The FaXeS Study. Offering Fragile X Carrier Testing To Women: Comparing Prenatal And Preconception Screening.
Funder
National Health and Medical Research Council
Funding Amount
$432,883.00
Summary
Fragile X syndrome is the leading cause of inherited intellectual disability. A genetic screening test is available to detect carriers of this condition. Using questionnaires and interviews we will directly compare carrier screening in pregnant and non-pregnant women in the general community, looking at issues such as informed decision-making, test uptake and its predictors and cost-effectiveness. This will be critical to inform policy and guidelines for genetic screening programs.
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
A Cluster Randomised Controlled Trial Of Knowledge Translation Methods For Obesity Prevention
Funder
National Health and Medical Research Council
Funding Amount
$432,292.00
Summary
This study aims to increase the use of evidence in the development of programs for childhood obesity prevention by local government. There has been a lot of research to examine what works and what doesn't to increase healthy eating, physical activity and prevent childhood obesity, and programs conducted by local government have an important role to play. However, many who work in local government have not been trained in how to access research, nor do they have the time to search extensively for ....This study aims to increase the use of evidence in the development of programs for childhood obesity prevention by local government. There has been a lot of research to examine what works and what doesn't to increase healthy eating, physical activity and prevent childhood obesity, and programs conducted by local government have an important role to play. However, many who work in local government have not been trained in how to access research, nor do they have the time to search extensively for it, or interpret what the results from studies conducted elsewhere may mean for them in the local context. This study aims to examine what are the most effective and cost effective methods to increase access to evidence, and to increase the adoption of evidence by those working in local government (eg planners, maternal and child health nurses, family day care, environmental planners etc) to address environmental factors (playgrounds, walkability and active transport, policies for sporting events, community gardens, sporting events, street closures), health and social services (parent education, access to health promotion and prevention programs, education initiatives, environmental policies). Comparable research on what works for knowledge translation has only been conducted in the clinical context, for example, hospital clinics, and it is difficult to generalise these findings to the community based public health setting and relevant programs.Read moreRead less
Deconstructing DTCA: Towards A Differentiated Policy Response To Direct-to-Consumer Advertising In Australia.
Funder
National Health and Medical Research Council
Funding Amount
$190,760.00
Summary
Spending on prescription pharmaceuticals is the fastest growing part of the health budget. In recent years attention has shifted to the impact of direct-to-consumer advertising (DTCA) on consumer demand and drug costs. Although DTCA is prohibited in Australia, it is clear that different types of DTCA are occurring. This study will examine the nature and range of DTCA, review the benefits and harms of DTCA, and identify the perspectives of major stakeholders regarding DTCA. The study will culmina ....Spending on prescription pharmaceuticals is the fastest growing part of the health budget. In recent years attention has shifted to the impact of direct-to-consumer advertising (DTCA) on consumer demand and drug costs. Although DTCA is prohibited in Australia, it is clear that different types of DTCA are occurring. This study will examine the nature and range of DTCA, review the benefits and harms of DTCA, and identify the perspectives of major stakeholders regarding DTCA. The study will culminate in a national workshop which will develop a differentiated set of recommendations for responding to different types and modes of DTCA. This is likely to lead to better health policy and to resources that may assist consumers and health professionals deal with DTCA.Read moreRead less
A Randomised Controlled Trial Of A Decision Aid For The Management Of Pain In Labour And Childbirth
Funder
National Health and Medical Research Council
Funding Amount
$267,375.00
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 regarding the management of pai ....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 regarding the management of pain in labour and childbirth. A decision aid for managing the pain of childbirth is both practical and timely because there is a strong evidence base on labour analgesia but a lack of evidence-based information for women. For example, brochures on epidural analgesia outline the advantages of epidurals such as complete amelioration of pain, but do not present any information on adverse obstetric outcomes such as the doubling of risk for an instrumental birth. Most women are willing to experience pain in childbirth but do not want pain to overwhelm them. The decision aid will include a range of available drug and non-drug options for pain relief in labour and childbirth. Each of the options 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 pain management decision aid developed in this project will be based on the best most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women with their pain management options that best suit them, taking ~30 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
Nurses' Pain Management Decisions In The Post Surgery Context: A Naturalistic Study
Funder
National Health and Medical Research Council
Funding Amount
