8 results on '"Zdenkowski, Nicholas"'
Search Results
2. Facilitating High Quality Cancer Care: A Qualitative Study of Australian Chairpersons' Perspectives on Multidisciplinary Team Meetings.
- Author
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Fradgley, Elizabeth A, Booth, Kate, Paul, Christine, Zdenkowski, Nicholas, and Rankin, Nicole M
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CANCER treatment ,QUALITATIVE research ,CANCER patients ,THEMATIC analysis ,TELEPHONE interviewing - Abstract
Aim: Multidisciplinary team meetings (MDMs) are a critical element of quality care for people diagnosed with cancer. The MDM Chairperson plays a significant role in facilitating these meetings, which are often time-poor environments for clinical decision making. This study examines the perceptions of MDM Chairpersons including their role and the factors that determine the quality of a Chair, as well as the Chairperson's perception of the value of personally attending meetings. Methods: This qualitative study used telephone interviews to explore the experiences of MDM Chairpersons from metropolitan and regional New South Wales, Australia. Using a state-wide register, 43 clinicians who chaired lung, genitourinary, gastrointestinal, and breast cancer meetings were approached to participate. Thematic data analysis was used to develop and organise themes. Results: Themes from the 16 interviews identified the perceived need for an expert and efficient MDM Chairperson with emphasis on personal rather than technical skills. The remaining themes related to the benefits of meetings to ensure quality and consistency of care; improve inter-professional relationships; and provide communication with and reassurance for patients. Conclusion: The role of the MDM Chairperson requires expert management and leadership skills to ensure meetings support quality patient-centred care. MDMs are perceived to provide multiple benefits to both clinicians and patients. Efforts to train Chairs and to maximise clinician and patient benefits may be warranted given the costly and time-consuming nature of MDMs. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
3. Do medical oncology patients and their support persons agree about end-of-life issues?
- Author
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Waller, Amy, Hall, Alix, Sanson‐Fisher, Rob, Zdenkowski, Nicholas, Douglas, Charles, and Walsh, Justin
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TERMINAL care laws ,TUMOR diagnosis ,CANCER patients ,CONFIDENCE intervals ,DECISION making ,GUARDIAN & ward ,HEALTH facilities ,SERVICES for caregivers ,PATIENT-family relations ,EVALUATION of medical care ,MEDICAL quality control ,MEDICAL personnel ,MEDICAL protocols ,PATIENT satisfaction ,STATISTICS ,SURVEYS ,DECISION making in clinical medicine ,WAITING rooms ,PATIENTS' attitudes ,TERTIARY care - Abstract
Background The perceptions of those called on to make decisions on behalf of patients who lack capacity at the end of life must accurately reflect patient preferences. Aims To establish the extent to which the views of medical oncology outpatients are understood by their support persons, specifically with regards to (i) preferred type and location of end-of-life care, (ii) preferred level of involvement in end-of-life decision-making and (iii) whether the patient has completed an advance care plan or appointed an enduring guardian. Methods Adults with a confirmed cancer diagnosis and their nominated support persons were approached between September 2015 and January 2016 in the waiting room of an Australian tertiary referral clinic. Consenting participants completed a pen-and-paper survey. Nominated support persons answered the same questions from the patient's perspective. Results In total, 208 participants (39% of eligible dyads) participated. Observed agreement across the five outcomes ranged from 54% to 84%. Kappa values for concordance between patient-support person responses were fair to moderate (0.24-0.47) for enduring guardian, decision-making, advance care plan and care location outcomes. A slight level of concordance ( k = 0.15; 95% confidence interval: −0.02, 0.32) was found for the type of care outcome. Conclusion Relying on support persons' views does not guarantee that patients' actual preferences will be followed. Strategies that make patient preferences known to healthcare providers and support persons while they still have the capacity to do so is a critical next step in improving quality cancer care. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
