Dr Lisa Mackenzie

Background: In 2018, Eswatini had the world's highest age-standardised cervical cancer incidence rate. Cervical cancer screening reduces women's risk of invasive cervical cancer. Data on adherence to cervical cancer screening recommendations in Eswatini are scarce. The purpose of the current study was to determine Eswatini women's self-reported adherence to cervical cancer screening recommendations, attitudes toward screening, and factors associated with non-adherence. Methods: A cross-sectional survey of women (n = 377) aged 25 to 59 accessing primary healthcare clinics (n = 4) in Eswatini assessed screening participation, attitudes and knowledge regarding cervical cancer screening, and socio-demographic variables. Adjusted logistic regression was used to assess factors associated with non-adherence to Eswatini cervical cancer screening recommendations. Results: One hundred and sixty-six (44%) women were classified as adherent to cervical cancer screening recommendations. Attitudinal barriers endorsed by over one-third of participants included a perceived low risk of cervical cancer (n = 161, 43%) and a view that screening is likely to be painful (n = 146, 38%). Participants had higher odds of being classified as non-adherent if they: were single compared with married (OR = 1.78, 95% CI: 1.05, 3.01, p = 0.03), perceived screening as likely painful (OR = 4.43, 95% CI: 2.62, 7.46, p < 0.001); and had not been advised by a doctor/ nurse to screen (OR = 2.82, 95% CI: 1.71, 4.64, p < 0.001). Also, a 1-year increase in age was associated with an increase in the odds of being classified as non-adherent (OR = 1.42, 95% CI: 1.39, 1.45, p = 0.01). Conclusions: Self-reported adherence was moderate among this group of women. Tailored interventions are needed to increase participation in cervical cancer screening, especially for those women with characteristics associated with being classified as non-adherent. Primary healthcare clinic nurses (and other health providers) may contribute toward improving participation in cervical cancer screening by advising eligible women to screen and providing health education addressing negative attitudes toward screening.

Telehealth facilitates access to cancer care for patients unable to attend in-person consultations, as in COVID-19. This systematic review used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to evaluate telehealth implementation and examine enablers and barriers to optimal implementation in oncology. MEDLINE, PubMed, CINAHL, and the Cochrane Database of Systematic Reviews were searched between January 2011-June 2022. Eighty-two articles representing 73 studies were included. One study explicitly used the RE-AIM framework to guide study design, conduct, or reporting. Reach (44%) and implementation (38%) were most commonly reported, maintenance (5%) least commonly. Key telehealth implementation enablers included professional-led delivery, patient-centred approaches, and positive patient perceptions. Key barriers included patient discomfort with technology, limited supporting clinic infrastructure, and poor access to reliable internet connection and videoconferencing. While a patient-centred and professional-supported approach enables telehealth implementation, technology and infrastructure constraints need surmounting for sustained implementation beyond the COVID-19 pandemic.

Objective: To examine perceived problems with involvement in medical decision making among people with breast cancer from various phases of the cancer care trajectory. Methods: Breast cancer outpatients (n = 663) from 13 treatment centres completed a survey of perceived involvement in treatment and care decisions in the last month, psychological distress, demographic and clinical factors. A subsample (n = 98) from three centres completed a follow-up survey on preferred and perceived treatment decision making roles. Results: Overall, 112 (17 %) of 663 respondents from 13 oncology centres had experienced problems with involvement in decision making about their treatment and care in the last month, and of these, 36 (32 %) reported an unmet need for help with this problem. Elevated psychological distress was associated with 5.7 times the odds of reporting this problem and 6.6 times the odds of reporting this unmet need in the last month. Among the follow-up subsample (n = 98), 39% (n = 38) reported discordance between preferred and perceived role in a major treatment decision. Psychological distress was not associated with this outcome. Conclusion: Psychological distress was significantly associated with recently experiencing problems with involvement in treatment and care decisions, but not with misalignment of preferred and perceived roles in prior major treatment decisions. Practice implications: There is a need to maintain support for patient involvement in healthcare decisions across the cancer care continuum.

