ORCID Profile
0000-0002-1286-5242
Current Organisation
The University of Newcastle
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 21-06-2021
DOI: 10.1111/ANS.17020
Abstract: Prior studies of telehealth report high levels of patient satisfaction, but within carefully selected clinical scenarios. The COVID‐19 pandemic led to telehealth replacing face‐to‐face care for many surgical consultations across a variety of situations. More evidence is needed regarding patient perceptions of telehealth in surgery, in particular, exploring barriers and facilitators associated with its sustained implementation beyond the pandemic. Survey invitations were emailed to a convenience s le of surgical patients by their surgeon following a telehealth consultation during the COVID‐19 pandemic. Surgeons were recruited from a s le ( n = 683) who completed a survey on telehealth (distributed via email to all Australian Fellows of the Royal Australasian College of Surgeons). Mixed methods analysis was performed of the patient survey data. A total of 1166 consultations were captured: 50% routine reviews, 17% initial appointments and 20% post‐operative reviews. Video‐link was used in 49% of consultations. The majority of patients (94%), were satisfied with the quality of their surgical telehealth consultation and 75% felt it delivered the same level of care as face‐to‐face encounters. Telehealth was convenient to use (96%) and led to cost savings for 60% of patients. When asked about future appointment preferences after the pandemic, 41% indicated they would prefer telehealth (24% video‐link and 17% telephone) over face‐to‐face appointments. There was a perception by patients that telehealth consultation fees should be less than face‐to‐face consultation fees. Patient satisfaction with surgical telehealth consultations is high. Barriers to more widespread implementation include financial, clinical appropriateness, technical and confidentiality concerns.
Publisher: Wiley
Date: 03-02-2017
DOI: 10.1002/MSC.1181
Abstract: The aim of the study was to explore the types of self-management strategies prescribed the number of strategies and the overall length of time allocated to self-management prescription, by consultation type and by injury location, in physiotherapy consultations. A cross-sectional, observational study of 113 physiotherapist-patient consultations was undertaken. Regression analyses were used to determine whether consultation type and injury location were associated with the number of strategies prescribed and the length/fraction of time spent on self-management. A total of 108 patients (96%) were prescribed at least one self-management strategy - commonly exercise and advice. The mean length of time spent on self-management was 5.80 min. Common injury locations were the neck (n = 40) and lower back (n = 39). No statistically significant associations were observed between consultation type or injury location for either outcome (number of strategies and the length/fraction of time allocated to self-management prescription). Physiotherapists regularly spend time prescribing self-management strategies such as exercise, advice, and the use of heat or ice to patients receiving treatment linked to a range of injury locations. This suggests that self-management is considered to be an important adjunct to in-clinic physiotherapy. The practice implications of this are that clinicians should reflect on how self-management strategies can be used to maximize patient outcomes, and whether the allocation of consultation time to self-management is likely to optimize patient adherence to each strategy.
Publisher: Wiley
Date: 26-02-2021
DOI: 10.1111/ANS.16693
Publisher: Informa UK Limited
Date: 24-08-2016
DOI: 10.1080/09638288.2016.1212281
Abstract: Physiotherapists often prescribe self-management strategies for their patients. However, the effectiveness of these strategies in improving patient outcome is related to the rate of patient adherence. The aims of this study were to explore physiotherapists' views on the importance and perceived rates of patient adherence to physiotherapist prescribed self-management strategies the perceived importance of methods physiotherapists can employ to aid patient adherence and the barriers to employing these methods. A cross-sectional web-based survey was emailed to 808 physiotherapist members of the Australian Physiotherapy Association. To maximize response rates, two reminder emails were utilized. In total, 352 physiotherapists completed the survey (response rate 44%). A majority of physiotherapists (89%) believed that patient self-management strategies were important in improving patient outcomes however, the mean perceived rate of patient adherence across all strategies was only 67%. Physiotherapists reported that there were a number of important methods that can be employed to aid patient adherence such as providing patient education and allowing time for patient practice with minimal perceived barriers to employing these methods. Results indicate that physiotherapists perceive that patient outcomes can be positively impacted by patient adherence to a range of self-management strategies. Physiotherapists should be encouraged to implement into their routine clinical practice evidence-based methods to aid patient adherence. Implications for Rehabilitation Physiotherapists believe that patient self-management strategies are important for improving patient outcomes, however, the perceived rates of patient adherence could be improved. Physiotherapists should adopt a collaborative approach with their patients to address any barriers to adherence to positively impact on patient outcome. Physiotherapists perceive that there are a number of modifiable characteristics which determine patient adherence including patient self-efficacy, physiotherapist communication skills and the complexity of the self-management strategy. Methods that physiotherapists can employ to positively influence patient adherence may include in idualizing the strategy to the patient, education and supplementary written information.
Publisher: Springer Science and Business Media LLC
Date: 16-03-2019
Publisher: Public Library of Science (PLoS)
Date: 2015
Publisher: Public Library of Science (PLoS)
Date: 08-06-2018
Publisher: JMIR Publications Inc.
Date: 28-08-2019
DOI: 10.2196/13423
Abstract: Variations in an in idual’s electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points. The aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated with class membership. Medical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership. Of the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00 P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29 P=.007). The identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients’ varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on in iduals’ internet use frequency and health information amount preferences.
