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author:("jia, moyen")
1.  Providing general practice needs-based care for carers of people with advanced cancer: a randomised controlled trial 
The British Journal of General Practice  2013;63(615):e683-e690.
Background
Carers of patients with advanced cancer often have health and psychosocial needs, which are frequently overlooked.
Aim
To meet the needs of carers through a GP consultation directed by a self-completed carer needs checklist.
Design and setting
Randomised controlled trial in general practice with recruitment through specialist oncology clinics, in Brisbane, Australia.
Method
Intervention was (a) carer–GP consultations directed by a self-completed checklist of needs at baseline and 3 months; and (b) a GP-Toolkit to assist GPs to address carer-identified needs. Control group received usual care. Outcome measures were intensity of needs, anxiety and depression, and quality of life.
Results
Total recruitment 392. Overall, no significant differences were detected in the number or intensity of need between groups. Compared to controls, intervention participants with baseline clinical anxiety showed improvements in mental wellbeing (P = 0.027), and those with baseline clinical depression had slower development of anxiety (P = 0.044) at 6 months. For those not anxious, physical wellbeing improved at 1 month (P = 0.040). Carers looking after patients with poor functional status had more physical needs (P = 0.037) at 1 month and more psychological and emotional needs at 3 months (P = 0.034). Those caring for less unwell patients showed improved mental wellbeing at 3 months (P = 0.022).
Conclusion
The intervention did not influence the number or intensity of needs reported by carers of people with advanced cancer. There was limited impact in people with pre-existing clinical anxiety and depression. For the carer of those most severely affected by advanced cancer, it drew attention to the needs arising from the caregiving role.
doi:10.3399/bjgp13X673694
PMCID: PMC3782801  PMID: 24152483
Cancer; carers; general practice; palliative care; randomised controlled trial; self-assessment
2.  Management of behavioural change in patients presenting with a diagnosis of dementia: a video vignette study with Australian general practitioners 
BMJ Open  2014;4(9):e006054.
Objective
To test the impact of feedback on the proposed management of standardised patients presenting with behavioural change with a diagnosis of dementia in Australian primary care.
Materials and methods
A video vignette study was performed with Australian general practitioners (GPs) in 2013. Participants viewed six pairs of matched videos depicting people presenting changed behaviour in the context of a dementia diagnosis in two phases. In both phases GPs indicated their diagnosis and management. After phase 1, GPs were offered feedback on management strategies for the patients depicted. Analyses focused on identification of change in management between the two phases of the study. Factors impacting on the intention to coordinate care for such patients were tested in a questionnaire based on the Theory of Planned Behaviour.
Results
Forty-five GPs completed the study. There was significant improvement in the proposed management of three of the six scenarios after the intervention. Older GPs were more likely to refer appropriately (OR=1.11 (1.01 to 1.23), p=0.04.). Overall referral to support agencies was more likely after the intervention (OR=2.52 (1.53 to 4.14), p<0.001). Older GPs were less likely to intend to coordinate care for such patients (OR=0.89 (0.81 to 0.98) p=0.02). Participants who felt confident about their ability to coordinate care were more likely to do so (OR=3.79 (1.08 to 13.32) p=0.04).
Conclusions
The intervention described in this study promoted multidisciplinary management of patients with behavioural problems with a diagnosis of dementia. Increasing practitioner confidence in their ability to coordinate care may increase the proportion of GPs who will respond to patients and carers in this context. Older GPs may benefit in particular.
doi:10.1136/bmjopen-2014-006054
PMCID: PMC4179570  PMID: 25256189
PRIMARY CARE
3.  Rating general practitioner consultation performance in cancer care: does the specialty of assessors matter? A simulated patient study 
BMC Family Practice  2014;15(1):152.
Background
Patients treated for prostate cancer may present to general practitioners (GPs) for treatment follow up, but may be reticent to have their consultations recorded. Therefore the use of simulated patients allows practitioner consultations to be rated. The aim of this study was to determine whether the speciality of the assessor has an impact on how GP consultation performance is rated.
