Exploring barriers to and enablers of adequate healthcare for Indigenous Australian prisoners with cancer: a scoping review drawing on evidence from Australia, Canada and the United States

Published: 3 May 2016Background: International frameworks supported by national principles in Australia stipulate that prisoners should be provided with health services equivalent to those provided in the general community. However, a number of barriers unique to the prison system may hinder the provision of equitable healthcare for this population. In Australia, Indigenous people carry a greater burden of cancer mortality, which the Cancer Data and Aboriginal Disparities (CanDAD) project is seeking to address. During the course of recruiting participants to the CanDAD study, Indigenous Australian prisoners with cancer emerged as an important, under-researched but difficult to access sub-group. Methods: This scoping review sought to identify barriers and facilitators of access to adequate and equitable healthcare for Indigenous Australian prisoners with cancer in Australia. This review demonstrated a lack of research and, as such, the scoping review was extended to prisoners with cancer in Australia, New Zealand, the United States and Canada. This approach was taken in order to summarise the existing body of evidence regarding the barriers and facilitators of access to adequate and equitable healthcare for those who are incarcerated and suffering from cancer, and highlight areas that may require further investigation. Results: Eight studies or commentaries were found to meet the inclusion criteria. This limited set of findings pointed to a range of possible barriers faced by prisoners with cancer, including a tension between the prisons’ concern with security versus the need for timely access to medical care. Conclusion: Findings identified here offer potential starting points for research and policy development. Further research is needed to better elucidate how barriers to adequate cancer care for prisoners may be identified and overcome, in Australia and internationally. Furthermore, given Indigenous Australians’ over-burden of cancer mortality and over-representation in the prison system, further research is needed to identify whether there are a unique set of barriers for this group.Jessica Olds, Rachel Reilly, Paul Yerrell, Janet Stajic, Jasmine Micklem, Kim Morey and Alex Brow

Cancer data and Aboriginal disparities (CanDAD)-developing an Advanced Cancer Data System for Aboriginal people in South Australia: a mixed methods research protocol

Introduction: In Australia, Aboriginal and Torres Strait Islander People carry a greater burden of cancerrelated mortality than non-Aboriginal Australians. The Cancer Data and Aboriginal Disparities Project aims to develop and test an integrated, comprehensive cancer monitoring and surveillance system capable of incorporating epidemiological and narrative data to address disparities and advocate for clinical system change. Methods and analysis: The Advanced Cancer Data System will integrate routinely collected unit record data from the South Australian Population Cancer Registry and a range of other data sources for a retrospective cohort of indigenous people with cancers diagnosed from 1990 to 2010. A randomly drawn non- Aboriginal cohort will be matched by primary cancer site, sex, age and year at diagnosis. Cross-tabulations and regression analyses will examine the extent to which demographic attributes, cancer stage and survival vary between the cohorts. Narratives from Aboriginal people with cancer, their families, carers and service providers will be collected and analysed using patient pathway mapping and thematic analysis. Statements from the narratives will structure both a concept mapping process of rating, sorting and prioritising issues, focusing on issues of importance and feasibility, and the development of a real-time Aboriginal Cancer Measure of Experience for ongoing linkage with epidemiological data in the Advanced Cancer Data System. Aboriginal Community engagement underpins this Project. Ethics and dissemination: The research has been approved by relevant local and national ethics committees. Findings will be disseminated in local and international peer-reviewed journals and conference presentations. In addition, the research will provide data for knowledge translation activities across the partner organisations and feed directly into the Statewide Cancer Control Plan. It will provide a mechanism for monitoring and evaluating the implementation of the recommendations in these documents.Paul Henry Yerrell, David Roder, Margaret Cargo, Rachel Reilly, David Banham, Jasmine May Micklem, Kim Morey, Harold Bundamurra Stewart, Janet Stajic, Michael Norris, Alex Brown, On behalf of the CanDAD Aboriginal Community Reference Group and CanDAD Investigator

Non-clinical community interventions: a systematised review of social prescribing schemes

Abstract Background: This review focused on evaluation of United Kingdom social prescribing schemes published in peer-reviewed journals and reports. Schemes, including arts, books, education, and exercise ‘on prescription’ refer patients to community sources of non-clinical intervention. Method: A systematised review protocol appraised primary research material evaluating social prescribing schemes published 2000-15. Searches were performed in electronic databases using keywords, and articles were screened for evaluation of patient data, referral process, assessment method and outcomes; non-evaluated articles were excluded. Results: Of 86 schemes located including pilots, 40 evaluated primary research material: 17 used quantitative methods including six randomised controlled trials; 16 qualitative methods, and seven mixed methods; 9 exclusively involved arts on prescription. Conclusions: Outcomes included increase in self-esteem and confidence; improvement in mental wellbeing and positive mood; and reduction in anxiety, depression and negative mood. Despite positive findings, the review identifies a number of gaps in the evidence base and makes recommendations for future evaluation and implementation of referral pathways

The expectancies of experimenters and experimental milieux effects

SIGLEAvailable from British Library Document Supply Centre- DSC:D70833/82 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Clinical guideline for nurse-led early extubation after coronary artery bypass: an evaluation.