Publisher: Springer Science and Business Media LLC
Date: 19-09-2012
Abstract: The diagnosis and treatment of cancer is associated with significant distress and psychosocial morbidity. Although psychosocial interventions have been developed in an attempt to improve psychosocial outcomes in cancer patients and survivors, there is continued debate about whether there is adequate high-level evidence to establish the effectiveness of these interventions. The evidence base is limited as a result of numerous challenges faced by those attempting to conduct psychosocial intervention trials within the health system. Barriers include insufficient participant recruitment, difficulty generalizing from single-trial studies, difficulty in building and managing research teams with multidisciplinary expertise, lack of research design expertise and a lack of incentives for researchers conducting intervention research. To strengthen the evidence base, more intervention studies employing methodologically rigorous research designs are necessary. In order to advance the evidence base of interventions designed to improve psychosocial outcomes for cancer patients and survivors, we propose the formation of a collaborative trials group that conducts multicenter trials to test the effectiveness of such interventions. Establishment of such a group would improve the quality of the evidence base in psychosocial research in cancer patients, by increasing support for conducting intervention research and providing intervention research training opportunities. A multidisciplinary collaborative group conducting multicenter trials would have the capacity to overcome many of the barriers that currently exist. A stronger evidence base is necessary to identify effective psychosocial interventions for cancer patients. The proposed formation of a psycho-oncology collaborative trials group that conducts multicenter trials to test the effectiveness of psychosocial interventions would assist in achieving this outcome.
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.NEUROSCIENCE.2010.05.005
Abstract: At present, exposure of a rodent to the odour of a predator is one of the most common animal models of post traumatic stress disorder (PTSD). Despite this, the model remains incompletely characterized, particularly in regard to within subject assessment of major PTSD-like behaviours. In an attempt to redress this situation, we have extensively characterized the two broad categories of behaviour that are considered to characterize PTSD, that is sensitized behaviours such as social withdrawal and hypervigilance and conditioned behaviours such as avoidance of trauma linked cues. Specifically, we determined the presence and duration of both conditioned and sensitized behaviours, in the same cohort of animals, after three exposures to predator odour. Conditioned fear was assessed on the basis of inhibition of locomotor activity upon return to context 2, 7, 14, 21, and 28 days after the last odour exposure session. To assess the impact on sensitization behaviours, we monitored acoustic startle responses and social interaction behaviour 4, 9, 16, 23, and 30 days after the last exposure session. In addition to examining the behavioural consequences associated with odour exposure, we also determined the key brain regions that were activated using DeltaFosB immunohistochemistry. Our results show that the two groups of behaviours thought to characterize PTSD (conditioned and sensitized) do not travel together in the predator odour model, with clear evidence of enduring changes in conditioned fear but little evidence of changes in social interaction or acoustic startle. With regard to associated patterns of activity in the brain, we observed that odour-exposed animals exhibited significantly higher numbers of FosB-positive nuclei in only the medial prefrontal cortex (mPFC), a finding that can be viewed as being consistent with the observed behavioural changes.
Publisher: Cambridge University Press (CUP)
Date: 07-2020
DOI: 10.1017/AEE.2020.31
Abstract: We acknowledge and pay respect to the people of the Yugambeh Nation on whose Land we work, meet and study. We recognise the significant role the past and future Elders play in the life of the University and the region. We are mindful that within and without the buildings, the Land always was and always will be Aboriginal Land. 1 This paper introduces staying-with the traces of inter/intra-subjective experience, with and within place, in mapping-making philosophy in environmental education. Through a conceptualisation of philosophy as concepts or knots in an infinite composition of knowledge, rather than separate knowledges, we use staying-with the traces 2 as method, whereby our embodied patterns of human and more than human relationality across place and time may engage with philosophy. This grounding of philosophy foregrounds the erse onto-epistemologies of posthumanism and indigenist 3 ways of knowing, acknowledging tensions and searching for the possibilities of connectivity between them. Through an embodied arts-based walking practice, our approach challenges the perpetuation of reductionist perspectives, including nature/culture binaries, within environmental education. We stay with the traces of bird, meeting, tree, watery and concrete in mutual inseparable relation and becoming.
Publisher: Springer Science and Business Media LLC
Date: 08-10-2013
Publisher: Springer Science and Business Media LLC
Date: 07-05-2020
Publisher: AMPCo
Date: 11-2015
DOI: 10.5694/MJA15.00596
Abstract: The study examined: 1) the proportion of patients who received their preferred level of information about life expectancy and 2) sociodemographic, clinical and psychological factors associated with patients' perceptions of whether they received too little, too much, or the right amount of information about life expectancy. Cross-sectional survey. Eleven large Australian medical oncology treatment centres. A total of 1431 medical oncology outpatients participated (81% consent rate). Eligible patients were approached between September 2012 and May 2014. Patients indicated whether the information about life expectancy they received aligned with their preferences. Almost one in four patients (24%) received too little information, 4% received too much, and 50% received all the information they wanted 22% of patients neither wanted nor received information about life expectancy. Patients were more likely to receive too little information if they were not in remission (odds ratio [OR], 1.77), did not know their cancer stage at diagnosis (OR, 3.64), or were anxious (OR, 1.48) or depressed (OR, 1.48). Patients had greater odds of receiving too much information if they were younger (OR, 1.45), had more advanced cancer (OR, 2.01) or did not know their cancer stage at diagnosis (OR, 4.42). That fact that 28% of cancer patients did not receive their desired level of information about life expectancy highlights the difficulties associated with discussing this sensitive topic. To ensure that life expectancy discussions correspond with patient preferences, clinicians should routinely ask patients whether they want to know this information, in what format, and at which level of detail.
Publisher: JMIR Publications Inc.
