'It sort of broke me': A thematic analysis of the psychological experiences and coping strategies employed by Australian fire-affected farmers

INTRODUCTION

People exposed to bushfires are known to be at heightened risk of experiencing mental health challenges. When farms are impacted, farmers often risk losing not only their homes but also their businesses, containing their livestock, infrastructure and identities.

OBJECTIVE

To understand the psychological experiences of farmers who have been exposed to fires on their farms and identify the coping strategies they already employ to recover and prepare psychologically for future bushfires.

DESIGN

In-depth, semi-structured interviews were conducted face-to-face or via Zoom. Thematic analysis was used to analyse the data, using a descriptive, essentialist approach. Sixteen farmers and/or their spouses (50% female; median age of 50.8 years), who owned and/or played an active role in the operation of a farming or pastoral enterprise and had been affected by a farm fire within the last 20 years, participated. Participants resided in inner regional, outer regional and remote South Australia and New South Wales.

FINDINGS

Seven overarching themes and 22 subthemes resulted: (1) intense emotions in the aftermath, (2) long-term psychological challenges, (3) deliberate focus on organising, prioritising and completing recovery-focused tasks, (4) importance of seeking and/or accessing support to rebuild, (5) adopting a positive attitude and outlook, (6) (dis)engaging from/with community and social connection and (7) various strategies employed to self-regulate emotions.

DISCUSSION/CONCLUSION

This study demonstrates the unique set of psychological challenges Australian farmers experience in the wake of a farm fire and the coping strategies they report using to help them manage. Findings will inform the development of contextually and culturally appropriate bushfire recovery and preparedness initiatives that are tailored to meet the unique needs of farmers and build upon their existing strengths.

'If you want something to happen, you have to do it yourself': Understanding rural Australian's perspectives of health volunteering

ISSUE ADDRESSED

Rurality is associated with poorer health outcomes and access to health services, yet a strength of rural living includes community cohesion indicated by high rates of volunteering. While volunteerism is an effective means to target health needs in resource-restricted contexts, research on volunteerism to address rural Australian health needs is limited. This research aimed to explore rural adults' perspectives of volunteerism in local activities and programs that had a direct health related benefit (health volunteering).

METHODS

Eight people from the Murray Mallee region of South Australia participated during April 2021, ranging in age from 32 to 75 years. Participants were invited to one-on-one interviews that occurred via a phone call or teleconference meeting, which were audio-recorded and transcribed verbatim to facilitate thematic analysis.

RESULTS

Seven main themes emerged. Participants identified that (1) health volunteering takes many forms, (2) health volunteering affords local ownership and accessibility, (3) health volunteers have particular skills and values, but also (4) gain social benefits and learn new skills. Rural health volunteering was also associated with (5) a variety of personal costs, and (6) there are several environmental barriers and (7) facilitators to rural health volunteering that should be considered when designing health programs.

CONCLUSION

Results provide insight into how rural communities can enhance the development and application of volunteering roles to support health volunteering. SO WHAT?: Including local champions, reducing the financial burden and developing support networks for volunteers are practical suggestions to enhance levels of volunteering for health in rural settings.

A 'Vocal Locals' social network campaign is associated with increased frequency of conversations about mental health and improved engagement in wellbeing-promoting activities in an Australian farming community

BACKGROUND

Farmers face numerous barriers to accessing professional mental health services and instead report a preference for informal support systems, such as lay or peer networks. Farmers also experience barriers to investing time in maintaining or improving their wellbeing, stemming from sociocultural norms and attitudes that are widespread in agricultural communities. The Vocal Locals social network campaign is an ifarmwell initiative that aims to promote conversations about wellbeing and challenge attitudes and behaviours that contribute to farmers' poor mental health.

METHODS

The Vocal Locals campaign was underpinned by the socio-ecological model which explains human behaviour as stemming from interactions between the individual, their closest social circle, the community, and broader society. The campaign ran in Loxton, South Australia, from June to August 2022. Ten community members (8/10 farmers) became 'Vocal Locals' and were supported to share 'calls-to-action' to encourage people in their social networks to engage in wellbeing-promoting activities. A broader communications campaign reinforced key messages and amplified Vocal Locals' activities in the community. The intrapersonal and community-level impacts of the campaign were evaluated via pre- and post-campaign surveys of Vocal Locals and community members respectively.

RESULTS

Vocal Locals reported significantly lower psychological distress (p = .014), and higher positive mental wellbeing (p = .011), levels of general mental health knowledge (p = .022), and confidence helping someone with poor mental health (p = .004) following the intervention. However, changes in stigmatising beliefs about mental illness, confidence recognising poor mental health, and confidence and comfort speaking to others about mental health were non-significant. Community members who were familiar with the campaign reported having significantly more wellbeing-related conversations post-campaign compared to before (p = .015). Respondents also reported being more comfortable speaking to others about mental health or wellbeing (p = .001) and engaging more in activities to maintain or improve their wellbeing (p = .012) following the campaign.

CONCLUSIONS

The Vocal Locals social network campaign is an example of how science and community can be brought together to achieve meaningful outcomes. The campaign may serve as a model for others who wish to challenge attitudinal or knowledge-related barriers to help-seeking and improve engagement in wellbeing-promoting activities in difficult-to-reach communities.

Understanding farmers' barriers to health and mental health-related help-seeking: The development, factor structure, and reliability of the Farmer Help-Seeking Scale

PURPOSE

The aim of this research was to develop a contextually and culturally appropriate scale to assess farmers' barriers to health-related help-seeking.

METHODS

An initial pool of items was developed from the academic literature and input from an expert panel of farmers, rural academics, and rural clinicians. A draft 32-item questionnaire was then developed and sent to farmers registered with FARMbase, which is an Australian national farmer database.

FINDINGS

Two hundred and seventy-four farmers completed the draft questionnaire (93.7% male, 73.7% aged 56-75 years). An exploratory factor analysis identified 6 factors; "Health Issues are a Low Priority," "Concerns about Stigma," "Structural Health System Barriers," "Minimization and Normalization," "Communication Barriers," and "Continuity of Care.". Test-retest reliability was examined with a further 10 farmers (90% male, Mean age = 57, SD = 5.91), who completed the questionnaire twice (at 2- to 3-week intervals). Results indicated moderate-good test-retest reliability.

CONCLUSIONS

The resulting 24-item Farmer Help-Seeking Scale provides a measure of help-seeking that is specifically designed to capture the unique context, culture, and attitudes that can interfere with farmers' help-seeking, and inform the development of strategies to increase health-service utilization in this at-risk group.

'It is a life changing experience': The experiences of living kidney donors who live in rural Australia

INTRODUCTION

A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations.

OBJECTIVE

To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs.

DESIGN/SETTING/PARTICIPANTS

Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis.

FINDINGS

Eight themes were identified: (1) donor's emotional well-being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well-being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall.

CONCLUSION

Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group.

What consumers, general practitioners and mental health professionals want: the co-design and prototype testing of a transdiagnostic, acceptance and commitment therapy-based online intervention to reduce distress and promote wellbeing among Australian adults

BACKGROUND

Many Australians experience mental health challenges, but only a third access face-to-face psychological services, due to multiple barriers including long waitlists. Additional strategies to prevent or help people de-escalate distress at an early stage are needed. Web-based mental health interventions are becoming increasingly acceptable to consumers and referring General Practitioners (GPs), but most are designed for specific disorders/populations. This study explores consumers' and health professionals' preferences and recommendations for the design of a transdiagnostic, Acceptance and Commitment Therapy (ACT)-based, online intervention for Australian adults.

