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Carers of people with dementia experience significant physical, emotional, and social burdens. Needs assessment can provide important information to assist services in providing support to carers to reduce these burdens. However, few studies have examined the prevalence of unmet needs experienced by carers of people with dementia using a quantitative instrument. This study aimed to examine the prevalence and type of unmet needs experienced by carers of people with dementia in Australia. This was a cross-sectional survey of carers providing support to community-dwelling individuals living with dementia. Carers were recruited through geriatric clinics, aged care providers, support services and community organisations. Consenting carers completed a survey including an 80-item study-specific unmet needs instrument for carers (UNI-C) and sociodemographic characteristics. Descriptive statistics were used to identify the most prevalent unmet needs reported by carers. A total of 169 carers (response rate 47%) completed the survey. Most (87%) carers reported at least one unmet need. Carers reported a median of 16.0 (IQR = 24.0; max = 58) out of a possible 80 unmet needs. The most frequently endorsed unmet needs spanned a range of areas including emotional wellbeing, accessing health and aged care services, managing apathy, and finding information. This study highlighted that a large proportion of carers experience unmet needs associated with caring for someone with dementia. Developing and rigorously testing interventions to meet carers' commonly reported unmet needs are warranted. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2053833. [ABSTRACT FROM AUTHOR]

To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64% of smokers and 91% of providers; between 56 and 62% of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85-90% of providers. Rewards for quitting were considered helpful by 63% of smokers and 56% of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women. Keywords Tobacco smoking * Smoking cessation * Indigenous * Consumer preference, Introduction Tobacco smoking among pregnant Aboriginal and Torres Strait Islander women remains three times as common as among non-Indigenous Australian pregnant women, with approximately 50% of women smoking during pregnancy [...]

Objective: This study examines the effectiveness and costs of follow-up phone calls in improving response rates to a community survey. Methods: Non-responders to a postal survey were randomly allocated to receive a phone call or no phone call. The resources used for the development and implementation of the survey were documented. The response rates and cost per level of follow-up contact examined. Results: Follow-up phone calls led to a statistical significant increase in the number of responses to a community-wide survey, relative to no phone call. This relative increase in responses (n=62 for the follow-up phone call group versus n=l for controls), did not increase the absolute survey response rate sufficiently (from 38.5% for two mailed surveys to 39.8% for two mailed surveys plus a phone call) to justify the phone call costs. Scenario analyses show increasing the initial response rate by 10% and conducting a second mailed survey achieves greater marginal cost savings than increasing the response rate to the second mailout or the follow-up phone calls. Conclusions: These results suggest a follow-up phone call was not cost effective. Survey research ought to primarily focus on obtaining optimal initial response rates by using strategies identified in a Cochrane meta-analytic review. Key words: response rate, non-response, survey, follow-up, cost, randomised controlled trial. Aust NZ J Public Health. 2010; 34:508-12 doi: 10.1111/j.1753-6405.2010.00598.x

Objective: To assess the prevalence and predictors of perceived unmet needs among women diagnosed with breast cancer, with a particular focus on the impact of location (rural/urban). Method: A random sample of women in NSW diagnosed with breast cancer was surveyed during 1995-96. The Breast Cancer Patients' Needs Questionnaire (BR-CPNQ) explores patients' perceived needs across five domains: psychological, health information, physical/daily living, patient care/support and interpersonal communication. Items assessing breast cancer specific needs and access to services and resources were included. Of 235 eligible rural women, 134 (57%) consented to participate and 129 (55%) returned completed surveys. Of 196 eligible urban women, 102 (52%) consented to participate and 100 (51%) returned completed surveys. Results: For 12 of the 52 items, at least one-third of the sample reported ever having a moderate/high need for help. Of the 15 highest moderate or high unmet needs, 10 related to health information and three to psychological needs. There were few differences in the prevalence of needs reported by rural and urban women. Only in the physical/daily living domain were rural women more likely than urban women to report some need for help (OR=2.59, 95% CI 1.21-5.52). Conclusions: Unmet needs, particularly in the information and psycho-social domains, are reported by both rural and urban women with breast cancer, with sub-groups experiencing different types of needs. Implications: There is a need to develop and trial targeted and innovative strategies to meet the health information and psychological needs of women with breast cancer, and the physical/daily living needs of rural women diagnosed with breast cancer.

