ORCID Profile
0000-0003-1602-4544
Current Organisations
Queensland University of Technology Faculty of Health
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Queensland University of Technology
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Linguistics | Discourse and Pragmatics |
Publisher: Elsevier BV
Date: 06-2016
Publisher: Elsevier BV
Date: 07-2023
Publisher: Ubiquity Press, Ltd.
Date: 26-02-2021
DOI: 10.5334/IJIC.S4065
Publisher: Mary Ann Liebert Inc
Date: 06-2018
Abstract: Global recognition of the need to improve outcomes for adolescents and young adults (AYA) with cancer has led to the development of specific oncology programs and services. In Australia, Youth Cancer Services (YCS) are now established across the country. While each service has been shaped by nationally agreed principles, program development has been influenced by local policy and geographic differences. Queensland is a vast state with a widely dispersed population coordination of cancer services for young people across this landscape presents unique challenges. The Queensland YCS (QYCS) work in a consultative partnership model with primary treating teams, across both pediatric and adult tertiary cancer services. Understanding how cancer services approach challenges and service development can provide guidance for other developing services. In this article, we describe the goals and development of QYCS and review the outcomes achieved in the service to date. We reviewed referral data and retrieved statewide clinical activity from the web-based data system. We compared these data with cancer registry data to identify disparities and areas for service development. While the service has achieved notable outcomes, challenges remain. These include recruitment of appropriately skilled and trained health professionals for this newly developing area of oncology. In addition, there is an ongoing need to advocate for this relatively small patient group, and to promote awareness and understanding of the need for AYA-specific services. With the dispersed population and concentration of services in metropolitan Brisbane, identifying and testing new innovative models, including telehealth, to reach all AYA diagnosed with cancer regardless of location of care are priorities.
Publisher: Mary Ann Liebert Inc
Date: 06-2018
Abstract: Young people with cancer have distinct clinical and psychosocial needs during and after cancer treatment. However, as adolescent and young adult (AYA) cancer is rare, and only recently recognized as specialty, health professionals may not have the skills, competence, and confidence to meet the needs of the young patient with cancer. The aim of this study was to identify the learning needs of health professionals providing cancer care to adolescents and young adults before and following the introduction of a state-wide AYA cancer education program. A survey of educational needs of health professionals was undertaken in 2013 at the commencement of the Queensland Youth Cancer Service. The survey was used to develop the education program of the service. The education program was delivered across the state in a variety of formats, covering a range of topics throughout 2013-2016. The second survey was completed in 2017. Results were compared to identify if educational needs or the self-rated confidence of health professionals in regard to AYA cancer care had changed over time. One hundred twenty-two participants completed the first survey and 73 completed the second. The most prominent educational needs in 2013 were palliative care and biomedical topics such as understanding AYA growth and development as well as specific AYA cancers and treatment. The second survey identified that palliative care education remained important however, there was a shift toward health professionals request for more psychosocial and practical education on topics including fertility, sexuality, and managing late effects. To provide high-quality healthcare to AYAs with cancer, health professionals require ongoing opportunities for education and training.
Publisher: SAGE Publications
Date: 10-11-2015
Abstract: The aim of this study was to identify barriers to the utilisation of videoconferencing within a multidisciplinary rehabilitation medicine healthcare team, as the first step towards creating a telerehabilitation service. A survey was developed on videoconference use and barriers to use, and distributed to healthcare providers including rehabilitation medicine societies and allied health societies through an anonymous link to SurveyMonkey®. There were 254 respondents, practicing primarily in Australia ( n = 245), in various healthcare roles. One-hundred and fifty-nine (66%) of respondents used videoconferencing regularly, primarily for their own education. Respondents not currently utilising videoconferencing ( n = 82, 34%) ranked the reasons for this and provided free-text responses to explain why this modality was not being utilised in practice. Respondents were reluctant to use videoconferencing because of perceived increase in time needed for video consultations compared to face-to-face consultations, concerns with lack of privacy and confidentiality, and a lack of clinical practice guidelines for video consultation. We believe many barriers to videoconferencing by healthcare providers can be managed with appropriate education and targeted training. Future research studies, which focus on standards and clinical practice guidelines for videoconferencing by healthcare providers, may result in increased utilisation of this modality for healthcare delivery in rehabilitation medicine.
Publisher: SAGE Publications
Date: 12-2012
Abstract: We conducted a pilot study to investigate the effectiveness of a home telehealth service for paediatric palliative care consultations. Over a 10 week period, 14 of the 17 caregivers approached to be part of the study agreed to participate. Families were allocated, non-randomly, to a control group (usual care) or an intervention group (usual care with the addition of home telehealth consultations). The primary outcome measure was quality-of-life score. Caregivers were surveyed for up to 99 days following recruitment. A descriptive analysis of the quality-of-life data showed no differences between caregivers in the two groups. However, important lessons were learnt regarding factors which influence the success of studies in this population group, and the domains of caregiver quality-of-life that warrant intervention. Palliative care is complex, and multiple interventions and supports are required if care is to be managed at home. Home telehealth consultations are a feasible and acceptable means of facilitating a palliative care consultation which can reduce the burden on families at a distressing time.
Publisher: Springer Science and Business Media LLC
Date: 28-07-2014
Publisher: Authorea, Inc.
Date: 07-04-2022
DOI: 10.22541/AU.164932204.47076912/V1
Abstract: Background Symptoms and associated distress in children diagnosed and treated for cancer are uniformly common, yet structured and systematic symptom monitoring is not yet commonplace. With increasing pressures on the healthcare workforce, improved systematic approaches to symptom management are required. Methods Medical, nursing and allied health oncology clinicians developed algorithms using consensus techniques to ascertain thresholds of concern for each symptom for the Symptom Screening in Pediatrics (SPPedi) tool, a Patient Reported Outcome Measure (PROM). Algorithm vetting and refinement were achieved through iterative interviews and consultation with clinicians. Self-management evidence-based recommendations for each symptom were developed. The algorithms were incorporated into an existing smartphone application (MyQCH), as part of the Oncology Hub, and an iterative evaluation is planned to test the feasibility, acceptability, safety, usefulness, and other domains including a hybrid effectiveness trial (ACTRN12621001084875). Discussion Digital solutions provide alternative options for communication, information, and education and opportunities to harness the best of community and hospital services. The Oncology Hub and RESPONSE system is a comprehensive approach to symptom management that includes a suite of tools and resources including a smartphone app that collects PROMs and delivers symptom management advice, as well as written resources for both the families of children with cancer and clinicians. Conclusions Using technology offers new ways to think about how clinicians and families communicate and share information. Understanding how information is exchanged using technology, and how this impacts clinical workflow is critical to successful implementation, and to ultimately optimise symptom assessment management in children with cancer.
Publisher: Wiley
Date: 2011
DOI: 10.1002/PBC.23299
Publisher: Springer Science and Business Media LLC
Date: 02-2013
Publisher: Wiley
Date: 11-01-2018
DOI: 10.1111/JOCN.14175
Publisher: SAGE Publications
Date: 12-2012
Abstract: We investigated the feasibility of using Internet video calls for a double check on medication or other complex interventions being administered in the home. Seven nurses were recruited to the study and received training on using laptop and tablet computers with mobile Internet connections. The devices were taken on scheduled home visits to patient homes and video calls with a second clinician were conducted to double-check various items associated with the clinical care of the patient. Over a 14-month period, 88 video calls were conducted during which a total of 600 checks were completed. The items checked included medication names, doses, segmentations on syringes and details of ventilator settings. The quality of the video call was acceptable on 97% of occasions. On three occasions (3%) it was not possible to establish a connection and the double check was not achieved. On every occasion that the video call was successful ( n = 85), nurses were 100% confident that they were able to carry out the full requirements of a double check. The use of Internet video calls is feasible for double-checking and has the potential to improve patient safety and reduce costs.
Publisher: BMJ
Date: 07-03-2020
DOI: 10.1136/BMJSPCARE-2016-001130
Abstract: Discussing the potential deterioration of a child who has a life-limiting condition has recognised benefits for future care, but can be challenging in a clinical context where uncertain illness trajectories are common. Existing research is restricted to indirect forms of evidence such as self-report data from clinicians and families. This study directly explores how discussions about deterioration are managed within actual paediatric palliative care consultations. 9 consultations were video recorded in an Australian paediatric palliative care service. Each consultation involved the same paediatric palliative care specialist. Conversation analysis was used to identify and explore recurrent ways in which discussions about deterioration came to be realised. The study identified two communicative practices used by a paediatric palliative care specialist that afforded opportunities to discuss deterioration: (1) soliciting the family's agenda for the consultation (2) initiating and maintaining topics where discussing deterioration is a relevant possibility. Across these different practices, a common feature was indirect initiation of discussions about deterioration. This approach made such discussions possible, but without mandating or even suggesting that such discussion must occur. These communicative practices balance the benefit of discussing deterioration against a recognised importance of allowing discussions to be directed by a child's family. This was achieved by creating opportunities for discussing deterioration, without making such discussions necessary.
Publisher: AMPCo
Date: 05-2014
DOI: 10.5694/MJA13.11101
Abstract: A large literature base on telemedicine exists, but the evidence base for telemedicine is very limited. There is little practical or useful information to guide clinicians and health policymakers. Telemedicine is often implemented based on limited or no prior formal analysis of its appropriateness to the circumstances, and adoption of telemedicine by clinicians has been slow and patchy. Formal analysis should be conducted before implementation of telemedicine to identify the patients, conditions and settings that it is likely to benefit. Primary studies of telemedicine tend to be of insufficient quality to enable synthesis of formal evidence. Methods typically used to assess effectiveness in medicine are often difficult, expensive or impractical to apply to telemedicine. Formal studies of telemedicine should examine efficacy, effectiveness, economics and clinician preferences. Successful adoption and sustainable integration of telemedicine into routine care could be improved by evidence-based implementation.
Publisher: Wiley
Date: 20-04-2023
DOI: 10.1002/PON.6136
Abstract: From diagnosis and beyond, a paediatric brain tumour and its treatment impact the child and their family in a myriad of ways. While it is considered best practice to offer ongoing psychosocial support for all family members, there is little scholarly investigation of both families' experiences and the practical implications of offering such care. We aimed to explore families' experiences of paediatric brain tumour and their associated psychosocial health service needs. Families receiving care at the Queensland Children's Hospital in Brisbane, Australia, for a child (0–18 years) who had been diagnosed with a brain tumour between 2019 and 2022 were invited to be interviewed about their experiences. Using qualitative description, we analysed these interviews to identify families' unmet psychosocial health service needs and their suggestions for improvement. Twenty‐three clinically and socially erse families were represented. While parents/carers expressed gratitude for the care their child had received, most also described unmet needs for the broader family. We identified three primary needs to be addressed: (1) parents want accessible psychological/emotional support for themselves (2) parents/carers want additional guidance to navigate the hospital setting to reduce uncertainty and loss of control and (3) parents want support to minimise treatment‐associated trauma for their child. Our findings evidence the need for improved family‐centred psychosocial care within paediatric brain tumour care in Queensland, Australia. We propose a counselling and care coordination intervention to support parents/carers to care for themselves, their child, and their family through an extremely challenging experience.
