What do haematological cancer survivors want help with? A cross-sectional investigation of unmet supportive care needs

BACKGROUND: This study aimed to identify the most prevalent unmet needs of haematological cancer survivors. METHODS: Haematological cancer survivors aged 18–80 years at time of recruitment were selected from four Australian state cancer registries. Survivors completed the Survivor Unmet Needs Survey. The most frequently reported “high/very high” unmet needs items were identified, as well as characteristics associated with the three most prevalent “high/very high” unmet needs reported by haematological cancer survivors. RESULTS: A total of 715 eligible survivors returned a completed survey. “Dealing with feeling tired” (17%), was the most frequently endorsed “high/very high” unmet need. Seven out of the ten most frequently endorsed unmet needs related to emotional health. Higher levels of psychological distress (e.g., anxiety, depression and stress) and indicators of financial burden as a result of cancer (e.g., having used up savings and trouble meeting day-to-day expenses due to cancer) were consistently identified as characteristics associated with the three most prevalent “high/very high” unmet needs. CONCLUSIONS: A minority of haematological cancer survivors endorsed a “high/very high” unmet need on individual items. Additional emotional support may be needed by a minority of survivors. Survivors reporting high levels of psychological distress or those who experience increased financial burden as a result of their cancer diagnosis may be at risk of experiencing the most prevalent “high/very high” unmet needs identified by this study.This project was co-funded by beyondblue and Cancer Australia (Grant ID: 569290)

An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial

Objective: To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks’ gestation among pregnant Aboriginal and Torres Strait Islander women. Design: Randomised controlled trial. Setting and participants: Pregnant Aboriginal and Torres Strait Islander women (n= 263) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009. Intervention: A general practitioner and other health care workers delivered tailored advice and support to quit smoking to women at their first antenatal visit, using evidence-based communication skills and engaging the woman’s partner and other adults in supporting the quit attempts. Nicotine replacement therapy was offered after two failed attempts to quit. The control (“usual care”) group received advice to quit smoking and further support and advice by the GP at scheduled antenatal visits. Main outcome measure: Self-reported smoking status (validated with a urine cotinine measurement) between 36 weeks’ gestation and delivery. Results: Participants in the intervention group (n = 148) and usual care group (n= 115) were similar in baseline characteristics, except that there were more women who had recently quit smoking in the intervention group than the control group. At 36 weeks, there was no significant difference between smoking rates in the intervention group (89%) and the usual care group (95%) (risk ratio for smoking in the intervention group relative to usual care group, 0.93 [95% CI, 0.86–1.08]; P = 0.212). Smoking rates in the two groups remained similar when baseline recent quitters were excluded from the analysis. Conclusion: An intensive quit-smoking intervention was no more effective than usual care in assisting pregnant Aboriginal and Torres Strait Islander women to quit smoking during pregnancy. Contamination of the intervention across groups, or the nature of the intervention itself, may have contributed to this result

Trends in publications regarding evidence-practice gaps: A literature review

<p>Abstract</p> <p>Background</p> <p>Well-designed trials of strategies to improve adherence to clinical practice guidelines are needed to close persistent evidence-practice gaps. We studied how the number of these trials is changing with time, and to what extent physicians are participating in such trials.</p> <p>Methods</p> <p>This is a literature-based study of trends in evidence-practice gap publications over 10 years and participation of clinicians in intervention trials to narrow evidence-practice gaps. We chose nine evidence-based guidelines and identified relevant publications in the PubMed database from January 1998 to December 2007. We coded these publications by study type (intervention versus non-intervention studies). We further subdivided intervention studies into those for clinicians and those for patients. Data were analyzed to determine if observed trends were statistically significant.</p> <p>Results</p> <p>We identified 1,151 publications that discussed evidence-practice gaps in nine topic areas. There were 169 intervention studies that were designed to improve adherence to well-established clinical guidelines, averaging 1.9 studies per year per topic area. Twenty-eight publications (34%; 95% CI: 24% - 45%) reported interventions intended for clinicians or health systems that met Effective Practice and Organization of Care (EPOC) criteria for adequate design. The median consent rate of physicians asked to participate in these well-designed studies was 60% (95% CI, 25% to 69%).</p> <p>Conclusions</p> <p>We evaluated research publications for nine evidence-practice gaps, and identified small numbers of well-designed intervention trials and low rates of physician participation in these trials.</p