A number of sources are available to clinicians to help them communicate a life threatening diagnosis to patients. However many of the guidelines are written from the perspective of the expert or physicians and the receivers' perspective has been less documented. There are also substantial variations in recommendations. Database reference material from 1994-1997 is reviewed., Literature related to breaking bad news to medical patients was reviewed. An analysis of citations appearing between 1994 and August 1997 updated earlier work and indicated that a minority (24%) [...]

Clinicians are encouraged to adopt the best practices for conveying bad news to medical patients. It is difficult to alter clinical behavior of medical personnel, however it is found that clinicians are under-informed in this area. Clinicians should be provided with feedback on their performance and training guidelines should be disseminated., Steps to encourage clinicians to adopt the best practices for communicating bad news to patients are outlined. First, official, credible guidelines endorsed by key organizations or professional bodies, giving a [...]

Consensus guidelines and principals are reviewed for breaking bad news to patients. The setting, manner and initial meeting is discussed. The patient's understanding and emotional status should be documented. Patients should be encouraged to express their feelings and steps for nonverbal empathic communication are outlined. A review of the situation should be scheduled within 24 hours and support services and should be offered., Reviews of the literature on how to convey bad news to patients with serious diseases have identified a paucity of empirically based information to guide clinicians in undertaking this difficult [...]

Results of a study suggest a growing inequity exists in Australia in the spending on anti-smoking activities vs revenues from cigarette sales to minors. The research was to determine whether changes in government revenue from sale of cigarettes to minors and the proportion of the revenue spent in an effort to prevent adolescents from taking up the habit, 1990-93. One who starts smoking at 14 or before is five times as likely to die of lung cancer as one who starts at 24 or later and 15 times as likely to die of lung cancer as never-smokers.

Interventions with retailers to cut down on cigarette sales to minors in Australia have been studied in a randomized controlled trial. Neither intervention achieved significant improvements for the two key behavioral outcomes, which were requiring proof of age and displaying a warning sign. Knowing about the law was not shown to have an intervention effect. Interventions may have been partly successful in modifying attitudes of retailers. One group received an educational letter and the other received a threat of enforcement of laws followed by a visit from a public health officer.

Keywords: elderly people, home environmental hazards, injuries Introduction In both the United States and Australia, injury ranks sixth as a cause of death and morbidity in older people [1, 2]. [...]

Background: People with brain cancer and their support persons (SPs) are critical sources of information on the components of care that contribute to psychosocial outcomes. Aims: To determine the proportion of studies that examined (1) at least one of 14 nominated components of psychosocial cancer care and (2) more than one component of care. Methods: Medline, The Cochrane Library, PsycINFO and Embase were electronically searched for publications from January 1999 to December 2019. Publications that met the inclusion criteria were coded according to the number and type of psychosocial care components assessed from 14 listed components, and whether patient and/or SPs' views about care were elicited. Results: Of the 113 included publications, 61 publications included patient-reported data only (54%), 27 included both patient and SP-reported data (24%) and 25 included SP-reported data only (22%). Most assessed a single component of care (77% of patient-reported and 71% of SP-reported). No publications assessed all 14 components. The "Psychosocial" component was the most frequently assessed component of care for patient-reported (n = 80/88, 91%) and SP-reported publications (n = 46/52, 88%). Conclusions: Publications reporting on psychosocial care in brain cancer present a relatively narrow view of patient and support person experiences. The inclusion of both patient and support person perspectives and the assessment of multiple components of care are required in future research to optimize psychosocial outcomes in brain cancer. [ABSTRACT FROM AUTHOR]