Date: 16-01-2019
Abstract: ariations in an in idual’s electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied to the eHEALS item or at the global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points. he aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated within each class. edical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership. f the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00 P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29 P=.007). he identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients’ varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on in iduals’ internet use frequency and health information amount preferences.
Publisher: Wiley
Date: 14-09-2011
DOI: 10.1002/PON.2057
Abstract: The aim of this review was to describe the findings and methodological quality of studies, which sought to validate the Hospital Anxiety and Depression Scale (HADS) against the Structured Clinical Interview for DSM in cancer populations. We also sought to compare the cut points recommended by these validation studies with the way in which the HADS is currently used to determine prevalence of psychological morbidity in cancer populations. An electronic database search was conducted of Medline from 1983 to October 2010 for validation studies of the HADS in cancer populations. Reference lists of HADS reviews were hand searched. To examine which cut points are commonly used in cancer specific literature to identify the prevalence of psychological disorders, studies published in 2009 were identified via an electronic database search of Medline. Ten studies, which validated the HADS against the Structured Clinical Interview for DSM in cancer patient populations, were found and examined in detail. None met all methodological criteria associated with the selection of a screening instrument. Recommendations for optimal HADS thresholds varied substantially across these studies. The most commonly used threshold for determining caseness in the 2009 literature on prevalence of psychological distress among patients with cancer was a subscale score of ≥ 8. This threshold was poorly supported by the results of the 10 cancer HADS validation studies examined. Caution is warranted in interpreting the results of prevalence studies using the HADS. There is a need to develop evidence about the optimal thresholds for defining caseness using the HADS.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.PEC.2018.05.025
Abstract: Responsiveness to information preferences is key to high-quality, patient-centred care. This study examined the top ten preparatory information items not delivered in accordance with medical imaging outpatients' preferences, and patient characteristics associated with reporting a greater number of unmet information preferences. Magnetic resonance imaging and computed tomography outpatients were recruited consecutively in one major public hospital waiting room. Participants self-administered a touchscreen computer questionnaire assessing their sociodemographic and scan characteristics, and unmet preferences for 33 guideline-endorsed preparatory information items. Of 317 eligible patients, 280 (88%) consented to participate. Given equal rankings, the top ten unmet information preferences included 13 items which were endorsed by at least 25% of participants, and commonly related to receiving 'too little' information. One item related to the pre-scan period, seven items to the scan period and five items to the post-scan period. None of the patient characteristics examined were significantly associated with reporting a greater number of unmet information preferences. There is room to improve responsiveness to medical imaging outpatients' preparatory information preferences. Improvements should be targeted at in iduals, rather than groups defined by sociodemographic or scan characteristics. A standardised approach to addressing in idual patient's information preferences is needed.
Publisher: Hindawi Limited
Date: 02-11-2011
Publisher: Springer Science and Business Media LLC
Date: 17-08-2016
DOI: 10.1007/S00520-016-3382-0
Abstract: A stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care. Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater. Of eligible patients, 222 were recruited in control epoch and 247 in intervention epoch. Twenty-seven health professionals (HPs) were trained to deliver the psychosocial intervention consisting of up to four sessions, tailored to patient symptoms and distress. HPs participated in group supervision with a psychiatrist. The primary outcome, analysed by intention to treat, was depression measured with the HADS at 10 weeks after receiving the intervention. At 10-week follow-up, there were no significant differences in HADS score for the 181 patients in control epoch and 177 in intervention epoch (adjusted difference -1.23, 95 % CI -3.81--1.35, p = 0.35). Patients with disease progression who received the intervention experienced significant benefits in unmet practical support needs including care and support, information, and physical and daily living. A brief psychosocial intervention delivered by front-line oncology health professionals is feasible to deliver but is insufficient as a stand-alone treatment for depression in cancer patients. Psychosocial interventions should be targeted to populations most likely to experience benefit.
Publisher: Wiley
Date: 26-06-2013
DOI: 10.1002/PON.3337
Abstract: A patient-centred approach to discussing life expectancy with cancer patients is recommended in Western countries. However, this approach to eliciting and meeting patient preferences can be challenging for clinicians. The aims of this study were the following: (i) to examine cancer patients' preferences for life expectancy disclosure and (ii) to explore agreement between cancer patients' preferences for, and perceived experiences of, life expectancy disclosure. Cancer patients undergoing radiotherapy treatment in metropolitan Australia completed a cross-sectional touchscreen computer survey including optional questions about their life expectancy disclosure preferences and experiences. Of the 208 respondents, 178 (86%) indicated that they would prefer their clinician to ask them before discussing life expectancy, and 30 (14%) indicated that they would prefer others (i.e. clinicians, family) to decide whether they were given life expectancy information. Of the 175 respondents who were classified as having a self- determined or other-determined disclosure experience, 105 (60%) reported an experience of life expectancy disclosure that was in accordance with their preferences. Cohen's κ was -0.04 (95% CI, -0.17, 0.08), indicating very poor agreement between patients' preferences for and perceived experiences of life expectancy disclosure (p = 0.74). In light of patient-centred prognosis disclosure guidelines, our findings of a majority preference for, and experience of, a self-determined approach to life expectancy disclosure amongst radiation oncology patients are encouraging. However, poor agreement between preferences and experiences highlights that additional effort from clinicians is required in order to achieve a truly patient-centred approach to life expectancy disclosure.