and Hunter Centre for Health Advancement

S U M M A RY Schools have a great in£uence on the health status of young people and health education programs have existed in schools for many years. A lack of evidence for positive long-term impact of these programs has led to the development of a new approach to school-based health promotionöHealth Promoting Schools. This is a comprehensive whole-school approach which incorporates the principles of the Ottawa Charter and has attracted a great degree of interest and commitment at international, national and state levels. However, it is not clear whether or how this approach is being adopted and implemented at the school level and what the current state of research in the ¢eld is. This paper reviews the current state of research and the nature of past and present school health promotion programs targeting three health risk behavioursösmoking, alcohol consumption and skin protection. A series of computer database searches were conducted for January 1983 to March 1995, identifying 600 relevant citations. These were, ¢rstly, classi¢ed into types of publications using the framework of the Staged Approach, the majority of publications focusing on descriptive research of smoking and alcohol use. Secondly, those articles classi¢ed as intervention trials were examined for incorporation of the principles of the Health Promoting Schools concept. Most programs utilised only a curriculum/social skills approach. No programs were identi¢ed which had attempted to implement and evaluate the Health Promoting Schools approach in its entirety for any of the three health risk behaviours. Given the increasing interest and investment in the approach, this review highlights a need for well-designed intervention trials which implement and evaluate the Health Promoting Schools approach

Training experiences immediately after medical school

Trainees in all teaching hospitals in New South Wales were surveyed using a self-completion, postal questionnaire to assess perceptions of the quality and extent of training received for interactional and technical skills. The response rate was 67.1%. Mean age was 25.4 years and 38.8% were female. Overall, training was found to be generally poor in terms of time and educational strategies used. Interactional skills were found to receive lower levels of training than technical skills both prior to and during the intern year with significantly fewer (P < 0.000) educational strategies reported for training received in interactional skills than for technical skills. Trainees' perceptions of the adequacy of training was significantly more negative for interactional than technical skills (P < 0.001). Assessment of competence was also significantly lower for interactional than technical skills (P < 0001). On average, fewer than one in three trainees considered themselves to be competent in interactional skills compared to two-thirds who reported themselves as competent for technical skills. The findings of this study highlight the need for improved efforts with regard to both the quality and quantity of training provided during the intern year. Considerable scope exists for improved educational experiences for both interactional and technical skill areas, but particularly for interactional skills. Overall, greater use of a range of basic educational strategies such as the provision of 'observation' and 'critical feedback' is indicated. Efforts also need to be directed toward the training of clinical educators to optimize the potential of the preregistration period

What's good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change

Background:The use of financial incentives or pay-for-performance programs for health care providers has triggered emerging interest in the use of financial incentives for encouraging health behaviour change. Purpose: This paper aims to identify key conditions under which the use of financial incentives for improvements in public health outcomes is most likely to be effective and appropriate. Methods: We review recent systematic reviews on their effectiveness in changing health behaviour and identify existing moral concerns concerning personal financial incentives. Results: Current evidence indicates that incentives can be effective in driving health behaviour change under certain provisos, while a number of misgivings continue to be deliberated on. We outline a number of key principles for consideration in decisions about the potential use of incentives in leading to public health improvements. Conclusion: These key principles can assist policy makers in making decisions on the use of financial incentives directed at achieving improvements in public health

An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander Australians: a randomized controlled trial (Reply to Letter)

IN REPLY: Although our trial did not decrease quit rates with an intensive intervention, health professionals should continue to deliver appropriate intensive smoking interventions to pregnant Indigenous women. Guidelines advise the exercise of caution with the use of nicotine replacement therapy (NRT) in pregnancy, given the lack of trial data supporting its use. A recent trial of NRT in pregnancy found similar rates of adverse pregnancy and birth outcomes among women who used NRT and those who did not. Our study recommended NRT after at least two attempts to quit without NRT. NRT gum was prescribed by the treating doctors, with a preference for intermittent doses rather than continuous low doses through the use of NRT patches, in line with current guidelines. Women were provided with a week’s supply of NRT but, for reasons that were not clear, none returned for repeat supplies. The frequency with which NRT was prescribed, provided and used by women was not recorded with sufficient accuracy to allow interpretation. No definite conclusions about the efficacy of NRT can be drawn from our study and further research is necessary

Supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking: views of antenatal care providers and Pregnant Indigenous Women

To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64 % of smokers and 91 % of providers; between 56 and 62 % of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85–90 % of providers. Rewards for quitting were considered helpful by 63 % of smokers and 56 % of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women