Kristy Forshaw

Preparatory education for cancer patients undergoing surgery: A systematic review of volume and quality of research output over time.

OBJECTIVE To determine the volume and scope of research output examining preparation of patients for people undergoing cancer-related surgical treatment, and the impact of pre-operative education on patient outcomes and health care utilisation. METHODS Medline, EMBASE, PsychINFO databases were systematically searched. Eligible papers were coded as data-based or non-data-based. Data-based papers were further classified as descriptive, measurement or intervention studies. Methodological quality and effectiveness of intervention studies were assessed using Cochrane Effective Practice and Organisation of Care (EPOC) criteria. RESULTS We identified 121 eligible papers. The number of publications significantly increased over time. Most were data-based (n=99) and descriptive (n=83). Fourteen intervention studies met EPOC design criteria. Face-to-face interventions reported benefits for anxiety (5/7), satisfaction (1/1), knowledge (3/3) and health care costs (1/1). Audio-visual and multi-media interventions improved satisfaction (1/1) and knowledge (2/3), but not anxiety (0/3). Written interventions were mixed. CONCLUSION Descriptive studies dominate the literature examining preoperative education in oncology populations, with few rigorous intervention studies. Pre-operative education can improve satisfaction, knowledge and reduce anxiety. PRACTICE IMPLICATIONS Further work should be directed at multi-modal interventions, and those that include the caregiver, given their role in assisting patients to prepare and recover from surgery.

Interventions for preparing patients for chemotherapy and radiotherapy: a systematic review

PurposeUndergoing chemotherapy and radiotherapy can be physically and psychologically stressful for people with cancer. Providing preparatory information to cancer patients as they face treatment and its aftermath has the potential to improve patient outcomes. This study assessed the methodological quality and effectiveness of interventions providing preparatory information about chemotherapy and/or radiotherapy to cancer patients in improving patient outcomes and health care use.MethodsMEDLINE, EMBASE, and Cochrane databases were systematically searched from January 1995 until October 2012. Inclusion criteria: (1) met Effective Practice and Organisation of Care (EPOC) criteria for study design; (2) included adults with a current cancer diagnosis; (3) delivered preparatory information via a health care provider or was self-directed; (4) examined psychological well-being, quality of life, physical symptoms, satisfaction, knowledge, or health service utilisation. Studies were assessed for methodological quality using the EPOC criteria.ResultsEighteen studies involving 3,443 cancer patients met inclusion criteria. Interventions included written information, audiotapes, videotapes, and computer programs. Interventions improved patient satisfaction (6/7 studies), information needs and patient knowledge (5/6 studies), physical symptoms (3/4 studies) and cost (1/1 study). More than half of the interventions improved psychological outcomes and quality of life (10/17 studies).ConclusionProviding preparatory information can improve patient-reported outcomes in cancer patients undergoing chemotherapy and radiotherapy, especially with respect to satisfaction and knowledge. Some, but not all, studies improved psychological outcomes and physical symptoms. There is a need for methodologically rigorous research to determine the most effective timing and method of delivery of preparatory information to improve patient outcomes.

Optimizing Patient Preparation and Surgical Experience Using eHealth Technology

With population growth and aging, it is expected that the demand for surgical services will increase. However, increased complexity of procedures, time pressures on staff, and the demand for a patient-centered approach continue to challenge a system characterized by finite health care resources. Suboptimal care is reported in each phase of surgical care, from the time of consent to discharge and long-term follow-up. Novel strategies are thus needed to address these challenges to produce effective and sustainable improvements in surgical care across the care pathway. The eHealth programs represent a potential strategy for improving the quality of care delivered across various phases of care, thereby improving patient outcomes. This discussion paper describes (1) the key functions of eHealth programs including information gathering, transfer, and exchange; (2) examples of eHealth programs in overcoming challenges to optimal surgical care across the care pathway; and (3) the potential challenges and future directions for implementing eHealth programs in this setting. The eHealth programs are a promising alternative for collecting patient-reported outcome data, providing access to credible health information and strategies to enable patients to take an active role in their own health care, and promote efficient communication between patients and health care providers. However, additional rigorous intervention studies examining the needs of potential role of eHealth programs in augmenting patients’ preparation and recovery from surgery, and subsequent impact on patient outcomes and processes of care are needed to advance the field. Furthermore, evidence for the benefits of eHealth programs in supporting carers and strategies to maximize engagement from end users are needed.

Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners

BackgroundIn Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control.MethodTrial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period.ResultsEleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued.ConclusionThere is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented.Trial registrationAustralian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976. Retrospectively registered on 31 May 2011.

Patterns of type 2 diabetes monitoring in rural towns: How does frequency of HbA1c and lipid testing compare with existing guidelines?

