Jane Madeline Fletcher

Home-based palliative care: a systematic literature review of the self-reported unmet needs of patients and carers

Background: There have been many studies on the unmet needs of palliative care patients and carers from the perspective of bereaved caregivers. However, the unmet needs of palliative care patients and carers from the perspective of current patients and their carers have received little research attention. Aim: As home-based services have become one of the main delivery models of palliative care, the aim of this review was to describe, evaluate and summarise the literature on the unmet needs of palliative home care patients and carers. Design: The systematic review of qualitative and quantitative studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources: PubMed, CINAHL, Embase, MEDLINE, PsycINFO, AMED and CareSearch were searched to find empirical studies on the self-reported unmet needs of palliative home care patients and carers. Results: Nine qualitative studies, three quantitative studies and three mixed-design studies were identified. The most frequently reported unmet need was effective communication with health-care professionals, the lack of which negatively impacted on the care received by patients and carers. Physical care needs were met, which indicates that the examined palliative home care services were delivering satisfactory care in this domain, but lacking in other areas. Conclusions: The focus therefore should be on improving other aspects of patient care, including communication by health professionals to prevent or reduce suffering in areas such as psychosocial domains. Valid and reliable quantitative measures of unmet needs in palliative care are needed to examine this area more rigorously.

Anxiety in the management of localised prostate cancer by active surveillance.

To describe a range of anxieties in men on active surveillance (AS) for prostate cancer and determine which of these anxieties predicted health‐related quality of life (HRQL).

Factors associated with adherence to physical activity guidelines in patients with prostate cancer

This study aimed to estimate the proportion of patients with prostate cancer (PCa) meeting the National Physical Activity Guidelines of Australia (NPAGA) and determine sociodemographic and medical factors associated with meeting these guidelines. Secondary aims included examining physical activity (PA) levels by treatment type and domain (leisure, work, transport and domestic) and establishing a predictive model of the likelihood that men with PCa would meet NPAGA.

Predictors of depression, anxiety and quality of life in patients with prostate cancer receiving androgen deprivation therapy

To evaluate the effects of androgen deprivation therapy (ADT) on depression, anxiety and quality of life (QoL) in patients with prostate cancer (PCa) and to examine the relationship between meeting the National Physical Activity Guidelines of Australia (NPAGA) and the presence and severity of both psychological sequelae and physical side effects associated with ADT. A secondary purpose was to examine the predictors of depression, anxiety and QoL in patients with PCa.

The Relationship of Knowledge, Health Value and Health Self-efficacy with Men’s Intentions to Receive the Human Papillomavirus (HPV) Vaccine

The aim of the present study was to determine whether it was possible to predict Human Papillomavirus (HPV) vaccination intentions an Australian male sample. One hundred and twenty one males aged 18 to 26 (M = 22.3, SD = 2.06), completed an online survey assessing HPV-related knowledge, health beliefs and health self-efficacy. HPV knowledge and health self-efficacy were significant independent predictors of vaccine acceptance. A moderating effect was found between HPV knowledge and health self-efficacy. It was concluded that the results of previous research into the predictors of HPV vaccination intentions can largely be applied to an Australian male population.

The impact of physical activity on psychosocial outcomes in men receiving androgen deprivation therapy for prostate cancer: a systematic review.

OBJECTIVE Depression, anxiety, and cognitive dysfunction are common complaints in men with prostate cancer (PCa) receiving androgen deprivation therapy (ADT). Consequently, the quality of life (QoL) of these men is negatively impacted. This systematic review evaluated the effectiveness of physical activity (PA) as an intervention to improve depression and anxiety symptoms, cognitive function, and QoL in patients receiving ADT for PCa. METHODS Inclusion criteria and search strategy were defined and documented in a protocol registered with the International Prospective Register of Systematic Reviews (Registration # CRD42012002666). Due to the limited number of studies examining these outcomes in this patient group, no limitations were placed on study designs included. A systematic search of Ovid MEDLINE, PsycINFO, EMBASE, Informit, Scopus, Cochrane Library, and CINAHL databases identified 7 relevant peer-reviewed studies: 4 clinical PA interventions, 2 pilot studies, and 1 cross-sectional survey. Data extraction and risk of bias assessment tools developed by the Cochrane Collaboration were used to evaluate evidence. RESULTS Existing data suggest that PA improved QoL in men with PCa receiving ADT. The existing evidence, however, is not sufficiently robust to determine the adequacy of PA as an intervention to improve depression, anxiety, and cognitive function outcomes in this patient group. CONCLUSIONS Despite the lack of studies conducted, preliminary findings support the utility of PA for improving QoL in men undergoing ADT for PCa. A clear gap in the current literature was identified, confirming the need for further clinical trials in which depression, anxiety, and cognitive function are evaluated.