Introduction: This review examined the: (1) number of publications exploring psychosocial outcomes of adults with brain cancer and/or support persons between 1999 and 2019 and whether there has been a change in the type of research over time; and (2) proportion of intervention studies meeting Cochrane Effective Practice and Organisation of Care (EPOC) research design criteria. Methods: Embase, The Cochrane Library, Medline and PsycINFO databases were electronically searched January 1999 to December 2019. Articles were examined against inclusion/exclusion criteria and coded into measurement, descriptive or intervention categories. Intervention studies were assessed against the EPOC design criteria. Results: 220 eligible publications were identified. The number of total publications significantly increased by an average of 1 each year (95%CI = 0.7–1.3; p < 0.001). There was no significant change in the proportion of publications by study type across three time periods. Descriptive research represented the majority within each time period. Of the 17 intervention studies, only 7(41%) met EPOC design criteria. Conclusions: Published literature on brain cancer psychosocial outcomes has increased significantly. However, descriptive research dominates research output. To increase high‐level knowledge that can guide psychosocial care of people with brain cancer, there is a need to undertake methodologically rigorous intervention trials. [ABSTRACT FROM AUTHOR]

Objectives. Outdoor workers are at high risk of developing skin cancer. Primary prevention in this group can potentially reduce the incidence of skin cancer, and also potentiates the spontaneous remission of existing solar keratoses. A randomized controlled trial was conducted to evaluate a solar protection intervention targeting outdoor workers. Methods. Outdoor workers are randomly allocated to an intervention (n = 65) or control group (n =77). The intervention group received individual skin screening by a dermatologist and participated in an education session. Pre- and posttest outcome measures included solar protection behavior (assessed using a validated diary), knowledge, and attitudes. Results. There was a significant increase (16%) in the percentage of outdoor workers who were using a high level of solar protection at posttest compared to pretest in the intervention group, but there was no change in the control group. Although both groups improved in their knowledge score, the intervention group showed a significantly greater improvement at posttest. No changes in attitudes were detected. Conclusions. The findings suggest that changes in solar protection are achievable with outdoor workers. (Am J Public Health. 1994;84:77-81), Preventive screening and education appear to be effective interventions for increasing outdoor workers' use of sun protection. Researchers assigned 65 workers to receive individual skin screening and education and 77 workers to no intervention for comparison. Pre-test skin damage, sun protection behavior and knowledge did not differ among the two groups. After the study, 66% of the intervention group used sun protection measures such as clothing/hats, shade and sunscreen lotion, compared to 49% of the comparison group. The proportion of workers using high levels of sun protection increased by 16% in the intervention group, while remaining stable in the comparison group. Both groups improved significantly in their average knowledge scores after the study. However, the intervention group significantly increased their scores by an average of 62%, compared to 58% in the comparison group. Neither group experienced attitude changes.

Print materials are common tools for public health education in New South Wales, but their effectiveness is rarely evaluated. A survey of sample materials showed the most cost-effective means to develop such materials were not commonly used, and their effectiveness was unreported. Health educators and administrators will need to note these results.

Given the influence of diet on infant and maternal health outcomes, adequate knowledge about nutrition during pregnancy is critical. To examine among women receiving antenatal care the proportion who: (1) believe information about diet should be provided as part of routine antenatal care; (2) recall receiving advice about diet as part of care including: (a) when information was provided, (b) the healthcare provider who gave information, and (c) the format in which it was provided; and (3) attitudes towards information received. A cross-sectional survey was conducted with women attending a public antenatal clinic in New South Wales, Australia. Women were eligible to participate if they were: pregnant or had given birth in the previous 10 weeks; ≥ 18 years; and had at least one prior antenatal appointment for their current pregnancy. A total of 223 women (64% consent rate) participated. While the majority (86%) believed healthcare providers should be giving dietary information to pregnant women, only 63% recalled receiving information during their current pregnancy. Most often it was given by a midwife (76%). Information was initially provided in the first (52%) or second (38%) trimester, in both written and verbal form (60%). Approximately one third of participants felt overwhelmed or confused by which foods should be avoided during pregnancy. A third of women did not recall receiving advice about diet as part of routine antenatal care. There is a need to develop a pathway to provide women with reliable, comprehensive advice about diet early in pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence, type, location of and injuries from home accidents, including falls and other accidents, and to explore whether variables including socio-demographic characteristics, medication use and home hazards were associated with all home accidents and falls. Method: 657 older people were interviewed about accidents in the previous four weeks. For a subsample (n=425), a home hazard check was completed. Results: Of the 10.1 accidents reported, 51% (n=51) were falls and 50% (n=50) were other accidents. The most common location for all accidents was outside (30%). Most resulted in minor injury to the legs (43%) or arms (39%). Medical treatment was sought for 14% of accidents. Having more than five hazards and infrequent home visits by healthcare providers were associated with having at least one accident and at least one fall. Use of a walking aid was also associated with falling. Conclusion: Rates of falls and other accidents are considerable. Implications: Work is required to confirm the importance of the relationships suggested and to provide data on the burden of injury associated with non-fall accidents. (Aust N Z J Public Health 2000; 24: 633-6)

