Novice Nurses’ Experiences With Palliative and End-of-Life Communication

Health care providers recognize that delivery of effective communication with family members of children with life-threatening illnesses is essential to palliative and end-of-life care (PC/EOL). Parents value the presence of nurses during PC/EOL of their dying child. It is vital that nurses, regardless of their years of work experience, are competent and feel comfortable engaging family members of dying children in PC/EOL discussions. This qualitative-descriptive study used focus groups to explore the PC/EOL communication perspectives of 14 novice pediatric oncology nurses (eg, with less than 1 year of experience). Audio-taped focus group discussions were reviewed to develop the following 6 theme categories: (a) Sacred Trust to Care for the Child and Family, (b) An Elephant in the Room, (c) Struggling with Emotional Unknowns, (d) Kaleidoscope of Death: Patterns and Complexity, (e) Training Wheels for Connectedness: Critical Mentors during PC/EOL of Children, and (f) Being Present with an Open Heart: Ways to Maintain Hope and Minimize Emotional Distress. To date, this is the first study to focus on PC/EOL communication perspectives of novice pediatric oncology nurses

Crop Updates 2008 - Farming Systems

This session covers thirty nine papers from different authors: PLENARY 1. Developments in grain end use, Dr John de Majnik, New Grain Products, GRDC, Mr Paul Meibusch, New Farm Products and Services, GRDC, Mr Vince Logan, New Products Executive Manager, GRDC PRESENTATIONS 2. Global warming potential of wheat production in Western Australia: A life cycle assessment, Louise Barton1, Wahid Biswas2 and Daniel Carter3, 1School of Earth & Geographical Sciences, The University of Western Australia, 2Centre of Excellence in Cleaner Production, Division of Science and Engineering, Curtin University of Technology, 3Department of Agriculture and Food 3. How much fuel does your farm use for different farm operations? Nicolyn Short1, Jodie Bowling1, Glen Riethmuller1, James Fisher2 and Moin Salam1, 1Department of Agriculture and Food, 2Muresk Institute, Curtin University of Technology 4. Poor soil water storage and soil constraints are common in WA cropping soils, Stephen Davies, Jim Dixon, Dennis Van Gool and Alison Slade, Department of Agriculture and Food, Bob Gilkes, School of Earth and Geographical Sciences, University of Western Australia 5. Developing potential adaptations to climate change for low rainfall farming system using economic analysis tool. STEP, Megan Abrahams, Caroline Peek, Dennis Van Gool, Daniel Gardiner and Kari-Lee Falconer, Department of Agriculture and Food 6. What soil limitations affect the profitability of claying on non-wetting sandplain soils? David Hall1, Jeremy Lemon1, Harvey Jones1, Yvette Oliver2 and Tania Butler1, 1Department of Agriculture and Food, 2CSIRO Div Sustainable Ecology, Perth 7. Farming systems adapting to a variable climate; Two case studies, Kari-Lee Falconer, Department of Agriculture and Food 8. Importance of accounting for variation in crop yield potential when making fertiliser decisions, Michael Robertson and Yvette Oliver, CSIRO Sustainable Ecosystems, Floreat 9. Soil acidity is a widespread problem across the Avon River Basin, Stephen Carr1, Chris Gazey2, David York1 and Joel Andrew1, 1Precision SoilTech, 2Department of Agriculture and Food 10. The use of soil testing kits and ion-selective electrodes for the analysis of plant available nutrients in Western Australian soils, Michael Simeoni and Bob Gilkes School of Earth and Geographical Sciences, University of Western Australia 11. Redlegged earth mite resistance and integrated strategies for their control in Western Australia, Mangano G. Peter and Micic Svetlana, Department of Agriculture and Food 12. The economics of treating soil pH (liming), Chris Gazey, Steve Davies, Dave Gartner and Adam Clune, Department of Agriculture and Food, 13. Health benefits – A future differentiator for high value grains, Matthew Morell, Theme Leader, CSIRO Food Futures Flagship 14. Carbon in Sustralian cropping soils – We need to be realistic, Alan Umbers (M Rur Sc), GRDC/DAFF Sustainable Industries Initiative Project 15. AGWEST® Bartolo bladder clover (Trifolium spumosum) − a low cost annual pasture legume for the wheat/sheep zone, Angelo Loi, Brad Nutt and Clinton Revell, Department of Agriculture and Food 16. Maximising the value of point based soil sampling: Monitering trends in soil pH through time, Joel Andrew1, David York1, Stephen Carr1 and Chris Gazey2, 1Precision SoilTech, 2Department of Agriculture and Food 17. Improved crop root growth and productivity with deep ripping and deep placed lime, Stephen Davies1, Geoff Kew2*, Chris Gazey1, David Gartner1 and Adam Clune1, 1Department of Agriculture and Food, 2School