Jessica K. Roydhouse

Chinese-Australian Women’s Knowledge, Facilitators and Barriers Related to Cervical Cancer Screening: A Qualitative Study

Understanding the different facilitators and barriers to screening within cultural and ethnic groups is important for developing appropriate education and outreach programs to underserved groups. Qualitative methods were employed to gain a rich understanding of participant views. In-depth interviews were conducted with 18 Chinese Australian women in their native languages and analysed using content analysis. Knowledge of cervical cancer was low, and few participants understood the benefits and purpose of screening. Having a doctor’s recommendation was a strong motivator, and returning for screening was encouraged by having a female Chinese doctor perform the exam, receiving a reminder letter and the absence of cost for screening participation. However, participation was inhibited by logistical barriers, cultural beliefs and previous painful screening experiences. A range of multifaceted facilitators and barriers must be considered when developing interventions to increase the rates of cervical screening in this population.

Asthma education in primary healthcare settings

Purpose of review Patient education is an essential component of asthma management. The current paradigm of asthma education has moved away from the ‘information-transfer’ programmes that characterized earlier approaches and that were shown to be largely ineffective, to approaches that promote self-management education. In this article, we review the most recent research studies that discuss the impact of self-management education on health outcomes for asthma patients in the primary care setting. Recent findings Although there are several recent examples of asthma education practices in primary healthcare, they are mostly with community-based pharmacists and largely confined to adults. Further research is clearly required especially in relation to children and adolescents. A key aspect of optimizing asthma self-management education for patients is the need for more effective training interventions for primary care providers, and structural and organizational reform based on good evidence. Summary Health outcomes may be improved if there is greater consistency between the various different primary healthcare providers who manage children and families with asthma. There may be value in extending the concept of multidisciplinary care to include partnerships with community groups and organizations to ensure that asthma educational messages are reinforced across a variety of settings.

The effectiveness of glucose in reducing needle-related procedural pain in infants

This systematic review examined the effectiveness of glucose in relieving needle-associated pain in infants. Meta-analysis was not undertaken, and there was variation in dose, administration method, concentration, and outcome measurement. Glucose was more effective than placebo in relieving infant pain as measured by behavioral outcomes, but there were mixed findings for physiological outcomes. Based on these findings, 25%-50% glucose appears effective for infant pain management.

Feasibility study of a communication and education asthma intervention for general practitioners in Australia

The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor-patient communication. The impact ofthe modified PACE Australia program on the processes and outcomes ofGP care ofchildren with asthma is now being measured in a randomised controlled trial.

Knowledge and skills of cancer clinical trials nurses in Australia

AIMS   This paper is a report of the development and testing of a questionnaire measuring knowledge and skills of cancer clinical trials nurse in Australia. BACKGROUND   The role of cancer clinical trials nurse, widely acknowledged as an integral member of the clinical research team, has evolved in recent years. Elements of the clinical trials nurse role in cancer have previously been described. To evaluate specific cancer clinical trials nurse educational and training needs, the development of a valid and reliable tool is required. METHODS   In 2009, a study was conducted in three stages. Stage I: questionnaire development and pilot testing; stage II: focus group; stage III: national survey. Internal consistency reliability testing and multi-trait analysis of item convergent/divergent validity were employed. Regression analysis was used to identify predictors of clinical trials nurse knowledge and skills. RESULTS   The national survey was a 48-item questionnaire, measuring six clinical trial knowledge and seven skills sub-scales. Of 61 respondents, 90% were women, with mean age 43 years, 19 years as a Registered Nurse and 5 years as a cancer clinical trials nurse. Self-reported knowledge and skills were satisfactory to good. Internal consistency reliability was high (Cronbachs alpha: knowledge = 0·98; skills = 0·90). Criteria for item convergent/divergent validity were met. Number of years as cancer clinical trials nurse was positively related to self-reported knowledge and skills. CONCLUSION   Preliminary data suggest that the national survey is reliable and valid. Data have contributed to better understanding the knowledge and skills of cancer clinical trials nurse in Australia and development of a postgraduate course in clinical trials.

The effect of cancer stage and treatment modality on quality of life in oropharyngeal cancer

To examine changes in health‐related quality of life among oropharyngeal cancer patients by stages and across treatment types among advanced cancer patients.

A description of the nutritional status and quality of life of Australian gynaecological cancer patients over time.

