Cancer multidisciplinary team meetings in rural and metropolitan South Australia: an evaluation of structure and practice

Aim: To gain an understanding of the key components of multidisciplinary team (MDT) meeting structure and practice; with the aim of improving current practice and informing best practice for future cancer MDTs. Methods: A retrospective review of MDT meeting documentation was undertaken, between June and July 2009, at the South Australian sites of two pilot cancer MDTs: a rural MDT which started running fortnightly meetings in October 2008, and a metropolitan MDT which started fortnightly meetings in December 2008. Data was collected with an evaluation database developed using the MDTs’ Terms of Reference (e.g. objectives, operational guidelines and protocols), meeting records (e.g. attendance lists, agenda, minutes) and templates (e.g. treatment plan pro-forma). The database consisted of two major sections: one for collecting data on the administrative aspects of running MDT meetings, another for collecting aggregated clinical discussion data. Results: Over the evaluation period, the mean number of cases discussed per MDT meeting was 6.9 (SD 3.3, range 1–12 patients) for the rural MDT and 7.2 (SD 1.7, range 4–10 patients) for the metropolitan MDT. Patient information required for comprehensive case presentation was not complete for 29% of rural MDT meetings and 18% of metropolitan meetings. Whereas the rural MDT documented that referring clinicians (100%) and general practitioners (100%) had been formally informed of MDT meeting outcomes, the metropolitan MDT did not captured that information. Rural MDT meetings were attended by approximately 16 (SD 3.6, range 8–22) core team members, with representation from up to 13 different disciplines. Metropolitan meetings consisted of about 26 (SD 7.1, range 14–39) core team members from up to 14 disciplines. Overall, 43% of the rural MDT members and 25% of metropolitan team members attended by videoconference. Conclusion: The findings have implications for coordinated cancer care in South Australia thereby improving the quality of patient care

Symptoms of Lower Urinary Tract Symptoms after Prostate Cancer Treatment

http://www.icsoffice.org/abstracts/abstractssearch.aspx?eventid=10

Prevalence of lower urinary tract symptoms (LUTS), lower bowel symptoms and sexual dysfunction after prostate cancer treatment

Aims: To examine the prevalence of lower urinary tract symptoms (LUTS), lower bowel symptoms (LBS) and sexual dysfunction (SD) after prostate cancer treatment. Methods: In this cross-sectional study, recruitment was undertaken from 30 urban and rural prostate cancer support groups across NSW, Queensland and Northern Territory between July 2010 and March 2011. Validated instruments were used to measure LUTS (ICIQ-LUT/ICSmaleSF), lower bowel symptoms (St Marks Incontinence Score) and sexual dysfunction (ICIQ-MLUTSsex/ICSmale). Participants were also asked to report whether they had been informed about potential side effects of prostate cancer (PC) treatment and which health professional provided that information. Results: 355 eligible current members of PC support groups agreed to participate, most of whom resided in urban areas (62%). Their mean age was 70 years (SD: 7.8; Range: 45–95). Radical prostatectomy was the predominant PC treatment (71%) followed by radiation therapy (30%). Participants recruited from rural support groups were signifi cantly more likely to have undergone radiation therapy (39% of rural men vs. 25% of urban men; p = 0.001) than a prostatectomy (60% rural vs. 79% urban; p = 0.007). After PC treatment, men reported at least one LUTS (95%), SD (62%) and LBS (4.5%). Urinary incontinence was the most commonly reported LUTS (74%). About 84% of the participants recalled receiving information about potential treatment side effects before undergoing PC treatment. Of these, the majority received that information from treating specialists (96%). Conclusions: While regional differences exist in regard to treatment protocols received by men attending support groups, there were no regional differences in the way participants received information about potential treatment side effects. Despite improved treatment techniques, LUTS, LBS and SD remain prevalent after PC treatment. Although the risk of developing these clinical symptoms increases with age, this can be exacerbated by PC treatment and more needs to be done to improve these symptoms

Symptoms of pelvic floor muscle dysfunction after prostate cancer treatment

Background: Pelvic fl oor muscle dysfunction (PFMD) is a common complication after treatment for prostate cancer. Whether the symptoms are mild or severe, PFMD is a significant clinical problem which can affect day-to-day activities and reduce quality of life. Aims: To establish the prevalence and severity of pelvic floor muscle dysfunction after prostate cancer treatment. Methods: Men who have had treatment for prostate cancer (i.e. prostatectomy, radiation therapy and/or hormone therapy) and have had symptoms of pelvic floor muscle dysfunction (PFMD) for four or more weeks after treatment were eligible to participate. PFMD symptoms, which include lower urinary tract symptoms, bowel symptoms and sexual dysfunction, were measured with the following validated instruments: (1) the ICIQ-MLUT/ICSmaleSF to assess urinary symptoms; (2) the St Marks Incontinence Score to assess bowel symptoms; (3) the ICIQ-MLUTSsex/ ICSmale to assess symptoms of sexual dysfunction. Participants were recruited from Prostate Cancer Foundation of Australia support groups located in New South Wales (NSW), South Australia (SA) and Queensland (QLD). Results: These preliminary results are part of a larger project associated with a 2009 COSA/Sanofi -Aventis research grant. They represent the baseline data for a cluster randomised controlled trial to assess the effectiveness of a DVD-guided pelvic floor muscle training tool compared with standard care