Methods
Six pairs of scenarios were developed for professional actors in two series of consultations by GPs. The scenarios included: chronic radiation proctitis, Prostate Specific Antigen (PSA) ‘bounce’, recurrence of cancer, urethral stricture, erectile dysfunction and depression or anxiety. Participating GPs were furnished with the patient’s past medical history, current medication, prostate cancer details and treatment, details of physical examinations. Consultations were video recorded and assessed for quality by two sets of assessors- a team of two GPs and two Radiation Oncologists deploying the Leicester Assessment Package (LAP). LAP scores by the GPs and Radiation Oncologists were compared.
Results
Eight GPs participated. In Series 1 the range of LAP scores by GP assessors was 61%-80%, and 67%-86% for Radiation Oncologist assessors. The range for GP LAP scores in Series 2 was 51%- 82%, and 56%-89% for Radiation Oncologist assessors. Within GP assessor correlations for LAP scores were 0.31 and 0.87 in Series 1 and 2 respectively. Within Radiation Oncologist assessor correlations were 0.50 and 0.72 in Series 1 and 2 respectively. Radiation Oncologist and GP assessor scores were significantly different for 4 doctors and for some scenarios. Anticipatory care was the only domain where GPs scored participants higher than Radiation Oncologist assessors.
Conclusion
The assessment of GP consultation performance is not consistent across assessors from different disciplines even when they deploy the same assessment tool.
doi:10.1186/1471-2296-15-152
PMCID: PMC4176849  PMID: 25218798
Radiation therapy; Prostate cancer; General practitioner; Consultation; Assessment; Side effects
4.  The Management of Acute Adverse Effects of Breast Cancer Treatment in General Practice: A Video-Vignette Study 
Background
There has been a focus recently on the use of the Internet and email to deliver education interventions to general practitioners (GPs). The treatment of breast cancer may include surgery, radiotherapy, chemotherapy, and/or hormone treatment. These treatments may have acute adverse effects. GPs need more information on the diagnosis and management of specific adverse effects encountered immediately after cancer treatment.
Objective
The goal was to evaluate an Internet-based educational program developed for GPs to advise patients with acute adverse effects following breast cancer treatment.
Methods
During phase 1, participants viewed 6 video vignettes of actor-patients reporting 1 of 6 acute symptoms following surgery and chemotherapy and/or radiotherapy treatment. GPs indicated their diagnosis and proposed management through an online survey program. They received feedback about each scenario in the form of a specialist clinic letter, as if the patient had been seen at a specialist clinic after they had attended the GP. This letter incorporated extracts from local guidelines on the management of the symptoms presented. This feedback was sent to the GPs electronically on the same survey platform. In phase 2, all GPs were invited to manage similar cases as phase 1. Their proposed management was compared to the guidelines. McNemar test was used to compare data from phases 1 and 2, and logistic regression was used to explore the GP characteristics that were associated with inappropriate case management.
Results
A total of 50 GPs participated. Participants were younger and more likely to be female than other GPs in Australia. For 5 of 6 vignettes in phase 1, management was consistent with expert opinion in the minority of cases (6%-46%). Participant demographic characteristics had a variable effect on different management decisions in phase 1. The variables modeled explained 15%-28% of the differences observed. Diagnosis and management improved significantly in phase 2, especially for diarrhea, neutropenia, and seroma sample cases. The proportion of incorrect management responses was reduced to a minimum (25.3%-49.3%) in phase 2.
Conclusions
There was evidence that providing feedback by experts on specific cases had an impact on GPs’ knowledge about how to appropriately manage acute treatment adverse effects. This educational intervention could be targeted to support the implementation of shared care during cancer treatment.
doi:10.2196/jmir.3585
PMCID: PMC4213802  PMID: 25274131
breast cancer; treatment; general practice; adverse effects; patient care planning
5.  A randomised trial deploying a simulation to investigate the impact of hospital discharge letters on patient care in general practice 
BMJ Open  2014;4(7):e005475.
