Esther L. Davis

Cancer patient disclosure and patient-doctor communication of complementary and alternative medicine use: A systematic review

OBJECTIVE To explore the nondisclosure of complementary and alternative medicine (CAM) use among cancer patients, including reasons for and outcomes from nondisclosure of CAM use, within the context of patient-doctor communication. METHOD A systematic review was conducted exploring investigations surrounding the communication of CAM use for patients with cancer published until August 2011. RESULTS A total of 21 studies were located, which reported a prevalence of CAM use among patients with cancer ranging between 11% and 95%; of these patients, 20% to 77% did not disclose their CAM use. The main reasons for nondisclosure were the doctors lack of inquiry; patients anticipation of the doctors disapproval, disinterest, or inability to help; and patients perception that disclosure of CAM use is irrelevant to their conventional care. There is some evidence to suggest that patient-doctor communication about the use of CAM was associated with an enhanced patient-doctor relationship and higher patient satisfaction. CONCLUSIONS Although the use of CAM by patients with cancer is high, patients frequently fail to disclose its use to their health professionals for reasons emanating from both sides of the dyadic patient-doctor relationship. Because a substantial proportion of patients with cancer may use CAM and there is potential for herb- or vitamin-drug interactions, further research in patient-doctor communication about CAM is necessary to maintain patient safety and wellbeing. The development of effective interventions to improve the disclosure of CAM use should be an integral part of this future research.

Acupuncture for treatment of arthralgia secondary to aromatase inhibitor therapy in women with early breast cancer: pilot study

Background Aromatase inhibitors (AIs) are recommended as adjuvant hormone treatment for postmenopausal women with early breast cancer. A substantial proportion of women taking AIs experience joint pain and stiffness. Studies have suggested that acupuncture may be effective in treating joint pain. Objective A pilot study was conducted to evaluate the feasibility, safety and efficacy of using acupuncture to treat AI-induced arthralgia. Methods A total of 32 patients were randomised to receive either sham or real electroacupuncture (EA) twice weekly for 6 weeks. Outcomes of joint pain, stiffness and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), overall pain severity and interference with the BPI-SF and quality of life (QOL) with the Functional Assessment of Cancer Therapy-General (FACT-G) instrument. Hand strength was assessed by a grip test, and a serum marker of inflammation (C reactive protein (CRP)) was also measured. All assessments were performed at baseline, 6 weeks and 12 weeks, except for blood samples at baseline and 6 weeks only. Results No serious adverse events were reported during or after acupuncture treatments. There were no significant differences in outcome measures. However, positive trends were observed in stiffness and physical function at week 12 in favour of real EA. Conclusions Findings suggest that acupuncture is feasible and safe in patients with breast cancer with joint pain caused by AI. A larger study with adequately powered to confirm these results and detect clinically relevant effects is needed.

Food hygiene knowledge in adolescents and young adults

Purpose – The purpose of this paper is to utilise the comprehensive Food Safety Knowledge Instrument to compare food hygiene knowledge across a population of high school and university students in Australia and the UK. Design/methodology/approach – In total, 475 students from secondary schools and universities in Australia and the UK took part in a survey, which included a Food Safety Knowledge Instrument and demographic items. Findings – Food safety knowledge was generally very low. High school students had a mean score of only 38 per cent, while university students just reached a “pass” with a mean of 54 per cent. Demographics accounted for 41 per cent of variance in food knowledge scores. Female gender, being at university rather than high school, and living out of home rather than with parents were associated with greater food knowledge. Residing in Australia rather than the UK and being older were also associated with greater knowledge; however, these findings were subsumed by education group. Socio-...

Incorporating health literacy in education for socially disadvantaged adults: an Australian feasibility study

BackgroundAdult education institutions have been identified as potential settings to improve health literacy and address the health inequalities that stem from limited health literacy. However, few health literacy interventions have been tested in this setting.MethodsFeasibility study for an RCT of the UK Skilled for Health Program adapted for implementation in Australian adult education settings. Implementation at two sites with mixed methods evaluation to examine feasibility, test for change in participants’ health literacy and pilot test health literacy measures.ResultsTwenty-two socially disadvantaged adults with low literacy participated in the program and received 80–90 hours of health literacy instruction. The program received institutional support from Australia’s largest provider of vocational education and training and was feasible to implement (100 % participation; >90 % completion; high teacher satisfaction). Quantitative results showed improvements in participants’ health literacy skills and confidence, with no change on a generic measure of health literacy. Qualitative analysis identified positive student and teacher engagement with course content and self-reported improvements in health knowledge, attitudes, and communication with healthcare professionals.ConclusionsPositive feasibility results support a larger RCT of the health literacy program. However, there is a need to identify better, multi-dimensional measures of health literacy in order to be able to quantify change in a larger trial. This feasibility study represents the first step in providing the high quality evidence needed to understand the way in which health literacy can be improved and health inequalities reduced through Australian adult education programs.

