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Griffin CP, Paul CL, Lynam J. Un héritage d’espoir. CMAJ 2024; 196:E578-E579. [PMID: 38684281 PMCID: PMC11057881 DOI: 10.1503/cmaj.231507-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Cassandra P Griffin
- École de médecine et de santé publique, Université de Newcastle, Callaghan, Australie; Institut de recherche médicale Hunter, Newcastle, Australie
| | - Christine L Paul
- École de médecine et de santé publique, Université de Newcastle, Callaghan, Australie; Institut de recherche médicale Hunter, Newcastle, Australie
| | - James Lynam
- Département d'oncologie médicale, Hôpital Calvary Mater, Newcastle, Australie; École de médecine et de santé publique, Université de Newcastle, Callaghan, Australie
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Rush A, Weil C, Siminoff L, Griffin C, Paul CL, Mahadevan A, Sutherland G. The Experts Speak: Challenges in Banking Brain Tissue for Research. Biopreserv Biobank 2024; 22:179-184. [PMID: 38621226 DOI: 10.1089/bio.2024.29135.ajr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Affiliation(s)
- A Rush
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - C Weil
- Independent Consultant, Human Research Protections and Bioethics, Bethesda, USA
| | - L Siminoff
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Pennsylvania, USA
| | - C Griffin
- College of Health, Medicine and Wellbeing University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- Mark Hughes Foundation Centre for Brain Cancer Research, The University of Newcastle, Newcastle, Australia
| | - C L Paul
- College of Health, Medicine and Wellbeing University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- Mark Hughes Foundation Centre for Brain Cancer Research, The University of Newcastle, Newcastle, Australia
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - G Sutherland
- Charles Perkins Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Paul CL, Verrills NM, Ackland S, Scott R, Goode S, Thomas A, Lukeman S, Nielsen S, Weidenhofer J, Lynam J, Fradgley EA, Martin J, Greer P, Smith S, Griffin C, Avery-Kiejda KA, Zdenkowski N, Searles A, Ramanathan S. The impact of a regionally based translational cancer research collaborative in Australia using the FAIT methodology. BMC Health Serv Res 2024; 24:320. [PMID: 38462610 PMCID: PMC10926601 DOI: 10.1186/s12913-024-10680-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Translating research, achieving impact, and assessing impact are important aspirations for all research collaboratives but can prove challenging. The Hunter Cancer Research Alliance (HCRA) was funded from 2014 to 2021 to enhance capacity and productivity in cancer research in a regional centre in Australia. This study aimed to assess the impact and benefit of the HCRA to help inform future research investments of this type. METHOD The Framework to Assess the Impact from Translational health research (FAIT) was selected as the preferred methodology. FAIT incorporates three validated methodologies for assessing impact: 1) Modified Payback; 2) Economic Analysis; and 3) Narrative overview and case studies. All three FAIT methods are underpinned by a Program Logic Model. Data were collected from HCRA and the University of Newcastle administrative records, directly from HCRA members, and website searches. RESULTS In addition to advancing knowledge and providing capacity building support to members via grants, fellowships, scholarships, training, events and targeted translation support, key impacts of HCRA-member research teams included: (i) the establishment of a regional biobank that has distributed over 13,600 samples and became largely self-sustaining; (ii) conservatively leveraging $43.8 M (s.a.$20.5 M - $160.5 M) in funding and support from the initial $9.7 M investment; (iii) contributing to clinical practice guidelines and securing a patent for identification of stem cells for endometrial cell regeneration; (iv) shifting the treatment paradigm for all tumour types that rely on nerve cell innervation, (v) development and implementation of the world's first real-time patient treatment verification system (Watchdog); (vi) inventing the effective 'EAT' psychological intervention to improve nutrition and outcomes in people experiencing radiotherapy for head and neck cancer; (vi) developing effective interventions to reduce smoking rates among priority groups, currently being rolled out to disadvantaged populations in NSW; and (vii) establishing a Consumer Advisory Panel and Consumer Engagement Committee to increase consumer involvement in research. CONCLUSION Using FAIT methodology, we have demonstrated the significant impact and downstream benefits that can be achieved by the provision of infrastructure-type funding to regional and rural research collaboratives to help address inequities in research activity and health outcomes and demonstrates a positive return on investment.
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Affiliation(s)
- Christine L Paul
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
- Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Nicole M Verrills
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Stephen Ackland
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Rodney Scott
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Susan Goode
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Ann Thomas
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Sarah Lukeman
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Sarah Nielsen
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Judith Weidenhofer
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - James Lynam
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth A Fradgley
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jarad Martin
- Calvary Mater Hospital Newcastle, Newcastle, NSW, Australia
| | - Peter Greer
- Calvary Mater Hospital Newcastle, Newcastle, NSW, Australia
| | - Stephen Smith
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Cassandra Griffin
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Kelly A Avery-Kiejda
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Nick Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Andrew Searles
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Shanthi Ramanathan
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
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Griffin CP, Paul CL, Lynam J. A legacy of hope. CMAJ 2024; 196:E270-E271. [PMID: 38438148 PMCID: PMC10911864 DOI: 10.1503/cmaj.231507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- Cassandra P Griffin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - James Lynam
- Department of Medical Oncology, Calvary Mater, Newcastle, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Griffin CP, Bowen JR, Walker MM, Lynam J, Paul CL. Understanding the value of brain donation for research to donors, next-of-kin and clinicians: A systematic review. PLoS One 2023; 18:e0295438. [PMID: 38117774 PMCID: PMC10732432 DOI: 10.1371/journal.pone.0295438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023] Open
Abstract
PURPOSE Post-mortem brain donation affords the opportunity to characterise disease by exploring global neuropathological changes. Such opportunities are essential to progress knowledge of CNS tumours such as Glioblastoma. A comprehensive understanding of the experience of consenting to brain donation is crucial to maximising consent rates while providing patient-centred care. This review aimed to synthesise the reported facilitators and barriers according to potential donors, next-of-kin (NOK) and clinician respondents. DESIGN Database searches included Embase, Medline, PsycINFO, Psychology and Behavioural Science and Scopus. Search terms focused on motivations, attitudes and psychosocial experiences of brain donation. Exclusions included organ transplantation and brain death. All studies were assessed for quality and validity using tools from the Joanna Briggs Institute. To determine perceptions of benefit and harm, a method guided by the thematic analysis of Braun and Clarke was employed to reflexively assess and identify common themes and experiences. RESULTS 40 studies (15 qualitative, 25 quantitative) were included involving participants with paediatric cancer, neurodegenerative and psychological diseases. Perceptions of benefit included benefit to future generations, aiding scientific research, avoidance of waste, improved treatments and the belief that donation will bring consolation or aid in the grieving process. Perceptions of harm included a perceived conflict with religious beliefs, disfigurement to the donor, emotional distress at the time of autopsy and discord or objections within the family. CONCLUSION Brain donation can afford a sense of purpose, meaning and empowerment for donors and their loved ones. Careful strategies are required to mitigate or reduce potential harms during the consent process.
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Affiliation(s)
- Cassandra P. Griffin
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jenna R. Bowen
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Marjorie M. Walker
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
| | - James Lynam
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Medical Oncology, Calvary Mater, Newcastle, NSW, Australia
| | - Christine L. Paul
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Priority Research Centre Cancer Research, Innovation and Translation, University of Newcastle, Callaghan, Australia
- Priority Research Centre Health Behaviour, University of Newcastle, Callaghan, Australia
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Maltby S, Garcia-Esperon C, Jackson K, Butcher K, Evans JW, O'Brien W, Dixon C, Russell S, Wilson N, Kluge MG, Ryan A, Paul CL, Spratt NJ, Levi CR, Walker FR. TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study. JMIR Serious Games 2023; 11:e43416. [PMID: 38060297 PMCID: PMC10739245 DOI: 10.2196/43416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 09/06/2023] [Accepted: 10/09/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context. OBJECTIVE We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact. METHODS The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training. RESULTS TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site). CONCLUSIONS TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways.
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Affiliation(s)
- Steven Maltby
- Centre for Advanced Training Systems, The University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Carlos Garcia-Esperon
- Hunter Medical Research Institute, New Lambton Heights, Australia
- John Hunter Hospital, New Lambton Heights, Australia
| | - Kate Jackson
- NSW Agency for Clinical Innovation, St Leonards, Australia
| | - Ken Butcher
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - James W Evans
- Department of Neurosciences, Gosford Hospital, Gosford, Australia
| | - William O'Brien
- Department of Neurosciences, Gosford Hospital, Gosford, Australia
| | - Courtney Dixon
- NSW Agency for Clinical Innovation, St Leonards, Australia
| | - Skye Russell
- NSW Agency for Clinical Innovation, St Leonards, Australia
| | - Natalie Wilson
- NSW Agency for Clinical Innovation, St Leonards, Australia
| | - Murielle G Kluge
- Centre for Advanced Training Systems, The University of Newcastle, Newcastle, Australia
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Annika Ryan
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Medicine and Public Health, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Christine L Paul
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Medicine and Public Health, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Neil J Spratt
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- John Hunter Hospital, New Lambton Heights, Australia
| | - Christopher R Levi
- School of Medicine and Public Health, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- John Hunter Health & Innovation Precinct, New Lambton Heights, Australia
| | - Frederick Rohan Walker
- Centre for Advanced Training Systems, The University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
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Taylor J, Fradgley EA, Clinton‐McHarg T, Hall A, Paul CL. Perceived importance of emotional support provided by health care professionals and social networks: Should we broaden our focus for the delivery of supportive care? Asia Pac J Clin Oncol 2023; 19:681-689. [PMID: 36698247 PMCID: PMC10947305 DOI: 10.1111/ajco.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/08/2022] [Accepted: 12/26/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Emotional support provided by health care professionals (HCPs) for people diagnosed with cancer is associated with improved outcomes. Support via social networks may also be important. AIMS To report among a sample of distressed patients and caregivers, (1) the importance attributed to different sources of emotional support (HCPs and social networks) by distressed cancer patients and caregivers; (2) the proportion who indicate they did not receive sufficient levels of emotional support; and (3) potential associations between respondents' demographic and clinical characteristics and reported lack of emotional support. METHODS This study utilised cross-sectional data from telephone interviews collected during the usual-care phase of the Structured Triage and Referral by Telephone (START) trial. Participants completed a telephone interview 6 months after their initial call to the Cancer Council Information and Support service and included recall of importance and sufficiency of emotional support. RESULTS More than two-thirds of patients (n = 234) and caregivers (n = 152) reported that family and friends were very important sources of emotional support. Nurses (69% and 42%) and doctors (68% and 47%) were reported very important, while a lower proportion reported that psychologists and psychiatrists were very important (39%, and 43%). Insufficient levels of support were reported by 36% of participants. Perceptions of insufficient support were significantly associated with distress levels (p < .0001) and not having a partner (p = .0115). CONCLUSION Social networks, particularly family, are an important source of emotional support. Higher levels of distress, those without partners, and caregivers may require targeted interventions to increase their access to emotional support.
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Affiliation(s)
- Jo Taylor
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
| | - Elizabeth A. Fradgley
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
- Cancer Institute New South WalesCancer Institute New South Wales, EveleighSydneyAustralia
| | - Tara Clinton‐McHarg
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- School of PsychologyUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Alix Hall
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
- Hunter New England Population HealthHunter New England Area Health ServiceNewcastleNew South WalesAustralia
| | - Christine L. Paul
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
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Carlson MA, Fradgley EA, Yates D, Morris S, Tait J, Paul CL. Response to Gorter et al. regarding "Acceptability and feasibility of neurocognitive assessments with adults with primary brain cancer and brain metastases: A systematic review". Neurooncol Pract 2023; 10:493-494. [PMID: 37720391 PMCID: PMC10502773 DOI: 10.1093/nop/npad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Affiliation(s)
- Melissa A Carlson
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Elizabeth A Fradgley
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Della Yates
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Sarah Morris
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Jordan Tait
- NSW and ACT Research and Evaluation Unit, GP Synergy, Mayfield West, NSW, Australia
| | - Christine L Paul
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Carlson MA, Fradgley EA, Roach D, Morris S, Tait J, Paul CL. Acceptability and feasibility of cognitive assessments with adults with primary brain cancer and brain metastasis: A Systematic Review. Neurooncol Pract 2022; 10:219-237. [PMID: 37188159 PMCID: PMC10180383 DOI: 10.1093/nop/npac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Routine cognitive assessment for adults with brain cancers is seldom completed but vital for guiding daily living, maintaining quality of life, or supporting patients and families. This study aims to identify cognitive assessments which are pragmatic and acceptable for use in clinical settings. MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane were searched to identify studies published in English between 1990 and 2021. Publications were independently screened by two coders and included if they: (1) were peer-reviewed; (2) reported original data relating to adult primary brain tumour or brain metastases; (3) used objective or subjective assessments; (4) reported assessment acceptability or feasibility. The Psychometric And Pragmatic Evidence Rating Scale was used. Consent, assessment commencement and completion, and study completion were extracted along with author-reported acceptability and feasibility data. PROSPERO Registration: CRD42021234794. Across 27 studies, 21 cognitive assessments had been assessed for feasibility and acceptability; 15 were objective assessments. Acceptability data were limited and heterogeneous, particularly consent (not reported in 23 studies), assessment commencement (not reported in 19 studies), and assessment completion (not reported in 21 studies). Reasons for non-completion could be grouped into patient-factors, assessment-factors, clinician-factors, and system-factors. The three cognitive assessments with the most acceptability and feasibility data reported were the MMSE, MoCA, and NIHTB-CB. Further acceptability and feasibility data are needed including consent, commencement and completion rates. Cost, length, time, and assessor burden are needed for the MMSE, MoCA, and NIHTB-CB, along with potentially new computerised assessments suited for busy clinical settings.