PURPOSE OF THE RESEARCH To describe the quality of life, nutritional status and physical activity of women with gynaecological cancer over three time points. METHODS AND SAMPLE Women referred to a major gynaecological cancer service in Sydney for initial treatment were invited to complete validated questionnaires at baseline, three and six months after diagnosis. Quality of life was assessed using the 36-item Short Form Health Survey (SF36) and the Symptom Distress Scale. Nutritional status was assessed using the Patient Generated-Subjective Global Assessment and physical activity was assessed using the International Physical Activity Questionnaire short form. Effect sizes corrected for correlation were calculated using Cohens d and Friedmans test was used to compare scores. Complete case analysis was used. KEY RESULTS Forty women were recruited and twenty-three (58%) completed assessment measures for all three time points. No important clinical or demographic differences existed between women who completed all measures and those who did not. Over the duration of the study, the number of well-nourished women increased from 16 to 21, while the number of malnourished women decreased from 7 to 2. Improvements in SF36 scores were seen in all aspects except general health, which declined (p>0.05). Statistically significant (p<0.05) improvements were seen for role physical, vitality, social functioning and role emotional. The median number of minutes of physical activity per week was highest at diagnosis and declined after that. CONCLUSIONS This study indicates the importance of assessing nutritional status at diagnosis for women with gynaecological cancer.

Psychosocial impact of cutaneous toxicities associated with epidermal growth factor receptor-inhibitor treatment.

Epidermal growth factor receptor inhibitors (EGFRIs) are an increasingly important class of anticancer agents. Cutaneous toxicities, the most common adverse effects of EGFRI therapy, require dose modification or treatment cessation when moderate or severe and may compromise treatment compliance. To date, assessment has focused on physical symptoms associated with cutaneous toxicities; however, the psychosocial impact of those effects requires greater consideration. This article reviews current knowledge of assessment of cutaneous toxicities and identifies gaps in evidence, with particular focus on the psychosocial impact of cutaneous toxicities. Promising new assessment tools and approaches including the use of electronic patient-reported outcome measures are discussed, as well as implications for research in evaluating psychosocial interventions.

Systematic review of caregiver responses for patient health-related quality of life in adult cancer care

PurposeIn surveys and in research, proxies such as family members may be used to assess patient health-related quality of life. The aim of this research is to help cancer researchers select a validated health-related quality of life tool if they anticipate using proxy-reported data.MethodsSystematic review and methodological appraisal of studies examining the concordance of paired adult cancer patient and proxy responses for multidimensional, validated HRQOL tools. We searched PubMed, CINAHL, PsycINFO and perused bibliographies of reviewed papers. We reviewed concordance assessment methods, results, and associated factors for each validated tool.ResultsA total of 32 papers reporting on 29 study populations were included. Most papers were cross-sectional (N = 20) and used disease-specific tools (N = 19), primarily the FACT and EORTC. Patient and proxy mean scores were similar on average for tools and scales, with most mean differences <10 points but large standard deviations. Average ICCs for the FACT and EORTC ranged from 0.35 to 0.62, depending on the scale. Few papers (N = 15) evaluated factors associated with concordance, and results and measurement approaches were inconsistent. The EORTC was the most commonly evaluated disease-specific tool (N = 5 papers). For generic tools, both concordance and associated factor information was most commonly available for the COOP/WONCA (N = 3 papers). The MQOL was the most frequently evaluated end-of-life tool (N = 3 papers).ConclusionsProxy and patient scores are similar on average, but there is large, clinically important residual variability. The evidence base is strongest for the EORTC (disease-specific tools), COOP/WONCA (generic tools), and MQOL (end-of-life-specific tools).

Nurse-led supportive care management: a 6-month review of the role of a nurse practitioner in a chemotherapy unit

OBJECTIVES This case study evaluates the oncology nurse practitioner (NP) role in a chemotherapy unit. BACKGROUND The NP works in the cancer centre of a major metropolitan public hospital. The NP role was established in the chemotherapy unit in 2007. The NP reviews all patients that have an unscheduled presentation to the unit, with symptoms relating either to their disease or treatment. METHODS All unscheduled occasions of service provided by the NP in the chemotherapy unit over 6 months were recorded. Data were collected on patient demographic characteristics, medical problems and reason for presentation. Data on duration of care, interventions and outcomes administered by the NP were captured. RESULTS There were 87 occasions of service (72 patients) during the study period. Nausea, vomiting or dehydration were the most common presenting problems and most presenting problems were moderate or severe (n = 73, 84%). The median time to review for the NP was 5 min and nearly all consultations (n = 83, 96%) took 30 min or less. Following NP consultation, most occasions of service did not require subsequent hospital admission (n = 52, 60%), medical advice (n = 61, 70%) or medical review (n = 75, 86%). CONCLUSIONS The NP is a valuable asset to a busy department, increasing access to timely and appropriate healthcare for patients on chemotherapy.