Greg Sharplin

Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156 non-Indigenous smokers from South Australia were shown 10 anti-smoking advertisements representing a range of advertisements typically aired in Australia. Participants rated advertisements on a five-point Likert scale assessing factors including message acceptance and personalized effectiveness. On average, Indigenous people rated the mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. Advertisements featuring real people describing the serious health consequences of smoking received mixed responses. Those featuring an ill person were rated higher by Indigenous people than those featuring the family of the person affected by a smoking-related disease. With limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are likely to be highly motivating for Indigenous smokers.

Mindfulness-based Cancer Stress Management: impact of a mindfulness-based programme on psychological distress and quality of life

Within the area of cancer care, mindfulness-based therapeutic interventions have been found to be efficacious in reducing psychological distress related to a cancer diagnosis; however, the impact of mindfulness-based interventions on quality of life is unclear. This study explores the impact of a Mindfulness-Based Cancer Stress Management programme on psychological distress and quality of life. Research methodology included a single-group quasi-experimental study of 26 participants experiencing distress related to a cancer diagnosis, including carers, who completed an MBCSM programme and all assessments. Participants completed the Functional Assessment of Cancer Therapy - General version 4 (FACT-G) and its associated spirituality index (FACIT-Sp-Ex), Hospital Anxiety and Depression Scale (HADS), Freiburg Mindfulness Inventory (FMI), and the Distress Thermometer at baseline, post-intervention, and three months after programme completion. Significant improvements were observed on all measures (ranges: P ≤ 0.001 to 0.008, r = -0.53 to -0.79) following the intervention, which were maintained at 3-month follow-up. Mindfulness was significantly correlated with all main outcome measures at post-intervention (range: r = -0.41 to 0.67) and 3-month follow-up (range: r = -0.49 to 0.73), providing evidence for the internal validity of the study. Our findings indicate that the MBCSM programme is effective in reducing psychological distress and improving quality of life, including spiritual well-being.

Colorectal cancer treatment and survival: the experience of major public hospitals in south Australia over three decades.

BACKGROUND Registry data from four major public hospitals indicate trends in clinical care and survival from colorectal cancer over three decades, from 1980 to 2010. MATERIALS AND METHODS Kaplan-Meier product- limit estimates and Cox proportional hazards models were used to investigate disease-specific survival and multiple logistic regression analyses to explore first-round treatment trends. RESULTS Five-year survivals increased from 48% for 1980-1986 to 63% for 2005-2010 diagnoses. Survival increases applied to each ACPS stage (Australian Clinico-Pathological Stage), and particularly stage C (an increase from 38% to 68%). Risk of death from colorectal cancer halved (hazards ratio: 0.50 (0.45, 0.56)) over the study period after adjusting for age, sex, stage, differentiation, primary sub-site, health administrative region, and measures of socioeconomic status and geographic remoteness. Decreases in stage were not observed. Survivals did not vary by sex or place of residence, suggesting reasonable equity in service access and outcomes. Of staged cases, 91% were treated surgically with lower surgical rates for older ages and more advanced stage. Proportions of surgical cases having adjuvant therapy during primary courses of treatment increased for all stages and were highest for stage C (an increase from 5% in 1980-1986 to 63% for 2005-2010). Radiotherapy was more common for rectal than colonic cases. Proportions of rectal cases receiving radiotherapy increased, particularly for stage C where the increase was from 8% in 1980-1986 to 60% in 2005-2010. The percentage of stage C colorectal cases less than 70 years of age having systemic therapy as part of their first treatment round increased from 3% in 1980-1986 to 81% by 1995-2010. Based on survey data on uptake of adjuvant therapy among those offered this care, it is likely that all these younger patients were offered systemic treatment. CONCLUSIONS We conclude that pronounced increases in survivals from colorectal cancer have occurred at major public hospitals in South Australia due to increases in stage-specific survivals. Use of adjuvant therapies has increased and the patterns of change accord with clinical guideline recommendations. Reasons for sub-optimal use of radiotherapy for rectal cases warrant further investigation, including the potential for limited rural access to impede uptake of treatments at metropolitan-based radiotherapy centres.

Keratinocyte cancers in South Australia: incidence, geographical variability and service trends.

Objectives: To determine the incidence, multiplicity, geographical variability and service trends of keratinocyte cancers (KC) in South Australia (SA).