4. Aromatase inhibitor induced musculoskeletal syndrome: a significant problem with limited treatment options.
- Author
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Lombard, Janine, Zdenkowski, Nicholas, Wells, Kathy, Beckmore, Corinna, Reaby, Linda, Forbes, John, Chirgwin, Jacquie, Lombard, Janine M, and Forbes, John F
- Subjects
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MUSCULOSKELETAL system diseases , *BREAST cancer treatment , *AROMATASE inhibitors , *ADJUVANT treatment of cancer , *PREDNISOLONE , *DULOXETINE , *WOMEN , *DISEASE risk factors , *BREAST tumors , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *QUALITY of life , *RESEARCH , *SYNDROMES , *EVALUATION research , *TREATMENT effectiveness , *CROSS-sectional method ,TREATMENT of musculoskeletal system diseases - Abstract
Background: Aromatase inhibitor induced musculoskeletal syndrome is experienced by approximately half of women taking aromatase inhibitors, impairing quality of life and leading some to discontinue treatment. Evidence for effective treatments is lacking. We aimed to understand the manifestations and impact of this syndrome in the Australian breast cancer community, and strategies used for its management.Methods: A survey invitation was sent to 2390 members of the Breast Cancer Network Australia Review and Survey Group in April 2014. The online questionnaire included 45 questions covering demographics, aromatase inhibitor use, clinical manifestations and risk factors for the aromatase inhibitor musculoskeletal syndrome, reasons for treatment discontinuation and efficacy of interventions used.Results: Aromatase inhibitor induced musculoskeletal syndrome was reported by 302 (82 %) of 370 respondents. Twenty-seven percent had discontinued treatment for any reason and of these, 68 % discontinued because of the musculoskeletal syndrome. Eighty-one percent had used at least one intervention from the following three categories to manage the syndrome: doctor prescribed medications, over-the-counter/complementary medicines or alternative/non-drug therapies. Anti-inflammatories, paracetamol (acetaminophen) and yoga were most successful in relieving symptoms in each of the respective categories. Almost a third of respondents reported that one or more interventions helped prevent aromatase inhibitor discontinuation. However, approximately 20 % of respondents found no intervention effective in any category.Conclusion: We conclude that aromatase inhibitor induced musculoskeletal syndrome is a significant issue for Australian women and is an important reason for treatment discontinuation. Women use a variety of interventions to manage this syndrome; however, their efficacy appears limited. [ABSTRACT FROM AUTHOR]- Published
- 2016
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5. Exploring Decision-Making about Neo-adjuvant Chemotherapy for Breast Cancer.
- Author
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Zdenkowski, Nicholas, Butow, Phyllis, Fewster, Sheryl, Beckmore, Corinna, Wells, Kathryn, Forbes, John F., and Boyle, Frances
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BREAST tumor treatment , *CANCER patient psychology , *COMBINED modality therapy , *COMMUNICATION , *INTERVIEWING , *RESEARCH methodology , *PHYSICIAN-patient relations , *QUALITY of life , *TRUST , *QUALITATIVE research , *SOCIAL support , *THEMATIC analysis , *PATIENTS' attitudes , *DESCRIPTIVE statistics , *PATIENT decision making - Abstract
The article discusses aspects of decision making in neo-adjuvant chemotherapy (NACT) for breast cancer. Topics include women's trust in clinicians to avoid the burden of decision-making in NACT for the treatment of breast cancer, women's access to a decision-support tool to help in their decision-making and the reasons behind breast cancer patients consideration of NACT.
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- 2016
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6. Finding My Way-Advanced: can a web-based psychosocial intervention improve the mental quality of life for women with metastatic breast cancer vs attention-control? Study protocol of a randomised controlled trial.
