Randomized Control Trial Of A Cancer Shared Care Model
Funder
National Health and Medical Research Council
Funding Amount
$242,400.00
Summary
Cancer care in Australia remains fragmented. Shared care has been seen as a potentially more effective way to manage patients with chronic and subacute diseases, by overcoming many of the difficulties which beset the traditional hospital-based model. These difficulties include poor communication between hospital-based and community-based carers, the high costs of hospital-based care and the loss of involvement of the primary care health professional in ongoing care. This project is a trial of a ....Cancer care in Australia remains fragmented. Shared care has been seen as a potentially more effective way to manage patients with chronic and subacute diseases, by overcoming many of the difficulties which beset the traditional hospital-based model. These difficulties include poor communication between hospital-based and community-based carers, the high costs of hospital-based care and the loss of involvement of the primary care health professional in ongoing care. This project is a trial of a Shared Care Model (SCM) with cancer patients in a hospital in Western Australia. The project is designed to improve the emotional well-being and feelings of empowerment of the patients as well as reduce the number of unplanned admissions these patients need to make during their cancer treatment. The SCM intervention includes: -A patient-held record (PHR) comprising chemotherapy road map, treatment intention, medication list and communication pages for health workers; - Earlier and timely direct communication between specialist and general practitioner; -A Shared Care coordinator to assist with patient care and information; and - General practitioner educational and resource packages with tailored side effects table detailing anticipated side effects and actions to be taken. - For rural patients, the model can be expanded to include general practitioner administration of selected chemotherapeutic agents on alternate cycles. - Protocols for general practitioners administration of selected chemotherapeutic agents.Read moreRead less
Development And Evaluation Of A Decision Aid For Women With A Breech-presenting Baby.
Funder
National Health and Medical Research Council
Funding Amount
$156,890.00
Summary
Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women with a breech presenting baby ( ....Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women with a breech presenting baby (bottom rather than head first) in late pregnancy. A decision aid for breech presentation is timely because recent results of an international trial have dramatically altered women's options in the management of breech presentation. The trial of vaginal breech birth versus planned caesarean section (CS) found overwhelming evidence of reduced infant death and disability for women with a planned CS. Planned CS is now considered best practice for delivery of a breech presentation at birth. However, another treatment option for women with a breech presentation is turning the breech to head first before birth (called external cephalic version, ECV). Each of these options (ECV or planned CS) has benefits and risks, and the relative importance of these benefits and risks varies for individual women, a scenario where a decision aid produces the greatest benefit. The breech decision aid developed in this project will be based on the best and most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women to a treatment option that best suits them, taking ~20 minutes to complete. The decision aid will be evaluated to assess the impact on women's satisfaction with decision making, knowledge, anxiety and pregnancy outcomes. If successful, the results could be applied to improve consumer information and participation in clinical decisions across a wide spectrum of pregnancy care issues.Read moreRead less
Consumer Information Materials And A Communication Aid For Diagnostic Tests For Breast Disease
Funder
National Health and Medical Research Council
Funding Amount
$105,863.00
Summary
Many studies have now shown that the majority of patients want to participate in clinical decisions about medical treatments they might receive. As a result, information materials are being developed to help consumers and doctors work together to reach satisfying treatment decisions which are based on the best available evidence and also reflect the individual patient's needs and preferences about the treatment options. Very little is known, however, about whether consumers also want to particip ....Many studies have now shown that the majority of patients want to participate in clinical decisions about medical treatments they might receive. As a result, information materials are being developed to help consumers and doctors work together to reach satisfying treatment decisions which are based on the best available evidence and also reflect the individual patient's needs and preferences about the treatment options. Very little is known, however, about whether consumers also want to participate in decisions about whether to have a medical test. Tests can be trivial, such as a blood or urine test, or quite major and invasive, such as a biopsy or a colonoscopy. People considering a medical test might want to know the answers to the following questions: What is my chance of having the disease being