Papers by Patrica Livingston
Medical Journal of Australia, 2010
Objective: To test the feasibility and acceptability of a telephone-based program to screen survi... more Objective: To test the feasibility and acceptability of a telephone-based program to screen survivors of colorectal cancer (CRC) for distress, and to refer distressed patients to their treating health service. Design, setting and participants: A prospective, multicentre study involving 59 patients with CRC recruited from six public and private health services in Melbourne, Victoria, from 15 June 2008 to 22 September 2009. Patients who had completed adjuvant chemotherapy for CRC were contacted (7-10 days after recruitment [outcall one] and again 4 weeks later [outcall two]) by the Cancer Council Victoria's helpline nurse, and screened for distress with the Distress and Impact Thermometer (DIT); participants were given tailored information and support and those with distress scores of у 5, and impact scores of у 4, were referred for follow-up. Telephone interviews were conducted 4 weeks after outcall two. Participating helpline and health service staff were surveyed on the feasibility and acceptability of the service. Main outcome measure: Anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS). Results: Of the 59 patients (87%) who agreed to participate, 63% were men; their mean age was 59 years (SD, 9.5 years). HADS depression decreased significantly from baseline (mean score, 4.93; SD, 4.22) to follow-up (mean score, 3.84; SD, 4.10; Z = −2.375; P = 0.02). However, there was no significant difference in HADS anxiety between baseline (mean score, 5.29; SD, 4.11) and follow-up (mean score, 4.78; SD, 3.65). Outcall one generated two referrals (4% of participants) and outcall two generated four referrals (8%); five of these six participants took up the referrals. Satisfaction with the program among participants was high; 82% found outcall one "quite or very helpful" and 79% found outcall two "quite or very helpful". Helpline and health service staff reported a straightforward process that did not adversely affect workloads. Conclusion: This model of care carries the potential to meet ongoing psychosocial
Australian Journal of Primary Health, 2017
Meeting men’s health needs by improving healthcare service access is a key objective of comprehen... more Meeting men’s health needs by improving healthcare service access is a key objective of comprehensive primary health care. The aims of this qualitative study were to explore the perception of nurses in men’s health services and to describe men’s expectation of the nurse. The comparative component identifies the barriers and facilitators to improved access to health services. A purposive sample of 19 nurses and 20 men was recruited from metropolitan and regional settings in the state of Victoria, Australia, and each participant was interviewed individually or as part of three focus groups. The main findings were: nurses and men were unclear on the role of the nurse in men’s health; and health promotion provided by nurses was predominantly opportunistic. Both participant groups indicated barriers to healthcare access related to: the culture and environment in general practice; limitation of Australia’s Medicare healthcare financing system; out-of-pocket costs, waiting time and lack of...
Scandinavian Journal of Caring Sciences, 2015
Psychosocial factors impacting on life transitions among young adults with type 2 diabetes: An Au... more Psychosocial factors impacting on life transitions among young adults with type 2 diabetes: An Australian-Danish qualitative study Background: Type 2 diabetes (T2DM) prevalence is increasing rapidly worldwide with a significant increase in young adults. There is limited information about psychosocial and service needs of this group. Aim: To explore similarities and differences in how psychosocial factors impact on Australian and Danish young adults with T2DM and to identify unmet support needs during life transitions. Method: A qualitative approach was adopted using thematic content analysis of 26 in-depth semi-structured interviews. An inductive descriptive content analysis was undertaken using a comparative coding system. Findings: Eligible participants were from Australia (12) and Denmark (14), aged 19-42 years who had T2DM for more than 10 months. In general, they reported diabetes management was difficult during transitions and diabetes self-care routines had to change to accommodate life changes. The underpinning sense of 'uncertainty' initiated by life transitions caused guilt that often resulted in low self-worth, anxiety and depression, which in turn had a negative impact on social and professional relationships. The participants emphasised the importance of connectedness to social networks, particularly with T2DM peers, and the need for flexible access to health professionals, age-specific tailored support and lower costs for Australians. Australian participants were more concerned than Danish participants about the cost associated with diabetes care and their ability to stay employed; hence, they were reluctant to disclose diabetes at work. Conclusion: T2DM had a similar impact on life transitions of Australian and Danish young adults with T2DM, suggesting health care needs to encompass managing life transitions. Participants had to cope with uncertainty and the impact of people's responses to diabetes, particularly at work and in relationships. Health professionals are urged to integrate these factors in care plans and education, which must be individualised and focus on the psychosocial aspects that operate during life transitions.