AIM: This paper is a report of an investigation of the development, implementation and outcomes of a clinical guideline for nurse-led early extubation of adult coronary artery bypass graft patients. BACKGROUND: Healthcare knowledge translation and utilization is an emerging but under-developed research area. The complex context for guideline development and use is methodologically challenging for robust and rigorous evaluation. This study contributes one such evaluation. METHODS: This was a mixed methods evaluation, with a dominant quantitative study with a secondary qualitative study in a single UK cardiac surgery centre. An interrupted time series study (N = 567 elective coronary artery bypass graft patients) with concurrent within person controls was used to measure the impact of the guideline on the primary outcome: time to extubation. Semi-structured interviews with 11 clinical staff, informed by applied practitioner ethnography, explored the process of guideline development and implementation. The data were collected between January 2001 and January 2003. RESULTS: There was no change in the interrupted time series study primary outcome as a consequence of the guideline implementation. The qualitative study identified three themes: context, process and tensions highlighting that the guideline did not require clinicians to change their practice, although it may have helped maintain practice through its educative role. CONCLUSION: Further investigation and development of appropriate methods to capture the dynamism in healthcare contexts and its impact on guideline implementation seems warranted. Multi-site mixed methods investigations and programmes of research exploring knowledge translation and utilization initiatives, such as guideline implementation, are needed

Consumerism in health care: the case of medication education

Background: The United Kingdom government's policy documents spanning the last decade clearly envisage the patient as a consumer of health care. In this context this paper discusses recent research findings related to the health-promotion practice of medication delivered by nurses in England in a variety of health care settings. Literature exploring consumerism in health care highlights a number of principles which were used to develop a framework to evaluate the data collected in this study.Method: Non-participant observation and audio-recordings of nurse-patient interactions about medications were collected in seven different contexts focusing on adults, older people, mental health and community nurse settings. Post-interaction interviews with nurse and patient participants were conducted to explore views on quality, satisfaction with, and intended outcomes of, the interactions.Findings: Generally, the findings demonstrated that the espoused theory and practice reality regarding the carrying out of consumerist principles are incongruous. Interactions contained relatively simple information, were dominated and led by nurses and offered little opportunity for patient choice. Patients, however, expressed a satisfaction with minimal information and involvement.Conclusion: The findings are discussed with reference to a number of different contextual factors: acuity of illness, perceived balance of power, information gaps, patterns of contact and nurse-patient relationships, and patient-centred care

A comparison of expert- and practitioner-derived criteria for post-operative pain management.

A comparison of two methods of criteria formulation was carried out as part of a 3-year research study looking at the effectiveness of a nursing quality assurance system (the Royal College of Nursing's Dynamic Standard Setting System). In particular, the study wished to explore whether and to what extent criteria sets derived from an expert group differed from criteria generated by local practitioner groups. One expert group and five local groups were helped to develop criteria on the topic of post-operative pain management. Results showed that the expert group underwent a much more controlled and systematic approach to the task than any of the local groups who were supported by newly trained facilitators. Despite this difference, two of the five local groups had criteria convergence scores of more than 55%, demonstrating that the local knowledge on the topic was acceptable. Whether the lower convergence of the groups was due to lack of knowledge or a combination of difficult group processes and novice facilitation is difficult to say. However, what the study did show was that local groups can generate criteria sets comparable to expert groups, given proper facilitation and support

Criteria formulation and application: an evaluative framework.

This paper critically examines how criteria are formulated and applied in quality assurance or quality improvement systems. It begins by drawing attention to the division that exists between criteria derived by so-called expert groups and those developed more locally by practitioners. In seeking to analyse the strengths and weaknesses of these two contrasting approaches, it explores the more fundamental questions of how criteria are formulated in general and how they can best be applied. An evaluative framework is offered as a working checklist for practitioners involved in criteria formulation. The framework identifies three main areas: actual construction of criteria; procedures for formulation and issues related to application. An example of each area is offered from results of the ODySSSy Project. The paper concludes by recommending more systematic studies in this highly complex area

Governance and health promotion:A case study of medication education

Findings from a research study investigating nurses' educational preparation for and practice of their role in educating patients about medication identified that the inclusion of patient education in clinical interactions has implications for the governance of clinical practice - an agenda now being implemented in UK health contexts. A review of patient education, concordance (compliance), health promotion and pharmacology literature was undertaken to illuminate the current status of the evidence for effective medication interactions. Obser vation (n =48) and audio-recordings (n = 37) of nurse-patient interactions about medication were collected in seven different contexts focusing on adult and older-person, mental-health and community-nursing settings. Post-inter action interviews with nurse (n = 29) and patient (n = 39) participants were conducted to explore views on the observed interaction and to attempt to identify intended outcomes of the interactions. Issues highlighted by the research concern: the need for a pluralistic understanding of what might constitute the evidence base for practice; a requirement to recognise the com plexities of professionals' and patients' perspectives on what constitutes qual ity ; the need for caution in the application of generic 'standards' to individualised care contexts, coupled with the problem of what counts as effective outcomes. The recognition of such concerns is posited as a critical ingredient in the process of clinical governance