Publisher: Elsevier BV
Date: 02-2019
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.EJON.2019.101709
Abstract: To assess unmet information and service needs in adolescent and young adult cancer survivors (15-29 years) who access specialist Youth Cancer Services in Queensland, Australia. Participants were recruited through Youth Cancer Services across Queensland and completed validated Patient Reported Outcome Measures and Patient Reported Experience Measures to assess unmet needs, symptoms and wellbeing and quality of life (QoL) through an online survey. Analysis included Spearman's correlation and t-tests. The s le (N = 42) was representative in terms of gender, cancer type, location of residence and types of treatment. Total QoL varied substantially within the s le, and 56% of total scores were lower than population norms. QoL was inversely correlated with unmet needs (r = -0.64, p=<0.001). There were no explanatory variables identified associated with higher or lower needs or QoL. Young people reported high needs regarding information and support at diagnosis, and for managing side effects and decision making. Most (61-82%) reported these needs were met. At cancer treatment centres, 42% of young people perceived needs were not met regarding talking to other young people, having access to leisure spaces and relevant supportive information. Participants reported low symptom burden and worry about the future but were concerned about their ability to connect with peers and participate in activities. While service and information needs are generally met, young people with cancer who reported higher needs also report substantially lower QoL compared to population norms. Addressing these needs may improve QoL. A continued focus on providing support and services to this population is warranted.
Publisher: Elsevier BV
Date: 02-2019
Publisher: SAGE Publications
Date: 16-09-2015
Abstract: The prevalence of ear disease and hearing loss is greater for Indigenous children than for their non-Indigenous counterparts. In 2009, we established a mobile ear-screening service in South Burnett, in which an Indigenous Health Worker (IHW) assesses children at school and shares results by telemedicine with ear, nose and throat (ENT) specialists, who in turn provide review and biannual surgical outreach to the community. We reviewed service data for the first six years of the service (Jan 2009–Dec 2014), to calculate: total number of completed assessments total number of patients failing at least one screening test and overall proportion of failed screening assessments per annum. Subgroup analysis was conducted by usual home postcode. The service has provided 5539 screening assessments. The mean screening failure rate for children outside of postcode 4605 (Cherbourg/Murgon area) was 22% (range 17–29%) and 38% for children living inside postcode 4605 (range 34–41%). While screening activity has increased by more than 50% since 2009, there has been a slight reduction in the proportion of children failing assessment, with the mean failure rate changing from 33% in 2009 to 26% in 2014. These early results suggest that community-based screening, integrated with specialist ENT services may improve ear and hearing health.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.IJMEDINF.2016.10.012
Abstract: The adoption of telemedicine into mainstream health services has been slower than expected. Many telemedicine projects tend not to progress beyond the trial phase there are a large number of pilot or project publications and fewer 'service' publications. This issue has been noted since 1999 and continues to be acknowledged in the literature. While overall telemedicine uptake has been slow, some services have been successful. The reporting and evaluation of these successful services may help to improve future uptake and sustainability. The aim of this literature review was to identify peer-reviewed publications of deployed telemedicine services in hospital facilities and to report, and appraise, the methodology used to evaluate these services. Computerised literature searches of bibliographic databases were performed using the MeSH terms for "Telemedicine" and "Hospital Services" or "Hospital", for papers published up to May 2016. A total of 164 papers were identified, representing 137 telemedicine services. The majority of reported telemedicine services were based in the United States of America (n=61, 44.5%). Almost two thirds of the services (n=86, 62.7%) were delivered by real time telemedicine. Of the reviewed studies, almost half (n=81, 49.3%) assessed their services from three different evaluation perspectives: clinical outcomes, economics and satisfaction. While the remaining half (n=83, 50.6%) described their service and its activities without reporting any evaluation measures. Only 30 (18.2%) studies indicated a two-step implementation and evaluation process. There was limited information in all reported studies regarding description of a structured planning strategy. Our systematic review identified only 137 telemedicine services. This suggests either telemedicine service implementation is still not a part of mainstream clinical services, or it is not being reported in the peer-reviewed literature. The depth and the quality of information were variable across studies, reducing the generalisability. The reporting of service implementation and planning strategies should be encouraged. Given the fast paced technology driven environment of telemedicine, this may enable others to learn and understand how to implement sustainable services. The key component of planning was underreported in these studies. Studies applying and reporting more rigorous methodology would contribute greatly to the evidence for telemedicine.
Publisher: SAGE Publications
Date: 05-2012
Abstract: Families caring for a child with incurable cancer require access to support and advice round the clock. In Brisbane, Australia, an after-hours phone service was established to support these families. This service is operated by oncology clinical nurse consultants (CNCs) experienced in pediatric palliative care. This is the first review of 8 years of activity, totaling 106 patients and 1954 calls. The majority of calls were between parents and CNCs (51%). Updating of the patient’s condition (18%) was the primary reason for calls, with support and reassurance (16%), and symptom management of pain (10%) being the other frequent reasons. The majority of calls occurred over the weekends in the morning, with only 11% (n = 209) of calls occurring between 10:00 pm and 7:00 am. Of all the calls made, 43% (n = 814) were calls managed by the CNC without requiring further intervention. Calls were received from throughout Queensland, indicating the value of the service in supporting families throughout the state. The after-hours phone service has proven to be a simple, effective, and valuable service, which is consistently accessed by families, regardless of distance from the hospital.
Publisher: Wiley
Date: 25-03-2019
DOI: 10.1111/JOCN.14842
Abstract: To synthesise the evidence on the use of evaluation frameworks by nurses and midwives in research designed to improve healthcare services and practice. A secondary aim was to identify the attributes and elements of evaluation frameworks. Evaluation is an integral component of any initiative to improve outcomes or change clinical practice. Yet often an evaluation may not yield the information required to sustain or integrate an initiative into practice. Evaluation frameworks can support effective evaluations, but there is a lack of consensus regarding elements and attributes of frameworks that support use. We undertook an integrative review to synthesise the use of evaluation frameworks in practice guided by the Preferred Reporting Items for Systematic review and Meta-Analysis flow diagram and checklist 2009 (Supporting Information File 4). The protocol was registered with PROSPERO (CRD42018087033). A broad range of electronic databases were systematically searched using keywords. Twenty-five papers were included from a erse range of clinical areas and across high-, middle- and low-income nations. Twenty of the research projects had used nine existing frameworks, and five had developed an evaluation specific to an initiative. Frameworks supported the processes of evaluation and made them more meaningful by simplifying a complex process (providing structure and guidance for the evaluation processes) identifying and including stakeholders explaining reasons for outcomes generating transferable lessons and identifying the mechanisms driving or inhibiting change. Nurses and midwives reported that frameworks were useful in undertaking evaluations. Each framework had positive attributes and missing or confusing elements. When undertaking an evaluation, it is pertinent to review the elements and attributes of a framework to ensure it includes evaluation measures that are relevant to specific projects. Nurses are actively involved in evaluation of clinical practice. This review identifies important elements to consider when choosing a framework for evaluation.
Publisher: Wiley
Date: 26-10-2022
DOI: 10.1111/AJCO.13868
Publisher: Elsevier BV
Date: 10-2022
Publisher: Springer Science and Business Media LLC
Date: 06-2022
Publisher: Springer Science and Business Media LLC
Date: 09-09-2021
DOI: 10.1186/S12913-021-06943-X
Abstract: Intense and aggressive treatment regimens for most children’s cancer have achieved vast improvements in survival but are also responsible for both a high number and burden of symptoms. The use of Patient Reported Outcome Measures (PROMs) demonstrates a range of benefits for improved symptom management in adults with cancer. There are, however, multiple barriers to integrating PROMs into routine care in children and adolescents with cancer. This study aims to evaluate: (1) the effectiveness of electronic PROMs to generate stratified alerts, symptom management recommendations and graphical summaries (the RESPONSE system) to improve health outcomes and (2) the implementation of the RESPONSE system by assessing feasibility, acceptability, satisfaction, and sustainability. A pragmatic hybrid II effectiveness-implementation controlled trial, using mixed methods, will be undertaken, advancing both knowledge of the effectiveness of the intervention and implementation factors. One-hundred and sixty children with cancer receiving active treatment will be recruited 1:1 to a non-randomised study involving two groups with an equal number of participants in each group. The intervention group ( n = 80) will be prospectively recruited to receive the RESPONSE system intervention over eight weeks, versus the historical matched control group ( n = 80) who will complete the ePROMs without access to the RESPONSE system. The primary outcome of the effectiveness trial is change between groups in total symptom burden. Secondary outcomes include child health-related quality-of-life and implementation outcomes. Trial data will be analysed using linear mixed-effects models. Formative implementation evaluation is informed by CFIR and ERIC frameworks and implementation outcomes will be mapped to the RE-AIM framework and include interviews, field notes, as well as administrative data to evaluate feasibility, acceptability, satisfaction and sustainability. ACTRN12621001084875 . Retrospectively Registered 16 August 2021.
Publisher: Sciedu Press
Date: 18-04-2013
Publisher: SAGE Publications
Date: 23-02-2012
Abstract: We investigated the feasibility and accuracy of using Internet-based videoconferencing for double-checking medications. Ten participants checked 30 different medications using a desktop PC and a webcam. The accuracy of the video-based checks was compared with ‘face-to-vial’ checks. The checks included the drug name, dosage and expiry dates of oules, vials and tablets, as well as graduations on syringes. There was 100% accuracy for drug name, dosage, and graduations on syringes greater than 1 unit. The expiry dates proved more difficult to read, and accuracy was only 63%. The mean overall accuracy was 91% for all items. Internet video-based medication double-checks may have a useful role to play in processes to ensure the safe use of medications in home care.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.IJMEDINF.2014.07.001
Abstract: We aimed to provide an up-to-date contemporary bibliometric view of the telemedicine and telehealth literature and a longitudinal analysis of changes in content themes. Software tools were used to extract and process MEDLINE entries. Frequencies of papers by year of publication and outlet were calculated, ranked, charted and tabulated. Frequency of publication by author was also calculated, ranked and tabulated. The process was repeated for two time periods to examine change: (i) 1970-1995 and (ii) 2009-2013. Content analysis of abstracts was conducted and tag clouds were generated. This visual representation was used to identify key words and prominent themes. 17,932 records relating to articles published in 2523 unique outlets were analyzed. In the cumulative literature, 3152 (18%) articles were published in specialist telemedicine journals while most articles (14,780 [82%]) were published in mainstream outlets. This pattern was observed in both epochs. Clinical journals were not highly represented. Over time 46,066 unique authors have contributed to the field, with 21,109 of them publishing in the period 2009-2013. Telemedicine is a large and growing field with most publication occurring outside of the specialist journals. Content analysis suggested a change of focus from the technical to the clinical between the two epochs. As a healthcare setting, the home also appears to be emergent. This study updates the findings of previous studies. The emphasis within the literature suggests a move from technical issues to clinical applications and evaluation. The maturity of the field and its accessibility to clinicians and policy makers remains unclear.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-05-2023
Publisher: SAGE Publications
Date: 30-10-2016
Abstract: A systematic review of studies which reported on telediabetes services within Indigenous communities was undertaken in June 2016. The aim of this study was to identify enablers and barriers associated with the delivery of telehealth services for diabetes care amongst Indigenous people. A total of 14 articles met the study inclusion criteria, reporting work in Canada, Australia, India, and the US. Key enablers included the use of cultural and spiritual elements, acknowledgement of local beliefs and traditions, and appropriate community engagement. The involvement of Indigenous health workers was also very important because of their role in communication in local language, helping clinicians understand the community, and the transportation of patients. The main barriers associated with telediabetes services were the potentially high fail-to-attend rates, lack of technical skills associated with the operation of telehealth equipment, and the lack of availability of local staff. Knowledge of the enablers and barriers associated with the delivery of healthcare services to Indigenous communities is important when planning a telediabetes service.