Purpose: To explore in a sample of adult cancer patients: (1) the relative influence of initiation source, information format and consultation format on preferred approach to life expectancy disclosure using a discrete choice experiment (DCE); and (2) whether patient age, cancer type and perceived prognosis were associated with preferences within the three attributes. Methods: A DCE survey of adult solid tumour and haematological cancer patients. Participants chose between three hypothetical scenarios about life expectancy disclosure consisting of three attributes: initiation source (i.e. doctor versus patient-initiated discussion), information content (i.e. estimate presented as best-worst-typical length of life case scenario versus median survival time) and consultation format (i.e. two 20-min versus one 40-min consultation). Respondents selected their most preferred scenario within each question. Results: Three hundred and two patients completed the DCE (78% consent rate). Initiation source was the most influential predictor of patient choice. More preferred a doctor deliver life expectancy information as soon as it is available rather than waiting for the patient to ask (59% vs 41% z = - 7.396, p < 0.01). More patients preferred the two 20-min rather than the one 40-min consultation format (55% vs 45%, z = 4.284, p < 0.01). Information content did not influence choice. Age, cancer type, and patient-perceived prognosis were not associated with preferences. Conclusion: Healthcare professionals should assess cancer patients' preferences for engaging in life expectancy discussions as soon as they have this information, and ensure patients have adequate time to consider the information they receive, seek additional information and involve others if they wish.

The effectiveness of exercise programs for chronic low back pain (CLBP) is dependent upon patient adherence which is problematic to measure accurately. This cross-sectional observational study aimed to compare patient-reported levels of adherence with physiotherapists' perceptions of patient adherence; and to explore the proportion of patients who could accurately recall and demonstrate the exercises contained within their prescribed exercise program for CLBP. Participating patients (n¿=¿61) included those attending for a follow-up consultation with a physiotherapist (n¿=¿15) at a consenting practice (n¿=¿6) who had been prescribed an exercise program for CLBP. Patients were asked to self-report their level of adherence to the exercise program which was then compared to their physiotherapist's perception of adherence. Patients were also asked to recall and demonstrate the exercise program to an independent researcher, which was compared to the prescribed program. Results indicated that in total, 24 patients (39%; 95% CI: 27¿52%) self-reported as being completely adherent compared with 10 patients (16%; 95% CI: 8¿28%) who were perceived by their physiotherapists as completely adherent (raw agreement: 0.21). However, only nine patients (15%, 95% CI: 7¿26%) were able to accurately recall and demonstrate their prescribed exercise program to the researcher, of which eight of these nine patients self-reported complete adherence to the exercise program. In comparison, only four of these nine patients were perceived by the physiotherapist to be completely adherent. These results suggest that patient adherence to home-based exercise programs for CLBP might be assessed more accurately using multi-faceted measures which include an observational component.

Public health policy has the potential to produce great benefits for individuals and communities. There is growing demand that such efforts be rigorously evaluated to ensure that the expected benefits are, in fact, realised. Commonly, public health policy is evaluated by consumer acceptability, reach, or changes in knowledge and attitudes. Non-robust research designs are often used. But these approaches to evaluation do not answer three critical questions: Has a change in the desired outcome occurred? Was it a consequence of the policy and not some extraneous factor? Was the size of the change considered significant and cost-effective? We, a team of government and academic scholars working in research and evaluation, have examined some of the more common impediments to robust evaluation: political impediments, a lack of investment in evaluation capacity within bureaucracy, and the failure of academic researchers to understand the need for the evaluation of public health policy.

Purpose: There is an increased focus on supporting patients with cancer to actively participate in their healthcare, an approach commonly termed 'self-management'. Comparing unmet self-management needs across cancer types may reveal opportunities to adapt effective self-management support strategies from one cancer type to another. Given that breast and colorectal cancers are prevalent, and have high survival rates, we compared these patients' recent need for help with self-management. Method: Data on multiple aspects of self-management were collected from 717 patients with breast cancer and 336 patients with colorectal cancer attending one of 13 Australian medical oncology treatment centres. Results: There was no significant difference between the proportion of patients with breast or colorectal cancer who reported a need for help with at least one aspect of self-management. Patients with breast cancer were significantly more likely to report needing help with exercising more, while patients with colorectal cancer were more likely to report needing help with reducing alcohol consumption. When controlling for treatment centre, patients who were younger, experiencing distress or had not received chemotherapy were more likely to report needing help with at least one aspect of self-management. Conclusions: A substantial minority of patients reported an unmet need for self-management support. This indicates that high-quality intervention research is needed to identify effective self-management support strategies, as well as implementation trials to identify approaches to translating these strategies into practice. Future research should continue to explore whether self-management support strategies could be adapted across cancer types.

