Sharon Licqurish

Cancer beliefs in ethnic minority populations: a review and meta-synthesis of qualitative studies.

People from ethnic minorities often experience poorer cancer outcomes, possibly due to later presentation to healthcare and later diagnosis. We aimed to identify common cancer beliefs in minority populations in developed countries, which can affect symptom appraisal and help seeking for symptomatic cancer. Our systematic review found 15 relevant qualitative studies, located in the United Kingdom (six), United States (five), Australia (two) and Canada (two) of African, African-American, Asian, Arabic, Hispanic and Latino minority groups. We conducted a meta-synthesis that found specific emotional reactions to cancer, knowledge and beliefs and interactions with healthcare services as contributing factors in help seeking for a cancer diagnosis. These findings may be useful to inform the development of interventions to facilitate cancer diagnosis in minority populations.

Cancer Risk Assessment Tools in Primary Care: A Systematic Review of Randomized Controlled Trials

PURPOSE We conducted this review to identify published randomized controlled trials (RCTs) of cancer risk assessment tools used in primary care and to determine their impact on clinical utility (clinicians), screening uptake (patients), and psychosocial outcomes (patients). METHODS We searched EMBASE, PubMed and the Cochrane databases for RCTs of cancer risk assessment tools in primary care up to May 2014. Only studies set in primary care, with patients eligible for screening, and English-language articles were included. RESULTS The review included 11 trials of 7 risk tools. The trials were heterogeneous with respect to type of tool that was used, type(s) of cancer assessed, and outcomes measured. Evidence suggested risk tools improved patient risk perception, knowledge, and screening intentions, but not necessarily screening behavior. Overall, uptake of a tool was greater if initiated by patients, if used by a dedicated clinician, and when combined with decision support. There was no increase in cancer worry. Health promotion messages within the tool had positive effects on behavior change. Trials were limited by low-recruitment uptake, and the heterogeneity of the findings necessitated a narrative review rather than a meta-analysis. CONCLUSIONS Risk tools may increase intentions to have cancer screening, but additional interventions at the clinician or health system levels may be needed to increase risk-appropriate cancer screening behavior.

Patients’ experience of using primary care services in the context of Indonesian universal health coverage reforms

BackgroundThe World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as Jaminan Kesehatan Nasional (JKN). It was designed to provide people with equitable and high-quality health care by strengthening primary care as the gate-keeper to hospitals. However, during its first year of implementation, recruitment of JKN members was slow, and the referral rates from primary to secondary care remained high. Little is known about how the public views the introduction of JKN or the factors that influence their decision to enroll in JKN.AimThis research aimed to explore patients’ views on the implementation of JKN and factors that influence a person’s decision to enroll in the JKN scheme.MethodsThis study was informed by interpretative phenomenological analysis (IPA) methodology to understand patients’ views. The interview participants were purposively recruited using maximum variation criteria. The data were gathered using in-depth interviews and was conducted in Yogyakarta from October to December 2014. The interviews were transcribed, translated and analyzed using IPA analysis.ResultTwenty three participants were interviewed from eight primary care clinics. Three superordinate themes: access, trust, and separation anxiety were identified which impacted on the uptake of JKN. Participants acknowledged that whilst primary care clinics were conveniently located, access was often complicated by long waiting times and short opening hours. Participants also expressed lower levels of trust with primary care doctors compared to hospital and specialist care. They also reported a sense of anxiety that the current JKN regulation might limit their ability to access the hospital service guaranteed in the past.DiscussionThis study identified patients’ views that could challenge the implementation of the gate-keeper role of primary care in Indonesia. While the patients valued the availability of medical care close to home, their lack of trust in primary care doctors and fear that they might lost the hospital care in the future appears to have impacted on the uptake of JKN. Unless targeted efforts are made to address these views through sustained public education and further capacity building in primary care, it is unlikely that the full potential of the JKN scheme in primary care will be realized.

The BLEED pilot study: determining the usability of a medical device before the clinical trial.

AIM To discuss the methods of a study which will aim to determine the usability of a medical device not yet approved for use in a clinical trial. BACKGROUND The Blood Loss Estimation and Evaluation of Drape (BLEED) pilot aims to determine the usability of a drape which measures blood loss during third stage labour. Third stage blood loss is usually estimated visually. This method has been found to be inaccurate. The drape has been tested in developing countries overseas and has been found to more accurately measure third stage blood loss when compared with visual methods. The usability of the drape has not yet been evaluated. REVIEW METHODS Before starting the BLEED pilot study, the risks to the participants were evaluated and the drape was determined to pose minimal risk of harm for participants. The pilot study will involve recruitment of women and health professionals who will use the drape to measure third stage blood loss and then complete a survey about their opinion of the drapes usability. The data will be used to determine the suitability of using the drape in a clinical trial. DISCUSSION The benefits of pursing this programme of research outweigh the challenges. The drape has been validated as more accurate than visual estimation for evaluating blood loss during third stage labour, yet the usability has not been established and a clinical trial is needed. This programme of research will determine if routine use of this drape in research and practice is justified. CONCLUSION This work will assist health professionals who are considering ways to improve clinical outcomes and will particularly inform researchers who are interested in piloting new devices in maternity care. While adherence to monitoring requirements and governance of clinical trials is essential, the system has become complicated for investigator-initiated research using devices. Despite these challenges, the authors of this paper believe that this research programme is justified. IMPLICATIONS FOR PRACTICE The complexity of navigating documentation and governance required for clinical trials may deter some healthcare professionals who plan to initiate research that involves the use of a medical device. While adherence to monitoring requirements and governance of clinical research is essential, research involving the evaluation of emerging medical technologies can be complicated, particularly for an investigator-initiated (clinician) researcher who does not have the support of a biotech company. These issues may deter clinician researchers from initiating trials and impede their ability to implement clinical research. Despite the challenges, the effectiveness and safety of technologies must be evaluated for their effectiveness in improving clinical outcomes for patients.