METHODS

Thirty-five people (consumers, carers, GPs, mental health professionals) participated in one or more co-design stages. Stage 1: semi-structured interviews to establish what is wanted from such websites (n = 22). Stage 2: feedback emailed on branding options (n = 20). Stage 3: feedback provided via Zoom or an online survey after testing a website prototype (n = 19). Data were analysed using Thematic Framework Analysis and descriptive statistics.

RESULTS

Stage 1 highlighted nine key design principles (plus 25 subthemes) that participants emphasised as important to ensure the website would have broad appeal and meet their needs: (1) user choice is valued highly; (2) ACT-based content is acceptable as it is focused on helping people be proactive and 'get unstuck'; (3) non-pathologising, direct, empowering, lay language is endorsed; (4) a positive look and feel is appreciated; (5) images and videos are important to break up text and maintain engagement; (6) short text messages to aid engagement are valued; (7) provision of tailored psychoeducation for highly distressed and suicidal users is endorsed; (8) personal and proactive brand name is preferred (icanactnow); (9) diverse marketing and training activities are recommended. In Stage 2, icanactnow branding preferences were elicited (simplicity, colours to represent growth and a call to action). Stage 3 resulted in the inclusion of a safety plan template and a tailored entry portal for people referred to icanactnow by health professionals. High levels of satisfaction with the prototype were reported.

CONCLUSIONS

These findings informed icanactnow and provide insights for the development of other online mental health interventions, in ways that appeal to both consumers and professionals recommending them.

Addressing the challenges of early career rural nursing to improve job satisfaction and retention: Strategies new nurses think would help

AIMS

To (a) explore the experiences of early career registered nurses in rural hospitals in Australia and (b) identify strategies they believe would help increase job satisfaction and retention.

DESIGN

Qualitative descriptive design.

METHODS

Thirteen registered nurses located in outer regional, remote or very remote (herein 'rural') Australian hospitals participated in semi-structured interviews. Participants had graduated from a Bachelor of Nursing program in 2018-2020. Data were analyzed using thematic analysis and an essentialist, bottom-up approach.

RESULTS

Seven themes related to the experiences of rural early career nursing: (1) appreciate diverse scope of practice; (2) rewarding sense of community and opportunity to give back; (3) staff support determines the quality of experience; (4) feeling underprepared and the need for ongoing education; (5) diverse views on the optimal length of rotation and level of input into choice of clinical area; (6) difficulty maintaining work/life balance due to work hours and rostering; and (7) lack of staff and resources. Strategies to improve nurses' experiences included: (1) assistance with accommodation and transport; (2) social gatherings to enhance connection; (3) sufficient orientation and supernumerary time; (4) increased frequency of contact with clinical facilitators and multiple mentors; (5) prioritizing clinical education across diverse topics; (6) greater involvement in choice of rotations and clinical areas; and (7) desire for more flexible work hours and rostering.

CONCLUSIONS

This study highlighted the experiences of rural nurses and explored their suggestions for how to overcome challenges in their roles. Greater consideration of early career registered nurses' needs and preferences is vital to improving and maintaining a satisfied, dedicated and sustainable rural nursing workforce.

IMPACT

Many of the strategies for improving job retention identified by nurses in this study could be actioned at a local level, with little financial or time investment.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

'Being a farmer, I mostly always think there is something more important to do': A mixed methods analysis of the skin cancer detection practices of Australian farmers

ISSUE ADDRESSED

Farmers experience skin cancer and die from melanoma at significantly higher rates than the general Australian population. This study examined Australian farmers' engagement with self-skin examinations (SSE), participation in clinical skin examinations (CSE) by a health professional, and self-reported barriers to engagement with these important skin cancer detection practices.

METHODS

A cross-sectional, mixed-methods design was used. Australian farmers were recruited through an industry-based organisation representing livestock farmers. Farmers (N = 498; 22-89 years; 83.1% male) responded to a paper-based survey that included closed- and open-ended questions.

RESULTS

Farmers reported engagement with self-conducted SSE and routine CSE that was comparable to findings in the general population, but 29.4% of farmers reported that they had not sought a CSE as soon as possible after noticing changes to their skin. Farmers reported a range of barriers to SSE, including physical difficulties examining their skin, difficulties identifying changes in their skin, forgetfulness, and lack of motivation. Barriers to CSE included accessibility, cost, difficulties finding the right doctor, and avoidance and complacency.

CONCLUSIONS

There is a need to make clinical skin cancer detection more accessible to farmers, in addition to promoting self-skin examination and help-seeking behaviours within this at risk population. SO WHAT?: Novel approaches are needed to address systemic barriers faced by Australian farmers. These may include the use of teledermatology or artificial intelligence to assist with CSE. Remote training delivery methods may be also utilised to teach SSE skills to farmers who may be otherwise unable to access such opportunities.

The experiences of health workers using telehealth services for diabetes-related foot complications: a qualitative exploration

BACKGROUND

Diabetes-related foot disease (DFD) accounts for up to 75% of lower-extremity amputations globally. Rural and remote communities are disproportionately affected by DFD. Telehealth has been advocated as a strategy to improve equity of access to health care in rural and remote communities. Current literature suggests that successful implementation of telehealth requires access to adequate reliable equipment, staff training, and support. A real-time video-based telehealth foot service (TFS) for delivering DFD management has recently been established in a Vascular Surgery and Podiatry clinic within a large South Australian metropolitan hospital. The purpose of this study was to gain insights into the experiences of rural and remote health professionals utilising the TFS, as this could be invaluable in optimising the uptake of telehealth use in DFD.

METHODS

This exploratory, descriptive qualitative study employed one-on-one, semi-structured interviews with health professionals who utilised the service. Thematic analysis using an essentialist inductive approach was employed.

RESULTS

Participants included 14 rural and remote health professionals; 2 general practitioners, 2 nurses, 1 Aboriginal Health Practitioner, and 9 podiatrists. In addition, 2 metropolitan-based TFS staff were interviewed. Five key themes were identified. 'Patients have reduced travel burden' included that telehealth enabled Indigenous patients to stay on country. 'Patients had increased psychosocial support' covered the benefits of having health professionals who knew the patient present in consults. 'Improved access' incorporated how telehealth improved interprofessional relationship building and communication. 'Technological and equipment challenges' highlighted that poor network connectivity and poor access to equipment to conduct telehealth consults in rural areas were barriers. The last theme,'Lack of service communication to rural health professionals', highlighted the need for communication around service details.

CONCLUSION

Telehealth is a valuable tool that can improve access to treatment for rural and remote Indigenous DFD patients. While this has the potential to improve DFD outcomes, empirical data is required to confirm outcomes. Considering the advantages of telehealth and rural staff shortages, there is an urgent need for investment in improved equipment and processes and an understanding of the training needs of the health care workforce to support the use of telehealth in DFD management.

Feasibility and preliminary effectiveness of virtual reality as a patient education tool for people with cancer undergoing immunotherapy: a protocol for a randomised controlled pilot study in a regional setting

INTRODUCTION

Patient education is a critical component of healthcare delivery. However, medical information and knowledge are complex and can be difficult for patients and families to comprehend when delivered verbally. The use of virtual reality (VR) to convey medical information to patients may bridge this communication gap and lead to more effective patient education. It may be of increased value to those with low health literacy and levels of patient activation, in rural and regional settings. The objective of this randomised, single-centre pilot study is to examine the feasibility and preliminary effectiveness of VR as an education tool for people with cancer. The results will provide data to inform the feasibility of a future randomised controlled trial, including sample size calculations.