Objective
To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs).
Trial design
GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient's problems.
Methods
Setting Primary care. Participants Practising Australian GPs. Intervention A short or long hospital discharge letter enumerating patient problems. Outcome measure Number of ongoing patient problems out of 10 identified for management by the GPs. Randomisation 1:1 randomisation. Blinding (masking) Single-blind.
Results
Numbers randomised 59 GPs. Recruitment GPs were recruited from a network of 102 GPs across Australia. Numbers analysed 59 GPs. Outcome GPs who received the long letter immediately were more satisfied with this information (p<0.001). Those who received the letter immediately identified significantly more health problems (p=0.001). GPs who received a short, delayed discharge letter were less satisfied than those who received a longer delayed letter (p=0.03); however, both groups who received the delayed letter identified a similar number of health problems. GPs who were older, who practised in an inner regional area or who offered more patient sessions per week identified fewer health problems (p values <0.01, <0.05 and <0.05, respectively). Harms Nil.
Conclusions
Receiving information during patient consultation, as well as GP characteristics, influences the number of patient problems addressed.
Trial registration number
ACTRN12614000403639.
doi:10.1136/bmjopen-2014-005475
PMCID: PMC4091507  PMID: 25005597
PRIMARY CARE
6.  Unmet needs of patients with chronic obstructive pulmonary disease (COPD): a qualitative study on patients and doctors 
BMC Family Practice  2014;15:67.
Background
Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease with repeated exacerbations resulting in gradual debilitation. The quality of life has been shown to be poor in patients with COPD despite efforts to improve self-management. However, the evidence on the benefit of self-management in COPD is conflicting. Whether this could be due to other unmet needs of patients have not been investigated. Therefore, we aimed to explore unmet needs of patients from both patients and doctors managing COPD.
Methods
We conducted a qualitative study with doctors and patients in Malaysia. We used convenience sampling to recruit patients until data saturation. Eighteen patients and eighteen doctors consented and were interviewed using a semi-structured interview guide. The interviews were audio-recorded, transcribed verbatim and checked by the interviewers. Data were analysed using a thematic approach.
Results
The themes were similar for both the patients and doctors. Three main themes emerged: knowledge and awareness of COPD, psychosocial and physical impact of COPD and the utility of self-management. Knowledge about COPD was generally poor. Patients were not familiar with the term chronic obstructive pulmonary disease or COPD. The word ‘asthma’ was used synonymously with COPD by both patients and doctors. Most patients experienced difficulties in their psychosocial and physical functions such as breathlessness, fear and helplessness. Most patients were not confident in self-managing their illness and prefer a more passive role with doctors directing their care.
Conclusions
In conclusion, our study showed that knowledge of COPD is generally poor. There was mislabelling of COPD as asthma by both patients and physicians. This could have resulted in the lack of understanding of treatment options, outcomes, and prognosis of COPD. The misconception that cough due to COPD was contagious, and breathlessness that resulted from COPD, had important physical and psychosocial impact, and could lead to social isolation. Most patients and physicians did not favour self-management approaches, suggesting innovations based on self-management may be of limited benefit.
doi:10.1186/1471-2296-15-67
PMCID: PMC3996170  PMID: 24739595
COPD; Qualitative; Self-management; Knowledge; Quality of life; Needs
7.  Supporting Patients Treated for Prostate Cancer: A Video Vignette Study With an Email-Based Educational Program in General Practice 
Background
Men who have been treated for prostate cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following treatment. However, there is no evidence that such men are consistently advised by GPs and patients experience substantial unmet need for reassurance and advice.
Objective
The intent of the study was to evaluate a brief, email-based educational program for GPs to manage standardized patients presenting with symptoms or side effects months or years after prostate cancer treatment.
