Clinical Correlates Of The Wish To Hasten Death Among The Terminally Ill
Funder
National Health and Medical Research Council
Funding Amount
$131,360.00
Summary
There is little research that has directly examined the role of the health professional in a patient's wish to die and the implications of this for the support and development of services to provide care to a dying patient. The aim of this study is to examine factors in the health service, clinical care and social environment that influence the wish to hasten death among terminally ill patients. This is an issue of increasing importance in our community as legislative change is undertaken to ena ....There is little research that has directly examined the role of the health professional in a patient's wish to die and the implications of this for the support and development of services to provide care to a dying patient. The aim of this study is to examine factors in the health service, clinical care and social environment that influence the wish to hasten death among terminally ill patients. This is an issue of increasing importance in our community as legislative change is undertaken to enable assisted suicide in the terminally ill. In particular, there is very limited published research on these issues which have accessed a subject pool of patients who are based in services that specifically provide care for the terminally ill. A specific focus of this study is to examine the factors within the doctor-patient relationship that may influence a patient's wish to hasten death. The doctor's experience of subjective burden in caring for a dying patient, level of confidence in patient management and features of the doctor-patient relationhip will be assessed. This will essentially be an exploratory study which will attempt to establish methodologies that will help to increase an understanding of why some patients request euthanasia, thus leading to the establishment of sound management strategies, as well as contribute empirical data to the euthanasia debate.Read moreRead less
Psychiatric Morbidity, Quality Of Life And Coping Styles Of Patients With Early Stage & Advanced Prostate Cancer
Funder
National Health and Medical Research Council
Funding Amount
$281,018.00
Summary
Prostate cancer affects thousands of men each year. Advances in treatment are continuing, but side-effects frequently create disruptions to daily living. If the quality of care for prostate cancer patients is to be further improved, there is much to be learned about the psychosocial impact of the disease and its treatment across its different phases. There has not been a systematic prospective study of psychosocial adjustment in men with prostate cancer. In this study, we longitudinally follow t ....Prostate cancer affects thousands of men each year. Advances in treatment are continuing, but side-effects frequently create disruptions to daily living. If the quality of care for prostate cancer patients is to be further improved, there is much to be learned about the psychosocial impact of the disease and its treatment across its different phases. There has not been a systematic prospective study of psychosocial adjustment in men with prostate cancer. In this study, we longitudinally follow two separate groups of men with prostate cancer, those with early disease and those with advanced illness. We focus on the particular side-effects of urinary incontinence, impotence and bowel symptoms and the potential these have to affect the patient's sense of wellbeing. We use a standardised interview and questionnaires to assess for the presence of psychiatric disorders and psychological problems, overall quality of life and coping styles in these men. We seek to recognise the predictors of men who may have coping problems. A statistical approach termed pathway analysis will help us understand the relative contributions of different factors associated with these problems. The outcome of this systematic, longitudinal study will be a body of knowledge concerning risk factors for poorer psychosocial adjustment and optimum coping strategies for managing the impact of prostate cancer and its treatment, thereby empowering a range of targeted interventions to be developed to enhance the wellbeing and quality of life of these men.Read moreRead less
Early Referral To Palliative Care; A Randomised Trial Of Patients With Metastatic Cancers & A Survival Expec Of
Funder
National Health and Medical Research Council
Funding Amount
$81,250.00
Summary
It is not known when, in the course of incurable cancer, palliative care advice should be sought. A randomised trial will be conducted on patients consulting with a medical or radiation oncologist. Consenting patients will be randomised to either receive palliative care advice immediately or somewhat later after diagnosis. The consequences of early contact with palliative care professionals will be documented using a range of patient measures including quality of life, symptom control and assess ....It is not known when, in the course of incurable cancer, palliative care advice should be sought. A randomised trial will be conducted on patients consulting with a medical or radiation oncologist. Consenting patients will be randomised to either receive palliative care advice immediately or somewhat later after diagnosis. The consequences of early contact with palliative care professionals will be documented using a range of patient measures including quality of life, symptom control and assessment of unmet needs. The research includes a cost consequence analysis.Read moreRead less
Preparing Cancer Patients For Clinical Decision Making: A Randomised Trial Of Preconsultation Preparation Packages.
Funder
National Health and Medical Research Council
Funding Amount
$228,427.00
Summary
Most cancer patients in Australia now expect and are told their cancer diagnosis. There is considerable variation in the extent to which patients are informed about treatment options and are involved in treatment decisions. It can be argued that a treatment decision should be based on the oncologist's knowledge and the patient's preference. Two possible models can achieve this optimal outcome: the oncologist decides treatment on the basis of information passed on to him-her from the patient (the ....Most cancer patients in Australia now expect and are told their cancer diagnosis. There is considerable variation in the extent to which patients are informed about treatment options and are involved in treatment decisions. It can be argued that a treatment decision should be based on the oncologist's knowledge and the patient's preference. Two possible models can achieve this optimal outcome: the oncologist decides treatment on the basis of information passed on to him-her from the patient (the enabled doctor), and the patient chooses treatment based on informaton provided by the doctor (the empowered patient). We have developed a booklet on 'how treatment decisions are made'. In a randomised trial, patients seeing an oncologist for the first time are given the booklet and shown a video of ' their' oncologist interviewing an actor patient. The subsequent consultation is audiotaped to study the effect of these interventions on patient and doctor behaviour. The results of this trial will inform the development of our new patient educational materials. We now plan to develop consultation preparation packages. Patients will be sent information at least 48 hours before their first appointment with an oncologist with the goal of helping patients to achieve their preferred involvement in the consultation. The complete package will contain four components : a booklet on how treatment decisions are made including an outline of the two treatment decision models, a question prompt sheet and recommendation to prepare a list of questions, a booklet on Patient Rights, and an introduction to the Cancer Centre. The effects of the total package, and of just the Cancer Centre component on patient preferences for information and involvement in medical decisions, their consultation behaviour, and patient and doctor satisfaction with decision making will be studied in a randomised trial with control patients receiving no preparatory materials.Read moreRead less
Australia has limited systems in place to identify, then reduce or withdraw (disinvest) ineffective or inappropriate health care practices. Such practices result in sub-optimal care and inefficient use of scarce resources. Disinvestment models are few and have not been tested in Australia. We will develop a novel, systematic policy framework by linking policy, clinical, patient and community members as partners in the decision process for disinvesting (or not) selected health care practices.