate PBDEs at two sites within the lower delta of the Snohomish River, both located in the immediate vicinity of a wastewater treatment plant outfall. Identification of the region within the Snohomish watershed where salmon are most exposed to PBDEs, as well as the source, allows environmental managers to establish corrective actions to control PBDE inputs. Ultimately, reductions in PBDE exposure should improve the health of Chinook salmon and enhance their marine survival