METHODS AND ANALYSIS

Patients with cancer undergoing immunotherapy will be recruited. A total of 36 patients will be recruited and randomised to one of three trial arms. Participants will be randomised 1:1:1 to receive VR, a two-dimensional video or standard care (ie, verbal communication and information leaflets). Feasibility will be assessed by recruitment rate, practicality, acceptability, usability and related adverse events. The potential impact of VR on patient-reported outcomes (ie, perceived information provision quality, knowledge about immunotherapy and patient activation) will be assessed and stratified by information coping style (ie, monitors vs blunters) whenever statistical analyses are significant. The patient-reported outcomes will be measured at baseline, post-intervention and 2 weeks post-intervention. In addition, semistructured interviews will be conducted with health professionals and participants randomised to the VR trial arm, to further explore acceptability and feasibility.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Greater Western Human Research Ethics Committee, New South Wales Local Health District (2022/ETH01760). Informed consent will be obtained from all participants. Findings will be disseminated via relevant conference presentations and publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12622001473752.

Development and initial psychometric evaluation of the Perceptions of Parental Illness Questionnaire for Cancer

OBJECTIVE

To evaluate the psychometric properties of the Perceptions of Parental Illness Questionnaire for Cancer (PPIQ-C) among adolescents and young adults (AYAs).

METHODS

A sample of 372 AYAs (aged 12-24 years) who had a parent diagnosed with cancer completed the PPIQ-C and the Kessler Psychological Distress Scale (K10). Exploratory factor analyses were conducted to examine the dimensional structure of the PPIQ-C. Scale reliability was evaluated using Cronbach's alpha (α) and McDonald's omega (ω). Pearson correlation analyses were conducted to assess construct validity by examining correlations between PPIQ-C subscale scores and K10 total scores.

RESULTS

The PPIQ-C is organised into three sections, each with a separate factor structure for items representing identity, core (emotional representations, coherence, timeline, consequences, and controllability), and cause dimensions of the Common-Sense Model of Self-Regulation. Exploratory factor analyses determined the structure of each section: identity items comprised two subscales (12 items), core items comprised 10 subscales (38 items), and cause items comprised three subscales (11 items). Scale reliability was acceptable for all subscales, except the cause subscale chance or luck attributions (α = 0.665). Correlations between PPIQ-C subscale scores and K10 total scores provided support for construct validity.

CONCLUSIONS

Preliminary evidence suggests that the PPIQ-C is a reliable, valid, and useful tool for assessing illness perceptions among AYAs with a parent with cancer. The PPIQ-C may be a useful addition to both clinical practice and future research, however further evaluation work is needed to confirm its structure and robustness prior to use.

Co-designing a peer-led model of delivering behavioural activation for people living with depression or low mood in Australian farming communities

INTRODUCTION

Farmers face a range of factors that negatively influence their mental health and suicide risk, yet have limited access to appropriate support. Behavioural activation (BA) is an evidence-based therapy that can be effectively delivered by nonclinical workers. Working with members of farming communities to deliver BA to their peers has the potential to overcome many well-established barriers to mental health help-seeking and improve outcomes for this at-risk group.

OBJECTIVE

This paper describes the findings of a co-design phase informing the development of a peer (farmer)-led approach for delivering BA for farmers living with depression or low mood.

DESIGN

This qualitative study used a co-design approach involving members of the target community. Focus groups were transcribed and analysed using Thematic Analysis and the Framework approach.

FINDINGS

Ten online focus groups with 22 participants were held over 3 months. Four overarching, interlinked themes were identified: (i) filling the gap in rural mental health support; (ii) alignment with the farming context-tailoring how, where and when we engage about mental health; (iii) the 'messenger' is as important as the message; and (iv) sustainability, governance and support.

DISCUSSION

Findings suggest BA could be a contextually appropriate model of support for the farming community-given its practical and solution-focused approach-and could help improve access to support. Having peer workers deliver the intervention was viewed as appropriate. Ensuring governance structures are developed to support peers to deliver the intervention will be essential to facilitate effectiveness, safety and sustainability.

CONCLUSION

Insights gained through co-design have been critical to the success of developing this new model of support for members of farming communities experiencing depression or low mood.

Stressors, Barriers and Facilitators Faced by Australian Farmers When Transitioning to Retirement: A Scoping Review

Farms in Australia are largely family owned and managed. Complex interactions between farming history, traditions, family, business, succession, identity and place can lead to difficulties in planning for retirement for farmers. Due to the significant implications of this for farmers' health and wellbeing, there is a clear need to determine how farmers may be best supported through the work-to-retirement transition. This scoping review summarises the literature on Australian farmers' retirement experiences and the stressors they face during this transition. Barriers and facilitators that may hinder or help farmers were also explored. The relevant peer-reviewed literature was identified through database searching and the grey literature was collected via a web-based search. Seven studies were included in the review. Poor health and diminishing capacity to work was identified as a key stressor related to retirement. Other drivers of stress (i.e., pressure to live up to farming ideals, perceiving retirement as a threat to self-identity and financial concerns) overlapped with barriers to retirement. Farmers identified gradual transition, strong social networks, variety in interests and activities and early financial and succession planning as key facilitators of retirement. Findings will help inform the development of interventions to assist Australian farmers through this challenging stage of their lives.

The Effects of Walnuts and Academic Stress on Mental Health, General Well-Being and the Gut Microbiota in a Sample of University Students: A Randomised Clinical Trial

Poorer mental health is common in undergraduate students due to academic stress. An interplay between stress and diet exists, with stress influencing food choices. Nutritional interventions may be effective in preventing mental health decline due to complex bidirectional interactions between the brain, the gut and the gut microbiota. Previous studies have shown walnut consumption has a positive effect on mental health. Here, using a randomized clinical trial (Australian New Zealand Clinical Trials Registry, #ACTRN12619000972123), we aimed to investigate the effects of academic stress and daily walnut consumption in university students on mental health, biochemical markers of general health, and the gut microbiota. We found academic stress had a negative impact on self-reported mood and mental health status, while daily walnut consumption improved mental health indicators and protected against some of the negative effects of academic stress on metabolic and stress biomarkers. Academic stress was associated with lower gut microbial diversity in females, which was improved by walnut consumption. The effects of academic stress or walnut consumption in male participants could not be established due to small numbers of participants. Thus, walnut consumption may have a protective effect against some of the negative impacts of academic stress, however sex-dependent mechanisms require further study.

Male Farmers' Perspectives on Psychological Wellbeing Self-Management Strategies That Work for Them and How Barriers to Seeking Professional Mental Health Assistance Could Be Overcome

This research aimed to explore the self-management strategies that Australian male farmers use to improve or maintain their psychological wellbeing and their views on what would assist them to overcome barriers to seeking professional mental health assistance. Individual semi-structured telephone interviews were audio-recorded with consent. Qualitative data were analysed inductively using thematic analysis. Fifteen male farmers participated, who were an average of thirty-nine years of age (23-74 years) with twenty years of farming experience (5-57 years). Seven themes relating to self-management strategies were identified: (1) interacting with a supportive network; (2) involvement in groups and teams; (3) physical activity; (4) proactively educating themselves; (5) self-prioritising and deliberately maintaining work-life balance; (6) being grateful; and (7) focusing on the controllable aspects of farming. Five themes were identified that related to mitigating barriers to seeking mental health assistance: (1) actively welcoming mental health professionals into the community; (2) normalising help-seeking; (3) making seeking mental health assistance a priority; (4) offering services that are culturally appropriate and accessible for male farmers; and (5) tailoring mental health information delivery to farming populations. Australian male farmers already use strategies to maintain and improve their mental health that are culturally and contextually appropriate. These proactive strategies could form the basis of interventions aiming to further promote male farmers' wellbeing. Barriers to seeking professional mental health assistance may be overcome by implementing solutions directly suggested by male farmers. Given the elevated risk of suicide in this group, investment in trialing promotion of these strategies is warranted.