Women's Health Issues, 2015
We sought to examine cancer diagnosis, cancer treatment, and related risk factors among Australia... more We sought to examine cancer diagnosis, cancer treatment, and related risk factors among Australian, middle-aged, exclusively heterosexual women compared with sexual minority women (SMW; mainly heterosexual, bisexual, mainly lesbian, and lesbian). Secondary data analysis of the Australian Longitudinal Study of Women's Health for women born in 1946 through 1951 (n = 10,451) included bivariate tests (i.e., contingency table analyses, independent t tests). SMW did not have significantly higher cancer diagnoses compared with exclusively heterosexual women, although they were more likely to report never having had a mammogram or pap smear. SMW were also significantly more likely to be high-risk drinkers (11.1% vs. 6.8%; p < .05), current smokers (15.1% vs. 8.3%; p < .001), report significantly higher rates of depression (mean ± SD; 6.4 ± 5.5 vs. 5.4 ± 5.1; p < .01.), have experienced physical abuse (10.2% vs. 5.1%; p < .001), and been in a violent relationship (27.2% vs. 12.8%; p < .001). SMW had higher rates of several known cancer risk factors, ostensibly placing them at higher risk of cancer as well as chronic health conditions. Further research is needed to determine whether increased risk results in increased cancer as these women age, and to inform the development of interventions to reduce the risk of disease for SMW.
Australasian journal on ageing, Jan 26, 2014
To identify the impact of in-reach services providing specialist nursing care on outcomes for old... more To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services. Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P < 0.001) and admission rates decreased by 23% (68 vs 45%, P < 0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P = 0.007). There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.
Health & Social Care in the Community, 2014
What is known about this topic • Advance care planning (ACP) provides people with an opportunity ... more What is known about this topic • Advance care planning (ACP) provides people with an opportunity to be involved in decision-making underpinning their care and treatment options, should they be unable to do so at a later stage. • Within Australia, ACP uptake in residential aged care settings has been increasing. However, the prevalence of ACP for older people in the Australian community remains unknown. • When an older person is transferred to the Emergency Department, health professionals seek to consider any advance directives for treatment options. What this paper adds • Low prevalence (13.3%) of ACP for older people attending the Emergency Department. ACP was more common for those from residential aged care with a comorbidity of cerebrovascular disease or dementia, compared to those living in the community and without cognitive impairment. • Advance care planning may be associated with shorter lengths of hospital stay and a lower rate of readmission to hospital and may influence requests both for and against medical intervention.
Aim: The purpose of this study was to determine the prevalence of Advance Care Planning among old... more Aim: The purpose of this study was to determine the prevalence of Advance Care Planning among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. Method: This retrospective, cross-sectional study comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011; 150 people who lived in the community and 150 transferred from residential aged care to ED. Data collected from patient medical records included patient characteristics, transfer and Advance Care Planning details, ED care and patient outcomes. Results: Overall prevalence of Advance Care Planning was 13.3% (n=40/300); over one-quarter (26.6%, n=40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n=0/150) of the people from the community. The directives contained within the Advance Care Plans were difficult to interpret, leading to ineffective arrangements for end-of-life care. ...
Background: Advance Care Planning (ACP) provides people with an opportunity to be involved in dec... more Background: Advance Care Planning (ACP) provides people with an opportunity to be involved in decision-making underpinning their care and treatment choices. When an older person is transferred to the Emergency Department (ED), health professionals seek to consider any advance directives for treatment options. Aim: To examine the uptake of ACP by older people and explore the deeper context of ACP adherence. Method: A mixed methods approach was used for this retrospective study of emergency presentations by older people, 150 from residential aged care and 150 from the community, who presented to any of three EDs at Eastern Health, Victoria in 2011. Results: Prevalence of ACP was 13.3% (n=40/300); over one-quarter (26.6%, n=40/150) of those presenting to the ED from residential aged care had documented ACP, compared to none (0%, n=0/150) of the people from the community. Those with a co-morbidity of cerebrovascular disease or dementia were more likely to have documented ACP on arrival ...