Methods
GPs viewed six pairs of video vignettes of actor-patients depicting men who had been treated for prostate cancer. The actor-patients presented problems that were attributable to the treatment of cancer. In Phase 1, GPs indicated their diagnosis and stated if they would prescribe, refer, or order tests based on that diagnosis. These responses were compared to the management decisions for those vignettes as recommended by a team of experts in prostate cancer. After Phase 1, all the GPs were invited to participate in an email-based education program (Spaced Education) focused on prostate cancer. Participants received feedback and could compare their progress and their performance with other participants in the study. In Phase 2, all GPs, regardless of whether they had completed the program, were invited to view another set of six video vignettes with men presenting similar problems to Phase 1. They again offered a diagnosis and stated if they would prescribe, refer, or order tests based on that diagnosis.
Results
In total, 64 general practitioners participated in the project, 57 GPs participated in Phase 1, and 45 in Phase 2. The Phase 1 education program was completed by 38 of the 57 (59%) participants. There were no significant differences in demographics between those who completed the program and those who did not. Factors determining whether management of cases was consistent with expert opinion were number of sessions worked per week (OR 0.78, 95% CI 0.67-0.90), site of clinical practice (remote practice, OR 2.25, 95% CI 1.01-5.03), number of patients seen per week (150 patients or more per week, OR 10.66, 95% CI 3.40-33.48), and type of case viewed. Completion of the Spaced Education did impact whether patient management was consistent with expert opinion (not completed, OR 0.88, 95% CI 0.5-1.56).
Conclusions
The management of standardized patients by GPs was particularly unlikely to be consistent with expert opinion in the management of impotence and bony metastasis. There was no evidence from this standardized patient study that Spaced Education had an impact on the management of patients in this context. However, the program was not completed by all participants. Practitioners with a greater clinical load were more likely to manage cases as per expert opinion.
doi:10.2196/jmir.3003
PMCID: PMC3961707  PMID: 24571952
medical education; prostate cancer; general practice; email; video
8.  Video Consultation Use by Australian General Practitioners: Video Vignette Study 
Background
There is unequal access to health care in Australia, particularly for the one-third of the population living in remote and rural areas. Video consultations delivered via the Internet present an opportunity to provide medical services to those who are underserviced, but this is not currently routine practice in Australia. There are advantages and shortcomings to using video consultations for diagnosis, and general practitioners (GPs) have varying opinions regarding their efficacy.
Objective
The aim of this Internet-based study was to explore the attitudes of Australian GPs toward video consultation by using a range of patient scenarios presenting different clinical problems.
Methods
Overall, 102 GPs were invited to view 6 video vignettes featuring patients presenting with acute and chronic illnesses. For each vignette, they were asked to offer a differential diagnosis and to complete a survey based on the theory of planned behavior documenting their views on the value of a video consultation.
Results
A total of 47 GPs participated in the study. The participants were younger than Australian GPs based on national data, and more likely to be working in a larger practice. Most participants (72%-100%) agreed on the differential diagnosis in all video scenarios. Approximately one-third of the study participants were positive about video consultations, one-third were ambivalent, and one-third were against them. In all, 91% opposed conducting a video consultation for the patient with symptoms of an acute myocardial infarction. Inability to examine the patient was most frequently cited as the reason for not conducting a video consultation. Australian GPs who were favorably inclined toward video consultations were more likely to work in larger practices, and were more established GPs, especially in rural areas. The survey results also suggest that the deployment of video technology will need to focus on follow-up consultations.
Conclusions
Patients with minor self-limiting illnesses and those with medical emergencies are unlikely to be offered access to a GP by video. The process of establishing video consultations as routine practice will need to be endorsed by senior members of the profession and funding organizations. Video consultation techniques will also need to be taught in medical schools.
doi:10.2196/jmir.2638
PMCID: PMC3713911  PMID: 23782753
videoconferencing; general practice; patient appointments; health care
9.  Medicine an evolving profession 
The Australasian Medical Journal  2013;6(4):196-202.