"We're Lucky to Have Doctors at All"; A Qualitative Exploration of Australian Farmers' Barriers and Facilitators to Health-Related Help-Seeking

This study aimed to explore barriers and facilitators that impact on farmers' help-seeking behaviours for health and mental health concerns. Fifteen semi-structured interviews were conducted with farmers (12 male; age 51.7 ± 12.6 years) from three rural regions in South Australia. Interviews explored demographic and farm-related characteristics, perceptions of individual (and where relevant family) health and mental health concerns and experiences, and perceived barriers of health support-seeking. Thematic analysis was used to identify key themes. Four key themes were identified relating to help-seeking; personal attitudes and beliefs, farm-related barriers, health system barriers and the provision of support from family and friends. Dominant personal attitudes included valuing independence, strength and privacy. Farm related barriers included the 'farm comes first' and the fact that 'farm work is never done'. Health system barriers included issues relating to availability of choice and access, professionals (lack of) understanding of farm life, and time and financial costs of accessing care. Provision of support from family and friends involved informal help and advice, including facilitating access to professional support. Multiple attitudinal, structural, and farm-related issues affect farmers' help-seeking. Professionals who understand farm work practices and routines are valued by farmers and this is likely to facilitate access to care. Workforce development programs and community programs that involve farmers' perspectives as consumers and co-designers, using evidence-based strategies, may assist in strengthening these relationships.

Optimizing Rural People's Access to Relevant Cancer Education and Support Using Peer-Led YouTube Films

Rural cancer patients have inferior cancer outcomes and unique unmet information needs. This paper explores the value of rural people affected by cancer delivering cancer-related education and support to their peers via 3-5 min online YouTube films. In part 1, 14 rural Australians affected by cancer (10 survivors, 4 carers), 50% (7/14) female, 55-79 years, "storytellers", were purposively invited to be filmed sharing their cancer-related experience and advice for others facing similar challenges. They then reflected on their storytelling experience during semi-structured interviews with an independent researcher. In part 2, 11 rural South Australians affected by cancer (8 survivors, 3 carers), 82% (9/11) female, 32-75 years, "viewers", who had watched at least three of the videos, were interviewed. When data saturation was reached, thematic analysis was employed. Storytellers were found to be highly satisfied with the film-making process and product. They valued rapport building prior to filming and the opportunity to help others. They also found storytelling cathartic and the films useful in communicating their cancer experience to family and friends. Rural viewers appreciated the honesty, authenticity, relatability and believability of the storytellers, the practical advice on rural-specific psychosocial issues, acknowledgment of the impact of isolation and the opportunity to understand others' cancer experiences. The film's short duration and professional film-making added appeal. Inclusion of younger storytellers and methods of delivery other than YouTube were suggested. This study highlights the value of this approach for storytellers and viewers. It may be particularly beneficial for isolated rural cancer survivors who feel that their unique challenges are not adequately addressed by mainstream cancer education resources However, further quantitative research to test acceptability and impact in representative rural samples is required.

Virtual reality as a patient education tool in healthcare: A scoping review

OBJECTIVE

To explore what is currently known about the use of virtual reality (VR) as a patient education tool in healthcare.

METHODS

Arksey and O'Malley's scoping review method and the PRISMA-ScR Checklist were employed. Four peer-reviewed databases were searched (Medline, Embase, PsychINFO, the Cochrane library). Pre-defined selection criteria identified 18 studies for inclusion. Results were synthesized using a narrative approach.

RESULTS

VR as an educational tool in healthcare is feasible and acceptable, and may improve patient's knowledge about their illness and satisfaction with treatment. Most studies used the Oculus VR glasses or headset, educated patients though the use of 3D 360° VR anatomical models, and were conducted with people affected with cancer. Opportunities exist for exploring unintended consequences, and the role of VR in educating populations with lower health literacy.

CONCLUSION

VR could assist in communicating medical information and knowledge to patients, but more research is needed, particularly to identify for whom and in what situations this method is most useful and to improve understanding about the potential unintended consequences.

PRACTICE IMPLICATIONS

Health professionals should consider using VR to educate their patients, and researchers can use this as a road map on how to address knowledge gaps in this field.

Use of behavioural activation to manage pain: a systematic scoping review

BACKGROUND

Behavioural activation (BA) is an effective treatment for depression; however, it is unclear if it can be used to manage pain.

OBJECTIVES

To conduct a scoping review of primary research that reported using BA to support people living with chronic pain to understand how BA had been used in relation to pain. In addition, we wanted to understand whether there were any reported changes in that pain, and how and who delivered BA.

ELIGIBILITY CRITERIA

Primary research published in English.

SOURCES OF EVIDENCE

We searched seven databases MEDLINE, Ovid Embase, Ovid Emcare, PsycINFO, CINAHL, Scopus and Web of Science, for primary research. No initial date limit was used with the date the searches were conducted used as the end date limit (1 July 2021).

CHARTING METHODS

A customised data extraction table was developed, piloted and used.

RESULTS

551 papers were screened for inclusion, with 15 papers included in our review. Studies were conducted in North America and in Canada. These included three case studies, nine uncontrolled trials and three randomised controlled trials. Only two studies reported pain as the primary outcome. BA was applied across a range of pain related conditions. The dose of BA ranged from 3 to 16 sessions. Duration of treatment was 3 weeks to 12 months. Most studies reported reductions in pain following exposure to BA.

CONCLUSION

BA has the potential to reduce pain. Caution needs to be exercised in the interpretation of these findings as a high risk of bias was observed in most studies. High-quality research is required to test if BA is an effective intervention for chronic pain.

Interventions to support adherence to oral anticancer therapies: research challenges, lessons learned, and strategies to overcome them from Australia and Switzerland

Not monitoring adherence to oral anticancer therapies (OAT) can lead to poor clinical outcomes, including premature death as reported by Foulon et al. (Acta Clin Belg 66(2):85-96, 2011) and Greer et al. (Oncologist 21(3):354-76, 2016). Barriers to the implementation of supportive cancer care interventions in medication adherence occur with multiple hospital sites, cancer diagnoses, and numerous healthcare professionals. This commentary describes challenges and strategies from two OAT adherence trials in Australia and Switzerland to assist researchers in the design and implementation of future interprofessional trials.

A smartphone program to support adherence to oral chemotherapy in people with cancer: Proof-of-concept trial

AIM

Nonadherence to oral chemotherapy (OC) can lead to health complications, including premature death. Mobile phones are increasingly used to deliver medication adherence interventions. However, there is limited evidence about mobile phone-based interventions to increase adherence to OC, specifically. This study explores the proof-of-concept of a smartphone program to support adherence to OC in people with cancer.

METHODS

This was a 10-week, nonrandomized, multisite trial. The outcomes assessed were acceptability, satisfaction with the intervention, adherence to OC, knowledge about OC, and side-effects presence and severity. The program consisted of short message service (SMS) reminders to take OC, as well as information about OC, including the management of side-effects.

RESULTS

Twenty-two participants (17-74 y/o, median age 60 y/o) were recruited at six hospitals. The sample included 10 different cancer diagnoses (predominance of breast cancer) and 11 OC medications. Acceptability of the intervention was high, with 95% of the enrolled participants completing postintervention measures, and 81% reporting high satisfaction with the program. The intervention was found to have no effect on supporting adherence to OC (assessed by self-report and medication event monitoring system) in this sample. An increase in knowledge about OC was observed at postintervention (p = 0.010).

CONCLUSIONS

This study demonstrated proof-of-concept of the smartphone program and highlighted the need for intervention and trial design-related refinements. Future work should evaluate the effect of the program on adherence to OC with nonadherent patients.

Combining Farmers' Preferences With Evidence-Based Strategies to Prevent and Lower Farmers' Distress: Co-design and Acceptability Testing of ifarmwell

Background

Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support.

Objective

This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population.

Methods

Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years; 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) “sheep, cattle and/or grain farmers.” Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology.