OBJECTIVE To indicate levels of monitoring of type 2 diabetes in rural and regional Australia by examining patterns of glycated haemoglobin (HbA1c) and blood lipid testing. DESIGN AND SETTING Retrospective analysis of pathology services data from twenty regional and rural towns in eastern Australia over 24 months. PARTICIPANTS Of 13 105 individuals who had either a single HbA1c result ≥7.0% (53 mmol mol-1 ); or two or more HbA1c tests within the study period. MAIN OUTCOME MEASURES Frequency of testing of HbA1c and blood lipids (cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides) were compared with guideline recommendations. RESULTS About 58.3% of patients did not have the recommended 6-monthly HbA1c tests and 30.6% did not have annual lipid testing. For those who did not receive tests at the recommended interval, the mean between-test interval was 10.5 months (95% CI = 7.5-13.5) rather than 6 months for HbA1c testing; and 15.7 (95% CI = 13.3-18.1) months rather than annually for blood lipids. For those with at least one out-of-range test result, 77% of patients failed to receive a follow-up HbA1c test and 86.5% failed to receive a follow-up blood lipid test within the recommended 3 months. Patients less than 50 years of age, living in a more remote area and with poor diabetes control were less likely to have testing at the recommended intervals (P < 0.0001). CONCLUSIONS Although poor diabetes testing is not limited to rural areas, more intensive diabetes monitoring is likely to be needed for patients living in non-metropolitan areas, particularly for some subgroups.

How accurately do general practitioners detect concurrent tobacco use and risky alcohol consumption? A cross-sectional study in Australian general practice

The negative health consequences of tobacco and risky alcohol consumption are compounded when used concurrently. Australian preventative health guidelines recommend that general practitioners (GPs) assess and provide evidence-based intervention. No studies, however, have examined the accuracy of GP detection of concurrent tobacco use and risky alcohol consumption or the factors associated with accurate detection. This study aimed to examine the: (i) accuracy of GP detection of concurrent tobacco and risky alcohol use compared to patient self-report; and (ii) GP and patient characteristics associated with accurate detection following a single clinical encounter. Patients attending 12 Australian general practices completed a survey assessing smoking and alcohol consumption. For each participating patient, GPs completed a checklist to indicate the presence of these risk factors. GP judgements were compared to patient self-report. Fifty-one GPs completed a health risk checklist for 1332 patients. Only 23% of patients who self-reported concurrent tobacco and risky alcohol use identified by their GP. Patients who visited their GP four to six times in the last year were most likely to have concurrent tobacco and risky alcohol use were identified. It is imperative to establish systems to increase detection of preventative health risks in general practice to enable the provision of evidence-based treatments.

Testing for type 2 diabetes in Indigenous Australians: guideline recommendations and current practice

Objectives: To determine the proportion of Aboriginal Controlled Community Health Service (ACCHS) patients tested according to three national diabetes testing guidelines; to investigate whether specific patient characteristics were associated with being tested.

Comparison of Two Sources of Clinical Audit Data to Assess the Delivery of Diabetes Care in Aboriginal Communities

The objective of this study was to determine the concordance between data extracted from two Clinical Decision Support Systems regarding diabetes testing and monitoring at Aboriginal Community Controlled Health Services in Australia. De-identified PenCAT and Communicare Systems data were extracted from the services allocated to the intervention arm of a diabetes care trial, and intra-class correlations for each extracted item were derived at a service level. Strong to very strong correlations between the two data sources were found regarding the total number of patients with diabetes per service (Intra-class correlation [ICC] = 0.99), as well as the number (ICC = 0.98–0.99) and proportion (ICC = 0.96) of patients with diabetes by gender. The correlation was moderate for the number and proportion of Type 2 diabetes patients per service in the group aged 18–34 years (ICC = 0.65 and 0.8–0.82 respectively). Strong to very strong correlations were found for numbers and proportions of patients being tested for diabetes, and for appropriate monitoring of patients known to have diabetes (ICC = 0.998–1.00). This indicated a generally high degree of concordance between whole-service data extracted by the two Clinical Decision Support Systems. Therefore, the less expensive or less complex option (depending on the individual circumstances of the service) may be appropriate for monitoring diabetes testing and care. However, the extraction of data about subgroups of patients may not be interchangeable.

Baseline evidence practice gap for type 2 diabetes care among Aboriginal Australians in a cluster randomised controlled trial

Background Type 2 diabetes is a major health problem in the Australian Indigenous population. Aboriginal Community Controlled Health Organisations (ACCHOs) are a primary care setting where there is opportunity to partner with health services to reduce the current evidence-practice gap in the provision of health care for Type 2 diabetes. The aim is to examine the effectiveness of a tailored ecologically-based collaborative model in achieving adherence to best practice clinical guidelines for Type 2 diabetes in ACCHOs. This study will examine whether the model results in improvements in diagnostic testing, monitoring and control of diabetes using reliable objective clinical indicators.