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Nickel B, Farber R, Brennan M, Hersch J, McCaffery K, Houssami N. Breast density notification: evidence on whether benefit outweighs harm is required to inform future screening practice. BMJ Evid Based Med 2021; 26:309-311. [PMID: 32665223 DOI: 10.1136/bmjebm-2020-111364] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Meagan Brennan
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Davies C, Marshall HS, Zimet G, McCaffery K, Brotherton JML, Kang M, Garland S, Kaldor J, McGeechan K, Skinner SR. Effect of a School-Based Educational Intervention About the Human Papillomavirus Vaccine on Psychosocial Outcomes Among Adolescents: Analysis of Secondary Outcomes of a Cluster Randomized Trial. JAMA Netw Open 2021; 4:e2129057. [PMID: 34726749 PMCID: PMC8564580 DOI: 10.1001/jamanetworkopen.2021.29057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Delivery of vaccination to adolescents via a school-based program provides an opportunity to promote their involvement in health decision-making, service provision, and self-efficacy (belief in one's ability to perform a certain behavior). OBJECTIVE To examine the effect of a human papillomavirus (HPV) vaccination education and logistical intervention on adolescent psychosocial outcomes. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized trial and process and qualitative evaluation, adolescents aged 12 to 13 years (first year of high school) were recruited at high schools in Western Australia (WA) and South Australia (SA) in 2013 and 2014. Statistical analysis was performed from January 2016 to December 2020. INTERVENTIONS The complex intervention consisted of an adolescent intervention to promote knowledge and psychosocial outcomes, shared decisional support tool, and logistical strategies. MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes were assessed. The HPV Adolescent Vaccination Intervention Questionnaire (HAVIQ) was used to measure changes in adolescent knowledge (6-item subscale), fear and anxiety (6-item subscale), self-efficacy (5-item subscale), and decision-making (8-item subscale). The hypothesis was that the intervention would improve adolescent involvement in vaccine decision-making (measured before dose 1 only), improve vaccine-related self-efficacy, and reduce vaccine-related fear and anxiety (measured before doses 1, 2, and 3). Mean (SD) scores for each subscale were compared between intervention and control students. In the process evaluation, focus groups were conducted. Analyses of the HAVIQ data were conducted from 2016 to 2020. Qualitative analyses of the focus groups were undertaken from 2017 to 2020. RESULTS The trial included 40 schools (21 intervention and 19 control) across sectors with 6967 adolescents (mean [SD] age, 13.70 [0.45] years). There were 3805 students (1689 girls and 2116 boys) in the intervention group and 3162 students (1471 girls and 1691 boys) in the control group. The overall response rate for the HAVIQ was 55%. In WA, where parental consent was required, the response rate was 35% (1676 of 4751 students); in SA, where parental consent was not required, it was 97% (2166 of 2216 students). The mean (SD) score for decision-making in the intervention group before dose 1 was 3.50 (0.42) of 5 points and 3.40 (0.40) in the control group, a small but significant difference of 0.11 point (95% CI, 0.06 to 0.16 point; P < .001). There was a small difference in favor of the intervention group in reduced vaccination-related anxiety (pre-dose 1 difference, -0.11 point [95% CI, -0.19 to -0.02 point]; pre-dose 2 difference, -0.18 point [95% CI, -0.26 to -0.10 point]; pre-dose 3 difference, -0.18 [95% CI, -0.24 to -0.11]) and increased vaccination self-efficacy (pre-dose 1 difference, 4.0 points; [95% CI, 1.0 to 7.0 points]; pre-dose 2 difference, 4.0 points [95% CI, 2.0 to 6.0 points]; pre-dose 3 difference, 3.0 points [95% CI, 1.0 to 5.0 points]). Focus group data from 111 adolescents in 6 intervention and 5 control schools revealed more confidence and less anxiety with each vaccine dose. CONCLUSIONS AND RELEVANCE In this cluster randomized trial, there was a small difference in adolescent decisional involvement and vaccine-related confidence and reduced vaccination-related fear and anxiety that was maintained throughout the vaccine course in the intervention vs control groups. Guidelines for vaccination at school should incorporate advice regarding how this outcome can be achieved. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12614000404628.
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Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Helen S. Marshall
- Women’s and Children’s Hospital and School of Medicine and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia M. L. Brotherton
- VCS Population Health, VCS Foundation, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Kang
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne Garland
- Centre for Women’s Infectious Diseases Research, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Reproductive and Neonatal Infectious Diseases, Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Bonner C, Batcup C, Ayre J, Cvejic E, Trevena L, McCaffery K, Doust J. The impact of health literacy-sensitive design and heart age in a cardiovascular disease prevention decision aid: randomised controlled trial and end user testing (Preprint). JMIR Cardio 2021; 6:e34142. [PMID: 35436208 PMCID: PMC9055529 DOI: 10.2196/34142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/10/2022] [Accepted: 03/05/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- Carissa Bonner
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carys Batcup
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Ayre
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Erin Cvejic
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lyndal Trevena
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jenny Doust
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Yen RW, Smith J, Engel J, Muscat DM, Smith SK, Mancini J, Perestelo-Pérez L, Elwyn G, O'Malley AJ, Leyenaar JK, Mac O, Cadet T, Giguere A, Housten AJ, Langford A, McCaffery K, Durand MA. A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IDPAS). Med Decis Making 2021; 41:870-896. [PMID: 34151614 PMCID: PMC8763253 DOI: 10.1177/0272989x211020317] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effectiveness of patient decision aids (PtDAs) and other shared decision-making (SDM) interventions for socially disadvantaged populations has not been well studied. PURPOSE To assess whether PtDAs and other SDM interventions improve outcomes or decrease health inequalities among socially disadvantaged populations and determine the critical features of successful interventions. DATA SOURCES MEDLINE, CINAHL, Cochrane, PsycINFO, and Web of Science from inception to October 2019. Cochrane systematic reviews on PtDAs. STUDY SELECTION Randomized controlled trials of PtDAs and SDM interventions that included socially disadvantaged populations. DATA EXTRACTION Independent double data extraction using a standardized form and the Template for Intervention Description and Replication checklist. DATA SYNTHESIS Twenty-five PtDA and 13 other SDM intervention trials met our inclusion criteria. Compared with usual care, PtDAs improved knowledge (mean difference = 13.91, 95% confidence interval [CI] 9.01, 18.82 [I2 = 96%]) and patient-clinician communication (relative risk = 1.62, 95% CI 1.42, 1.84 [I2 = 0%]). PtDAs reduced decisional conflict (mean difference = -9.59; 95% CI -18.94, -0.24 [I2 = 84%]) and the proportion undecided (relative risk = 0.39; 95% CI 0.28, 0.53 [I2 = 75%]). PtDAs did not affect anxiety (standardized mean difference = 0.02, 95% CI -0.22, 0.26 [I2 = 70%]). Only 1 trial looked at clinical outcomes (hemoglobin A1C). Five of the 12 PtDA studies that compared outcomes by disadvantaged standing found that outcomes improved more for socially disadvantaged participants. No evidence indicated which intervention characteristics were most effective. Results were similar for SDM intervention trials. LIMITATIONS Sixteen PtDA studies had an overall unclear risk of bias. Heterogeneity was high for most outcomes. Most studies only had short-term follow-up. CONCLUSIONS PtDAs led to better outcomes among socially disadvantaged populations but did not reduce health inequalities. We could not determine which intervention features were most effective.[Box: see text].
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Jenna Smith
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jaclyn Engel
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Danielle Marie Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sian K Smith
- University of Bath, School of Management, Bath, Somerset, UK
| | - Julien Mancini
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Marseille, Provence-Alpes-Cote d'Azu, France
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Biomedical Sciences, Dartmouth College, Lebanon, NH, USA
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Olivia Mac
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tamara Cadet
- School of Social Work, Simmons University, Boston, MA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | | | - Aisha Langford
- New York University School of Medicine, Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Langone Medical Centre, New York, NY, USA
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Faculté de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
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Nickel B, Copp T, Brennan M, Farber R, McCaffery K, Houssami N. The Impact of Breast Density Information or Notification on Women's Cognitive, Psychological, and Behavioral Outcomes: A Systematic Review. J Natl Cancer Inst 2021; 113:1299-1328. [PMID: 33544867 PMCID: PMC8486329 DOI: 10.1093/jnci/djab016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/31/2020] [Accepted: 02/01/2021] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. This systematic review aims to synthesize evidence from existing studies to understand the impact of BD information and/or notification on women's cognitive, psychological, and behavioral outcomes. METHODS Studies were identified via relevant database searches up to March 2020. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias. RESULTS Of the 1134 titles identified, 29 studies were included. Twenty-three studies were quantitative, including only 1 randomized controlled trial of women receiving BD information, and 6 were qualitative. Twenty-seven studies were conducted in the United States, with 19 conducted post-BD legislation. The overall results in terms of BD awareness, knowledge, attitudes, perceptions, and intentions were heterogeneous across included studies, with the strongest consistency demonstrated regarding the importance of communication with and involvement of health-care professionals. Together, the studies did, however, highlight that there is still limited awareness of BD in the community, especially in more socioeconomic disadvantaged communities, and limited knowledge about what BD means and the implications for women. Importantly, BD information in the context of overall breast cancer risk has not yet been studied. CONCLUSIONS There are important gaps in the understanding of the impact of BD information or notification on women and how best to communicate BD information to women. More high-quality evidence to inform both current and future practice related to BD is still needed.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Meagan Brennan
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, The University of Notre Dame, Sydney, Australia
| | - Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Farmer C, O'Connor DA, Lee H, McCaffery K, Maher C, Newell D, Cashin A, Byfield D, Jarvik J, Buchbinder R. Consumer understanding of terms used in imaging reports requested for low back pain: a cross-sectional survey. BMJ Open 2021; 11:e049938. [PMID: 34518265 PMCID: PMC8438839 DOI: 10.1136/bmjopen-2021-049938] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate (1) self-reported societal comprehension of common and usually non-serious terms found in lumbar spine imaging reports and (2) its relationship to perceived seriousness, likely persistence of low back pain (LBP), fear of movement, back beliefs and history and intensity of LBP. DESIGN Cross-sectional online survey of the general public. SETTING Five English-speaking countries: UK, USA, Canada, New Zealand and Australia. PARTICIPANTS Adults (age >18 years) with or without a history of LBP recruited in April 2019 with quotas for country, age and gender. PRIMARY AND SECONDARY OUTCOME MEASURES Self-reported understanding of 14 terms (annular fissure, disc bulge, disc degeneration, disc extrusion, disc height loss, disc protrusion, disc signal loss, facet joint degeneration, high intensity zone, mild canal stenosis, Modic changes, nerve root contact, spondylolisthesis and spondylosis) commonly found in lumbar spine imaging reports. For each term, we also elicited worry about its seriousness, and whether its presence would indicate pain persistence and prompt fear of movement. RESULTS From 774 responses, we included 677 (87.5%) with complete and valid responses. 577 (85%) participants had a current or past history of LBP of whom 251 (44%) had received lumbar spine imaging. Self-reported understanding of all terms was poor. At best, 235 (35%) reported understanding the term 'disc degeneration', while only 71 (10.5%) reported understanding the term 'Modic changes'. For all terms, a moderate to large proportion of participants (range 59%-71%), considered they indicated a serious back problem, that pain might persist (range 52%-71%) and they would be fearful of movement (range 42%-57%). CONCLUSION Common and usually non-serious terms in lumbar spine imaging reports are poorly understood by the general population and may contribute to the burden of LBP. TRIAL REGISTRATION NUMBER ACTRN12619000545167.
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Affiliation(s)
- Caitlin Farmer
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia
| | - Denise A O'Connor
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Maher
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
| | | | - Aidan Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - David Byfield
- University of South Wales Faculty of Life Sciences and Education, Treforest, UK
| | - Jeffrey Jarvik
- Departments of Radiology, Neurological Surgery and Health Services, School of Medicine, University of Washington, Seattle, Washington, USA
- UW Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Disorders, University of Washington, Seattle, Washington, USA
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia
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Rozbroj T, Haas R, O'Connor D, Carter SM, McCaffery K, Thomas R, Donovan J, Buchbinder R. How do people understand overtesting and overdiagnosis? Systematic review and meta-synthesis of qualitative research. Soc Sci Med 2021; 285:114255. [PMID: 34391966 DOI: 10.1016/j.socscimed.2021.114255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Abstract
RATIONALE The public should be informed about overtesting and overdiagnosis. Diverse qualitative studies have examined public understandings of this information. A synthesis was needed to systematise the body of evidence and yield new, generalisable insights. AIM Synthesise data from qualitative studies exploring patient and public understanding of overtesting and overdiagnosis. METHODS We searched Scopus, CINAHL, Ovid MEDLINE and PsycINFO databases from inception to March 18, 2020. We included published English-language primary studies exploring the perspectives of patients/the public about overtesting/overdiagnosis from any setting, year and relating to any condition. Only qualitative parts of mixed-methods studies were synthesised. We excluded studies that only examined overtreatment or sampled people with specialised medical knowledge. Two authors independently selected studies, extracted data, assessed the methodological quality of included studies using the CASP tool, and assessed confidence in the synthesis findings using the GRADE-CERQual approach. Data was analysed using thematic meta-synthesis, utilising descriptive and interpretive methods. RESULTS We synthesised data from 21 studies, comprising 1638 participants, from 2754 unique records identified. We identified six descriptive themes, all graded as moderate confidence (indicating they are likely to reasonably represent the available evidence): i) high confidence in screening and testing; ii) difficulty in understanding overuse; iii) acceptance that overuse can be harmful; iv) rejection or problematisation of overuse; v) limited impacts of overuse information on intended test and screening uptake; vi) desire for information and shared decision-making regarding overuse. The descriptive themes were underpinned by two analytic themes: i) perceived intrinsic value of information and information gathering, and; ii) differences in comprehension and acceptance of overuse concepts. CONCLUSIONS This study identified novel and important insights about how lay people interpret overuse concepts. It will guide the development of more effective public messages about overuse, highlighting the importance of interpretative frameworks in these communications.
