Development And Evaluation Of A Decision Aid For Women With A Breech-presenting Baby.
Funder
National Health and Medical Research Council
Funding Amount
$156,890.00
Summary
Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women with a breech presenting baby ( ....Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women with a breech presenting baby (bottom rather than head first) in late pregnancy. A decision aid for breech presentation is timely because recent results of an international trial have dramatically altered women's options in the management of breech presentation. The trial of vaginal breech birth versus planned caesarean section (CS) found overwhelming evidence of reduced infant death and disability for women with a planned CS. Planned CS is now considered best practice for delivery of a breech presentation at birth. However, another treatment option for women with a breech presentation is turning the breech to head first before birth (called external cephalic version, ECV). Each of these options (ECV or planned CS) has benefits and risks, and the relative importance of these benefits and risks varies for individual women, a scenario where a decision aid produces the greatest benefit. The breech decision aid developed in this project will be based on the best and most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women to a treatment option that best suits them, taking ~20 minutes to complete. The decision aid will be evaluated to assess the impact on women's satisfaction with decision making, knowledge, anxiety and pregnancy outcomes. If successful, the results could be applied to improve consumer information and participation in clinical decisions across a wide spectrum of pregnancy care issues.Read moreRead less
Consumer Information Materials And A Communication Aid For Diagnostic Tests For Breast Disease
Funder
National Health and Medical Research Council
Funding Amount
$105,863.00
Summary
Many studies have now shown that the majority of patients want to participate in clinical decisions about medical treatments they might receive. As a result, information materials are being developed to help consumers and doctors work together to reach satisfying treatment decisions which are based on the best available evidence and also reflect the individual patient's needs and preferences about the treatment options. Very little is known, however, about whether consumers also want to particip ....Many studies have now shown that the majority of patients want to participate in clinical decisions about medical treatments they might receive. As a result, information materials are being developed to help consumers and doctors work together to reach satisfying treatment decisions which are based on the best available evidence and also reflect the individual patient's needs and preferences about the treatment options. Very little is known, however, about whether consumers also want to participate in decisions about whether to have a medical test. Tests can be trivial, such as a blood or urine test, or quite major and invasive, such as a biopsy or a colonoscopy. People considering a medical test might want to know the answers to the following questions: What is my chance of having the disease being tested for? If the test result is positive what is the chance I have the disease? If the test result is negative what is the chance I have the disease anyway? How will the test result influence treatment of my condition? What are possible side-effects of the test? Generally information materials about medical tests only describe the test itself, and do not contain the information people need to answer these questions. Even doctors may not have to hand the data needed to answer these questions. Yet without this information, consumers cannot make truly informed and rational choices about whether to have the test. This project aims to find out whether consumers want to participate in decisions about medical tests, what information they would want to do this, and to develop and trial information materials and a communication aid for a small number of breast cancer tests. We will use tests for diagnosing breast cancer as our model but we anticipate the work will be applicable across a wide range of medical tests.Read moreRead less
Evaluation Of A Group Intervention To Promote Older People's Adjustment To Driving Cessation
Funder
National Health and Medical Research Council
Funding Amount
$350,755.00
Summary
As a result of age-related changes, chronic medical conditions, the side-effects of medication or a combination of these, many older people decide or are required to give up driving. Driving is a highly valued role, associated with freedom, independence and convenience. Because of this, the transition to driving cessation can be traumatic and associated with depression, social isolation and compromised well-being. Despite the frequent reporting of poor outcomes for older people after driving ces ....As a result of age-related changes, chronic medical conditions, the side-effects of medication or a combination of these, many older people decide or are required to give up driving. Driving is a highly valued role, associated with freedom, independence and convenience. Because of this, the transition to driving cessation can be traumatic and associated with depression, social isolation