Publisher: Informa UK Limited
Date: 02-01-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2015
DOI: 10.11124/JBISRIR-2015-2413
Abstract: The objective of this review is to identify and synthesize the best international qualitative evidence on healthcare users' experiences of communication with healthcare professionals about children who have life-limiting conditions. For the purposes of this review, "healthcare users" will be taken to include children who have life-limiting conditions and their families. The question to be addressed is:What are healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions? The prospect of the death of a child from an incurable medical condition is harrowing, yet finding a way to discuss this prospect is crucial to maximize the quality of life for such children and their families. High-quality communication is well recognized as a core skill health care professionals need to maximize the quality of care they provide. This skill is valued by service users, who consistently rate it as one of the highest priorities for the care they receive. Evidence suggests, however, that healthcare professionals can feel ill-equipped or uncomfortable communicating with and about such children. Therefore, it is important to understand what represents high-quality communication and what is involved in accomplishing this within pediatric palliative care.In recent decades there has been an increased focus on providing palliative care for children who have life-limiting conditions. These are conditions for which no cure is available and for which the probable outcome is premature death. Palliative care may also be appropriate for children who have life-threatening conditions these are conditions where there is not only a high probability of premature death but also a chance of long-term survival into adulthood Although pediatric palliative care is underpinned by the same philosophy as adult palliative care, children who have life-limiting conditions and their families have particular needs that distinguish them from users of adult palliative care. For ex le, at a physical level children are more likely than adults to have non-malignant conditions that follow trajectories in which children oscillate between feeling relatively well and acutely unwell. The social dynamic of their care is also radically different, particularly given the role of parents or guardians in making surrogate decisions about their child's care. Such factors warrant considering pediatric palliative care as distinct from palliative care more generally.Although the particular circumstances of children who have life-limiting conditions have led to development of pediatric palliative care, the particular provisions of this care differs among countries. One aspect of variation is the age range of patients. Pediatric palliative care is usually provided to neonates, infants, children, adolescents and young adults, but international variations in the definitions of these age ranges, particularly for adolescents and young adults, means pediatric palliative care is provided to different age groups in different countries. This review therefore adopts a pragmatic rather than an age-based definition of a pediatric palliative care, considering all studies relating to service users who are being cared for by pediatric rather than adult healthcare services.In catering for the unique needs of children who have life-limiting conditions and their families, pediatric palliative care aims to achieve pain and symptom management, enhanced dignity and quality of life, and psychosocial and spiritual care. It also seeks to incorporate care for patients' broader families and facilitating access to appropriate services and support. High-quality communication is crucial for achieving these aims. It enables healthcare users and providers to make decisions that underpin the care that is provided and the quality of the life that is possible for patients and their families.Although both users and providers recognize the value of high-quality communication with and about children who have life-limiting conditions, this does not mean that these stakeholders necessarily share the same perspective of what constitutes high-quality communication and the best way of accomplishing this. Focusing on healthcare users' experiences of communication with healthcare professionals about children who have life-limiting conditions, the present review will explore the subjective impact of professionals' communication on the people for whom they provide care.It may be necessary to consider a range of contextual factors to understand healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions. For instance, age, developmental stage, cognitive capacity, emotional and social strengths, and family dynamics can influence a child's level of involvement in discussions about their condition and care. Although there are factors that appear more consistent across the range of pediatric palliative care users, such as parents' preferences for being treated by healthcare professionals as partners in making decisions about the care of their child, there is not always such consistency. Nor is it clear whether such findings can be generalized across different cultural contexts. In appraising existing research, this systematic review will therefore consider the relationship between the context of in idual studies and their reported findings.The primary aim of this review is to identify, appraise and synthesize existing qualitative evidence of healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions. The review will consider relevant details of these findings, particularly whether factors like age are relevant for understanding particular experiences of communication. An outcome of this review will be the identification of best available qualitative evidence that can be used to inform professional practice, as well as an identification of priorities for future research in pediatric palliative care.A preliminary search in MEDLINE and CINAHL found primary studies exploring healthcare users' experiences of aspects of communicating with healthcare professionals about children who have life-limiting conditions. A search was also conducted for existing systematic reviews in PubMed, CINAHL, EMBASE, PsycINFO, the Cochrane Database of Systematic Reviews, the JBI Database of Systematic Reviews and Implementation Reports, and PROSPERO. No systematic reviews on this topic were found.
Publisher: Mary Ann Liebert Inc
Date: 02-2021
Publisher: American Society of Clinical Oncology (ASCO)
Date: 2023
DOI: 10.1200/CCI.22.00134
Abstract: To codesign, develop, and evaluate a smartphone app that includes patient-reported measures of symptoms and real-time advice in children's cancer. The Oncology Hub is a comprehensive approach to symptom management that includes a suite of codesigned tools and resources including clinical algorithms to determine the level of concern, symptom management advice, and resources for families of children with cancer. The evaluation involved Think Aloud interviews with parent and adolescent patients to complete tasks in the app as well as a User Experience questionnaire (score range, 0-120) and qualitative feedback. The accuracy of algorithms was determined by repeated testing of inputs and outputs over 4 weeks. Design and wireframes were iteratively refined through consultation with parents and adolescents confirming the final design. Beta testing evaluation was then completed by 25 participants including two adolescents. Across all participants, 84% of tasks were easy to navigate, and the Oncology Hub demonstrated high usability, usefulness, and acceptability with participants' scores ranging between 90 and 120 (mean = 112.2, standard deviation = 9.43). Qualitative feedback was positive. Testing of algorithms identified inconsistencies in understanding between clinical research and coding teams refinements were made until the expected response notifications were returned with 100% accuracy. Technology offers new ways to think about how clinicians and families communicate and share information to harness the best of community and hospital services. Understanding how information is exchanged using health apps, and how this affects clinical workflow is critical to successful implementation, and optimizing symptom assessment and management in children with cancer.
Publisher: Mary Ann Liebert Inc
Date: 02-2018
Abstract: The consequences of cancer and treatment on fertility can be a continuing source of distress for adolescents and young adults. The study aims were to assess the effects of bundled interventions on clinical practice concerning fertility in young people aged 14-25 years with cancer. Bundled interventions, including development of quality indicators, resources, and targeted education, were introduced during 2015 across five cancer centers. Data before interventions (2012-2014) were compared with data prospectively collected during 2015-2016. Relative risks (RR) with 95% confidence intervals (CI) were calculated to assess effects of interventions. Compared with the pre-intervention cohort (n = 260), the post-intervention cohort (n = 216) was 1.47 times more likely to have documented discussion of risk of infertility (95% CI 1.12-1.63, p = <0.001). Similarly, documented referral to fertility specialists was more likely in the post-intervention cohort (RR 1.53, 95% CI 1.26-1.87, p = <0.001) as was documented fertility preservation outcomes (RR 2.56, 95% CI 1.91-3.44, p = <0.001). These differences were significant across age, gender, and diseases. Females had greater improvement in documented risk of infertility discussion between cohorts (RR 1.70, 95% CI 1.19-2.08, p = <0.001). Among diseases, the greatest improvements were seen in those with brain cancers (RR 2.15, 95% CI 1.28-3.62, p = 0.004) and soft tissue sarcoma (RR 2.60, 95% CI 1.17-5.78, p = 0.02). We have demonstrated the effects of bundled interventions to improve clinical practice associated with fertility preservation in young people with cancer. Interventions were successful for reducing disparities identified in the pre-intervention cohort associated with gender and certain diseases. Assessment of the quality of patient care is not possible without accurate, consistent documentation.
Publisher: Springer Science and Business Media LLC
Date: 06-2015
Publisher: Wiley
Date: 28-01-2022
Abstract: Children's agency in their own lives is increasingly recognised as important, including within paediatric health care. The issue of acknowledging child agency is complex in the context of paediatric palliative care, where children have serious and complex conditions that often impact their ability to verbally communicate with others. This study explores how clinicians and parents/guardians direct talk towards a child patient when they are present in a consultation. Conversation analysis methods were used to examine 74 video‐recorded paediatric palliative care consultations. Detailed turn‐by‐turn examination of the recorded consultations identified the recurrent use of a practice described by linguists as a ‘tag question’, which follows some statement (e.g. ‘he loves that, don't ya’). Both clinicians and parents/guardians often directed these tag questions towards the child patient. Analysis demonstrated how these tag questions: (1) validated the child's epistemic authority over what was being said and (2) made a child's response a possible, but not necessary, next action. The findings are discussed in relation to the sociology of child agency and how this agency is acknowledged and displayed within and through social interaction. This research provides direct evidence of children's competence as informants about their own symptoms.
Publisher: SAGE Publications
Date: 6
Abstract: For most children and adolescents diagnosed with a brain tumor, whether malignant or not, there will be an irrevocably negative impact on their life and that of their family. In Australia, 5 year disease-free survival is 76% meaning that many young people will go on to live with the negative consequences—including neurological and cognitive deficits, reduced school performance, psychological problems, and problems with peer social relationships—of the tumor and associated treatment. Little is known about the experiences and psychosocial healthcare needs of families living with brain tumor, particularly from the perspectives of children and adolescents. We will fill this knowledge gap with a multimethods approach for flexible data collection that addresses the erse needs of children and families living with a life-threatening illness. Recruited through the largest state pediatric health service in Queensland, Australia, we will follow families from diagnosis to capture their experiences and healthcare needs as they navigate their child’s treatment and survivorship or death. Data collection methods include semi-structured interviews, virtual tours and Photovoice all family members will be invited to participate. Reflexive thematic analysis will be used to explore the lived experiences of families, and their community and health services needs and associated facilitators and barriers to receiving such care. Our analysis will consider multiple perspectives: the in idual, dynamics within each family, and patterns observed across families. This research will inform the co-design of interventions with families to address the service gaps and healthcare needs identified by participants.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JPAINSYMMAN.2018.12.003
Abstract: Financial toxicity (FT) is used to describe the financial distress/hardship associated with cancer and its treatment. The aim of this review was to explore the relationship between FT and symptom burden. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE, EMBASE, and CINAHL (from January 2000 to January 2018) and accepted quantitative, mixed-methods and qualitative studies. Data were extracted and appraised by two reviewers. Owing to significant heterogeneity in the included studies, a narrative synthesis was performed. Nine studies involving 11,544 cancer survivors were included. Of these nine studies, eight were of high quality. The relationships between FT and psychological symptoms and physical symptoms were examined in eight and three studies, respectively. Six studies reported a positive relationship between FT and depression. Three studies found a positive association between FT and anxiety. Limited evidence was found for an association between FT and stress, fear of recurrence, spiritual suffering, pain, and overall symptom burden. A relatively clear association exists between FT and psychological symptoms. Clinicians should regularly screen for, assess, and manage emotional distress that may be attributed to FT. Although the causal pathway is not known, future intervention studies aimed at minimizing or preventing FT should evaluate psychological symptoms as secondary outcomes. Little is known about the relationships between FT and physical symptoms. Future research should overcome methodological limitations by incorporating longitudinal data collection, use of mixed-methods approaches, and homogeneity of s les.