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Affiliation(s)
- Tomas Rozbroj
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia.
| | - Romi Haas
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
| | - Denise O'Connor
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, NSW 2500, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia
| | - Jan Donovan
- Consumers Health Forum of Australia, 7B/17 Napier Close, Deakin, ACT 2600, Australia
| | - Rachelle Buchbinder
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
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Zadro J, Jones C, Harris I, Buchbinder R, O'Connor DA, McCaffery K, Thompson RE, Karunaratne S, Teng MJ, Maher C, Hoffmann T. Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study. BMJ Open 2021; 11:e054032. [PMID: 34462283 PMCID: PMC8407224 DOI: 10.1136/bmjopen-2021-054032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To develop and user test a patient decision aid for people with subacromial pain syndrome that presents evidence-based information on the benefits and harms of subacromial decompression surgery and rotator cuff repair surgery. DESIGN Mixed-methods study outlining the development of a patient decision aid. SETTING We assembled a multidisciplinary steering group, and used existing decision aids and decision science to draft the decision aid. Participants were recruited through social media (not restricted by country nor setting), local hospitals and the authors' collaboration network. PARTICIPANTS People with shoulder pain and health professionals who manage people with shoulder pain. PRIMARY AND SECONDARY OUTCOMES We interviewed participants to gather feedback on the decision aid, assessed useability and acceptability (using qualitative and quantitative methods) and performed iterative cycles of redrafting the decision aid and reinterviewing participants as necessary. Interview data were analysed using thematic analysis. Quantitative data were summarised descriptively. RESULTS We interviewed 26 health professionals (11 physiotherapists, 7 orthopaedic surgeons, 4 general practitioners, 3 chiropractors and 1 osteopath) and 14 people with shoulder pain. Most health professionals and people with shoulder pain rated all aspects of decision aid acceptability as adequate-to-excellent (eg, length, presentation, comprehensibility). Interviews highlighted agreement among health professionals and people with shoulder pain on most aspects of the decision aid (eg, treatment options, summary of benefits, harms and practical issues, questions to ask a health professional, graphics, formatting). However, some aspects of the decision aid elicited divergent views among health professionals (eg, causes and symptoms of shoulder pain, evidence on benefits and harms). CONCLUSION This decision aid could be an acceptable and valuable tool for helping people with subacromial pain syndrome make informed treatment choices. A randomised controlled trial evaluating whether this decision aid reduces people's intentions to undergo shoulder surgery and facilitates informed treatment choices is underway.Trial registration number ACTRN12621000992808.
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Affiliation(s)
- Joshua Zadro
- Institute for Musculoskeletal Health, Sydney School of Public Health, University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Caitlin Jones
- Institute for Musculoskeletal Health, Sydney School of Public Health, University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Ian Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Rachelle Buchbinder
- Dept of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Denise A O'Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Min Jiat Teng
- Institute for Musculoskeletal Health, Sydney School of Public Health, University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Christopher Maher
- Institute for Musculoskeletal Health, Sydney School of Public Health, University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Nickel B, Dolan H, Carter S, Houssami N, Brennan M, Hersch J, Kaderbhai A, McCaffery K. General practitioners' (GPs) understanding and views on breast density in Australia: a qualitative interview study. BMJ Open 2021; 11:e047513. [PMID: 34408038 PMCID: PMC8375715 DOI: 10.1136/bmjopen-2020-047513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To understand general practitioners' (GPs') awareness and knowledge of mammographic breast density (BD) and their perspectives around information and potential notification of BD for women. DESIGN Qualitative study using semistructured telephone interviews. Interviews were audiorecorded, transcribed and analysed using framework analysis. SETTING Australia. PARTICIPANTS Australian GPs (n=30). RESULTS GPs had limited knowledge of BD and little experience discussing BD with women. There were mixed views on notification of BD with some GPs believing this information would help informed decision making about breast health and that women have the right to know any information about their bodies. While others were concerned about causing unnecessary anxiety and were worried about the uncertainty about what to advise women to do with this information, particularly in relation to supplemental breast screening. The need for an equitable system where all women are either notified or not, and also provided with publicly funded supplemental screening was raised by GPs. Overall, there was high interest in education, training and support around the topic of BD. CONCLUSIONS Australian GPs require education, support and evidence-based guidelines to have discussions with women with dense breasts and help manage their risk, especially if widespread notification is to be introduced in population-based screening programmes.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Hankiz Dolan
- Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Stacy Carter
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Meagan Brennan
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
- Westmead Breast Cancer Institute, Sydney, New South Wales, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Alia Kaderbhai
- The Royal Australian College of General Practitioners, Melbourne, Victoria, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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60
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Nickel B, Miller JA, Cvejic E, Gild ML, Cope D, Dodd R, McCaffery K, Glover A. Thyroid cancer clinicians' views and experiences of delayed treatment during the COVID-19 pandemic: An international cross-sectional survey. ANZ J Surg 2021; 91:2562-2564. [PMID: 34350698 PMCID: PMC8420195 DOI: 10.1111/ans.17128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie A Miller
- Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Australian and New Zealand Endocrine Surgeons, St Leonards, New South Wales, Australia
| | - Erin Cvejic
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matti L Gild
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Daron Cope
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Rachael Dodd
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Glover
- Australian and New Zealand Endocrine Surgeons, St Leonards, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Endocrine Cancer Program, Cancer Theme, The Kinghorn Cancer Centre, Garvan Institute of Medical Research, St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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61
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Copp T, Nickel B, Lensen S, Hammarberg K, Lieberman D, Doust J, Mol BW, McCaffery K. Anti-Mullerian hormone (AMH) test information on Australian and New Zealand fertility clinic websites: a content analysis. BMJ Open 2021; 11:e046927. [PMID: 34233986 PMCID: PMC8264877 DOI: 10.1136/bmjopen-2020-046927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The anti-Mullerian hormone (AMH) test has been promoted as a way to inform women about their future fertility. However, data consistently show the test is a poor predictor of natural fertility potential for an individual woman. As fertility centre websites are often a primary source of information for reproductive information, it is essential the information provided is accurate and reflects the available evidence. We aimed to systematically record and categorise information about the AMH test found on Australian and New Zealand fertility clinic websites. DESIGN Content analysis of online written information about the AMH test on fertility clinic websites. SETTING Accredited Australian and New Zealand fertility clinic websites. METHODS Data were extracted between April and June 2020. Any webpage that mentioned the AMH test, including blogs specifically about the AMH test posted since 2015, was analysed and the content categorised. RESULTS Of the 39 active accredited fertility clinics' websites, 25 included information about the AMH test. The amount of information varied widely, and embodied four overarching categories; (1) the utility of the AMH test, (2) who the test is suitable for, (3) possible actions in response to the test and (4) caveats and limitations of the test. Eight specific statements about the utility of the test were identified, many of which are not evidence-based. While some websites were transparent regarding the test's limitations, others mentioned no caveats or included persuasive statements actively promoting the test as empowering for a range of women in different circumstances. CONCLUSIONS Several websites had statements about the utility of the AMH test that are not supported by the evidence. This highlights the need for higher standards for information provided on fertility clinic websites to prevent women being misled to believe the test can reliably predict their fertility.
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Affiliation(s)
- Tessa Copp
- Faculty of Medicine and Health, Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Faculty of Medicine and Health, Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Lensen
- Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia
| | - Devora Lieberman
- City Fertility Centre Pty Ltd, Sydney, New South Wales, Australia
| | - Jenny Doust
- Centre of Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Kirsten McCaffery
- Faculty of Medicine and Health, Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Van Der Pol-Harney E, Turner R, McCaffery K, Bonner C. The effects of communicating cardiovascular disease risk as 'fitness age' on behavioral intentions and psychological outcomes. Patient Educ Couns 2021; 104:1704-1711. [PMID: 33485734 DOI: 10.1016/j.pec.2020.12.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/08/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES There is increasing interest in 'biological age' formats to convey the risk of chronic disease. Fitness Age is a relatively new construct that may be useful for younger people who perceive cardiovascular disease (CVD) risk as less relevant. The current study tested whether Fitness Age increases behavioral intentions and psychosocial outcomes compared to formats commonly used for middle aged adults: Heart Age and percentage risk. METHODS 180 young adults were randomized to 1 of 3 risk formats: Fitness Age, Heart Age, or lifetime percentage risk of CVD. To make the intervention more personally relevant, participants were assigned to receive a low or high risk result based on self-reported lifestyle factors. Validated measures were used for intentions, worry, perceived risk and credibility. RESULTS Percentage risk and Heart Age resulted in greater lifestyle change intentions and more accurate numeric risk perception than Fitness Age. High risk results were perceived as less credible but more worrying. CONCLUSIONS Fitness Age may be detrimental for risk perception and behavior change for young adults. Percentage risk and Heart Age formats were equally effective. PRACTICE IMPLICATIONS Labels for biological age formats matter when developing risk communication tools, and Fitness Age would not be a recommended format.
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Affiliation(s)
| | - Robin Turner
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | | | - Carissa Bonner
- School of Public Health, University of Sydney, Sydney, Australia.
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Shih P, Nickel B, Degeling C, Thomas R, Brito JP, McLeod DSA, McCaffery K, Carter SM. Terminology Change for Small Low-Risk Papillary Thyroid Cancer As a Response to Overtreatment: Results from Three Australian Community Juries. Thyroid 2021; 31:1067-1075. [PMID: 33238815 DOI: 10.1089/thy.2020.0694] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: The majority of small papillary thyroid cancers (sPTCs) are treated surgically, rather than by active surveillance. Patient and clinician preference for surgery may be partially driven by the use of cancer terminology. Some experts propose that changing terminology would better communicate the indolent nature of sPTCs and improve uptake of active surveillance. Others argue that terminology that includes "cancer" correctly reflects the biological nature of these tumors. The views of informed lay publics can provide value-based perspectives on complex issues and guide policy discussions. Methods: We recruited 40 people for three community juries, held in Sydney, Wodonga, and Cairns, Australia. Participants were of diverse backgrounds and ages, recruited through random digit dialing and a topic-blinded social media strategy. Juries were informed about thyroid cancer, overdiagnosis, and overtreatment, and heard arguments for and against terminology change before deliberation. The deliberative process in Jury 1 led to a refinement of jury charge, the updated version that was then used in Juries 2 and 3. Results: Jury 1 favored no terminology change, and Juries 2 and 3 were divided on the topic. Key reasons for opposing terminology change included a strong desire to retain terminology that aligns with the pathological definition of cancer, and to avoid even a minimal risk of harm that could arise if patients became complacent in follow-up. Key reasons to support terminology change included a desire to reduce psychological distress, stigma, and discrimination associated with a cancer diagnosis, and an argument that terminology change may be a more effective trigger for health system reform compared with other options. The juries unanimously recommended community education and health system reforms to reduce harms of overtreatment, and expressed an expectation that clinicians and researchers reach agreement on clinical guidelines to promote better uptake of active surveillance. Conclusions: The conceptual tension between a pathological and an outcome-based understanding of cancer was apparent in deliberation. This highlights an ongoing challenge for those advocating changing disease terminology. Regardless of action on terminology, jurors shared a strong expectation that practical changes would be made to respond to the harms of overtreatment.