Objective: To describe among radiation oncology patients: (1) the proportion likely to be experiencing symptoms of depression and anxiety as identified by (a) the Hospital Anxiety and Depression Scale (HADS; standardised tool), (b) patient-reported single items (ultrashort tool), and (c) radiation oncologist¿reported single items (clinician judgement); (2) preferences for being offered psychological support; and (3) agreement between single-item measures and the HADS. Methods: Adult cancer patients (n¿=¿152; consent rate 58%) receiving radiotherapy completed a touchscreen tablet survey assessing symptoms of anxiety and depression (HADS and a single-item tool) and support preferences. Each participant's treating radiation oncologist completed a survey assessing his or her perception of whether the patient was anxious or depressed. Results: Prevalence estimates for likely depression (6.9-18%) and anxiety (17-33%) overlapped across the 3 measures. Overall, only 9.9% of patients (95% CI, 5.6%-16%) wanted to be offered psychological support. For depression, agreement between the HADS and ultrashort tool was fair (¿¿=¿0.37, P¿<¿0.0001); agreement between the HADS and clinician judgement was slight (¿¿=¿0.14, P¿<¿0.05). For anxiety, agreement between the HADS and clinician judgement was not significantly greater than chance alone (¿¿=¿0.04, P¿=¿0.33), and agreement between the HADS and ultrashort tool was moderate (¿¿=¿0.49, P¿<¿0.0001). Conclusions: These findings highlight the important role that oncology consultations play in interpreting assessment tool results and responding to individual patient's history and preferences for psychological support.

Objective: Responsiveness to information preferences is key to high-quality, patient-centred care. This study examined the top ten preparatory information items not delivered in accordance with medical imaging outpatients' preferences, and patient characteristics associated with reporting a greater number of unmet information preferences. Methods: Magnetic resonance imaging and computed tomography outpatients were recruited consecutively in one major public hospital waiting room. Participants self-administered a touchscreen computer questionnaire assessing their sociodemographic and scan characteristics, and unmet preferences for 33 guideline-endorsed preparatory information items. Results: Of 317 eligible patients, 280 (88%) consented to participate. Given equal rankings, the top ten unmet information preferences included 13 items which were endorsed by at least 25% of participants, and commonly related to receiving 'too little' information. One item related to the pre-scan period, seven items to the scan period and five items to the post-scan period. None of the patient characteristics examined were significantly associated with reporting a greater number of unmet information preferences. Conclusion: There is room to improve responsiveness to medical imaging outpatients' preparatory information preferences. Improvements should be targeted at individuals, rather than groups defined by sociodemographic or scan characteristics. Practice Implications: A standardised approach to addressing individual patient's information preferences is needed.

This study assessed agreement between radiation oncologist- and cancer patient-reported perceptions about cancer diagnosis, time since diagnosis, treatment purpose, and whether life expectancy had been discussed; and described preferences for prognosis discussions. Adult cancer patients receiving radiotherapy at a Japanese hospital were invited to complete a touchscreen tablet survey. Patient survey responses were linked and comparisons made with a survey completed by their radiation oncologist. Among 146 cancer patient-oncologist dyads, there was almost perfect agreement on cancer diagnosis (¿ = 0.88, 95% CI: 0.82¿0.94), substantial agreement on time since diagnosis (¿ = 0.70, 95% CI: 0.57¿0.83) and moderate agreement on whether treatment goal was curative or palliative (¿ = 0.44, 95% CI: 0.28¿0.57; all p's < 0.0001). Agreement about whether a life expectancy discussion had occurred was less than expected by chance (¿ = -0.06, p = 0.9). Radiation oncologists reported that they had spoken to over two thirds of patients about this, whilst less than one third of patients stated that this discussion had occurred with their radiation oncologist. Over half of the patients who had not discussed life expectancy wanted to. Patients had variable preferences for whether they (80%), their radiation oncologist (78%) or their partner/family (52%) should decide whether they discuss their life expectancy. Although patient self-reported information about diagnosis and time since diagnosis appears to be reasonably accurate (compared with clinician-reported information), limitations of self-reported data about prognostic discussions were highlighted by poor agreement between patient- and clinician-reported information about whether prognostic discussions have occurred. Additional support is needed to improve prognosis communication and understanding in radiation oncology settings.