The number of medical practitioners in the developed world has increased but in relative terms their incomes have decreased. Published comments suggest that some doctors are dissatisfied with what they earn. However doctors are still perceived as having a high status in society. Publicly available data suggests that doctors chose to live and work in affluent suburbs where arguably the need for their skills is less than that in neighbouring deprived areas. The gender balance in medicine is also changing with more women entering the workforce and a greater acceptance of parttime working arrangements. In some countries doctors have relinquished the responsibility for emergency out of hours care in general practice and personal continuity of care is no longer on offer. The profession is also challenged by policy makers’ enthusiasm for guidelines while the focus on multidisciplinary teamwork makes it more likely that patients will routinely be able to consult professionals other than medical practitioners. At the same time the internet has changed patient expectations so that health care providers will be expected to deploy information technology to satisfy patients. Medicine still has a great deal to offer. Information may be readily available on the internet, but it is not an independently sufficient, prerequisite for people to contend with the physical and psychological distress associated with disease and disability. We need to understand and promote the crucial role doctors play in society at a time of tremendous change in the attitudes to, and within, the profession.
doi:10.4066/AMJ.2013.1683
PMCID: PMC3650312  PMID: 23671466
Doctors; profession; income; working hours
10.  Innovating for General Practice 
This editorial will consider the challenge of innovation for healthcare from three perspectives: the general practitioner (GP), the patient and the policy maker. The knowledge, attitudes and beliefs of each, respectively, are likely to affect the type of innovation adopted in practice. Each stakeholder has priorities and needs that must be reflected in the design and implementation of innovations.
doi:10.4066/AMJ.2013.1593
PMCID: PMC3575065  PMID: 23424611
11.  Health care innovation: Working with General Practitioners 
The development of innovations for clinical practice warrants active engagement of clinicians in the research process. This requires attention to factors that serve as incentive to participate. The explanation for the success of factors that encourage practitioners to participate in research can be found in sources of satisfaction and dissatisfaction with clinical practice. It is also important to consider intrinsic incentives such as common and troublesome clinical presentations that are related to workload or unsatisfactory clinical encounters. This review will consider each of these factors and suggest ways in which clinicians, especially general practitioners, may be invited to assist on research projects.
doi:10.4066/AMJ.2013.1594
PMCID: PMC3575066  PMID: 23422871
Research; general practice; innovation; workload
12.  Doctors and the media 
The Australasian Medical Journal  2012;5(11):603-608.
doi:10.4066/AMJ.2012.1562
PMCID: PMC3518778  PMID: 23289051
13.  Does prognosis and socioeconomic status impact on trust in physicians? Interviews with patients with coronary disease in South Australia 
BMJ Open  2012;2(5):e001389.
Objectives
There is concern across a range of healthcare settings worldwide that trust in physicians is declining. Decreased trust may lead to lesser tolerance of prognosis uncertainty and an increased demand for tests, referrals and second opinions. Literature suggests that there has been a recent cultural shift towards decreased trust in, and increased questioning of, medical advice. We investigated the impact of varying prognosis and socioeconomic status (SES) on trust in physicians, and patient questioning of medical advice.
Design
Semistructured, audio-recorded transcribed interviews were conducted. The interview schedule was developed with reference to the Health Belief Model. Interviews were conducted between October 2008 and September 2009.
Setting
Participants were recruited via general practitioner clinics and hospital cardiac rehabilitation programmes.
Participants
Participants consisted of patients either receiving preventive treatment or active treatment for established cardiovascular disease.
Outcome measures
A coding structure was developed based on the aim of the research, to investigate the impact of varying prognosis and SES on trust in physicians.
Results
Older participants are more likely than their younger counterparts to be unquestioning of medical advice. Higher SES participants are more likely to question medical advice than lower SES participants. Also, unlike primary prevention participants, established pathology increased participants’ trust, or decreased questioning behaviour. Participants who perceived themselves at risk of a poor or uncertain outcome were unlikely to doubt medical advice.
