Introduction International and national guidelines highlight the need for general practitioner in... more Introduction International and national guidelines highlight the need for general practitioner involvement during and after active cancer treatment and throughout long-term follow-up care. This paper aimed to evaluate patients' acceptance of radiation oncology shared follow-up care using the Theoretical Framework of Acceptability (TFA). Methods This cross-sectional study was conducted at two cancer care centres in the Illawarra Shoalhaven region of Australia. A sample of patients scheduled for a radiation oncology follow-up consultation in 2021 were sent a 32-point self-complete paper-based survey. Data were analysed using descriptive, parametric and non-parametric statistical analysis. This paper followed the Checklist for Reporting of Survey Studies (CROSS). Of the 414 surveys returned (45% response rate), the acceptance for radiation oncology shared cancer follow-up care was high (80%). Patients treated with only radiotherapy were 1.7 times more likely to accept shared follow-up care than those treated with multiple modalities. Patients who preferred follow-up care for fewer than three years were 7.5 times more likely to accept shared care than those who preferred follow-up care for five years. Patients who travelled more than 20 minutes to their radiation oncologist or to the rural cancer centre were slightly more likely to accept shared care than those who travelled less than twenty minutes to the regional cancer centre. A high understanding of shared care (Intervention Coherence) and a positive feeling towards shared care (Affective Attitude) were significant predictive factors in accepting shared radiation oncology follow-up care. Health services need to ensure patient preferences are considered to provide patient-centred cancer follow-up care. Shared cancer follow-up care implementation should start with patients who prefer a shorter follow-up period and understand the benefits of shared care. However, patients' involvement needs to be considered alongside other clinical risk profiles and organisational factors. Future qualitative research using the TFA constructs is warranted to inform clinical practice change.
Introduction: Facilitators to implement shared cancer follow-up care into clinical practice inclu... more Introduction: Facilitators to implement shared cancer follow-up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two-way information sharing and clear follow-up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. Methods: Semi-structured interviews were conducted pre- and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. Results: Thirty-two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow-up care, however, patients were concerned about the GPs cancer-specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low-risk, stable patients around 2-3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow-up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. Conclusion: Patients, GPs and ROs felt this shared cancer follow-up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. Patient or public contribution: Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed.
Background: Dementia is the second leading cause of death in Australia. Over half of patients wit... more Background: Dementia is the second leading cause of death in Australia. Over half of patients with dementia are undiagnosed in primary care. This paper describes the development, implementation and initial evaluation of the first national continuing medical education program on the timely diagnosis and management of dementia in general practice in Australia. Methods: Continuing medical education workshops were developed and run in 16 urban and rural locations across Australia (12 were delivered as small group workshops, four as large groups), and via online modules. Two train-the-trainer workshops were held. The target audience was general practitioners, however, international medical graduates, GP registrars, other doctors, primary care nurses and other health professionals were also welcome. Self-complete questionnaires were used for the evaluation. Results: Of 1236 people (GPs, other doctors, nurses and other health professionals) who participated in the program, 609 completed the full program (small group workshops (282), large group workshops (75), online modules (252)); and 627 elected to undertake one or more individual submodules (large group workshops (444), online program (183)). Of those who completed the full program as a small group workshop, 14 undertook the additional Train-the-trainer program. 76% of participants felt that their learning needs were entirely met and 78% felt the program was entirely relevant to their practice. Conclusion: Continuing medical education programs are an effective method to deliver education to GPs. A combination of face-to-face and online delivery modes increases reach to primary care providers. Train-the-trainer sessions and online continuing medical education programs promote long-term delivery sustainability. Further research is required to determine the long-term knowledge translation effects of the program.