The objectives of this study were to describe patient-reported adherence to physiotherapist-prescribed self-management strategies; and the perceived barriers and enablers to adherence to each strategy. Patients attending physiotherapy private practices (n=4) were observed during their consultation. Patients prescribed one or more self-management strategies received a follow-up telephone interview within 10-14 days of the observed consultation and were asked to self-report their level of adherence and their perceived barriers and/or enablers to each prescribed strategy. Results indicated that patients (n=108) reported receiving 177 strategies and being fully adherent to 36% (95% CI: 29-44%) of these strategies. Patient-reported adherence barriers (n=113) and enablers (n=172) were coded using a modified version of the World Health Organisation five dimensions of adherence. Frequently reported barriers included social/economic-related (n=52; 46%) such as being too busy, and patient-related (n=29; 26%) including being too tired/lack of motivation. Frequently reported enablers included therapy-related (n=71; 41%) such as "the strategy was easy to complete", and condition-related (n=45; 26%) including "that the strategy helped to manage symptoms". Thus, patient adherence may be aided by ensuring that: the strategy is less complex; it does not cause pain; it isn't time consuming; and it leads to an improvement in condition-related symptoms.

Background There is a high prevalence of depressive disorder and depressive symptoms among advanced, incurable cancer patients. Patients commonly report a preference for non-pharmacological treatments such as psychotherapy over pharmacological treatments for depression. The objective of this review was to investigate the effectiveness of psychotherapy for the treatment of depression in people with advanced, incurable cancer via a meta-analysis of randomized controlled trials (RCTs). Methods We searched research databases and clinical trial registries for studies published prior to June 2015. No language restrictions were applied when selecting studies. Cochrane Collaboration meta-analysis review methodology was used. All relevant RCTs comparing psychotherapy with control conditions on depression outcomes for adults with advanced cancer were eligible for inclusion. We calculated pooled effect sizes using Hedges g and a standardized mean difference (SMD) of change between baseline and post-treatment scores. Quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results Of 13 studies included in the review, 12 reported data suitable for meta-analysis. Psychotherapy was associated with moderate decrease in depression score (SMD -0.67, 95% confidence interval -1.06 to -0.29, P¿=¿0.0005). Few studies focused on people with clinically diagnosed depression. Overall, quality of evidence across the included studies was rated as low, and heterogeneity was high. Conclusions Low quality evidence suggests that psychotherapy is moderately more effective for the amelioration of symptoms of depression among advanced, incurable cancer patients than the control conditions. There is insufficient high-quality evidence supporting the effectiveness of psychotherapy for patients with clinically diagnosed depression.

Objective: The aim of the study was to explore the types of self-management strategies prescribed; the number of strategies and the overall length of time allocated to self-management prescription, by consultation type and by injury location, in physiotherapy consultations. Methods: A cross-sectional, observational study of 113 physiotherapist¿patient consultations was undertaken. Regression analyses were used to determine whether consultation type and injury location were associated with the number of strategies prescribed and the length/fraction of time spent on self-management. Results: A total of 108 patients (96%) were prescribed at least one self-management strategy ¿ commonly exercise and advice. The mean length of time spent on self-management was 5.80¿min. Common injury locations were the neck (n¿=¿40) and lower back (n¿=¿39). No statistically significant associations were observed between consultation type or injury location for either outcome (number of strategies and the length/fraction of time allocated to self-management prescription). Conclusion: Physiotherapists regularly spend time prescribing self-management strategies such as exercise, advice, and the use of heat or ice to patients receiving treatment linked to a range of injury locations. This suggests that self-management is considered to be an important adjunct to in-clinic physiotherapy. The practice implications of this are that clinicians should reflect on how self-management strategies can be used to maximize patient outcomes, and whether the allocation of consultation time to self-management is likely to optimize patient adherence to each strategy.