Results

This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies—ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health–related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion.

Conclusions

Sequential integration of research evidence, expert knowledge, and farmers’ preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526

Caring for someone with cancer in rural Australia

PURPOSE

To explore the experiences of people caring for someone with cancer, while living in rural Australia, and the impact of the cancer-caring role on their well-being.

METHOD

Eighteen adults in regional or remote ('rural') Australia who cared for a person with cancer took part in semi-structured telephone interviews. Participants were aged 32-77 years and mainly female (66%). Data were analysed using thematic analysis and an essentialist approach.

RESULTS

Eight themes were identified: (1) travel is hard, but supports are available; (2) frustration with systems that do not demonstrate understanding of the rural context; (3) the importance of lay and peer support; (4) the impact of access to trusted, local health care services; (5) the importance of access to rurally relevant information (particularly on relevant services and what to expect); (6) living with uncertainty and balancing loss with hope; (7) reluctance to seek or accept psychological support; and (8) the gendered nature of care.

CONCLUSION

Rural cancer carers' roles can be made easier by improving health systems and coordination to ease the burden of travel, providing information about available support and what to expect throughout cancer treatment that is relevant to the rural context, and increasing access to quality health, community, and support services, including palliative care, in rural areas. More training on the specific needs of rural patients and their carers is needed for urban health care professionals. Peer support groups may have particular value for cancer carers in rural settings, where there are known to be multiple barriers to accessing professional sources of psychosocial support.

Choosing and Managing Aged Care Services from Afar: What Matters to Australian Long-Distance Care Givers

This research aims to identify the factors that influence caregivers' decisions about the aged care providers they select for their elder relatives when caring from a distance and what they value once they have engaged a service. Adult long-distance carers for older relatives living within Australia were purposively sampled and they participated in audio-recorded interviews. A thematic analysis was employed to investigate the data. A sample of 13 participants enabled data saturation with no new major themes identified in the final three interviews. Participants were 50 to 65 years (Mean = 59.8) and mostly (77%) female. Four themes emerged relating to selection of care providers: (1) availability of care, (2) financial arrangements, (3) proximity and location, and (4) reputation of care provider. Five themes detailed valued qualities of care: (1) vigilant monitoring and responsivity, (2) communication with family, (3) flexibility and proactiveness of care, (4) staffing, and (5) access to appropriate and holistic care to maintain wellbeing. Long-distance caregivers face barriers in selecting and managing aged care services from afar within a complex Australian aged care system. They strongly value regular, proactive communication about the wellbeing of their relatives and may be particular beneficiaries of communication and assistive monitoring technologies.

Understanding and addressing psychological distress experienced by farmers, from the perspective of rural financial counsellors

OBJECTIVE

To explore rural financial counsellors' experiences interacting with psychologically distressed farmers and identify contextually appropriate methods to maintain their own well-being and link farmers to psychological supports, within their existing roles.

SETTING

Rural, regional and remote Australia.

PARTICIPANTS

Fifty rural financial counsellors participated. They worked across 6 Australian states/territories.

DESIGN

Individual semi-structured telephone interviews were audio-recorded with consent. Qualitative data were analysed using thematic analysis. Themes were identified using an essentialist, bottom-up approach.

RESULTS

Forty-six themes emerged relating to the 5 topics explored: (a) how to recognise distress in farmers (eg inability to focus/make decisions, deterioration in presentation/organisation, anger, blaming); (b) impact of farmers' psychological distress on the financial case management process (eg slows, disrupts or stops it, negatively impacts counsellor well-being); (c) strategies for working effectively with distressed farmers (eg flexibility, open-ended questions, listening to story, simplicity, instilling hope); (d) referral of distressed farmers to psychological support (eg willing if tried themselves/positive reports, lack of local rural face-to-face services, stigma and lack of understanding of importance challenging, a farming focus and support from family/ community assists); and (e) strategies to maintain their own well-being (eg compartmentalising, exercise, supervision).

CONCLUSION

Rural financial counsellors play an important role by recognising signs of distress in farmers and referring them to appropriate psychological supports. However, this is a demanding role and ensuring counsellors have appropriate services to refer farmers to, and support with their own well-being, is imperative.

Psychosocial well-being and supportive care needs of cancer patients and survivors living in rural or regional areas: a systematic review from 2010 to 2021

Purpose

To summarise what is currently known about the psychosocial morbidity, experiences, and needs of people with cancer and their informal caregivers, who live in rural or regional areas of developed countries.

Methods

Eligible studies dating from August 2010 until May 2021 were identified through several online databases, including MEDLINE, EMBASE, PsychINFO, and RURAL (Rural and Remote Health Database). Results were reported according to the PRISMA guidelines and the protocol was registered on PROSPERO (CRD42020171764).

Results

Sixty-five studies were included in this review, including 20 qualitative studies, 41 quantitative studies, and 4 mixed methods studies. Qualitative research demonstrated that many unique psychosocial needs of rural people remain unmet, particularly relating to finances, travel, and accessing care. However, most (9/19) quantitative studies that compared rural and urban groups reported no significant differences in psychosocial needs, morbidity, or quality of life (QOL). Five quantitative studies reported poorer psychosocial outcomes (social and emotional functioning) in urban cancer survivors, while three highlighted poorer outcomes (physical functioning, role functioning, and self-reported mental health outcomes) in the rural group.

Conclusion

Recent research shows that rural people affected by cancer have unique unmet psychosocial needs relating to rurality. However, there was little evidence that rural cancer survivors report greater unmet needs than their urban counterparts. This contrasts to the findings from a 2011 systematic review that found rural survivors consistently reported worse psychosocial outcomes. More population-based research is needed to establish whether uniquely rural unmet needs are due to general or cancer-specific factors.

Communicating cancer and its treatment to Australian Aboriginal and Torres Strait Islander patients with cancer: a qualitative study

PURPOSE

To investigate the successful strategies of health workers who support and regularly communicate with Aboriginal and Torres Strait Islander people about cancer and its treatment.

METHODS

Semi-structured interviews were conducted face-to face or via telephone and audio-recorded with twenty-three health professionals (medical and radiation oncologists, oncology nurses and Aboriginal Health Workers), 5 identifying as Aboriginal or Torres Strait Islander in the Northern Territory and South Australia. When data saturation was reached, thematic analysis using a bottom up, essentialist/realist approach was used.

RESULTS

Six themes emerged. (1) Create a safe environment, engender trust and build rapport. This involves considering the physical environment and allowing time in interviews to establish a relationship. (2) Employ specific communication strategies to explain cancer, treatment and its side effects through language choices and employing visual aids such as drawings, metaphors and relatable analogies. (3) Obtain support from Aboriginal and Torres Strait Islander staff and patient escorts who can assist in communication. (4) Consider culture which involves collective decision making, strong connection to country and community, with cultural obligations and a unique understanding of cancer. (5) Anticipate the contextual complexities of conflicts between Western medicine and Aboriginal culture, practitioner bias and difficulty maintaining contact with patients. (6) Develop personal qualities of good communicators, including being patient-centred, showing respect, patience, empathy and honesty.

CONCLUSION

These insights will help foster more positive interactions with the health system and promote optimal outcomes for Aboriginal and Torres Strait Islander people with cancer.

Use of behavioural activation to manage pain: a scoping review protocol

INTRODUCTION

Chronic pain is a distressing condition and often poorly treated and managed. Psychological therapies are considered first-line intervention for people with chronic pain. Common psychological therapies require extensive clinician training and specialist qualifications. One approach that does not need lengthy training nor specialist qualification, but has empirical support in other health domains, is behavioural activation (BA). BA seeks to increase engagement in behaviours that are valued by the person and progress through behaviours that can increase mood and develop skills that build satisfying routines. BA can help people to manage their condition through scheduling behaviours, promoting routine and mastery over their condition. The extent to which BA has been used to support people living with chronic pain is not clear.