Abstract: Background: To ensure the provision of patient‐centred health care, it is essential that consumers are actively involved in the process of determining and implementing health‐care quality improvements. However, common strategies used to involve consumers in quality improvements, such as consumer membership on committees and collection of patient feedback via surveys, are ineffective and have a number of limitations, including: limited representativeness; tokenism; a lack of reliable and valid patient feedback data; infrequent assessment of patient feedback; delays in acquiring feedback; and how collected feedback is used to drive health‐care improvements. Objectives: We propose a new active model of consumer engagement that aims to overcome these limitations. This model involves the following: (i) the development of a new measure of consumer perceptions; (ii) low cost and frequent electronic data collection of patient views of quality improvements; (iii) efficient feedback to the health‐care decision makers; and (iv) active involvement of consumers that fosters power to influence health system changes. [ABSTRACT FROM AUTHOR]

Objectives: To improve imaging utilisation and reduce the widespread overuse of staging investigations, in the form of computed tomography (CT) and whole‐body bone scans for men with newly diagnosed prostate cancer in the Hunter region of NSW, Australia, by implementation of a multifaceted clinician‐centred behaviour change programme. Patients and Methods: Records of all patients with a new diagnosis of prostate cancer were reviewed prior to the intervention (July 2014 to July 2015), and the results of this audit were presented to participating urologists by a clinical champion. Urologists then underwent focused education based on current guidelines. Patterns of imaging use for staging were then re‐evaluated (November 2015 to July 2016). Patients were stratified into low‐, intermediate‐ and high‐risk groups as described by the D'Amico classification system. Results: A total of 144 patients were retrospectively enrolled into the study cohort. The use of diagnostic imaging for staging purposes significantly decreased in men with low‐ and intermediate‐risk disease post intervention. In low‐risk patients, the use of CT decreased from 43% to 0% (P = 0.01). A total of 21% of patients underwent bone scans in the pre‐intervention group compared with18% in the post‐intervention group (P = 0.84). In intermediate‐risk patients, the use of CT decreased from 89% to 34% (P < 0.001), whilst the use of bone scan decreased from 63% to 37% (P = 0.02). In high‐risk patients, the appropriate use of imaging was maintained, with CT performed in 87% compared with 85% and bone scan in 87% compared with 65% (P = 0.07). Conclusion: Our results show that a focused, clinician‐centred education programme can lead to improved guideline adherence at a regional level. The assessment of trends and application of such a programme at a state‐based or national level could be further assessed in the future with the help of registry data. This will be particularly important in future with the advent of advanced imaging, such as prostate‐specific membrane antigen positron‐emission tomography. [ABSTRACT FROM AUTHOR]