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Affiliation(s)
- Patti Shih
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, and Wiser Healthcare, University of Wollongong, Wollongong, Australia
| | - Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, and Wiser Healthcare, University of Wollongong, Wollongong, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, and Wiser Healthcare, Bond University, Gold Coast, Australia
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Donald S A McLeod
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Department of Diabetes and Endocrinology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, and Wiser Healthcare, University of Wollongong, Wollongong, Australia
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64
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Ayre J, Cvejic E, McCaffery K, Copp T, Cornell S, Dodd RH, Pickles K, Batcup C, Isautier JMJ, Nickel B, Dakin T, Bonner C. Contextualising COVID-19 prevention behaviour over time in Australia: Patterns and long-term predictors from April to July 2020 in an online social media sample. PLoS One 2021; 16:e0253930. [PMID: 34185816 PMCID: PMC8241082 DOI: 10.1371/journal.pone.0253930] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Australia in March 2020 a national public health directive required that non-essential workers stay at home, except for essential activities. These restrictions began easing in May 2020 as community transmission slowed. OBJECTIVES This study investigated changes in COVID prevention behaviours from April-July 2020, and psychosocial predictors of these behaviours. METHODS An Australia-wide (national) survey was conducted in April, with monthly follow-up over four months. Participants who were adults (18+ years), currently residing in Australia and who could read and understand English were eligible. Recruitment was via online social media. Analysis sample included those who provided responses to the baseline survey (April) and at least one subsequent follow-up survey (N = 1834 out of a possible 3216 who completed the April survey). 71.7% of the sample was female (n = 1,322). Principal components analysis (PCA) combined self-reported adherence across seven prevention behaviours. PCA identified two behaviour types: 'distancing' (e.g. staying 1.5m away) and 'hygiene' (e.g. washing hands), explaining 28.3% and 24.2% of variance, respectively. Distancing and hygiene behaviours were analysed individually using multivariable regression models. RESULTS On average, participants agreed with statements of adherence for all behaviours (means all above 4 out of 7). Distancing behaviours declined each month (p's < .001), whereas hygiene behaviours remained relatively stable. For distancing, stronger perceptions of societal risk, self-efficacy to maintain distancing, and greater perceived social obligation at baseline were associated with adherence in June and July (p's<0.05). For hygiene, the only significant correlate of adherence in June and July was belief that one's actions could prevent infection of family members (p < .001). CONCLUSION High adherence to COVID prevention behaviours were reported in this social media sample; however, distancing behaviours tended to decrease over time. Belief in social responsibility may be an important aspect to consider in encouraging distancing behaviours. These findings have implications for managing a shift from government-imposed restrictions to individual responsibility.
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Affiliation(s)
- Julie Ayre
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tessa Copp
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Samuel Cornell
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael H. Dodd
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristen Pickles
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carys Batcup
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer M. J. Isautier
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Dakin
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Affiliation(s)
- Jennifer M J Isautier
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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O'Keeffe M, Nickel B, Dakin T, Maher CG, Albarqouni L, McCaffery K, Barratt A, Moynihan R. Journalists' views on media coverage of medical tests and overdiagnosis: a qualitative study. BMJ Open 2021; 11:e043991. [PMID: 34078634 PMCID: PMC8173287 DOI: 10.1136/bmjopen-2020-043991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Promotional media coverage of early detection tests is an important driver of overdiagnosis. Following research evidence that global media coverage presents the benefits of testing healthy people far more frequently than harms, and gives little coverage to overdiagnosis, we sought to examine journalists' views on media reporting of tests, overdiagnosis, and strategies to improve critical reporting on tests. DESIGN Qualitative study using semistructured telephone interviews. Interviews were conducted between February and March 2020 and were audiorecorded and transcribed verbatim. Framework thematic analysis was used to analyse the data. PARTICIPANTS AND SETTING Twenty-two journalists (mainly specialising in health reporting, average 14.5 years' experience) based in Australia. RESULTS This sample of journalists acknowledged the potential harms of medical tests but felt that knowledge of harms was low among journalists and the public at large. Most were aware of the term overdiagnosis, but commonly felt that it is challenging to both understand and communicate in light of strong beliefs in the benefits of early detection. Journalists felt that newsworthiness in the form of major public health impact was the key ingredient for stories about medical tests. The journalists acknowledged that factors, like the press release and 'click bait culture' in particular, can influence the framing of coverage about tests. Lack of knowledge and training, as well as time pressures, were perceived to be the main barriers to critical reporting on tests. Journalists felt that training and better access to information about potential harms would enable more critical reporting. CONCLUSIONS Effectively communicating overdiagnosis is a challenge in light of common beliefs about the benefits of testing and the culture of current journalism practices. Providing journalists with training, support and better access to information about potential harms of tests could aid critical reporting of tests.
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Dakin
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
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Muscat DM, Smith J, Mac O, Cadet T, Giguere A, Housten AJ, Langford AT, Smith S, Durand MA, McCaffery K. Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards. Med Decis Making 2021; 41:848-869. [PMID: 34053361 DOI: 10.1177/0272989x211011101] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development. PURPOSE An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations. DATA SOURCES Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions). STUDY SELECTION RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s). DATA EXTRACTION Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability. DATA SYNTHESIS Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ2 = 14.11, P = 0.0002, I2 = 92.9%). LIMITATIONS We were unable to access 13 of 24 PtDAs. Conclusions. Greater attention to health literacy and socially-disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support.
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Affiliation(s)
- Danielle M Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jenna Smith
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia Mac
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tamara Cadet
- School of Social Work, Simmons University, Boston MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | | | - Aisha T Langford
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health. New York, NY, USA
| | - Sian Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia
| | - Marie-Anne Durand
- Université Toulouse III Paul Sabatier, Toulouse, France.,Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Suisse.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Bath Centre for Healthcare Innovation and Improvement, Information Decisions and Operations, School of Management, University of Bath, Somerset, UK
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68
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Ayre J, Bonner C, Muscat DM, Bramwell S, McClelland S, Jayaballa R, Maberly G, McCaffery K. Type 2 diabetes self-management schemas across diverse health literacy levels: a qualitative investigation. Psychol Health 2021; 37:867-889. [PMID: 33931003 DOI: 10.1080/08870446.2021.1909023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to explore how people with diabetes and diverse health literacy levels conceptualise their experience and efforts to engage in self-management behaviours (their self-management 'schemas'). DESIGN A qualitative design was applied. METHODS Twenty-six people in Sydney, Australia, took part in semi-structured interviews, which were audio-recorded and coded using Framework analysis. RESULTS Half the participants (54%) had limited health literacy, whereas 38% adequate health literacy (using Newest Vital Sign). Regardless of health literacy, people described how monitoring increased self-management awareness and signalled periods of low self-management ('lulls'). Accounts of monitoring to sustain motivation were more apparent for participants with adequate health literacy. Most participants described simple and flexible rules (e.g. use artificial sweeteners; eat in moderation). Two schemas related to 'lulls': a 'problem-solving orientation' depicted lulls as inevitable and was associated with varied coping strategies; a 'willpower orientation' attributed lulls to lack of 'willpower,' and described willpower as a main coping strategy. CONCLUSION There is considerable variation in how people think about their diabetes self-management and the strategies they use. Health literacy may contribute to some of this variation. Self-management interventions could benefit from depicting motivation as fluctuating and challenging ideas about willpower and self-blame.
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Affiliation(s)
- Julie Ayre
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sian Bramwell
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia
| | - Sharon McClelland
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia
| | - Rajini Jayaballa
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia.,School of Medicine, Western Sydney University, Blacktown, Australia
| | - Glen Maberly
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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69
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Young B, Kotzur M, Gatting L, Bonner C, Ayre J, McConnachie A, Batcup C, McCaffery K, O'Carroll R, Robb KA. The impact of theory-based messages on COVID-19 vaccination intentions: a structured summary of a study protocol for a randomised controlled trial. Trials 2021; 22:311. [PMID: 33926540 PMCID: PMC8082050 DOI: 10.1186/s13063-021-05277-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives Uptake of vaccination against COVID-19 is key to controlling the pandemic. However, a significant proportion of people report that they do not intend to have a vaccine, often because of concerns they have about vaccine side effects or safety. This study will assess the impact of theory-based messages on COVID-19 vaccination intention, drawing on the Necessity-Concerns framework to address previously reported beliefs and concerns about COVID-19 vaccination, and assess whether hypothesised variables (illness coherence, perceived necessity and concerns) mediate change in vaccination intention. Trial design Prospective, parallel two-arm, individually randomised (1:1) trial. Participants Adults aged over 18 years, living in Scotland and not vaccinated for COVID-19. A quota sampling approach will be used with the aim of achieving a nationally representative sample on gender, region and ethnic group, with oversampling of individuals with no educational qualifications or with only school-level qualifications. Intervention and comparator Intervention: Brief exposure to online text and image-based messages addressing necessity beliefs and concerns about COVID-19 vaccination. Comparator: Brief exposure to online text and image-based messages containing general information about COVID-19 and COVID-19 vaccination. Main outcomes Primary outcome: Self-reported intention to receive a vaccine for COVID-19 if invited, immediately post-intervention. Secondary outcomes: Self-reported COVID-19 illness coherence, perceived necessity of a COVID-19 vaccine and concerns about a COVID-19 vaccine, immediately post-intervention. Randomisation Quasi-randomisation performed automatically by online survey software, by creating a variable derived from the number of seconds in the minute that the participant initiates the survey. Participants starting the survey at 0-14 or 30-44 seconds in the minute are allocated to the intervention and 15-29 or 45-59 seconds to the comparator. Blinding (masking) Participants will not be blinded to group assignment but will not be informed of the purpose of the study until they have completed the follow-up survey. Investigators will be blinded to allocation as all procedures will be undertaken digitally and remotely without any investigator contact with participants. Numbers to be randomised (sample size) A total of 1,094 will be randomised 1:1 into two groups with 547 individuals in each. Trial Status Protocol version number 1.0, 26th February 2021. Recruitment status: Not yet recruiting, set to start April 2021 and end April 2021. Trial registration ClinicalTrials.gov, NCT04813770, 24th March 2021. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05277-7.
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70
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Hersch J, Barratt A, McGeechan K, Jansen J, Houssami N, Dhillon H, Jacklyn G, Irwig L, McCaffery K. Informing Women About Overdetection in Breast Cancer Screening: Two-Year Outcomes From a Randomized Trial. J Natl Cancer Inst 2021; 113:1523-1530. [PMID: 33871631 PMCID: PMC8562961 DOI: 10.1093/jnci/djab083] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Supporting well-informed decisions about breast cancer screening requires communicating that inconsequential disease may be detected, leading to overdiagnosis and overtreatment. Having previously shown that telling women about overdetection improved informed choice, we investigated effects on screening knowledge and participation over 2 years. METHODS We conducted a community-based, parallel-group, randomized controlled trial in Australia. Participants were women aged 48-50 years, without personal or strong family history of breast cancer, who had not undergone mammography in the past 2 years. We randomly assigned 879 women to receive the intervention decision aid (evidence-based information on overdetection, breast cancer mortality reduction, and false-positives) or control decision aid (identical but without overdetection information). We interviewed 838 women postintervention and recontacted them for follow-up at 6 months and 1 and 2 years. Main outcomes for this report are screening knowledge and participation. RESULTS We interviewed 790, 746, and 712 participants at 6 months, 1, and 2 years, respectively. The intervention group demonstrated superior knowledge throughout follow-up. After 2 years, conceptual knowledge was adequate in 123 (34.4%) of 358 women in the intervention group compared with 71 (20.1%) of 354 control participants(odds ratio = 2.04, 95% confidence interval = 1.46 to 2.85). Groups were similar in total screening participation (200 [55.1%] vs 204 [56.0%]; = 0.97, 95% confidence interval = 0.73 to 1.29). CONCLUSIONS A brief decision aid produced lasting improvement in women's understanding of potential consequences of screening, including overdetection, without changing participation rates. These findings support the use of decision aids for breast cancer screening.
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Affiliation(s)
- Jolyn Hersch
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Wiser Healthcare: A Research Collaboration for Reducing Overdiagnosis and Overtreatment, The University of Sydney, Sydney, NSW, Australia,Centre for Medical Psychology and Evidence-based Decision-making, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Correspondence to: Jolyn Hersch, PhD, School of Public Health, Edward Ford Building A27, The University of Sydney, NSW 2006, Australia (e-mail: )
| | - Alexandra Barratt
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Wiser Healthcare: A Research Collaboration for Reducing Overdiagnosis and Overtreatment, The University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Wiser Healthcare: A Research Collaboration for Reducing Overdiagnosis and Overtreatment, The University of Sydney, Sydney, NSW, Australia
| | - Jesse Jansen
- Wiser Healthcare: A Research Collaboration for Reducing Overdiagnosis and Overtreatment, The University of Sydney, Sydney, NSW, Australia,Centre for Medical Psychology and Evidence-based Decision-making, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Department of General Practice, Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Nehmat Houssami
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Wiser Healthcare: A Research Collaboration for Reducing Overdiagnosis and Overtreatment, The University of Sydney, Sydney, NSW, Australia
| | - Haryana Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Gemma Jacklyn
- Wiser Healthcare: A Research Collaboration for Reducing Overdiagnosis and Overtreatment, The University of Sydney, Sydney, NSW, Australia
| | - Les Irwig
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Wiser Healthcare: A Research Collaboration for Reducing Overdiagnosis and Overtreatment, The University of Sydney, Sydney, NSW, Australia
| | - Kirsten McCaffery
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Wiser Healthcare: A Research Collaboration for Reducing Overdiagnosis and Overtreatment, The University of Sydney, Sydney, NSW, Australia,Centre for Medical Psychology and Evidence-based Decision-making, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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71
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Affiliation(s)
| | - Jenny Doust
- University of Queensland, Brisbane, Australia
| | | | | | - Jesse Jansen
- Maastricht University, Maastricht, Netherlands
- University of Sydney, Sydney, Australia
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72
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Muscat DM, Morris GM, Bell K, Cvejic E, Smith J, Jansen J, Thomas R, Bonner C, Doust J, McCaffery K. Benefits and Harms of Hypertension and High-Normal Labels: A Randomized Experiment. Circ Cardiovasc Qual Outcomes 2021; 14:e007160. [PMID: 33813855 DOI: 10.1161/circoutcomes.120.007160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent US guidelines lowered the threshold for diagnosing hypertension while other international guidelines use alternative/no labels for the same group (blood pressure [BP], <140/90 mm Hg). We investigated potential benefits and harms of hypertension and high-normal BP labels, compared with control, among people at lower risk of cardiovascular disease. METHODS We conducted a randomized experiment using a national sample of Australians (n=1318) 40 to 50 years of age recruited from an online panel. Participants were randomized to 1 of 3 hypothetical scenarios where a general practitioner told them they had a BP reading of 135/85 mm Hg, using either hypertension/high-normal BP/control (general BP description) labels. Participants were then randomized to receive an additional absolute risk description or nothing. Primary outcomes were willingness to change diet and worry. Secondary outcomes included exercise/medication intentions, risk perceptions, and other psychosocial outcomes. RESULTS There was no difference in willingness to change diet across label groups (P=0.22). The hypertension label (mean difference [MD], 0.74 [95% CI, 0.41-1.06]; P<0.001) and high-normal BP label (MD, 0.45 [95% CI, 0.12-0.78]; P=0.008) had increased worry about cardiovascular disease risk compared with control. There was no evidence that either label increased willingness to exercise (P=0.80). However, the hypertension (MD, 0.20 [95% CI, 0.04-0.36]; P=0.014), but not high-normal label (MD, 0.06 [95% CI, -0.10 to 0.21]; P=0.49), increased willingness to accept BP-lowering medication compared with control. Psychosocial differences including lower control, higher risk perceptions, and more negative affect were found for the hypertension and high-normal labels compared with control. Providing absolute risk information decreased willingness to change diet (MD, 0.25 [95% CI, 0.10-0.41]; P=0.001) and increase exercise (MD, 0.28 [95% CI, 0.11-0.45]; P=0.001) in the hypertension group. CONCLUSIONS Neither hypertension nor high-normal labels motivated participants to change their diet or exercise more than control, but both labels had adverse psychosocial outcomes. Labeling people with systolic BP of 130 to 140 mm Hg, who are otherwise at low risk of cardiovascular disease, may cause harms that outweigh benefit. Registration: URL: http://www.anzctr.org.au/; Unique identifier: ACTRN12618001700224.