Symptoms of posttraumatic stress in Australian women with ovarian cancer

The aim of the study was to assess the prevalence and nature of symptoms of posttraumatic stress disorder (PTSD) in women with ovarian cancer. A further aim was to examine the demographic, medical and psychosocial factors associated with PTSD symptoms.

Factors associated with anxiety and depression in the management of acoustic neuroma patients

The objectives of this study were to describe anxiety and depression levels among acoustic neuroma patients; examine differences in anxiety and depression across the acoustic neuroma management options of microsurgery, radiation and observation; and to investigate management, medical and demographic factors that might predict anxiety and depression in this patient group. A cross-sectional questionnaire was completed by 205 adults diagnosed with, or treated for, a unilateral acoustic neuroma within five years of questionnaire distribution. Median age of participants was 57.0 years, and 120 (58.5%) were female. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Clinically significant anxiety was reported by 29.8% of participants and 10.2% were depressed. Mean anxiety and depression scores did not differ from general population norms. No significant differences in anxiety and depression were found across management options. Time since management, number of symptoms and comorbid medical conditions predicted anxiety, while depression was predicted by number of symptoms. This appears to be the first study among acoustic neuroma patients in which anxiety and depression were compared across management options. Treating physicians should be aware that as the number of acoustic neuroma symptoms increases, so may the likelihood of clinically significant anxiety and depression.

The lived experience of volunteering in a palliative care biography service

OBJECTIVE Many patients approaching death experience hopelessness, helplessness, and a depressed mood, and these factors can contribute to a difficult end-of-life (EoL) period. Biography services may assist patients in finding meaning and purpose at this time. The aim of our study was to investigate the lived experience of volunteers involved in a biography service in Melbourne, Australia, using a qualitative methodology. METHOD The participants were 10 volunteers who had participated in a biography service within a private palliative care service. Each volunteer was interviewed separately using a study-specific semistructured interview guide. The transcripts of these interviews were then subjected to thematic analysis. RESULTS Analysis yielded the following themes: motivations for volunteering; dealing with death, dying, and existential issues; psychosocial benefits of volunteering; and benefits and challenges of working with patients and their families. Our results indicated that volunteering gave the volunteers a deeper appreciation of existential issues, and helped them to be more appreciative of their own lives and gain a deeper awareness of the struggles other people experience. They also suggested that volunteers felt that their involvement contributed to their own personal development, and was personally rewarding. Furthermore, the results highlighted that volunteers found that encounters with family members were sometimes challenging. While some were appreciative, others imposed time limits, became overly reliant on the volunteers, and were sometimes offended, hurt, and angered by what was included in the final biography. SIGNIFICANCE OF RESULTS It is hoped that the findings of the current study will provide direction for improvements in the biography services that will benefit patients, family members, and volunteers. In particular, our findings highlight the need to provide ongoing support for volunteers to assist them in handling the challenges of volunteering in a palliative care setting.

Factors associated with symptom-specific psychological and functional impact among acoustic neuroma patients

INTRODUCTION The main purpose of this study was to investigate the psychological and functional impact attributed to acoustic neuroma symptoms. MATERIALS AND METHODS A sample of 207 acoustic neuroma patients completed a study-specific questionnaire about the severity, frequency, and psychological and functional impact of 9 acoustic neuroma symptoms. RESULTS The survey response rate was 56.4 per cent. All symptoms had some degree of psychological impact for the majority of participants; hearing loss was the symptom most often reported to have a severe psychological impact. The majority of respondents reported functional impact attributed to hearing loss, balance disturbance, dizziness, eye problems, headache and fatigue; balance disturbance was the symptom most often reported to have a severe functional impact. For most symptoms, psychological and functional impact were related to severity and frequency. CONCLUSION Of the acoustic neuroma symptoms investigated, hearing loss and balance disturbance were the most likely to have a severe psychological and functional impact, respectively.