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Affiliation(s)
- Melissa A Carlson
- College of Health, Medicine, and Wellbeing, University of Newcastle , Australia
| | | | - Della Roach
- College of Health, Medicine, and Wellbeing, University of Newcastle , Australia
| | - Sarah Morris
- College of Health, Medicine, and Wellbeing, University of Newcastle , Australia
| | - Jordan Tait
- GP Synergy, NSW & ACT Research and Evaluation Unit , Australia
| | - Christine L Paul
- College of Health, Medicine, and Wellbeing, University of Newcastle , Australia
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White C, Scott R, Paul CL, Ackland SP. Pharmacogenomics in the era of personalised medicine. Med J Aust 2022; 217:510-513. [PMID: 36259142 PMCID: PMC9827847 DOI: 10.5694/mja2.51759] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Cassandra White
- Maitland HospitalMaitlandNSW,University of NewcastleNewcastleNSW
| | - Rodney Scott
- University of NewcastleNewcastleNSW,Pathology NorthNewcastleNSW
| | - Christine L Paul
- University of NewcastleNewcastleNSW,Priority Research Centre for Health BehaviourUniversity of NewcastleNewcastleNSW
| | - Stephen P Ackland
- Lake Macquarie Private HospitalGatesheadNSW,Hunter Cancer Research AllianceNewcastleNSW
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Ryan A, Young AL, Tait J, McCarter K, McEnallay M, Day F, McLennan J, Segan C, Blanchard G, Healey L, Avery S, White S, Vinod S, Bradford L, Paul CL. Building staff capability, opportunity, and motivation to provide smoking cessation to people with cancer in Australian cancer treatment centres: development of an implementation intervention framework for the Care to Quit cluster randomised controlled trial. Health Serv Outcomes Res Methodol 2022; 23:1-33. [PMID: 36193179 PMCID: PMC9517978 DOI: 10.1007/s10742-022-00288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
Few rigorous studies provide a clear description of the methodological approach of developing an evidence-based implementation intervention, prior to implementation at scale. This study describes the development, mapping, rating, and review of the implementation strategies for the Care to Quit smoking cessation trial, prior to application in nine cancer services across Australia. Key stakeholders were engaged in the process from conception through to rating, reviewing and refinement of strategies and principles. An initial scoping review identified 21 barriers to provision of evidence-based smoking cessation care to patients with cancer, which were mapped to the Theoretical Domains Framework and Behaviour Change Wheel (BCW) to identify relevant intervention functions. The mapping identified 26 relevant behaviour change techniques, summarised into 11 implementation strategies. The implementation strategies were rated and reviewed against the BCW Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety, and Equity criteria by key stakeholders during two interactive workshops to facilitate a focus on feasible interventions likely to resonate with clinical staff. The implementation strategies and associated intervention tools were then collated by form and function to provide a practical guide for implementing the intervention. This study illustrates the rigorous use of theories and frameworks to arrive at a practical intervention guide, with potential to inform future replication and scalability of evidence-based implementation across a range of health service settings. Supplementary Information The online version contains supplementary material available at 10.1007/s10742-022-00288-6.
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Affiliation(s)
- Annika Ryan
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
| | - Alison Luk Young
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
| | - Jordan Tait
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
| | - Kristen McCarter
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, 2308, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
| | - Melissa McEnallay
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, 2308, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
| | - Fiona Day
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
- Calvary Mater Newcastle, Corner Edith and Platt Streets, Waratah, NSW 2289 Australia
| | - James McLennan
- St Vincent’s Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW 2010 Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC Australia
- School of Population and Global Health, Centre for Health Policy, The University of Melbourne, MelbourneMelbourne, VIC Australia
| | - Gillian Blanchard
- Calvary Mater Newcastle, Corner Edith and Platt Streets, Waratah, NSW 2289 Australia
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW Australia
| | - Laura Healey
- Calvary Mater Newcastle, Corner Edith and Platt Streets, Waratah, NSW 2289 Australia
| | - Sandra Avery
- South Western Sydney Local Health District, Elizabeth Street, Liverpool, NSW 2170 Australia
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW Australia
| | - Sarah White
- Department of Health Quitline, 615 St Kilda Rd, Melbourne, VIC 3004 Australia
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW Australia
- South Western Sydney Clinical School and Ingham Institute for Applied Medical Research, Liverpool, NSW Australia
| | - Linda Bradford
- The Alfred, 55 Commercial Rd, Melbourne, VIC 3004 Australia
| | - Christine L. Paul
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, 2308, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
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12
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Ryan A, Paul CL, Cox M, Whalen O, Bivard A, Attia J, Bladin C, Davis SM, Campbell BCV, Parsons M, Grimley RS, Anderson C, Donnan GA, Oldmeadow C, Kuhle S, Walker FR, Hood RJ, Maltby S, Keynes A, Delcourt C, Hatchwell L, Malavera A, Yang Q, Wong A, Muller C, Sabet A, Garcia-Esperon C, Brown H, Spratt N, Kleinig T, Butcher K, Levi CR. TACTICS - Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship: evaluating the effectiveness of an 'implementation intervention' in providing better patient access to reperfusion therapies: protocol for a non-randomised controlled stepped wedge cluster trial in acute stroke. BMJ Open 2022; 12:e055461. [PMID: 35149571 PMCID: PMC8845197 DOI: 10.1136/bmjopen-2021-055461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Stroke reperfusion therapies, comprising intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT), are best practice treatments for eligible acute ischemic stroke patients. In Australia, EVT is provided at few, mainly metropolitan, comprehensive stroke centres (CSC). There are significant challenges for Australia's rural and remote populations in accessing EVT, but improved access can be facilitated by a 'drip and ship' approach. TACTICS (Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship) aims to test whether a multicomponent, multidisciplinary implementation intervention can increase the proportion of stroke patients receiving EVT. METHODS AND ANALYSIS This is a non-randomised controlled, stepped wedge trial involving six clusters across three Australian states. Each cluster comprises one CSC hub and a minimum of three primary stroke centre (PSC) spokes. Hospitals will work in a hub and spoke model of care with access to a multislice CT scanner and CT perfusion image processing software (MIStar, Apollo Medical Imaging). The intervention, underpinned by behavioural theory and technical assistance, will be allocated sequentially, and clusters will move from the preintervention (control) period to the postintervention period. PRIMARY OUTCOME Proportion of all stroke patients receiving EVT, accounting for clustering. SECONDARY OUTCOMES Proportion of patients receiving IVT at PSCs, proportion of treated patients (IVT and/or EVT) with good (modified Rankin Scale (mRS) score 0-2) or poor (mRS score 5-6) functional outcomes and European Quality of Life Scale scores 3 months postintervention, proportion of EVT-treated patients with symptomatic haemorrhage, and proportion of reperfusion therapy-treated patients with good versus poor outcome who presented with large vessel occlusion at spokes. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Hunter New England Human Research Ethics Committee (18/09/19/4.13, HREC/18/HNE/241, 2019/ETH01238). Trial results will be disseminated widely through published manuscripts, conference presentations and at national and international platforms regardless of whether the trial was positive or neutral. TRIAL REGISTRATION NUMBER ACTRN12619000750189; UTNU1111-1230-4161.
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Affiliation(s)
- Annika Ryan
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christine L Paul
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Martine Cox
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Olivia Whalen
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Andrew Bivard
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christopher Bladin
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Mark Parsons
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Department of Neurology, Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Rohan S Grimley
- Queensland State-wide Stroke Clinical Network, Healthcare Improvement Unit, Queensland Health, Herston, Queensland, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Craig Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Oldmeadow
- Data Sciences, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Sarah Kuhle
- Queensland State-wide Stroke Clinical Network, Healthcare Improvement Unit, Queensland Health, Herston, Queensland, Australia
| | - Frederick R Walker
- Centre for Advanced Training Systems, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Rebecca J Hood
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Centre for Advanced Training Systems, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Steven Maltby
- Centre for Advanced Training Systems, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Angela Keynes
- Centre for Advanced Training Systems, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Candice Delcourt
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Luke Hatchwell
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Alejandra Malavera
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Qing Yang
- Apollo Medical Imaging Technology Pty Ltd, Melbourne, Victoria, Australia
| | - Andrew Wong
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Claire Muller
- Queensland State-wide Stroke Clinical Network, Healthcare Improvement Unit, Queensland Health, Herston, Queensland, Australia
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Arman Sabet
- School of Medicine, Griffith University, Southport, Queensland, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Carlos Garcia-Esperon
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Area Administration, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Helen Brown
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Neil Spratt
- Division of Medicine, Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, Translational Stroke Laboratory, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ken Butcher
- Department of Neurology, Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Clinical Neuroscience, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Christopher R Levi
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Area Administration, Hunter New England Local Health District, New Lambton, New South Wales, Australia
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13
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Griffin CP, Paul CL, Alexander KL, Walker MM, Hondermarck H, Lynam J. Postmortem brain donations vs premortem surgical resections for glioblastoma research: viewing the matter as a whole. Neurooncol Adv 2022; 4:vdab168. [PMID: 35047819 PMCID: PMC8760897 DOI: 10.1093/noajnl/vdab168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There have been limited improvements in diagnosis, treatment, and outcomes of primary brain cancers, including glioblastoma, over the past 10 years. This is largely attributable to persistent deficits in understanding brain tumor biology and pathogenesis due to a lack of high-quality biological research specimens. Traditional, premortem, surgical biopsy samples do not allow full characterization of the spatial and temporal heterogeneity of glioblastoma, nor capture end-stage disease to allow full evaluation of the evolutionary and mutational processes that lead to treatment resistance and recurrence. Furthermore, the necessity of ensuring sufficient viable tissue is available for histopathological diagnosis, while minimizing surgically induced functional deficit, leaves minimal tissue for research purposes and results in formalin fixation of most surgical specimens. Postmortem brain donation programs are rapidly gaining support due to their unique ability to address the limitations associated with surgical tissue sampling. Collecting, processing, and preserving tissue samples intended solely for research provides both a spatial and temporal view of tumor heterogeneity as well as the opportunity to fully characterize end-stage disease from histological and molecular standpoints. This review explores the limitations of traditional sample collection and the opportunities afforded by postmortem brain donations for future neurobiological cancer research.