and compromised well-being. Despite the frequent reporting of poor outcomes for older people after driving cessation, limited attention has been given to developing and evaluating methods to help older people prepare for and cope with this transition. This study will evaluate the effect of a group intervention on older people's episodes away from home, use of alternative transport modes, life satisfaction, depression, and self-rated performance of and satisfaction with up to five lifestyle goals related to transport. This study will contribute to evidence for the effectiveness of a group intervention versus usual practice (which is to say, no intervention) to help older people maintain their well-being and stay engaged in valued roles, activities and the community after retiring from driving. It will also contribute to the theoretical underpinnings of adjustment after undergoing the transition to retired driver.Read moreRead less
COMBIT: Randomised Controlled Trial Of Novel Upper Neurorehabilitation For Congenital Hemiplegia
Funder
National Health and Medical Research Council
Funding Amount
$486,588.00
Summary
Cerebral palsy is the most common disability in children - there are over one million children with the hemiplegic form in the industrialised world. Rehabilitation to improve hand use impacts on daily care, access to education and vocational aspirations, and consumes a great deal of time and money. Our team wishes to test a novel COMbined Constraint and BImanual Training study (COMBIT) in a randomized controlled trial investigating upper limb function, participation and mechanisms of action of t ....Cerebral palsy is the most common disability in children - there are over one million children with the hemiplegic form in the industrialised world. Rehabilitation to improve hand use impacts on daily care, access to education and vocational aspirations, and consumes a great deal of time and money. Our team wishes to test a novel COMbined Constraint and BImanual Training study (COMBIT) in a randomized controlled trial investigating upper limb function, participation and mechanisms of action of the intervention.Read moreRead less
An Ethical Analysis Of The Disclosure Of Surgeons' Performance Data To Patients Within The Informed Consent Process
Funder
National Health and Medical Research Council
Funding Amount
$148,937.00
Summary
For over a decade, hospitals in the American state of New York have been collecting information about the mortality rates of surgeons conducting Coronary Artery Bypass Grafts, and making this information available to patients. The United Kingdom is set to make these and other performance indicators on the ability of surgeons ('report cards') available from 2004. There are good reasons to think a similar system may be introduced in Australia in the near future. Patients can use the information co ....For over a decade, hospitals in the American state of New York have been collecting information about the mortality rates of surgeons conducting Coronary Artery Bypass Grafts, and making this information available to patients. The United Kingdom is set to make these and other performance indicators on the ability of surgeons ('report cards') available from 2004. There are good reasons to think a similar system may be introduced in Australia in the near future. Patients can use the information contained in report cards when deciding whether or not to consent to have a particular surgeon conduct an operation on them. Contemporary bioethicists stress the importance of a proper informed consent process in medicine. This is a process in which a doctor advises a patient of relevant information and ensures that the patient comprehends that information, before the patient consents to an operation. Currently report cards in America are publicly disseminated on the internet, however there is no systematic attempt to incorporate the information contained in report cards into the informed consent process. We do not know if patients understand the information they are given, or if they incorporate it into their decision making procedures appropriately. In our study we will consider how information that is contained in report cards could best be used in the informed consent process. We will keep in mind the importance of helping patients to make their own informed decisions to consent to operations, the importance of respecting the professional integrity of surgeons and the importance of providing the best possible standard of care for patients. The result of our study will be a revised model of the informed consent process that incorporates report cards in an ethically acceptable way.Read moreRead less
Exercise Self-management To Improve Long-term Functioning And Prevent Falls After Hip Fracture.
Funder
National Health and Medical Research Council
Funding Amount
$848,478.00
Summary
Up to 20,000 older Australians suffer hip fractures each year. Many people don't fully recover. We have designed a self-management training program which incorporates individualised exercise prescription. This novel program is designed for people who have completed usual treatment and rehabilitation for hip fracture. We will conduct a well-designed randomised controlled trial to test the effects of this program on disability, falls and hospital readmissions and to assess its cost-effectiveness.