Preventive Medicine, 2007
Purpose. To examine the influence of tan preference and skin type on sun protection behaviors of ... more Purpose. To examine the influence of tan preference and skin type on sun protection behaviors of Australian adolescents. Methods. The Australian Secondary School Alcohol and Drug Questionnaires were conducted in 1993, 1996, 1999 and 2002 among randomly selected students aged 12-17. Schools were randomly selected from each education sector in each state. The self-administered questionnaire contained questions about tan preferences, skin type and usual SunSmart behavior (use of sunscreen, hats and covering clothing). Results. The routine use of SunSmart behavior was low in all survey years. There was a significant decrease over time in the proportion of students who practiced SunSmart behavior, with prevalence rates lower in 2002 than in any other survey year (males: p < 0.01 and females: p < 0.01). As desire for a tan increased, routine practice of SunSmart behaviors decreased. Across the four survey periods, male (p < 0.01) and female (p < 0.01) students who preferred no tan were significantly more likely to practice SunSmart behavior than students who preferred any sort of tan. Across the four survey years, male (p < 0.01) and female (p < 0.01) students with skin that 'just burns' were most likely to routinely practice SunSmart behavior. Conclusions. Sun protection practices among adolescents have continued to decline significantly over time. Future educational programs require an innovative approach to modify adolescent behaviors in relation to sun exposure and sun protection.
Ophthalmology, 1998
Participants were recruited by a household census from two of nine clusters of the Melbourne Visu... more Participants were recruited by a household census from two of nine clusters of the Melbourne Visual Impairment Project, a population-based study of age-related eye disease in the 40 and older age group of Melbourne, Australia. Nine hundred and twenty-six (82.3% of eligible) people participated: 433 (46.8%) were male. They ranged in age from 40 to 97 years, with a mean of 59.2 years. Main Outcome Measures: Self-reported symptoms of dry eye were elicited by an interviewer-administered questionnaire. Four objective assessments of dry eye were made: Schirmer's test, tear film breakup time, rose bengal staining, and fluorescein cornea1 staining. A standardized clinical slit-lamp examination was performed on all participants. Dry eye for the individual signs or symptoms was defined as: rose bengal > 3, Schirmers < 8, tear film breakup time < 8, > '& fluorescein staining, and severe symptoms (3 on a scale of 0 to 3). Results: Dry eye was diagnosed as follows: 10.8% by rose bengal, 16.3% by Schirmer's test, 8.6% by tear film breakup time, 1.5% by fluorescein staining, 7.4% with two or more signs, and 5.5% with any severe symptom not attributed to hay fever. Women were more likely to report severe symptoms of dry eye (odds ratio [OR] = 1.85; 95% confidence limits [CL] = 1 .Ol, 3.41). Risk factors for two or more signs of dry eye include age (OR = 1.04; 95% CL = 1 .Ol, 1.06), and self-report of arthritis (OR = 3.27; 95% CL = 1.74, 6.17). These results were not changed after excluding the 21 people (2.27%) who wore contact lenses. Conclusions: These are the first reported population-based data of dry eye in Australia. The prevalence of dry eye varies by sign and symptom. Ophthalmology 7998; 705:7 7 74-7 7 79 Dry eye, or keratoconjunctivitis sicca (KCS), is a distressing problem for both patients and ophthalmologists. The prevalence of this condition in the community is unknown because patients present for assessment and treatment when the condition is moderate to severe and the symptoms have become intolerable. Even at this stage, the diagnosis may not be made if the ophthalmologist does not perform the diagnostic tests required to detect dry eye. The condition of dry eye is therefore often overlooked and hence underdiagnosed in the population.
Health & Place, 2014
A trial installing shade sails at secondary schools found increased students 0 use of newly shade... more A trial installing shade sails at secondary schools found increased students 0 use of newly shaded areas, but relatively low use overall. We examined site features and weather related to use of these shaded areas. Tables with seats and temperatures Z 27 1C increased student use of shaded areas, presence of grass decreased use. Focus groups at eight schools suggest students were unaware of changes to their habitual use of favoured locations. Results infer careful selection of locations for built-shade and provision of tables with seats will assist in maximising student use and investments in shade sails.