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Affiliation(s)
- Cassandra P Griffin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Biobank: NSW Regional Biospecimen and Research Services, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Priority Research Centre Cancer Research, Innovation and Translation, University of Newcastle, New South Wales, Australia
- Priority Research Centre Health Behaviour, University of Newcastle, New South Wales, Australia
| | - Kimberley L Alexander
- Neurosurgery Department, Chris O’Brien Lifehouse, Camperdown, New South Wales, Australia
- Brainstorm Brain Cancer Research, Brain and Mind Centre, The University of Sydney, New South Wales, Australia
- Neuropathology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Marjorie M Walker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Hubert Hondermarck
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - James Lynam
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Cancer Research Alliance, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Medical Oncology, Calvary Mater, Newcastle, New South Wales, Australia
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14
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Hood RJ, Maltby S, Keynes A, Kluge MG, Nalivaiko E, Ryan A, Cox M, Parsons MW, Paul CL, Garcia-Esperon C, Spratt NJ, Levi CR, Walker FR. Development and Pilot Implementation of TACTICS VR: A Virtual Reality-Based Stroke Management Workflow Training Application and Training Framework. Front Neurol 2021; 12:665808. [PMID: 34858305 PMCID: PMC8631764 DOI: 10.3389/fneur.2021.665808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Delays in acute stroke treatment contribute to severe and negative impacts for patients and significant healthcare costs. Variability in clinical care is a contributor to delayed treatment, particularly in rural, regional and remote (RRR) areas. Targeted approaches to improve stroke workflow processes improve outcomes, but numerous challenges exist particularly in RRR settings. Virtual reality (VR) applications can provide immersive and engaging training and overcome some existing training barriers. We recently initiated the TACTICS trial, which is assessing a "package intervention" to support advanced CT imaging and streamlined stroke workflow training. As part of the educational component of the intervention we developed TACTICS VR, a novel VR-based training application to upskill healthcare professionals in optimal stroke workflow processes. In the current manuscript, we describe development of the TACTICS VR platform which includes the VR-based training application, a user-facing website and an automated back-end data analytics portal. TACTICS VR was developed via an extensive and structured scoping and consultation process, to ensure content was evidence-based, represented best-practice and is tailored for the target audience. Further, we report on pilot implementation in 7 Australian hospitals to assess the feasibility of workplace-based VR training. A total of 104 healthcare professionals completed TACTICS VR training. Users indicated a high level of usability, acceptability and utility of TACTICS VR, including aspects of hardware, software design, educational content, training feedback and implementation strategy. Further, users self-reported increased confidence in their ability to make improvements in stroke management after TACTICS VR training (post-training mean ± SD = 4.1 ± 0.6; pre-training = 3.6 ± 0.9; 1 = strongly disagree, 5 = strongly agree). Very few technical issues were identified, supporting the feasibility of this training approach. Thus, we propose that TACTICS VR is a fit-for-purpose, evidence-based training application for stroke workflow optimisation that can be readily deployed on-site in a clinical setting.
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Affiliation(s)
- Rebecca J Hood
- Centre for Advanced Training Systems, The University of Newcastle, Callaghan, NSW, Australia.,School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Steven Maltby
- Centre for Advanced Training Systems, The University of Newcastle, Callaghan, NSW, Australia.,School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Angela Keynes
- Centre for Advanced Training Systems, The University of Newcastle, Callaghan, NSW, Australia.,School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Murielle G Kluge
- Centre for Advanced Training Systems, The University of Newcastle, Callaghan, NSW, Australia.,School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Eugene Nalivaiko
- Centre for Advanced Training Systems, The University of Newcastle, Callaghan, NSW, Australia.,School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Annika Ryan
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Martine Cox
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Mark W Parsons
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Christine L Paul
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Carlos Garcia-Esperon
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Neil J Spratt
- School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Christopher R Levi
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, Australia.,The Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, NSW, Australia
| | - Frederick R Walker
- Centre for Advanced Training Systems, The University of Newcastle, Callaghan, NSW, Australia.,School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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15
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Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, Huy NT, Marušić A, Paul CL, Kwok J, Karbwang J, de Waure C, Drummond FJ, Kizawa Y, Taal E, Vermeulen J, Lee GHM, Gyedu A, To KG, Verra ML, Jacqz-Aigrain ÉM, Leclercq WKG, Salminen ST, Sherbourne CD, Mintzes B, Lozano S, Tran US, Matsui M, Karamouzian M. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med 2021; 36:3179-3187. [PMID: 33886027 PMCID: PMC8481359 DOI: 10.1007/s11606-021-06737-1] [Citation(s) in RCA: 467] [Impact Index Per Article: 155.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/17/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Akash Sharma
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India.,Online Research Club, Nagasaki, Japan
| | - Nguyen Tran Minh Duc
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Tai Luu Lam Thang
- Online Research Club, Nagasaki, Japan.,Department of Emergency, City's Children Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Hai Nam
- Online Research Club, Nagasaki, Japan.,Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sze Jia Ng
- Online Research Club, Nagasaki, Japan.,Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA
| | - Kirellos Said Abbas
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nguyen Tien Huy
- Institute of Tropical Medicine (NEKKEN) and School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan.
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Janette Kwok
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital Hong Kong, Pok Fu Lam, Hong Kong
| | - Juntra Karbwang
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University School of Medicine, Hyogo, Japan
| | - Erik Taal
- Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Joeri Vermeulen
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
| | - Gillian H M Lee
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kien Gia To
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Martin L Verra
- Department of Physiotherapy, Bern University Hospital, Insel Group, Bern, Switzerland
| | | | - Wouter K G Leclercq
- Department of Surgery, Máxima Medical Center, Veldhoven, Veldhoven, the Netherlands
| | - Simo T Salminen
- Department of Social Psychology, University of Helsinki, Helsinki, Finland
| | | | - Barbara Mintzes
- School of Pharmacy and Charles Perkins Centrey, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sergi Lozano
- School of Economics, University of Barcelona, Barcelona, Spain
| | - Ulrich S Tran
- Department of Cognition, Emotion, and Methods in Psychology, School of Psychology, University of Vienna, Vienna, Austria
| | - Mitsuaki Matsui
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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16
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Dave N, Bui S, Morgan C, Hickey S, Paul CL. Interventions targeted at reducing diagnostic error: systematic review. BMJ Qual Saf 2021; 31:297-307. [PMID: 34408064 DOI: 10.1136/bmjqs-2020-012704] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 08/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Incorrect, delayed and missed diagnoses can contribute to significant adverse health outcomes. Intervention options have proliferated in recent years necessitating an update to McDonald et al's 2013 systematic review of interventions to reduce diagnostic error. OBJECTIVES (1) To describe the types of published interventions for reducing diagnostic error that have been evaluated in terms of an objective patient outcome; (2) to assess the risk of bias in the included interventions and perform a sensitivity analysis of the findings; and (3) to determine the effectiveness of included interventions with respect to their intervention type. METHODS MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched from 1 January 2012 to 31 December 2019. Publications were included if they delivered patient-related outcomes relating to diagnostic accuracy, management outcomes and/or morbidity and mortality. The interventions in each included study were categorised and analysed using the six intervention types described by McDonald et al (technique, technology-based system interventions, educational interventions, personnel changes, structured process changes and additional review methods). RESULTS Twenty studies met the inclusion criteria. Eighteen of the 20 included studies (including three randomised controlled trials (RCTs)) demonstrated improvements in objective patient outcomes following the intervention. These three RCTs individually evaluated a technique-based intervention, a technology-based system intervention and a structured process change. The inclusion or exclusion of two higher risk of bias studies did not affect the results. CONCLUSION Technique-based interventions, technology-based system interventions and structured process changes have been the most studied interventions over the time period of this review and hence are seen to be effective in reducing diagnostic error. However, more high-quality RCTs are required, particularly evaluating educational interventions and personnel changes, to demonstrate the value of these interventions in diverse settings.
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Affiliation(s)
- Neha Dave
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sandy Bui
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Corey Morgan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Simon Hickey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Christine L Paul
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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17
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Taylor J, Fradgley EA, Clinton-McHarg T, Hall A, Paul CL. Referral and uptake of services by distressed callers to the Cancer Council Information and Support telephone service. Asia Pac J Clin Oncol 2021; 18:303-310. [PMID: 34185960 DOI: 10.1111/ajco.13604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient-centered cancer care includes emotional, informational, and practical support that is personalised to the needs of patients and inclusive of family and friends. However, when supportive care referrals are offered in hospital settings, distressed patients and carers do not consistently act on those referrals, which can prolong patient suffering. The degree to which sub-optimal referral uptake also occurs in Australian telephone support services is unknown. AIMS To report, among a sample of distressed patients and caregivers who called a cancer information and support service: 1) the types of services used; 2) proportion who received and actioned a referral (uptake); 3) associations between referral to a service and callers' characteristics); and, 4) associations between uptake of a referred service and callers' characteristics. METHODS This study used cross-sectional data collected at 3-month post-baseline from control participants (usual care group) enrolled in the Structured Triage and Referral by Telephone (START) trial. The START trial recruited distressed adult cancer patients and caregivers from the Cancer Council Information and Support Service (CIS). A research assistant conducted a 30-45 min telephone interview with participants, which included recall of referrals provided by CIS staff and reported uptake of referral(s) to the offered service types. RESULTS Most patients (98%) and caregivers (97%) reported receiving a referral to a service. For patients and caregivers respectively, information materials (71%, 77%), CIS call-back (51%, 43%), practical services (52%, 45%), and group peer support (49%, 51%) were the services most frequently offered. For callers receiving a referral, uptake was highest for information materials (91%) and CIS call-backs (89%) and lowest for specialist psychological services (30%). Significant association was found between older age and reduced uptake of services (p = 0.03). CONCLUSION The high uptake rate of CIS call-backs suggests it is a potentially more acceptable form of support compared to specialist psychological services. Efforts to reduce the barriers to telephone-based psychological services are required. Specifically, older age peoples' and caregivers' preferences for support and priorities who may benefit from a referral coordinator.
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Affiliation(s)
- Jo Taylor
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, Newcastle, New South Wales, Australia
| | - Elizabeth A Fradgley
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, New South Wales, Australia.,Cancer Institute New South Wales, Cancer Institute New South Wales, Eveleigh, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, Newcastle, New South Wales, Australia
| | - Tara Clinton-McHarg
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, New South Wales, Australia.,School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alix Hall
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, Newcastle, New South Wales, Australia
| | - Christine L Paul
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, Newcastle, New South Wales, Australia
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18
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Byaruhanga J, Paul CL, Wiggers J, Byrnes E, Mitchell A, Lecathelinais C, Bowman J, Campbell E, Gillham K, Tzelepis F. The short-term effectiveness of real-time video counselling on smoking cessation among residents in rural and remote areas: An interim analysis of a randomised trial. J Subst Abuse Treat 2021; 131:108448. [PMID: 34098302 DOI: 10.1016/j.jsat.2021.108448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Real-time video counselling for smoking cessation uses readily accessible software (e.g. Skype). This study aimed to assess the short-term effectiveness of real-time video counselling compared to telephone counselling or written materials (minimal intervention control) on smoking cessation and quit attempts among rural and remote residents. METHODS An interim analysis of a three-arm, parallel group randomised trial with participants (n = 655) randomly allocated to; 1) real-time video counselling; 2) telephone counselling; or 3) written materials only (minimal intervention control). Participants were daily tobacco users aged 18 years or older residing in rural or remote areas of New South Wales, Australia. Video and telephone counselling conditions offered up to six counselling sessions while those in the minimal intervention control condition were mailed written materials. The study measured seven-day point prevalence abstinence, prolonged abstinence and quit attempts at 4-months post-baseline. RESULTS Video counselling participants were significantly more likely than the minimal intervention control group to achieve 7-day point prevalence abstinence at 4-months (18.9% vs 8.9%, OR = 2.39 (1.34-4.26), p = 0.003), but the video (18.9%) and telephone (12.7%) counselling conditions did not differ significantly for 7-day point prevalence abstinence. The video counselling and minimal intervention control groups or video counselling and telephone counselling groups did not differ significantly for three-month prolonged abstinence or quit attempts. CONCLUSION Given video counselling may increase cessation rates at 4 months post-baseline, quitlines and other smoking cessation services may consider integrating video counselling into their routine practices as a further mode of cessation care delivery. TRIAL REGISTRATION www.anzctr.org.au ACTRN12617000514303.
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Affiliation(s)
- Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia.
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Jennifer Bowman
- Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia; School of Psychology, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia
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19
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Skelton E, Guillaumier A, Tzelepis F, Walsberger S, Paul CL, Dunlop AJ, Palazzi K, Bonevski B. Alcohol and other drug health-care providers and their client's perceptions of e-cigarette use, safety and harm reduction. Drug Alcohol Rev 2021; 40:998-1002. [PMID: 33774886 DOI: 10.1111/dar.13276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION E-cigarettes containing nicotine may potentially assist cessation in a heavily nicotine-dependent population with high relapse and tobacco-related burden. This study aims to determine alcohol and other drug (AOD) health-care provider and client awareness, use and attitudes regarding harm reduction and safety of e-cigarettes. METHODS The study was part of a larger cluster randomised controlled trial with 32 Australian AOD services. At a post-intervention survey conducted October 2016, health-care providers were asked whether they believed e-cigarettes could help smokers quit tobacco, whether they believe e-cigarettes are safer than tobacco smoking and whether they would recommend e-cigarettes to clients who are interested in quitting smoking. At the 6-month follow-up survey conducted January 2015-March 2016, AOD clients were asked about their e-cigarette knowledge, ever use, current use, reasons for use and place of purchase. RESULTS One hundred and eighty health-care providers and 427 AOD clients responded. A minority of health-care providers agreed with the statements that e-cigarettes could help smokers quit tobacco (30%), while just under one-third (25%) agreed that e-cigarettes were safer than tobacco smoking. However, only 19% would recommend e-cigarettes. Most AOD clients (93%) reported awareness of e-cigarettes, 39% reported ever use; however, only 7% reported current use. Of those reporting ever use, 52% used a nicotine e-cigarette. The most common reasons for e-cigarette use were 'wanted to try' (72%) and 'help cut down smoking' (70%). DISCUSSION AND CONCLUSIONS Both AOD health-care providers and clients are aware of e-cigarettes but are cautious in using and recommending their use.
