Interventions for improving medical students' interpersonal communication in medical consultations.

BACKGROUND: Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES: To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS: We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS: We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence).  Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported.  AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.

A scoping review of admission criteria and selection methods in nursing education.

BACKGROUND: Nursing education institutions are required to select and train applicants who have appropriate characteristics for delivering effective healthcare. Unlike other healthcare professions and despite the need to attract and select a competent workforce, there has been no comprehensive analysis of the selection criteria and methods used to recruit nursing students. As there is relatively limited prior research available, we conducted a scoping review to explore and synthesise the existing evidence regarding admission criteria and selection methods of nursing students and for the purpose of identifying an agenda for future research in this field. METHODS: Our scoping review follows the Arksey and O'Malley five-step proposition including identifying the research question and relevant studies, study selection, tabulation of data, and summarizing and reporting the results. Seven databases (PubMed, CINAHL, Scopus, ERIC, SID, Irandoc and PsycINFO) were searched systematically using relevant keywords. Articles on admission of undergraduate nursing students published in both English and/or Persian from 2006 to 2019 were retrieved. RESULTS: Existing research evidence suggests that nursing students are largely selected on the basis of two criteria - "cognitive-academic abilities" and "non-cognitive abilities." Cognitive-academic abilities were assessed in four main dimensions of mathematics, language, natural sciences and reasoning skills mainly through standardized tests and academic records. Our review shows a wide range of non-cognitive characteristics are evaluated in nursing applicants including: morality, interpersonal communication skills and psychological strength. The selection method most commonly used to assess characteristics was through interviews (panel interviews or multiple mini interviews). Other methods included references, personal statements and personality assessment tools. CONCLUSIONS: This is the first scoping review of literature regarding nursing education selection and recruitment. Results can be used to inform nursing education policymakers and institutions in the design of their selection practices. Future research should concentrate on the evaluation and improvement methods of student selection including content and predictive validity analysis of multiple mini interview and standardized tests, development of cost-effective selection methods and job analysis studies to identify specific non-cognitive characteristics for nursing.

Use of the supportive care framework to explore haematological cancer survivors' unmet needs: a qualitative study.

BACKGROUND: Some sub-types of haematological cancers are acute and require intensive treatment soon after diagnosis. Other sub-types are chronic, relapse over many years and require life-long cycles of monitoring interspersed with bouts of treatment. This often results in significant uncertainty about the future, high levels of depression and anxiety, and reduced quality of life. Little is known about how to improve care for haematological cancer survivors. This study explored qualitatively, in a sample of haematological cancer survivors, (i) their unmet needs experienced as a result of their disease and treatment; and (ii) strategies that may help address these needs. METHODS: Semi-structured interviews were conducted with 17 adult haematological cancer survivors. Data was analysed using qualitative content analysis. The Supportive Care Framework guided data collection and analysis. RESULTS: Participants had a mean age of 57 years (SD 13). Most were male (n = 10, 59%). Five themes emerged from the data: (i) changes in unmet needs across the care trajectory (with greatest unmet needs experienced soon after diagnosis, at discharge from hospital and with cancer recurrence); (ii) informational unmet needs requiring improved patient-centred communication; (iii) uncertainty about treatment and the future; (iv) coordinated, tailored and documented post-treatment care planning as a strategy for optimal care delivery; and (v) ongoing support services to meet psychosocial and practical unmet needs by involving peer support, less bureaucratic transport services and flexible work arrangements. CONCLUSIONS: To our knowledge, this is the first qualitative investigation using the Supportive Care Framework to explore unmet needs of haematological cancer survivors. Our findings offer fresh insights into this important area of study. Written, take-home care plans which provide simple but tailored guidance on where to seek additional support may help decrease uncertainty and feelings of vulnerability post-treatment for adult haematological cancer survivors. Future research should further develop and test strategies aimed at addressing unmet needs of haematological cancer survivors identified in this study.

A national study of the unmet needs of support persons of haematological cancer survivors in rural and urban areas of Australia.