METHODS AND ANALYSIS

This scoping review aims to identify published studies describing the application of BA to support people living with chronic pain. To map the evidence regarding BA and chronic pain, including the study type and the associated evidence, a scoping review was adopted. The search will be conducted in bibliographic databases, clinical trial registries and grey literature. No date limits will be applied to the search strategy. Screening of titles and abstracts, and full-text screening, will be independently undertaken by two investigators using Covidence software. Any disagreement between investigators will be resolved by a third investigator. Data from included publications will be extracted using a customised data extraction tool.

ETHICS AND DISSEMINATION

The scoping review is an analysis of existing data and therefore ethics approval is not required. The findings of this scoping review will further our understanding of how BA has been used to support people living with chronic pain and inform future training and education programmes in this area.

Improving Survivors' Quality of Life Post-Treatment: The Perspectives of Rural Australian Cancer Survivors and Their Carers

Simple Summary

Existing programs to support cancer survivors post-treatment tend to be delivered face-to-face, reducing their accessibility to those living in rural and remote locations. Additionally, little is known about the acceptability of urban-developed survivorship care programs among rural cancer survivors who may have unique values and different attitudes towards help-seeking. The purpose of this study was to explore the experiences of cancer survivors who return to their rural communities upon completion of active treatment, and to identify the challenges these survivors experience in engaging with quality of life-related support services. The findings of this study will inform the design and development of new interventions, or modification of existing interventions, to better meet the preferences and needs of rural survivors. Identifying the specific challenges and intervention preferences of rural cancer survivors will help to ensure they benefit as much as urban survivors, from efforts to improve post-treatment quality of life.

Abstract

The transition from urban centres back to rural and remote communities can be challenging for rural cancer survivors after treatment. This study aimed to (a) provide deeper understanding of the experiences of rural survivors who have completed active cancer treatment and returned to their rural communities, and (b) determine strategies to re-orient existing services or develop new interventions to more appropriately meet rural survivors’ service preferences and needs. Semi-structured interviews were conducted with 22 adults (64% female) who lived outside of a metropolitan area and had completed active cancer treatment (n = 13), were the carer for a rural/remote cancer survivor (n = 6), or were both a survivor and carer (n = 3). Thematic analysis was conducted to identify dominant themes in the qualitative data. A range of physical, psychological and practical challenges that impact quality of life among rural survivors post-treatment were found. These challenges appeared to be compounded by a lack of trust in local rural healthcare services and a lack of clear post-treatment pathways to quality of life-enhancing support services. Acceptable strategies to overcome barriers included nurse-led, telephone-based, or face-to-face interventions, initiated and continued by the same service provider, and that included support to manage emotional challenges associated with post-treatment survivorship. The findings will inform the design of interventions to better meet rural cancer survivors’ post-treatment support needs.

Understanding the strategies rural cancer patients and survivors use to manage financial toxicity and the broader implications on their lives

PURPOSE

To explore strategies rural Australians use to cope with the financial consequences of their cancer diagnosis and how that impacts on their lives.

METHODS

Twenty adult cancer patients/survivors residing in regional-remote areas of Australia were purposively sampled and participated in audio-recorded, semi-structured interviews. When data saturation was reached, thematic analysis was employed to analyse the data.

RESULTS

Participants were 20-78 years (M=60), 70% female, 35% were undergoing treatment and the remaining 65% had finished treatment within the past 5 years. Three themes provide context to rural financial toxicity-related experiences (travelling to access cancer treatment away from home is expensive, being single or lacking family support exacerbates the financial strain, and no choice other than to adopt cost-saving strategies if wanted to access treatment). Strategies commonly employed to minimise financial toxicity include: accessing travel-related support, changes to lifestyle (buying cheaper food, saving on utilities), accessing savings and retirement funds, missing holidays and social activities, reduced car use and not taking a companion to cancer-related appointments at metropolitan treatment areas. Although cost-saving strategies can effectively increase the ability of rural people to cover cancer treatment-related and other costs, most have broader negative psychological, social and practical consequences for them and their families.

CONCLUSIONS

Increasing rural cancer patients' and survivors' awareness of various cost-saving strategies and their impact (positive and negative) may decrease their risk of experiencing financial toxicity and unexpected unintended consequences of adopting cost-saving measures.

Why are some drought-affected farmers less distressed than others? The association between stress, psychological distress, acceptance, behavioural disengagement and neuroticism

OBJECTIVE

To identify the modifiable psychological and behavioural coping strategies associated with low levels of psychological distress, independent of more stable personality and demographic factors, in a sample of farmers who reported being exposed to a recent stressful event during an extended drought.

DESIGN/SETTING/PARTICIPANTS

Three hundred and nine South Australian, drought-affected grain, sheep and/or cattle farmers completed printed or online questionnaires. Only those who reported experiencing a stressful event in the past month that they rated ≥7 on a scale ranging from 1 (not stressful at all) to 10 (extremely stressful) were included in the analyses (n = 175, 65.06%). Participants ranged in age from 24 to 85 years and 40% were female.

MAIN OUTCOME MEASURES

Psychological distress was measured using the Kessler Psychological Distress Scale, and coping strategies were measured using a situational version of the COPE inventory. Five personality factors (extraversion, neuroticism, openness, conscientiousness and agreeableness) were assessed using the Quickscales-R.

RESULTS

In the final multivariable model, distress was elevated among individuals reporting higher neuroticism and behavioural disengagement, and lower in individuals reporting greater use of acceptance. These 3 variables explained 44% of the variance in distress.

CONCLUSION

Farmers recently exposed to a significant stressor, who used acceptance as a coping strategy, did not engage in behavioural disengagement and scored low on neuroticism, were least likely to experience distress. Given the stability of personality factors, interventions that foster farmers' use of acceptance and prevent behavioural disengagement as coping strategies might assist them with the management of future stressors, particularly in times of drought.

The psychosocial experiences and supportive care preferences of organ transplant recipients and their carers who live in regional Australia

BACKGROUND

There is no evidence that being a rural or regional organ transplant recipient has adverse physical health outcomes post-surgery compared with those experienced by people living in cities, but the impact of living remotely from transplant centres on psychosocial outcomes has not been explored.

OBJECTIVE

To identify the social, emotional, psychological, spiritual, informational and practical issues associated with being a regionally based organ transplant recipient or carer and determine how support services could be improved for this group.

DESIGN/ SETTING/ PARTICIPANTS

Twenty-two purposively sampled adult Australians who lived outside metropolitan centres and had received an organ transplant (n = 15) or were the primary carer of someone who had received one (n = 7), participated in semi-structured, telephone interviews. Qualitative data were collected until data saturation was reached and were analysed using thematic analysis.

RESULTS

Five key themes (plus subthemes) were identified: (a) travelling for specialist transplant care takes a toll, (b) unique transplant-related psychological and emotional issues experienced before and after transplants, (c) caring for transplant recipients is a demanding role, (d) lay, peer and professional support, including rural general practitioners and accommodation facilities, help ease the burden, but (e) significant barriers to accessing transplant-focused psychosocial support exist.

CONCLUSION

Novel methods of delivering targeted, transplant-specific information and psychosocial care to rural transplant recipients and their carers, employers and rural health professionals require development and evaluation. Strategies might be delivered by peers or professionals via telehealth, telephone, social media or websites for example, depending on preferences and level of need.

Associations between baseline demographic, clinical and lifestyle factors, and changes in fatigue, depression, and health-related quality of life in long-term cancer survivors: a cohort study

PURPOSE

To investigate the longitudinal associations between demographic, clinical and lifestyle factors, and changes in patient-reported outcomes (PROs) in cancer survivors 6-9 years post-diagnosis in Western Australia.

