Improving Outcomes For People With Cancer: Consultation Skills Training With Oncologists
Funder
National Health and Medical Research Council
Funding Amount
$499,070.00
Summary
Each year approximately 30,000 Australians die from cancer and 65,000 new cancers are diagnosed. Despite much research for a cure for cancer, the incidence and mortality from cancer has not changed. New treatments now cause people with cancer to live longer with the disease, so we now need to focus on efforts to optimise the quality of life of these people. Although the emotional burden on patients and families is recognized, there is a sense that this is an inevitable by-product of the disease ....Each year approximately 30,000 Australians die from cancer and 65,000 new cancers are diagnosed. Despite much research for a cure for cancer, the incidence and mortality from cancer has not changed. New treatments now cause people with cancer to live longer with the disease, so we now need to focus on efforts to optimise the quality of life of these people. Although the emotional burden on patients and families is recognized, there is a sense that this is an inevitable by-product of the disease and its management in existing clinical systems. However, this does not need to be the case. There is now ample evidence that the way that doctors interact with their patients can effect the accuracy of diagnosis and prognosis, as well as patients' satisfaction, adherence with treatment instructions and quality of life after being diagnosed with cancer. Both patient advocate groups and clinicians have called for further training for doctors to effectively manage psychosocial aspects of cancer care, however, despite this support, there have been few opportunities for such training in Australia. We have developed an innovative consultation-skills program for oncologists. So that the effectiveness of the project can be evaluated, it will be implemented as a randomised controlled trial with oncologists from major Australian cancer clinics being randomly allocated to an intervention or control group. The training program will be delivered by videoconferencing, to overcome many of the barriers that have impeded busy clinicians from participating in previous training programs. This is the first international study to use videoconferencing between remote locations for this type of consultation skills training. A variety of measures will be used to evaluate the impact of the training, including patients' quality of life, anxiety, depression and perceived needs, and oncologists' burn-out.Read moreRead less
Improving QOL At The End Of Life: A Randomised Controlled Trial Of A Doctor-nurse-patient Intervention.
Funder
National Health and Medical Research Council
Funding Amount
$687,655.00
Summary
This project aims to promote mutual understanding between patients with incurable disease, carers and clinicians about prognosis, end of life issues and treatment goals in order to improve the quality of remaining life. Currently many patients do not understand their prognosis and make poor decisions about treatment, receiving costly, futile and invasive treatments just days before death. This project will empower patients and doctors to better discuss these issues.
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
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
Supply, Demand And The Distribution Of Health Services In Australia
Funder
National Health and Medical Research Council
Funding Amount
$308,038.00
Summary
The distribution of medical services and its impact on access and equity is widely recognised as a key concern of the Australian community. Access and equity are key indicators to the public of the performance of a health system. These concerns have led to the adoption of major policy goals under Medicare relating to equitable access to medical services for the population as a whole. Furthermore, both the community and policy makers have expressed high levels of concern over the distribution of ....The distribution of medical services and its impact on access and equity is widely recognised as a key concern of the Australian community. Access and equity are key indicators to the public of the performance of a health system. These concerns have led to the adoption of major policy goals under Medicare relating to equitable access to medical services for the population as a whole. Furthermore, both the community and policy makers have expressed high levels of concern over the distribution of medical services between sub-markets and sub-populations, in particular, in the distribution of medical services between urban and rural-remote areas. This project, for the first time, comprehensively examines the performance of Medicare in terms of access to medical services over time. Australian data sets, largely untapped by economic modelling, will be used for analysis of the relationships between the distribution of, access to, and demand and fees for Australian medical services and their impact upon mortality over time. The study will result in the first comprehensive Australian description of access and supply of different medical services by social group and by geographic location over time. Furthermore it will provide evidence on the key determinants of distribution and changes in the distribution of medical services and estimates the likely effects of policy instruments designed to address the distribution of, and access to, medical services.Read moreRead less
What People With Aphasia Want: Towards Person-centred Goal-setting In Aphasia Rehabilitation
Funder
National Health and Medical Research Council
Funding Amount
$427,702.00
Summary
Consumers of health services expect their concerns and priorities to form part of their health care. People with aphasia have difficulty communicating their needs and speech pathologists are challenged to plan therapy to meet aphasic clients' needs. Family members of people with aphasia also have unrecognised concerns. The first aim of this study is to determine the goals of people with aphasia and their families and to gain their perspective of whether these goals were addressed in speech thera ....Consumers of health services expect their concerns and priorities to form part of their health care. People with aphasia have difficulty communicating their needs and speech pathologists are challenged to plan therapy to meet aphasic clients' needs. Family members of people with aphasia also have unrecognised concerns. The first aim of this study is to determine the goals of people with aphasia and their families and to gain their perspective of whether these goals were addressed in speech therapy. The study will then seek the perspective of their treating speech pathologists about the goals of therapy and the challenges that speech pathologists face in practising person-centered goal setting. This study will not only provide a framework for aphasia services in Australia but also provide data that will inform professional educational programs about person-centered practice for speech pathologists and other health professionals. It will also contribute to current theories on collaborative goal setting in a rehabilitation context.Read moreRead less
Diagnosis, Management And Outcomes Of Depression In Primary Care (DIAMOND) - A Longitudinal Study
Funder
National Health and Medical Research Council
Funding Amount
$463,125.00
Summary
Depression is the single largest cause of disability for people in Australia. It is mainly managed in general practice, yet many people experiencing depression go unrecognised by their family doctor or general practitioner (GP). Some people, even when given treatment, remain depressed. Guides on how to manage depression have been mainly based upon people attending psychiatrists and hospitals. In addition, there have been a number of large studies overseas testing new ways of helping people with ....Depression is the single largest cause of disability for people in Australia. It is mainly managed in general practice, yet many people experiencing depression go unrecognised by their family doctor or general practitioner (GP). Some people, even when given treatment, remain depressed. Guides on how to manage depression have been mainly based upon people attending psychiatrists and hospitals. In addition, there have been a number of large studies overseas testing new ways of helping people with depression. Unfortunately, they do not seem any better than usual care by a GP. The proposed DIAMOND study will follow, over time, 900 people who receive care in general practice to investigate the factors, from the patients' and doctors' point of view, that are likely to aid recovery from depression, and prevent further episodes. We will investigate in detail the way in which a patient is cared for in the primary health care system. We will be able to describe the care patients receive from both doctors and other professionals, including alternative practitioners. This information will be used to develop a new way to improve the care that GPs provide to people experiencing depression. DIAMOND will give us important information about the impact of new Government policies on care in general practice. This will help to inform health workers, consumers and policy makers about what factors are key for treatment and recovery from depression.Read moreRead less