Publisher: Oxford University Press (OUP)
Date: 22-04-2022
DOI: 10.1093/MTP/MIAC003
Abstract: Music therapy (MT) is a widely used non-pharmacological intervention in pediatric health care, an integral part of pediatric palliative care (PPC). Yet, there is a lack of evidence of efficacy, and best practices are not well established. The nature and extent of physiologic impacts of MT in PPC have not previously been reported. This study explores how MT contributes to psycho-physiological changes in children receiving palliative care. We used a convergent mixed-methods feasibility study with a pre–post design. MT sessions were delivered to children (0–18 years), who were registered with a statewide Pediatric Palliative Care Service. Pre–post measures of pain and heart rate were collected using validated and objective measures and analyzed using mixed-model analysis. Analysis of 36 MT sessions demonstrated a statistically significant reduction in pain scores and heart rate after MT sessions. Post measures of pain measured with Face, Legs, Activity, Cry, Consolability scale (FLACC scale) scores were −1.57 (95% confidence interval [CI] −2.31 to −0.83) and by Likert pain scale −2.03 (95% CI −2.79 to −1.27). Heart rate reduced by a mean of −7.6 beats per minute (95% CI −10.74 to −3.37). Five parents participated in semi-structured interviews. Following thematic analysis, two major themes emerged: (1) MT has a positive impact on physiological symptoms and (2) MT enhances the opportunity to experience joy. Results demonstrate the feasibility of study components and may inform future research design for a larger study. This research contributes to the limited evidence about non-pharmacological interventions enhancing the quality of life for children receiving PPC.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY15105
Abstract: A retrospective analysis of hospitalisation due to oral and dental conditions (ODC) was performed for patients in Queensland. The aim was to identify the rate and cost of hospitalisation and to examine the association between hospitalisation and age, geographical location and Indigenous status. There were 81528 admissions to Queensland’s hospitals due to ODC during the 3-year study period (2011–2013). The annual cost of ODC-related hospitalisation was estimated to be AU$87million. Indigenous infants (Z=4.08, P .001) and primary school children (Z=2.01, P=0.046) were significantly more likely to be hospitalised than their non-Indigenous counterparts. A non-Indigenous high school child was almost fourfold more likely to be hospitalised. There was no significant difference in the rate of hospitalisation for adults. Infants (Z=6.70, P .001) and primary school children (Z=8.73, P .001) from remote areas were significantly more likely to be hospitalised than their age-matched metropolitan counterparts. Whereas high school children (Z=2.74, P=0.006) and adults (Z=6.02, P .001) from remote areas were significantly less likely to be hospitalised. Our findings suggest that there is a need for alternative models of primary dental care to service remote areas of Queensland and Indigenous populations. Strategies that enable Indigenous Health Workers to provide dental care, and the use of teledentistry, are models of care that may reduce potentially preventable hospitalisations and lead to cost savings and better health outcomes.
Publisher: SAGE Publications
Date: 04-2000
Abstract: As part of a randomized controlled trial of the costs and benefits of realtime teledermatology in comparison with conventional face-to-face appointments, patients were asked to complete a questionnaire at the end of their consultation. One hundred and nine patients took part in an initial teledermatology consultation and 94 in a face-to-face consultation. The proportion of patients followed up by the dermatologist was almost the same after teledermatology 24 as after a hospital appointment 26 and for similar reasons. Two hundred and three questionnaires were completed after the first visit and a further 20 after subsequent visits. Patients seen by teledermatology at their own health centre travelled an average of 12 km, whereas those who attended a conventional clinic travelled an average of 271 km. The telemedicine group spent an average of 51 min attending the appointment compared with 4.3 h for those seen at the hospital. The results of the present study, as in a similar study conducted in Northern Ireland, show that the economic benefits of teledermatology favour the patient rather than the health-care system.
Publisher: Elsevier BV
Date: 02-2017
Publisher: Wiley
Date: 02-07-2022
DOI: 10.1002/PON.5987
Abstract: Most adolescents and young adults (AYA) can expect to survive a cancer diagnosis and treatment, but all will be left with the potential of long‐term negative effects that can impact their ability to reach their full potential in life. Understanding aspects of psychological, functional, and social health and well‐being outcomes, is pivotal for optimising long‐term well‐being. We completed a systematic review of longitudinal studies reporting outcomes after anti‐cancer treatment for Adolescents and Young Adults diagnosed between the age of 12–29 years according to established systematic review processes. The protocol was registered with PROSPERO (ID: CRD 42020203116). Thirteen reports from 10 studies met eligibility criteria representing 17,645 in iduals (50.3% female, mean age at diagnosis 22 years, and 26 years at last, follow up). Eleven reports were from eight quantitative studies that relied on self‐report surveys and two were qualitative studies. Psychological outcomes were reported to improve over time, as were functional health outcomes, although reported health behaviours were inconsistent between studies. Neurocognitive deficits were reported to affect the ability to return to work and impacts on fertility and sexuality were sustained over time. While some outcomes for AYA are reported to improve over time, particularly for physical functioning, and anxiety and depression, the long‐term impact of cancer on many important domains remains largely unknown. Specifically, the evidence to understand what changes occur over time, and when, remains underdeveloped.
Publisher: Wiley
Date: 14-06-2021
DOI: 10.1002/PON.5745
Abstract: Brain tumors are the most common and fatal of all solid tumors for children and adolescents those who survive live with long‐term physical and emotional consequences, as do their families. We aimed to synthesize relevant qualitative evidence on families’ experiences and psychosocial service needs across the lifespan to identify gaps in care delivery and research. Searches were conducted in Medline, CINAHL, PsycInfo, Embase, and Web of Science. Identified papers were assessed with the Joanna Briggs Institute Critical Appraisal Tool. Data were extracted into NVivo12 and analyzed by qualitative description and, where appropriate, thematic analysis. The search yielded 628 papers, of which 40 (33 studies) were eligible (6%). Although the methodological quality of the papers was low, we identified concerns that were consistently reported over time and from different perspectives. In idual family members had varying psychosocial needs to be addressed within healthcare, schooling, and public policy. These include for survivor’s mental health (particularly for body image), and to the disproportionate biopsychosocial burden faced by mother‐caregivers. Addressing the biological aspects of brain tumor cannot be our only focus. We have an obligation to provide services that meet the needs of families across diagnosis, treatment, survivorship, palliative care, and bereavement.
Publisher: Wiley
Date: 18-08-2023
DOI: 10.1002/CAM4.6444
Abstract: Adolescent and young adult (AYA) cancer patients and survivors face significant mental health challenges throughout their cancer journey that are different to those faced by children and older adults. Patient‐reported outcome measures (PROMs) can be used to explore the experiences of AYAs, and to identify important issues and areas for potential improvement in quality of life. We aimed to compare patient reported mental health outcomes between AYAs diagnosed with cancer and non‐cancer controls. We built on a larger systematic review of AYA cancer PROMs which searched PubMed, EMBASE, CINAHL and PsychINFO. This review identified 175 articles, which were filtered to those reporting on mental health and including a non‐cancer control group. We identified 12 eligible studies. Seven studies (58%) found those diagnosed with cancer reported poorer mental health than the non‐cancer controls. The remaining five (42%) studies found no significant difference in severity or prevalence of mental health between the AYA cancer cohort and the healthy control group. Most (83%) were cross‐sectional studies, highlighting the need for further longitudinal assessment of this group throughout their journey. The mental health outcomes feature conflicting results and illustrate the need for larger studies to characterise discrepancies.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.PEC.2018.08.014
Abstract: To consider whether and how family members and clinicians discuss end of life during paediatric palliative care consultations. Nine naturally occurring paediatric palliative care consultations were video recorded and analysed using conversation analytic methods. Focusing on three consultations in which end of life was treated as a certain outcome, analysis explored ways in which end of life was made either implicit or explicit within these consultations. Our analysis suggests that end of life was made explicit when: 1) ancillary to the current focus of discussion, 2) in relation to someone else's child, or 3) specifically relevant to the local context of the discussion. More commonly, in all other instances in the data, end of life was made implicit during discussions relating to this matter. This preliminary research indicates that the local context of a conversation can influence how end of life is mentioned and discussed. Clinicians often are encouraged to promote honest and 'open' discussions about end of life. Our findings show that it is not necessary to explicitly mention end of life in order to discuss it.
Publisher: Springer Science and Business Media LLC
Date: 15-02-2021
DOI: 10.1186/S12913-021-06119-7
Abstract: Technology is increasingly transforming the way we interact with others and undertake activities in our daily lives. The healthcare setting has, however, not yet realised the potential of technology solutions to facilitate communication between patients and healthcare providers. While the procedural and policy requirements of healthcare systems will ultimately drive such solutions, understanding the preferences and attitudes of patients is essential to ensure that technology implemented in the healthcare setting facilitates communication in safe, acceptable, and appropriate ways. Therefore, the purpose of this study was to examine patient preferences for using technology to communicate with health service providers about symptoms experienced following discharge from the hospital. Primary data were collected from patients admitted to a large metropolitan hospital in Australia during three consecutive months in 2018. Participants were asked about their daily use of technology including use of computers, email, phone, text messaging, mobile applications, social media, online discussion forums, and videoconference. They were then asked about their use of technologies in managing their health, and preferences for use when communicating about symptoms with health service providers following discharge from hospital. Five hundred and twenty-five patients with a wide range of differing clinical conditions and demographics participated. Patients indicated they used a range of technologies in their everyday lives and to manage their health. Almost 60% of patients would prefer to return to hospital if they were experiencing symptoms of concern. However, if patients experienced symptoms that were not of concern, over 60% would prefer to communicate with the hospital via telephone or using technology. Admitting condition, income, and age were significantly associated with preferences for communication about symptoms following hospital discharge. Patients have varied preferences for communicating with their health service providers post-hospital discharge. Findings suggest that some, but not all patients, would prefer to use technology to traditional methods of communicating with the healthcare team. Health services should offer patients multiple options for communicating about their recovery to ensure in idual needs are appropriately met.
Publisher: Elsevier BV
Date: 04-2017
Publisher: Springer Science and Business Media LLC
Date: 20-03-2017
DOI: 10.1007/S10916-017-0709-4
Abstract: Providing equitable access to healthcare services in rural and remote communities is an ongoing challenge that faces most governments. By increasing access to specialty expertise, telemedicine may be a potential solution to this problem. Regardless of its potential, many telemedicine initiatives do not progress beyond the research phase, and are not implemented into mainstream practice. One reason may be that some telemedicine services are developed without the appropriate planning to ascertain community needs and clinical requirements. The aim of this paper is to report the development of a planning framework for telemedicine services based on needs assessment. The presented framework is based on the key processes in needs assessment, Penchansky and Thomas's dimensions of access, and Bradshaw's types of need. This proposed planning framework consists of two phases. Phase one comprises data collection and needs assessment, and includes assessment of availability and expressed needs accessibility perception and affordability. Phase two involves prioritising the demand for health services, balanced against the known limitations of supply, and the implementation of an appropriate telemedicine service that reflects and meets the needs of the community. Using a structured framework for the planning of telemedicine services, based on need assessment, may help with the identification and prioritisation of community health needs.
Publisher: Wiley
Date: 13-08-2020
DOI: 10.1002/PON.5462
Publisher: Wiley
Date: 02-2016
DOI: 10.1111/IJN.12426
Publisher: Mary Ann Liebert Inc
Date: 08-2022
Publisher: SAGE Publications
Date: 22-11-2020
Abstract: Effective communication is a cornerstone of quality paediatric palliative care. Families report struggling, however, to know what to discuss, with whom, and when. Although question prompt lists exist for adult palliative care, they do not suit the unique circumstances of paediatric palliative care. To develop a prompt list suitable for paediatric palliative care. Underpinned by Delphi methodology, a six-phase procedure was adopted: (1) drafting items based on the findings of a literature review, (2) condensing the list of items based on group discussion, (3) refining items based on a survey of expert healthcare professionals, (4) additional refining of items based on another survey of professionals, (5) further refining of items based on cognitive interviews with family members, and (6) final review by healthcare professional and family member groups. Three participant groups were involved during various phases: (1) members of an Australasian paediatric palliative care national reference group, (2) healthcare professionals associated with a local paediatric palliative care service, and (3) family members who were users of the same local service. Through multi-phase consultation across participant groups, the draft question prompt list was refined progressively to 28 items, split across two booklets to allow end-of-life items to be provided separately, and reconceptualised as a discussion prompt list rather than a question prompt list. By involving representatives of major stakeholder groups, this study has facilitated the design of a prompt list suited to the circumstances of paediatric palliative care. Future research should trial the effectiveness of this resource.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
Publisher: SAGE Publications
Date: 06-06-2018
Abstract: Febrile neutropenia requires prompt assessment and antibiotic administration and is the most common reason for unexpected hospital admission in pediatric oncology. Parents are expected to be vigilant and “drop everything” to take their child to their nearest hospital for assessment if fever occurs. Delays in antibiotic administration are associated with poorer outcomes however, delays are common. Our aim was to understand and describe the lived experience of parents of children with cancer who received treatment for fever with confirmed/suspected neutropenia. We used descriptive phenomenological concepts to undertake and analyze interviews with parents, who were asked to describe their recent experience of hospitalization in Queensland, Australia. Nine participants were interviewed. Five children were treated in the tertiary treating center and four were treated in smaller regional towns. Three main categories were identified that shaped and characterized parents’ experiences: being heard, confidence in capabilities of health care professionals, and living with anticipated distress and uncertainty. Parents’ experiences were related to the level they needed to advocate for their child’s care across all themes. Familiarity with health care professionals increased confidence and improved parents’ experiences. Maintaining vigilance and managing the child and family’s response to an unexpected admission had a substantial negative effect on parents. Understanding parents’ experiences and perceptions of the management of febrile neutropenia adds to the current body of knowledge and offers potential new insights to improve clinical practice.