METHODS

A total of 290 individuals participated in this study. Three-quarters of participants were female, and 55%, 31%, and 14% were survivors of breast cancer, colon cancer, and non-Hodgkin lymphoma (NHL), respectively. PROs (fatigue, depression, and health-related quality of life (HRQOL)) were reported at two time points (2012-13 and 2017). Descriptive statistics were used to assess the overall changes over time and linear mixed models were used to identify factors associated with changes over time, after adjusting for confounders.

RESULTS

No significant changes were observed in PROs between time point 1 and follow-up at the population level, yet a notable proportion of participants (23% for fatigue, 10% for depression, and 39% for HRQOL) reported a negative minimal clinically important difference (MCID). Being non-Caucasian and having had NHL were associated with negative changes over time. Being obese and having had radiotherapy were related to improved outcomes.

CONCLUSION

Cancer survivors whose levels of fatigue, depression, and quality of life are compromised during cancer treatment may require intervention even 6-9 years post-treatment. Our results suggest particular attention should be paid to those who are non-Caucasian and who have had NHL. This is crucial for providing appropriate care and to support those who are at increased risk of deteriorating naturally over time.

Can targeting information on cancer-related psychosocial services by male gender and rurality improve attitude to service use in this difficult-to-engage population?

OBJECTIVE

Rural men affected by cancer are difficult to engage in psychosocial support services. This exploratory study tested whether exposure to printed brochures describing services, distinguished by a focus on rural men affected by cancer, resulted in more positive help-seeking attitudes than exposure to material focused on rural location only or generic cancer support material.

METHODS

Targeted versions of a South Australian Cancer Council service brochure were developed to enhance cultural appropriateness, consistent with the Elaboration Likelihood Model. Rural men affected by cancer were recruited via supportive accommodation and randomized to receive one of the three brochures. The primary outcome was positive attitude to help-seeking at post-test (between 1 and 2 days). Negative attitudes to help-seeking, intention to seek help, perceived isolation, and service use were secondary outcomes; perceived information relevance at immediate post-test was also measured.

RESULTS

Analysis (N = 114) indicated no detectable group differences (rurality/male gender, n = 33; rurality, n = 41; control, n = 40) on primary or secondary outcome measures (p > 0.05). Participants' existing service use was high, due to the recruitment methods. Support service information was primarily sourced from other people (e.g., friends/family, 22.22%; medical professionals, 27.27%).

CONCLUSIONS

Existing service use rates suggest that ceiling effects obscured any potential benefit from demographic targeting of materials. Further research should consider building understanding about the acceptability of targeting techniques in this population, replication with materials designed with greater consumer input, and employ samples recruited outside a support service.

Communicating cancer and its treatment to Australian Aboriginal patients with cancer: A qualitative study

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Background: To enable clinicians to effectively communicate about cancer and its treatment to Aboriginal and Torres Strait (Aboriginal) people with cancer who need to make informed choices about the Western medicine offered, we sought strategies from health professionals with experience in that field. Methods: Semi-structured interviews were conducted face-to face or via telephone with the experienced health professionals and audio-recorded. Thematic analysis using a bottom up, essentialist/realist approach was employed to analyse the data, when data saturation was reached. Results: The 23 health professionals interviewed were medical and radiation oncologists, oncology nurses and Aboriginal health workers. Twelve were female, 11 were male with 5 identifying as Aboriginal. Six themes emerged. (1) Create a safe environment, engender trust and build rapport. This involves avoiding assumptions, allowing time, considering the physical environment, asking about home and family, being aware of gender issues and noting non-verbals. (2) Employ specific strategies to explain cancer, treatment and its side effects by using simple language, employing visual aids such as drawings, metaphors and relatable analogies such as trees with roots, weeds, abandoned rusty cars and blocked pipes. Use repetition and ensure alignment with patient needs. Warning about upcoming sensitive issues minimised the chance of disengagement. (3) Obtain support from those who can assist in communication. This includes interpreters, aboriginal liaison officers and health workers, and patient escorts. (4) Consider the culture which involves collective decision-making, strong connection to country and community, with cultural obligations and unique understanding of cancer which can involve curses, shame and utilise bush medicine. (5) Develop personal qualities of good communicators, including showing respect, patience, empathy, honesty, being person centred and embracing personal reflection. (6) Understand the contextual complexity of multiple languages, possible disengagement with treatment, difficulty maintaining contact with patients, conflicts between Western medicine and Aboriginal culture and late stage presentations. Be aware of practitioner bias. Conclusions: These insights will help foster more positive interactions with the health system and promote optimal outcomes for Aboriginal people with cancer and enable the creation of educational modules for inexperienced clinicians.

A review of factors influencing non-adherence to oral antineoplastic drugs

PURPOSE

Adherence to oral antineoplastic drugs is a complex phenomenon, and knowledge about the reasons that people with cancer do not adhere to their prescriptions is essential to inform adherence-related support in clinical and research contexts. This study aims to provide an up-to-date summary of the key reasons for non-adherence to oral antineoplatic drugs (OAD) in people with cancer.

METHODS

Electronic databases Medline, Embase, Emcare, and PsychINFO were searched for systematic reviews and studies published between January 2010 and March 2018. Data was analyzed and extracted by two independent reviewers.

RESULTS

Three systematic reviews and two studies were included in the review. Key factors for non-adherence were classified as either modifiable or non-modifiable factors. Side effects, forgetfulness, and poor knowledge about OAD were identified as modifiable factors while co-payment, age, regimen complexity. and time since diagnosis were identified as non-modifiable factors. Most of the included studies focused on breast cancer and chronic myeloid leukemia (CML) patients. Low methodological quality and different adherence cut-off rates were observed in the included literature.

CONCLUSIONS

More research with rigorous methodology and diverse cancer types is needed to increase evidence on the reasons for OAD non-adherence. However, findings from this study may serve to aid in drafting guidelines and suitable interventions for adherence-related support to OAD users.

Online psychosocial interventions for posttreatment cancer survivors: an international evidence review and update

PURPOSE OF REVIEW

The present review describes recent research on online psychosocial interventions for posttreatment cancer survivors from January 2018 to June 2019.

RECENT FINDINGS

Twenty-three studies were included in the review (the majority included were feasibility studies and only five randomized controlled trials had large samples). Websites were the most common platforms for intervention delivery (9/23) and cognitive behavioral therapy was the most frequently used therapeutic approach (11/23). Three interventions based on this framework and delivered via websites or combined website-telehealth platforms showed to be effective in improving psychosocial issues (fear of cancer recurrence, insomnia, sleep quality, and prospective memory failures) in posttreatment cancer survivors. Web-based self-compassion writing was also found to be effective in addressing body image distress and body appreciation in breast cancer survivors. Feasibility studies mostly showed online interventions to be plausible and acceptable to cancer survivors. A good representation of online interventions for young adult cancer survivors (30%) was found.

SUMMARY

Online interventions show promise in addressing the psychosocial needs of cancer survivors. Despite new online interventions being found to be feasible and acceptable and some showing promise in addressing important psychosocial issues in cancer survivors posttreatment, more rigorous studies are required to inform supportive care for this population.

Pain Education for Adolescents and Young Adults Living Beyond Cancer: An Interdisciplinary Meeting Report

Pain is an understudied and undertreated consequence of cancer survival. Pain education is now a recommended treatment approach for persistent non-cancer pain, yet it has not been well applied to the context of adolescent and young adult (AYA) cancer survival. In March 2018, an interdisciplinary meeting was held in Adelaide, South Australia to set a research agenda for pain education in AYA cancer survivors. We identified that AYAs with persistent pain and those with heightened pain-related fear have the potential to benefit from pain education. We identified a number of unique challenges of engaging AYA survivors in pain education, and point towards future research directions.