Cancer multidisciplinary team meetings in a rural and metropolitan site: investigating the facilitators and understanding the challenges

Aim: To examine the facilitators of and barriers to the implementation of two pilot cancer multidisciplinary teams (MDTs) established in a rural and metropolitan site across South Australia. Methods: Healthcare professionals involved in the delivery of cancer MDTs were randomly selected to participate in qualitative structured interviews between April and June 2009. The interviews investigated the enablers of and barriers to the MDT process and also explored opportunities and strategies for improvement. Content and thematic analyses were undertaken. Results: A total of 24 interviews (13 rural, 11 metropolitan) were conducted. Administration and coordination, leadership and a strong commitment to the MDT approach emerged as key enablers to the delivery and implementation of the cancer MDTs. While information and communication technology (ICT) was seen as key enabler of communication between clinicians working from different sites, across the state and interstate, the poor quality of the available ICT, in both settings, was problematic. Furthermore, opportunities for the improvement of the metropolitan MDT included the refinement of the pre- and post-MDT meeting process and the need to more clearly define roles and responsibilities. For the rural cancer MDT, the importance of addressing the psychosocial needs of patients in cancer care was highlighted. Conclusion: This qualitative evaluation has revealed that the effective functioning of cancer MDTs is based on an interplay of factors including team commitment, strong leadership, effective administration and coordination and a well-defined MDT processes. It is therefore essential that cancer MDTs are adequately resourced and funded. The identification of these facilitators and barriers further contributes to the continued improvement and refinement of the multidisciplinary approach to cancer care in both metropolitan and rural South Australia

Indigenous cultural competency training: a survey of oncology clinicians

Objective: Breast cancer is the most common cancer and the second leading cause of cancer death in Indigenous women [1]. There are multiple factors contributing to a poor outlook for Indigenous women diagnosed with breast cancer, including issues relating to lack of access to services and reduced compliance with treatment and follow up. Cultural competency in cancer service delivery could potentially improve practice and outcomes by addressing the needs of Indigenous clients. As limited research exists in the area of oncology clinicians’ attitudes towards cultural competency training in Australia, National Breast and Ovarian Cancer Centre undertook a survey to assess oncology clinicians’ perceptions about cultural competency and to identify training needs. Methods: A self-completed online questionnaire was emailed to oncology clinicians across Australia from NBOCC’s contact database, and promoted to other oncology clinicians via their college or through our electronic newsletter. A follow up letter and email were sent to encourage participation. Results: Oncology clinicians reported on their communication with Indigenous women with breast cancer, their perception of patients’ satisfaction with their level of cultural communication skills, and their attitudes and behaviors towards cultural competency training. The information from respondents provided some insight into the value they place on cultural competency training, and their support for continuing education in this area. Oncology clinicians identified a number of preferences for the provision of cultural competency training. Conclusion: This survey identified some key issues in the interactions of oncology clinicians with Indigenous women with breast cancer, and their families. It also highlights a number of areas for future research around workforce and health service interventions. Such research could be in the area of training and education, awareness-raising, development of indicators for cultural competency and resource development

General practitioner referral pattens for women with gynaecological symptoms: a randomised incomplete block study design