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Affiliation(s)
- Danielle Marie Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Georgina May Morris
- Faculty of Medicine and Health, Sydney School of Public Health (G.M.M., K.B., E.C.), The University of Sydney, New South Wales, Australia
| | - Katy Bell
- Faculty of Medicine and Health, Sydney School of Public Health (G.M.M., K.B., E.C.), The University of Sydney, New South Wales, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Public Health (G.M.M., K.B., E.C.), The University of Sydney, New South Wales, Australia
| | - Jenna Smith
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Jesse Jansen
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia (R.T., J.D.)
| | - Carissa Bonner
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Jenny Doust
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia (R.T., J.D.)
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
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Coombs DM, Machado GC, Richards B, Needs C, Buchbinder R, Harris IA, Howard K, McCaffery K, Billot L, Edwards J, Rogan E, Facer R, Li Q, Maher CG. Effectiveness of a multifaceted intervention to improve emergency department care of low back pain: a stepped-wedge, cluster-randomised trial. BMJ Qual Saf 2021; 30:825-835. [PMID: 33692191 DOI: 10.1136/bmjqs-2020-012337] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Overuse of lumbar imaging is common in the emergency department (ED). Few trials have examined interventions to address this. We evaluated the effectiveness of a multifaceted intervention to implement guideline recommendations for low back pain in the emergency department. METHODS We conducted a stepped-wedge, cluster-randomised trial in four EDs in New South Wales, Australia. After a 13-month control phase of usual care, the EDs received a multifaceted intervention to support guideline-endorsed care in a random order, based on a computer-generated random sequence, every 4 weeks over a 4-month period. All sites were followed up for at least 3 months. The primary outcome was the proportion of low back pain presentations receiving lumbar imaging. Secondary healthcare utilisation outcomes included prescriptions of opioid and non-opioid pain medicines, inpatient admissions, length of ED stay, specialist referrals and re-presentations. Clinician beliefs and knowledge about low back pain care were measured before and after the intervention. Patient-reported pain, disability, quality of life and satisfaction were measured at 1, 2 and 4 weeks post ED presentation. RESULTS A total of 269 ED clinicians and 4625 episodes of care for low back pain (4491 patients) were included. The data did not provide clear evidence that the intervention reduced lumbar imaging (OR 0.77; 95% CI 0.47 to 1.26; p=0.29). It did reduce opioid use (OR 0.57; 95% CI 0.38 to 0.85; p=0.006) and improved clinicians' beliefs (mean difference (MD), 2.85; 95% CI 1.85 to 3.85; p<0.001; on a scale from 9 to 45) and knowledge about low back pain care (MD, 0.48; 95% CI 0.13 to 0.83; p<0.01; on a scale from 0 to 11). There was no difference in pain scores at 1-week follow-up (MD, 0.04; 95% CI -1.00 to 1.08; p=0.94; on a scale from 0 to 10). A similar trend was observed for all other patient-reported outcomes and time points. This study found no effect on the other secondary healthcare utilisation outcomes. CONCLUSION It is uncertain if a multifaceted intervention to implement guideline recommendations for low back pain care decreased lumbar imaging in the ED; however, it did reduce opioid prescriptions without adversely affecting patient outcomes. Trial registration number ACTRN12617001160325.
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Affiliation(s)
- Danielle M Coombs
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.,Physiotherapy Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Bethan Richards
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.,Rheumatology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Chris Needs
- Rheumatology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.,Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Orthopaedic Department, South Western Sydney Local Health District, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kirsten Howard
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Laurent Billot
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - James Edwards
- Emergency Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Eileen Rogan
- Emergency Department, Canterbury Hospital, Campsie, New South Wales, Australia
| | - Rochelle Facer
- Emergency Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Qiang Li
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
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74
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Nickel B, Copp T, Brennan M, Farber R, McCaffery K, Houssami N. Breast Density Notification: A Systematic Review of the Impact on Primary Care Practitioners. J Womens Health (Larchmt) 2021; 30:1457-1468. [PMID: 33656924 DOI: 10.1089/jwh.2020.8898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: In the last decade, there has been an unprecedented amount of advocacy and attention surrounding the issue of breast density (BD) in relation to mammography screening. It is largely unknown what impact notifying women of their BD has had on clinical practice for PCPs. This systematic review aimed to synthesize evidence from existing studies to understand the impact of BD notification on primary care practitioners' (PCPs) knowledge, attitudes, and practice implications. Methods: Empirical studies were identified through relevant database searches (database inception to May 2020). Two authors evaluated the eligibility of studies, extracted and crosschecked data, and assessed the risk of bias. Results were synthesized in a narrative form. Results: Six studies of the 232 titles identified and screened were included. All studies were undertaken in the United States, with five conducted postlegislation in their respective states, and one study conducted in states that were both prelegislation and postlegislation. Five studies were quantitative, including four cross-sectional surveys, and one study was qualitative. Findings consistently demonstrated PCPs' overall lack of knowledge about BD, low level of comfort in discussing and managing patients in relation to dense breasts, and limited consensus on the most appropriate approach for managing women with dense breasts, particularly in relation to supplemental screening. Conclusions: This review highlights important gaps in PCPs' understanding of BD and confidence in having discussions with women about the implications of dense breasts. It identifies the need for high-quality research and the development of evidence-based guidelines to better support PCPs.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tessa Copp
- Wiser Healthcare, Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Meagan Brennan
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,School of Medicine Sydney, The University of Notre Dame, Sydney, Australia
| | - Rachel Farber
- Wiser Healthcare, Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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75
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Thomas R, Greenwood H, Michaleff ZA, Abukmail E, Hoffmann TC, McCaffery K, Hardiman L, Glasziou P. Examining Australian's beliefs, misconceptions and sources of information for COVID-19: a national online survey. BMJ Open 2021; 11:e043421. [PMID: 33622946 PMCID: PMC7907616 DOI: 10.1136/bmjopen-2020-043421] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Public cooperation to practise preventive health behaviours is essential to manage the transmission of infectious diseases such as COVID-19. We aimed to investigate beliefs about COVID-19 diagnosis, transmission and prevention that have the potential to impact the uptake of recommended public health strategies. DESIGN An online cross-sectional survey. PARTICIPANTS A national sample of 1500 Australian adults with representative quotas for age and gender provided by an online panel provider. MAIN OUTCOME MEASURE Proportion of participants with correct/incorrect knowledge of COVID-19 preventive behaviours and reasons for misconceptions. RESULTS Of the 1802 potential participants contacted, 289 did not qualify, 13 declined and 1500 participated in the survey (response rate 83%). Most participants correctly identified 'washing your hands regularly with soap and water' (92%) and 'staying at least 1.5 m away from others' (90%) could help prevent COVID-19. Over 40% (incorrectly) considered wearing gloves outside of the home would prevent them from contracting COVID-19. Views about face masks were divided. Only 66% of participants correctly identified that 'regular use of antibiotics' would not prevent COVID-19.Most participants (90%) identified 'fever, fatigue and cough' as indicators of COVID-19. However, 42% of participants thought that being unable to 'hold your breath for 10 s without coughing' was an indicator of having the virus. The most frequently reported sources of COVID-19 information were commercial television channels (56%), the Australian Broadcasting Corporation (43%) and the Australian Government COVID-19 information app (31%). CONCLUSIONS Public messaging about hand hygiene and physical distancing to prevent transmission appears to have been effective. However, there are clear, identified barriers for many individuals that have the potential to impede uptake or maintenance of these behaviours in the long term. We need to develop public health messages that harness these barriers to improve future cooperation. Ensuring adherence to these interventions is critical.
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Affiliation(s)
- Rae Thomas
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Hannah Greenwood
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Zoe A Michaleff
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Eman Abukmail
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Leah Hardiman
- Consumer Representative, Maternity Choices Australia, Brisbane, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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76
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Weir KR, Naganathan V, Carter SM, Tam CWM, McCaffery K, Bonner C, Rigby D, McLachlan AJ, Jansen J. The role of older patients' goals in GP decision-making about medicines: a qualitative study. BMC Fam Pract 2021; 22:13. [PMID: 33419389 PMCID: PMC7796626 DOI: 10.1186/s12875-020-01347-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND To optimise medication use in older people, it is recommended that clinicians evaluate evidence on potential benefits and harms of medicines in light of the patients' overall health, values and goals. This suggests general practitioners (GPs) should attempt to facilitate patient involvement in decision-making. In practice this is often challenging. In this qualitative study, we explored GPs' perspectives on the importance of discussing patients' goals and preferences, and the role patient preferences play in medicines management and prioritisation. METHODS Semi-structured interviews were conducted with GPs from Australia (n = 32). Participants were purposively sampled to recruit GPs with variation in experience level and geographic location. Transcribed audio-recordings of interviews were coded using Framework Analysis. RESULTS The results showed that most GPs recognised some value in understanding older patients' goals and preferences regarding their medicines. Most reported some discussions of goals and preferences with patients, but often this was initiated by the patient. Practical barriers were reported such as limited time during busy consultations to discuss issues beyond acute problems. GPs differed on the following main themes: 1) definition and perception of patients' goals, 2) relationship with the patient, 3) approach to medicines management and prioritisation. We observed that GPs preferred one of three different practice patterns in their approach to patients' goals in medicines decisions: 1) goals and preferences considered lower priority - 'Directive'; 2) goals seen as central - 'Goal-oriented'; 3) goals and preferences considered but not explicitly elicited - 'Tacit'. CONCLUSIONS This study explores how GPs differ in their approach to eliciting patients' goals and preferences, and how these differences are operationalised in the context of older adults taking multiple medicines. Although there are challenges in providing care that aligns with patients' goals and preferences, this study shows how complex decisions are made between GPs and their older patients in clinical practice. This work may inform future research that investigates how GPs can best incorporate the priorities of older people in decision-making around medicines. Developing practical support strategies may assist clinicians to involve patients in discussions about their medicines.
