Protocol of a multi-centre randomised controlled trial of a web-based information intervention with nurse-delivered telephone support for haematological cancer patients and their support persons

BACKGROUND: High rates of anxiety, depression and unmet needs are evident amongst haematological cancer patients undergoing treatment and their Support Persons. Psychosocial distress may be minimised by ensuring that patients are sufficiently involved in decision making, provided with tailored information and adequate preparation for potentially threatening procedures. To date, there are no published studies evaluating interventions designed to reduce psychosocial distress and unmet needs specifically in patients with haematological cancers and their Support Persons. This study will examine whether access to a web-based information tool and nurse-delivered telephone support reduces depression, anxiety and unmet information needs for haematological cancer patients and their Support Persons. METHODS/DESIGN: A non-blinded, parallel-group, multi-centre randomised controlled trial will be conducted to compare the effectiveness of a web-based information tool and nurse-delivered telephone support with usual care. Participants will be recruited from the haematology inpatient wards of five hospitals in New South Wales, Australia. Patients diagnosed with acute myeloid leukaemia, acute lymphoblastic leukaemia, Burkitt’s lymphoma, Lymphoblastic lymphoma (B or T cell), or Diffuse Large B-Cell lymphoma and their Support Persons will be eligible to participate. Patients and their Support Persons will be randomised as dyads. Participants allocated to the intervention will receive access to a tailored web-based tool that provides accurate, up-to-date and personalised information about: cancer and its causes; treatment options including treatment procedures information; complementary and alternative medicine; and available support. Patients and Support Persons will complete self-report measures of anxiety, depression and unmet needs at 2, 4, 8 and 12 weeks post-recruitment. Patient and Support Person outcomes will be assessed independently. DISCUSSION: This study will assess whether providing information and support using web-based and telephone support address the major psychosocial challenges faced by haematological patients and their Support Persons. The approach, if found to be effective, has potential to improve psychosocial outcomes for haematological and other cancer patients, reduce the complexity and burden of meeting patients’ psychosocial needs for health care providers with high potential for translation into clinical practice. .The study is funded by Cancer Institute New South Wales (10/THS/2-14). This research was also supported by a Strategic Research Partnership grant provided by Cancer Council New South Wales to the Newcastle Cancer Control Collaborative, and infrastructure funding from the Hunter Medical Research Institute. Dr. Jamie Bryant is supported by an Australian Research Council Post-Doctoral Industry Fellowship. A/Prof Christine Paul is supported by an NHMRC Career Development Fellowship. Dr. Flora Tzelepis was supported by a Leukaemia Foundation of Australia and Cure Cancer Australia Foundation Post-Doctoral Research Fellowship

Australian oncologists\u27 self-reported knowledge and attitudes about non-traditional therapies used by cancer patients

Objective: To assess Australian radiation and medical oncologists\u27 self-reported knowledge about and attitudes towards a range of non-traditional therapies used by people with cancer. Design: Postal survey during May and June 1997 of all 265 radiation and medical oncologists practising in Australia. Participants: 161 oncologists returned surveys (61% response rate). Main outcome measures: Oncologists\u27 own level of knowledge, and, for each known therapy, their perceptions of its likely harm or benefit in patients being treated curatively and palliatively, and of the prevalence of use among their patients. Results: Oncologists reported knowing most about acupuncture, antioxidant therapy and meditation and least about cellular therapy, magnetotherapy and psychic surgery. The therapies most likely to be considered helpful were meditation, acupuncture and hypnotherapy. Those most likely to be considered harmful were coffee enemas, psychic surgery, Iscador therapy and diet therapies. Perceptions of patients\u27 use of most therapies varied widely, with herbal therapies, antioxidant therapy and meditation considered the most commonly used. Conclusions: These results indicate self-identified gaps in oncologists\u27 knowledge about non-traditional therapies their patients may use; they suggest a need to consider including education about these therapies in oncologists\u27 training

Assessing the effectiveness of computerised dissemination of the \u27NHMRC\u27s Clinical Guidelines for the Management of Early Breast Cancer\u27: final report

In 1995, the National Health and Medical Research Council (NHMRC) launched the “Clinical Guidelines for the Management of Early Breast Cancer” (1). These guidelines aimed to provide breast cancer specialists with evidence-based information and recommendations for best practice in relation to the management of women with early stage breast cancer. It was intended that the NHMRC guidelines be adopted by surgeons, medical oncologists, radiotherapists, general practitioners and other health care providers involved in the management of women with early breast cancer. The next step in the implementation of the NHMRC guidelines is their effective dissemination to relevant health care providers. Relatively little is known about how best to encourage the implementation of clinical practice guidelines. A recent review of the effectiveness of guidelines at affecting clinical practice concluded that more active methods of dissemination, such as the use of computer prompting or reminder and feedback systems were more effective than simple postal dissemination of guidelines (2). However, no previous studies have involved breast cancer care guidelines. Therefore, this project aimed to assess the effectiveness of a computerised method of disseminating the NHMRC Guidelines for the Management of Early Breast Cancer. For the sake of brevity, these will be referred to as the Guidelines throughout this report. More specifically, the study aimed to assess the effectiveness of printed feedback from an interactive touchscreen computer survey, completed by patients, at increasing the proportion of medical oncology patients with early breast cancer who are treated in accordance with the Guidelines. The study focused on providing tools to assist medical oncologists in providing a level of care as outlined by the NHMRC, by accessing the recommendations contained in the Guidelines. This study provided an opportunity to explore one strategy which could potentially be effective at implementing guidelines in a clinical setting, while also attempting to ensure all women diagnosed with early breast cancer receive optimal treatment. A subset of the Guidelines considered most relevant to medical oncologists and their patients have been used as outcome measures, indicating the interactive computer program’s effectiveness. The acceptability of the interactive computer program, to patients and medical oncologists, was also assessed in this study