A Randomised Controlled Trial Of A Bowel Cancer Screening Decision Aid For Adults With Low Education And Literacy
Funder
National Health and Medical Research Council
Funding Amount
$237,277.00
Summary
The Commonwealth has committed funds for a national bowel cancer screening program. This will involve mailing bowel testing kits direct to eligible consumers at their homes. To minimise inequalities in accessing screening and to ensure effectiveness of the program, information and instructions for testing will have to be accessible to participants from low as well as high educational backgrounds. This project will evaluate communication strategies to achieve this. Reliance on written information ....The Commonwealth has committed funds for a national bowel cancer screening program. This will involve mailing bowel testing kits direct to eligible consumers at their homes. To minimise inequalities in accessing screening and to ensure effectiveness of the program, information and instructions for testing will have to be accessible to participants from low as well as high educational backgrounds. This project will evaluate communication strategies to achieve this. Reliance on written information has rapidly increased within healthcare. In particular, the use of patient decision aids to support and inform health decisions is rapidly increasing. The need to improve information in screening programs has been particularly highlighted and decision aids provide an evidence based approach to achieve this. However, whilst there is level 1 evidence that decision aids improve the decision making process for consumers, research has been carried out almost exclusively among educated participants with high literacy. There is concern that the needs of adults with low education and limited literacy have been ignored. The proposed study is 2 phased. Phase I will test optimal quantitative risk communication formats for adults with low education and literacy. Phase 2 will evaluate a tailored low literacy decision aid for FOBT screening. The trial will test whether the decision aid can increase knowledge of screening, increase involvement in decisions and improve the quality of decision making among adults with low education, and will examine its impact on screening intentions and behaviour. This is a highly significant study. Screening providers need better ways to inform consumers of screening programs that are accessible to a diverse audience and equitable across the target population. This study will have direct implications for use in the national bowel cancer screening program.Read moreRead less
Population Testing Of An Internet-based Personalised Decision Support System For Colorectal Cancer Screening
Funder
National Health and Medical Research Council
Funding Amount
$480,230.00
Summary
This study will determine the impact of a fully developed computerised Personalised Decision Support (PDS) package on colorectal cancer screening participation. The PDS tool is designed to guide people through the decision processes relevant to deciding whether to undertake screening. The PDS presents personally tailored messages aimed at progressing individuals towards screening test use and has the potential to supplement traditional paper methods of increasing screening participation.
A Population Based Communication Strategy To Optimise Colorectal Cancer Screening Behaviour In Australia.
Funder
National Health and Medical Research Council
Funding Amount
$532,425.00
Summary
There is good evidence that population screening, based on the detection of blood in faeces, is effective in reducing deaths from bowel cancer (CRC) by around 30-40%. The process depends on the use of a simple faecal occult blood test (FOBT) to identify those who need a more complex and costly test (colonoscopy), which is capable of accurately detecting curable cancers and precancers so that they can be removed. If we are to reduce deaths from CRC at the population level, we must have an effecti ....There is good evidence that population screening, based on the detection of blood in faeces, is effective in reducing deaths from bowel cancer (CRC) by around 30-40%. The process depends on the use of a simple faecal occult blood test (FOBT) to identify those who need a more complex and costly test (colonoscopy), which is capable of accurately detecting curable cancers and precancers so that they can be removed. If we are to reduce deaths from CRC at the population level, we must have an effective way of encouraging as many people as possible to do FOBT tests. While much has been learnt about how to offer screening from experience with programs for breast and cervical cancer, CRC screening involves different behavioural, psychological and social issues. We need to better understand how these factors influence participation in CRC screening. We plan a series of studies that will lead to improvements in participation in CRC screening programs: a) a survey of a randomly selected group of the general population to measure a range of behavioural features that are of importance to CRC screening, especially as they relate to participation. b) an offer of FOBTscreening to those invited to complete the survey, to match population characteristics with intentions and actual participation, c) on the basis of these studies, to design new screening program strategies, especially in relation to the communication of messages to encourage community participation, d) to test the effectiveness of the new communication strategies by offering FOBT screening to another randomly selected group from the general population. This will allow us to optimise the delivery of messages that encourage participation. If we can design a better communication strategy that achieves an increase in screening participation and has minimum cost implications, we will substantially reduce the number of deaths from CRC in Australia.Read moreRead less