Purpose To examine the percentage of patients with raised state anxiety levels before undergoing a medical imaging procedure; their attribution of procedural-related anxiety or worry; and sociodemographic, health, and procedural characteristics associated with raised state anxiety levels. Materials and Methods This prospective cross-sectional study was undertaken in the outpatient medical imaging department at a major public hospital in Australia, with institutional board approval. Adult outpatients undergoing a medical imaging procedure (CT, x-ray, MRI, ultrasound, angiography, or fluoroscopy) completed a preprocedural survey. Anxiety was measured by the short-form state scale of the six-item State-Trait Anxiety Inventory (STAI: Y-6). The number and percentage of participants who reported raised anxiety levels (defined as a STAI: Y-6 score ≥ 33.16) and their attribution of procedural-related anxiety or worry were calculated. Characteristics associated with raised anxiety were examined using multiple logistic regression analysis. Results Of the 548 (86%) patients who consented to participate, 488 (77%) completed all STAI: Y-6 items. Half of the participants (n = 240; 49%) experienced raised anxiety, and of these, 48% (n = 114) reported feeling most anxious or worried about the possible results. Female gender, imaging modality, medical condition, first time having the procedure, and lower patient-perceived health status were statistically significantly associated with raised anxiety levels. Conclusion Raised anxiety is common before medical imaging procedures and is mostly attributed to the possible results. Providing increased psychological preparation, particularly to patients with circulatory conditions or neoplasms or those that do not know their medical condition, may help reduce preprocedural anxiety among these subgroups. [ABSTRACT FROM AUTHOR]

GPs were not informed about the incentive trial until a thank-you letter was posted at the conclusion of the survey; all participating GPs then received $20 gift vouchers. Keywords: Randomized controlled trial as topic; General practice; Research design EN Randomized controlled trial as topic General practice Research design 585 586 2 06/21/22 20220615 NES 220615 General practitioners view health and medical research positively, but their participation in postal surveys is typically low.1 Poor response rates reduce the sample size and consequently the generalisability of survey results. [Extracted from the article]

Objectives: To determine the proportion of Aboriginal Controlled Community Health Service (ACCHS) patients tested according to three national diabetes testing guidelines; to investigate whether specific patient characteristics were associated with being tested. Design, setting and participants: Cross-sectional study of 20 978 adult Indigenous Australians not diagnosed with diabetes attending 18 ACCHSs across Australia. De-identified electronic whole service data for July 2010 e June 2013 were analysed. Main outcomes measures: Proportions of patients appropriately screened for diabetes according to three national guidelines for Indigenous Australians: National Health and Medical Research Council (at least once every 3 years for those aged 35 years or more); Royal Australian College of General Practitioners and Diabetes Australia (at least once every 3 years for those aged 18 years or more); National Aboriginal Community Controlled Health Organisation (annual testing of those aged 18 years or more at high risk of diabetes). Results: 74% (95% CI, 74e75%) of Indigenous adults and 77%(95%CI, 76e78%) of 10 760 patients aged 35 or more had been tested for diabetes at least once in the past 3 years. The proportions of patients tested varied between services (range: all adults, 16e90%; people aged 35 years or more, 23e92%). 18% (95% CI, 18e19%) of patients aged 18 or more were tested for diabetes annually (range, 0.1e43%). Patients were less likely to be tested if they were under 50 years of age, were transient rather than current patients of the ACCHS, or attended the service less frequently. Conclusions: Some services achieved high rates of 3-yearly testing of Indigenous Australians for diabetes, but recommended rates of annual testing were rarely attained. ACCHSs may need assistance to achieve desirable levels of testing. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify the most prevalent unmet needs of haematological cancer survivors. Methods: Haematological cancer survivors aged 18-80 years at time of recruitment were selected from four Australian state cancer registries. Survivors completed the Survivor Unmet Needs Survey. The most frequently reported "high/very high" unmet needs items were identiied, as well as characteristics associated with the three most prevalent "high/very high" unmet needs reported by haematological cancer survivors. Results: A total of 715 eligible survivors returned a completed survey. "Dealing with feeling tired" (17%), was the most frequently endorsed "high/very high" unmet need. Seven out of the ten most frequently endorsed unmet needs related to emotional health. Higher levels of psychological distress (e.g., anxiety, depression and stress) and indicators of inancial burden as a result of cancer (e.g., having used up savings and trouble meeting day-to-day expenses due to cancer) were consistently identiied as characteristics associated with the three most prevalent "high/very high" unmet needs. Conclusions: A minority of haematological cancer survivors endorsed a "high/very high" unmet need on individual items. Additional emotional support may be needed by a minority of survivors. Survivors reporting high levels of psychological distress or those who experience increased inancial burden as a result of their cancer diagnosis may be at risk of experiencing the most prevalent "high/very high" unmet needs identiied by this study. [ABSTRACT FROM AUTHOR]