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Affiliation(s)
- Eliza Skelton
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Ashleigh Guillaumier
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Flora Tzelepis
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | | | - Christine L Paul
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Adrian J Dunlop
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Newcastle Community Health Centre, Hunter New England Local Health District, Newcastle, Australia
| | | | - Billie Bonevski
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
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20
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Paul CL, Warren G, Vinod S, Meiser B, Stone E, Barker D, White K, McLennan J, Day F, McCarter K, McEnallay M, Tait J, Canfell K, Weber M, Segan C. Care to Quit: a stepped wedge cluster randomised controlled trial to implement best practice smoking cessation care in cancer centres. Implement Sci 2021; 16:23. [PMID: 33663518 PMCID: PMC7934502 DOI: 10.1186/s13012-021-01092-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cigarette smoking in people with cancer is associated with negative treatment-related outcomes including increased treatment toxicity and complications, medication side effects, decreased performance status and morbidity. Evidence-based smoking cessation care is not routinely provided to patients with cancer. The purpose of this study is to determine the effectiveness of a smoking cessation implementation intervention on abstinence from smoking in people diagnosed with cancer. METHODS A stepped wedge cluster randomised design will be used. All sites begin in the control condition providing treatment as usual. In a randomly generated order, sites will move to the intervention condition. Based on the Theoretical Domains Framework, implementation of Care to Quit will include (i) building the capability and motivation of a critical mass of key clinical staff and identifying champions; and (ii) identifying and implementing cessation care models/pathways. Two thousand one hundred sixty patients with cancer (diagnosed in the prior six months), aged 18+, who report recent combustible tobacco use (past 90 days or in the 30 days prior to cancer diagnosis) and are accessing anti-cancer therapy, will be recruited at nine sites. Assessments will be conducted at baseline and 7-month follow-up. The primary outcome will be 6-month abstinence from smoking. Secondary outcomes include biochemical verification of abstinence from smoking, duration of quit attempts, tobacco consumption, nicotine dependence, provision and receipt of smoking cessation care, mental health and quality of life and cost effectiveness of the intervention. DISCUSSION This study will implement best practice smoking cessation care in cancer centres and has the potential for wide dissemination. TRIAL REGISTRATION The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN ( ACTRN12621000154808 ) prior to the accrual of the first participant and will be updated regularly as per registry guidelines.
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Affiliation(s)
- Christine L Paul
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, Australia. .,University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia. .,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia. .,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.
| | - Graham Warren
- Department of Radiation Oncology, Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School and Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Emily Stone
- St Vincent's Hospital Sydney, Kinghorn Cancer Centre, University of NSW, Kensington, Australia
| | - Daniel Barker
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia
| | - Kate White
- Faculty of Medicine and Health, University of Sydney, CNRU Sydney Local Health District, Sydney, Australia
| | - James McLennan
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Fiona Day
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Hunter Region Mail Centre, Waratah, NSW, Australia
| | - Kristen McCarter
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, Australia.,University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Melissa McEnallay
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, Australia.,University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Jordan Tait
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Marianne Weber
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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21
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Byaruhanga J, Wiggers J, Paul CL, Byrnes E, Mitchell A, Lecathelinais C, Tzelepis F. Acceptability of real-time video counselling compared to other behavioural interventions for smoking cessation in rural and remote areas. Drug Alcohol Depend 2020; 217:108296. [PMID: 32980788 PMCID: PMC7491422 DOI: 10.1016/j.drugalcdep.2020.108296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study evaluated the acceptability of real-time video counselling compared to a) telephone counselling and b) written materials in assisting rural and remote residents to quit smoking. METHODS Participants were recruited into a three-arm, parallel group randomised trial and randomly allocated to either: a) real-time video counselling; b) telephone counselling; or c) written materials. At 4-months post-baseline participants completed an online survey that examined self-reported acceptability and helpfulness of the support. RESULTS Overall, 93.5 % of video counselling participants and 96.2 % of telephone counselling participants who received support thought it was acceptable for a smoking cessation advisor to contact them via video software or telephone respectively. There were significant differences between video counselling and telephone counselling groups on three of 10 acceptability or helpfulness measures. Video counselling participants had significantly lower odds of reporting the number of calls were about right (OR 0.50, 95 % CI 0.27-0.93), recommending the support to family and friends (OR 0.18, 95 % CI 0.04-0.85) and reporting the support helped with motivation to try quitting (OR 0.24, 95 % CI 0.07-0.76) compared to telephone counselling participants. Video counselling participants had significantly greater odds than written materials participants of rating the support favourably on all seven acceptability and helpfulness items compared. CONCLUSIONS Real-time video counselling for smoking cessation is acceptable and well-received by those living in rural and remote locations. Further research is required to enhance the three attributes that were less acceptable for video counselling than telephone counselling.
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Affiliation(s)
- Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287 Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305 Australia.
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287 Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305 Australia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305 Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305 Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287 Australia
| | - Christophe Lecathelinais
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287 Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287 Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305 Australia
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Hasnain MG, Attia JR, Akter S, Rahman T, Hall A, Hubbard IJ, Levi CR, Paul CL. Effectiveness of interventions to improve rates of intravenous thrombolysis using behaviour change wheel functions: a systematic review and meta-analysis. Implement Sci 2020; 15:98. [PMID: 33148294 PMCID: PMC7641813 DOI: 10.1186/s13012-020-01054-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite being one of the few evidence-based treatments for acute ischemic stroke, intravenous thrombolysis has low implementation rates-mainly due to a narrow therapeutic window and the health system changes required to deliver it within the recommended time. This systematic review and meta-analyses explores the differential effectiveness of intervention strategies aimed at improving the rates of intravenous thrombolysis based on the number and type of behaviour change wheel functions employed. METHOD The following databases were searched: MEDLINE, EMBASE, PsycINFO, CINAHL and SCOPUS. Multiple authors independently completed study selection and extraction of data. The review included studies that investigated the effects of intervention strategies aimed at improving the rates of intravenous thrombolysis and/or onset-to-needle, onset-to-door and door-to-needle time for thrombolysis in patients with acute ischemic stroke. Interventions were coded according to the behaviour change wheel nomenclature. Study quality was assessed using the QualSyst scoring system for quantitative research methodologies. Random effects meta-analyses were used to examine effectiveness of interventions based on the behaviour change wheel model in improving rates of thrombolysis, while meta-regression was used to examine the association between the number of behaviour change wheel intervention strategies and intervention effectiveness. RESULTS Results from 77 studies were included. Five behaviour change wheel interventions, 'Education', 'Persuasion', 'Training', 'Environmental restructuring' and 'Enablement', were found to be employed among the included studies. Effects were similar across all intervention approaches regardless of type or number of behaviour change wheel-based strategies employed. High heterogeneity (I2 > 75%) was observed for all the pooled analyses. Publication bias was also identified. CONCLUSION There was no evidence for preferring one type of behaviour change intervention strategy, nor for including multiple strategies in improving thrombolysis rates. However, the study results should be interpreted with caution, as they display high heterogeneity and publication bias.
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Affiliation(s)
- Md Golam Hasnain
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
| | - John R. Attia
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales Australia
- John Hunter Hospital, New Lambton Heights, New South Wales Australia
| | - Shahinoor Akter
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- Department of Anthropology, Jagannath University, Dhaka, Bangladesh
| | - Tabassum Rahman
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- Centre for Development, Economics and Sustainability, Monash University, Melbourne, Victoria Australia
| | - Alix Hall
- Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales Australia
| | - Isobel J. Hubbard
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
| | - Christopher R. Levi
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Liverpool, New South Wales Australia
| | - Christine L. Paul
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, New South Wales Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales Australia
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23
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Hasnain MG, Paul CL, Attia JR, Ryan A, Kerr E, Oldmeadow C, D'Este CA, Bivard A, Hubbard IJ, Milton AH, Levi CR. Thrombolysis implementation intervention and clinical outcome: a secondary analysis of a cluster randomized trial. BMC Cardiovasc Disord 2020; 20:432. [PMID: 33023494 PMCID: PMC7542125 DOI: 10.1186/s12872-020-01705-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background Multiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia. Methods A posthoc analysis was conducted using individual-level patient data. Excellent (Three-month post treatment modified Rankin Score 0–2) and poor clinical outcome (Three-month post treatment modified Rankin Score 5–6) and post treatment parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups. Results There was a non-significant higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73–3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73–2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significant lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56–2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61–3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21–1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36–2.52). Conclusion The TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage. Trial registration Clinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.
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Affiliation(s)
- Md Golam Hasnain
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, Australia.
| | - Christine L Paul
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, Australia
| | - John R Attia
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, Australia.,John Hunter Hospital (JHH), New Lambton Heights, Australia
| | - Annika Ryan
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, Australia
| | - Erin Kerr
- John Hunter Hospital (JHH), New Lambton Heights, Australia
| | | | - Catherine A D'Este
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University (ANU), Canberra, Australia
| | | | - Isobel J Hubbard
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, Australia
| | | | - Christopher R Levi
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, Australia.,The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Sydney, Australia
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Byaruhanga J, Paul CL, Wiggers J, Byrnes E, Mitchell A, Lecathelinais C, Tzelepis F. Connectivity of Real-Time Video Counselling Versus Telephone Counselling for Smoking Cessation in Rural and Remote Areas: An Exploratory Study. Int J Environ Res Public Health 2020; 17:ijerph17082891. [PMID: 32331356 PMCID: PMC7215336 DOI: 10.3390/ijerph17082891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
Abstract
This study compared the connectivity of video sessions to telephone sessions delivered to smokers in rural areas and whether remoteness and video app (video only) were associated with the connectivity of video or telephone sessions. Participants were recruited into a randomised trial where two arms offered smoking cessation counselling via: (a) real-time video communication software (201 participants) or (b) telephone (229 participants). Participants were offered up to six video or telephone sessions and the connectivity of each session was recorded. A total of 456 video sessions and 606 telephone sessions were completed. There was adequate connectivity of the video intervention in terms of no echoing noise (97.8%), no loss of internet connection during the session (88.6%), no difficulty hearing the participant (88.4%) and no difficulty seeing the participant (87.5%). In more than 94% of telephone sessions, there was no echoing noise, no difficulty hearing the participant and no loss of telephone line connection. Video sessions had significantly greater odds of experiencing connectivity difficulties than telephone sessions in relation to connecting to the participant at the start (odds ratio, OR = 5.13, 95% confidence interval, CI 1.88–14.00), loss of connection during the session (OR = 11.84, 95% CI 4.80–29.22) and hearing the participant (OR = 2.53, 95% CI 1.41–4.55). There were no significant associations between remoteness and video app and connectivity difficulties in the video or telephone sessions. Real-time video sessions are a feasible option for smoking cessation providers to provide support in rural areas.
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Affiliation(s)
- Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; (C.L.P.); (J.W.); (E.B.); (A.M.); (F.T.)
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia;
- Correspondence:
| | - Christine L. Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; (C.L.P.); (J.W.); (E.B.); (A.M.); (F.T.)
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; (C.L.P.); (J.W.); (E.B.); (A.M.); (F.T.)
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia;
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; (C.L.P.); (J.W.); (E.B.); (A.M.); (F.T.)
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305, Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; (C.L.P.); (J.W.); (E.B.); (A.M.); (F.T.)
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia;
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia;
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; (C.L.P.); (J.W.); (E.B.); (A.M.); (F.T.)