Publisher: Hindawi Limited
Date: 23-11-2011
Publisher: Springer Science and Business Media LLC
Date: 20-03-2019
DOI: 10.1007/S00520-019-04740-1
Abstract: Patients are a critical source of information about the quality of the components of cancer care that contributes to optimal psychosocial outcomes. Recently published research was examined to determine the: (1) proportion of studies that examined at least one of 14 components of cancer care, (2) the proportion of studies that included multiple components of care, and (3) the phase of the cancer care pathway in which data collection occurred (i.e. pre-, during and post-treatment). MEDLINE was searched to retrieve all data-based publications indexed for two international psychosocial cancer care journals (Supportive Care in Cancer and Psycho-Oncology) over a 2-year period. A total of 333 publications yielded 214 eligible publications that were assessed against the 14 components of care for which measurement by healthcare providers at multiple phases during cancer care is recommended. Publications were coded based on the: (1) specific component/s of care focused upon in the research, (2) number of components examined and (3) timing of data collection. The most frequently assessed component of care was physical and psychosocial screening (n = 198, 93%). Most studies (n = 187, 87%) examined a single component of care. No studies assessed all 14 components. Only seven studies (2.1%) examined components of care across multiple phases of the care pathway. Recently published studies have examined limited segments of patients' experiences of cancer care. To improve psychosocial outcomes among people living with and beyond cancer, there should be a greater focus on patients' experiences across multiple components and the whole care pathway.
Publisher: Wiley
Date: 28-05-2009
DOI: 10.1002/CNCR.24415
Publisher: Springer Science and Business Media LLC
Date: 07-08-2015
DOI: 10.1007/S12529-015-9502-2
Abstract: Studies in western clinical settings suggest that touch screen computer surveys are an acceptable mode of collecting information about cancer patients' wellbeing We examined the acceptability of a touch screen tablet survey among cancer patients in Japan. Eligible patients (n = 262) attending a university hospital radiation therapy (RT) department were invited to complete a touch screen tablet survey about psychosocial communication and care. Survey consent and completion rates, the proportion and characteristics of patients who completed the touch screen survey unassisted, and patient-reported acceptability were assessed. Of 158 consenting patients (consent rate 60 % [95 % CI 54, 66 %] of eligible patients), 152 completed the touch screen computer survey (completion rate 58 % [95 % CI 52, 64 %] of eligible patients). The survey was completed without assistance by 74 % (n = 113 95 % CI 67, 81 %) of respondents. Older age was associated with higher odds of having assistance with survey completion (OR 1.09 95 % CI 1.04, 1.14 %). Ninety-two percent of patients (95 % CI 86, 96 %) felt that the touch screen survey was easy to use and 95 % (95 % CI 90, 98 %) agreed or strongly agreed that they were comfortable answering the questions. Overall, 65 % (95 % CI 57, 73 %) of respondents would be willing to complete such a survey more than once while waiting for RT treatment. Although patient self-reported acceptability of the touch screen survey was high, self-administered touch screen tablet surveys may not be entirely appropriate for older cancer patients or possibly for patients with lower educational attainment.
Publisher: American Medical Association (AMA)
Date: 02-2016
DOI: 10.1001/JAMAPEDIATRICS.2015.3342
Abstract: Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children. To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children. A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended search was performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions, were identified. Secondary data extraction was performed in August 2015. Controlled trials of routine child health care delivered by health care professionals (physicians, nurses, medical assistants, health educators, and dieticians) that addressed the outcomes of interest (TSE reduction in children and parental smoking behaviors) were eligible for inclusion in this review and meta-analysis. Study details and quality characteristics were independently extracted by 2 authors. If outcome measures were sufficiently similar, meta-analysis was performed using the random-effects model by DerSimonian and Laird. Otherwise, the results were described narratively. The primary outcome measure was reduction in child TSE. Secondary outcomes of interest were parental smoking cessation, parental smoking reduction, and maternal postpartum smoking relapse prevention. Sixteen studies met the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05 95% CI, 0.74-1.50 P = .78). Meta-analysis of the 3 trials that measured maternal postpartum smoking relapse prevention demonstrated a significant overall intervention effect (n = 1293) (risk ratio 1.53 95% CI, 1.10-2.14 P = .01). High levels of study heterogeneity likely resulted from variability in outcome measures, length of follow up, intervention strategies, and unknown intervention fidelity. Interventions delivered by health care professionals who provide routine child health care may be effective in preventing maternal smoking relapse. Further research is required to improve the effectiveness of such interventions in reducing child TSE and increasing parental smoking cessation. The findings of this meta-analysis have policy and practice implications relating to interventions by routine pediatric health care professionals that aim to reduce child exposure to tobacco smoke.
Publisher: JMIR Publications Inc.