Cultural beliefs about cancer influencing help-seeking and symptom appraisal: a meta-synthesis of qualitative findings

Background - Primary brain tumours are rare among adults, but patients often experience physical, cognitive, neurological and psychosocial morbidity. Research has documented high rates of unmet supportive care needs among subgroups, such as patients receiving specific treatments or those receiving palliative care, but the needs of patients in the period soon after diagnosis are not known. Aim - To describe the unmet supportive care needs of adults recently diagnosed with primary brain tumours and change in needs over the early diagnosis/treatment period. Methods - A representative population-based sample of 40 patients was recruited approximately three months after diagnosis through a state cancer registry in Queensland, Australia. Patients or carer proxies completed surveys of supportive care needs in six domains (physical/daily living, psychological, patient care and support, sexuality, health system and information needs, and brain tumour-specific needs) at baseline and three months later. Mean supportive care needs scores (scale 0-100, with higher scores indicating higher levels of need) were calculated and compared over time. Results - The highest mean supportive care needs score at each time point was for physical needs (baseline 47.9, SD 26.3), closely followed by psychological needs (baseline 45.8, SD 35.6). Mean scores for other domains ranged from 30.4 to 37.9. Mean scores in all domains except for sexuality significantly declined over time, with the greatest decline for the patient care and support needs domain (mean 15.9 point decrease). Conclusions - Adults with primary brain tumours experience high levels of unmet physical and psychological needs early in the disease trajectory. However, levels of needs, particularly for patient care, decline over time, perhaps with the completion of primary treatments. Further research is needed to confirm these findings in a larger sample and investigate reasons for the decline seen.Programme/Policy Process: Once a VHL develops its activities through a cooperative network of institutions which are users and producers of information, it was essential to structure such a network within the field of cancer control and develop a governance model that could allow its sustainable operation. The model is composed of Executive Secretary, Advisory Committee, Executive Committee and Responsibility Matrix. The institutions which are part of this collaborative network have been selected in order to represent the regional diversity present in Brazil and also the diverse profiles of institutions related to cancer control, such as research, academia, government, scientific societies and organizations representing patients.Background: Smoking rates in Aboriginal Australians are gradually reducing in some age groups, but not for people in the peak reproductive years.¹ Smoking cessation is vital for cancer prevention.² Many regional programs avoid the use of threat messages when targeting Australian Aboriginal smokers.³ Aim: To assess, for the first time, the responses of Aboriginal smokers, 18–45 years, to Risk Behaviour Diagnosis scales (RBD)⁴ and intentions to quit smoking, including gender differences. Methods: We interviewed 121 Aboriginal smokers, using a structured questionnaire including adapted RBD scales. The RBD measured perceived threat (susceptibility and severity of threat) and perceived efficacy (self-efficacy and response efficacy) on Likert scales. Intentions to quit were assessed. Scales were recoded into high-low responses. Face validity was assessed via an Aboriginal panel, and scales assessed for reliability. Chi-square tests investigated the associations between intention to quit, efficacy/threat and gender. Results: Among men, intention to quit was associated with perceived efficacy (X² = 15.23;df = 1; p < 0.0001), but not with perceived threat. For women, intention to quit was neither associated with efficacy nor threat. Both genders were more likely to have high intention to quit, with high efficacy and high threat (n = 54;45%:maleX² = 12.6;df = 1; p < 0.001:femaleX²= 5.6;df = 1; p < 0.05). There was no difference in intention to quit with low efficacy-high threat for either gender (n = 39;32%). In contrast, all of the men with low threat-high efficacy (n = 5;4%) intended to quit, whereas all of the women with low threat-low efficacy (n = 6;5%) intended to quit. Conclusions: High-perceived threat was associated with high intention to quit smoking only when perceived efficacy was high. Gender differences may be a consideration. The RBD scales could be used to tailor messages to the level of efficacy and threat in clinical consultations, and in regional programs. All Aboriginal Australian smokers may benefit from increased efficacy to quit smoking.Abstract presented at the 2014 World Cancer Congress, 3-6 December 2014, Melbourne, Australia