Assessment of psychosocial outcomes in adolescents and young adults with cancer: a systematic review of available instruments

Claire E Wakefield1,2 Pandora Patterson3 Fiona E J McDonald3 Helen L Wilson1,2 Esther Davis3 Ursula M Sansom-Daly2,4 1School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia; 2Centre for Children’s Cancer and Blood Disorders, Sydney Children’s Hospital, Sydney, NSW, Australia; 3CanTeen, Sydney, NSW, Australia; 4School of Psychology, University of New South Wales, Sydney, NSW, Australia

Prediction of individual differences in adjustment to loss: Acceptance and valued-living as critical appraisal and coping strengths

ABSTRACT Our strengths-based model of coping with death and dying proposes acceptance and valued-living as key coping and appraisal strengths for the bereaved. These are core components of Acceptance and Commitment Therapy (ACT). The aim of this study was to provide an initial exploration of the theorized relationships via a survey of 97 bereaved university students. Using hierarchical regression analysis it was found that acceptance and valued-living were significant predictors of grief, while controlling for other model variables and loss characteristics. Results have implications for ACT-based approaches in supporting those bereaved who are struggling with their grief.

Parental perceptions of barriers to mental health services for young people.

This study explores a range of barriers that parents encountered in accessing mental health services. The study also explored whether parents experienced similar barriers to accessing services in 2003 and 2013.

An acceptance and commitment therapy self-help intervention for carers of patients in palliative care: Protocol of a feasibility randomised controlled trial

Undertaking a caregiving role at end of life can have enduring psychological consequences for carers, including poor adjustment in bereavement. Acceptance and commitment therapy–based interventions have demonstrated effectiveness in helping people cope with a range of life challenges. This article presents the protocol of a feasibility randomised controlled trial of an acceptance and commitment therapy self-help intervention for psychological distress and grief in carers of patients in palliative care. We will assess feasibility and acceptability of the trial procedures and intervention as well as preliminary effectiveness of the intervention on carer well-being outcomes.

A qualitative study of consumer attitudes to sharing psychosocial information within the multidisciplinary cancer care team

To the Editor, Psychologists are recognised as an essential part of the multidisciplinary cancer team (MDCT), and their interventions have been shown to improve patient outcomes [1]. However, little research to date has investigated best practice for written communication between psychologists and other clinical staff. This is a critical mode of communication that relays important psychosocial patient information, influences care planning, facilitates effective working relationships and becomes part of the patient’s formal written records. Existing guidelines for psychologists’ report writing are generic and often fail to address the specific requirements of the oncology setting. It has also been argued that clinical guidelines should consider patient-based data [2, 3]. International research exploring patients’ attitudes towards the sharing of electronic health records has demonstrated that patients felt strongly about the privacy, security and control over the information they provide [4–6]. In addition, Australian legal precedent suggests that some cancer patients may be reluctant for psychosocial information to be shared amongst all clinical staff [7]. Therefore, it is important to ensure that written communication by psychologists in oncology is consistent with consumer preferences. To better understand these preferences, we conducted a qualitative study exploring consumer attitudes towards the content and format of written communication between psychologists and clinical care providers in the MDCT.

Effects of Qigong on Quality of Life, Fatigue, Stress, Neuropathy, and Sexual Function in Women with Metastatic Breast Cancer: A Feasibility Study

Background: Women with metastatic breast cancer (MBC) suffer from psychological and physiological symptoms and side effects of therapy. When the treatment is non-curative, quality of life (QOL) is a major issue. This study aimed to examine the feasibility, safety, and effects of Medical Qigong (MQ: integration of gentle exercise and meditation) in improving QOL in women with MBC. Method: Women with MBC were randomized to a MQ group (n=14) or meditation control group (n=13). QOL, fatigue, stress, neuropathy symptoms and sexual function were measured by the Functional Assessment of Cancer Therapy - Breast (FACT-B), Functional Assessment of Cancer Therapy-fatigue (FACT-F), Perceived Stress Scale (PSS), neurotoxicity subscale of the FACT/GOG-NTX, and Sexual Functioning Questionnaire (SFQ) subscales at pre-intervention and weeks 5 and 10. Results: No serious adverse events were reported during or after MQ intervention. Sixty three percent of participants completed the study (MQ intervention (n=9) and meditation control (n=8)). There were no significant differences in overall QOL (p= 0.84), fatigue (p=0.71), perceived stress level (p=0.52), sexual satisfaction (p=0.55), sexual activities (p=0.95) and sexual relationship (p=0.79) between the groups, although difference in neuropathic symptoms (p=0.014) were significant. Conclusions: A MQ trial in women with MBC is feasible and safe. MQ may have the potential to relieve symptoms experienced by women with MBC and prevent deterioration of neuropathy. A larger study with adequate power to confirm these results and detect clinically relevant effects is needed.