Factors influencing treatment decisions for men with prostate cancer

The decision-making process for men with early stage prostate cancer is complex and difficult because prostate cancer, despite having a high incidence, has a low mortality and treatments, despite having significant side effects, may not prolong survival with many men dying of non-cancer health issues. There is, therefore, an imperative to treat young, healthy men with aggressive cancers (preventing undertreatment) and avoid treatment of men with low grade cancers and/or a limited life expectancy due to age or comorbidities (avoiding overtreatment). This thesis places the process of decision making as the central locus. Study A (Chapter 4) was a practice audit of four urology practices and investigated the influence of cancer and non-cancer patient factors (such as age and comorbidities) on the treatment decision-making process. The concordance of the treatment chosen with published guidelines was established and then any possible over- or under-treatments estimated. Our study demonstrated that 80% of patients received treatment concordant with published guidelines; however, for low risk cancers approximately one third of patients received non- concordant treatment. Appropriately, younger patients with few comorbidities and more aggressive cancers were more likely to receive curative treatment. Study B (Chapter 5) was a survey of 151 men diagnosed with prostate cancer and examined whether there was an association between the extent to which men wished to be involved in the decision-making process, their satisfaction with that process, and their levels of decision regret after treatment. Although one third of men found the decision difficult to make, the majority were satisfied with the decision making process and the level of communication with their clinician and for these men, rates of regret were low. A major finding of the study was that taking an active role in the treatment decision-making process led to greater satisfaction with that process which, in turn, reduced the chance of experiencing regret following treatment. Study C (Chapter 6) aimed to gain a better understanding of the health literacy of men newly diagnosed with prostate cancer, the information sources they accessed, how helpful they found these sources, as well as the readability, understandability and actionability of these sources. The major finding was that approximately 20% of men, newly diagnosed with prostate cancer, had inadequate health literacy (HL), and this lower HL correlated with a younger age at leaving school. More than 80% of men used more than four sources of information, but older men, who are typically the group diagnosed with prostate cancer, were shown to access fewer sources, which may limit their ability to be involved in the shared decision-making process. In terms of information sources, men found their primary treating urologist the most helpful source of information and even though the internet was used by approximately half of the study participants, older men were less likely to use the internet as a source of information. The readability and understandability of many information sources was at too high a level and the actionability of these information sources was too low, meaning that men were not empowered to be involved and actually make a decision. Study D (Chapter 7) assessed the level of health literacy among a broad group of men attending a urological clinic and investigated the concordance between two different published measures of health literacy. We also explored if there was an association between health literacy, cancer literacy and comprehension, and prostate cancer knowledge among this group of men. Similar to the previous study, more than 20% of men were shown to have low health literacy, with low scores specifically in areas relating to seeking and understanding information about their health. There was high concordance between two measures of health literacy and a positive correlation between cancer literacy and comprehension, and both measures of health literacy used in this study. Our overall conclusion is that the process of decision making for men with prostate cancer is critical, with clinicians needing to assess both the life expectancy of the patient from non-cancer causes and the risk from the cancer if untreated and patients being involved in, and satisfied with, the decision-making process, which we have shown lead to lower rates of post-treatment regret. We also identified that low health literacy, and the low readability, understandability and actionability of available prostate cancer information sources, can potentially interfere with men’s involvement in the decision-making process

Scoping study to investigate online learning environments to facilitate evidence sharing by literacy and numeracy practitioners (LNET project)

The purpose of the scoping study was to identify effective online interfaces or learning environments that provide education stakeholders with opportunities to share examples of good practice, ideas and quality resources. A review of the literature was undertaken and consultations carried out with a wide range of education stakeholders via focus groups, telephone interviews, videoconference and online survey. Those consulted included ICT experts, representatives of professional education associations, teachers, and personnel from state and territory Independent, Catholic and government jurisdictions. The main obstacles to usage continue to be lack of time and lack of confidence among teachers. School leadership that does not model a strong commitment to ICT and professional learning was also raised as an issue. Another reason identified in the literature and supported by anecdotal evidence through the consultations is that not all teachers are willing to share resources

Online Personas: Who We Become When We Learn with Others Online

At the beginning of the millennium, Gladwell (2000) introduced the people who “do” the work within networks. These were dubbed connectors, mavens and salesmen. A decade on, Ochman (2013) intriguingly suggested that there were 181,000 social media gurus, ninjas, masters and mavens on Twitter. But who are these unexplained characters or personas? Have connectors, mavens and salesmen translated into contemporary social media and personal learning networks? This paper is therefore about the “who” rather than the “what” and “how” that are typically the focus of investigations into personal learning networks and social media interactions. This paper will contend that connectors, mavens and salesmen are still identifiable and active in network interactions, with the definition of the maven being concatenated into the role of mentor. The findings from an online survey also revealed another set of other discrete personas with characteristics created and affirmed by interactions with others. Interestingly, individuals can adopt different personas dependent on context. Thus “who” we are depends on “where” we are and “who” is with us.

Clinical trials in a remote Aboriginal setting: lessons from the BOABS smoking cessation study

Background: There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs)investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program. Methods: Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents. Results: Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project.The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur. Conclusions: The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation

The epidemiology of coronary heart disease : A review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31999/1/0000041.pd

Professional learning in 140 characters

The World Wide Web has grown into a global information and communication space with more than a billion users and has entered a new, more social and participatory phase where people create and manage online content rather than just viewing it; a place where people can communicate knowledge, share resources and participate in social networks. Online social networks are being used to support professional learning where groups of people are using the Web to communicate and collaborate in order to build and share knowledge and form professional learning networks (PLNs). This session will present the results of research into how microblogging, a form of online social networking, is being employed by educators to support their professional learning. The study examined activities and perceptions of a group of educators in order to provide an insight into how and why they engage in microblogging and the value they place on microblogging as a professional learning tool. The session will outline the advantages of microblogging as a professional learning tool; the range of behaviours and activities that are undertaken to support professional learning; and the implications for practice