Lea Budden

Women's decision satisfaction and psychological distress following early breast cancer treatment: a treatment decision support role for nurses

This prospective cross-sectional study investigated Australian womens (n = 104) decision satisfaction with cancer treatment decision for early breast cancer as well as their psychological distress 3-4 months following surgery. Womens satisfaction was surveyed using the Treatment Decision Satisfaction Questionnaire, and the Brief Symptom Inventory-18 was used to measure psychological distress. Women who were living alone, who worked as professionals and who were not involved in the decision-making process by their doctors were less likely to be satisfied with their decision process, outcome and their overall treatment decision. Following treatment, 26.0% of women were distressed; 18.3% experienced anxiety; 19.2% somatization; and 27.9% depression. Women who experienced somatization were more likely to be dissatisfied with the treatment decision (P = 0.003) as were those who reported psychological distress (P = 0.020). Women who were involved in choosing their treatment were more satisfied with their decision. Many women experienced distress following breast cancer treatment and might have required referral for psychological assessment, management and long-term support. Women who experienced distress were more likely to be dissatisfied with the treatment decision (or vice versa).

Australian women's prediagnostic decision-making styles, relating to treatment choices for early breast cancer treatment.

Women diagnosed with early breast cancer are now asked by their doctors to choose from a range of options for their preferred medical treatment plan. Little information is known about women’s treatment decision-making and therefore nurses do not have evidence to guide this decision support. The aim of this descriptive survey was to investigate the prediagnostic decision-making behavior of a sample (N = 377) of Australian women, regarding their treatment choices for early breast cancer. The data were collected using the Pre-Decision Portfolio Questionnaire (PDPQ) by Pierce (1996), which includes the Michigan Assessment of Decision Styles (MADS). Of 366 participating women, 19.9% strongly agreed to all three items of the MADS factor Deferring Responsibility; 0.3% strongly agreed to all four factors of Avoidance; 32.7% strongly agreed on all four items of Information Seeking; and 63.4% strongly agreed to all five items of Deliberation. Women showed a variety of preferred decision styles, depending on age, education, occupation and employment status. Only 36% of women indicated it was critically important to “get the treatment over as soon as possible;” 55% to “participate in selecting treatment;” and 53% to “read a lot of information.” The understanding of factors that are important to women when they are making decisions for medical treatment is a mandatory step in designing customized evidence-based decision support, which can be delivered by nurses to help women during this distressing experience.

Telehealth: a new opportunity to discuss smoking cessation with indigenous cancer patients and their families

[Extract] Public health initiatives aimed at promoting the negative health impacts of smoking have led to decreases in smoking among non-indigenous populations; however, higher rates of smoking continue to be the leading cause of disease burden among indigenous populations throughout the developed world. For Aboriginal and Torres Strait Islander peoples (hereafter referred to as Indigenous Australians), the situation is dire with Indigenous Australians 1.9 times more likely to die of lung cancer Rates of smoking vary within and between Indigenous communities with significantly higher rates reported for Indigenous populations (41%) compared with non-Indigenous Australians (16%). Remoteness and younger age appear to be critical risk factors for higher rates of smoking among Indigenous Australians with rates as high as 62% reported for women aged 15 to 34 years in a remote community in North Queensland and 76% among men in a community in the Northern Territory.

Is population flow an unintended consequence of alcohol management plans

AIMS AND OBJECTIVES The aim of this study was to gauge whether, and to what extent, population flow occurred as a result of the implementation of alcohol management plans in Indigenous communities. BACKGROUND Alcohol management plans involving carriage limits and dry places were introduced into 15 Queensland Indigenous communities between 2002-2004. Controls on alcohol availability were further tightened between 2008-2010, seeing the closure of eight mainly remote community taverns/canteens. DESIGN A retrospective observational study was undertaken using data from the Queensland Injury Surveillance Unit. METHODS Population flow was measured by changing patterns of alcohol-related injuries in a mining region near dry Indigenous communities following the introduction of alcohol management plans and a control mining region distant from Indigenous communities with alcohol management plans. Data were analysed using descriptive and inferential statistics. Logistic regression was used for the comparison of the characteristics between the emergency department presentations. The rates of alcohol-related injury presentations per 1000/population were calculated and age-standardised to the Australian population. RESULTS Between the five-year periods 2003-2007 and 2008-2012, alcohol-related injury presentations to the Mount Isa emergency department trebled from an age-adjusted average annual rate of 9·5/1000 in the regions population to 27·1/1000 population. In the control region, alcohol-related emergency department injury presentations did not increase to the same degree with age-adjusted average annual rates of 1·42/1000 and 2·21/1000, respectively. CONCLUSIONS The 10-year pattern of emergency department presentations for alcohol-related injuries increased significantly in the Mount Isa region compared with the control region. Further research should investigate the impacts of population flow related to Indigenous community alcohol management plans. RELEVANCE TO CLINICAL PRACTICE Although initiatives such as alcohol management plans have been implemented to reduce alcohol use and related consequences in Indigenous communities, there needs to be a greater consideration of the impact of these policies in nearby towns in the future.