tested for? If the test result is positive what is the chance I have the disease? If the test result is negative what is the chance I have the disease anyway? How will the test result influence treatment of my condition? What are possible side-effects of the test? Generally information materials about medical tests only describe the test itself, and do not contain the information people need to answer these questions. Even doctors may not have to hand the data needed to answer these questions. Yet without this information, consumers cannot make truly informed and rational choices about whether to have the test. This project aims to find out whether consumers want to participate in decisions about medical tests, what information they would want to do this, and to develop and trial information materials and a communication aid for a small number of breast cancer tests. We will use tests for diagnosing breast cancer as our model but we anticipate the work will be applicable across a wide range of medical tests.Read moreRead less
A Randomised Controlled Trial Of A Decision Aid For The Management Of Pain In Labour And Childbirth
Funder
National Health and Medical Research Council
Funding Amount
$267,375.00
Summary
Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women regarding the management of pai ....Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women regarding the management of pain in labour and childbirth. A decision aid for managing the pain of childbirth is both practical and timely because there is a strong evidence base on labour analgesia but a lack of evidence-based information for women. For example, brochures on epidural analgesia outline the advantages of epidurals such as complete amelioration of pain, but do not present any information on adverse obstetric outcomes such as the doubling of risk for an instrumental birth. Most women are willing to experience pain in childbirth but do not want pain to overwhelm them. The decision aid will include a range of available drug and non-drug options for pain relief in labour and childbirth. Each of the options has benefits and risks, and the relative importance of these benefits and risks varies for individual women, a scenario where a decision aid produces the greatest benefit. The pain management decision aid developed in this project will be based on the best most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women with their pain management options that best suit them, taking ~30 minutes to complete. The decision aid will be evaluated to assess the impact on women's satisfaction with decision making, knowledge, anxiety and pregnancy outcomes. If successful, the results could be applied to improve consumer information and participation in clinical decisions across a wide spectrum of pregnancy care issues.Read moreRead less
This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professiona ....This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professionals in relatively small rural hospitals. Patients and rural doctors often have little choice but to manage urgent cases locally and in some cases experienced and skilled local teams are able to offer a wider range of services, including a limited number of elective procedures. Despite underlying assumptions that the quality of the services cannot match that of specialist care in larger hospitals, there is no agreement on what constitutes quality of rural procedural care and little evidence that the quality is different. This issue is important as substantial government funds are spent on recruiting, training and retaining a qualified rural medical workforce, and yet fewer rural doctors are providing these services and fewer rural hospitals have the facilities to support those rural doctors still providing the services. Further, measuring the quality of care is a complex issue on which different stakeholders may have different views. This study proposes a multi-perspective approach to assessing the quality of care through a number of case studies provided by rural doctors.Read moreRead less
Our lives depend upon maintaining the correct body temperature. Failure to regulate it properly may be lethal. This is particularly true in the elderly, who are more susceptible on the one hand to heat stroke and on the other to hypothermia. Many die each year from both these causes. Body temperature is regulated by the brain, yet our understanding of how and where in the brain this happens is poor. This proposal aims to work out the 'wiring diagram' of brain temperature control pathways in rats ....Our lives depend upon maintaining the correct body temperature. Failure to regulate it properly may be lethal. This is particularly true in the elderly, who are more susceptible on the one hand to heat stroke and on the other to hypothermia. Many die each year from both these causes. Body temperature is regulated by the brain, yet our understanding of how and where in the brain this happens is poor. This proposal aims to work out the 'wiring diagram' of brain temperature control pathways in rats and to begin to extend this knowledge to humans. This work will generate new knowledge about a vital function. The insights obtained will inform and guide future strategies in aged care, intensive care and perioperative care.Read moreRead less
Discrimination Or Discretion? Factors Contributing To Discrimination Of People With Hepatitis C In Health Care Settings.