Journal of radiation oncology informatics, Feb 7, 2023
The COVID-19 global pandemic required health services to be innovative and quickly adapt their he... more The COVID-19 global pandemic required health services to be innovative and quickly adapt their health service delivery, including adopting health technology in cancer clinical practice. COVID-19 restrictions forced our health service to introduce follow-up consultations for many patients via telehealth. At the same time, we explored an alternative follow-up model of care in preparation for unknown future restrictions and changes to health resources. We adapted an existing Patient Reported Outcome messaging service that linked to the patient's medical record. Clear and meaningful interpretation of patient-reported outcome scores is fundamental to their use to determine if they could become a means of follow-up care when service delivery is impeded. Therefore, this study aimed to evaluate the feasibility of a patient self-reported follow-up model of care for radiation oncology that was opportunistically introduced during COVID. Methods: This was a cross-sectional clinical practice study set in Wollongong, Australia. Patients on radiation oncology follow-up care were sent an unannounced text message with a weblink to a survey to self-report their health before their radiation oncology telehealth appointment. Radiation oncologists completed the same set of questions during or within a day of the telehealth follow-up consultation. Descriptive statistics were analysed to evaluate the uptake of self-reporting. Percent agreement and Cohen's Kappa were used to determine patient-clinician agreement. Results: A moderate response rate of 62% was achieved from the 142 patients. Percent agreement between the patientreported and the clinician-reported for weight change, appetite, physical performance, side effects was acceptable (>75%). However, percent agreement was moderate for pain and sleep. For most items, Cohen's Kappa indicated moderate agreement, with pain, side effects, and recurrence being fair. Patients were more likely to report themselves worse than the clinician for all items, except for side effects. Conclusions: Based on the findings of this study, a standalone patient-reported follow-up model of care is not feasible due to the lower than ideal response rate and fair to moderate patient-clinician agreement. However, we show the importance of capturing the patient perspective for radiation oncology follow-up care as complementary information for clinicians prior to telehealth consultations. Patient-reported information could triage phone consultation from a standard to a long consultation or triage patients requiring physical consultation and immediate attention. With further research, patients self-reporting before their telehealth consultation holds promise for future models of follow-up care, particularly for rural and remote patients and during pandemics and other disasters where clinic attendance is not possible.
BackgroundThe increasing incidence of cancer, coupled with improved survivorship, has increased d... more BackgroundThe increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care and the need to find alternative models of care. Shared cancer follow-up care in general practice is a safe option in terms of quality of life and cancer recurrence; however, there are barriers to translating this into practice. This review aimed to identify factors that influence the translation of shared cancer follow-up care into clinical practice.MethodsSystematic review. Seven electronic databases: MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psychinfo, Health Source: Nursing/Academic Edition and Psychology and Behavioural Sciences Collection, were searched for published papers between January 1999 and December 2021. The narrative review included papers if they were available in full-text, English, peer-reviewed and focused on shared cancer follow-up care.ResultsThirty-eight papers were included in the final review. Five main...
Additional file 4. Table S3. Mean score change for subset of GPs who submitted surveys at each of... more Additional file 4. Table S3. Mean score change for subset of GPs who submitted surveys at each of two time-points.
Additional file 1. Figure S1. Flowchart of survey response rates in a convenience sample of GPs e... more Additional file 1. Figure S1. Flowchart of survey response rates in a convenience sample of GPs engaged in dementia-focused CME.
Additional file 8. Table S7. Exemplars of General Practitioner suggestions for improving future d... more Additional file 8. Table S7. Exemplars of General Practitioner suggestions for improving future dementia-focused Continuing Medical Education programs.
Additional file 5. Table S4. Logistic regression of General Practitioner characteristics on pre-C... more Additional file 5. Table S4. Logistic regression of General Practitioner characteristics on pre-CME program awareness and practice.
BackgroundPresentations at scientific conferences are an important method of research disseminati... more BackgroundPresentations at scientific conferences are an important method of research dissemination, with abstracts often used to inform clinical practice. Abstract to publication ratio is a commonly used tool for determining meeting quality. The aim of this study was to determine the publication rate for abstracts presented at the Australian Orthopaedic Association Annual Scientific Meeting (AOA ASM) between 2012 and 2015 inclusive and identify reasons for non‐publication.MethodsMEDLINE, PubMed and Google Scholar were searched to determine whether each abstract presented at AOA ASMs between 2012 and 2015 was associated with a full text publication in a peer‐reviewed journal. Where a publication could not be located, the presenter was contacted to confirm the reason for non‐publication.ResultsA total of 1130 abstracts were submitted (951 oral and 179 posters), and 573 resulted in full‐text peer‐reviewed publications (51%). The majority of publications (73%) were published within 2 y...