Publisher: Oxford University Press (OUP)
Date: 30-05-2019
DOI: 10.1634/THEONCOLOGIST.2019-0043
Abstract: Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. Currently, oncofertility competencies do not exist. The aim of this study was to develop an oncofertility competency framework that defines the key components of oncofertility care, develops a model for prioritizing service development, and defines the roles that health care professionals (HCPs) play. A quantitative modified Delphi methodology was used to conduct two rounds of an electronic survey, querying and synthesizing opinions about statements regarding oncofertility care with HCPs and patient and family advocacy groups (PFAs) from 16 countries (12 high and 4 middle income). Statements included the roles of HCPs and priorities for service development care across ten domains (communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, oncofertility training, reproductive survivorship care and fertility-related psychosocial support, supportive care, and ethical frameworks) that represent 33 different elements of care. The first questionnaire was completed by 457 participants (332 HCPs and 125 PFAs). One hundred and thirty-eight participants completed the second questionnaire (122 HCPs and 16 PFAs). Consensus was agreed on 108 oncofertility competencies and the roles HCPs should play in oncofertility care. A three-tier service development model is proposed, with gradual implementation of different components of care. A total of 92.8% of the 108 agreed competencies also had agreement between high and middle income participants. FP guidelines establish best practice but do not consider the skills and requirements to implement these guidelines. The competency framework gives HCPs and services a structure for the training of HCPs and implementation of care, as well as defining a model for prioritizing oncofertility service development. Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. The competency framework gives 108 competencies that will allow health care professionals (HCPs) and services a structure for the development of oncofertility care, as well as define the role HCPs play to provide care and support. The framework also proposes a three-tier oncofertility service development model which prioritizes the development of components of oncofertility care into essential, enhanced, and expert services, giving clear recommendations for service development. The competency framework will enhance the implementation of FP guidelines, improving the equitable access to medical and psychological oncofertility care.
Publisher: SAGE Publications
Date: 10-2014
Abstract: We implemented a community telehealth project in the three towns in the Darling Downs area of Queensland over a 2-year period starting in July 2012. The purpose of the project was to generate telehealth activity in hospitals, general practice and selected residential aged care facilities. Telehealth education and training was provided to clinicians in the three towns and a community awareness c aign was delivered using advertisements in newspapers, messages in social media and presentations at community events. A total of 55 stakeholders were engaged with during 61 site visits to health care facilities during the first two years of the project. During the study period, telehealth activity in Queensland increased in the hospital sector by 39% and in the non-hospital sector by 99%. In the Darling Downs region, telehealth activity in the hospital sector increased by 104%, compared to 28% in the rest of Queensland. However, in the non-hospital sector, the increase in telehealth activity in the Darling Downs region was similar to the rest of Queensland. Telehealth services established and/or facilitated by the project included specialist geriatric ward rounds in Dalby, Chinchilla and Miles for patients in the local hospitals and nursing homes and ad-hoc teleconsultations for children and adults living in these communities, with specialists at Toowoomba and hospitals in Brisbane. An increase in telehealth implies better access to a range of clinical services, which may result in improved clinical outcomes for patients.
Publisher: SAGE Publications
Date: 10-2014
Abstract: We compared the records of paediatric palliative consultations undertaken face-to-face, with telemedicine consultations undertaken in patients’ homes. A convenience s le of consecutive paediatric palliative care patients was identified from the hospital's palliative care database. A total of 100 consultations was reviewed (50 telemedicine consultations during home visits and 50 face-to-face consultations) according to 14 established principles and components of a paediatric palliative care consultation. In the telemedicine group there was a higher proportion of patients in a stable condition (58% vs 7%), and a lower proportion of patients in terminal phase (2% vs 17%). Discussion about pain and anorexia were significantly more common in the telemedicine group. Discussion about follow up was significantly more common in the telemedicine group (86% vs 56%), whilst resuscitation planning was more common in deteriorating patients receiving inpatient care. All other components and principles of a palliative care consultation were documented equally regardless of method of consultation. The findings confirm that palliative consultations via telemedicine are just as effective as face-to-face consultations in terms of the documented components of the consultation.
Publisher: JMIR Publications Inc.
Date: 12-04-2022
DOI: 10.2196/36357
Abstract: There is an urgent need to reduce preventable deaths and hospitalizations from prescription opioid harms and minimize the negative effect opioid misuse can have on injured in iduals, families, and the wider community. Data linkage between administrative hospitalization records for injured patients and community opioid dispensing can improve our understanding of the health and surgical trajectories of injured persons and generate insights into corresponding opioid dispensing patterns. The Community Opioid Dispensing after Injury (CODI) study aims to link inpatient hospitalization data with opioid dispensing data to examine the distribution and predictive factors associated with high or prolonged community opioid dispensing among adults, for 2 years following an injury-related hospital admission. This is a retrospective population-based cohort study of adults aged 18 years or older hospitalized with an injury in Queensland, Australia. The study involves the linkage of statewide hospital admissions, opioid prescription dispensing, and mortality data collections. All adults hospitalized for an injury between January 1, 2014, and December 31, 2015, will be included in the cohort. Demographics and injury factors are recorded at the time of the injury admission. Opioid dispensing data will be linked and extracted for 3 months prior to the injury admission date to 2 years after the injury separation date (last date December 31, 2017). Deaths data will be extracted for the 2-year follow-up period. The primary outcome measure will be opioid dispensing (frequency and quantity) in the 2 years following the injury admission. Patterns and factors associated with community opioid dispensing will be examined for different injury types, mechanisms, and population subgroups. Appropriate descriptive statistics will be used to describe the cohort. Regression models will be used to examine factors predictive of levels and duration of opioid use. Nonparametric methods will be applied when the data are not normally distributed. The project is funded by the Royal Brisbane and Women’s Hospital Foundation. As of November 2021, all ethics and data custodian approvals have been granted. Data extraction and linkage has been completed. Data management and analysis is underway with results relating to an analysis for blunt chest trauma patients expected to be published in 2022. Little is currently known of the true prevalence or patterns of opioid dispensing following injury across Queensland. This study will provide new insights about factors associated with high and long-term opioid dispensing at a population level. This information is essential to inform targeted public policy and interventions to reduce the risk of prolonged opioid use and dependence for those injured. The novel work undertaken for this project will be vital to planning, delivering, monitoring, and evaluating health care services for those injured. The findings of this study will be used to inform key stakeholders as well as clinicians and pain management services. RR1-10.2196/36357
Publisher: Mary Ann Liebert Inc
Date: 30-10-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
Publisher: Mary Ann Liebert Inc
Date: 05-2015
Publisher: University of KwaZulu-Natal
Date: 06-12-2018
Abstract: Introduction: Access to speech-language pathology services for children in rural and remote communities is often limited. Telehealth is increasingly used to provide these services to schools, demonstrating high satisfaction with both service providers and recipients, but the requirements for successful program implementation are as yet unclear. We aimed to explore the implementation requirements for a telehealth speech-language pathology service for children from the perspective of a rural school. Methods: A qualitative approach, supplemented by program activity data, was used to understand the experiences and perceptions of the benefits, limitations, enablers and barriers of a telehealth speech-language pathology program delivered to a school servicing approximately 400 children in a small rural town in the state of Queensland, Australia. Thematic analysis was conducted of transcripts of in idual semi-structured interviews with nine school teaching staff and field notes of informal discussions regarding 85 speech-language pathology telehealth sessions (n = 9 children) during program establishment and implementation. Results: The speech-language pathology telehealth service was acceptable to teaching staff at the rural school, who cited improved access, the suitability of the technology for child engagement, and perceived effectiveness. Implementation issues were highlighted as critical to program success and scalability, particularly staff workload, technological issues, communication processes, and sustainability. Conclusion: School-based speech-language pathology services delivered via telehealth were perceived as a suitable way of increasing access for children by rural school staff. Future implementations of telehealth speech-language pathology programs should prospectively consider workload implications and develop strategies to communicate with and involve school staff.
Publisher: Springer Science and Business Media LLC
Date: 16-12-2023
Publisher: SAGE Publications
Date: 30-12-2014
Abstract: Febrile neutropenia (FN) is a common complication in pediatric oncology with intravenous antibiotics being given routinely for decades. This study aimed to compare the management of FN in children in different locations across Queensland, Australia. FN episodes were identified from 4 settings: tertiary oncology outpatient department (OD), tertiary emergency department (ED), regional ward (RW), and regional emergency department (RED) between July 2009 and June 2011. Retrospective data were extracted from medical records, collated, and then analyzed to identify differences in outcomes attributable to location. Sixty-one episodes of FN were reviewed: 5 cases from OD, 28 from ED, 19 from RW, and 5 from RED. Statistically significant differences occurred in the time taken for medical review for cases depending on location of presentation. Patients who presented to the ED or the RW were more likely to be seen within 30 minutes than in other locations ( P = .014), and patients who presented to the tertiary hospital in either the OD or ED were more likely to commence antibiotics within 120 minutes of presentation ( P = .023). Antibiotics were commenced within 60 minutes (the gold standard) on only 10 occasions. Despite education input emphasizing the importance of early commencement of antibiotics, this study identified that this objective was not met in the majority of cases. Further study is needed to look at reasons for the delay in beginning treatment for pediatric oncology patients in Queensland and what measures may assist with improving the time from presentation with FN to antibiotic administration across all settings.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.IJMEDINF.2015.06.006
Abstract: Low-cost and no-cost software-based video tools may be a feasible and effective way to provide some telemedicine services, particularly in low-resource settings. One of the most popular tools is Skype it is freely available, may be installed on many types of devices, and is easy to use by clinicians and patients. While a previous review found no evidence in favor of, or against the clinical use of Skype, anecdotally it is believed to be widely used in healthcare for providing clinical services. However, the range of clinical applications in which Skype has been used has not been described. We aimed to identify and summarize the clinical applications of Skype. We reviewed the literature to identify studies that reported the use of Skype in clinical care or clinical education. We searched three electronic databases using the single search term "Skype". We found 239 unique articles. Twenty seven of the articles met our criteria for further review. The use of Skype was most prevalent in the management of chronic diseases such as cardiovascular diseases and diabetes, followed by educational and speech and language pathology applications. Most reported uses were in developed countries. In all but one case, Skype was reported by the authors to be feasible and to have benefit. However, while Skype may be a pragmatic approach to providing telemedicine services, in the absence of formal studies, the clinical and economic benefits remain unclear.
Publisher: JMIR Publications Inc.
