Dr Emilie Cameron

Objective: This study examined the perceptions of a sample of Australian people living with dementia regarding the person-centred care and support they received from health professionals and family. Methods: Community-dwelling people living with dementia were invited to complete a cross-sectional survey. Results: Seventy-one people participated in the study. More than 90% agreed that health professionals explain who they are, why they are seeing them and listen to what they have to say; 63% agreed that health professionals ask how they would like to be involved in decisions about treatment; 78% agreed health professionals mainly speak to them rather than anyone accompanying them; 76% reported their family 'support you to do tasks by yourself', and 36% indicated that family caregivers 'get frustrated with you'. Conclusions: Results suggest that people living with dementia have a positive perception of the care and support they receive. Improvements may be needed in how health professionals speak directly to the person living with dementia when exploring how they would like to be involved in treatment decisions. Family caregivers may benefit from education and support on how they can manage frustrations and assist the person they support to maintain their independence.

Audit and feedback is commonly used as a method of both monitoring and attempting to improve the quality of healthcare. No review has examined the literature on systems-level audit and feedback strategies to improve the quality of oncology care. This scoping review examines the number, care focus (technical, nontechnical, or both) and methodological quality of published intervention studies which have used systems-level audit and feedback intended to improve the quality of care delivered in oncology treatment centers. Medline, Embase, PsycINFO, and the Cochrane database were searched, from inception to March 2021, for intervention studies which examined the effectiveness of systems-level audit and feedback in improving care for cancer patients. Studies which met the Effective Practice and Organization of Care (EPOC) minimum design criteria were then assessed using the EPOC risk of bias tool. Study characteristics and outcomes were extracted for those meeting methodological criteria. A narrative approach was used to synthesize the results. A total of 32 intervention studies met the inclusion criteria, of which 53% focused on technical aspects of care, 31% focused on nontechnical and 16% focused on both. Four of the included 32 studies met the EPOC minimum design criteria (13%). Most studies had a before-after study design (75%; n = 24) and methodological quality of the final four studies was moderate. Audit and feedback studies involving oncology treatment centers have primarily focused on technical care aspects. The low number and moderate methodological quality of the studies make it difficult to draw clear inferences about the effectiveness of systems-level audit and feedback. Furthermore, high-quality audit and feedback interventions are required across technical and nontechnical aspects of care to quantify the effectiveness of strategies for improving cancer care and ensure healthcare resources are being optimized.

Background: Accurately identifying the unmet needs of community-dwelling people with dementia allows targeted support to be provided to assist these individuals to stay at home. Objective: We developed a self-report instrument to identify the unmet needs of community-dwelling people with dementia and used this to explore the prevalence and type of unmet needs present in this population. Methods: This was a cross-sectional survey of people with dementia living in the community in Australia. Participants were recruited from geriatric clinics, respite centers, aged care providers, and carers attending support groups. Eligible people with dementia were provided with a study information pack and survey which included the self-report Unmet Needs Instrument for Dementia (UNI-D), sociodemographic characteristics and survey acceptability. Results: The UNI-D contained 26 items across 5 domains and demonstrated acceptable internal consistency, face and construct validity, and acceptability. Ninety-five eligible participants completed the survey (response rate 35%) with 85% identifying at least one unmet need (median = 4; IQR = 1-9). The items most frequently endorsed included needing more help with remembering things (64%), finding possible treatments for dementia (44%), understanding who to contact regarding a problem or concern related to dementia (36%), and to see friends and family more often (33%). Conclusion: The UNI-D is a promising tool to identify the self-reported needs of people with dementia. The development and rigorous testing of interventions targeting unmet needs related to health and wellbeing, dementia support, and meaningful activities appears warranted.

