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Vinod S.K.,Liverpool Cancer Therapy Center | Vinod S.K.,University of New South Wales | Vinod S.K.,University of Western Sydney | Lonergan D.M.,University of New South Wales | And 2 more authors.
Journal of Medical Imaging and Radiation Oncology | Year: 2013

Introduction Multisource feedback (MSF) is an assessment of performance through evaluation of an individual's competence from multiple perspectives. It is mandated in many specialist training schemes in medicine. The aim of this study was to test the feasibility of implementing MSF for consultant radiation oncologists. Methods A validated tool consisting of a self-assessment questionnaire, medical colleague questionnaire, co-worker questionnaire and patient questionnaire was used for MSF. Statements were rated on a 5-point Likert scale with 1 being a low rating and 5 a high rating. Seven radiation oncologists volunteered to undergo MSF. They each nominated 10 medical colleagues, 10 co-workers and 10 patients to be surveyed. Clinician feedback was provided as an individual report with a mean score and range for each data item. Results Two hundred ten surveys were mailed out and seven self-assessments were completed. The response rate was 87% for medical colleagues, 89% for co-workers and 79% for patients. The mean feedback scores averaged for the radiation oncologists ranged from 4.4 to 4.9, significantly higher than self-assessments scores which ranged from 3.2 to 3.7. MSF identified areas for potential improvement including communication and collaboration with co-workers and accessibility to and adequacy of clinic space for patients. All radiation oncologists found the MSF a positive experience, and five planned to make changes in their practice in response to this. Conclusions The high response rate to the surveys has shown that it is feasible to implement MSF for radiation oncologists. This could potentially be used as a method for ongoing revalidation. © 2013 The Authors. Journal of Medical Imaging and Radiation Oncology © 2013 The Royal Australian and New Zealand College of Radiologists. Source

Dimoska A.,University of Sydney | Butow P.N.,University of Sydney | Lynch J.,Cancer Care Center | Hovey E.,Liverpool Cancer Therapy Center | And 3 more authors.
Patient Education and Counseling | Year: 2012

Objective: To examine the feasibility and acceptability of routine provision of patient question prompt lists (QPLs) to promote patient participation and patient-clinician communication in medical consultations. Methods: Four cancer centres across NSW, Australia (two rural, two urban) were invited to participate, involving distribution of QPLs to patients seeing a medical or radiation oncologist, or palliative care clinician. Patients rated their satisfaction after their next consultation. Cancer specialists provided their views at the end of the study. Results: Sixty-four percent (389/606) of patients attending consultations received a QPL. Of patients offered a QPL (426), 91% accepted. Of 139 patients surveyed post-consultation, 89% reported reading the QPL and, of these, 44% referred to the QPL during the consultation at least once. All of 10 cancer specialists providing their views post-implementation reported that QPL implementation in routine practice was feasible and did not strain resources. Conclusions: Cancer patients and cancer specialists showed support for routine dissemination of the QPL. Practice implications: For successful implementation of evidence-based tools we recommend promotion by local clinical champions, negotiation with clinic staff about dissemination methods, raised patient awareness through on-site project facilitators, media, consumer and support groups, and availability of resources in hard copy and via online sources. © 2011 Elsevier Ireland Ltd. Source

Girgis A.,Ingham Institute for Applied Medical Research | Girgis A.,University of New South Wales | Delaney G.P.,Ingham Institute for Applied Medical Research | Delaney G.P.,University of New South Wales | And 3 more authors.
Cancer Forum | Year: 2015

Cancer survivors represent approximately 3.5% of the Australian population. Physical and psychosocial issues experienced as a result of a cancer diagnosis and treatment persist into long-term survivorship. While oncology care pathways that routinely include comprehensive symptom and emotional well-being assessments have been shown to improve patient outcomes, such assessments are not routinely undertaken. Electronic Patient Reported Outcomes (ePRO) systems are increasingly used in cancer clinical care settings and are superior to paper-based PRO assessments, as they can facilitate assessment in a range of languages, as well as automated scoring and generation of real-time feedback reports to the care team. Linkage of ePROs into existing patient records integrates psychosocial information with other clinical information, enabling patient-centred care. In NSW, an ehealth system being developed and pilot tested, supports ePRO assessments which generate realtime feedback to the clinical team and access to self-management resources to assist survivors to better manage their own health and wellbeing. Source

Luckett T.,University of Sydney | Luckett T.,University of New South Wales | Goldstein D.,Prince of Wales Hospital | Goldstein D.,University of New South Wales | And 7 more authors.
The Lancet Oncology | Year: 2011