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Affiliation(s)
- Kristie Rebecca Weir
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Concord West, New South Wales, 2139, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, Faculty of the Arts, Humanities and Social Sciences, University of Wollongong, Keiraville, New South Wales, 2522, Australia
| | - Chun Wah Michael Tam
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, 2170, Australia
- School of Population Health, The University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Carissa Bonner
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Debbie Rigby
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane City, Queensland, 4000, Australia
| | - Andrew J McLachlan
- Centre for Education and Research on Ageing (CERA), Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Jesse Jansen
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
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Thompson R, Muscat DM, Jansen J, Cox D, Zadro JR, Traeger AC, McCaffery K. Promise and perils of patient decision aids for reducing low-value care. BMJ Qual Saf 2020; 30:bmjqs-2020-012312. [PMID: 33361344 DOI: 10.1136/bmjqs-2020-012312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Rachel Thompson
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Danielle M Muscat
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jesse Jansen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Darlene Cox
- Health Care Consumers' Association, Hackett, Australian Capital Territory, Australia
| | - Joshua R Zadro
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Nickel B, McCaffery K, Houssami N, Jansen J, Saunders C, Spillane A, Rutherford C, Dixon A, Barratt A, Stuart K, Robertson G, Hersch J. Views of healthcare professionals about the role of active monitoring in the management of ductal carcinoma in situ (DCIS): Qualitative interview study. Breast 2020; 54:99-105. [PMID: 32971350 PMCID: PMC7509786 DOI: 10.1016/j.breast.2020.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is an in-situ (pre-cancerous) breast malignancy whereby malignant cells are contained within the basement membrane of the breast ducts. Increasing awareness that some low-risk forms of DCIS might remain indolent for many years has led to concern about overtreatment, with at least 3 clinical trials underway internationally assessing the safety of active monitoring for low-risk DCIS. This study aimed to understand healthcare professionals' (HCPs) views on the management options for patients with DCIS. METHODS Qualitative study using semi-structured interviews with HCPs involved in the diagnosis and management of DCIS in Australia and New Zealand. Interviews were audio-recorded, transcribed and analysed thematically using Framework Analysis method. RESULTS Twenty-six HCPs including 10 breast surgeons, 3 breast physicians, 6 radiation oncologists, and 7 breast care nurses participated. There was a strong overall consensus that DCIS requires active treatment. HCPs generally felt uncomfortable recommending active monitoring as a management option for low-risk DCIS as they viewed this as outside current standard care. Overall, HCPs felt that active monitoring was an unproven strategy in need of an evidence base; however, many acknowledged that active monitoring for low-risk DCIS could be appropriate for patients with significant co-morbidities or limited life expectancy. They believed that most patients would opt for surgery wherever possible. CONCLUSIONS This study highlights the important need for robust randomised controlled trial data about active monitoring for women with low-risk DCIS, to provide HCPs with confidence in their management recommendations and decision-making.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | | | - Andrew Spillane
- The University of Sydney, Northern Clinical School, St Leonards, NSW, Australia; Mater Hospital, Wollstonecraft, NSW, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Claudia Rutherford
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia; The University of Sydney, Faculty Medicine and Health, Sydney Nursing School, Sydney, NSW, Australia
| | - Ann Dixon
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Kirsty Stuart
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead, NSW, Australia; Westmead Breast Cancer Institute, Westmead, NSW, Australia; Western Clinical School, The University of Sydney, NSW, Australia
| | | | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
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Traeger AC, Checketts J, Tcharkhedian E, O'Connor DA, Klinner C, Sharma S, Vyas P, Albarqouni L, McCaffery K. Patient and general practitioner views of tools to delay diagnostic imaging for low back pain: a qualitative study. BMJ Open 2020; 10:e039936. [PMID: 33162393 PMCID: PMC7651716 DOI: 10.1136/bmjopen-2020-039936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Delayed prescribing is a promising strategy to manage patient requests for unnecessary tests and treatments. The purpose of this study was to explore general practitioner (GP) and patient views of three communication tools (Overdiagnosis Leaflet, Dialogue Sheet and 'Wait-and-see' Note) to support delayed prescribing of diagnostic imaging. DESIGN Qualitative study. SETTING Primary and emergency care in Sydney, Australia. PARTICIPANTS 16 GPs and 14 patients with recent episode of low back pain. OUTCOME Views on the tools to delay diagnostic imaging for low back pain. Data were collected using a combination of focus groups and individual interviews. ANALYSIS Two researchers independently performed a thematic analysis, and the author team reviewed and refined the analysis. RESULTS GP participants responded positively to the Overdiagnosis Leaflet. The Dialogue Sheet and 'Wait-and-see' Note raised several concerns about patient pushback, adding to time pressure and being overwhelmed with hard-to-find paper resources. GPs preferred to communicate verbally the reasons to delay an imaging test. For patients, the reactions to the tools were more positive. Patients valued written information and a signed agreement to delay the test. However, patients expressed that a strong desire for diagnostic imaging would likely over-ride any effect of written advice to delay the test. The term 'false alarm' to describe overdiagnosis was poorly understood by patients. CONCLUSIONS GPs and patients agreed that a leaflet about overdiagnosis could support a delayed prescribing approach to imaging for low back pain. The Dialogue Sheet and 'Wait-and-see' Note were acceptable to patients but not to GPs.
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Affiliation(s)
- Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Juliet Checketts
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
| | - Elise Tcharkhedian
- Department of Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christiane Klinner
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sweekriti Sharma
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Parima Vyas
- Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Kirsten McCaffery
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Goddard SL, Templeton DJ, Petoumenos K, Jin F, Hillman RJ, Law C, Roberts JM, Fairley CK, Garland SM, Grulich AE, Poynten IM, Farnsworth A, Biro C, Richards A, Thurloe J, Ekman D, McDonald R, Adams M, Tabrizi S, Phillips S, Molano Luque M, Comben S, McCaffery K, Howard K, Kelly P, Seeds D, Carr A, Feeney L, Gluyas R, Prestage G, Law M, Acraman B, McGrath P, Mellor R, Pezzopane P, Varma R, Langton-Lockton J, Tong W. Prevalence and Association of Perianal and Intra-Anal Warts with Composite High-Grade Squamous Intraepithelial Lesions Among Gay and Bisexual Men: Baseline Data from the Study of the Prevention of Anal Cancer. AIDS Patient Care STDS 2020; 34:436-443. [PMID: 32955927 DOI: 10.1089/apc.2020.0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Human papillomavirus (HPV) causes anal warts and anal squamous cell carcinoma (SCC). A higher incidence of anal cancer has been found among individuals previously diagnosed with anogenital warts. We aimed to investigate the association between anal warts and the presumed anal SCC precursor high-grade squamous intraepithelial lesion (HSIL), among participants in the Study of the Prevention of Anal Cancer (SPANC). SPANC was a longitudinal study of anal HPV infections and related lesions among gay and bisexual men (GBM) age 35 years and older, in Sydney, Australia. Anal cytology and high-resolution anoscopy were performed. Logistic regression was used to investigate the association between clinically diagnosed anal warts and intra-anal composite-HSIL (cytology and/or histology) at the baseline visit. The prevalence of HSIL within biopsies from intra-anal warts was calculated. Laser capture microdissection (LCM) and HPV-genotyping was performed on HSIL lesions. Among 616 participants at study entry, 165 (26.8%) and 51 (8.3%) had intra-anal and perianal warts, respectively. Warts were associated with composite-HSIL, even after adjustment for HIV status, age, lifetime receptive anal intercourse partner number, and smoking (perianal: aOR 2.13, 95% CI 1.17-3.87, p = 0.013; intra-anal: aOR 1.69, 95% CI 1.16-2.46, p = 0.006). HSIL was detected in 24 (14.5%) of 165 biopsies from intra-anal warts. Of 17 HSIL lesions, 16 (94.1%) had high-risk HPV detected by LCM. Anal warts were common. Prevalent anal warts were associated with composite-HSIL. HSIL may be detected within biopsies of intra-anal warts. Anal warts may be a useful addition to risk stratification for HSIL among GBM.
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Affiliation(s)
- Sian L. Goddard
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Infection and Immunity, Barts Health NHS Trust, London, United Kingdom
| | - David J. Templeton
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Sexual Health Service, Sydney Local Health District, and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathy Petoumenos
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Richard J. Hillman
- Dysplasia and Anal Cancer Services, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Carmella Law
- Dysplasia and Anal Cancer Services, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Christopher K. Fairley
- Melbourne Sexual Health Center, and Central Clinical School Monash University, Melbourne, Victoria, Australia
| | - Suzanne M. Garland
- Center for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia
- Infection Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew E. Grulich
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Hersch J, Copp T, Jacklyn G, Jansen J, Liefers GJ, McCaffery K, Stiggelbout A. Authors' response. Med Decis Making 2020; 40:715-717. [PMID: 32845231 PMCID: PMC7573677 DOI: 10.1177/0272989x20946290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Gemma Jacklyn
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Jesse Jansen
- Department of Primary Care, Maastricht University Medical Center, Netherlands
| | | | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Anne Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Netherlands
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Abstract
OBJECTIVES The use of more medicalised labels can increase both concern about illness and the desire for more invasive treatment. This study analyses the media's coverage of an Analysis article in The BMJ which generated a large amount of high-profile international media coverage. It aims to understand how to better communicate messages about low-risk cancers and overdiagnosis to the public. DESIGN Content analysis of media coverage. SETTING Media was identified by Isentia Media Portal, searched in Google News and cross-checked in Factiva and Proquest databases from August 2018. METHODS Media headlines, full text and open access public comments responding to the coverage on the article proposing to 'rename low-risk conditions currently labelled as cancer' were analysed to determine the main themes. RESULTS 45 original media articles and their associated public comments (n=167) were identified and included in the analysis. Overall, headlines focused on cancer generally and there was little mention of 'low-risk', 'overdiagnosis' or 'overtreatment'. The full text generally presented a more balanced view of the evidence and were supportive of the proposal, however, public responses tended to be more negative towards the idea of renaming low-risk cancers and indicated confusion. Comments seemed to focus on the headlines rather than the full article. CONCLUSIONS This study offers a novel insight into media coverage of the complex and counterintuitive problem of overdiagnosis. Continued deliberation on how to communicate similar topics to the public through the mainstream media is needed. Future work in the area of low-risk cancer communication should consider the powerful impact of people's previous experience with a cancer diagnosis and the criticism about being paternalistic and concealing the truth from patients.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ray Moynihan
- Wiser Healthcare, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Alexandra Barratt
- Wiser Healthcare, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism & Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Kirsten McCaffery
- Wiser Healthcare, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Rozbroj T, Haas R, O'Connor DA, Thomas R, McCaffery K, Carter S, Buchbinder R. How do patients and the public understand overtesting and overdiagnosis? A protocol for a thematic meta-synthesis of qualitative research. BMJ Open 2020; 10:e037283. [PMID: 32636285 PMCID: PMC7342480 DOI: 10.1136/bmjopen-2020-037283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Examining patient and public understanding of overtesting and overdiagnosis (OverTD) is vital for reducing the burden of OverTD. Studies from disparate contexts, disciplines and focusing on disparate healthcare issues have examined patient and public understanding of OverTD. A synthesis is needed to bring this literature together, examine common themes, strengthen conclusions and identify gaps. This will help steer further research, policy and practice to improve patient and public understanding of OverTD. The objective of this study is to synthesise qualitative research data about patient and public understanding of OverTD. METHODS AND ANALYSIS A thematic meta-synthesis will be used to synthesise primary qualitative research and qualitative components of primary mixed-methods research about patient and public understanding of OverTD. Studies published in English will be included. These will be identified using systematic searches from inception to March 2020 in the Scopus, CINAHL, PsycINFO and MEDLINE databases. Studies that satisfy eligibility criteria will be assessed for methodological quality using the Critical Appraisal Skills Programme (CASP) checklist. Thematic meta-synthesis will comprise three stages: (1) line-by-line coding; (2) generation of descriptive themes and (3) generation of analytic themes. Confidence in the synthesis findings will be assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence (GRADE CERQual) approach. A summary of GRADE CERQual results will be presented alongside the key themes. Study eligibility screening, data extraction, analysis and the CASP and GRADE CERQual assessments will be undertaken independently by two review authors. ETHICS AND DISSEMINATION Ethics approval is not required for this secondary analysis of published data. The results will be disseminated in peer-reviewed journals and may be presented in conference papers and elsewhere. PROSPERO REGISTRATION NUMBER CRD42020156838.
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Affiliation(s)
- Tomas Rozbroj
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Clayton, Victoria, Australia
- Cabrini Institute, Cabrini Health, Malvern, Victoria, Australia
| | - Romi Haas
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Clayton, Victoria, Australia
- Cabrini Institute, Cabrini Health, Malvern, Victoria, Australia
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Clayton, Victoria, Australia
- Cabrini Institute, Cabrini Health, Malvern, Victoria, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Stacy Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Clayton, Victoria, Australia
- Cabrini Institute, Cabrini Health, Malvern, Victoria, Australia
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84
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Muscat DM, Morony S, Nutbeam D, Ayre J, Shepherd HL, Smith SK, Dhillon HM, Hayen A, Luxford K, Meshreky W, McCaffery K. Learners' experience and perceived impact of a health literacy program in adult basic education: a qualitative study. Public Health Res Pract 2020; 30:29231909. [PMID: 32601653 DOI: 10.17061/phrp29231909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives and importance of the study: Adult literacy programs aim to empower learners to participate more effectively in everyday life. This includes programs with health content embedded in curricula to target health literacy. Adult learners who attend these programs represent a heterogeneous population, but include a high proportion of hard-to-reach or socially disadvantaged groups in terms of age, ethnicity, educational background, language and prevalence of learning disabilities. In 2014, we conducted a cluster-randomised controlled trial of a health literacy program in adult basic education classes across New South Wales, Australia. This paper reports findings from a qualitative study exploring learners' experience of the course and its perceived impact on their lives, as well as their understanding and confidence about health. STUDY TYPE Qualitative interview study. METHOD We conducted semistructured interviews as part of the evaluation of the 18-week health literacy program, with participants purposively recruited from six health literacy classes (n = 22). Researchers trained in qualitative methods interviewed adult learners either face to face or over the phone using a topic guide. Data was analysed using the Framework method, a matrix-based approach to thematic analysis. RESULTS The majority of interviewees were female, lived in metropolitan areas and were from non-English-speaking backgrounds. Most had existing self-reported health problems and inadequate functional health literacy. Most participants described positive impacts of the health literacy course on their language, literacy and numeracy skills, functional health literacy skills, and health knowledge. They also reported being able to translate this into health actions including interacting with providers, accessing and using healthcare, and managing health and illness (e.g. making healthier food choices). Learners also described positive social outcomes of the course, including feelings of connectedness and interpersonal trust within a new network of learners, and reported sharing new knowledge with others in their communities. CONCLUSIONS The findings add value to existing limited evidence that has demonstrated the untapped potential of adult basic education to develop health literacy skills among socially disadvantaged groups. Learners valued the opportunity to share experiences in structured group learning, and reported confidence to transfer new knowledge into their home and wider social network.