Date: 19-02-2018
Publisher: Public Library of Science (PLoS)
Date: 2015
Publisher: Wiley
Date: 24-03-2015
DOI: 10.1002/PON.3806
Abstract: Although elevated psychological distress is commonly reported among cancer patients, our understanding of patients' preferences for, and perceived barriers to, accessing psychological support from key cancer care providers is limited. The aim of this study was to assess cancer patients' level of concern about, and willingness to discuss, their anxiety and depression. Radiation oncology outpatients completed a touchscreen computer survey with questions assessing their concern about and willingness to discuss anxiety and depression. Among consenting respondents (n = 145), 51% (95% CI: 43%-59%) were concerned about their levels of anxiety, and 34% (95% CI: 26%-42%) about their levels of depression. If experiencing anxiety or depression, 92% (95% CI: 87%-96%) would want to discuss this with their general practitioner (GP), and 60% (95% CI: 52%-68%) with their cancer doctor. Almost half of the 58 respondents who would not want to discuss anxiety or depression with their cancer doctor indicated that this was because there were more important things to talk about during their appointment. The majority of cancer patients undergoing radiotherapy would be willing to discuss anxiety and depression with their cancer doctor and GP. These findings provide additional support for service delivery models in which GPs and oncologists play key roles in initiating and coordinating discussions about cancer patients' psychosocial concerns.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.PHYSIO.2015.10.003
Abstract: Physiotherapist prescribed self-management strategies are an important adjunct to 'hands on' treatment. However, treatment outcomes are likely to be related to whether patients adhere to the prescribed strategy. Therefore, physiotherapists should be aware of adherence aiding interventions designed to maximise patient outcomes underpinned by quality research studies. To conduct a systematic review of the interventions used to aid patient adherence to all physiotherapist prescribed self-management strategies. The search included the databases CINAHL, EMBASE, MEDLINE, PUBMED, PSYCINFO, SPORTSDiscus, the Cochrane Central Register of Controlled Trials, PEDro and Mednar for randomised controlled trials (RCTs) published in a peer reviewed journal from inception to November 2014. Data were extracted using a standardised form from twelve included RCTs for patient adherence rates to self-management strategies for interventions used to aid patient adherence and usual care. Two independent reviewers conducted methodological quality assessment. Twelve different interventions to aid patient adherence to exercise were recorded from twelve fair to high quality RCTs. Potential adherence aiding interventions include an activity monitor and feedback system, written exercise instructions, behavioural exercise programme with booster sessions and goal setting. Despite a number of studies demonstrating interventions to positively influence patient adherence to exercise, there is insufficient data to endorse their use in clinical practice. No RCTs examining adherence aiding interventions to self-management strategies other than exercise were identified, indicating a significant gap in the literature. PROSPERO CRD42015014516.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2018
DOI: 10.1007/S00520-017-3896-0
Abstract: There is an increased focus on supporting patients with cancer to actively participate in their healthcare, an approach commonly termed 'self-management'. Comparing unmet self-management needs across cancer types may reveal opportunities to adapt effective self-management support strategies from one cancer type to another. Given that breast and colorectal cancers are prevalent, and have high survival rates, we compared these patients' recent need for help with self-management. Data on multiple aspects of self-management were collected from 717 patients with breast cancer and 336 patients with colorectal cancer attending one of 13 Australian medical oncology treatment centres. There was no significant difference between the proportion of patients with breast or colorectal cancer who reported a need for help with at least one aspect of self-management. Patients with breast cancer were significantly more likely to report needing help with exercising more, while patients with colorectal cancer were more likely to report needing help with reducing alcohol consumption. When controlling for treatment centre, patients who were younger, experiencing distress or had not received chemotherapy were more likely to report needing help with at least one aspect of self-management. A substantial minority of patients reported an unmet need for self-management support. This indicates that high-quality intervention research is needed to identify effective self-management support strategies, as well as implementation trials to identify approaches to translating these strategies into practice. Future research should continue to explore whether self-management support strategies could be adapted across cancer types.
Publisher: Elsevier BV
Date: 04-2014
Abstract: We assessed agreement between reported anxiety and depression levels of cancer patients using (i) single self-report items and (ii) the Hospital Anxiety and Depression Scale (HADS). We also explored whether anxiety and depression assessment by (i) single self-report items or (ii) the HADS was most strongly associated with a preference to be offered professional assistance. The proportion of patients indicating that they would accept (or were currently using) professional support if they were experiencing anxiety or depression was also examined. A consecutive s le of cancer patients undergoing radiotherapy at four metropolitan public hospitals in Australia completed a touch screen computer survey. A consecutive subs le of patients attending three of these treatment centres answered additional questions about psychological support preferences. Of 304 respondents, 54% [95% confidence interval (CI) 48% to 60%] perceived that they were currently experiencing mild to severe anxiety and depression. 22% (95% CI 18% to 27%) indicated a preference to be offered professional help. There was moderate agreement between the HADS and single-item responses for categorisation of anxiety and depression. Patient-perceived mild to severe anxiety and depression levels appeared to be the best measure for identifying those with a preference to be offered professional assistance. Of a subs le of 193 respondents, 89% (95% CI 84% to 93%) indicated that if they were experiencing anxiety or depression, they would accept (or were currently using) professional support. Single-item screening in a cancer care setting may not adequately capture clinical anxiety and depression. However, single-items assessing patients' perceived levels of anxiety and depression are useful indicators of whether patients want to be offered, and are likely to accept, psychosocial care.
Publisher: Mark Allen Group
Date: 02-01-2020
Abstract: Physiotherapist-prescribed self-management strategies are an important component of physiotherapy practice but they can only be effective if patients adhere. The aim of this study was to explore patient-reported adherence to physiotherapist-prescribed self-management strategies, and the extent to which patient, physiotherapist, consultation and prescription characteristics are associated with high levels of adherence. A cross-sectional observational study across four private practices including 14 physiotherapists and 113 patients was conducted. Data were collected in two stages. The first stage consisted of observing a patient at their physiotherapist consultation to collect data regarding the physiotherapist's prescription of self-management strategies. The second stage consisted of a follow-up telephone interview with each observed patient to record the patient-reported level of adherence to each prescribed self-management strategy. Prescribed self-management strategies where physiotherapists asked patients to repeat details of the self-management strategy were 6.54 times (95% confidence interval 2.91–14.98) more likely to be highly adhered to than strategies where the physiotherapist did not do this. Prescribed strategies accompanied by printed information were 2.73 times (95% confidence interval 1.24–6.00) more likely to be highly adhered to than strategies that were not. Advice such as to rest from activity (odds ratio=0.18 95% confidence interval 0.08–0.40) was less likely to be highly adhered to when compared to home-based exercise programmes. To improve patient-reported adherence to self-management strategies, physiotherapists should be encouraged to provide supplementary printed information and ask their patients to repeat details of the prescribed strategy.