of Earth and Geographical Sciences University of Western Australia, *Presenting author 18. The role of pastures in hosting Root Lesion Nematode (RLN, Pratylenchus neglectus), Vivien Vanstone, Ali Bhatti and Ming Pei You, Department of Agriculture and Food 19. To rip or not to rip. When does it pay? Imma Farre, Bill Bowden and Stephen Davies, Department of Agriculture and Food 20. Can yield be predicted from remotely sensed data, Henry Smolinski, Jane Speijers and John Bruce, Department of Agriculture and Food 21. Rotations for profit, David McCarthy and Gary Lang, Facey Group, Wickepin, WA 22. Rewriting rules for the new cropping economics, David Rees, Consultant, Albany 23. Reducing business risk in Binnu! – A case study, Rob Grima, Department of Agriculture and Food 24. Does improved ewe management offer grain farmers much extra profit? John Young, Farming Systems Analysis Service, Ross Kingwell, Department of Agriculture and Food, and UWA, Chris Oldham, Department of Agriculture and Food RESEARCH HIGHLIGHTS 25. Crop establishment and productivity with improved root zone drainage, Dr Derk Bakker, Research Officer, Department of Agriculture and Food 26. Will wheat production in Western Australia be more risky in the future? Imma Farre and Ian Foster, Department of Agriculture and Food PAPERS 27. Building farmers’ adaptive capacity to manage seasonal variability and climate change, David Beard, Department of Agriculture and Food 28. Precision placement increases crop phosphorus uptake under variable rainfall: Simulation studies, Wen Chen1 2, Richard Bell1, Bill Bowden2, Ross Brennan2, Art Diggle2 and Reg Lunt2, 1School of Environmental Science, Murdoch University, 2Department of Agriculture and Food 29. What is the role of grain legumes on red soil farms? Rob Grima, Department of Agriculture and Food 30. Fertiliser placement influences plant growth and seed yield of grain crops at different locations of WA, Qifu Ma1, Zed Rengel1, Bill Bowden2, Ross Brennan2, Reg Lunt2 and Tim Hilder2, 1Soil Science & Plant Nutrition, University of Western Australia, 2Department of Agriculture and Food 31. A review of pest and disease occurrences for 2007, Peter Mangano and Dusty Severtson, Department of Agriculture and Food 32. Effect of stocking rates on grain yield and quality of wheat in Western Australia in 2007, Shahajahan Miyan, Sam Clune, Barb Sage and Tenielle Martin, Department of Agriculture and Food 33. Storing grain is not ‘set and forget’ management, Chris Newman, Department of Agriculture and Food 34. Improving understanding of soil plant available water capacity (PAWC): The WA soil water database (APSoil), Yvette Oliver, Neal Dalgliesh and Michael Robertson, CSIRO Sustainable Ecosystems 35. The impact of management decisions in drought on a low rainfall northern wheatbelt farm, Caroline Peek and Andrew Blake, Department of Agriculture and Food 37. Cullen – A native pasture legume shows promise for the low-medium rainfall cropping zone, Megan Ryan, Richard Bennett, Tim Colmer, Daniel Real, Jiayin Pang, Lori Kroiss, Dion Nicol and Tammy Edmonds-Tibbett, School of Plant Biology, The University of Western Australia and Future Farm Industries CRC 38. Climate risk management tools – useful, or just another gadget? Lisa Sherriff, Kari-Lee Falconer, Daniel Gardiner and Ron McTaggart Department of Agriculture and Food 39. Benefits of crop rotation for management of Root Lesion Nematode (RLN, Pratylenchus neglectus), Vivien Vanstone, Sean Kelly and Helen Hunter, Department of Agriculture and Foo

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Novice Nurses’ Experiences With Palliative and End-of-Life Communication

Health care providers recognize that delivery of effective communication with family members of children with life-threatening illnesses is essential to palliative and end-of-life care (PC/EOL). Parents value the presence of nurses during PC/EOL of their dying child. It is vital that nurses, regardless of their years of work experience, are competent and feel comfortable engaging family members of dying children in PC/EOL discussions. This qualitative-descriptive study used focus groups to explore the PC/EOL communication perspectives of 14 novice pediatric oncology nurses (eg, with less than 1 year of experience). Audio-taped focus group discussions were reviewed to develop the following 6 theme categories: (a) Sacred Trust to Care for the Child and Family, (b) An Elephant in the Room, (c) Struggling with Emotional Unknowns, (d) Kaleidoscope of Death: Patterns and Complexity, (e) Training Wheels for Connectedness: Critical Mentors during PC/EOL of Children, and (f) Being Present with an Open Heart: Ways to Maintain Hope and Minimize Emotional Distress. To date, this is the first study to focus on PC/EOL communication perspectives of novice pediatric oncology nurses