Maurice Eisenbruch

A cohort study of 20 822 young drivers: the DRIVE study methods and population

Publisher: BMJ

Date: 12-2006

DOI: 10.1136/IP.2006.011825

Immigrants' perceptions of the quality of their cancer care: An Australian comparative study, identifying potentially modifiable factors

Publisher: Elsevier BV

Date: 08-2014

DOI: 10.1093/ANNONC/MDU182

Abstract: Recent data show a falling cancer mortality in the general population without a similar shift in immigrant outcomes, leading to a greater cancer burden and mortality for immigrants. Our aims were to compare perceived patterns of care in immigrants and native-born cancer patients. This was a hospital-based s le of first-generation immigrants and Australian-born Anglo patients in the first year following diagnosis. It was restricted to Chinese, Arabic, or Greek speakers. Eligible participants, recruited via 16 oncology clinics, were over 18, with cancer (any type or stage), and having commenced treatment at least 1 month previously. Five hundred and seventy-one CALD patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. Immigrants had difficulty communicating with the doctor (73% versus 29%) and understanding the health system (38% versus 10%). Differences were found in 'difficulty knowing who to see' (P = 0.0002), 'length of time to confirm diagnosis' (P = 0.04), wanting more choice about a specialist and hospital (P < 0.0001) being offered the opportunity to see a counselor (P < 0.0001) and actually seeing one (P < 0.0001). There were no significant self-reported differences regarding how cancer was detected, time to see a health professional, or type first seen however, immigrants reported difficulty knowing who to see. Previous studies showed differences in patterns of care according to socioeconomic status (SES) and educational level. Despite adjusting for age, sex, education, marital status, SES, time since diagnosis, and type of cancer, we did not find significant differences. Instead, we found that understanding of the health system and confidence understanding English were important factors. This study confirmed that immigrants with cancer perceive an inferior quality of cancer care. We highlight potentially modifiable factors including assistance in navigating the health system, translated information, and cultural competency training for health professionals.

Inferior health-related quality of life and psychological well-being in immigrant cancer survivors: A population-based study

Publisher: Elsevier BV

Date: 05-2013

DOI: 10.1016/J.EJCA.2013.01.011

Abstract: This study compared health-related quality of life (QOL) and psychological morbidity in a population-based s le of first generation immigrant and Anglo-Australian cancer survivors. Eligible participants, recruited via three State Cancer Registries, included those: with a new diagnosis of one of 12 most incident cancers (all stages) 1-6years earlier aged 18-80 at diagnosis born in a Chinese, Arabic, or Greek speaking country and able to speak one of these languages. A random s le of English-speaking Anglo-Australian-born controls frequency matched for cancer diagnosis was recruited. 596 patients (277 of whom were immigrants) participated (a 26% response rate). In multiple linear regression models adjusted for age, sex, education, marital status, socio-economic status, time since diagnosis and type of cancer, immigrants had clinically significantly worse QOL (5.4-8.5 points on Functional Assessment of Cancer Therapy - General (FACT-G), P<0·0001), higher depression (P<0·0001) and higher incidence of clinical depression (P<0·01) than Anglo-Australians. Understanding the health system partially mediated this relationship for depression (P=0·0004) and QOL (P=0·001). Immigrant survivors of cancer have worse psychological and QOL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information and cultural competency training for health professionals.

Should culture affect practice? A comparison of prognostic discussions in consultations with immigrant versus native-born cancer patients

Publisher: Elsevier BV

Date: 08-2013

DOI: 10.1016/J.PEC.2013.03.006

Abstract: Poor prognosis is difficult to impart, particularly across a cultural ide. This study compared prognostic communication with immigrants (with and without interpreters) versus native-born patients in audio-taped oncology consultations. Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis. Fifty percent of doctor and 59% of patient prognostic speech units were not interpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few prognostic facts, and oncologist characteristics no prognostic facts, disclosed. Oncologists were significantly less likely to convey hope to immigrants (p=0.0004), and more likely to use medical jargon (p=0.009) than with Australian-born patients. Incurable disease status and a limited life span were commonly acknowledged, generally with no timeframe provided. Physical issues were discussed more commonly than emotional aspects. While culture did not appear to influence doctor speech, interpreters filtered or blocked much prognostic communication. Initiatives to empower all patients to attain needed information, optimise communication when an interpreter is present and train cancer health professionals in culturally appropriate care, are urgently required.