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Affiliation(s)
- Danielle M Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Suzanne Morony
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Don Nutbeam
- School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Julie Ayre
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Heather L Shepherd
- School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia; School of Psychology, University of Sydney, NSW, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Australia
| | | | - Andrew Hayen
- Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Karen Luxford
- Clinical Excellence Commission, Sydney, NSW, Australia
| | | | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia;
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85
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Smith J, Dodd RH, Hersch J, Cvejic E, McCaffery K, Jansen J. Effect of different communication strategies about stopping cancer screening on screening intention and cancer anxiety: a randomised online trial of older adults in Australia. BMJ Open 2020; 10:e034061. [PMID: 32532766 PMCID: PMC7295415 DOI: 10.1136/bmjopen-2019-034061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess different strategies for communicating to older adults about stopping cancer screening. DESIGN 4 (recommendation statement about stopping screening)×(2; time) online survey-based randomised controlled trial. SETTING Australia. PARTICIPANTS 271 English-speaking participants, aged 65-90, screened for breast/prostate cancer at least once in past decade. INTERVENTIONS Time 1: participants read a scenario in which their general practitioner (GP) informed them about the potential benefits and harms of cancer screening, followed by double-blinded randomisation to one of four recommendation statements to stop screening: control ('this screening test would harm you more than benefit you'), health status ('your other health issues should take priority'), life expectancy framed positively ('this test would not help you live longer') and negatively ('you may not live long enough to benefit'). Time 2: in a follow-up scenario, the GP explained why guidelines changed over time (anchoring bias intervention). MEASURES Primary outcomes: screening intention and cancer anxiety (10-point scale, higher=greater intention/anxiety), measured at both time points. SECONDARY OUTCOMES trust (in their GP, the information provided, the Australian healthcare system), decisional conflict and knowledge of the information presented. RESULTS 271 participants' responses analysed. No main effects were found. However, screening intention was lower for the negatively framed life expectancy versus health status statement (6.0 vs 7.1, mean difference (MD)=1.1, p=0.049, 95% CI 0.0 to 2.2) in post hoc analyses. Cancer anxiety was lower for the negatively versus positively framed life expectancy statement (4.8 vs 5.8, MD=1.0, p=0.025, 95% CI 0.1 to 1.9). The anchoring bias intervention reduced screening intention (MD=0.8, p=0.044, 95% CI 0.6 to 1.0) and cancer anxiety (MD=0.3, p=0.002, 95% CI 0.1 to 0.4) across all conditions. CONCLUSION Older adults may reduce their screening intention without reporting increased cancer anxiety when clinicians use a more confronting strategy communicating they may not live long enough to benefit and add an explicit explanation why the recommendation has changed. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12618001306202; Results).
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Affiliation(s)
- Jenna Smith
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael H Dodd
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jolyn Hersch
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin Cvejic
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jesse Jansen
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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86
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Nickel B, Tan T, Cvejic E, Baade P, McLeod DSA, Pandeya N, Youl P, McCaffery K, Jordan S. Health-Related Quality of Life After Diagnosis and Treatment of Differentiated Thyroid Cancer and Association With Type of Surgical Treatment. JAMA Otolaryngol Head Neck Surg 2020; 145:231-238. [PMID: 30653212 DOI: 10.1001/jamaoto.2018.3870] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Concerns around possible overdiagnosis and overtreatment of differentiated thyroid cancer (DTC) have been raised. Issues concerning health-related quality of life (HRQOL) after diagnosis and treatment of DTC are understudied in this patient group. Objective To better understand the range of HRQOL outcomes, including possible adverse effects of treatment, associated with diagnosis and treatment of DTC and whether these outcomes vary by type of surgery received. Design, Setting, and Participants This content analysis assessed responses to an open-ended question about outcomes and concerns after DTC diagnosis and treatment among patients ascertained from the major postsurgical thyroid cancer treatment center and the population-based Cancer Registry in Queensland, Australia. Participants were aged 18 to 79 years and recently diagnosed with throid cancer. Responses underwent analysis to identify and code emergent themes to describe HRQOL issues and adverse effects of treatment experienced. Quantitative analysis was used to explore whether surgery type was associated with HRQOL issues and/or adverse effects of treatment. Of 1416 eligible patients, 1005 (71.0%) participated. Data were collected from July 1, 2013, through August 31, 2016, and analyzed from January 11 through April 9, 2018. Main Outcomes and Measures Issues concerning HRQOL. Results The analysis included 1005 patients (72.2% female [n = 726]; mean [SD] age, 52 [14.0 years) with DTC. Most patients were diagnosed with papillary thyroid cancer (889 of 1003 [88.6%]), had tumors smaller than 2 cm in size (564 of 1000 [56.4%]), and received a total thyroidectomy (791 of 1005 [78.7%]). Overall, 775 patients (77.1%) reported HRQOL issues after diagnosis and treatment of DTC. The following 4 main themes emerged from content analysis of patient responses: physical (663 [66.0%]), psychological (187 [18.6%]), lifestyle (82 [8.2%]), and no issue or adverse effect (246 [24.5%]). Patients who had a total thyroidectomy (without neck dissection) were 1.5 times (odds ratio, 1.49; 95% CI, 1.04-2.12) more likely to report an HRQOL issue or an adverse effect of treatment compared with patients who underwent a hemithyroidectomy. Conclusions and Relevance According to results of this study, patients diagnosed with DTC report wide-ranging HRQOL issues; these are more prevalent among patients who have total thyroidectomies rather than hemithyroidectomies. For patients with small, localized DTCs, hemithyroidectomy may offer fewer adverse effects of treatment and better HRQOL outcomes than total thyroidectomy. It appears that issues with HRQOL should be considered by patients and physicians when deciding on the best treatment approach after a diagnosis of DTC.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tessa Tan
- Faculty of Medicine, University of Newcastle, Newcastle, Australia
| | - Erin Cvejic
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Peter Baade
- Cancer Council Queensland, Brisbane, Australia.,Menzies Health Institute, Griffith University, Gold Coast, Australia
| | | | - Nirmala Pandeya
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Philippa Youl
- University of the Sunshine Coast, Sippy Downs, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Susan Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, University of Queensland, Brisbane, Australia
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87
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Copp T, Cvejic E, McCaffery K, Hersch J, Doust J, Mol BW, Dokras A, Mishra G, Jansen J. Impact of a diagnosis of polycystic ovary syndrome on diet, physical activity and contraceptive use in young women: findings from the Australian Longitudinal Study of Women’s Health. Hum Reprod 2020; 35:394-403. [DOI: 10.1093/humrep/dez274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
STUDY QUESTION
Do diet, physical activity and contraceptive use change after receiving a diagnosis of polycystic ovary syndrome (PCOS)?
SUMMARY ANSWER
Using longitudinal data 12 months apart, young women newly diagnosed with PCOS were more likely to stop using contraception but did not change their physical activity or vegetable intake.
WHAT IS KNOWN ALREADY
Diagnostic criteria for PCOS have widened to capture more women, despite limited evidence of the benefits and harms. Possible benefits of a PCOS diagnosis are that it may help women with family planning and motivate them to implement healthy lifestyle changes to reduce the reproductive, metabolic and cardiovascular risks associated with PCOS. However, there are no empirical studies investigating how women respond to a diagnosis of PCOS with respect to their health behaviour, and longitudinal population-based studies are lacking.
STUDY DESIGN, SIZE, DURATION
This is a longitudinal analysis of two waves of data collected 12 months apart from the cohort born 1989–1995 in the Australian Longitudinal Survey on Women’s Health, a population-based cohort study. Women in this cohort were first surveyed in 2012-2013, aged 18-23 years.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Women who responded to the 2014 survey (aged 19–24, n = 11 344) and 2015 survey (aged 20–25, n = 8961) were included. Using logistic regression, multinomial logistic regression and linear regression, change in vegetable intake, physical activity and contraceptive use were compared for women newly diagnosed with PCOS to women not reporting a diagnosis of PCOS. Changes in psychological distress and BMI were also examined.
MAIN RESULTS AND THE ROLE OF CHANCE
Young women reporting a new diagnosis of PCOS were no more likely to increase their vegetable intake or physical activity than women not reporting a PCOS diagnosis. Women newly diagnosed with PCOS were 3.4 times more likely to stop using contraception during the 12-month study period than women without PCOS (14% versus 4%, 95% CI = 2.3 to 5.1, P < 0.001). This difference remained significant after controlling for demographics, chronic conditions associated with PCOS, endometriosis, BMI and psychological distress (P < 0.001).
LIMITATIONS, REASONS FOR CAUTION
All data was self-reported including PCOS diagnosis, assessment of diet quality was limited to vegetable intake only. The exact timing of diagnosis within the 12-month period and whether the women intended to conceive are unknown. The number of women reporting a new diagnosis of PCOS was also relatively small.
WIDER IMPLICATIONS OF THE FINDINGS
These findings suggest that a diagnosis of PCOS may not produce short-term benefits by way of improving health behaviour. The observed reduction in contraception use suggests some women may be at increased risk of unplanned pregnancies, highlighting the importance of counselling about contraceptive needs. Both potential benefits and harms must be considered when determining the appropriateness of a PCOS diagnosis.
STUDY FUNDING/COMPETING interest(s)
The Australian Longitudinal Study on Women’s Health is funded by the Australian Government Department of Health. BWM reports consultancy for ObsEva, Merck, Merck KGaA and Guerbet. No further competing interests exist.
TRIAL REGISTRATION NUMBER
N/A
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Affiliation(s)
- Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Erin Cvejic
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Jenny Doust
- Wiser Healthcare, Centre for Research in Evidence-Based Practice, Bond University, Robina, 4226, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3800, Australia
| | - Anuja Dokras
- Penn PCOS Centre, Department of Obstetrics and Gynaecology, University of Pennsylvania, Philadelphia, 19104, USA
| | - Gita Mishra
- School of Public health, Faculty of Medicine, The University of Queensland, QLD, 4006, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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88
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Pickles K, Kazda L, Barratt A, McGeechan K, Hersch J, McCaffery K. Evaluating two decision aids for Australian men supporting informed decisions about prostate cancer screening: A randomised controlled trial. PLoS One 2020; 15:e0227304. [PMID: 31940376 PMCID: PMC6961909 DOI: 10.1371/journal.pone.0227304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Australian clinicians are advised to 'offer evidence-based decisional support to men considering whether or not to have a PSA test'. This randomised trial compared the performance and acceptability of two new decision aids (DAs) to aid men in making informed choices about PSA screening. METHODS ~3000 Australian men 45-60 years with varying educational attainment were recruited via an online panel and randomised to view one of two online decision aids (one full length, one abbreviated) and completed a questionnaire. The primary outcome was informed choice about PSA screening. FINDINGS Significantly more men in the long DA group (38%) made an informed choice than men who received the shorter DA (33%) (95% CI 1.1% to 8.2%; p = 0.008). On knowledge, the long DA group scored, on average, 0.45 points higher than the short DA group (95% CI 0.14 to 0.76; p = 0.004) and 5% more of the participants achieved an adequate knowledge score (95% CI 1.9% to 8.8%; p = 0.002). Men allocated the long DA were less likely to intend to have a PSA test in the future (53%) than men in the short DA group (59%). Both DAs rated highly on acceptability. CONCLUSIONS Both DAs were useful and acceptable to men regardless of education level and both supported informed decision making. The long version resulted in higher knowledge, and a higher proportion of men able to make an informed choice, but the differences were small. Long DAs may be useful for men whose informational needs are not satisfied by a short DA.