Purpose: Physiotherapists often prescribe self-management strategies for their patients. However, the effectiveness of these strategies in improving patient outcome is related to the rate of patient adherence. The aims of this study were to explore physiotherapists' views on the importance and perceived rates of patient adherence to physiotherapist prescribed self-management strategies; the perceived importance of methods physiotherapists can employ to aid patient adherence and the barriers to employing these methods. Method: A cross-sectional web-based survey was emailed to 808 physiotherapist members of the Australian Physiotherapy Association. To maximize response rates, two reminder emails were utilized. Results: In total, 352 physiotherapists completed the survey (response rate 44%). A majority of physiotherapists (89%) believed that patient self-management strategies were important in improving patient outcomes; however, the mean perceived rate of patient adherence across all strategies was only 67%. Physiotherapists reported that there were a number of important methods that can be employed to aid patient adherence such as providing patient education and allowing time for patient practice; with minimal perceived barriers to employing these methods. Conclusions: Results indicate that physiotherapists perceive that patient outcomes can be positively impacted by patient adherence to a range of self-management strategies. Physiotherapists should be encouraged to implement into their routine clinical practice evidence-based methods to aid patient adherence.Implications for Rehabilitation Physiotherapists believe that patient self-management strategies are important for improving patient outcomes, however, the perceived rates of patient adherence could be improved. Physiotherapists should adopt a collaborative approach with their patients to address any barriers to adherence to positively impact on patient outcome. Physiotherapists perceive that there are a number of modifiable characteristics which determine patient adherence including patient self-efficacy, physiotherapist communication skills and the complexity of the self-management strategy. Methods that physiotherapists can employ to positively influence patient adherence may include individualizing the strategy to the patient, education and supplementary written information.

Background: Studies in western clinical settings suggest that touch screen computer surveys are an acceptable mode of collecting information about cancer patients' wellbeing Purpose: We examined the acceptability of a touch screen tablet survey among cancer patients in Japan. Methods: Eligible patients (n = 262) attending a university hospital radiation therapy (RT) department were invited to complete a touch screen tablet survey about psychosocial communication and care. Survey consent and completion rates, the proportion and characteristics of patients who completed the touch screen survey unassisted, and patient-reported acceptability were assessed. Results: Of 158 consenting patients (consent rate 60¿% [95¿% CI 54, 66¿%] of eligible patients), 152 completed the touch screen computer survey (completion rate 58¿% [95¿% CI 52, 64¿%] of eligible patients). The survey was completed without assistance by 74¿% (n = 113; 95¿% CI 67, 81¿%) of respondents. Older age was associated with higher odds of having assistance with survey completion (OR 1.09; 95¿% CI 1.04, 1.14¿%). Ninety-two percent of patients (95¿% CI 86, 96¿%) felt that the touch screen survey was easy to use and 95¿% (95¿% CI 90, 98¿%) agreed or strongly agreed that they were comfortable answering the questions. Overall, 65¿% (95¿% CI 57, 73¿%) of respondents would be willing to complete such a survey more than once while waiting for RT treatment. Conclusions: Although patient self-reported acceptability of the touch screen survey was high, self-administered touch screen tablet surveys may not be entirely appropriate for older cancer patients or possibly for patients with lower educational attainment.

IMPORTANCE Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children. OBJECTIVE To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children. DATA SOURCES A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended searchwas performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions,were identified. Secondary data extractionwas performed in August 2015. STUDY SELECTION Controlled trials of routine child health care delivered by health care professionals (physicians, nurses, medical assistants, health educators, and dieticians) that addressed the outcomes of interest (TSE reduction in children and parental smoking behaviors) were eligible for inclusion in this review and meta-Analysis. DATA EXTRACTION AND SYNTHESIS Study details and quality characteristicswere independently extracted by 2 authors. If outcome measures were sufficiently similar, meta-Analysis was performed using the random-effects model by DerSimonian and Laird. Otherwise, the results were described narratively. MAIN OUTCOMES AND MEASURES The primary outcome measurewas reduction in child TSE. Secondary outcomes of interest were parental smoking cessation, parental smoking reduction, and maternal postpartum smoking relapse prevention. RESULTS Sixteen studiesmet the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-Analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05; 95%CI, 0.74-1.50; P = .78). Meta-Analysis of the 3 trials that measured maternal postpartum smoking relapse prevention demonstrated a significant overall intervention effect (n = 1293) (risk ratio 1.53; 95%CI, 1.10-2.14; P = .01). High levels of study heterogeneity likely resulted from variability in outcome measures, length of follow up, intervention strategies, and unknown intervention fidelity. CONCLUSIONS AND RELEVANCE Interventions delivered by health care professionals who provide routine child health care may be effective in preventing maternal smoking relapse. Further research is required to improve the effectiveness of such interventions in reducing child TSE and increasing parental smoking cessation. The findings of this meta-Analysis have policy and practice implications relating to interventions by routine pediatric health care professionals that aim to reduce child exposure to tobacco smoke.