BMJ, 2009
Objective To examine whether students use or avoid newly shaded areas created by shade sails inst... more Objective To examine whether students use or avoid newly shaded areas created by shade sails installed at schools. Design Cluster randomised controlled trial with secondary schools as the unit of randomisation. Setting 51 secondary schools with limited available shade, in Australia, assessed over two spring and summer terms. Participants Students outside at lunch times. Intervention Purpose built shade sails were installed in winter 2005 at full sun study sites to increase available shade for students in the school grounds. Main outcome measure Mean number of students using the primary study sites during weekly observations at lunch time. Results Over the study period the mean change in students using the primary study site from pre-test to posttest was 2.63 (95% confidence interval 0.87 to 4.39) students in intervention schools and −0.03 (−1.16 to 1.09) students in control schools. The difference in mean change between groups was 2.67 (0.65 to 4.68) students (P=0.011). Conclusions Students used rather than avoided newly shaded areas provided by purpose built shade sails at secondary schools in this trial, suggesting a practical means of reducing adolescents' exposure to ultraviolet radiation. Trial registration Exempt.
Australian Health Review, 2007
This study explored the diversity of emergency code telephone numbers currently in use in Austral... more This study explored the diversity of emergency code telephone numbers currently in use in Australian hospitals and examined the feasibility of a standard emergency code telephone number for all Australian hospitals, based on the United Kingdom experience. An email and telephone convenience survey of Australian hospitals from six states and two territories was conducted. Of the 108 hospitals surveyed, seven did not use a telephone number system and used a button/ pager system to call an emergency. Of the 101 hospitals surveyed that used a telephone number system, 40 different emergency telephone numbers were in place, and in nine hospitals the telephone number used for Code Blue (medical emergency) was different to the telephone number used for other emergency codes. With increasing mobility of staff across hospitals, uniformity of emergency code telephone numbers is required to reduce confusion, potential danger and improve staff response in emergency situations. A single Australian...
These conference proceedings was published in the Asia-Pacific Journal of Clinical Oncology, v.11... more These conference proceedings was published in the Asia-Pacific Journal of Clinical Oncology, v.11, supplement S4, page 157, 201
Resuscitation, 2011
Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in... more Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. Design and Setting: A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings. Patients: All inpatients were eligible except intensive care and psychiatric patients. Measurement and main results: On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment. Conclusion: In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.
BMC Family Practice, 2014
Background: Health literacy refers to an individual's ability to engage with health information a... more Background: Health literacy refers to an individual's ability to engage with health information and services. Cancer caregivers play a vital role in the care of people with cancer, and their capacity to find, understand, appraise and use health information and services influences how effectively they are able to undertake this role. The aim of this study was to develop an instrument to measure health literacy of cancer caregivers. Method: Content areas for the new instrument were identified from a conceptual model of cancer caregiver health literacy. Item content was guided by statements provided by key stakeholders during consultation activities and selected to be representative across the range of cancer caregiver experiences. Content validity of items was assessed through expert review (n = 7) and cognitive interviews with caregivers (n = 16). Results: An initial pool of 82 items was generated across 10 domains. Two categories of response options were developed for these items: agreement with statements, and difficulty undertaking presented tasks. Expert review revealed that the majority of items were relevant and clear (Content Validity Index > 0.78). Cognitive interviews with caregivers suggested that all except three items were well understood. Conclusion: A resultant 88 item questionnaire was developed to assess cancer caregiver health literacy. Further work is required to assess the construct validity and reliability of the new measure, and to remove poorly performing and redundant items, which will result in a shorter, final measure. The new measure has the potential to inform the development and evaluation of interventions and the improvement of health service delivery to cancer caregivers.