Funder
National Health and Medical Research Council
Funding Amount
$419,750.00
Summary
Hepatitis C is now the leading communicable disease in Australia and stigma and discrimination have been identified as major barriers to addressing this epidemic. This study builds on our previous work in which we have found evidence of discrimination against people with hepatitis C in health care settings. Discrimination, inappropriate and unfair treatment against people with hepatitis C, in health care settings is a major barrier to care, treatment and support. A key strategy for developing ef ....Hepatitis C is now the leading communicable disease in Australia and stigma and discrimination have been identified as major barriers to addressing this epidemic. This study builds on our previous work in which we have found evidence of discrimination against people with hepatitis C in health care settings. Discrimination, inappropriate and unfair treatment against people with hepatitis C, in health care settings is a major barrier to care, treatment and support. A key strategy for developing effective strategies to reduce both perceived and real discrimination of people with hepatitis C in health care settings is to gain a better understanding of the range of issues experienced by the health care providers themselves and factors in the broader health service context that impact on optimal care. The aim of this study is to identify these factors and the findings will influence policy and practice with the ultimate goal of removing barriers to equitable and appropriate health care for people with hepatitis C. The study will focus on both people (health care providers)- the knowledge, attitudes and practices among health care professionals in relation to infection control practices, hepatitis C and injecting drug use; and contexts (health care settings)- factors in the health care settings that contribute to discriminatory, inappropriate or unfair treatment of people with hepatitis C. The study will focus specifically on health care settings of general practice, dentistry, nursing and pharmacists. The outcomes will be used to develop practical and effective strategies for both improving health care for HCV positive individuals and improving the working relationships and environments for these health professionals working with this client population.Read moreRead less
Evaluation Of Exercise Rehabilitation For Survivors Of Intensive Care
Funder
National Health and Medical Research Council
Funding Amount
$359,282.00
Summary
Intensive care medicine has improved survival in critically ill patients. However, international literature reports poor quality of life and physical outcomes in ICU survivors compared to people of the same age. In addition, patients who require a prolonged ICU stay consume a large amount of resources. This project is testing whether an early ICU physiotherapist-directed exercise rehabilitation program continuing until after hospital discharge will improve patient's quality of life, physical fun ....Intensive care medicine has improved survival in critically ill patients. However, international literature reports poor quality of life and physical outcomes in ICU survivors compared to people of the same age. In addition, patients who require a prolonged ICU stay consume a large amount of resources. This project is testing whether an early ICU physiotherapist-directed exercise rehabilitation program continuing until after hospital discharge will improve patient's quality of life, physical function and decrease the use of health resources compared with patients' receiving standard care. Patients in the rehabilitation group will take part in a physiotherapy exercise rehabilitation program including returning to out patient classes after discharge. The physiotherapist will treat patients daily during hospital stay then twice weekly for 8 weeks after discharge. All patients will complete 2 quality of life questionnaires and physical function will be assessed using a new test developed for the acute ICU stay the 6 minute walk test, which measures how far patients can walk quickly in 6 minutes. The timed up and go test will also be used and it measures how quickly patients can get up from a chair and walk. An activity monitor, worn on the wrist, for some of the time after discharge will measure how much exercise and moving about patients are doing at home. Measurements will performed by a physiotherapist, blinded to the group to which patients were randomly allocated, on admission to the ICU (quality of life only by proxy), on discharge from the ICU, discharge from hospital and at 3, 6, 12 months after discharge. Economic evaluation will be performed to examine overall use of resources using information from the questionnaires.Read moreRead less
A National Analysis Of The Palliative And Supportive Care Needs Of Families Whose Children Die From Cancer
Funder
National Health and Medical Research Council
Funding Amount
$68,250.00
Summary
Palliative and supportive care services for children dying from cancer are underdeveloped in the paediatric setting. There is an increasing awareness of the need for comprehensive care for these dying children and their families, however, there is a striking lack of evidence based literature on which to base paediatric palliaitive and supportive care models of care. This study is the first of its kind in the area of paediatric supportive and palliative care in Australia. This study will involve ....Palliative and supportive care services for children dying from cancer are underdeveloped in the paediatric setting. There is an increasing awareness of the need for comprehensive care for these dying children and their families, however, there is a striking lack of evidence based literature on which to base paediatric palliaitive and supportive care models of care. This study is the first of its kind in the area of paediatric supportive and palliative care in Australia. This study will involve five Australian states (WA, SA, VIC, NSW and QLD). To answer these research questions, a retrospective study will be undertaken because of: a)the profound impact that caring for a dying child has on the family, b) the potential effects on parents of participating in research related to the care of their dying child, and c) it has been shown that research undertaken after-death is an important method for evaluation of the quality of palliative care. The study will provide broad and detailed description of the palliative and supportive care needs of families whose died from cancer, as well as the types of care that may be required. The study will therefore, address four research questions: 1. What are the supportive and palliative care needs of families of children who have died from cancer? 2. To what extent have the supportive care and palliative care needs of families been met in both the hospital and community settings? 3. How were the supportive and palliative care needs of families of children who died from cancer met? 4. What were the perceived barriers and facilitating factors associated with the supportive care and palliative care received by families whose children died from cancer? This study is the first phase of a four-phase research program that will culminate in the development and testing of models for the provision of palliative and supportive care for parents of children with life-limiting conditions.Read moreRead less
The Australasian Resuscitation In Sepsis Evaluation - Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$2,424,807.00
Summary
Patients with severe infections often present to Emergency Departments and early treatment with particular fluids, blood transfusions and stimulants, may improve survival rates. To determine whether early treatment is safe and effective in reducing deaths, the Australian and New Zealand Intensive Care Society Clinical Trials Group, in conjunction with the Australasian College of Emergency Medicine, plan to perform a large trial of early goal directed therapy in patients with severe infections.