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Affiliation(s)
- Kristen Pickles
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Luise Kazda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jolyn Hersch
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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89
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Barnes LA, Barclay L, McCaffery K, Aslani P. Complementary medicine products: Information sources, perceived benefits and maternal health literacy. Women Birth 2019; 32:493-520. [DOI: 10.1016/j.wombi.2018.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/15/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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90
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Stiggelbout A, Copp T, Jacklyn G, Jansen J, Liefers GJ, McCaffery K, Hersch J. Women's Acceptance of Overdetection in Breast Cancer Screening: Can We Assess Harm-Benefit Tradeoffs? Med Decis Making 2019; 40:42-51. [PMID: 31722605 PMCID: PMC6985988 DOI: 10.1177/0272989x19886886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background. Breast cancer screening has been presented to women as mostly positive for decades, despite voices raising issues related to harms since its introduction. Public communications about breast cancer screening tended to use persuasive techniques aimed at maximizing uptake. Concern about the harm of overdetection is more recent, and awareness of overdetection among the public is limited. We aimed to assess the impact of extensive information on treatment following overdetection in breast screening on women’s acceptance of screening, and to assess correlates of acceptance. Methods. We performed an online survey among women aged 45-75 from the general public in the Netherlands and Australia, asking women their maximum acceptable ratio of overdetection, per breast cancer death avoided, for four treatment scenarios (randomized order): mastectomy; lumpectomy; lumpectomy plus radiotherapy; lumpectomy plus radiotherapy and hormone therapy. The effect of treatment was assessed using General Linear Models, controlling for socio-demographics, experience, and psychological characteristics. Results. Four-hundred Australian and 403 Dutch women responded. Around half of the women would always screen, even at a 6:1 overdetection-to-death-avoided ratio. Acceptance was highest for the lumpectomy scenario, decreasing with more invasive treatment. In multivariate analyses the effect of treatment remained (p<0.001). Higher acceptance was seen for women with children (p=0.04), screening experience (p<0.001), and less understanding of overdetection (p<0.001). A learning effect was seen: acceptance was highest for the first scenario shown. Conclusions. Acceptance of overdetection was high, but decreased after the first scenario and with invasiveness of treatment. This provides a first indication that with more knowledge and understanding, women may move from uncritical acceptance of screening towards a more informed decision that involves a trade-off of the benefits and harms.
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Affiliation(s)
- Anne Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Gemma Jacklyn
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
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91
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Muscat DM, Chang EHF, Thompson R, Cvejic E, Tracy M, Zadro J, Smith JK, Lindner R, McCaffery K. Evaluation of the Choosing Wisely Australia 5 Questions resource and a shared decision-making preparation video: protocol for an online experiment. BMJ Open 2019; 9:e033126. [PMID: 31727667 PMCID: PMC6886943 DOI: 10.1136/bmjopen-2019-033126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Choosing Wisely, an international effort to reduce low value care worldwide, considers communication between clinicians and patients during routine clinical encounters a key mechanism for change. In Australia, Choosing Wisely has developed a 5 Questions resource to facilitate better conversations. The primary aim of this study is to evaluate the impact of the Choosing Wisely Australia 5 Questions resource and a video designed to prepare patients for question-asking and participation in shared decision-making on (a) self-efficacy to ask questions and participate in shared decision-making, (b) intention to participate in shared decision-making and (c) a range of secondary outcomes. The secondary aim of this study is to determine whether participants' health literacy modifies the effects of the interventions. METHODS AND ANALYSIS We will use 2×2×2 between-subjects factorial design (preparation video: yes, no × Choosing Wisely 5 Questions resource: yes, no × health literacy: adequate, inadequate). Participants will be recruited by an online market research company, presented with a hypothetical non-specific low back pain scenario, and randomised to study groups stratified by health literacy. Quantitative primary and secondary outcome data will be analysed as intention-to-treat using appropriate regression models (ie, linear regression for continuous outcomes, logistic regression for dichotomous categorical outcomes). ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the University of Sydney Human Research Ethics Committee (protocol number: 2018/965). The results from this work will be disseminated through peer-reviewed international journals, conferences and updates with collaborating public health bodies. Resources developed for this study will be made available to patients and clinicians following trial completion. TRIAL REGISTRATION NUMBER This trial has been registered with the Australia New Zealand Clinical Trials Registry (trial number: 376477) and the stage is Pre-results.
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Affiliation(s)
- Danielle Marie Muscat
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Edward Hoi-Fan Chang
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Thompson
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marguerite Tracy
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joshua Zadro
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jessica Kathleen Smith
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Lindner
- NPS Medicinewise, Strawberry Hills, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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92
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Ayre J, Bonner C, Bramwell S, McClelland S, Jayaballa R, Maberly G, McCaffery K. Implications for GP endorsement of a diabetes app with patients from culturally diverse backgrounds: a qualitative study. Aust J Prim Health 2019; 26:52-57. [PMID: 31718769 DOI: 10.1071/py19062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 08/23/2019] [Indexed: 11/23/2022]
Abstract
Although many diabetes self-management apps exist, these are not tailored for people from culturally and linguistically diverse (CALD) backgrounds. This study aimed to explore GP perceptions of how diabetes app features could help GPs better support their patients from CALD backgrounds. Twenty-five semi-structured interviews with GPs in Western Sydney explored attitudes towards a proposed app's suitability for CALD patients. Interviews were audio-recorded, transcribed and coded using Framework Analysis. Theme 1 explored the implications of perceptions that patients' health literacy is dependent on the language used. Theme 2 explored the influence of messaging from sources that share the patient's language and culture (including misinformation from community sources). Theme 3 described the suitability of the app platform for CALD patients, and its potential challenges in this group. GPs perceived that a diabetes app could be useful for providing support to patients from CALD backgrounds. Findings suggest app features should be optimised to address existing challenges that GPs face and carefully consider strategies for recruiting CALD patients. It is important that GPs feel comfortable promoting an app to their CALD patients to help increase participation rates by people in the CALD community.
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Affiliation(s)
- Julie Ayre
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia
| | - Carissa Bonner
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia; and The University of Sydney, Discipline of General Practice, Ask, Share, Know: Rapid Evidence for General Practice Decisions Centre for Research Excellent, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia
| | - Sian Bramwell
- Western Sydney Diabetes, Western Sydney Local Health District, Level 3, Administration and Education Building, Blacktown Hospital Campus, Marcel Crescent, Blacktown, NSW 2148, Australia
| | - Sharon McClelland
- Western Sydney Diabetes, Western Sydney Local Health District, Level 3, Administration and Education Building, Blacktown Hospital Campus, Marcel Crescent, Blacktown, NSW 2148, Australia
| | - Rajini Jayaballa
- Western Sydney Diabetes, Western Sydney Local Health District, Level 3, Administration and Education Building, Blacktown Hospital Campus, Marcel Crescent, Blacktown, NSW 2148, Australia; and Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Glen Maberly
- Western Sydney Diabetes, Western Sydney Local Health District, Level 3, Administration and Education Building, Blacktown Hospital Campus, Marcel Crescent, Blacktown, NSW 2148, Australia; and The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia
| | - Kirsten McCaffery
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia; and Corresponding author
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93
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Weir KR, Naganathan V, Rigby D, McCaffery K, Bonner C, Trevena L, McLachlan AJ, Jansen J. Home medicines reviews: a qualitative study of GPs' experiences. Aust J Prim Health 2019; 26:24-30. [PMID: 31733660 DOI: 10.1071/py19072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/23/2019] [Indexed: 11/23/2022]
Abstract
This qualitative study explored GPs' experiences with pharmacist-led home medicines reviews (HMRs) and the barriers and facilitators to GPs using HMRs to optimise medicines for older people. Semi-structured interviews were conducted with 32 GPs Australia-wide. Purposeful sampling was undertaken to obtain a representative group in terms of age, gender and location. Data were analysed using framework analysis. Overall, GPs found HMRs useful for educating patients about their medicines, improving adherence and understanding the patient's home environment. Barriers to effective use of HMRs included patient resistance to having medicines reviewed and limited access to HMRs in regional or rural areas. GPs differed in the extent and way they use HMRs. One group found HMRs very useful, wanted more access to HMRs and reported frequent interactions with pharmacists. A second group was ambivalent, and perceived HMRs could be useful but had limitations in what they can achieve. A third group was sceptical, and reported HMRs rarely provide new insights, and recommendations were not clinically relevant to patients. Understanding GPs' expectations and preferences through interprofessional communication and partnerships are ways to address these barriers. Future improvements to the HMR program may include incentives and resources that promote collaboration between GPs and pharmacists.
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Affiliation(s)
- Kristie Rebecca Weir
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Corresponding author
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia; and Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, NSW 2139, Australia
| | - Debbie Rigby
- DR Pharmacy Consulting, Brisbane, Qld 4001, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Carissa Bonner
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Lyndal Trevena
- Ask Share Know Centre for Research Excellence, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Andrew J McLachlan
- Centre for Education and Research on Ageing (CERA), Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia; and Faculty of Medicine and Health, Sydney Pharmacy School, University of Sydney, NSW 2006, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; and Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
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94
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Woudstra AJ, Smets EMA, Dekker E, Broens THF, Penning J, Smith S, McCaffery K, Fransen MP. Development and pilot-testing of a colorectal cancer screening decision aid for individuals with varying health literacy levels. Patient Educ Couns 2019; 102:1847-1858. [PMID: 31064682 DOI: 10.1016/j.pec.2019.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/15/2019] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Making an informed decision about colorectal cancer screening requires health literacy. Our aim was to develop and pilot-test a computer-based decision aid to support informed decision making about whether or not to participate in colorectal cancer screening for individuals with varying health literacy levels in the Netherlands. METHODS First, we designed and adapted the decision aid prototype among 25 individuals with low (n = 15) and adequate (n = 10) health literacy. Second, we used a before/after study to assess changes in knowledge, attitude, intention, decisional conflict, deliberation, anxiety and risk perception in an online survey among 81 individuals eligible for colorectal cancer screening with low (n = 35) and adequate (n = 46) health literacy. RESULTS The decision aid was acceptable, comprehensible, reduced decisional conflict, increased deliberation and improved knowledge about colorectal cancer screening, but not about colorectal cancer, among individuals with adequate and low health literacy. Usability was slightly higher for participants with adequate health literacy compared to those with low health literacy. CONCLUSION The decision aid is promising in supporting informed decision making about colorectal cancer screening, also among individuals with lower health literacy. PRACTICE IMPLICATIONS Further refinement of interactive features, such as videos, animations and the values clarification exercise, is needed to increase the usability of the decision aid.
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Affiliation(s)
- Anke J Woudstra
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Ellen M A Smets
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Evelien Dekker
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology & Hepatology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Tom H F Broens
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Judith Penning
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sian Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, Lowy Research Centre, UNSW Sydney, NSW, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public health, The University of Sydney, NSW, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Mirjam P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
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95
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Barnes LAJ, Barclay L, McCaffery K, Aslani P. Women's health literacy and the complex decision-making process to use complementary medicine products in pregnancy and lactation. Health Expect 2019; 22:1013-1027. [PMID: 31116500 PMCID: PMC6803395 DOI: 10.1111/hex.12910] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/27/2019] [Accepted: 04/22/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Little is known about women's decision-making processes regarding using complementary medicine products (CMPs) during pregnancy or lactation. OBJECTIVES To explore the decision-making processes of women choosing to use CMPs in pregnancy and lactation; and to investigate how women's health literacy influences their decisions. DESIGN, SETTING AND PARTICIPANTS In-depth interviews and focus group discussions were held with twenty-five pregnant and/or breastfeeding women. Data were analysed using thematic analysis. RESULTS Key to women's decision making was the desire to establish a CMPs safety and to receive information from a trustworthy source, preferably their most trusted health-care practitioner. Women wanted positive therapeutic relationships with health-care practitioners and to be highly involved in the decisions they made for the health of themselves and their children. Two overarching components of the decision-making process were identified: (a) women's information needs and (b) a preference for CMP use. Women collated and assessed information from other health-care practitioners, other mothers and published research during their decision-making processes. They showed a strong preference for CMP use to support their pregnancy and breastfeeding health, and that of their unborn and breastfeeding babies. DISCUSSION AND CONCLUSIONS Complex decision-making processes to use CMPs in pregnancy and lactation were identified. The participants showed high levels of communicative and critical health literacy skills in their decision-making processes. These skills supported women's complex decision-making processes.
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Affiliation(s)
- Larisa A. J. Barnes
- School of PharmacyThe University of SydneySydneyNew South WalesAustralia
- University Centre for Rural HealthThe University of SydneyLismoreNew South WalesAustralia
| | - Lesley Barclay
- University Centre for Rural HealthThe University of SydneyLismoreNew South WalesAustralia
- School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Kirsten McCaffery
- School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Parisa Aslani
- School of PharmacyThe University of SydneySydneyNew South WalesAustralia
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96
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Nickel B, Howard K, Brito JP, Barratt A, Moynihan R, McCaffery K. Association of Preferences for Papillary Thyroid Cancer Treatment With Disease Terminology: A Discrete Choice Experiment. JAMA Otolaryngol Head Neck Surg 2019; 144:887-896. [PMID: 30140909 DOI: 10.1001/jamaoto.2018.1694] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Given recent evidence of overdiagnosis and overtreatment of small papillary thyroid cancers (PTCs) and other low-risk cancers, strategies are needed to help patients consider less invasive treatment options. Objectives To determine which factors influence treatment preferences for patients with PTC, and the trade-offs in treatment factors people are willing to accept, and to understand how terminology influences preferences and benefit-harm trade-offs. Design, Setting, and Participants Preferences in PTC treatment were evaluated using a discrete choice experiment (DCE) conducted as a web-based survey using an existing public online research panel. Participants were randomized to receive 1 of 2 frames of information based on the terminology used to describe the condition: "cancer" or "lesion." Participants chose between 3 treatment options for PTC (thyroidectomy, hemithyroidectomy, and active surveillance). Analyses were conducted using a mixed logit model. Main Outcomes and Measures The main outcome variable was treatment preference; attributes of treatment options and sociodemographic characteristics were explanatory variables. Results The DCE was completed by 2054 participants (993 [48.3%] men and 1061 [51.7%] women; mean [SD] age, 46.0 [16.5] years) with no history of thyroid cancer. Participants preferred options with less frequent follow-up, lower out-of-pocket costs, lower chances of having voice and calcium level problems, and a lower risk of developing invasive thyroid cancer and of dying of thyroid cancer. When trading benefits against harms, participants were willing to accept a higher number of extra patients experiencing adverse effects to avoid a thyroid cancer death when the condition was described as a cancer compared with a lesion. Specifically, participants for whom the condition was described as a cancer were willing to accept more patients requiring lifelong medication (mean, 273; 95% CI, 207-339 vs mean, 98; 95% CI, 66-131), experiencing calcium problems (mean, 110; 95% CI, 77-144 vs mean, 56; 95% CI, 55-58), and fatigue (mean, 958; 95% CI, 691-1224 vs mean, 469; 95% CI, 375-564). For both the cancer and lesion terminology, health literacy consistently was associated with preferences for treatment options. Those with lower health literacy had a significantly lower preference for less invasive treatment options. Conclusions and Relevance This study makes an important contribution to understanding how attributes of treatment options, terminology, and patient characteristics, in particular health literacy, influence treatment decision making for PTC. As a result of increasing evidence of the indolent nature of PTC and other low-risk cancers, strategies to deal with potential overtreatment are critically needed. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12617000066381.