Date: 13-01-2022
Abstract: here is an urgent need to reduce preventable deaths and hospitalizations from prescription opioid harms and minimize the negative effect opioid misuse can have on injured in iduals, families, and the wider community. Data linkage between administrative hospitalization records for injured patients and community opioid dispensing can improve our understanding of the health and surgical trajectories of injured persons and generate insights into corresponding opioid dispensing patterns. he Community Opioid Dispensing after Injury (CODI) study aims to link inpatient hospitalization data with opioid dispensing data to examine the distribution and predictive factors associated with high or prolonged community opioid dispensing among adults, for 2 years following an injury-related hospital admission. his is a retrospective population-based cohort study of adults aged 18 years or older hospitalized with an injury in Queensland, Australia. The study involves the linkage of statewide hospital admissions, opioid prescription dispensing, and mortality data collections. All adults hospitalized for an injury between January 1, 2014, and December 31, 2015, will be included in the cohort. Demographics and injury factors are recorded at the time of the injury admission. Opioid dispensing data will be linked and extracted for 3 months prior to the injury admission date to 2 years after the injury separation date (last date December 31, 2017). Deaths data will be extracted for the 2-year follow-up period. The primary outcome measure will be opioid dispensing (frequency and quantity) in the 2 years following the injury admission. Patterns and factors associated with community opioid dispensing will be examined for different injury types, mechanisms, and population subgroups. Appropriate descriptive statistics will be used to describe the cohort. Regression models will be used to examine factors predictive of levels and duration of opioid use. Nonparametric methods will be applied when the data are not normally distributed. he project is funded by the Royal Brisbane and Women’s Hospital Foundation. As of November 2021, all ethics and data custodian approvals have been granted. Data extraction and linkage has been completed. Data management and analysis is underway with results relating to an analysis for blunt chest trauma patients expected to be published in 2022. ittle is currently known of the true prevalence or patterns of opioid dispensing following injury across Queensland. This study will provide new insights about factors associated with high and long-term opioid dispensing at a population level. This information is essential to inform targeted public policy and interventions to reduce the risk of prolonged opioid use and dependence for those injured. The novel work undertaken for this project will be vital to planning, delivering, monitoring, and evaluating health care services for those injured. The findings of this study will be used to inform key stakeholders as well as clinicians and pain management services. R1-10.2196/36357
Publisher: Mary Ann Liebert Inc
Date: 03-2014
Abstract: Pediatric palliative care is an evolving specialty that aims to improve the lives of children with a life-limiting condition. As an emerging specialty, there is much to be learned about service provision and the expected outcomes that can be achieved. Additionally, quantification of the needs for pediatric palliative care is complicated by the uncertainty of defining the population that requires care. Our aim was to define the characteristics of the population cared for by a newly formed state-wide service in Queensland, Australia, and describe the development of the service over a 24-month period. Data on all referrals and outcomes were collected. Descriptive statistics were used to describe patterns including the variation in outcomes between children with oncology and non-oncology diagnoses. Other factors influencing the development of the service including involved health professionals and the model of the Australian health care system are also described. Over a 24-month period, 150 patients were referred of whom 117 subsequently died. There was a wide range of diseases and ages, and significantly, 58% of children were from regional or rural locations where there are can be limited access to specialist pediatric services. The average length of service was 83 days. A variety of factors were identified as being important for providing optimal care including ensuring equity in access, timing of referral, and continuity of care. The importance of a population-based approach to pediatric palliative care in a state that is geographically large and erse like Queensland is highlighted. This article may provide valuable information to other health care providers who care for children with life-limiting illnesses.
Publisher: Springer Science and Business Media LLC
Date: 28-08-2021
DOI: 10.1186/S12874-021-01371-1
Abstract: Variations in clinical practice contribute to negative outcomes for children with cancer. Research in this area is imperative to standardise practice, yet such research is challenging to undertake, and a significant proportion of studies fail. A common reason for failure is poor recruitment, yet little information is available to support researchers and clinicians planning such research. Our primary aim was to describe the recruitment strategies and outcomes in a tertiary children’s hospital across multiple observational supportive care studies. Secondary aims were to establish principles to improve both recruitment strategies and the reporting of recruitment. We undertook a retrospective descriptive analysis of the recruitment logs and data from three studies in pediatric oncology. The mean time to recruit one participant was calculated. Common reasons for not approaching eligible participants and reasons potential participants declined are described. Of the 235 potential candidates across all studies, 186 (79%) were approached and of these 125 (67%) provided consent, with 117 (63%) completing baseline measures. We estimated recruitment per participant required an average 98 min of experienced research nurse time. Four factors are described that influence recruitment and six principles are outlined to maximise recruitment and the generalisability of research findings. We highlight the recruitment experiences across three different projects in children’s cancer supportive care research and provide a roadmap for other researchers planning to undertake clinical research in pediatrics.
Publisher: Mary Ann Liebert Inc
Date: 02-2018
Abstract: The consequences of cancer and treatment on fertility can be a continuing source of distress for adolescents and young adults. The study aims were to assess the effects of bundled interventions on clinical practice concerning fertility in young people aged 14-25 years with cancer. Bundled interventions, including development of quality indicators, resources, and targeted education, were introduced during 2015 across five cancer centers. Data before interventions (2012-2014) were compared with data prospectively collected during 2015-2016. Relative risks (RR) with 95% confidence intervals (CI) were calculated to assess effects of interventions. Compared with the pre-intervention cohort (n = 260), the post-intervention cohort (n = 216) was 1.47 times more likely to have documented discussion of risk of infertility (95% CI 1.12-1.63, p = <0.001). Similarly, documented referral to fertility specialists was more likely in the post-intervention cohort (RR 1.53, 95% CI 1.26-1.87, p = <0.001) as was documented fertility preservation outcomes (RR 2.56, 95% CI 1.91-3.44, p = <0.001). These differences were significant across age, gender, and diseases. Females had greater improvement in documented risk of infertility discussion between cohorts (RR 1.70, 95% CI 1.19-2.08, p = <0.001). Among diseases, the greatest improvements were seen in those with brain cancers (RR 2.15, 95% CI 1.28-3.62, p = 0.004) and soft tissue sarcoma (RR 2.60, 95% CI 1.17-5.78, p = 0.02). We have demonstrated the effects of bundled interventions to improve clinical practice associated with fertility preservation in young people with cancer. Interventions were successful for reducing disparities identified in the pre-intervention cohort associated with gender and certain diseases. Assessment of the quality of patient care is not possible without accurate, consistent documentation.
Publisher: Elsevier BV
Date: 06-2021
Publisher: BMJ
Date: 13-10-2020
DOI: 10.1136/BMJSPCARE-2020-002449
Abstract: Health service planning in paediatric palliative care is complex, with the erse geographical and demographic characteristics adding to the challenge of developing services across different nations. Accurate and reliable data are essential to inform effective, efficient and equitable health services. To quantify health service usage by children and young people aged 0–21 years with a life-limiting condition admitted to hospital and health service facilities in Queensland, Australia during the 2011 and 2016 calendar years, and describe the clinical and demographic characteristics associated with health services usage. Retrospective health administrative data linkage of clinical and demographic information with hospital admissions was extracted using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification (ICD-10-AM) diagnostic codes. Data were analysed using descriptive statistics. In iduals aged 0–21 years with a life-limiting condition admitted to a Queensland Public Hospital and Health Service or private hospital. Hospital admissions increased from 17 955 in 2011 to 23 273 in 2016, an increase of 5318 (29.6%). The greatest percentage increase in admissions were for those aged 16–18 years (58.1%, n=1050), and those with non-oncological conditions (36.2%, n=4256). The greatest number of admissions by ICD-10-AM chapter for 2011 and 2016 were by in iduals with neoplasms (6174, 34.4% and 7206, 31.0% respectively). Overall, the number of admissions by Indigenous children and young people increased by 70.2% (n=838). Administrative data are useful to describe clinical and demographic characteristics and quantify health service usage. Available data suggest a growing demand for health services by children eligible for palliative care that will require an appropriate response from health service planners.
Publisher: AME Publishing Company
Date: 09-2023
DOI: 10.21037/APM-22-1124
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.IJNURSTU.2018.02.002
Abstract: With the increasing burden of chronic and age-related diseases, and the rapidly increasing number of patients receiving ambulatory or outpatient-based care, nurse-led services have been suggested as one solution to manage increasing demand on the health system as they aim to reduce waiting times, resources, and costs while maintaining patient safety and enhancing satisfaction. The aims of this review were to assess the clinical effectiveness, economic outcomes and key implementation characteristics of nurse-led services in the ambulatory care setting. A systematic review was conducted using the standard Cochrane Collaboration methodology and was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and PsycINFO Ovid (from inception to April 2016). Data were extracted and appraisal undertaken. We included randomised controlled trials quasi-randomised controlled trials controlled and non-controlled before-and-after studies that compared the effects of nurse-led services in the ambulatory or community care setting with an alternative model of care or standard care. Twenty-five studies of 180,308 participants were included in this review. Of the 16 studies that measured and reported on health-related quality of life outcomes, the majority of studies (n = 13) reported equivocal outcomes with three studies demonstrating superior outcomes and one demonstrating inferior outcomes in comparison with physician-led and standard care. Nurse-led care demonstrated either equivalent or better outcomes for a number of outcomes including symptom burden, self-management and behavioural outcomes, disease-specific indicators, satisfaction and perception of quality of life, and health service use. Benefits of nurse-led services remain inconclusive in terms of economic outcomes. Nurse-led care is a safe and feasible model of care for consideration across a number of ambulatory care settings. With appropriate training and support provided, nurse-led care is able to produce at least equivocal outcomes or at times better outcomes in terms of health-related quality of life compared to physician-led care or standard care for managing chronic conditions. There is a lack of high quality economic evaluations for nurse-led services, which is essential for guiding the decision making of health policy makers. Key factors such as education and qualification of the nurse self-management support resources available for the nurse prescribing capabilities and evaluation using appropriate outcome should be carefully considered for future planning of nurse-led services.
Publisher: Mary Ann Liebert Inc
Date: 05-2011
Abstract: Clown care has been shown to have health-related benefits and is a well-established part of the routine in many children's hospitals. However, children who have been admitted to general hospitals or who are being cared for at home cannot usually enjoy visits by Clown Doctors. Therefore, the aim of this work was to investigate whether an existing telemedicine network could be used to improve equity of access to humor for sick children, specifically those who are hospitalized away from the nearest clown-enabled hospital or who are being cared for at home. Using videoconferencing, we conducted regular clown outreach links from The Royal Children's Hospital in Brisbane, Australia, to children in regional hospitals and to sick children in their homes. Using a program of performance, which was modified for delivery by videoconference, teleclowning was found to be feasible. Further work is required to determine whether the health-related benefits that accrue from in-person clowning are successfully translated to the video-based modality.
Publisher: Springer Science and Business Media LLC
Date: 06-04-2021
Publisher: Mary Ann Liebert Inc
Date: 11-2014
Abstract: Pediatric palliative care is a distinct specialty that requires input from pediatric and palliative medicine specialists to provide comprehensive high-quality care. Consultations undertaken early in a child's illness trajectory, when end-of-life care is not anticipated to be required, enables relationships to be established and may enhance the quality of care provided. To define optimal components of an early pediatric palliative care consultation. Consensus of an expert group was sought in a five-round Delphi study. Based on the literature and existing standards for specialist palliative care, components of an early pediatric palliative care consultation were derived. In rounds 2 and 3, experts from around Australia participated in online surveys to review and prioritize the components and principles. Consensus of survey items was determined by defined criteria. A flowchart was developed in the fourth round and the final round involved review and refinement of the flowchart by the expert group. Nineteen experts participated and prioritized 34 components and principles in the first survey round, and 36 statements in the second survey round. There was consensus from all participants that the first priority of a consultation was to establish rapport with the family, and ex les of how to achieve this were defined. Other components of a consultation included: establishing the family's understanding of palliative care symptom management an emergency plan discussion of choices for location of care, and a management plan. Components considered suitable to defer to later consultations, or appropriate to address if initiated by family members, included: spiritual or religious issues discussion around resuscitation and life-sustaining therapies end-of-life care and the dying process. We have provided the first published framework from expert consensus that defines the components and principles of an early pediatric palliative care consultation. This framework will provide guidance for clinical practice as well as being useful for education and research in this area.