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia;
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Levi CR, Attia JA, D'Este C, Ryan AE, Henskens F, Kerr E, Parsons MW, Sanson‐Fisher RW, Bladin CF, Lindley RI, Middleton S, Paul CL. Cluster-Randomized Trial of Thrombolysis Implementation Support in Metropolitan and Regional Australian Stroke Centers: Lessons for Individual and Systems Behavior Change. J Am Heart Assoc 2020; 9:e012732. [PMID: 31973599 PMCID: PMC7033885 DOI: 10.1161/jaha.119.012732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022]
Abstract
Background Intravenous thrombolytic therapy (IVT) with tissue plasminogen activator for acute ischemic stroke is underutilized in many parts of the world. Randomized trials to test the effectiveness of thrombolysis implementation strategies are limited. Methods and Results This study aimed to test the effectiveness of a multicomponent, multidisciplinary tissue plasminogen activator implementation package in increasing the proportion of thrombolyzed cases while maintaining accepted benchmarks for low rates of intracranial hemorrhage and high rates of functional outcomes at 3 months. A cluster randomized controlled trial of 20 hospitals in the early stages of thrombolysis implementation across 3 Australian states was undertaken. Monitoring of IVT rates during the baseline period allowed hospitals (the unit of randomization) to be grouped into 3 baseline IVT strata-very low rates (0% to ≤4.0%); low rates (>4.0% to ≤10.0%); and moderate rates (>10.0%). Hospitals were randomized to an implementation package (experimental group) or usual care (control group) using a 1:1 ratio. The 16-month intervention was based on behavioral theory and analysis of the steps, roles, and barriers to rapid assessment for thrombolysis eligibility and involved comprehensive strategies addressing individual and system-level change. The primary outcome was the difference in tissue plasminogen activator proportions between the 2 groups postintervention. The absolute difference in postintervention IVT rates between intervention and control hospitals adjusted for baseline IVT rate and stratum was not significant (primary outcome rate difference=1.1% (95% CI -1.5% to 3.7%; P=0.38). Rates of intracranial hemorrhage remained below international benchmarks. Conclusions The implementation package resulted in no significant change in tissue plasminogen activator implementation, suggesting that ongoing support is needed to sustain initial modifications in behavior. Clinical Trial Registration URL: www.anzctr.org.au Unique identifiers: ACTRN12613000939796 and U1111-1145-6762.
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Affiliation(s)
- Christopher R. Levi
- The University of Newcastle, School of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew Lambton HeightsAustralia
- Hunter New England HealthNew Lambton HeightsAustralia
| | - John A. Attia
- The University of Newcastle, School of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Cate D'Este
- The University of Newcastle, School of Medicine and Public HealthCallaghanAustralia
- National Centre for Epidemiology and Population HealthThe Australian National UniversityActonAustralia
| | - Annika E. Ryan
- The University of Newcastle, School of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Frans Henskens
- The University of Newcastle, School of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Erin Kerr
- Hunter New England HealthNew Lambton HeightsAustralia
| | | | - Robert W. Sanson‐Fisher
- The University of Newcastle, School of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | | | - Richard I. Lindley
- The George Institute for Global HealthSydneyAustralia
- The University of SydneyDarlingtonAustralia
| | - Sandy Middleton
- Nursing Research InstituteAustralian Catholic University and St Vincent's Health AustraliaSydney and DarlinghurstAustralia
| | - Christine L. Paul
- The University of Newcastle, School of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew Lambton HeightsAustralia
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Hasnain MG, Paul CL, Attia JR, Ryan A, Kerr E, D'Este C, Hall A, Milton AH, Hubbard IJ, Levi CR. Door-to-needle time for thrombolysis: a secondary analysis of the TIPS cluster randomised controlled trial. BMJ Open 2019; 9:e032482. [PMID: 31843839 PMCID: PMC6924711 DOI: 10.1136/bmjopen-2019-032482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The current study aimed to evaluate the effects of a multi-component in-hospital intervention on the door-to-needle time for intravenous thrombolysis in acute ischaemic stroke. DESIGN This study was a post hoc analysis of door-to-needle time data from a cluster-randomised controlled trial testing an intervention to boost intravenous thrombolysis implementation. SETTING The study was conducted among 20 hospitals from three Australian states. PARTICIPANT Eligible hospitals had a Stroke Care Unit or staffing equivalent to a stroke physician and a nurse, and were in the early stages of implementing thrombolysis. INTERVENTION The intervention was multifaceted and developed using the behaviour change wheel and informed by breakthrough collaborative methodology using components of the health behaviour change wheel. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome for this analysis was door-to-needle time for thrombolysis and secondary outcome was the proportion of patients received thrombolysis within 60 min of hospital arrival. RESULTS The intervention versus control difference in the door-to-needle times was non-significant overall nor significant by hospital classification. To provide additional context for the findings, we also evaluated the results within intervention and control hospitals. During the active-intervention period, the intervention hospitals showed a significant decrease in the door-to-needle time of 9.25 min (95% CI: -16.93 to 1.57), but during the post-intervention period, the result was not significant. During the active intervention period, control hospitals also showed a significant decrease in the door-to-needle time of 5.26 min (95% CI: -8.37 to -2.14) and during the post-intervention period, this trend continued with a decrease of 12.13 min (95% CI: -17.44 to 6.81). CONCLUSION Across these primary stroke care centres in Australia, a secular trend towards shorter door-to-needle times across both intervention and control hospitals was evident, however the TIPS (Thrombolysis ImPlementation in Stroke) intervention showed no overall effect on door-to-needle times in the randomised comparison. TRIAL REGISTRATION NUMBER Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN 12613000939796.
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Affiliation(s)
- Md Golam Hasnain
- School of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, Australia
| | - Christine L Paul
- School of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, Australia
| | - John R Attia
- School of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, Australia
- Hunter Medical Research Institute (HMRI), Clinical Research Design and Statistical Services, New Lambton Heights, New South Wales, Australia
| | - Annika Ryan
- School of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, Australia
| | - Erin Kerr
- John Hunter Hospital, Department of Neurology, New Lambton Heights, New South Wales, Australia
| | - Catherine D'Este
- School of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, Australia
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University (ANU), Acton, Australian Capital Territory, Australia
| | - Alix Hall
- Hunter Medical Research Institute (HMRI), Clinical Research Design and Statistical Services, New Lambton Heights, New South Wales, Australia
| | | | - Isobel J Hubbard
- School of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, Australia
| | - Christopher R Levi
- School of Medicine and Public Health (SMPH), Faculty of Health and Medicine, University of Newcastle (UoN), Callaghan, New South Wales, Australia
- The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Sydney, New South Wales, Australia
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Hasnain MG, Levi CR, Ryan A, Hubbard IJ, Hall A, Oldmeadow C, Grady A, Jayakody A, Attia JR, Paul CL. Can a multicomponent multidisciplinary implementation package change physicians' and nurses' perceptions and practices regarding thrombolysis for acute ischemic stroke? An exploratory analysis of a cluster-randomized trial. Implement Sci 2019; 14:98. [PMID: 31771599 PMCID: PMC6880372 DOI: 10.1186/s13012-019-0940-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Thrombolysis ImPlementation in Stroke (TIPS) trial tested the effect of a multicomponent, multidisciplinary, collaborative intervention designed to increase the rates of intravenous thrombolysis via a cluster randomized controlled trial at 20 Australian hospitals (ten intervention, ten control). This sub-study investigated changes in self-reported perceptions and practices of physicians and nurses working in acute stroke care at the participating hospitals. METHODS A survey with 74 statements was administered during the pre- and post-intervention periods to staff at 19 of the 20 hospitals. An exploratory factor analysis identified the structure of the survey items and linear mixed modeling was applied to the final survey domain scores to explore the differences between groups over time. RESULT The response rate was 45% for both the pre- (503 out of 1127 eligible staff from 19 hospitals) and post-intervention (414 out of 919 eligible staff from 18 hospitals) period. Four survey domains were identified: (1) hospital performance indicators, feedback, and training; (2) personal perceptions about thrombolysis evidence and implementation; (3) personal stroke skills and hospital stroke care policies; and (4) emergency and ambulance procedures. There was a significant pre- to post-intervention mean increase (0.21 95% CI 0.09; 0.34; p < 0.01) in scores relating to hospital performance indicators, feedback, and training; for the intervention hospitals compared to control hospitals. There was a corresponding increase in mean scores regarding perceptions about the thrombolysis evidence and implementation (0.21, 95% CI 0.06; 0.36; p < 0.05). Sub-group analysis indicated that the improvements were restricted to nurses' responses. CONCLUSION TIPS resulted in changes in some aspects of nurses' perceptions relating to the evidence for intravenous thrombolysis and its implementation and hospital performance indicators, feedback, and training. However, there is a need to explore further strategies for influencing the views of physicians given limited statistical power in the physician sample. TRIAL REGISTRATION ACTRN12613000939796, UTN: U1111-1145-6762.
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Affiliation(s)
- Md Golam Hasnain
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, NSW, Australia
| | - Christopher R Levi
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, NSW, Australia
- The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Liverpool, NSW, Australia
| | - Annika Ryan
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, NSW, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Isobel J Hubbard
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, NSW, Australia
| | - Alix Hall
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, NSW, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Alice Grady
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, NSW, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Amanda Jayakody
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, NSW, Australia
| | - John R Attia
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, NSW, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
- John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Christine L Paul
- School of Medicine and Public Health (SMPH), University of Newcastle (UoN), Callaghan, NSW, Australia.
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia.
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Tzelepis F, Paul CL, Williams CM, Gilligan C, Regan T, Daly J, Hodder RK, Byrnes E, Byaruhanga J, McFadyen T, Wiggers J. Real-time video counselling for smoking cessation. Cochrane Database Syst Rev 2019; 2019:CD012659. [PMID: 31684699 PMCID: PMC6818086 DOI: 10.1002/14651858.cd012659.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Real-time video communication software such as Skype and FaceTime transmits live video and audio over the Internet, allowing counsellors to provide support to help people quit smoking. There are more than four billion Internet users worldwide, and Internet users can download free video communication software, rendering a video counselling approach both feasible and scalable for helping people to quit smoking. OBJECTIVES To assess the effectiveness of real-time video counselling delivered individually or to a group in increasing smoking cessation, quit attempts, intervention adherence, satisfaction and therapeutic alliance, and to provide an economic evaluation regarding real-time video counselling. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, CENTRAL, MEDLINE, PubMed, PsycINFO and Embase to identify eligible studies on 13 August 2019. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov to identify ongoing trials registered by 13 August 2019. We checked the reference lists of included articles and contacted smoking cessation researchers for any additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), randomised trials, cluster RCTs or cluster randomised trials of real-time video counselling for current tobacco smokers from any setting that measured smoking cessation at least six months following baseline. The real-time video counselling intervention could be compared with a no intervention control group or another smoking cessation intervention, or both. DATA COLLECTION AND ANALYSIS Two authors independently extracted data from included trials, assessed the risk of bias and rated the certainty of the evidence using the GRADE approach. We performed a random-effects meta-analysis for the primary outcome of smoking cessation, using the most stringent measure of smoking cessation measured at the longest follow-up. Analysis was based on the intention-to-treat principle. We considered participants with missing data at follow-up for the primary outcome of smoking cessation to be smokers. MAIN RESULTS We included two randomised trials with 615 participants. Both studies delivered real-time video counselling for smoking cessation individually, compared with telephone counselling. We judged one study at unclear risk of bias and one study at high risk of bias. There was no statistically significant treatment effect for smoking cessation (using the strictest definition and longest follow-up) across the two included studies when real-time video counselling was compared to telephone counselling (risk ratio (RR) 2.15, 95% confidence interval (CI) 0.38 to 12.04; 2 studies, 608 participants; I2 = 66%). We judged the overall certainty of the evidence for smoking cessation as very low due to methodological limitations, imprecision in the effect estimate reflected by the wide 95% CIs and inconsistency of cessation rates. There were no significant differences between real-time video counselling and telephone counselling reported for number of quit attempts among people who continued to smoke (mean difference (MD) 0.50, 95% CI -0.60 to 1.60; 1 study, 499 participants), mean number of counselling sessions completed (MD -0.20, 95% CI -0.45 to 0.05; 1 study, 566 participants), completion of all sessions (RR 1.13, 95% CI 0.71 to 1.79; 1 study, 43 participants) or therapeutic alliance (MD 1.13, 95% CI -0.24 to 2.50; 1 study, 398 participants). Participants in the video counselling arm were more likely than their telephone counselling counterparts to recommend the programme to a friend or family member (RR 1.06, 95% CI 1.01 to 1.11; 1 study, 398 participants); however, there were no between-group differences on satisfaction score (MD 0.70, 95% CI -1.16 to 2.56; 1 study, 29 participants). AUTHORS' CONCLUSIONS There is very little evidence about the effectiveness of real-time video counselling for smoking cessation. The existing research does not suggest a difference between video counselling and telephone counselling for assisting people to quit smoking. However, given the very low GRADE rating due to methodological limitations in the design, imprecision of the effect estimate and inconsistency of cessation rates, the smoking cessation results should be interpreted cautiously. High-quality randomised trials comparing real-time video counselling to telephone counselling are needed to increase the confidence of the effect estimate. Furthermore, there is currently no evidence comparing real-time video counselling to a control group. Such research is needed to determine whether video counselling increases smoking cessation.