Conclusions
Blind trust in physicians remains strong in older participants, participants who perceive their prognosis to be uncertain and a proportion of lower SES participants. This is important for practitioners in terms of patient agency and points to the importance of moral and ethical practice. However, physicians also need to be aware that there are a growing proportion of patients for whom trust needs to be developed, and cannot be assumed.
doi:10.1136/bmjopen-2012-001389
PMCID: PMC3488703  PMID: 23035015
Preventive Medicine; Medical Education & Training
14.  Doctors and Medical Training 
The Australasian Medical Journal  2012;5(9):513-516.
doi:10.4066/AMJ.2012.1512.
PMCID: PMC3477781  PMID: 23115587
15.  Doctors and Medical Science 
The Australasian Medical Journal  2012;5(8):462-467.
doi:10.4066/AMJ.2012.1491
PMCID: PMC3442191  PMID: 23024721
16.  When only a doctor will do 
The Australasian Medical Journal  2012;5(7):414-417.
doi:10.4066/AMJ.2012.1446
PMCID: PMC3413005  PMID: 22905066
Generalist; Doctor; impersonator; skills; innovation
17.  Impact of the Presence of Medical Equipment in Images on Viewers’ Perceptions of the Trustworthiness of an Individual On-Screen 
Background
It is now common practice for doctors to consult patients by means other than face-to-face, often appearing before the patient on a computer screen. Also, many websites are using depictions of health professionals to increase the credibility of their services. Being trustworthy is an essential attribute for successful ehealth services. Little is known about which depicted accessories make a health professional appear more trustworthy.
Objective
To estimate the odds of an individual on-screen being rated trustworthy when viewed in a static image holding or wearing specific items of medical equipment.
Methods
We surveyed consecutive people attending community pharmacies to collect prescriptions in Western Australia. Respondents were presented with a series of 10 photographs, generated at random, of a man with varying numbers and combinations of medical equipment: stethoscope, reflex hammer, surgical scrubs, otoscope, and pen. They were then invited to rate the man as honest, trustworthy, honorable, moral, ethical, or genuine, or a combination of these, on the Source Credibility Scale.
Results
A total of 168 of 250 people gave informed consent, for a participation rate of 67.2%. There were 102 female and 66 male respondents. Of the 168 respondents, 96 (57%) were born in Australia and 102 (60.7%) were attending medical practices with more than one general practitioner. The mean age of respondents was 47 (SD 16) years (range 26–92 years). When only 1 item was present in an image, the stethoscope was associated with the highest odds for the person being considered honest (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6–4.3), trustworthy (OR 2.3, 95% CI 1.4–3.8), honorable (OR 2.7, 95% CI 1.6–4.5), moral (OR 2.4 95% CI 1.4–4.1), ethical (OR 2.6, 95% CI 1.5–4.6), and genuine (OR 1.8, 95% CI 1.0–3.1). The presence of a stethoscope increased the odds of the person being rated in a positive light in all photographs in which it was included.
Conclusions
When an individual is portrayed in a static image, concurrent presentation of 3 or more items of medical equipment, and especially a stethoscope, is likely to exert a positive influence on the viewers’ perceptions of the qualities of the person depicted.
doi:10.2196/jmir.1986
PMCID: PMC3409609  PMID: 22782078
Icons; semiotics; stethoscope; doctors; trustworthiness
18.  The health of women treated for breast cancer: A challenge in primary care 
The Australasian Medical Journal  2012;5(6):316-321.