Barriers to Seeking Help for Skin Cancer Detection in Rural Australia

This study explores rural South Australians’ barriers to help-seeking for skin cancer detection. A total of 201 randomly selected rural adults (18–94 years, 66% female) were presented with a skin-cancer-related scenario via telephone and were asked the extent to which various barriers would impede their help-seeking, based on an amended version of the Barriers to Help-Seeking Scale. Older (≥63 years) and less educated participants endorsed barriers more strongly than their younger, more educated counterparts in the following domains; “Concrete barriers and distrust of caregivers”, “Emotional control”, “Minimising problem and Normalisation”, “Need for control and self-reliance” (every domain other than “Privacy”). Socioeconomic disadvantage, gender, and farmer status did not predict stronger overall barriers, but some gender and occupation-related differences were detected at the item level. Farmers were also more likely to endorse the “Minimising problem and normalization” domain than their non-farmer working rural counterparts. Widely endorsed barriers included the tendency to minimise the problem, a desire to remain in control/not be influenced by others, reluctance to show emotion or complain, and having concerns about privacy or waiting times.

Staff and patient perspectives of a smoke-free health services policy in South Australia: a state-wide implementation

Few jurisdictions have implemented and evaluated a complete smoking ban across all health sites in their jurisdiction, with no designated smoking areas. This article examines staff and patient perceptions and experiences of a mandated smoke-free policy implemented across all government health facilities in South Australia, including mental health sites. An online survey of health staff was conducted prior to policy implementation (n=3098), 3 months post-implementation (n=2673) and 15 months post-implementation (n=2890). Consumer experiences of the policy were assessed via a telephone survey (n=1722; smokers n=254). Staff support for the policy was high across all time points. Two thirds of staff reported having witnessed some policy non-compliance, and self-reported exposure to second-hand smoke was comparable pre-implementation to 15 months post-implementation. Under the policy, 56.3% of smoking patients abstained completely whilst hospitalised and 37.6% cut down the amount that they smoked. Furthermore, 34.7% reported having been offered cessation support during hospitalisation. Whilst the smoke-free policy was viewed positively and had benefits for staff and patients, reports of witnessing some non-compliance were prevalent. While the extent of non-compliance is not known, and the measure used was sensitive, complementary strategies may be needed to reduce exposure to second-hand smoke, particularly at entrances. Health-care staff should be further encouraged to offer support to nicotine-dependent patients to foster compliance and promote abstinence during hospitalisation.

Faecal occult blood testing (FOBT)-based colorectal cancer screening trends and predictors of non-use: findings from the South Australian setting and implications for increasing FOBT uptake

Objective The present study used data from three South Australian population health surveys to examine trends in knowledge, recent use and reasons for use or non-use of faecal occult blood testing (FOBT) for colorectal cancer (CRC) screening from 2011 to 2014. Screening awareness and demographic factors related to non-use were also examined. Methods FOBT trends were examined for respondents aged 50-75 years across survey years (n ~ 1000). Logistic regression analyses were undertaken to determine predictors of non-use and reasons for non-use of FOBT based on latest data. Results The proportion of respondents reporting recent FOBT use has trended up, whereas the proportion reporting non-use has trended down. Awareness of screening recommendations has increased. Respondents who were aware of screening recommendations and those aged 65-69 years were significantly less likely to report non-use. The most commonly reported reasons for FOBT use were as part the national screening program or routine examination, whereas reasons for non-use were not having symptoms and doctor not advising to have the test. Conclusions FOBT screening trends are indicative of the positive effect of the continued expansion of the national screening program. FOBT uptake may be increased by addressing salient barriers, as indicated by persisting reasons for non-use of FOBT. What is known about the topic? Australia has one of the highest age-standardised incidence rates of CRC (or bowel cancer) in the world. Population screening using non-invasive stool-based FOBT was implemented in Australia in 2006 with the introduction of the National Bowel Cancer Screening Program (NBCSP). To date, the NBCSP has been extended to only a small proportion of the target population and FOBT screening rates remain well below desired levels to effect changes in CRC outcomes at the population level. There is a recognised need for more robust data on CRC screening practices to inform interventions aimed at increasing FOBT uptake, beyond the scope of the NBCSP. What does this paper add? The study provides valuable insights into trends of FOBT screening indicators over time in the South Australia, drawing on data from population state health surveys undertaken from 2011 to 2014. A particular advantage of the dataset was that it included data on reasons for use and non-use of FOBT. These data are not routinely assessed in population-level studies of FOBT uptake, although such information would be beneficial for tracking implementation of the national program and identifying salient barriers to FOBT uptake in low-participation groups. Thus, the study also describes factors related to non-use and reasons for non-use of FOBT among the target population for CRC screening. What are the implications for practitioners? Results suggest that there have been considerable shifts in community knowledge and FOBT screening participation rates from 2011 to 2014, reflecting the positive effect of the NBCSP. Reliance on physician recommendation to screen, as well as knowledge deficits related to screening frequency and the perceived relevance of screening remain prominent barriers to FOBT uptake. Recommendations for increasing FOBT uptake are made in view of salient barriers and identified segments of the population less likely to report FOBT use.