Background: Physiotherapist prescribed self-management strategies are an important adjunct to 'hands on' treatment. However, treatment outcomes are likely to be related to whether patients adhere to the prescribed strategy. Therefore, physiotherapists should be aware of adherence aiding interventions designed to maximise patient outcomes underpinned by quality research studies. Objective: To conduct a systematic review of the interventions used to aid patient adherence to all physiotherapist prescribed self-management strategies. Data sources: The search included the databases CINAHL, EMBASE, MEDLINE, PUBMED, PSYCINFO, SPORTSDiscus, the Cochrane Central Register of Controlled Trials, PEDro and Mednar for randomised controlled trials (RCTs) published in a peer reviewed journal from inception to November 2014. Data extraction and synthesis: Data were extracted using a standardised form from twelve included RCTs for patient adherence rates to self-management strategies for interventions used to aid patient adherence and usual care. Two independent reviewers conducted methodological quality assessment. Results: Twelve different interventions to aid patient adherence to exercise were recorded from twelve fair to high quality RCTs. Potential adherence aiding interventions include an activity monitor and feedback system, written exercise instructions, behavioural exercise programme with booster sessions and goal setting. Conclusion and implications of key findings: Despite a number of studies demonstrating interventions to positively influence patient adherence to exercise, there is insufficient data to endorse their use in clinical practice. No RCTs examining adherence aiding interventions to self-management strategies other than exercise were identified, indicating a significant gap in the literature. Systematic review registration number: PROSPERO CRD42015014516.

Objectives: The study examined: 1) the proportion of patients who received their preferred level of information about life expectancy; and 2) sociodemographic, clinical and psychological factors associated with patients' perceptions of whether they received too little, too much, or the right amount of information about life expectancy. Design: Cross-sectional survey. Setting: Eleven large Australian medical oncology treatment centres. Participants: A total of 1431 medical oncology outpatients participated (81% consent rate). Eligible patients were approached between September 2012 and May 2014. Main outcome measures: Patients indicated whether the information about life expectancy they received aligned with their preferences. Results: Almost one in four patients (24%) received too little information, 4% received too much, and 50% received all the information they wanted; 22% of patients neither wanted nor received information about life expectancy. Patients were more likely to receive too little information if they were not in remission (odds ratio [OR], 1.77), did not know their cancer stage at diagnosis (OR, 3.64), or were anxious (OR, 1.48) or depressed (OR, 1.48). Patients had greater odds of receiving too much information if they were younger (OR, 1.45), had more advanced cancer (OR, 2.01) or did not know their cancer stage at diagnosis (OR, 4.42). Conclusions: That fact that 28% of cancer patients did not receive their desired level of information about life expectancy highlights the difficulties associated with discussing this sensitive topic. To ensure that life expectancy discussions correspond with patient preferences, clinicians should routinely ask patients whether they want to know this information, in what format, and at which level of detail.

Aims: To examine the published literature on patient adherence to physiotherapist prescribed self-management strategies in order to describe: changes in the proportion of publications over time; methodological quality of non-intervention and intervention-based studies; types of measures used to assess patient adherence and the reported accuracy of those measures. Methods: A comprehensive search of eight electronic databases was conducted, covering the period from January 1995 to November 2014. Data were extracted and coded for the number and proportion of articles that were: i) non data-based; ii) data-based, no new data (reviews); iii) data-based, new data. The methodological quality of non-intervention and intervention publications was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and data were extracted regarding the type and accuracy of adherence measures reported in these publications. Results: A total of 80 relevant papers were identified. Of these, 49 non-intervention and intervention quantitative study designs underwent methodological assessment, with only 14 studies (29%) assessed as being of at least moderate quality. Fifty-three different measures of patient adherence were recorded from the 49 included studies, with only 5 of the 49 included studies (10%) reporting statistical evidence to support accuracy of the adherence measures applied. Conclusions: The results indicate that despite a trend towards intervention-based studies and reviews over the last 20 years, the methodological quality of studies on patient adherence could be improved. Accurate and standardised measures of patient adherence are needed for any future research involving patient adherence to physiotherapist prescribed self-management strategies.