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Affiliation(s)
- Brooke Nickel
- The University of Sydney, Wiser Healthcare, Sydney, New South Wales, Australia.,The University of Sydney, Sydney School of Public Health, Sydney, New South Wales, Australia.,The University of Sydney, Sydney Health Literacy Lab, New South Wales, Australia
| | - Kirsten Howard
- The University of Sydney, Wiser Healthcare, Sydney, New South Wales, Australia.,The University of Sydney, Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Minnesota
| | - Alexandra Barratt
- The University of Sydney, Wiser Healthcare, Sydney, New South Wales, Australia.,The University of Sydney, Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Ray Moynihan
- The University of Sydney, Wiser Healthcare, Sydney, New South Wales, Australia.,Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia
| | - Kirsten McCaffery
- The University of Sydney, Wiser Healthcare, Sydney, New South Wales, Australia.,The University of Sydney, Sydney School of Public Health, Sydney, New South Wales, Australia.,The University of Sydney, Sydney Health Literacy Lab, New South Wales, Australia
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97
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Nickel B, Barratt A, McGeechan K, Brito JP, Moynihan R, Howard K, McCaffery K. Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences: A Randomized Crossover Trial. JAMA Otolaryngol Head Neck Surg 2019; 144:867-874. [PMID: 30335875 DOI: 10.1001/jamaoto.2018.1272] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Given evidence of overdiagnosis and overtreatment of small papillary thyroid cancers (PTCs), strategies are needed to promote the consideration of less invasive treatment options for patients with low-risk PTC. Objective To determine the association of treatment preferences and anxiety levels for PTC with the terminology used to describe the condition. Design, Setting, and Participants This randomized crossover study involved a community sample of 550 Australian men and women 18 years or older without a history of thyroid cancer. Between March 16, 2016, and July 26, 2016, participants accessed an online study that presented 3 hypothetical but clinically realistic scenarios, each of which described PTC as papillary thyroid cancer, papillary lesion, or abnormal cells. Participants were exposed to all 3 scenarios with the different terminologies, and participants were randomized by the order (first, second, or third) in which they viewed the terminologies. Data analysis was conducted from September 1, 2016, to May 15, 2017. Main Outcomes and Measures Treatment choice (total thyroidectomy, hemithyroidectomy, or active surveillance), diagnosis anxiety, and treatment choice anxiety. Results Of the 550 participants who completed the online study and were included in the analysis, 279 (50.7%) were female and the mean (SD) age was 49.9 (15.2) years. A higher proportion of participants (108 [19.6%]) chose total thyroidectomy when papillary thyroid cancer was used to describe the condition compared with the percentage of participants who chose total thyroidectomy when papillary lesion (58 [10.5%]) or abnormal cells (60 [10.9%]) terminology was used. At first exposure, the papillary thyroid cancer terminology led 60 of 186 participants (32.3%) to choose surgery compared with 46 of 191 participants (24.1%) who chose surgery after being exposed to papillary lesion terminology first (risk ratio [RR], 0.73; 95% CI, 0.53-1.02) and 47 of 173 participants (27.2%) after being exposed to abnormal cells (RR, 0.82; 95% CI, 0.60-1.14) terminology first. After the first exposure, participants who viewed papillary thyroid cancer terminology reported significantly higher levels of anxiety (mean, 7.8 of 11 points) compared with those who viewed the papillary lesion (mean, 7.0 of 11 points; mean difference, -0.8; 95% CI, -1.3 to -0.3) or abnormal cells (mean, 7.3 of 11 points; mean difference, -0.5; 95% CI, -1.0 to 0.01). Overall, interest in active surveillance was high and higher levels of anxiety were reported by those who chose surgery, regardless of which terminology was viewed first (mean difference, 1.5; 95% CI, 1.0-1.9). Conclusions and Relevance Changing the terminology of small PTCs may be one strategy to reduce patients' anxiety levels and help them consider less invasive management options. To curtail overdiagnosis and overtreatment in PTC, other strategies may include providing balanced information about the risks and advantages of alternative treatments. Trial Registration anzctr.org.au Identifier: ACTRN12616000271404.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Ray Moynihan
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia.,Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Kirsten Howard
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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98
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Abstract
OBJECTIVES Choosing Wisely holds promise for increasing awareness of low-value care in physiotherapy. However, it is unclear how physiotherapists' view Choosing Wisely recommendations. The aim of this study was to evaluate physiotherapists' feedback on Choosing Wisely recommendations and investigate agreement with each recommendation. SETTING The Australian Physiotherapy Association emailed a survey to all 20 029 physiotherapist members in 2015 seeking feedback on a list of Choosing Wisely recommendations. PARTICIPANTS A total of 9764 physiotherapists opened the email invitation (49%) and 543 completed the survey (response rate 5.6%). Participants were asked about the acceptability of the wording of recommendations using a closed (Yes/No) and free-text response option (section 1). Then using a similar response format, participants were asked whether they agreed with each Choosing Wisely recommendation (sections 2-6). PRIMARY AND SECONDARY OUTCOMES We performed a content analysis of free-text responses (primary outcome) and used descriptive statistics to report agreement and disagreement with each recommendation (secondary outcome). RESULTS There were 872 free-text responses across the six sections. A total of 347 physiotherapists (63.9%) agreed with the 'don't' style of wording. Agreement with recommendations ranged from 52.3% (electrotherapy for back pain) to 76.6% (validated decision rules for imaging). The content analysis revealed that physiotherapists felt that blanket rules were inappropriate (range across recommendations: 13.9%-30.1% of responses), clinical experience is more valuable than evidence (11.7%-28.3%) and recommendations would benefit from further refining or better defining key terms (7.3%-22.4%). CONCLUSIONS Although most physiotherapists agreed with both the style of wording for Choosing Wisely recommendations and with the recommendations, their feedback highlighted a number of areas of disagreement and suggestions for improvement. These findings will support the development of future recommendations and are the first step towards increasing the impact Choosing Wisely has on physiotherapy practice.
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Affiliation(s)
- Joshua Zadro
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Aimie L Peek
- Musculoskeletal Health Research Group, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Rachael H Dodd
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Maher
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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99
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Weir KR, Naganathan V, Bonner C, McCaffery K, Rigby D, McLachlan AJ, Jansen J. Pharmacists' and older adults' perspectives on the benefits and barriers of Home Medicines Reviews - a qualitative study. J Health Serv Res Policy 2019; 25:77-85. [PMID: 31505975 DOI: 10.1177/1355819619858632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Conducting a medication review is one way to optimize medications and support older people to reduce the burden of polypharmacy. In Australia, a service called a Home Medicines Review (HMR) is conducted by pharmacists as part of a nationally funded program. HMRs aim to identify and resolve problems associated with polypharmacy and improve collaboration between patient, pharmacist and general practitioner. The aim of this study was to explore the benefits of and barriers to HMRs from the perspective of older patients and pharmacists. Methods This qualitative study involved observations of HMRs ( n = 12) and telephone interviews with 32 participants including 11 accredited pharmacists, 17 older adults aged 65 years and above, with 4 of their companions, in Australia. The researcher observing took notes during the HMR and added more detail and reflections afterwards. Transcribed audio-recordings and observational notes were thematically coded using framework analysis. Results Older patients and their companions found the HMR useful and they appreciated the opportunity to learn more about their medicines. However, many did not understand the purpose of the HMR, had limited understanding about their medicines and some did not want to know more. Pharmacists found HMRs useful for identifying medication errors and improving adherence. They also reported barriers to effective HMRs relating to patients (resistance to the evaluation of their medicines, misunderstanding about the aim of the HMR) and GPs (limited information upon referral, and limited follow-up afterwards). Conclusions Older patients and pharmacists reported a range of benefits for HMRs in terms of optimizing medicines use. Barriers to effective HMR use need to be addressed, including gaps in inter-professional communication and factors related to patient involvement, such as limited medicines understanding and health literacy.
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Affiliation(s)
- Kristie Rebecca Weir
- PhD Candidate, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Vasi Naganathan
- Consultant Geriatrician, Centre for Education and Research on Ageing (CERA), Concord Clinical School, The University of Sydney, Australia
| | - Carissa Bonner
- Research Fellow, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Kirsten McCaffery
- Professorial Research Fellow, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Debbie Rigby
- Consultant Pharmacist, DR Pharmacy Consulting, Brisbane, Australia
| | - Andrew J McLachlan
- Dean of Pharmacy, Sydney School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Jesse Jansen
- Associate Professor, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
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100
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Bonner C, Fajardo MA, Doust J, McCaffery K, Trevena L. Implementing cardiovascular disease prevention guidelines to translate evidence-based medicine and shared decision making into general practice: theory-based intervention development, qualitative piloting and quantitative feasibility. Implement Sci 2019; 14:86. [PMID: 31466526 PMCID: PMC6716813 DOI: 10.1186/s13012-019-0927-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 07/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The use of cardiovascular disease (CVD) prevention guidelines based on absolute risk assessment is poor around the world, including Australia. Behavioural barriers amongst GPs and patients include capability (e.g. difficulty communicating/understanding risk) and motivation (e.g. attitudes towards guidelines/medication). This paper outlines the theory-based development of a website for GP guidelines, and piloting of a new risk calculator/decision aid. METHODS Stage 1 involved identifying evidence-based solutions using the Behaviour Change Wheel (BCW) framework, informed by previous research involving 400 GPs and 600 patients/consumers. Stage 2 co-developed website content with GPs. Stage 3 piloted a prototype website at a national GP conference. Stage 4 iteratively improved the website based on "think aloud" interviews with GPs and patients. Stage 5 was a feasibility study to evaluate potential efficacy (guidelines-based recommendations for each risk category), acceptability (intended use) and demand (actual use over 1 month) amongst GPs (n = 98). RESULTS Stage 1 identified GPs as the target for behaviour change; the need for a new risk calculator/decision aid linked to existing audit and feedback training; and online guidelines as a delivery format. Stage 2-4 iteratively improved content and format based on qualitative feedback from GP and patient user testing over three rounds of website development. Stage 5 suggested potential efficacy with improved identification of hypothetical high risk patients (from 26 to 76%) and recommended medication (from 57 to 86%) after viewing the website (n = 42), but prescribing to low risk patients remained similar (from 19 to 22%; n = 37). Most GPs (89%) indicated they would use the website in the next month, and 72% reported using it again after one month (n = 98). Open feedback identified implementation barriers including a need for integration with medical software, low health literacy resources and pre-consultation assessment. CONCLUSIONS Following a theory-based development process and user co-design, the resulting intervention was acceptable to GPs with high intentions for use, improved identification of patient risk categories and more guidelines-based prescribing intentions for high risk but not low risk patients. The effectiveness of linking the intervention to clinical practice more closely to address implementation barriers will be evaluated in future research.
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Affiliation(s)
- Carissa Bonner
- The University of Sydney, Sydney School of Public Health, ASK-GP Centre of Research Excellence, Rm 128 Edward Ford Building (A27), Sydney, NSW Australia
| | - Michael Anthony Fajardo
- The University of Sydney, Sydney School of Public Health, ASK-GP Centre of Research Excellence, Rm 128 Edward Ford Building (A27), Sydney, NSW Australia
| | - Jenny Doust
- Bond University, Faculty of Health Sciences & Medicine, ASK-GP Centre of Research Excellence, Robina, QLD Australia
| | - Kirsten McCaffery
- The University of Sydney, Sydney School of Public Health, ASK-GP Centre of Research Excellence, Rm 128 Edward Ford Building (A27), Sydney, NSW Australia
| | - Lyndal Trevena
- The University of Sydney, Sydney School of Public Health, ASK-GP Centre of Research Excellence, Rm 128 Edward Ford Building (A27), Sydney, NSW Australia
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