Background The stressful nature of medical training and other work-related factors put postgradua... more Background The stressful nature of medical training and other work-related factors put postgraduate medical trainees at high risk of burnout and poor psychological wellbeing. This has negative implications for patient care and the effectiveness of the healthcare system. The structure of the healthcare system and postgraduate medical education in Australia is different to that of other countries. Whilst a significant body of research exists on burnout and wellbeing in trainees in the USA, evidence specific to Australian trainees is lacking. The aim of this review is to synthesise the current knowledge on the factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees. Methods/design A systematic review will be conducted across eight digital databases: Academic Search Complete, MEDLINE, Embase, Web of Science, PsychInfo, Scopus, CINAHL Plus and Informit Health Collection. Peer reviewed empirical studies and relevant grey literature published aft...
Purpose In Australia, approximately 86% of the adult population visit their GP each year. Adults ... more Purpose In Australia, approximately 86% of the adult population visit their GP each year. Adults are receptive to advice about healthy eating and physical activity from their primary care providers-yet few routine consultations include this advice. This study explores the frequency of advice provided as part of a preventive health check consultation around healthy eating and physical activity, and the characteristics of patients receiving advice and referral. Methods The Cardiovascular Absolute Risk Trial was a cluster RCT (with GP practices the unit of cluster) conducted between 2008 and 2010. Data were obtained through an audit of the GP medical records and via patient self-reported questionnaires. Results Over 1,000 adults (42.8% Male) aged 45-69 returned questionnaires, and 850 attended a GP visit. Nutrition and physical activity advice was provided to 29.4% and 23.9% of participants respectively. Participants were significantly more likely to receive nutrition advice if they ha...
Aim: To assess how the Indigenous status of patients is identified in general practice in Sydney.... more Aim: To assess how the Indigenous status of patients is identified in general practice in Sydney. Methods: Mixed methods using self-complete surveys, a medical records audit and Indigenous unannounced standardised patients (USP) visits to seven general practices in Sydney. Findings: Two GPs and four administration staff in separate practices did not know what systems their practice used to identify patients’ Indigenous status, and two GPs from separate practices did not know if the Indigenous status was recorded in the medical record. One practice did not ask any patients their Indigenous status. The USP’s Indigenous status was correctly identified on two occasions; on four occasions it was incorrectly recorded in the medical record, and the USP was recorded as being non-Indigenous based on physical appearance in two practices. Most practices relied solely on patients self-identifying their Indigenous status on a New Patient Registration Form. One practice asked patients their Indig...
Introduction International and national guidelines highlight the need for general practitioner in... more Introduction International and national guidelines highlight the need for general practitioner involvement during and after active cancer treatment and throughout long-term follow-up care. This paper aimed to evaluate patients' acceptance of radiation oncology shared follow-up care using the Theoretical Framework of Acceptability (TFA). Methods This cross-sectional study was conducted at two cancer care centres in the Illawarra Shoalhaven region of Australia. A sample of patients scheduled for a radiation oncology follow-up consultation in 2021 were sent a 32-point self-complete paper-based survey. Data were analysed using descriptive, parametric and non-parametric statistical analysis. This paper followed the Checklist for Reporting of Survey Studies (CROSS). Of the 414 surveys returned (45% response rate), the acceptance for radiation oncology shared cancer follow-up care was high (80%). Patients treated with only radiotherapy were 1.7 times more likely to accept shared follow-up care than those treated with multiple modalities. Patients who preferred follow-up care for fewer than three years were 7.5 times more likely to accept shared care than those who preferred follow-up care for five years. Patients who travelled more than 20 minutes to their radiation oncologist or to the rural cancer centre were slightly more likely to accept shared care than those who travelled less than twenty minutes to the regional cancer centre. A high understanding of shared care (Intervention Coherence) and a positive feeling towards shared care (Affective Attitude) were significant predictive factors in accepting shared radiation oncology follow-up care. Health services need to ensure patient preferences are considered to provide patient-centred cancer follow-up care. Shared cancer follow-up care implementation should start with patients who prefer a shorter follow-up period and understand the benefits of shared care. However, patients' involvement needs to be considered alongside other clinical risk profiles and organisational factors. Future qualitative research using the TFA constructs is warranted to inform clinical practice change.
Introduction: Facilitators to implement shared cancer follow-up care into clinical practice inclu... more Introduction: Facilitators to implement shared cancer follow-up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two-way information sharing and clear follow-up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. Methods: Semi-structured interviews were conducted pre- and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. Results: Thirty-two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow-up care, however, patients were concerned about the GPs cancer-specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low-risk, stable patients around 2-3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow-up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. Conclusion: Patients, GPs and ROs felt this shared cancer follow-up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. Patient or public contribution: Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed.
