Kym Spathonis

Follow-up care after breast cancer treatment: experiences and perceptions of service provision and provider interactions in rural Australian women

PurposeThis study aims to explore and examine experiences and perceptions of follow-up care (medical and psychosocial) after active treatment for breast cancer among women living outside major Australian cities.MethodTwenty-five semi-structured telephone interviews were conducted. Participants also completed a brief questionnaire to collect demographic, diagnosis, and treatment information. Interviews were audio-recorded, transcribed, independently coded, and then thematically analysed.ResultsThemes that emerged from the interviews centred on patient experiences and perceptions of follow-up service provision and provider interactions related to medical, psychosocial, and lifestyle (e.g., diet, physical activity) care. Many women perceived a marked decline in the quality and duration of follow-up consultations with clinicians in comparison to their initial treatment experiences. Several women experienced considerable overlap in follow-up care when multiple providers were involved resulting in ‘unnecessary’ time and travel costs. Generally, women experienced limited availability of medical providers in rural areas, resulting in a lack of continuity in care, exacerbated by limited communication and coordination between treating health professionals. Lastly, women perceived a lack of available psychosocial support and resources for rural breast cancer survivors in their areas.ConclusionsBreast cancer survivors living outside major Australian cities have limited access to medical follow-up care, and psychosocial and lifestyle support programmes. There is a need for greater co-ordination of care between health professionals to improve communication and reduce patient and medical system burden. Finding solutions (such as eHealth options) could help to alleviate these barriers and improve follow-up care for rural breast cancer survivors.

Sun exposure and sun protection behaviours among young adult sport competitors

Objective: To explore the relationship between sun protection and physical activity in young adults (18‐30 years) involved in four organised sports.

Suicide and euthanasia in late life

Epidemiological studies of suicide in the elderly indicate that, in the last few decades, there has been a relevant increase in suicide rates in old age in a number of Asian and Latin nations, with an almost parallel decrease in Anglo-Saxon counties. Mental disorders, particularly depression, physical illness, personality traits such as hostility, hopelessness, the inability to verbally express psychological pain and dependency on others, recent life events and losses are all factors that may contribute to suicide in later life. Compared with suicide in other age groups, mors voluntaris in late life is associated with the use of highly lethal methods, less ambivalence and impulsivity, and more determination and intent to die. Accordingly, elderly suicidal individuals are more likely than younger subjects to complete rather than attempt suicide. Some evidence suggests also that the characteristics of elderly individuals who attempt suicide may not overlap with those who complete suicide. Death thoughts and suicidal ideations are relatively rare among mentally healthy elderly adults, and are less predominant in this age bracket. However, whether elderly suicidal behaviour exists along a continuum, progressing in severity from death thoughts and suicidal ideation to suicide attempts and completed suicide, remains unclear. Assisted suicide and euthanasia in the elderly have been associated with the desire to escape chronic physical pain and suffering caused by terminal illness, and to relieve mental anguish and feelings of hopelessness, depression and extreme “tiredness of life.” The role of the family and those treating chronically ill members is crucial in the final stages of life, particularly when autonomy and the ability of the elderly individual to make end-of-life decisions are compromised. The main aspects associated with these controversial phenomena, particularly from a transcultural perspective, are reviewed in this article.

Do Psychosocial and Pharmacological Interventions Reduce Suicide in Schizophrenia and Schizophrenia Spectrum Disorders

Suicide is the leading cause of premature death among individuals with schizophrenia. Approximately 10-15% of patients with schizophrenia die by suicide, and 18-55% make a suicide attempt throughout their life. Despite the progress of pharmacological efforts in reducing the symptoms of schizophrenia, treatments have had limited success in reducing the overall rate of suicide among this sub-population. Few controlled studies have determined the efficacy of psychosocial interventions in the prevention of suicide. The complexity of this relationship is heightened further by incomplete research efforts investigating the particular nature of suicidal behavior among patients with comorbid conditions (such as major depression and substance abuse disorder), and across the diverse spectrum of disorders that categorize chizophrenia. This article reviews these findings in combination with a brief epidemiological consideration of suicide n schizophrenia and risk factors for suicide among this sub-population. Shortcomings of previous research, and possible avenues for future investigations relating to this matter are also discussed.