The healthy living after cancer partnership project

Background - Primary brain tumours are rare among adults, but patients often experience physical, cognitive, neurological and psychosocial morbidity. Research has documented high rates of unmet supportive care needs among subgroups, such as patients receiving specific treatments or those receiving palliative care, but the needs of patients in the period soon after diagnosis are not known. Aim - To describe the unmet supportive care needs of adults recently diagnosed with primary brain tumours and change in needs over the early diagnosis/treatment period. Methods - A representative population-based sample of 40 patients was recruited approximately three months after diagnosis through a state cancer registry in Queensland, Australia. Patients or carer proxies completed surveys of supportive care needs in six domains (physical/daily living, psychological, patient care and support, sexuality, health system and information needs, and brain tumour-specific needs) at baseline and three months later. Mean supportive care needs scores (scale 0-100, with higher scores indicating higher levels of need) were calculated and compared over time. Results - The highest mean supportive care needs score at each time point was for physical needs (baseline 47.9, SD 26.3), closely followed by psychological needs (baseline 45.8, SD 35.6). Mean scores for other domains ranged from 30.4 to 37.9. Mean scores in all domains except for sexuality significantly declined over time, with the greatest decline for the patient care and support needs domain (mean 15.9 point decrease). Conclusions - Adults with primary brain tumours experience high levels of unmet physical and psychological needs early in the disease trajectory. However, levels of needs, particularly for patient care, decline over time, perhaps with the completion of primary treatments. Further research is needed to confirm these findings in a larger sample and investigate reasons for the decline seen.Programme/Policy Process: Once a VHL develops its activities through a cooperative network of institutions which are users and producers of information, it was essential to structure such a network within the field of cancer control and develop a governance model that could allow its sustainable operation. The model is composed of Executive Secretary, Advisory Committee, Executive Committee and Responsibility Matrix. The institutions which are part of this collaborative network have been selected in order to represent the regional diversity present in Brazil and also the diverse profiles of institutions related to cancer control, such as research, academia, government, scientific societies and organizations representing patients.Background: Smoking rates in Aboriginal Australians are gradually reducing in some age groups, but not for people in the peak reproductive years.¹ Smoking cessation is vital for cancer prevention.² Many regional programs avoid the use of threat messages when targeting Australian Aboriginal smokers.³ Aim: To assess, for the first time, the responses of Aboriginal smokers, 18–45 years, to Risk Behaviour Diagnosis scales (RBD)⁴ and intentions to quit smoking, including gender differences. Methods: We interviewed 121 Aboriginal smokers, using a structured questionnaire including adapted RBD scales. The RBD measured perceived threat (susceptibility and severity of threat) and perceived efficacy (self-efficacy and response efficacy) on Likert scales. Intentions to quit were assessed. Scales were recoded into high-low responses. Face validity was assessed via an Aboriginal panel, and scales assessed for reliability. Chi-square tests investigated the associations between intention to quit, efficacy/threat and gender. Results: Among men, intention to quit was associated with perceived efficacy (X² = 15.23;df = 1; p < 0.0001), but not with perceived threat. For women, intention to quit was neither associated with efficacy nor threat. Both genders were more likely to have high intention to quit, with high efficacy and high threat (n = 54;45%:maleX² = 12.6;df = 1; p < 0.001:femaleX²= 5.6;df = 1; p < 0.05). There was no difference in intention to quit with low efficacy-high threat for either gender (n = 39;32%). In contrast, all of the men with low threat-high efficacy (n = 5;4%) intended to quit, whereas all of the women with low threat-low efficacy (n = 6;5%) intended to quit. Conclusions: High-perceived threat was associated with high intention to quit smoking only when perceived efficacy was high. Gender differences may be a consideration. The RBD scales could be used to tailor messages to the level of efficacy and threat in clinical consultations, and in regional programs. All Aboriginal Australian smokers may benefit from increased efficacy to quit smoking.Abstract presented at the 2014 World Cancer Congress, 3-6 December 2014, Melbourne, Australia