Publisher: Mary Ann Liebert Inc
Date: 10-2018
Abstract: Globally, an estimated eight million children could benefit from palliative care each year. Effective communication about children with life-limiting conditions is well recognized as a critical component of high-quality pediatric palliative care. To synthesize existing qualitative research exploring healthcare users' experiences of communicating with healthcare professionals about children with life-limiting conditions. The results of a systematic literature search were screened independently by two reviewers. Raw data and analytic claims were extracted from included studies and were synthesized using thematic analysis methods for systematic reviews. MEDLINE, PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science, ProQuest, and ScienceDirect were searched for articles published in English between 1990 and May 2017. This review included 29 studies conducted across 11 countries and involving at least 979 healthcare users (adults [n = 914], patients [n = 25], and siblings [n = 40]). The four domains of communication experience identified through thematic synthesis are: Information, Emotion, Collaboration, and Relationship. Although included studies were from a range of settings and erse populations, further research is needed to explore whether and how domains of communication experience differ across settings and populations. In particular, further research about children's palliative care experiences is needed. Healthcare users typically value communication with healthcare professionals: that (1) is open and honest, (2) acknowledges emotion, (3) actively involves healthcare users, and (4) occurs within established and trusting relationships.
Publisher: Wiley
Date: 14-12-2022
DOI: 10.1111/JPC.15851
Abstract: Following the establishment of paediatric palliative care services over recent decades, this study sought to identify information to inform future policy and practice. A rapid review using thematic synthesis was conducted to synthesise existing information about improving paediatric palliative care. Information was extracted in relation to key areas for investment and change: quality, access, advance care planning, skills, research, collaboration and community awareness. A total of 2228 literature sources were screened, with 369 included. Synthesised information identified clear ways to improve quality of care, access to care, advance care planning, and research and data collection. The synthesis identified knowledge gaps in understanding how to improve skills in paediatric palliative care, collaboration across Australian jurisdictions and community awareness. The findings of this review bring together information from a vast range of sources to provide action-oriented information to target investment and change in paediatric palliative care over the coming decades.
Publisher: Elsevier BV
Date: 02-2017
Abstract: To examine reported outcomes of health services delivered by telehealth to Indigenous Australians. Systematic review of the literature. Searches were conducted to identify articles that reported a telehealth service used to provide clinical services to Indigenous Australians. Articles were screened for inclusion using pre-defined criteria. Findings were synthesised narratively and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. 14 articles, describing 11 distinct telehealth services, were selected based on the inclusion criteria. Authors of included studies report that telehealth has improved social and emotional wellbeing, clinical outcomes and access to health services for Indigenous Australians. Further, it has reduced travel and improved screening rates. Indigenous people report positive perceptions of their telehealth interaction. Telehealth is used to address poor accessibility to health services and for targeted screening programs for at risk populations. Reported outcomes from existing services demonstrate the potential of telehealth for health service delivery for Indigenous Australians. Confidence in the findings of this review is reduced by the predominance of descriptive studies and small s le sizes in many of the included articles. Telehealth models of care facilitated through partnerships between Aboriginal community-controlled health services and public hospitals may improve both patient outcomes and access to specialist services for Indigenous people.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
Publisher: BMJ
Date: 17-07-2021
DOI: 10.1136/BMJSPCARE-2020-002333
Abstract: Our aim was to synthesise the available evidence surrounding the structure, processes and outcomes of family meetings in the paediatric palliative care literature. We undertook an integrative literature review informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered with PROSPERO (CRD42019138938). Electronic databases were systematically search using keywords and hand searching of reference articles and grey literature was also completed. Ten empirical studies and five theoretical articles were included in the synthesis. Empirical studies provided more information about meeting structure, whereas theoretical articles more frequently described a desired process for planning and undertaking meetings. No articles identified how the success of a meeting was defined or made recommendations for doing so. Despite reports that family meetings are commonly occurring, few articles described outcomes from either the family or clinician perspectives. Family meetings are essential communication strategies commonly used in paediatric palliative care, yet there is little guidance about how meetings should be organised and conducted, who should participate and when they should occur. The limited data available on the outcomes of family meetings suggest improvements are required to meet the needs of families. We present a framework that synthesises the available evidence. The framework offers an overview of the elements to consider when planning for and undertaking family meetings in paediatric palliative care and may be useful for both clinicians and researchers.
Publisher: Elsevier BV
Date: 11-2017
Publisher: Mary Ann Liebert Inc
Date: 12-2021
Publisher: Springer Science and Business Media LLC
Date: 20-03-2017
DOI: 10.1007/S10916-017-0709-4
Abstract: Providing equitable access to healthcare services in rural and remote communities is an ongoing challenge that faces most governments. By increasing access to specialty expertise, telemedicine may be a potential solution to this problem. Regardless of its potential, many telemedicine initiatives do not progress beyond the research phase, and are not implemented into mainstream practice. One reason may be that some telemedicine services are developed without the appropriate planning to ascertain community needs and clinical requirements. The aim of this paper is to report the development of a planning framework for telemedicine services based on needs assessment. The presented framework is based on the key processes in needs assessment, Penchansky and Thomas's dimensions of access, and Bradshaw's types of need. This proposed planning framework consists of two phases. Phase one comprises data collection and needs assessment, and includes assessment of availability and expressed needs accessibility perception and affordability. Phase two involves prioritising the demand for health services, balanced against the known limitations of supply, and the implementation of an appropriate telemedicine service that reflects and meets the needs of the community. Using a structured framework for the planning of telemedicine services, based on need assessment, may help with the identification and prioritisation of community health needs.
Publisher: Wiley
Date: 30-05-2017
DOI: 10.1111/IJN.12564
Publisher: Oxford University Press (OUP)
Date: 20-11-2018
Publisher: Springer Science and Business Media LLC
Date: 16-06-2014
Publisher: Elsevier BV
Date: 08-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-02-2022
Publisher: SAGE Publications
Date: 08-2001
Abstract: A randomized controlled trial was carried out to measure the societal costs of realtime teledermatology compared with those of conventional hospital care in New Zealand. Two rural health centres were linked to a specialist hospital via ISDN at 128 kbit/s. Over 10 months, 203 patients were referred for a specialist dermatological consultation and 26 were followed up, giving a total of 229 consultations. Fifty-four per cent were randomized to the teledermatology consultation and 46% to the conventional hospital consultation. A cost-minimization analysis was used to calculate the total costs of both types of dermatological consultation. The total cost of the 123 teledermatology consultations was NZ$34,346 and the total cost of the 106 conventional hospital consultations was NZ$30,081. The average societal cost of the teledermatology consultation was therefore NZ$279.23 compared with NZ$283.79 for the conventional hospital consultation. The marginal cost of seeing an additional patient was NZ$135 via teledermatology and NZ$284 via conventional hospital appointment. From a societal viewpoint, and assuming an equal outcome, teledermatology was a more cost-efficient use of resources than conventional hospital care.
Publisher: Elsevier BV
Date: 07-2020
Publisher: Wiley
Date: 10-09-2018
Publisher: Mary Ann Liebert Inc
Date: 06-2017
Publisher: Elsevier BV
Date: 04-2020
Publisher: Cambridge Media
Date: 26-06-2020
Publisher: Oxford University Press (OUP)
Date: 24-03-2021
DOI: 10.1093/BJS/ZNAB101
Abstract: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351 best case 196, worst case 816) or non-cancer surgery (733 best case 407, worst case 1664). Both exceeded the NNV in the general population (1840 best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
Publisher: Wiley
Date: 09-08-2021
DOI: 10.1111/ANAE.15560
Abstract: We aimed to determine the impact of pre‐operative isolation on postoperative pulmonary complications after elective surgery during the global SARS‐CoV‐2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre‐defined sub‐group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS‐CoV‐2 infection. Patients who isolated pre‐operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS‐CoV‐2 incidence and high‐income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre‐operative testing use of COVID‐19‐free pathways or community SARS‐CoV‐2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Hindawi Limited
Date: 28-01-2021
DOI: 10.1111/ECC.13413
Publisher: SAGE Publications
Date: 29-08-2017
Publisher: SAGE Publications
Date: 10-2013
Abstract: We compared the costs associated with three different methods of administering antibiotics to paediatric oncology patients. In scenario A, medicine was prepared in the home, checked in the home using a video link to a second nurse, and administered in the home. In scenario B, medicine was prepared by outsourcing the work to a commercial organisation, checked by pharmacists off-site and administered in the home. In scenario C, medicine was prepared in the hospital, checked by a second nurse and administered in the outpatient department. The staff time required for home administration was calculated from actual home visits. The cost of tablet computers and mobile Internet charges for double-checks in the home was based on an assumed useful life of 3 years for the equipment. The cost of outsourcing the preparation of medications was calculated from the actual cost of doing so during a four month period. Patient outcome was assumed to be the same in all three scenarios. The mean costs of a medication episode (i.e. one occasion of medication administration) was $129.91 in scenario A, $312.00 in scenario B and $355.91 in scenario C. Nurse preparation and administration in the home would save the oncology health service $124,899 per annum compared to outsourcing medication preparation. Nurse preparation and administration in the home would save the oncology health service $155,329 per annum compared to nurse preparation and administration in the outpatient department. Use of Internet-based video appears to produce savings compared to other methods of administering antibiotics and the technique may have wider application in supporting complex interventions in the home.
Publisher: Wiley
Date: 21-11-2022
DOI: 10.1111/BJEP.12474
Abstract: Brain tumours are the most common and fatal of all solid tumours for children and adolescents. The effects of the tumour and treatment (chemotherapy, radiation, and/or surgery) results in significant disruptions to childhood development and large amounts of missed schooling. Among other challenges for families, this produces obstacles for children and adolescents to achieve and maintain academic performance and experience positive schooling encounters. We thus aimed to systematically identify and synthesize qualitative evidence on how families experience paediatric brain tumour from diagnosis and beyond with regards to their schooling and education to identify gaps in service delivery, research, and policy. A protocol for this review was registered with PROSPERO (ID: CRD42020177165). Searches were conducted in Medline, CINAHL, PsycInfo, Embase, and Web of Science, and yielded 22 eligible papers (representing 17 studies). Data were extracted into NVivo12 and analysed by qualitative description. We formed the following domain summaries: academic (perceived failure to keep up with peers and finding success where one could, the importance of encouragement for diagnosed children), social (the importance of friendships and the harm of bullying), and support (the defining factor in overall return‐to‐school experience, often not enough received from educational professionals and clinicians). Our review highlights the need for more comprehensive, in idualized, and integrated support for diagnosed children to return to educational institutions, and for the need to address their social experiences, particularly with regards to bullying, potentially through a school‐wide social and emotional learning approach. Funding support, evidence‐based guidelines, staff skill development, and clear communication structures across families, health care facilities, schools, and educational departments are essential to achieving this.
Publisher: SAGE Publications
Date: 21-11-2018
Abstract: The Oncology Family App supports families across the vast state of Queensland, Australia, with easy access to vital information, including management plans for a deteriorating child, patient specific information and other resources. This article describes the development and evaluation of this mobile app. The app was developed and tested in collaboration with parents, caregivers, and clinicians and released in November 2015. This first version featured “Statewide Hospital Contacts,” including phone numbers, links to Google maps, and 24-hour emergency contacts with click to call functionality “When to Call” describing symptoms to look out for in a deteriorating child “Blood Results Table” and “Information” listing recommended websites, health care team contacts, appointments, and notes. The app was evaluated through interviews with parents, caregivers and patients and download metrics. Six months after the app release, 68% of the 38 parents and caregivers surveyed had downloaded the app. The most used modules were “Blood Results Table,” “When to Call,” and “Statewide Hospital Contacts,” but families reported using all features available. Families were enthusiastic about the support the app provided and gave useful feedback to direct future development. Using mobile health technology to support families is a novel, but rapidly growing concept. Family and caregiver feedback showed that the Oncology Family App was an efficient and convenient way to provide much needed information. A new version of the app is under development and evaluation of outcomes will be ongoing.