Background: Dementia is the second leading cause of death in Australia. Over half of patients wit... more Background: Dementia is the second leading cause of death in Australia. Over half of patients with dementia are undiagnosed in primary care. This paper describes the development, implementation and initial evaluation of the first national continuing medical education program on the timely diagnosis and management of dementia in general practice in Australia. Methods: Continuing medical education workshops were developed and run in 16 urban and rural locations across Australia (12 were delivered as small group workshops, four as large groups), and via online modules. Two train-the-trainer workshops were held. The target audience was general practitioners, however, international medical graduates, GP registrars, other doctors, primary care nurses and other health professionals were also welcome. Self-complete questionnaires were used for the evaluation. Results: Of 1236 people (GPs, other doctors, nurses and other health professionals) who participated in the program, 609 completed the full program (small group workshops (282), large group workshops (75), online modules (252)); and 627 elected to undertake one or more individual submodules (large group workshops (444), online program (183)). Of those who completed the full program as a small group workshop, 14 undertook the additional Train-the-trainer program. 76% of participants felt that their learning needs were entirely met and 78% felt the program was entirely relevant to their practice. Conclusion: Continuing medical education programs are an effective method to deliver education to GPs. A combination of face-to-face and online delivery modes increases reach to primary care providers. Train-the-trainer sessions and online continuing medical education programs promote long-term delivery sustainability. Further research is required to determine the long-term knowledge translation effects of the program.
Journal of radiation oncology informatics, Feb 7, 2023
The COVID-19 global pandemic required health services to be innovative and quickly adapt their he... more The COVID-19 global pandemic required health services to be innovative and quickly adapt their health service delivery, including adopting health technology in cancer clinical practice. COVID-19 restrictions forced our health service to introduce follow-up consultations for many patients via telehealth. At the same time, we explored an alternative follow-up model of care in preparation for unknown future restrictions and changes to health resources. We adapted an existing Patient Reported Outcome messaging service that linked to the patient's medical record. Clear and meaningful interpretation of patient-reported outcome scores is fundamental to their use to determine if they could become a means of follow-up care when service delivery is impeded. Therefore, this study aimed to evaluate the feasibility of a patient self-reported follow-up model of care for radiation oncology that was opportunistically introduced during COVID. Methods: This was a cross-sectional clinical practice study set in Wollongong, Australia. Patients on radiation oncology follow-up care were sent an unannounced text message with a weblink to a survey to self-report their health before their radiation oncology telehealth appointment. Radiation oncologists completed the same set of questions during or within a day of the telehealth follow-up consultation. Descriptive statistics were analysed to evaluate the uptake of self-reporting. Percent agreement and Cohen's Kappa were used to determine patient-clinician agreement. Results: A moderate response rate of 62% was achieved from the 142 patients. Percent agreement between the patientreported and the clinician-reported for weight change, appetite, physical performance, side effects was acceptable (>75%). However, percent agreement was moderate for pain and sleep. For most items, Cohen's Kappa indicated moderate agreement, with pain, side effects, and recurrence being fair. Patients were more likely to report themselves worse than the clinician for all items, except for side effects. Conclusions: Based on the findings of this study, a standalone patient-reported follow-up model of care is not feasible due to the lower than ideal response rate and fair to moderate patient-clinician agreement. However, we show the importance of capturing the patient perspective for radiation oncology follow-up care as complementary information for clinicians prior to telehealth consultations. Patient-reported information could triage phone consultation from a standard to a long consultation or triage patients requiring physical consultation and immediate attention. With further research, patients self-reporting before their telehealth consultation holds promise for future models of follow-up care, particularly for rural and remote patients and during pandemics and other disasters where clinic attendance is not possible.
BackgroundThe increasing incidence of cancer, coupled with improved survivorship, has increased d... more BackgroundThe increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care and the need to find alternative models of care. Shared cancer follow-up care in general practice is a safe option in terms of quality of life and cancer recurrence; however, there are barriers to translating this into practice. This review aimed to identify factors that influence the translation of shared cancer follow-up care into clinical practice.MethodsSystematic review. Seven electronic databases: MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psychinfo, Health Source: Nursing/Academic Edition and Psychology and Behavioural Sciences Collection, were searched for published papers between January 1999 and December 2021. The narrative review included papers if they were available in full-text, English, peer-reviewed and focused on shared cancer follow-up care.ResultsThirty-eight papers were included in the final review. Five main...