Unmet needs in immigrant cancer survivors: a cross-sectional population-based study

Publisher: Springer Science and Business Media LLC

Date: 27-04-2013

DOI: 10.1007/S00520-013-1819-2

Abstract: Social suffering, language difficulties, and cultural factors may all make the cancer experience more difficult for immigrants. This study aimed to document unmet needs, and variables associated with these, in a population-based s le of first-generation immigrants and Anglo-Australians who had survived cancer. Participants were recruited via Australian cancer registries. Eligible cancer survivors had a new diagnosis 1-6 years earlier and were aged between 18 and 80 years at diagnosis. Eligible immigrant participants and parents were born in a country where Arabic, Chinese (Mandarin, Cantonese, and other dialects), or Greek is spoken, and they spoke one of these languages. A random s le of English-speaking Anglo-Australian-born controls was recruited. Five hundred ninety-six patients (277 immigrants) were recruited to the study (response rate, 26%). Compared to Anglo-Australians, the adjusted odds ratio of Chinese immigrants for at least one unmet information/support need was 5.1 (95% CI 3.1, 8.3) and for any unmet physical need was 3.1 (95% CI 1.9, 5.1). For Greek, these were 2.0 (95% CI 1.1, 4.0) and 2.7 (95% CI 1.4, 5.2). Arabic patients had elevated, but not statistically significant, odds ratios compared to Anglo-Australians. Written information and having a specialist, support services, and other health professionals who spoke their language were in the top ten unmet needs amongst immigrants. Immigrant cancer survivors, several years after initial diagnosis, are more likely to have an unmet need for information or for help with a physical problem than Anglo-Australians. They strongly desire information and support in their own language.

A review of the cultural competence view of cardiac rehabilitation

Publisher: Wiley

Date: 08-04-2010

DOI: 10.1111/J.1365-2702.2009.03004.X

Abstract: Aims and objectives. This paper describes cultural competence issues within the scientific and scholarly discourse surrounding cardiac rehabilitation (CR). Background. CR is an important secondary prevention strategy, improving health‐related outcomes and reducing the risks of subsequent cardiovascular events. Internationally, it is widely accepted as a discrete health service model and is endorsed by government and professional bodies. Over past decades, low participation rates in CR remain a concern, particularly among minority groups and culturally and linguistically erse populations. Design. Systematic review. Methods. Search of electronic databases. Conclusions. Few studies to date have described cultural competence in CR service design and as a consequence, there are minimal data to assist CR professionals and policy makers in tailoring health service delivery models. The limited scholarly debate and discussion regarding cultural competence in the CR literature limits the development and evaluation of culturally appropriate interventions. Relevance to clinical practice. There needs to be greater attention to the concept of cultural competence, both in practice and research settings, to ensure access to CR for people from culturally and linguistically erse backgrounds.

Assessing the invariance of a culturally competent multi-lingual unmet needs survey for immigrant and Australian-born cancer patients: a Rasch analysis

Publisher: Springer Science and Business Media LLC

Date: 24-05-2014

DOI: 10.1007/S11136-014-0717-5

Abstract: The purpose of this study was to assess the invariance of a culturally competent multi-lingual unmet needs survey. A cross-sectional study was conducted among immigrants of Arabic-, Chinese- and Greek-speaking backgrounds, and Anglo-Australian-born controls, recruited through Cancer Registries (n = 591) and oncology clinics (n = 900). The survey included four subscales, with newly developed items addressing unmet need in culturally competent health information and patient support (CCHIPS), and items adapted from existing questionnaires addressing physical and daily living (PDL), sexuality (SEX) and survivorship (SURV) unmet need. The survey was translated into Arabic, Chinese and Greek. Rasch analysis was carried out on the four domains. Whilst many items were mistargeted to less prevalent areas of unmet need, causing substantial floor effects in person estimates, reliability indices were acceptable. The CCHIPS domain showed differential item functioning (DIF) for cultural background and language, and the PDL domain showed DIF for treatment phase and gender. The results for SEX and SURV domains were limited by floor effects and missing responses. All domains showed adequate fit to the model after DIF was resolved and a small number of items were deleted. The study highlights the intricacies in designing a culturally competent survey that can be applied to culturally and linguistically erse groups across different treatment contexts. Overall, the results demonstrate that this survey is somewhat invariant with respect to these factors. Future refinements are suggested to enhance the survey's cultural competence and general validity.

RAD51B in Familial Breast Cancer

Publisher: Public Library of Science (PLoS)

Date: 05-05-2016

DOI: 10.1371/JOURNAL.PONE.0153788

Annexin A1 expression in a pooled breast cancer series: association with tumor subtypes and prognosis

Publisher: Springer Science and Business Media LLC

Date: 02-07-2015

DOI: 10.1186/S12916-015-0392-6

Migrant health in cancer: Outcome disparities and the determinant role of migrant-specific variables

Publisher: Oxford University Press (OUP)