- Author
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Beatty L, Kemp E, Butow P, Girgis A, Hulbert-Williams N, Kaambwa B, Schofield P, Turner J, Woodman R, Boyle F, Daly A, Jones A, Kiely B, Zdenkowski N, and Koczwara B
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- Adult, Female, Humans, Psychosocial Intervention, Australia, Quality of Life psychology, Randomized Controlled Trials as Topic, Internet-Based Intervention, Breast Neoplasms therapy
- Abstract
Background: Women living with metastatic breast cancer (MBC) are at risk of significantly impaired quality of life (QOL), symptom burden, distress and fear of progression, and unmet needs, yet they face barriers to accessing evidence-based psychosocial treatments. Our group therefore developed Finding My Way-Advanced (FMW-A), a web-based self-guided psychosocial program for women with MBC. This study aims to assess its efficacy in improving mental and other QOL domains, distress, fear of progression, unmet needs, and health service utilisation., Methods: The multi-site randomised controlled trial (RCT) will enrol 370 Australian participants. Eligible participants are adult (18 years +) women diagnosed with MBC, with a life expectancy of 6 months or more, with sufficient English-language literacy to provide informed consent. Participants will be identified, screened and referred from one of 10 Australian sites, or via self-referral in response to advertisements. Participants complete four online questionnaires: prior to accessing their program ('baseline'), 6 weeks later ('post-intervention'), then 3 months and 6 months post-intervention. Consenting participants will be randomised to either FMW-A (intervention), or Breast Cancer Network Australia's (BCNA) online/app resource My Journey (minimal intervention attention-control). This is a single-blind study, with randomisation computer-generated and stratified by site. FMW-A is a 6-module program addressing some of the most common issues experienced by women with MBC, with BCNA control resources integrated within the 'resources' section. All modules are immediately accessible, with an additional booster module released 10 weeks later. The primary outcome is mental QOL; statistical criteria for superiority is defined as a 4-point difference between groups at post-treatment. Secondary outcomes include other QOL domains, distress, fear of progression, health service use, intervention adherence, and user satisfaction., Discussion: This will be the first adequately powered RCT of a self-directed online intervention for women with MBC. If efficacious, FMW-A will help address two national key priorities for management of MBC - enhancing QOL and reducing symptom burden. FMW-A has the potential to address unmet needs and overcome access barriers for this overlooked population, while reducing health system burden., Trial Registration: The study was registered prospectively with the ANZCTR on 29/10/2021. Trial ID ACTRN12621001482853p. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382714&isReview=true., (© 2022. The Author(s).)
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- 2022
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7. Results of a survey of cancer patients' willingness to travel to participate in a clinical trial.
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Zdenkowski N, Lynam J, Sproule V, Wall L, Searston J, and Brown S
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- Aged, Australia, Clinical Trials as Topic, Cross-Sectional Studies, Female, Health Expenditures, Humans, Logistic Models, Male, Middle Aged, Neoplasms economics, Patient Participation statistics & numerical data, Rural Population, Socioeconomic Factors, Surveys and Questionnaires, Attitude to Health, Neoplasms therapy, Patient Participation psychology, Travel
- Abstract
Only 2-3% of cancer patients enrol in a trial. We surveyed patients' willingness to change clinician or treating centre, or to travel, to participate in trials, to improve trial recruitment. Of 188 respondents, 79% were willing to participate in a trial in at least one scenario. Increasing travel time, change in oncologist, private health insurance and out of pocket expenses decreased likelihood of joining a trial. Rural and regional patients, and those from lower socio-economic areas, were more willing to travel. To optimise access to trials, clinicians should refer within and between institutions., (© 2019 Royal Australasian College of Physicians.)
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- 2019
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8. Not asking cancer patients about their preferences does make a difference. A cross-sectional study examining cancer patients' preferred and perceived role in decision-making regarding their last important cancer treatment.
- Author
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Herrmann A, Hall A, Sanson-Fisher R, Zdenkowski N, Watson R, and Turon H
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- Adult, Aged, Australia, Communication, Cross-Sectional Studies, Decision Making, Female, Humans, Logistic Models, Male, Middle Aged, Patient Satisfaction, Physician-Patient Relations, Neoplasms therapy, Patient Participation psychology, Patient Preference, Patient-Centered Care standards, Referral and Consultation standards
- Abstract
We examined whether not having been asked by their clinicians about how involved cancer patients would like to be in their treatment decisions is related to discordance between patients' preferred and perceived involvement in treatment decision-making. This was a cross-sectional survey of adult cancer patients recruited from five medical and radiation oncology outpatient clinics in Australia. Discordance of patients' preferred and perceived decision-making roles was assessed via an adapted version of the Control Preferences Scale. Logistic regression modelling was conducted to assess the relationship between role discordance and whether patients were not asked but wanted to be asked about how involved they would like to be in deciding on their treatment. Of 423 study participants, almost a third (n = 128, 31%) reported discordance between their preferred and perceived involvement in their treatment decisions. Of those reporting discordance, 72% (n = 92) were less involved than they would have liked to have been. Not being asked about their preferences for involvement in treatment decisions, despite wanting this, was associated with discordance between patients' preferred and perceived involvement in treatment decision-making (p < 0.04). To achieve patient-centred care, it is vital that clinicians seek patients' views about how involved they would like to be in deciding on their cancer treatment., (© 2018 John Wiley & Sons Ltd.)
- Published
- 2018
- Full Text
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