Development of a Smartphone Program to Support Adherence to Oral Chemotherapy in People with Cancer

PURPOSE

To describe the theoretical, evidence-based and consumer-informed development of a smartphone self-management program aiming to support adherence to oral chemotherapy in adolescents and adults diagnosed with cancer.

METHODS

The design of the program followed two frameworks for the development and evaluation of mHealth interventions and was conducted in three steps: 1) conceptualization, which involved an extensive literature review and a scoping review that led to the identification of the behavioral change strategies in the program; 2) definition of features and structure, based on a formative study with end-users to explore their preferences about the structure and elements of the program; and 3) selection of program delivery technology, whereby available technology platforms were examined and the most suitable tool to deliver the program was selected.

RESULTS

Three main reasons for oral chemotherapy non-adherence were identified: forgetfulness, side-effects and poor knowledge about oral chemotherapy. Key behavior change strategies were also identified, namely, medication intake reminders and information about oral chemotherapy and managing side-effects. Based upon end-user feedback the method of delivery of these behavioral strategies that was deemed most appropriate was conventional text messages. The reminders were standard, short, text-only messages sent when each oral chemotherapy dose was due, one way (no need to reply) and addressed the end-users using their first name. Delivery of information about oral chemotherapy and side-effects was tailored to each individual's preferred frequency.

CONCLUSION

The careful design process described in this paper may serve to inform the development of future mobile phone-based medication adherence-enhancing interventions for people with cancer. A trial to explore end-users acceptability of and satisfaction with the intervention is currently underway.Trial Registration: ACTRN12618001987257p.

Mobile-Based Oral Chemotherapy Adherence-Enhancing Interventions: Scoping Review

Background

Adherence to oral chemotherapy is crucial to maximize treatment outcomes and avoid health complications in cancer patients. Mobile phones are widely available worldwide, and evidence that this technology can be successfully employed to increase medication adherence for the treatment of other chronic diseases (eg, diabetes) is well established. However, the extent to which there is evidence that mobile phone–based interventions improve adherence to oral chemotherapy is unknown.

Objective

This scoping review aims to explore what is known about mobile phone–delivered interventions designed to enhance adherence to oral chemotherapy, to examine the reported findings on the utility of these interventions in increasing oral chemotherapy adherence, and to identify opportunities for development of future interventions.

Methods

This study followed Arksey and O’Malley’s scoping review methodological framework.

Results

The review search yielded 5 studies reporting on 4 interventions with adults (aged >18 years) diagnosed with diverse cancer types. All interventions were considered acceptable, useful, and feasible. The following themes were evident: text messages and mobile apps were the main methods of delivering these interventions, the 2 most commonly employed oral chemotherapy adherence–enhancing strategies were management and reporting of drug-related symptoms and reminders to take medication, the importance of stakeholders’ engagement in intervention design, and the overall positive perceptions of delivery features. Areas for future research identified by this review include the need for further studies to evaluate the impact of mobile phone–delivered interventions on adherence to oral chemotherapy as well as the relevance for future studies to incorporate design frameworks and economic evaluations and to explore the moderator effect of high anxiety, poor baseline adherence, and longer time taking prescribed drug on adherence to oral chemotherapy.

Conclusions

Despite the increasing body of evidence on the use of mobile phones to deliver medication adherence–enhancing interventions in chronic diseases, literature on the oral chemotherapy context is lacking. This review showed that existing interventions are highly acceptable and useful to cancer patients. The engagement of stakeholders as well as the use of a design framework are important elements in the development of mobile phone–delivered interventions that can be translated into oncology settings.

The challenges of recruiting cancer patient/caregiver dyads: informing randomized controlled trials

Background

Family members are increasingly involved in the care of cancer patients, however many are not prepared for this challenging role. Intervention-based studies are valuable to inform the most appropriate and effective support for caregivers. Barriers in the recruitment of patient/caregiver dyads exist but the reasons for non-participation are less well understood. This analysis determined the factors associated with participation in a randomized controlled trial involving patient/caregiver dyads, reasons for non-participation and factors associated with these reasons.

Methods

Patients with any type of cancer (other than non-melanoma skin cancer), and their caregiver were recruited at four Australian health services. Eligible patients were invited to participate together with their caregiver (N = 737). Non-participation data were collected from non-participants. Bivariate and binary logistic regression analyses were conducted to examine factors associated with participation.

Results

Of the 737 eligible dyads, 521 (71%) declined participation. Dyad characteristics associated with participation were caregiver gender, patient treatment modality and hospital type. The odds for participating were almost two times greater for female than male caregivers (p = 0.005); 13 times greater for patients receiving chemoradiotherapy compared to radiotherapy alone (p < 0.001); and three times greater for dyads attending a private versus public hospital (p < 0.001). Reasons for non-participation were lack of interest (33%), lack of time (29%), not requiring support (23%), too burdensome (15%); factors significantly associated with these reasons were treatment modality, patient age, cancer type, and hospital type. Patients diagnosed with prostate cancer and receiving chemotherapy alone were less likely to decline due to a lack of interest. Patients more likely to decline due to lack of time were those aged 40–59 years and receiving chemotherapy alone. Patients who were more likely to decline because they felt participation was too burdensome were those attending a private hospital for treatment.

Conclusions

To optimize recruitment, it is recommended that special attention is given to different cancer types and treatment modalities, gender and age. Approaching dyads at varied time points when their need for support is high is recommended. This analysis provides important information for researchers undertaking randomized controlled trials involving people diagnosed with cancer and their caregivers.

Farmers' stress and coping in a time of drought

INTRODUCTION

Farmers as a group have unique attitudes, sources of stress and a heightened risk of suicide. In the context of a prolonged drought and associated stress and increased risk of mental-health problems, this study provides an insight into the levels of psychological distress experienced by different demographic groups within the Australian farming community. The study also addresses a significant gap in the literature by exploring ways in which this unique cohort copes and may better cope, with the inevitable challenges of life 'on the land'.

METHODS

A sample of 309 drought-affected South Australian farmers and their spouses (M=51.81, SD=11.69) completed questionnaires containing measures of psychological distress (Kessler Psychological Distress Scale) and coping (situational version of the COPE) in response to a recent stressor.

RESULTS

There was<strong> </strong>no significant difference detected between the levels of distress reported by men and women. Younger farmers (25-54 years) were experiencing significantly higher levels of distress than those in the 55-64 age group but not those aged 65-74 years. The most commonly employed coping strategies were <em>planning</em>, <em>acceptance</em> and <em>active coping</em> and least used were <em>alcohol/drug use</em>, <em>denial</em>, <em>behavioural disengagement</em> and <em>religion</em>. Gender, age-group and the type of stressor (ie farm related, non-farm related, combination) were found to affect farmers' choice of some coping strategies. A multiple regression analysis suggested that behavioural disengagement<em> </em>(&&num;946;=.28, <em>p</em> < .05),<em> suppression of competing activities </em>(&&num;946;= .20, <em>p <</em> .05)<em>, venting </em>(&&num;946;= .18, <em>p</em> < .05)<em>, </em><em>alcohol/drug use </em>(&&num;946;= .18, <em>p < </em>.05)<em>, </em>and <em>mental disengagement </em>(&&num;946;=.12, <em>p </em>< .05) all significantly and positively predicted distress in this population, collectively accounting for 34.6% of the variance.

CONCLUSION

This study offers a rare examination of farmers' psychological distress and coping in a time of drought. The results demonstrate that in this unique context it is erroneous to assume the universality of models of coping that have been validated in other samples. The results provide for the development of tailored interventions to help farmers cope more effectively during future times of drought.