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Affiliation(s)
- Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Christine L Paul
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
| | - Christopher M Williams
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Conor Gilligan
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Tim Regan
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Justine Daly
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Rebecca K Hodder
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Emma Byrnes
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Judith Byaruhanga
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
| | - Tameka McFadyen
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - John Wiggers
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
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Fradgley EA, Boltong A, O'Brien L, Boyes AW, Lane K, Beattie A, Clinton-McHarg T, Jacobsen PB, Doran C, Barker D, Roach D, Taylor J, Paul CL. Implementing Systematic Screening and Structured Care for Distressed Callers Using Cancer Council's Telephone Services: Protocol for a Randomized Stepped-Wedge Trial. JMIR Res Protoc 2019; 8:e12473. [PMID: 31099341 PMCID: PMC6542249 DOI: 10.2196/12473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/10/2019] [Accepted: 03/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Structured distress management, comprised a 2-stage screening and referral model, can direct supportive care resources toward individuals who are most likely to benefit. This structured approach has yet to be trialed in Australian community-based services such as Cancer Council New South Wales (NSW) and Victoria Cancer Information and Support (CIS) 13 11 20 lines who care for a large community of cancer patients and caregivers. Objective The aim of this study was to evaluate the effectiveness of structured screening and referral in (1) increasing the proportion of distressed CIS callers who accept supportive care referrals and (2) reducing distress levels at 6-month follow-up. Methods In this stepped-wedge trial, Cancer Council NSW and Victoria CIS consultants are randomized to deliver structured care during inbound 13 11 20 calls in accordance with 3 intervention periods. Eligible callers are patients or caregivers who score 4 or more on the Distress Thermometer; NSW or Victorian residents; aged 18 years or older; and English proficient. Study data are collected via computer-assisted telephone interviews (CATIs) at 3- and 6-month follow-up and CIS record audit. CATIs include demographic and service use items and the General Health Questionnaire (GHQ-28) to assess distress. An economic analysis of the structured care model will be completed. Results The structured care model was developed by guideline review and identification of service characteristics to guide mapping decisions; place-card methodology; and clinical vignettes with think-aloud methodology to confirm referral appropriateness. The model includes an additional screening tool (Patient Health Questionnaire-4) and a referral model with 16-20 CIS services. Descriptive statistics will be used to assess referral uptake rates. Differences between GHQ-28 scores for structured and usual care callers will be tested using a generalized linear mixed model with fixed effects for intervention and each time period. The trial will recruit 1512 callers. The sample size will provide the study with approximately 80% power to detect a difference of 0.3 SD in the mean score of the GHQ-28 at an alpha level of .05 and assuming an intra-cluster correlation of .04. A random sample of recorded calls will be reviewed to assess intervention fidelity and contamination. To date, 1835 distressed callers have been invited to participate with 60.71% (1114/1835) enrolled in the study. A total of 692 participants have completed 6-month CATIs. Recruitment is anticipated to end in late 2019. Conclusions This trial is among the first to rigorously test the outcomes of a community-based structured approach to distress management. The model is evidence-informed, practice-ready, and trialed in a real-world setting. The study outcomes will advance the understanding of distress management internationally for both patients and caregivers. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12617000352303; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372105&isReview=true (Archived by WebCite on http://www.webcitation.org/78AW0Ba09) International Registered Report Identifier (IRRID) DERR1-10.2196/12473
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Anna Boltong
- Strategy and Support, Cancer Council Victoria, Melbourne, Australia
| | | | - Allison W Boyes
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, Callaghan, Australia
| | - Katherine Lane
- Cancer Information and Support Services, Cancer Council Victoria, Melbourne, Australia
| | - Annette Beattie
- Cancer Information and Support Services, Cancer Council NSW, Woolloomooloo, Australia
| | - Tara Clinton-McHarg
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Psychology, University of Newcastle, Callaghan, Australia
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Christopher Doran
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, University of Central Queensland, Brisbane, Australia
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Della Roach
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jo Taylor
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Christine L Paul
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Fradgley EA, Karnon J, Roach D, Harding K, Wilkinson-Meyers L, Chojenta C, Campbell M, Harris ML, Cumming J, Dalziel K, McDonald J, Pain T, Smiler K, Paul CL. Taking the pulse of the health services research community: a cross-sectional survey of research impact, barriers and support. AUST HEALTH REV 2019; 44:160-167. [PMID: 30779882 DOI: 10.1071/ah18213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/23/2018] [Indexed: 11/23/2022]
Abstract
Objective This study reports on the characteristics of individuals conducting health service research (HSR) in Australia and New Zealand, the perceived accessibility of resources for HSR, the self-reported impact of HSR projects and perceived barriers to conducting HSR. Methods A sampling frame was compiled from funding announcements, trial registers and HSR organisation membership. Listed researchers were invited to complete online surveys. Close-ended survey items were analysed using basic descriptive statistics. Goodness of fit tests determined potential associations between researcher affiliation and access to resources for HSR. Open-ended survey items were analysed using thematic analysis. Results In all, 424 researchers participated in the study (22% response rate). Respondents held roles as health service researchers (76%), educators (34%) and health professionals (19%). Most were employed by a university (64%), and 57% held a permanent contract. Although 63% reported network support for HSR, smaller proportions reported executive (48%) or financial (26%) support. The least accessible resources were economists (52%), consumers (49%) and practice change experts (34%); researchers affiliated with health services were less likely to report access to statisticians (P<0.001), economists (P<0.001), librarians (P=0.02) and practice change experts (P=0.02) than university-affiliated researchers. Common impacts included conference presentations (94%), publication of peer-reviewed articles (87%) and health professional benefits (77%). Qualitative data emphasised barriers such as embedding research culture within services and engaging with policy makers. Conclusions The data highlight opportunities to sustain the HSR community through dedicated funding, improved access to methodological expertise and greater engagement with end-users. What is known about the topic? HSR faces several challenges, such as inequitable funding allocation and difficulties in quantifying the effects of HSR on changing health policy or practice. What does this paper add? Despite a vibrant and experienced HSR community, this study highlights some key barriers to realising a greater effect on the health and well-being of Australian and New Zealand communities through HSR. These barriers include limited financial resources, methodological expertise, organisational support and opportunities to engage with potential collaborators. What are the implications for practitioners? Funding is required to develop HSR infrastructure, support collaboration between health services and universities and combine knowledge of the system with research experience and expertise. Formal training programs for health service staff and researchers, from short courses to PhD programs, will support broader interest and involvement in HSR.
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Health Behaviour and Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; and Corresponding author.
| | - Jon Karnon
- School of Public Health, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia.
| | - Della Roach
- Priority Research Centre for Health Behaviour and Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ;
| | - Katherine Harding
- Allied Health Clinical Research Office, Level 2, 5 Arnold Street, Box Hill, Vic. 3128, Australia.
| | - Laura Wilkinson-Meyers
- Health Systems, School of Population Health, The University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand.
| | - Catherine Chojenta
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ;
| | - Megan Campbell
- The Australian Centre for Health Services Innovation (AusHSI), Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld 4059, Australia.
| | - Melissa L Harris
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ;
| | - Jacqueline Cumming
- Health Services Research Centre, Faculty of Health, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand. ; ;
| | - Kim Dalziel
- Centre for Health Policy, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Janet McDonald
- Health Services Research Centre, Faculty of Health, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand. ; ;
| | - Tilley Pain
- Allied Health Management Unit, Townsville Hospital and Health Service, PO Box 670, Townsville, Qld 4810, Australia.
| | - Kirsten Smiler
- Health Services Research Centre, Faculty of Health, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand. ; ;
| | - Christine L Paul
- Priority Research Centre for Health Behaviour and Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ;
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White R, Hayes C, Boyes AW, Chiu S, Paul CL. General practitioners and management of chronic noncancer pain: a cross-sectional survey of influences on opioid deprescribing. J Pain Res 2019; 12:467-475. [PMID: 30774416 PMCID: PMC6348964 DOI: 10.2147/jpr.s168785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background General practitioners’ (GPs) views about deprescribing prescription opioid analgesics (POAs) may influence the care provided for patients experiencing chronic noncancer pain (CNCP). There are limited data addressing GPs’ beliefs about deprescribing, including their decisions to deprescribe different types of POAs. Aim To determine the proportion of GPs who hold attitudes congruent with local pain stewardship, describe their deprescribing decisions, and determine whether type of POA influences deprescribing. Design and setting In 2016, a cross-sectional survey of all GPs (n=1,570) in one mixed urban and regional primary health network (PHN) in Australia was undertaken. Methods A mailed self-report questionnaire assessed agreement with local guidelines for treating CNCP; influences on deprescribing POAs and likelihood of deprescribing in a hypothetical case involving either oral codeine or oxycodone. Results A response rate of 46% was achieved. Approximately half (54%) of GPs agreed POAs should be reserved for people with acute, cancer pain or palliative care and a third (32%) did not agree that a medication focus has limited benefits for peoples’ long-term quality of life and function. Most (77%) GPs were less likely to deprescribe when effective alternate treatments were lacking, while various patient factors (eg, fear of weaning) were reported to decrease the likelihood of deprescribing for 25% of GPs. A significantly higher proportion of GPs reported being very likely to deprescribe codeine compared to the equivalent opioid dose of oxycodone for a hypothetical patient. Conclusions Many GPs in the PHN hold attitudes at odds with local guidance that opioids are a nonsuperior treatment for CNCP. Attitudinal barriers to deprescribing include: a lack of consistent approach to deprescribing opioids as a class of drugs, perceived lack of effective treatment alternatives and patient fear of deprescribing. Therefore, the next step in this target population is to appropriately train and support GPs in how to apply the evidence in practice and how to support patients appropriately.
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Affiliation(s)
- Ruth White
- Hunter Integrated Pain Service, Hunter New England Health, Newcastle, NSW, Australia, .,School of Medicine and Public Health, University of Newcastle, NSW, Australia,
| | - Chris Hayes
- Hunter Integrated Pain Service, Hunter New England Health, Newcastle, NSW, Australia,
| | - Allison W Boyes
- School of Medicine and Public Health, University of Newcastle, NSW, Australia, .,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Simon Chiu
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, NSW, Australia, .,Hunter Medical Research Institute, Newcastle, NSW, Australia
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Tzelepis F, Wiggers J, Paul CL, Byaruhanga J, Byrnes E, Bowman J, Gillham K, Campbell E, Ling R, Searles A. A randomised trial of real-time video counselling for smoking cessation in regional and remote locations: study protocol. Contemp Clin Trials 2018; 74:70-75. [PMID: 30290277 DOI: 10.1016/j.cct.2018.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/22/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Real-time video communication technology (e.g. Skype) may be an effective mode for delivering smoking cessation treatment to regional and remote residents. This randomised trial examines the effectiveness of real-time video counselling compared to: 1) telephone counselling; and 2) written materials (control) in achieving smoking abstinence in regional and remote residents. DESIGN A three-arm, parallel group, randomised trial will be conducted with smokers residing in regional and remote areas of New South Wales, Australia. Potential participants will complete an online screening survey and if eligible an online baseline survey. Participants will be randomly allocated into: 1) real-time video counselling; 2) telephone counselling; or 3) written materials (control). In the video counselling intervention an advisor will deliver up to six video sessions (e.g. via Skype) to participants. Those who nominate a quit date within a month during the initial video session will be offered sessions on the quit date, 3-, 7-, 14- and 30-days after the quit date. Those not ready to set a quit date within a month during the initial video session will be offered sessions 2-, 4- and 6-weeks later. Other than delivery mode, the video counselling and telephone counselling will be identical in content and callback schedules. Control group participants will be mailed one-off written materials. Follow-up surveys will occur at 4-months, 7-months and 13-months post-baseline. The primary outcome will be 7-day point prevalence abstinence at 13-months post-baseline. DISCUSSION Real-time video counselling may be an effective strategy for smoking cessation that could be integrated into quitlines globally.
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Affiliation(s)
- Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305, Australia.