Background: Ethnic minority is associated with higher cancer incidence and poorer survival than is being in the majority group. We did a systematic review and meta-analysis to assess whether psychological morbidity and health-related quality of life (HRQoL) were affected by minority status. Methods: We searched Medline, AMED, PsycINFO, Embase, CENTRAL, CINAHL, PubMed, Sociological Abstracts, and Web of Science for English-language articles published between Jan 1, 1995, and October, 2009. Articles were eligible if they reported original data on anxiety, depression, distress (for psychological morbidity), or HRQoL in minority and majority cancer patients or survivors. Minority status was defined as being an immigrant or having an ethnic, linguistic, or religious background different to the majority of the population in the country where the research was done. We excluded African Americans and indigenous groups. Eligible articles were rated for quality of reporting, external validity, internal validity, sample size, and power. Each quality criterion was rated independently by two reviewers until inter-rater reliability was achieved. In a meta-analysis we compared mean scores adjusted for socioeconomic status and other sociodemographic and clinical variables, where available. Effect sizes greater than 0·5 and 95% CI that included 0·5 or -0·5 were deemed clinically important, with negative values indicating worse outcomes in minority patients. We assessed publication bias by estimating the number of potential unpublished studies and the number of non-signficant studies with p=0·05 required to produce a non-significant overall result. Findings: We identified 21 eligible articles that included 18 datasets collected in the USA and one in each of Canada, Romania, and the UK. Ethnic minority groups were Hispanic, Asian or Pacific Islander, or Hungarian (one dataset). Overall, we found minority versus majority groups to have significantly worse distress (mean difference -0·37, 95% CI -0·46 to -0·28; p<0·0001), depression (-0·23, -0·36 to -0·11; p=0·0003), and overall HRQoL (-0·33, -0·58 to -0·07; p=0·013). Further analyses found disparities to be specific to Hispanic patients in the USA, in whom poorer outcomes were consistent with potentially clinically important differences for distress (effect size -0·37, 95% CI -0·54 to -0·20; p<0·0001), social HRQoL (-0·45, -0·87 to -0·03; p=0·035), and overall HRQoL (-0·49, -0·78 to -0.20; p=0·0008). Results were significantly heterogeneous for overall HRQoL and all domains. Tests for interaction, for adjusted versus unadjusted and comparisons of high-quality, medium-quality, and low-quality articles, were generally non-significant, which suggests no bias. We found no evidence of any substantive publication bias. Interpretation: Hispanic cancer patients in the USA, but not other ethnic minority groups, report significantly worse distress, depression, social HRQoL, and overall HRQoL than do majority patients, of which all but depression might be clinically important. Heterogeneous results might, however, have limited the interpretation. Data for other minority groups and for anxiety are scarce. More studies are needed from outside the USA. Future reports should more clearly describe their minority group samples and analyses should control for clinical and sociodemographic variables known to predict outcomes. Understanding of why outcomes are poor in US Hispanic patients is needed to inform the targeting of interventions. Funding: Prince of Wales Hospital, Sydney, Australia. © 2011 Elsevier Ltd. Source

Whiting D.L.,Brain Injury Rehabilitation Unit | Simpson G.K.,Brain Injury Rehabilitation Unit | Simpson G.K.,University of Sydney | Koh E.-S.,University of New South Wales | And 6 more authors.
Brain Injury | Year: 2012

Purpose: Untreated behavioural and cognitive changes after primary brain tumour (PBT) can result in challenging behaviours (CBs), with limited documentation on treatment approaches. This study explored the feasibility of employing a Behavioural Consultancy approach to manage CBs, targeting individuals with PBT, family and treating staff. Methods: Participants were patients and families of two hospitals and health professionals from cancer/neurological services. A single-case experimental design piloted skill-based training and environmental changes in managing socio-behavioural impairments in a person with a low grade astrocytoma. A half-day workshop to train family members (n=7) in compensatory strategy use to manage CBs after PBT was piloted. Finally, a 1-day workshop was provided to 43 health professionals in managing CBs after PBT. For both workshops, a prepost impact evaluation was conducted employing a purpose-designed Strategies Use Measure. Results: All three interventions demonstrated positive results. The single case showed a 71% decrease in the target behaviour (time spent talking) post-intervention. Some attrition to these gains was observed at two follow-up time points (3 and 5 months). Participants from both workshops demonstrated significant post-intervention increases in perceived knowledge of Strategy Use (family members z=2.03, p<0.05; health professionals z=4.95, p<0.00; Wilcoxon signed-rank test). Conclusions: These initial studies highlight the potential of employing an integrated multi-tiered intervention based on a Behavioural Consultancy model to manage CBs after PBT. © 2012 Informa UK Ltd. Source

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