Publisher: Mark Allen Group
Date: 02-11-2015
DOI: 10.12968/IJTR.2015.22.11.535
Abstract: To examine the published literature on patient adherence to physiotherapist prescribed self-management strategies in order to describe: changes in the proportion of publications over time methodological quality of non-intervention and intervention-based studies types of measures used to assess patient adherence and the reported accuracy of those measures. A comprehensive search of eight electronic databases was conducted, covering the period from January 1995 to November 2014. Data were extracted and coded for the number and proportion of articles that were: i) non data-based ii) data-based, no new data (reviews) iii) data-based, new data. The methodological quality of non-intervention and intervention publications was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and data were extracted regarding the type and accuracy of adherence measures reported in these publications. A total of 80 relevant papers were identified. Of these, 49 non-intervention and intervention quantitative study designs underwent methodological assessment, with only 14 studies (29%) assessed as being of at least moderate quality. Fifty-three different measures of patient adherence were recorded from the 49 included studies, with only 5 of the 49 included studies (10%) reporting statistical evidence to support accuracy of the adherence measures applied. The results indicate that despite a trend towards intervention-based studies and reviews over the last 20 years, the methodological quality of studies on patient adherence could be improved. Accurate and standardised measures of patient adherence are needed for any future research involving patient adherence to physiotherapist prescribed self-management strategies.
Publisher: Wiley
Date: 16-05-2018
DOI: 10.1002/PON.4736
Abstract: To describe among radiation oncology patients: (1) the proportion likely to be experiencing symptoms of depression and anxiety as identified by (a) the Hospital Anxiety and Depression Scale (HADS standardised tool), (b) patient-reported single items (ultrashort tool), and (c) radiation oncologist-reported single items (clinician judgement) (2) preferences for being offered psychological support and (3) agreement between single-item measures and the HADS. Adult cancer patients (n = 152 consent rate 58%) receiving radiotherapy completed a touchscreen tablet survey assessing symptoms of anxiety and depression (HADS and a single-item tool) and support preferences. Each participant's treating radiation oncologist completed a survey assessing his or her perception of whether the patient was anxious or depressed. Prevalence estimates for likely depression (6.9-18%) and anxiety (17-33%) overlapped across the 3 measures. Overall, only 9.9% of patients (95% CI, 5.6%-16%) wanted to be offered psychological support. For depression, agreement between the HADS and ultrashort tool was fair (κ = 0.37, P < 0.0001) agreement between the HADS and clinician judgement was slight (κ = 0.14, P < 0.05). For anxiety, agreement between the HADS and clinician judgement was not significantly greater than chance alone (κ = 0.04, P = 0.33), and agreement between the HADS and ultrashort tool was moderate (κ = 0.49, P < 0.0001). These findings highlight the important role that oncology consultations play in interpreting assessment tool results and responding to in idual patient's history and preferences for psychological support.
Publisher: Informa UK Limited
Date: 17-05-2018
DOI: 10.1080/09593985.2018.1474402
Abstract: The effectiveness of exercise programs for chronic low back pain (CLBP) is dependent upon patient adherence which is problematic to measure accurately. This cross-sectional observational study aimed to compare patient-reported levels of adherence with physiotherapists' perceptions of patient adherence and to explore the proportion of patients who could accurately recall and demonstrate the exercises contained within their prescribed exercise program for CLBP. Participating patients (
Publisher: Springer Science and Business Media LLC
Date: 15-05-2019
Publisher: JMIR Publications Inc.
Date: 03-10-2017
Abstract: lectronic health (eHealth) literacy is needed to effectively engage with Web-based health resources. The 8-item eHealth literacy scale (eHEALS) is a commonly used self-report measure of eHealth literacy. Accumulated evidence has suggested that the eHEALS is unidimensional. However, a recent study by Sudbury-Riley and colleagues suggested that a theoretically-informed three-factor model fit better than a one-factor model. The 3 factors identified were awareness (2 items), skills (3 items), and evaluate (3 items). It is important to determine whether these findings can be replicated in other populations. he aim of this cross-sectional study was to verify the three-factor eHEALS structure among magnetic resonance imaging (MRI) and computed tomography (CT) medical imaging outpatients. RI and CT outpatients were recruited consecutively in the waiting room of one major public hospital. Participants self-completed a touchscreen computer survey, assessing their sociodemographic, scan, and internet use characteristics. The eHEALS was administered to internet users, and the three-factor structure was tested using structural equation modeling. f 405 invited patients, 87.4% (354/405) were interested in participating in the study, and of these, 75.7% (268/354) were eligible. Of the eligible participants, 95.5% (256/268) completed all eHEALS items. Factor loadings were 0.80 to 0.94 and statistically significant (P .001). All reliability measures were acceptable (indicator reliability: awareness=.71-.89, skills=.78-.80, evaluate=.64-.79 composite reliability: awareness=.89, skills=.92, evaluate=.89 variance extracted estimates: awareness=.80, skills=.79, evaluate=.72). Two out of three goodness-of-fit indices were adequate (standardized root mean square residual (SRMR)=.038 comparative fit index (CFI)=.944 root mean square error of approximation (RMSEA)=.156). Item 3 was removed because of its significant correlation with item 2 (Lagrange multiplier [LM] estimate 104.02 P .001) and high loading on 2 factors (LM estimate 91.11 P .001). All 3 indices of the resulting 7-item model indicated goodness of fit (χ211=11.3 SRMR=.013 CFI=.999 RMSEA=.011). he three-factor eHEALS structure was supported in this s le of MRI and CT medical imaging outpatients. Although further factorial validation studies are needed, these 3 scale factors may be used to identify in iduals who could benefit from interventions to improve eHealth literacy awareness, skill, and evaluation competencies.