Incursions of the Queensland fruit fly Bactrocera tryoni (Qfly) into areas without permanent Qfly populations present serious threats to the Australian and New Zealand horticultural industries. Identifying the origins of recent incursions will help reduce future threats by enabling the targeting of problematic incursion routes for more stringent quarantine protocols. Here we present an analytical framework based on supervised and unsupervised machine learning to identify the origins and recent population history of incursion individuals. Our framework is based on a recently developed reference dataset of genome-wide markers for 35 Qfly populations from across the ranges of Qfly and the related taxon Bactrocera aquilonis (NTfly). We apply our framework to recent incursions into New Zealand, Tasmania and South Australia. Two distinct Qfly sources were identified for incursions into New Zealand (total 18 individuals), one from the east coast of Australia and one from New Caledonia. All eight recent incursion collections analysed (total 85 individuals) from South Australia and Tasmania most likely originated from just one of six clusters of populations in our reference database, Qfly from the east coast of Australia. None were found to originate from clusters containing NTfly or Qfly/NTfly hybrids in the Northern Territory or north Western Australia. Several, but not all, of the collections showed signals of small founding population size and two Tasmanian collections each included individuals apparently derived from three different sources within the east coast of Australia. In total, several more incursion events were detected than previously known, although some were founded by relatively few individuals.

Background. Economic evaluations are less commonly applied to implementation interventions compared to clinical interventions. The efficacy of an implementation strategy to improve adherence to screening guidelines among first-degree relatives of people with colorectal cancer was recently evaluated in a randomized-controlled trial. Using these trial data, we examined the costs and cost-effectiveness of the intervention from societal and health care funder perspectives. Method. In this prospective, trial-based evaluation, mean costs, and outcomes were calculated. The primary outcome of the trial was the proportion of participants who had screening tests in the year following the intervention commensurate with their risk category. Quality-adjusted life years were included as secondary outcomes. Intervention costs were determined from trial records. Standard Australian unit costs for 2016/2017 were applied. Cost-effectiveness was assessed using the net benefit framework. Nonparametric bootstrapping was used to calculate uncertainty intervals (UIs) around the costs and the incremental net monetary benefit statistic. Results. Compared with usual care, mean health sector costs were $17 (95% UI [$14, $24]) higher for those receiving the intervention. The incremental cost-effectiveness ratio for the primary trial outcome was calculated to be $258 (95% UI [$184, $441]) per additional person appropriately screened. The significant difference in adherence to screening guidelines between the usual care and intervention groups did not translate into a mean quality-adjusted life year difference. Discussion. Providing information on both the costs and outcomes of implementation interventions is important to inform public health care investment decisions. Challenges in the application of cost¿utility analysis hampered the interpretation of results and potentially underestimated the value of the intervention. Further research in the form of a modeled extrapolation of the intermediate increased adherence effect and distributional cost-effectiveness to include equity requirements is warranted.

Problem: Given the influence of diet on infant and maternal health outcomes, adequate knowledge about nutrition during pregnancy is critical. Aims: 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. Methods: 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. Findings: 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. Conclusions: 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.

Background: Detection and management of antenatal risk factors is critical for quality care. Aims: To determine (1) women's views about when they should be asked about antenatal health factors as recommended in the Australian antenatal guidelines; and (2) the time required to provide recommended care using a clinical scenario. Methods: In Phase 1, pregnant women attending an outpatient obstetrics clinic at a public hospital were surveyed about preferred screening for antenatal risk factors during visit(s). In Phase 2, a hypothetical clinical scenario of a woman attending her first antenatal visit with a practising midwife was video-recorded to extrapolate the time taken to ask about and offer assistance to manage clinical, screening and lifestyle risk factors. Findings: Most women (96%) perceived they should be asked about each of the risk factors at least once (i.e. at first visit). Total time taken to ask about all risk factors was 52 min. More time was spent discussing clinical (11 min) than lifestyle factors (4 min). Adjusting for the estimated prevalence of each risk factor, the time taken to offer assistance was 8 min per woman. Average time required for detecting and offering assistance to manage risk factors is 60 min per average risk woman. Conclusion: Women are willing to be asked about risk factors; however this process is time-consuming. Strategies to streamline visits and prioritise recommendations so time-efficient yet comprehensive care can be delivered are needed, particularly when factors require monitoring over time and for those who may be 'at-risk' for multiple factors.