Objectives: This review sought to identify, describe and assess the effectiveness of teacher-mediated interventions that aim to support child and adolescent recovery after a natural or man-made disaster. We also aimed to assess intervention applicability to rural and remote Australian school settings. Method: A systematic search of the academic literature was undertaken utilising six electronic databases (EBSCO, Medline, PsycINFO, Embase, ERIC and CINAHL) using terms that relate to: teacher-mediated and school-based interventions; children and adolescents; mental health and wellbeing; natural disasters and man-made disasters. This was supplemented by a grey literature search. Results: A total of 20 articles reporting on 18 separate interventions were identified. Nine separate interventions had been evaluated using methodologically adequate research designs, with findings suggesting at least short-term improvement in student wellbeing outcomes and academic performance. Conclusions: Although none of the identified studies reported on Australian-based interventions, international interventions could be adapted to the Australian rural and remote context using existing psychosocial programs and resources available online to Australian schools. Future research should investigate the acceptability, feasibility and effectiveness of implementing interventions modelled on the identified studies in Australian schools settings.

BACKGROUND: Overweight and obese patients attempt weight loss when advised to do so by their physicians; however, only a small proportion of these patients report receiving such advice. One reason may be that physicians do not identify their overweight and obese patients. OBJECTIVES: We aimed to determine the extent that Australian general practitioners (GP) recognise overweight or obesity in their patients, and to explore patient and GP characteristics associated with non-detection of overweight and obesity. METHODS: Consenting adult patients (n = 1,111) reported weight, height, demographics and health conditions using a touchscreen computer. GPs (n = 51) completed hard-copy questionnaires indicating whether their patients were overweight or obese. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for GP detection, using patient self-reported weight and height as the criterion measure for overweight and obesity. For a subsample of patients (n = 107), we did a sensitivity analysis with patient-measured weight and height. We conducted an adjusted, multivariable logistic regression to explore characteristics associated with non-detection, using random effects to adjust for correlation within GPs. RESULTS: Sensitivity for GP assessment was 63 % [95 % CI 57-69 %], specificity 89 % [95 % CI 85-92 %], PPV 87 % [95 % CI 83-90 %] and NPV 69 % [95 % CI 65-72 %]. Sensitivity increased by 3 % and specificity was unchanged in the sensitivity analysis. Men (OR: 1.7 [95 % CI 1.1-2.7]), patients without high blood pressure (OR: 1.8 [95 % CI 1.2-2.8]) and without type 2 diabetes (OR: 2.4 [95 % CI 1.2-8.0]) had higher odds of non-detection. Individuals with obesity (OR: 0.1 [95 % CI 0.07-0.2]) or diploma-level education (OR: 0.3 [95%CI 0.1-0.6]) had lower odds of not being identified. No GP characteristics were associated with non-detection of overweight or obesity. CONCLUSIONS: GPs missed identifying a substantial proportion of overweight and obese patients. Strategies to support GPs in identifying their overweight or obese patients need to be implemented. © 2013 Society of General Internal Medicine.

Objective A patient-centred approach to discussing life expectancy with cancer patients is recommended in Western countries. However, this approach to eliciting and meeting patient preferences can be challenging for clinicians. The aims of this study were the following: (i) to examine cancer patients' preferences for life expectancy disclosure; and (ii) to explore agreement between cancer patients' preferences for, and perceived experiences of, life expectancy disclosure. Methods Cancer patients undergoing radiotherapy treatment in metropolitan Australia completed a cross-sectional touchscreen computer survey including optional questions about their life expectancy disclosure preferences and experiences. Results Of the 208 respondents, 178 (86%) indicated that they would prefer their clinician to ask them before discussing life expectancy, and 30 (14%) indicated that they would prefer others (i.e. clinicians, family) to decide whether they were given life expectancy information. Of the 175 respondents who were classified as having a self- determined or other-determined disclosure experience, 105 (60%) reported an experience of life expectancy disclosure that was in accordance with their preferences. Cohen's ¿ was -0.04 (95% CI, -0.17, 0.08), indicating very poor agreement between patients' preferences for and perceived experiences of life expectancy disclosure (p = 0.74). Conclusions In light of patient-centred prognosis disclosure guidelines, our findings of a majority preference for, and experience of, a self-determined approach to life expectancy disclosure amongst radiation oncology patients are encouraging. However, poor agreement between preferences and experiences highlights that additional effort from clinicians is required in order to achieve a truly patient-centred approach to life expectancy disclosure. Copyright © 2013 John Wiley & Sons, Ltd.