At least one in a hundred consultations in general practice in Australia involves women being treated for breast cancer. The challenges presented during these consultations test the quality of primary care. Firstly, women are reported to prefer to discuss their breast cancer-related problems with a specialist even though research suggests that patients generally prefer to consult with a general practitioner (GP). The extent to which these patients will have maintained or return to their previous level of functioning will be a reflection on the quality of primary care, as some breast cancer-related health issues may persist beyond the time period when they are undergoing specialist review. Further, psychosocial matters, sexuality and relationships may require repeated review and perhaps consultations involving family members and would therefore be better addressed by a GP. An increasingly urgent need exists to review how best to support people who are successfully treated for life limiting illnesses, such as breast cancer.
doi:10.4066/AMJ.20121344
PMCID: PMC3395290  PMID: 22848330
Breast cancer; primary care; cancer morbidity
19.  The Business of Doctoring 
The Australasian Medical Journal  2012;5(6):329-333.
doi:10.4066/AMJ.2012.1420
PMCID: PMC3395294  PMID: 22848332
Generalist; Doctor; Consultation; Interruption
20.  Doctors – paradoxes and possibilities 
The Australasian Medical Journal  2012;5(5):284-289.
doi:10.4066/AMJ.2012.1225
PMCID: PMC3395282  PMID: 22848325
Medicine; Doctor; Roles; Society
21.  Developing and testing a strategy to enhance a palliative approach and care continuity for people who have dementia: study overview and protocol 
BMC Palliative Care  2012;11:4.
Background
Typically, dementia involves progressive cognitive and functional deterioration, leading to death. A palliative approach recognizes the inevitable health decline, focusing on quality of life. The approach is holistic, proactive, supports the client and the family, and can be provided by the client's usual care team.
In the last months of life, distressing symptoms, support needs, and care transitions may escalate. This project trialed a strategy intended to support a consistent, high quality, palliative approach for people with dementia drawing close to death. The strategy was to implement two communities of practice, drawn primarily from service provider organizations across care sectors, supporting them to address practice change. Communities comprised practitioners and other health professionals with a passionate commitment to dementia palliative care and the capacity to drive practice enhancement within partnering organizations.
Project aims were to document: (i) changes driven by the communities of practice; (ii) changes in staff/practitioner characteristics during the study (knowledge of a palliative approach and dementia; confidence delivering palliative care; views on death and dying, palliative care, and a palliative approach for dementia); (iii) outcomes from perspectives of family carers, care providers, and community of practice members; (iv) the extent to which changes enhanced practice and care continuity; and (v) barriers to and facilitators of successful community of practice implementation.
Methods/design
This action research project was implemented over 14 months in 2010/11 in metropolitan Perth, Western Australia and regional Launceston, Tasmania. Each state based community of practice worked with the researchers to scope existing practice and its outcomes. The research team compiled a report of existing practice recommendations and resources. Findings of these two steps informed community of practice action plans and development of additional resources. Change implementation was recorded and explored in interviews, comparisons being made with practice recommendations. Changes in staff/practitioner characteristics were evaluated using survey data. Findings from semi structured interviews and survey administration established outcomes from perspectives of family carers, care providers, and community of practice members. Consideration of processes and outcomes, across the two state based settings, informed identification of barriers and facilitators. Community of practice reflections also informed study recommendations.
doi:10.1186/1472-684X-11-4
PMCID: PMC3394215  PMID: 22471327
Dementia; Palliative care; Evidence translation; Action research
22.  The AMJ Serving Australasia 
The Australasian Medical Journal  2011;4(11):636-637.
doi:10.4066/AMJ.2011.1130
PMCID: PMC3562923  PMID: 23386880
23.  Consultation etiquette in general practice: a qualitative study of what makes it different for lay cancer caregivers 
BMC Family Practice  2011;12:110.
Background
It is commonplace for lay caregivers to overlook their own health concerns when supporting someone with advanced cancer. During this time, caregivers' needs as patients are often marginalised by health professionals, including General Practitioners (GPs), who may miss the breadth of caregivers' needs by focusing on the practicalities of caregiving. GPs traditionally rely on patients to raise their concerns, and then respond to these concerns, but caregivers as patients may be disinclined to cue their GP. The norms of engagement when caregivers consult their GP are less defined, and how they interact with their GP regarding their own health is under-explored. This sub-study investigates the norms, assumptions and subtleties which govern caregiver-GP consultations, and explores factors affecting their interaction regarding caregivers' own health concerns.