Background: As a precaution against acquiring food-borne illnesses, guidelines recommend women avoid some foods during pregnancy. Aims: To examine among women receiving antenatal care: (i) level of knowledge and self-reported adherence to guidelines about foods that should be avoided during pregnancy; and (ii) associated socio-demographic characteristics. Methods: Women attending a public outpatient clinic who were: pregnant or had recently given birth; 18 years or older; able to complete an English language survey with minimal assistance; and had at least one prior antenatal appointment for their current pregnancy, were asked to complete a cross-sectional survey. Results: In total 223 women (64% consent rate) participated. Knowledge of foods to avoid during pregnancy was poor, with 83% of women incorrectly identifying at least one unsafe food as safe to consume. The average knowledge score for foods to avoid during pregnancy was 7.9 (standard deviation = 3.4; median = 9; interquartile range: 6¿11; n = 218) out of a possible score of 12. Having more general practice (GP) visits for antenatal care and fewer tertiary antenatal visits were significantly associated with higher knowledge. Women with a higher number of GP visits and those receiving care in a high-risk clinic were more likely to be adherent to guidelines. Conclusions: The majority of pregnant women have poor knowledge of food avoidance guidelines and continue to consume foods that put them at risk.

Purpose: There are few recent longitudinal studies investigating the quality of life of colorectal cancer patients in the early years following diagnosis. This study aimed to (i) compare the health status of people with colorectal cancer less than 1¿year from diagnosis with health status 1¿year later and (ii) determine the characteristics associated with a change in overall health status. Methods: The study was conducted as part of a larger trial. Participants (n = 539) were identified via the Victorian Cancer Registry in Australia, completed a computer-assisted baseline telephone interview (including the EQ-5D-3L) within 6¿12¿months of diagnosis, and mailed a survey 12¿months later. Results: At baseline, the majority of participants (55¿%) reported some problems, including difficulties in usual activities (26¿%), pain or discomfort (25¿%), anxiety or depression (23¿%) and mobility issues (15¿%). Sixty-nine percent had either an unchanged or increased health utility score from baseline to follow-up. The largest proportion reporting an increase in problems between baseline and follow-up related to pain or discomfort (18¿%). While visual analogue scale scores indicated a significantly improved health state over time overall, 32¿% reported a decreased health utility score from baseline to follow-up. Those aged over 80¿years were more likely to report a decreased health utility score compared to 60¿80-year-olds. Conclusions: A sizeable minority of patients experience ongoing problems in their daily lives and should be offered assistance in overcoming disabilities and returning to best possible functioning, particularly older patients who appear to be vulnerable to poor outcomes.

Objective: To test the effectiveness of a targeted print-based intervention to improve screening adherence in first degree relatives of people with colorectal cancer (CRC). Methods: People with CRC and their adult first degree relatives were identified through a population-based cancer registry and randomly allocated as a family unit to the intervention or control condition. The control group received general information about CRC screening. The intervention group received printed advice regarding screening that was targeted to their risk level. Screening adherence was assessed at baseline and at 12 months via self report. Results: 752 (25%) index cases and 574 (34%) eligible first degree relatives consented to take part in the trial and completed baseline interviews. At 12 months, 58% of first degree relatives in the control group and 61% in the intervention group were adherent to screening guidelines (mixed effects logistic regression group by time interaction effect =2.7; 95%CI=1.2¿5.9; P=0.013). Subgroup analysis indicated that the intervention was only effective for those with the lowest risk. Conclusions: Provision of personalised risk information may have a modest effect on adherence to CRC screening recommendations among first degree relatives of people diagnosed with CRC. Implications: Improved strategies for identifying and engaging first degree relatives are needed to maximise the population impact of the intervention.

Objective: First degree relatives (FDRs) of someone with colorectal cancer (CRC) are at increased risk of the disease. In this study we examine the factors associated with discussing family history of CRC with a health professional. Methods: People with CRC, recruited through the population-based Victorian Cancer Registry in Australia, were asked to refer FDRs to the study. Eight hundred and nineteen FDRs completed a telephone interview. Results: Thirty-six percent of FDRs recalled ever being asked about their family history of bowel cancer by a health professional. Factors associated with having this discussion were being aged 50-60 years, having a university education, being in the potentially high risk category, being very worried about getting bowel cancer and knowing that family history increases risk through discussions with family, friends or their own education. Conclusion: Despite evidence that doctor endorsement is a key factor in the uptake of CRC screening, our study shows that the majority of FDRs do not recall being asked by a health professional about their family history. Practice implications: There is a need to identify the most appropriate method to improve rates of health professional discussion of family history with relatives of CRC patients in order to improve screening rates. © 2013 The Authors.