Publisher: Hindawi Limited
Date: 18-02-2019
DOI: 10.1111/ECC.13021
Abstract: To describe the (a) number and type of cancer care providers that radiation oncology outpatients report discussing life expectancy with, and (b) perceptions of the acceptability and utility of life expectancy information. A cross-sectional survey of patients receiving radiotherapy was undertaken in four treatment centres. Patients indicated whether they had discussed life expectancy with a cancer doctor (i.e., medical oncologists, radiation oncologists, surgeon, haematologists) and/or other cancer care provider (i.e., general practitioner, radiation therapist, nurse) and acceptability and utility of information. Of 207 respondents, 133 (64%) had discussed life expectancy with at least one provider. General practitioners (GPs) were the most frequent source of information. Of those who had discussed life expectancy, half (n = 110/207) perceived cancer would not impact life expectancy. Information was easy to understand (91%), discussed sensitively (90%), helped plan for future (83%) and gave them certainty (86%). The information made 11% feel overloaded and 34% feel anxious. Two-thirds of respondents had discussed life expectancy with at least one cancer care provider. Providers from the range of disciplines involved in cancer care need to be skilled at communicating life expectancy information and recognising the adverse impact this may have on some patients.
Publisher: SAGE Publications
Date: 2019
Abstract: Accurate public perceptions on the risk factors associated with cancer are important in promoting primary, secondary, and tertiary prevention. Limited studies have explored this topic among patients with cancer in non-western, low-to-middle-income countries. A cross-sectional survey to compare Australian and Vietnamese cancer patients’ perceptions of what caused their cancer was undertaken. Adult, patients with cancer from both countries, receiving radiotherapy treatment completed a standardized survey, which included a 25-item module assessing their beliefs on the causes of their cancer. Items ranged from known evidence-based causes (eg, smoking, sun exposure) to non-evidence-based beliefs (eg, stress or anxiety, physical injury, or trauma). Country-specific logistic regression analyses were conducted to identify differences in the determinants of patients’ top perceived causes. A total of 585 patient surveys were completed (75% response rate 285 from Australia, and 300 from Vietnam). Most patients were male (58%) and aged 60 years and older (55%). The most frequently reported risk factor overall and for the Australian s le was “getting older” (overall = 42%, Australia = 49%, and Vietnam = 35%). While the most frequently reported risk factor for the Vietnamese s le was “poor diet” (overall = 39%, Australia = 11%, and Vietnam = 64%). There were differences in the characteristics associated with the top causes of cancer identified by Australian and Vietnamese patients. Patients’ beliefs about what may have caused their cancer are complex and likely to be impacted by multiple factors, including the country from which they reside. Developing public awareness c aigns that are accurate and tailored to address the specific beliefs and possible misconceptions held by the target community are needed.
Publisher: BMJ
Date: 2013
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.CTRV.2017.03.012
Abstract: There is a high prevalence of depressive disorder and depressive symptoms among advanced, incurable cancer patients. Patients commonly report a preference for non-pharmacological treatments such as psychotherapy over pharmacological treatments for depression. The objective of this review was to investigate the effectiveness of psychotherapy for the treatment of depression in people with advanced, incurable cancer via a meta-analysis of randomized controlled trials (RCTs). We searched research databases and clinical trial registries for studies published prior to June 2015. No language restrictions were applied when selecting studies. Cochrane Collaboration meta-analysis review methodology was used. All relevant RCTs comparing psychotherapy with control conditions on depression outcomes for adults with advanced cancer were eligible for inclusion. We calculated pooled effect sizes using Hedges g and a standardized mean difference (SMD) of change between baseline and post-treatment scores. Quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Of 13 studies included in the review, 12 reported data suitable for meta-analysis. Psychotherapy was associated with moderate decrease in depression score (SMD -0.67, 95% confidence interval -1.06 to -0.29, P=0.0005). Few studies focused on people with clinically diagnosed depression. Overall, quality of evidence across the included studies was rated as low, and heterogeneity was high. Low quality evidence suggests that psychotherapy is moderately more effective for the amelioration of symptoms of depression among advanced, incurable cancer patients than the control conditions. There is insufficient high-quality evidence supporting the effectiveness of psychotherapy for patients with clinically diagnosed depression.
Publisher: Informa UK Limited
Date: 03-03-2016
Publisher: Springer Science and Business Media LLC
Date: 11-05-2012
Publisher: Springer Science and Business Media LLC
Date: 24-10-2012
DOI: 10.1007/S00520-012-1624-3
Abstract: The objective of this study was to examine the likely presence of, and factors associated with, anxiety, depression and overall psychological distress in cancer outpatients undergoing radiation therapy treatment in Sydney, Australia. A touchscreen computer survey was conducted in four radiation therapy treatment centre waiting rooms. Patients waiting to receive treatment completed the survey which included questions about demographic and disease characteristics, survey acceptability and the Hospital Anxiety and Depression Scale (HADS). A total of 454 patients (70 %) completed the touchscreen computer survey. The likely presence of anxiety (HADS-A ≥11), depression (HADS-D ≥11) and overall psychological distress (HADS-T ≥15) was 15, 5.7 and 22 %, respectively. Cancer type was found to be associated with each HADS screening category. The majority of patients reported high survey acceptability and willingness to complete similar touchscreen computer surveys in the treatment centre waiting room on additional occasions. As radiotherapy patients frequently attend the radiation oncology department, routine screening and intervention for elevated levels of psychological distress in this setting appears to be feasible. High survey completion rates and high patient-rated acceptability support this approach to screening. The likely presence of psychological distress is reported for this s le however, the selection of HADS threshold scores is likely to have influenced the reported rates. Further research is needed to identify how cancer type impacts on likely caseness across the different HADS classifications examined.