Publisher: Wiley
Date: 24-08-2021
DOI: 10.1111/ANAE.15563
Abstract: SARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery) recent (1–6 weeks before surgery) previous (≥7 weeks before surgery) or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS‐CoV‐2 2.2% (50/2317) in patients with peri‐operative SARS‐CoV‐2 1.6% (15/953) in patients with recent SARS‐CoV‐2 and 1.0% (11/1148) in patients with previous SARS‐CoV‐2. After adjustment for confounding factors, patients with peri‐operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS‐CoV‐2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS‐CoV‐2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30‐day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS‐CoV‐2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri‐operative or recent SARS‐CoV‐2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS‐CoV‐2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
Publisher: BMJ
Date: 23-09-2019
DOI: 10.1136/BMJQS-2019-009570
Abstract: Experience-based codesign (EBCD) is an approach to health service design that engages patients and healthcare staff in partnership to develop and improve health services or pathways of care. The aim of this systematic review was to examine the use (structure, process and outcomes) and reporting of EBCD in health service improvement activities. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Library) were searched to identify peer-reviewed articles published from database inception to August 2018. Search terms identified peer-reviewed English language qualitative, quantitative and mixed methods studies that underwent independent screening by two authors. Full texts were independently reviewed by two reviewers and data were independently extracted by one reviewer before being checked by a second reviewer. Adherence to the 10 activities embedded within the eight-stage EBCD framework was calculated for each study. We identified 20 studies predominantly from the UK and in acute mental health or cancer services. EBCD fidelity ranged from 40% to 100% with only three studies satisfying 100% fidelity. EBCD is used predominantly for quality improvement, but has potential to be used for intervention design projects. There is variation in the use of EBCD, with many studies eliminating or modifying some EBCD stages. Moreover, there is no consistency in reporting. In order to evaluate the effect of modifying EBCD or levels of EBCD fidelity, the outcomes of each EBCD phase (ie, touchpoints and improvement activities) should be reported in a consistent manner. CRD42018105879.
Publisher: Wiley
Date: 16-03-2022
DOI: 10.1002/PBC.29621
Abstract: To synthesize existing qualitative research exploring the experiences of parents caring for children with cancer during the end‐of‐life phase, and the factors that influence parental decision‐making when choosing the location of end‐of‐life care and death for their child. This review included 15 studies of 460 parents of 333 children and adolescents who died from progressive cancer. Where reported, the majority (58%) of children died at home or in a hospital (39%), with only a small fraction dying in a hospice. Factors impacting decision‐making for the location of care included the quality of communication and the quality of care available. Themes related to choosing home for end‐of‐life care and death included honoring the child's wishes, the familiarity of home, and parents’ desire to be their child's primary carer. Preference for the location of death in the hospital included trust in hospital staff, practical logistics, and the safety of the hospital environment.
Publisher: SAGE Publications
Date: 16-09-2015
Abstract: The aim of this review was to determine if photographic examination and subsequent image analysis provides comparable accuracy to visual inspection for the diagnosis of common dental conditions in children and adolescents. We searched the PubMed database for studies that compared diagnostic accuracy of the two inspection techniques. Studies were screened for inclusion and were assessed for quality and risk of bias using the quality assessment of diagnostic accuracy studies tools. Findings were reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Sixteen studies met the inclusion criteria. Nine of the included studies evaluated dental caries and eight evaluated enamel defects (one study evaluated both conditions). Three studies found image analysis to be superior. For the remaining six studies the diagnostic accuracy was comparable. For enamel defects, three studies found image analysis to be superior, two found visual inspection to be superior and three studies reported comparable diagnostic accuracy. Most studies have found at least comparable results between photographic and visual inspection techniques. However, the wide variation in equipment and personnel used for the collection and interpretation of photographic images made it impossible to generalise the results. It remains unclear exactly how effective store-and-forward teledentistry is for the diagnosis of common dental conditions in children.
Publisher: Mary Ann Liebert Inc
Date: 08-2023
Publisher: John Wiley & Sons, Ltd
Date: 20-02-2014
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.IJNURSTU.2016.02.014
Abstract: Around the world, guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) vary greatly. To prevent occlusion, most institutions recommend the use of heparin when the CVC is not in use. However, there is debate regarding the need for heparin and evidence to suggest normal saline may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased costs. To assess the clinical effects (benefits and harms) of heparin versus normal saline to prevent occlusion in long-term central venous catheters in infants, children and adolescents. A Cochrane systematic review of randomised controlled trials was undertaken. The Cochrane Vascular Group Specialised Register (including MEDLINE, CINAHL, EMBASE and AMED) and the Cochrane Register of Studies were searched. Hand searching of relevant journals and reference lists of retrieved articles was also undertaken. Data were extracted and appraisal undertaken. We included studies that compared the efficacy of normal saline with heparin to prevent occlusion. We excluded temporary CVCs and peripherally inserted central catheters. Rate ratios per 1000 catheter days were calculated for two outcomes, occlusion of the CVC, and CVC-associated blood stream infection. Three trials with a total of 245 participants were included in this review. The three trials directly compared the use of normal saline and heparin. However, between studies, all used different protocols with various concentrations of heparin and frequency of flushes. The quality of the evidence ranged from low to very low. The estimated rate ratio for CVC occlusion per 1000 catheter days between the normal saline and heparin group was 0.75 (95% CI 0.10 to 5.51, two studies, 229 participants, very low quality evidence). The estimated rate ratio for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37, two studies, 231 participants low quality evidence). It remains unclear whether heparin is necessary for CVC maintenance. More well-designed studies are required to understand this relatively simple, but clinically important question. Ultimately, if this evidence were available, the development of evidenced-based clinical practice guidelines and consistency of practice would be facilitated.
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.PEC.2021.07.034
Abstract: Cancer can have long-term biopsychological impacts for young people that persist for years. To promote adjustment, it is essential to understand how young people cope, yet this is relatively understudied. This study explored the coping strategies using semi-structured interviews with 16 young people with cancer aged 15-24 years. Eligible participants were diagnosed within the previous 24 months and recruited through Australian Youth Cancer Services. Transcribed interviews were analysed using content analysis. Coping strategies included: seeking support controlling the focus avoiding negatives and staying positive meaning making and changes with time. During treatment, seeking support, focussing on the present, distraction and avoidance were commonly applied. Following treatment, planning for the future, avoidance of re-traumatising situations and meaning making were used. Findings support the concept of coping as a dynamic process where different strategies are used depending on the stressor, available resources and previous experiences. Comprehensive, developmentally appropriate psychosocial assessments, open communication, education and information provision, as well as appropriate referral for support are essential, particularly for young cancer survivors identified at risk.
Publisher: SAGE Publications
Date: 05-04-2023
DOI: 10.1177/27527530221147880
Abstract: Background: Home-based cancer care offers new ways of delivering supportive therapies, including post-chemotherapy hydration, traditionally delivered in hospital settings. Understanding how programs are developed and how parents perceive managing care at home offers opportunities to improve services and experiences. Aim: To describe the implementation process and evaluation of a home intravenous hydration program for children with cancer and thus to provide practical information for future initiatives. Methods: Data were prospectively collected on clinical impact, safety indicators, and estimated costs these were tabulated and analysed. Semi-structured interviews were undertaken with a subset of parents regarding their experience and analysed using content analysis. Results: Over 34 months, 21 children were eligible, and 16 parents were educated and assessed competent with providing home care. All 16 children received home hydration with a median of 5.5 days per child (IQR 6.65 days). This avoided 116 hospital bed-days and associated costs, at an estimated total value of USD $ 105,521, on average saving USD $ 910 per day and USD $ 6,596 per child. There were no adverse events reported, and no child required re-admission to hospital while receiving home hydration. Parents were overwhelmingly positive in their feedback about the program. Verbatim quotes were synthesized under one overarching theme—supporting normality promotes recovery. Conclusion: When adequately trained and well supported, parents highly value providing home-based care to their children. This offers opportunities to improve experiences and outcomes for children and families as well as reduce costs to health services, achieving clinical impact without reducing safety.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Wiley
Date: 30-10-2022
DOI: 10.5694/MJA2.51751
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 28-08-2023
DOI: 10.1002/CNCR.34920
Abstract: Despite the widespread use of medical cannabis, little is known regarding the safety, efficacy, and dosing of cannabis products in children with cancer. The objective of this study was to systematically appraise the existing published literature for the use of cannabis products in children with cancer. This systematic review, registered with the International Prospective Register of Systematic Reviews (CRD42020187433), searched four databases: MEDLINE, Embase, PsycINFO, and the Cochrane Library. Abstracts and full texts were screened in duplicate. Data on types of cannabis products, doses, formulations, frequencies, routes of administration, indications, and clinical and demographic details as well as reported efficacy outcomes were extracted. Data on cannabinoid‐related adverse events were also summarized. Out of 34,611 identified citations, 19 unique studies with a total of 1927 participants with cancer were included: eight retrospective chart reviews, seven randomized controlled trials, two open‐label studies, and two case reports. The included studies reported the use of various cannabis products for the management of symptoms. Cannabinoids were commonly used for the management of chemotherapy‐induced nausea and vomiting (11 of 19 [58%]). In controlled studies, somnolence, dizziness, dry mouth, and withdrawal due to adverse events were more commonly associated with the use of cannabinoids. Across all included studies, no serious cannabis‐related adverse events were reported. Although there is evidence to support the use of cannabis for symptom management, in children with cancer, there is a lack of rigorous evidence to inform the dosing, safety, and efficacy of cannabinoids. Because of the increasing interest in using cannabis, there is an urgent need for more research on medical cannabis in children with cancer.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Wiley
Date: 23-11-2015
Publisher: Wiley
Date: 30-04-2020
Publisher: SAGE Publications
Date: 22-10-2018
Abstract: The aim of this study was to explore how telehealth facilitates or impedes the provision of culturally appropriate healthcare to Indigenous Australians from the perspective of staff at an Aboriginal Community Controlled Health Service (ACCHS). An exploratory qualitative study was performed. Semi-structured interviews were conducted with nine ACCHS staff. Interview transcripts were analysed using thematic analysis. One central theme and three sub-themes were identified. The central theme of Care provided in a supportive environment describes how telehealth enabled specialist consultations to be conducted in the safe environment of an ACCHS instead of a mainstream health service. The first sub-theme described how telehealth improved affordability and convenience and brought a reduction in the stress of healthcare. The second sub-theme explained the importance of the presence of an Indigenous health worker to facilitate culturally appropriate healthcare. The third sub-theme described how telehealth supported a holistic view of health. Our findings show culturally appropriate healthcare may be enhanced by the use of telehealth because it allows care to be provided in the supportive environment of an ACCHS. It allows the community member to have the advocacy and assistance of an Indigenous health worker and reduces the burden of travel and dislocation from community and family.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2016
Location: Australia
Location: Australia
Start Date: 2018
End Date: 2020
Funder: Australian Research Council
View Funded ActivityStart Date: 2019
End Date: 2020
Funder: Queensland University of Technology
View Funded ActivityStart Date: 2020
End Date: 2024
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 12-2018
End Date: 11-2023
Amount: $588,592.00
Funder: Australian Research Council
View Funded Activity