Preventive Medicine, 2007
Purpose. To examine the influence of tan preference and skin type on sun protection behaviors of ... more Purpose. To examine the influence of tan preference and skin type on sun protection behaviors of Australian adolescents. Methods. The Australian Secondary School Alcohol and Drug Questionnaires were conducted in 1993, 1996, 1999 and 2002 among randomly selected students aged 12--17. Schools were randomly selected from each education sector in each state. The self-administered questionnaire contained questions about tan preferences, skin type and usual SunSmart behavior (use of sunscreen, hats and covering clothing). Results. The routine use of SunSmart behavior was low in all survey years. There was a significant decrease over time in the proportion of students who practiced SunSmart behavior, with prevalence rates lower in 2002 than in any other survey year (males: p < 0.01 and females: p < 0.01). As desire for a tan increased, routine practice of SunSmart behaviors decreased. Across the four survey periods, male (p < 0.01) and female (p < 0.01) students who preferred no tan were significantly more likely to practice SunSmart behavior than students who preferred any sort of tan. Across the four survey years, male (p < 0.01) and female (p < 0.01) students with skin that 'just burns' were most likely to routinely practice SunSmart behavior. Conclusions. Sun protection practices among adolescents have continued to decline significantly over time. Future educational programs require an innovative approach to modify adolescent behaviors in relation to sun exposure and sun protection.
Scandinavian Journal of Caring Sciences, 2015
ABSTRACT Background Type 2 diabetes (T2DM) prevalence is increasing rapidly worldwide with a sign... more ABSTRACT Background Type 2 diabetes (T2DM) prevalence is increasing rapidly worldwide with a significant increase in young adults. There is limited information about psychosocial and service needs of this group.AimTo explore similarities and differences in how psychosocial factors impact on Australian and Danish young adults with T2DM and to identify unmet support needs during life transitions.MethodA qualitative approach was adopted using thematic content analysis of 26 in-depth semi-structured interviews. An inductive descriptive content analysis was undertaken using a comparative coding system.FindingsEligible participants were from Australia (12) and Denmark (14), aged 19–42 years who had T2DM for more than 10 months. In general, they reported diabetes management was difficult during transitions and diabetes self-care routines had to change to accommodate life changes. The underpinning sense of ‘uncertainty’ initiated by life transitions caused guilt that often resulted in low self-worth, anxiety and depression, which in turn had a negative impact on social and professional relationships. The participants emphasised the importance of connectedness to social networks, particularly with T2DM peers, and the need for flexible access to health professionals, age-specific tailored support and lower costs for Australians. Australian participants were more concerned than Danish participants about the cost associated with diabetes care and their ability to stay employed; hence, they were reluctant to disclose diabetes at work.ConclusionT2DM had a similar impact on life transitions of Australian and Danish young adults with T2DM, suggesting health care needs to encompass managing life transitions. Participants had to cope with uncertainty and the impact of people&#39;s responses to diabetes, particularly at work and in relationships. Health professionals are urged to integrate these factors in care plans and education, which must be individualised and focus on the psychosocial aspects that operate during life transitions.
BMC Family Practice, 2014
Background: Health literacy refers to an individual's ability to engage with health information a... more Background: Health literacy refers to an individual's ability to engage with health information and services. Cancer caregivers play a vital role in the care of people with cancer, and their capacity to find, understand, appraise and use health information and services influences how effectively they are able to undertake this role. The aim of this study was to develop an instrument to measure health literacy of cancer caregivers. Method: Content areas for the new instrument were identified from a conceptual model of cancer caregiver health literacy. Item content was guided by statements provided by key stakeholders during consultation activities and selected to be representative across the range of cancer caregiver experiences. Content validity of items was assessed through expert review (n = 7) and cognitive interviews with caregivers (n = 16). Results: An initial pool of 82 items was generated across 10 domains. Two categories of response options were developed for these items: agreement with statements, and difficulty undertaking presented tasks. Expert review revealed that the majority of items were relevant and clear (Content Validity Index > 0.78). Cognitive interviews with caregivers suggested that all except three items were well understood. Conclusion: A resultant 88 item questionnaire was developed to assess cancer caregiver health literacy. Further work is required to assess the construct validity and reliability of the new measure, and to remove poorly performing and redundant items, which will result in a shorter, final measure. The new measure has the potential to inform the development and evaluation of interventions and the improvement of health service delivery to cancer caregivers.
Resuscitation, 2011
Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in... more Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. Design and Setting: A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings. Patients: All inpatients were eligible except intensive care and psychiatric patients. Measurement and main results: On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment. Conclusion: In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.
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Papers by Patrica Livingston