Publisher: Springer Science and Business Media LLC
Date: 23-07-2019
Publisher: SAGE Publications
Date: 18-04-2018
Abstract: Medical imaging outpatients often experience inadequate information provision and report high levels of anxiety. However, no studies have assessed patients’ receipt of preparatory information in this setting. To examine medical imaging outpatients’ perceived receipt or non-receipt of preparatory information from health professionals and imaging department staff prior to their procedure. Computed tomography and magnetic resonance imaging outpatients at one Australian hospital self-completed a touchscreen computer survey assessing their perceived receipt of 33 guideline-recommended preparatory information items. Of 317 eligible patients, 280 (88%) consented to participate. Eight percent (95% confidence interval: 5%-12%) of participants reported receiving all information items. The median number of information items not received was 18 (interquartile range: 8-25). Items most frequently endorsed as “not received ” were: how to manage anxiety after (74%) and during the scan (69%). Items most commonly endorsed as “received” were: reason for referral (85%) and how to find the imaging department (74%). Few medical imaging outpatients recalled receiving recommended preparatory information. Preparatory communication needs to be improved to better meet patient-centered service imperatives.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Springer Science and Business Media LLC
Date: 02-10-2018
DOI: 10.1057/S41271-018-0145-9
Abstract: Public health policy has the potential to produce great benefits for in iduals and communities. There is growing demand that such efforts be rigorously evaluated to ensure that the expected benefits are, in fact, realised. Commonly, public health policy is evaluated by consumer acceptability, reach, or changes in knowledge and attitudes. Non-robust research designs are often used. But these approaches to evaluation do not answer three critical questions: Has a change in the desired outcome occurred? Was it a consequence of the policy and not some extraneous factor? Was the size of the change considered significant and cost-effective? We, a team of government and academic scholars working in research and evaluation, have examined some of the more common impediments to robust evaluation: political impediments, a lack of investment in evaluation capacity within bureaucracy, and the failure of academic researchers to understand the need for the evaluation of public health policy.
Publisher: Physiotherapy New Zealand
Date: 09-05-2023
Abstract: The objectives of this study were to describe patient-reported adherence to physiotherapist-prescribed self-management strategies and the perceived barriers and enablers to adherence to each strategy. Patients attending physiotherapy private practices (n = 4) were observed during their consultation. Patients prescribed one or more self-management strategies received a follow-up telephone interview within 10–14 days of the observed consultation and were asked to self-report their level of adherence and their perceived barriers and/or enablers to each prescribed strategy. Results indicated that patients (n = 108) reported receiving 177 strategies and being fully adherent to 36% (95% CI: 29-44%) of these strategies. Patient-reported adherence barriers (n = 113) and enablers (n = 172) were coded using a modified version of the World Health Organisation five dimensions of adherence. Frequently reported barriers included social/economic-related (n = 52 46%) such as being too busy, and patient-related (n = 29 26%) including being too tired/lack of motivation. Frequently reported enablers included therapy-related (n = 71 41%) such as “the strategy was easy to complete”, and condition-related (n = 45 26%) including “that the strategy helped to manage symptoms”. Thus, patient adherence may be aided by ensuring that: the strategy is less complex it does not cause pain it isn’t time consuming and it leads to an improvement in condition-related symptoms.
Publisher: Wiley
Date: 03-11-2022
DOI: 10.1111/AJR.12940
Abstract: This study explored use and perceived barriers to the use of post‐operative video‐link telehealth among a s le of Australian surgeons shortly before the COVID‐19 pandemic. During 2019–2020, a survey was mailed to RACS or RANZCOG Fellows. Cross‐sectional survey. A total of 907 surgeons practising in Australia completed the survey. The study‐specific survey assessed telehealth use in the last 3 months and the perceived barriers and enablers to the use of post‐operative teleconsultations, across the domains: quality of care convenience and efficiency legal/regulatory issues financial issues and technological issues. Twenty‐five percent of eligible surgeons returned the survey, with n = 763 pre‐pandemic responses included in analyses. Approximately one‐quarter (26%) of surgeons had used telehealth post‐operatively with patients in the last 3 months. The most frequently endorsed barriers to use related to quality of care: ‘I cannot undertake a patient examination’ and ‘I cannot provide the same level of care as during an in‐person consultation’ and convenience and efficiency: ‘Teleconsultations are more difficult to arrange’. Surgeons who had recently used telehealth were less likely to endorse most barriers. Younger age, awareness of Medicare telehealth reimbursement and working in neurosurgery, urology, paediatric surgery and plastic and reconstructive surgery (compared to general surgery) were associated with recent telehealth use by surgeons. Some surgeons' perceived barriers to telehealth pre‐COVID may be overcome by COVID‐19‐related telehealth uptake and familiarisation. However, many barriers will need to be addressed to ensure that telehealth adoption is sustained beyond the pandemic.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Lisa Mackenzie.