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305, Australia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305, Australia
| | - Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Jennifer Bowman
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305, Australia; School of Psychology, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Rod Ling
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305, Australia
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Fradgley EA, Chong SE, Cox ME, Gedye C, Paul CL. Patients' experiences and preferences for opt-in models and health professional involvement in biobanking consent: A cross-sectional survey of Australian cancer outpatients. Asia Pac J Clin Oncol 2018; 15:31-37. [PMID: 29573159 DOI: 10.1111/ajco.12866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many biobanks rely upon patients' willingness to donate biospecimens and healthcare professionals to initiate opt-in consent processes. This study explored if: (1) patients accept opt-in or opt-out consent models with varying levels of professional involvement; (2) professionals discuss participation with specific patient groups; and (3) this discussion is associated with patient knowledge of biobanking processes. METHODS Outpatients completed surveys at a tertiary cancer center in New South Wales, Australia. Eligible participants were English-speaking adults who recently had cancer-related surgery. Participants completed 27 questions exploring acceptable consent models, biobanking experiences, knowledge, and willingness. Logistic regression and chi-square tests examined differences in the characteristics and knowledge of participants who were offered the opportunity to participate versus those who were not. RESULTS A total of 113 outpatients participated (97% response). Most participants (92%) found opt-out, patient-initiated consent acceptable; however, high acceptability was reported for all models except for opt-in, patient-initiated consent (58%). University or technical qualifications (P = 0.001) was associated with increased odds (OR = 4.5) of being offered biobanking. The majority did not know what occurred to samples after surgery (59.3%) or pathology review (81.4%) and ability to answer these questions was associated with discussion of participation (P < 0.001). Of the few outpatients who discussed biobanking with their doctor (29%), all consented. CONCLUSION Professional-initiated, opt-in consent resulted in a few educated patients being approached; greater professional initiation of consent would be fruitful as most patients were willing to participate if asked. However, other consent approaches minimizing professional involvement were as acceptable to participants warranting further consideration.
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Shu Er Chong
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Martine E Cox
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Craig Gedye
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia.,Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Christine L Paul
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, NSW, Australia
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Tzelepis F, Paul CL, Sanson-Fisher RW, Campbell HS, Bradstock K, Carey ML, Williamson A. Unmet supportive care needs of haematological cancer survivors: rural versus urban residents. Ann Hematol 2018. [DOI: 10.1007/s00277-018-3285-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fradgley EA, Paul CL, Bryant J, Zucca A, Oldmeadow C. System-Wide and Group-Specific Health Service Improvements: Cross-Sectional Survey of Outpatient Improvement Preferences and Associations with Demographic Characteristics. Int J Environ Res Public Health 2018; 15:ijerph15020179. [PMID: 29360743 PMCID: PMC5858254 DOI: 10.3390/ijerph15020179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/16/2017] [Accepted: 01/17/2018] [Indexed: 11/16/2022]
Abstract
Efficient patient-centred quality improvement requires an understanding of the system-wide areas of dissatisfaction along with evidence to identify the programs which can be strategically targeted according to specific patient characteristics and preferences. This cross-sectional study reports the proportion of chronic disease outpatients selecting 23 patient-centred improvement initiatives. Using univariate tests and multivariable logistic regressions, this multi-site study also identifies initiatives differentially selected by outpatients according to clinical and demographic characteristics. A total of 475 outpatients participated (49% response). Commonly selected initiatives included: reducing wait-times (22.3%); convenient appointment scheduling (16.0%); and receiving up-to-date treatment information (16.0%). Within univariate tests, preferences for information and service accessibility initiatives were not significantly associated with specific subgroups. However, seven initiatives were preferred according to age, gender, diagnosis status, and chronic disease type within multivariate models. For example, neurology outpatients were more likely to select assistance to manage psychological symptoms when compared to oncology outpatients (OR: 2.89). Study findings suggest that system-wide programs to enhance information provision are strategic approaches to improve experiences across patient characteristics. Furthermore, a few initiatives can be targeted to specific groups and emphasized the importance of detailed scoping analyses and tailored implementation plans when designing patient-centred quality improvement programs.
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, Callaghan, NSW 2308, Australia.
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Christine L Paul
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, Callaghan, NSW 2308, Australia.
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
- Health Behaviour Research Group, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Alison Zucca
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
- Health Behaviour Research Group, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia.
- School of Mathematical and Physical Sciences, Faculty of Science and Information Technology, University of Newcastle, Callaghan, NSW 2308, Australia.
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Paul CL, Ishiguchi P, D'Este CA, Shaw JE, Sanson‐Fisher RW, Forshaw K, Bisquera A, Robinson J, Koller C, Eades SJ. Testing for type 2 diabetes in Indigenous Australians: guideline recommendations and current practice. Med J Aust 2017; 207:206-210. [DOI: 10.5694/mja16.00769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/03/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Christine L Paul
- University of Newcastle, Newcastle, NSW
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW
- Hunter Medical Research Institute, Newcastle, NSW
| | | | - Catherine A D'Este
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | | | | | - Kristy Forshaw
- University of Newcastle, Newcastle, NSW
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW
| | | | | | - Claudia Koller
- University of Newcastle, Newcastle, NSW
- Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW
- Hunter Medical Research Institute, Newcastle, NSW
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Bonevski B, Borland R, Paul CL, Richmond RL, Farrell M, Baker A, Gartner CE, Lawn S, Thomas DP, Walker N. No smoker left behind: it's time to tackle tobacco in Australian priority populations. Med J Aust 2017; 207:141-142. [PMID: 28814207 DOI: 10.5694/mja16.01425] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/26/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW
| | | | | | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, SA
| | | | - Natalie Walker
- National Institute for Health Innovation, University of Auckland, Auckland, NZ
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Affiliation(s)
- Flora Tzelepis
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Christine L Paul
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
| | - Christopher M Williams
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Conor Gilligan
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
| | - Tim Regan
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Justine Daly
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Rebecca K Hodder
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - John Wiggers
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
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Paul CL, Piterman L, Shaw JE, Kirby C, Forshaw KL, Robinson J, Thepwongsa I, Sanson-Fisher RW. Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners. Trials 2017; 18:137. [PMID: 28335809 PMCID: PMC5364574 DOI: 10.1186/s13063-017-1869-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/01/2017] [Indexed: 11/20/2022] Open
Abstract
Background In 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. Method Trial 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. Results Eleven 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. Conclusion There 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 registration Australian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976. Retrospectively registered on 31 May 2011.
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Affiliation(s)
- Christine L Paul
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia. .,University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia. .,W4 HMRI Building, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Leon Piterman
- Monash University, School of Rural Health, Churchill, VIC, Australia.,Eastern Victoria General Practice Training, Churchill, VIC, Australia
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Clinical Diabetes and Epidemiology Group, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Catherine Kirby
- Monash University, School of Rural Health, Churchill, VIC, Australia.,Eastern Victoria General Practice Training, Churchill, VIC, Australia
| | - Kristy L Forshaw
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia.,University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia
| | - Jennifer Robinson
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Isaraporn Thepwongsa
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Robert W Sanson-Fisher
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia.,University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia
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Tzelepis F, Hanna JH, Paul CL, Boyes AW, Carey ML, Regan T. Quality of patient-centred care: Medical oncology patients' perceptions and characteristics associated with quality of care. Psychooncology 2017; 26:1998-2001. [PMID: 28101971 DOI: 10.1002/pon.4380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 12/29/2016] [Accepted: 01/15/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Flora Tzelepis
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute (HMRI), Callaghan, NSW, Australia
| | | | - Christine L Paul
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute (HMRI), Callaghan, NSW, Australia
| | - Allison W Boyes
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute (HMRI), Callaghan, NSW, Australia
| | - Mariko L Carey
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute (HMRI), Callaghan, NSW, Australia
| | - Timothy Regan
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute (HMRI), Callaghan, NSW, Australia
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Paul CL, Boyes AW, O'Brien L, Baker AL, Henskens FA, Roos I, Clinton-McHarg T, Bellamy D, Colburn G, Rose S, Cox ME, Fradgley EA, Baird H, Barker D. Protocol for a Randomized Controlled Trial of Proactive Web-Based Versus Telephone-Based Information and Support: Can Electronic Platforms Deliver Effective Care for Lung Cancer Patients? JMIR Res Protoc 2016; 5:e202. [PMID: 27784648 PMCID: PMC5103105 DOI: 10.2196/resprot.6248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/30/2016] [Accepted: 09/20/2016] [Indexed: 01/22/2023] Open
Abstract
Background Community-based services such as telephone support lines can provide valuable informational, emotional, and practical support for cancer patients via telephone- or Web-based (live chat or email) platforms. However, very little rigorous research has examined the efficacy of such services in improving patient outcomes. Objective This study will determine whether: proactive telephone or Web-delivered support produces outcomes superior to printed information; and Web-delivered support produces outcomes comparable to telephone support. Methods A consecutive sample of 501 lung cancer outpatients will be recruited from 50 Australian health services to participate in a patient-randomized controlled trial (RCT). Eligible individuals must: be 18 years or older; have received a lung cancer diagnosis (including mesothelioma) within the previous 4 months; have an approximate life expectancy of at least 6 months; and have Internet access. Participants will be randomly allocated to receive: (1) an information booklet, (2) proactive telephone support, or (3) proactive Web support, chat, and/or email. The primary patient outcomes will be measured by the General Health Questionnaire (GHQ-12) and Health Education and Impact Questionnaire (heiQ) at 3 and 6 months post recruitment. The acceptability of proactive recruitment strategies will also be assessed. Results It is hypothesized that participants receiving telephone or Web support will report reduced distress (GHQ-12 scores that are 0.3 standard deviations (SD) lower) and greater self-efficacy (heiQ scores that are 0.3 SDs higher) than participants receiving booklets. Individuals receiving Web support will report heiQ scores within 0.29 SDs of individuals receiving telephone support. Conclusions If proven effective, electronic approaches such as live-chat and email have the potential to increase the accessibility and continuity of supportive care delivered by community-based services. This evidence may also inform the redesigning of helpline-style services to be effective and responsive to patient needs.
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Affiliation(s)
- Christine L Paul
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
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Abstract
Identification of patients’ and health professionals’ quality improvement preferences is an essential first step in collaborative improvement models. This includes experience-based codesign (EBCD), where service change is strategically introduced following stakeholder consultation. This study compared the number and types of improvement initiatives selected by outpatients and health professionals. Using electronic surveys designed to inform EBCD studies, 541 outpatients (71.1% consent) and 124 professionals (47.1% response) selected up to 23 general initiatives. On average, outpatients selected 2.4 (median = 1, interquartile range = 1–3) initiatives and professionals selected 10.7 (median = 10; interquartile range = 6–15) initiatives. Outpatients demonstrated a strong preference for improvements to clinic organization, such as appointment scheduling and clinic contact. Outpatients selected relatively fewer initiatives potentially reducing the complexity of service change and resources required to address preferences. Comparatively, professionals indicated a greater degree of change is needed and selected initiatives related to communication with patients and other professionals, including coordinating multidisciplinary care. Improvements to information provision were commonly selected by both groups and offered a strategic opportunity to address patients’ and professionals’ preferences. By quantifying the ways in which preferences differed, this study emphasizes the need for collaborative approaches to health service change and may be used to initiate an informed discussion on patients’ and professionals’ quality improvement preferences in tertiary care.
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Affiliation(s)
- Elizabeth A. Fradgley
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christine L. Paul
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicolas Collins
- Department of Cardiovascular Medicine, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Stephen P. Ackland
- Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Douglas Bellamy
- Cancer Network, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Christopher R. Levi
- Department of Neurology, John Hunter Hospital and Research Support and Development Unit, Hunter New England Local Health District, New Lambton, New South Wales, Australia
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Fradgley EA, Paul CL, Bryant J, Oldmeadow C. Getting right to the point: identifying Australian outpatients' priorities and preferences for patient-centred quality improvement in chronic disease care. Int J Qual Health Care 2016; 28:470-7. [PMID: 27283439 DOI: 10.1093/intqhc/mzw049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To identify specific actions for patient-centred quality improvement in chronic disease outpatient settings, this study identified patients' general and specific preferences among a comprehensive suite of initiatives for change. DESIGN AND SETTING A cross-sectional survey was conducted in three hospital-based clinics specializing in oncology, neurology and cardiology care located in New South Wales, Australia. PARTICIPANTS AND MEASURES Adult English-speaking outpatients completed the touch-screen Consumer Preferences Survey in waiting rooms or treatment areas. Participants selected up to 23 general initiatives that would improve their experience. Using adaptive branching, participants could select an additional 110 detailed initiatives and complete a relative prioritization exercise. RESULTS A total of 541 individuals completed the survey (71.1% consent, 73.1% completion). Commonly selected general initiatives, presented in order of decreasing priority (along with sample proportion), included: improved parking (60.3%), up-to-date information provision (15.0%), ease of clinic contact (12.9%), access to information at home (12.8%), convenient appointment scheduling (14.2%), reduced wait-times (19.8%) and information on medical emergencies (11.1%). To address these general initiatives, 40 detailed initiatives were selected by respondents. CONCLUSIONS Initiatives targeting service accessibility and information provision, such as parking and up-to-date information on patient prognoses and progress, were commonly selected and perceived to be of relatively greater priority. Specific preferences included the need for clinics to provide patient-designated parking in close proximity to the clinic, information on treatment progress and test results (potentially in the form of designated brief appointments or via telehealth) and comprehensive and trustworthy lists of information sources to access at home.