Social Cognitive Correlates of Young Adult Sport Competitors’ Sunscreen Use:

Young adults participating in outdoor sports represent a high-risk group for excessive sun exposure. The purpose of this study was to identify modifiable social cognitive correlates of sunscreen use among young adult competitors. Participants aged 18 to 30 years who competed in soccer (n = 65), surf-lifesaving (n = 63), hockey (n = 61), and tennis (n = 48) completed a sun habits survey. Almost half (n = 113) of the participants used sunscreen inadequately and 30% (n = 70) reported not using sunscreen. In fully adjusted models, social cognitive attributes significantly (p < .05) associated with inadequate sunscreen use (vs. nonuse) included skin cancer risk perceptions (OR = 0.6, 95% CI = 0.3, 1.0), perceived barriers to sunscreen use (OR = 0.5, 95% CI = 0.3, 0.9), and stronger personal norms for applying sunscreen (OR = 1.8, 95% CI = 1.0, 3.2). These findings provide insight into the attributes that enable or inhibit the use of sunscreen among young competitors and as a result may be useful in informing behavior change interventions within the sporting context.

Relationships of Sun-Protection Habit Strength with Sunscreen Use During Outdoor Sport and Physical Activity

The objective of this cross-sectional questionnaire study was to assess associations of a self-report index of sun protection habit strength with sunscreen use in sporting environments and outdoor physical activity. Participants (n = 234) in field hockey, soccer, tennis and surf sports in Queensland, Australia, completed a self-administered survey on sun protection during organized sport, and during general outdoor physical activity during 2005/2006. The sun protection habit strength index was dichotomized into two categories. Multinomial logistic regression analyses assessed the associations of low versus high sun protection habit strength with three categories of sunscreen use (no or rare use; inadequate use; and adequate use). Compared to participants with low sun protection habit strength, those with high sun protection habit strength had significantly greater odds of any sunscreen use during organized sport and during general outdoor physical activity. This association was strongest for adequate sunscreen use in both settings. In conclusion, this study suggests that the measure of sun protection habit strength is a potentially useful assessment tool for future sun protection studies.

Physical Activity and Health

Introduction Participation in physical activity is associated with significant benefits to health, most importantly in the prevention of Type 2 diabetes, cardiovascular disease and some cancers (Bauman et al., 2002; United States Department of Health and Human Services [USDHHS], 1996). In this chapter, we provide an overview of research on health-enhancing physical activity in adults. We provide brief examples of epidemiological studies on the relationships of physical activity to health outcomes: we also consider descriptive studies of adult populations on levels of participation. Our focus is on physical activity as a set of behaviours: we describe research findings on the ‘determinants’ of physical activity and describe the theories of health behaviour that are now widely used in understanding and influencing physical activity. Physical activity exercise and fitness The terms, ‘physical activity’, ‘exercise’ and ‘fitness’ are sometimes used interchangeably and at times incorrectly (Sallis & Owen, 1999). ‘Physical activity’ refers to any bodily movement, but generally to the movements of groups of large muscles (particularly of the legs and arms) that result in significant increases in metabolic energy expenditure, above the resting level. Regularly taking part in such activities is associated with better health outcomes. Physical activity can be performed at a wide range of intensities: walking or other moderate-intensity activities such as swimming at a low, moderate or brisk pace; vigorous endurance activities (for example, jogging or running, walking fast uphill, riding a bicycle fast or in hilly terrain); and activities that increase strength and/or flexibility (for example, weight training, calisthenics or strenuous occupational or domestic tasks such as heavy lifting or carrying).

Transition to follow-up care after breast cancer treatment in rural Australia: women'S experiences of service provision

Abstract of a poster presentation presented at the Joint Meeting of the COSA 39th Annual Scientific Meeting and IPOS 14th World Congress of Psycho-Oncology, 13-15 November 2012, Brisbane Convention and Exhibition Centre.