$56,368.00
Summary
In the hospital environment, doctors often prescribe medications for pain using an as required format on the drug order chart. Very often, this form of prescription occurs in the surgical wards of a hospital, where a patient may need a lot of pain relieving medication in the early period following the operation, and very little medication a few days following the operation. In the as required form of prescribing, the nurse caring for the patient has enormous flexibility in determining when and h ....In the hospital environment, doctors often prescribe medications for pain using an as required format on the drug order chart. Very often, this form of prescription occurs in the surgical wards of a hospital, where a patient may need a lot of pain relieving medication in the early period following the operation, and very little medication a few days following the operation. In the as required form of prescribing, the nurse caring for the patient has enormous flexibility in determining when and how much medication should be administered. Previous work has consistently shown that nurses do not administer adequate medication, which often results in poor pain control. Several nurse-related reasons have been proposed for poor pain management, including the fear of addiction, the fear of producing difficulties in breathing, and inadequate education about the medications administered. The focus of previous work has relied on examining small areas in isolation. Primarily, researchers have examined information on the drug order charts following patient discharge from hospital. They have also relied on analysing nurses' views on pain management relating to hypothetical patient situations. Overall, the research fails to address the multiple and interconnected factors faced by the nurse which could impact on pain management. Sources of these factors may be the patient, nurse, medication or environment. Examples of these factors include the presence or absence of the doctor, nurses' communication with doctors and other nurses about patient care, layout of the hospital ward, ward management structure, and methods used by the nurse to assess patient pain. By identifying the complex factors that impinge on decisions for managing pain, this study will provide opportunities to address the barriers that prevent adequate pain management. Nurses will then be in a position to change their practice in order to improve the management of patients' pain.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.
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
Using Evidence To Set Priorities In Health: An Analysis Of Decisions Of The Pharmaceutical Benefits Advisory Committee
Funder
National Health and Medical Research Council
Funding Amount
$174,575.00
Summary
Australia has pioneered the use of rigorous clinical and economic evidence in the evaluation of drugs prior to funding on our nationally subsidised Pharmaceutical Benefits Scheme. In the ten years since the introduction of the requirement that drugs demonstrate cost effectiveness prior to subsidy being granted there has been no formal independent evaluation of the system to assess its performance. This project will examine the recommendations of the Pharmaceutical Benefits Advisory Committee in ....Australia has pioneered the use of rigorous clinical and economic evidence in the evaluation of drugs prior to funding on our nationally subsidised Pharmaceutical Benefits Scheme. In the ten years since the introduction of the requirement that drugs demonstrate cost effectiveness prior to subsidy being granted there has been no formal independent evaluation of the system to assess its performance. This project will examine the recommendations of the Pharmaceutical Benefits Advisory Committee in the last decade and consider the factors that explain those decisions. At times it has been asserted that those decisions have been arbitrary or based on inappropriate considerations such as the financial cost to government or politics of the day rather than the value for money of the drug in question. We will examine the reasons behind the decisions against the objectives of providing access to life enhancing medicines in a cost effective manner. We will look at what are the key determinants of whether a drug is recommended for listing on the PBS or is rejected. A key focus will be on whether those determinants could be described as legitimate in terms of their consistency with the objectives of the scheme. For example whether the main cause of rejection is a lack of high quality evidence on effectiveness- cost effectiveness or simply because of factors such as the high financial cost to government. The project will create a database of all submissions to the PBAC 1992-2004 that will allow us to explore a number of questions about the effectiveness of the decision making process in using evidence on effectiveness and costs in health more broadly as well as those specific to the PBS. In highlighting some of the problems with the evidence and its interpretation the overall aim is to improve the quality of the decision making process in the future.Read moreRead less
Adolescent Population Health: Application Of Best-Worst Scaling Discrete Choice Experiments To Value Health States For Use In Economic Evaluation
Funder
National Health and Medical Research Council
Funding Amount
$178,779.00
Summary
Historically, economic evaluations of health care treatment and preventive programs developed for adolescents have failed to incorporate adolescent values about their preferred health outcomes. This project will apply a novel approach known as Best-Worst Scaling to ascertain adolescent specific values for health states for incorporation into economic evaluation, thereby enabling the views of adolescents to be incorporated directly into the health care priorities decision-making process.