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Christine L Paul
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia Hunter Medical Research Institute, New Lambton, New South Wales, Australia Health Behaviour Research Group, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- Public Health Research Program, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, New South Wales, Australia
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Fradgley EA, Bryant J, Paul CL, Hall AE, Sanson-Fisher RW, Oldmeadow C. Cross-Sectional Data That Explore the Relationship Between Outpatients' Quality of Life and Preferences for Quality Improvement in Oncology Settings. J Oncol Pract 2016; 12:e746-54. [PMID: 27221990 DOI: 10.1200/jop.2016.011023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This cross-sectional study assessed the association between oncology outpatients' quality improvement preferences and health-related quality of life (HRQoL). Implementation of specific initiatives preferred by patients with lower HRQoL may be a strategic approach to enhancing care for potentially vulnerable patients. METHODS English-speaking adults were recruited from five outpatient chemotherapy clinics located in New South Wales, Australia. Using touch screen devices, participants selected up to 25 initiatives that would improve their experiences and completed the Functional Assessment of Cancer Therapy-General (FACT-G) survey. The logistic odds of selecting an initiative according to FACT-G scores were calculated to determine whether preferences were associated with HRQoL after controlling for potential confounders. RESULTS Of the 411 eligible outpatients approached to participate, 263 (64%) completed surveys. Commonly selected initiatives were up-to-date information on treatment and condition progress (19.8%), access to or information on financial assistance (18.3%), and reduced clinic wait times (17.5%). For those with relatively lower FACT-G scores, the adjusted odds of selecting five initiatives illustrated an increasing trend: convenient appointment scheduling systems (+23% [P = .002]), reduced wait times (+15% [P = .01]), information on medical emergencies (+14% [P = .04]), access to or information on financial assistance (+15% [P = .009]), help to maintain daily living activities (+18% [P = .007]). CONCLUSION Two areas of improvement were commonly selected: easily accessible health services and information and support for self-management. Although the results suggest an association between a few quality improvement preferences and HRQoL, a wider spectrum of patient characteristics must be considered when targeting quality improvement to patient subgroups.
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Affiliation(s)
| | - Jamie Bryant
- University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Alix E Hall
- University of Newcastle, Callaghan, New South Wales, Australia
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Paul CL, Piterman L, Shaw JE, Kirby C, Barker D, Robinson J, Forshaw KL, Sikaris KA, Bisquera A, Sanson-Fisher RW. Patterns of type 2 diabetes monitoring in rural towns: How does frequency of HbA1c and lipid testing compare with existing guidelines? Aust J Rural Health 2016; 24:371-377. [PMID: 27086673 DOI: 10.1111/ajr.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Christine L Paul
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, Callaghan, Australia
| | - Leon Piterman
- Department of General Practice, Berwick and Peninsula Campuses, Monash University, Berwick, Australia
| | - Jonathan E Shaw
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Melbourne, Australia.,Clinical Diabetes and Epidemiology Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Catherine Kirby
- Department of General Practice, Berwick and Peninsula Campuses, Monash University, Berwick, Australia
| | - Daniel Barker
- School of Medicine and Public Health, Callaghan, Australia.,Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, Australia
| | | | - Kristy L Forshaw
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, Callaghan, Australia
| | - Kenneth A Sikaris
- Melbourne Pathology, Sonic Healthcare, Melbourne, Victoria, Australia
| | - Alessandra Bisquera
- Hunter Medical Research Institute, CReDITSS, New Lambton Heights, New South Wales, Australia
| | - Robert W Sanson-Fisher
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, Callaghan, Australia
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Paul CL, Ryan A, Rose S, Attia JR, Kerr E, Koller C, Levi CR. How can we improve stroke thrombolysis rates? A review of health system factors and approaches associated with thrombolysis administration rates in acute stroke care. Implement Sci 2016; 11:51. [PMID: 27059183 PMCID: PMC4825073 DOI: 10.1186/s13012-016-0414-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 03/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thrombolysis using intravenous (IV) tissue plasminogen activator (tPA) is one of few evidence-based acute stroke treatments, yet achieving high rates of IV tPA delivery has been problematic. The 4.5-h treatment window, the complexity of determining eligibility criteria and the availability of expertise and required resources may impact on treatment rates, with barriers encountered at the levels of the individual clinician, the social context and the health system itself. The review aimed to describe health system factors associated with higher rates of IV tPA administration for ischemic stroke and to identify whether system-focussed interventions increased tPA rates for ischemic stroke. METHODS Published original English-language research from four electronic databases spanning 1997-2014 was examined. Observational studies of the association between health system factors and tPA rates were described separately from studies of system-focussed intervention strategies aiming to increase tPA rates. Where study outcomes were sufficiently similar, a pooled meta-analysis of outcomes was conducted. RESULTS Forty-one articles met the inclusion criteria: 7 were methodologically rigorous interventions that met the Cochrane Collaboration Evidence for Practice and Organization of Care (EPOC) study design guidelines and 34 described observed associations between health system factors and rates of IV tPA. System-related factors generally associated with higher IV tPA rates were as follows: urban location, centralised or hub and spoke models, treatment by a neurologist/stroke nurse, in a neurology department/stroke unit or teaching hospital, being admitted by ambulance or mobile team and stroke-specific protocols. Results of the intervention studies suggest that telemedicine approaches did not consistently increase IV tPA rates. Quality improvement strategies appear able to provide modest increases in stroke thrombolysis (pooled odds ratio = 2.1, p = 0.05). CONCLUSIONS In order to improve IV tPA rates in acute stroke care, specific health system factors need to be targeted. Multi-component quality improvement approaches can improve IV tPA rates for stroke, although more thoughtfully designed and well-reported trials are required to safely increase rates of IV tPA to eligible stroke patients.
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Affiliation(s)
- Christine L Paul
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Annika Ryan
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Shiho Rose
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - John R Attia
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Erin Kerr
- Hunter New England Health, Lookout Road, New Lambton Heights, NSW, 2305, Australia
| | - Claudia Koller
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Christopher R Levi
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Health, Lookout Road, New Lambton Heights, NSW, 2305, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Aranda S, Paul CL. Rethinking system change in cancer. Asia Pac J Clin Oncol 2016; 12:10-2. [DOI: 10.1111/ajco.12479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sanchia Aranda
- Cancer Council Australia and The University of Melbourne; Melbourne Victoria Australia
| | - Christine L Paul
- School of Medicine and Pubic Health; University of Newcastle; Newcastle, New South Wales Australia
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Noble NE, Paul CL, Turner N, Blunden SV, Oldmeadow C, Turon HE. A cross-sectional survey and latent class analysis of the prevalence and clustering of health risk factors among people attending an Aboriginal Community Controlled Health Service. BMC Public Health 2015; 15:666. [PMID: 26173908 PMCID: PMC4502927 DOI: 10.1186/s12889-015-2015-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/02/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Indigenous Australians are a socially disadvantaged group who experience significantly poorer health and a higher prevalence of modifiable health behaviours than other Australians. Little is known about the clustering of health risks among Indigenous Australians. The aims of this study were to describe the clustering of key health risk factors, such as smoking, physical inactivity and alcohol consumption, and socio-demographics associated with clusters, among a predominantly Aboriginal sample. METHODS Participants (n = 377) attending an Aboriginal Community Controlled Health Service (ACCHS) in regional/rural New South Wales, Australia, in 2012-2013 completed a self-report touch screen health risk survey. Clusters were identified using latent class analysis. RESULTS Cluster 1 ('low fruit/vegetable intake, lower risk'; 51%) consisted of older men and women; Cluster 2 ('risk taking'; 22%) included younger unemployed males with a high prevalence of smoking, risky alcohol, and illicit drug use. Cluster 3 ('inactive, overweight, depressed'; 28%) was characterised by younger to mid aged women likely to have experienced emotional or physical violence. CONCLUSIONS If future research identifies similar stable clusters of health behaviours for this population, intervention approaches targeting these clusters of risk factors should be developed and tested for Aboriginal and Torres Strait Islander Australians.
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Affiliation(s)
- Natasha E Noble
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Level 4 West HMRI Building, Callaghan, NSW, 2308, Australia.
| | - Christine L Paul
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Level 4 West HMRI Building, Callaghan, NSW, 2308, Australia.
| | - Nicole Turner
- School of Medicine and Public Health & Department of Rural Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Stephen V Blunden
- Casino Aboriginal Medical Service, 43 Johnson Street, Casino, NSW, 2470, Australia.
| | - Christopher Oldmeadow
- Hunter Medical Research Institute and Faculty of Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Heidi E Turon
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Level 4 West HMRI Building, Callaghan, NSW, 2308, Australia.
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Tzelepis F, Paul CL, Knight J, Duncan SL, McElduff P, Wiggers J. Improving the continuity of smoking cessation care delivered by quitline services. Patient Educ Couns 2015; 98:S0738-3991(15)30011-2. [PMID: 26223849 DOI: 10.1016/j.pec.2015.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/12/2015] [Accepted: 07/04/2015] [Indexed: 02/28/2024]
Abstract
OBJECTIVES This study identified smokers' intended use of new quitline features aimed at improving smoking cessation such as having the same quitline advisor for each call, longer-term telephone counselling and provision of additional cessation treatments. METHODS Smokers who had previously used quitline counselling completed a computer-assisted telephone interview examining intended use of potential quitline enhancements. RESULTS The majority of smokers (61.1%) thought their chances of quitting would have increased a lot/moderately if they had the same quitline advisor for each call. Most smokers reported likely use of longer-term quitline telephone support after a failed (58.3%) or successful (60%) quit attempt. Smokers were likely to use quitline support long-term (mean=9.9 months). Most smokers would be likely to use free or subsidised nicotine replacement therapy (NRT) (74.9%) if offered by quitlines. Younger smokers had greater odds of being likely to use text messages, whereas less educated smokers had greater odds of being likely to use free or subsidised NRT. CONCLUSIONS Smokers appear interested in quitlines offering longer-term telephone support, increased continuity of care and additional effective quitting strategies. PRACTICE IMPLICATIONS Quitlines could adopt a stepped care model that involves increasingly intensive treatments and extended telephone counselling delivered by the same quitline advisor.
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Affiliation(s)
- Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle & Hunter Medical Research Institute, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia.
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle & Hunter Medical Research Institute, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Jenny Knight
- School of Medicine and Public Health, University of Newcastle & Hunter Medical Research Institute, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia.
| | - Sarah L Duncan
- School of Medicine and Public Health, University of Newcastle & Hunter Medical Research Institute, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Patrick McElduff
- School of Medicine and Public Health, University of Newcastle & Hunter Medical Research Institute, University Drive, Callaghan, New South Wales 2308, Australia.
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle & Hunter Medical Research Institute, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia.
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Grady AM, Bryant J, Carey ML, Paul CL, Sanson-Fisher RW, Levi CR. Agreement with evidence for tissue Plasminogen Activator use among emergency physicians: a cross-sectional survey. BMC Res Notes 2015; 8:267. [PMID: 26111807 PMCID: PMC4482289 DOI: 10.1186/s13104-015-1242-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/17/2015] [Indexed: 11/21/2022] Open
Abstract
Background Emergency department staff play a crucial role in the triage of stroke patients and therefore the capacity to deliver time-dependent treatments such as tissue Plasminogen Activator. This study aimed to identify among emergency physicians, (1) rates of agreement with evidence supporting tissue Plasminogen Activator use in acute stroke care; and (2) individual and hospital factors associated with high agreement with evidence supporting tissue Plasminogen Activator use. Methods Australian fellows and trainees of the Australasian College for Emergency Medicine were invited to complete an online cross-sectional survey assessing perceptions of tissue Plasminogen Activator use in acute stroke. Demographic and hospital characteristics were also collected. Results 429 Australasian College for Emergency Medicine members responded (13% response rate). Almost half (47.2%) did not agree with any statements regarding the benefits of tissue Plasminogen Activator use for acute stroke. Perceived routine administration of tissue Plasminogen Activator by the head of respondents’ emergency department was significantly associated with high agreement with the evidence supporting tissue Plasminogen Activator use in acute stroke. Conclusions Agreement with evidence supporting tissue Plasminogen Activator use in acute stroke is not high among responding Australian emergency physicians. In order for tissue Plasminogen Activator treatment to become widely accepted and adopted in emergency settings, beliefs and attitudes towards treatment need to be in accordance with clinical practice guidelines. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1242-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alice M Grady
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Mariko L Carey
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Christine L Paul
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Rob W Sanson-Fisher
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Christopher R Levi
- Department of Neurology, John Hunter Hospital, New Lambton, NSW, 2305, Australia. .,Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
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