Objective: To describe why, when and to whom general practitioners refer women with symptoms possibly attributable to cervical, endometrial or ovarian cancers, and to identify patient and GP factors that predict referral to either a gynaecologist or a gynaecological oncologist. Design and setting: A national survey of GPs between 1 April and 31 August 2009 using a randomised incomplete block design based on case vignettes, and using a self-completed postal or online questionnaire. Participants: A sample of GPs, stratified by location and randomly selected from a database of GPs maintained by the Australasian Medical Publishing Company. Main outcome measures: Proportion of vignettes that were deemed to reflect a high probability of cancer being referred; and the patient and clinician factors that were the strongest predictors of referral. Results: Of the 3082 GPs who were selected for participation, 1402 responded, giving a response rate of 45.5%. Overall, for vignettes identified as describing women with a high probability of cancer, 75% were referred by metropolitan GPs and 73% by rural practitioners. Metropolitan GPs were significantly more likely to refer women in scenarios indicative of endometrial cancer than rural GPs. For all three cancers, GPs were significantly more likely to refer a patient to a gynaecologist (between 70.8% and 95.4%) than a gynaecological oncologist. Metropolitan GPs had significantly greater access to both private and public gynaecological oncologists than their rural counterparts. Referral rates were higher for ovarian and cervical cancer (83% and 80%, respectively) and lower for endometrial cancer (68%). For all three cancers, patient factors were stronger predictors of referral than the demographic factors of participating GPs. Conclusion: There appears to be significant variation in referral practices among GPs and this variation is greater for endometrial cancer, for which there are currently no evidence-based clinical practice guidelines in Australia. There is a need for further research into understanding the basis of these differences, including a review of the existing guidelines for ovarian and cervical cancer and the development of guidelines for endometrial cancer.Shanthi A Ramanathan, Genevieve Baratiny, Nigel P Stocks, Andrew M Searles and Russell J Redfor

Referral patterns for women with gynaecological symptoms: a national survey of gynaecologists

Aim: To describe if and to whom gynaecologists refer women with symptoms attributable to endometrial, ovarian and vulval cancer and to identify patient and clinician factors predictive of referral. Method: In a randomised incomplete block design, gynaecologists were presented with a randomised allocation of 12 vignettes, each containing a hypothetical scenario about a patient with gynaecological symptoms. Logistic regression was used to estimate the odds of referrals being associated with study factors. Results: Of the eligible 520 gynaecologists, 404 (77%) completed the vignettes online or returned their response by mail. Overall, 76% of endometrial vignettes, 75% of ovarian vignettes and 70% of vulval vignettes which had a high probability of cancer were referred; primarily to gynaecological oncologists (94%). For endometrial cancer, the two best predictors of referral were biopsy fi ndings of cancer (OR:13.8 95%CI 8.0–24.0) and the gender of the clinician (OR for female clinicians: 3.0 95%CI 1.8–5.2). For ovarian cancer it was an elevated CA125 result (OR:12.2 95%CI 9.3–16.1) and ultrasound fi ndings of a solid cyst (OR:4.5 95%CI 3.6–5.7). For vulval cancer it was biopsy fi ndings of cancer (OR:232.0 95%CI 116.1–463.6) and presence of an ulcer (OR:2.0 95%CI 1.3–3.3). Private gynaecological oncologist services could be accessed by 95% of metropolitan and 90% of rural gynaecologists; with 92% of these services associated with a cancer multidisciplinary team (MDT). Public gynaecological oncologist services could be accessed by 94% of metropolitan and 97% of rural gynaecologists; with 97% associated with a MDT. Conclusion: The results suggest variation in referral practices for women with gynaecological symptoms amongst gynaecologists and this variation does not appear to be associated with the presence or absence of Australian evidence-based guidelines. There is a need for further research into understanding the basis of these differences including a review of the existing guidelines for ovarian cancer

Screening for colorectal cancer in remote, rural and metropolitan South Australia: analysis of the National Bowel Cancer Screening Program data

Angelita Martini, Sara Javanparast, Paul R Ward, Stephen Cole, Paul Aylward, Genevieve Baratiny, Tiffany Gill, George Tsourtos, Gary Misan, Carlene Wilson, Graeme Youn

How equitable are colorectal cancer screening programs which include FOBTs? A review of qualitative and quantitative studies

ObjectiveTo review published literature on the equity of participation in colorectal cancer screening amongst different population subgroups, in addition to identifying factors identified as barriers and facilitators to equitable screening. Studies were included in the review if they included FOBT as at least one of the screening tests.MethodRelevant published articles were identified through systematic electronic searches of selected databases and the examination of the bibliographies of retrieved articles. Studies of the association with colorectal cancer screening test participation, barriers to equitable participation in screening, and studies examining interventional actions to facilitate screening test participation were included. Data extraction and analysis was undertaken using an approach to the synthesis of qualitative and quantitative studies called Realist Review.ResultsSixty-three articles were identified that met the inclusion criteria. SES status, ethnicity, age and gender have been found as predictors of colorectal cancer screening test participation. This review also found that the potential for equitable cancer screening test participation may be hindered by access barriers which vary amongst population sub-groups.ConclusionThis review provides evidence of horizontal inequity in colorectal cancer screening test participation, but limited understanding of the mechanism by which it is sustained, and few evidence-based solutions.Sara Javanparast, Paul Ward, Graeme Young, Carlene Wilson, Stacy Carter, Gary Misan, Stephen Cole, Moyez Jiwa, George Tsourtos, Angelita Martini, Tiffany Gill, Genevieve Baratiny, Michelle Ah Mat