Additional file 4. Table S3. Mean score change for subset of GPs who submitted surveys at each of... more Additional file 4. Table S3. Mean score change for subset of GPs who submitted surveys at each of two time-points.
Additional file 1. Figure S1. Flowchart of survey response rates in a convenience sample of GPs e... more Additional file 1. Figure S1. Flowchart of survey response rates in a convenience sample of GPs engaged in dementia-focused CME.
Additional file 8. Table S7. Exemplars of General Practitioner suggestions for improving future d... more Additional file 8. Table S7. Exemplars of General Practitioner suggestions for improving future dementia-focused Continuing Medical Education programs.
Additional file 5. Table S4. Logistic regression of General Practitioner characteristics on pre-C... more Additional file 5. Table S4. Logistic regression of General Practitioner characteristics on pre-CME program awareness and practice.
BackgroundPresentations at scientific conferences are an important method of research disseminati... more BackgroundPresentations at scientific conferences are an important method of research dissemination, with abstracts often used to inform clinical practice. Abstract to publication ratio is a commonly used tool for determining meeting quality. The aim of this study was to determine the publication rate for abstracts presented at the Australian Orthopaedic Association Annual Scientific Meeting (AOA ASM) between 2012 and 2015 inclusive and identify reasons for non‐publication.MethodsMEDLINE, PubMed and Google Scholar were searched to determine whether each abstract presented at AOA ASMs between 2012 and 2015 was associated with a full text publication in a peer‐reviewed journal. Where a publication could not be located, the presenter was contacted to confirm the reason for non‐publication.ResultsA total of 1130 abstracts were submitted (951 oral and 179 posters), and 573 resulted in full‐text peer‐reviewed publications (51%). The majority of publications (73%) were published within 2 y...
Background The stressful nature of medical training and other work-related factors put postgradua... more Background The stressful nature of medical training and other work-related factors put postgraduate medical trainees at high risk of burnout and poor psychological wellbeing. This has negative implications for patient care and the effectiveness of the healthcare system. The structure of the healthcare system and postgraduate medical education in Australia is different to that of other countries. Whilst a significant body of research exists on burnout and wellbeing in trainees in the USA, evidence specific to Australian trainees is lacking. The aim of this review is to synthesise the current knowledge on the factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees. Methods/design A systematic review will be conducted across eight digital databases: Academic Search Complete, MEDLINE, Embase, Web of Science, PsychInfo, Scopus, CINAHL Plus and Informit Health Collection. Peer reviewed empirical studies and relevant grey literature published aft...
Purpose In Australia, approximately 86% of the adult population visit their GP each year. Adults ... more Purpose In Australia, approximately 86% of the adult population visit their GP each year. Adults are receptive to advice about healthy eating and physical activity from their primary care providers-yet few routine consultations include this advice. This study explores the frequency of advice provided as part of a preventive health check consultation around healthy eating and physical activity, and the characteristics of patients receiving advice and referral. Methods The Cardiovascular Absolute Risk Trial was a cluster RCT (with GP practices the unit of cluster) conducted between 2008 and 2010. Data were obtained through an audit of the GP medical records and via patient self-reported questionnaires. Results Over 1,000 adults (42.8% Male) aged 45-69 returned questionnaires, and 850 attended a GP visit. Nutrition and physical activity advice was provided to 29.4% and 23.9% of participants respectively. Participants were significantly more likely to receive nutrition advice if they ha...
Aim: To assess how the Indigenous status of patients is identified in general practice in Sydney.... more Aim: To assess how the Indigenous status of patients is identified in general practice in Sydney. Methods: Mixed methods using self-complete surveys, a medical records audit and Indigenous unannounced standardised patients (USP) visits to seven general practices in Sydney. Findings: Two GPs and four administration staff in separate practices did not know what systems their practice used to identify patients’ Indigenous status, and two GPs from separate practices did not know if the Indigenous status was recorded in the medical record. One practice did not ask any patients their Indigenous status. The USP’s Indigenous status was correctly identified on two occasions; on four occasions it was incorrectly recorded in the medical record, and the USP was recorded as being non-Indigenous based on physical appearance in two practices. Most practices relied solely on patients self-identifying their Indigenous status on a New Patient Registration Form. One practice asked patients their Indig...
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