Methods
We conducted semi-structured interviews with six lay caregivers and 19 health professionals in Brisbane, Australia, and analyzed the interview transcripts thematically.
Results
Traditional norms of engagement are subjected to assumptions and expectations which caregivers and GPs bring to the consultation. Practice pressures also influence both parties' capacity and willingness to discuss caregivers' health. Nonetheless, some GPs monitor caregivers' health opportunistically. Their interaction is enhanced by the quality of the caregiver-GP relationship and by the GP's skills.
Conclusions
Caregivers are caught in a paradox whereby their health needs may become subsumed by the care recipient's needs in a setting where patient needs are normally scrutinised and supported. Caregivers may not raise their health concerns with their GP, who instead may need to cue them that it is timely and safe to do so. The routine use of a prompt may help to address caregivers' needs systematically, but it needs to be complemented by GPs' desire and capacity to engage with patients in a caregiving role. The potential difference GPs can make to the health of these patients is substantial.
doi:10.1186/1471-2296-12-110
PMCID: PMC3198678  PMID: 21970440
24.  Developing a Self-Administered Questionnaire as a Guide to Consultations with Women Treated for Breast Cancer 
Background. Health professionals, including general practitioners involved in followup of breast cancer patients, need to systematically assess opportunities to offer patients support with ongoing or new problems. Methods. A self-administered needs assessment questionnaire was developed with reference to a multidisciplinary team. Short, evidence-based, readable questions were emphasized, and questions were tested for face validity. The questions flowed across three domains: physical, social, and psychological. Content validity and user friendliness were assessed. Results. A final set of 30 questions was rated as easy to read and comprehend (Flesch Reading Ease score 65.8 and Flesch-Kincaid Grade Level 6.9). When piloted with twenty-one patients the self-administered questionnaire detected 121 items of unmet need encompassing all three domains. Conclusions. This self-administered questionnaire has the potential to assist in the holistic assessment of breast cancer patient after treatment. The clinical value of the self-administered questionnaire will need to be further tested before it can be widely adopted.
doi:10.1155/2011/390692
PMCID: PMC3263838  PMID: 22295185
25.  A GP caregiver needs toolkit versus usual care in the management of the needs of caregivers of patients with advanced cancer: a randomized controlled trial 
Trials  2010;11:115.
Background
Caring for a person with progressive cancer creates challenges for caregivers. However the needs of caregivers are often not assessed or recognised by health care providers. Research is also lacking in this area, with little knowledge relating to effective strategies to address the specific needs of caregivers. This paper outlines a study protocol aimed at developing and evaluating the effectiveness of a general practice-based intervention to better meet the needs of caregivers of patients with advanced cancer.
Methods/Design
Two hundred and sixty caregivers will be randomised into each of two arms of the intervention (520 participants in total) through patients with advanced cancer attending medical and radiation oncology outpatient clinics at two tertiary hospital sites. Consenting caregivers will be followed up for six months, and telephone surveyed at baseline, 1, 3 and 6 months following their entry into the study or until the patient's death, whichever occurs first. Assessment and management of the unmet needs of caregivers in the intervention arm will be facilitated through a specifically developed general practice-based strategy; caregivers in the control group will receive usual care. Qualitative interviews will be conducted with a sample of up to 20 caregivers and 10 GPs at the conclusion of their participation, to explore their views regarding the usefulness of the intervention.
Discussion
This study will determine whether systematic assessment of caregiver needs supported by caregiver-specific information for General Practitioners is effective in alleviating the unmet needs experienced by caregivers caring for patients with advanced cancer.
Trial registration number
ISRCTN: ISRCTN43614355
doi:10.1186/1745-6215-11-115
PMCID: PMC3009964  PMID: 21114863

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