Date: 23-03-2015

DOI: 10.1634/THEONCOLOGIST.2014-0274

Abstract: Multiethnic societies face challenges in delivering evidence-based culturally competent health care. This study compared health-related quality of life and psychological morbidity in a hospital-based s le of first-generation migrants and Australian-born Anglo cancer patients, controlling for potential confounders related to migrant status. Further, it explored the relative contribution of ethnicity versus migrant-related variables. Eligible participants, recruited via 16 oncology clinics in Australia, included those over the age of 18, diagnosed with cancer (any type or stage) within the previous 12 months and having commenced treatment at least 1 month previously. In total, 571 migrant patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. In multiple linear regression models adjusted for age, sex, education, marital status, socioeconomic status, time since diagnosis, and type of cancer, migrants had clinically significantly worse health-related quality of life (HRQL 3.6–7.3 points on FACT-G, p & .0001), higher depression and anxiety (both p & .0001), and higher incidence of clinical depression (p & .0001) and anxiety (p = .003) than Anglo-Australians. Understanding the health system (p & .0001 for each outcome) and difficulty communicating with the doctor (p = .04 to .0001) partially mediated the impact of migrancy. In migrant-only analyses, migrant-related variables (language difficulty and poor understanding of the health system), not ethnicity, predicted outcomes. Migrants who develop cancer have worse psychological and HRQL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information, and cultural competency training for health professionals.

Prognostic communication preferences of migrant patients and their relatives

Publisher: Wiley

Date: 23-02-2011

DOI: 10.1002/PON.1923

Abstract: Migrant patients comprise a significant proportion of Western oncologists' clientele. Although previous research has found that barriers exist in the communication between ethnically erse patients and health professionals, little is known about their personal preferences for communication and information, or the concordance of views held between patients and family members. Seventy-three patients (31 Anglo-Australians, and 20 Chinese, 11 Arabic and 11 Greek migrants) and 65 relatives (25 Anglo-Australians, and 23 Chinese, 11 Arabic and 7 Greek migrants) were recruited through nine Sydney oncology clinics. Following prognostic consultations, participants were interviewed in their preferred language about their experiences and ideals regarding information and communication with oncologists. Interviews were audio-taped, translated and transcribed, and then thematically analysed using N-Vivo software. Consistency was found in patient preferences, regardless of ethnicity, in that almost all patients preferred prognostic information to be delivered in a caring and personalised manner from an authoritative oncologist. Contrary to previous research, migrant patients often expressed a desire for prognostic disclosure. Discordance was found between migrant patients and their families. These families displayed traditional non-Western preferences of non-disclosure of prognosis and wanted to actively influence consultations by meeting with oncologists separately beforehand and directing the oncologists on what and how information should be conveyed to patients. Many of the communication issues facing patients in the metastatic cancer setting are shared amongst Anglo-Australian and migrant patients alike. Understanding the dynamics within migrant families is also an important component in providing culturally sensitive communication. Future directions for research are provided.

Interpretation in Consultations With Immigrant Patients With Cancer: How Accurate Is It?

Publisher: American Society of Clinical Oncology (ASCO)

Date: 10-07-2011

DOI: 10.1200/JCO.2010.34.3335

Abstract: Immigrants with cancer often have professional and/or family interpreters to overcome challenges communicating with their health team. This study explored the rate and consequences of nonequivalent interpretation in medical oncology consultations. Consecutive immigrant patients with newly diagnosed with incurable cancer, who spoke Arabic, Cantonese, Mandarin, or Greek, were recruited from the practices of 10 medical oncologists in nine hospitals. Their first two consultations were audio taped, transcribed, translated into English and coded. Thirty-two of 78 participants had an interpreter at 49 consultations 43% of interpreters were family, 35% professional, 18% both a professional and family, and 4% a health professional. Sixty-five percent of professional interpretations were equivalent to the original speech versus 50% for family interpreters (P= .02). Seventy percent of nonequivalent interpretations were inconsequential or positive however, 10% could result in misunderstanding, in 5% the tone was more authoritarian than originally intended, and in 3% more certainty was conveyed. There were no significant differences in interpreter type for equivalency of interpretations. Nonequivalent interpretation is common, and not always innocuous. Our study suggests that there may remain a role for family or telephone versus face-to-face professional interpreters. Practice implications: careful communication between oncologists and interpreters is required to ensure optimal communication with the patient.

Discovery Projects - Grant ID: DP0665062

Start Date: 2006

End Date: 06-2009

Amount: $155,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP0559813

Start Date: 2005

End Date: 12-2010

Amount: $405,000.00

Funder: Australian Research Council

Special Research Initiatives - Grant ID: SR0354621

Start Date: 01-2004

End Date: 11-2004

Amount: $10,000.00

Funder: Australian Research Council

Special Research Initiatives - Grant ID: SR0354900

Start Date: 03-2004

End Date: 06-2005

Amount: $30,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP110200049

Start Date: 06-2012

End Date: 12-2015

Amount: $270,000.00

Funder: Australian Research Council