PURPOSE: This study aimed to compare support persons of haematological cancer survivors living in rural and urban areas in regard to the type, prevalence and factors associated with reporting unmet needs. METHODS: One thousand and four (792 urban and 193 rural) support persons of adults diagnosed with haematological cancer were recruited from five Australian state population-based cancer registries. Participants completed the Support Person Unmet Needs Survey (SPUNS) that assessed the level of unmet needs experienced over the past month across six domains. RESULTS: Overall, 66% of support persons had at least one 'moderate, high or very high' unmet need and 24% (n = 182) reported having multiple (i.e. 6 or more) 'high/very high' unmet needs in the past month. There were no significant differences between rural and urban support persons in the prevalence of multiple unmet needs or mean total unmet needs scores. There were however significant differences in the types of 'high/very high' unmet needs with support persons living in rural areas more likely to report finance-related unmet needs. Support persons who indicated they had difficulty paying bills had significantly higher odds of reporting multiple 'high/very high' unmet needs. CONCLUSIONS: This is the first large, population-based study to compare the unmet needs of support persons of haematological cancer survivors living in rural and urban areas. Findings confirm previous evidence that supporting a person diagnosed with haematological cancer correlates with a high level of unmet needs and highlight the importance of developing systemic strategies for assisting support persons, especially in regard to making financial assistance and travel subsidies known and readily accessible to those living in rural areas.

Dyadic interdependence of psychosocial outcomes among haematological cancer survivors and their support persons.

PURPOSE: This study aimed to explore the dyadic relationships between unmet need, depression, and anxiety in people diagnosed with haematological cancer and their support persons. METHODS: Adult survivors (18 years+) who had been diagnosed with a haematological cancer were recruited to a cross-sectional mailed survey via five state cancer registries in Australia. Participating survivors invited a support person to also complete a survey. Structural equation modelling was used to explore the relationships among survivor and support person self-reported depression, anxiety, and unmet needs. RESULTS: Of the 4299 eligible haematological cancer survivors contacted by the registries, 1511 (35%) returned a completed survey as did 1004 support persons. There were 787 dyads with complete data. After adjusting for age, gender, rurality, cancer type, and whether the support person was a relative, positive correlations were found between survivor and support person scores for depression (p = 0.0029) and unmet needs (p < 0.001), but not anxiety scores (p = 0.075). Survivor unmet needs were significantly related to support person depression (p = 0.0036). Support person unmet needs were significantly related to a higher depression score for survivors (p = 0.0067). Greater support person unmet needs were significantly related to a higher anxiety score for survivors (p = 0.0083). Survivor unmet needs did not have a significant relationship to support person anxiety (p = 0.78). CONCLUSION: Unmet needs may mediate the interdependence of psychosocial experiences for survivors and support persons, although a longitudinal study is required to confirm causality. Addressing unmet needs may be a potential target for improving outcomes for both groups.

Who are the support persons of haematological cancer survivors and how is their performance perceived?

OBJECTIVE: To explore: (1) how haematological cancer survivors and their support persons perceive the overall performance of the support person; (2) disagreement between survivor and support person ratings; and (3) characteristics associated with support persons rating their performance poorly. METHODS: This is a substudy of a larger project of Australian haematological cancer survivors and their support persons. For this substudy, haematological cancer survivors were recruited from 4 Australian population-based cancer registries and asked to pass on a questionnaire package to their support persons. Survivors who passed on a questionnaire package to their support person were asked to answer questions about the support person and how they perceived the support person's performance. Similarly, support persons answered questions on their own performance as a support person. RESULTS: A total of 924 haematological cancer survivors and 821 support persons were eligible for this study. Most survivors rated their support person as performing very well (84%) while less than half (48%) of support persons rated their own performance as very well. There was significant disagreement between survivor and their support person (dyad) ratings of the support person's performance. Support persons with above normal levels of depression (vs those with normal levels) had significantly higher odds of rating their own performance as "not well/somewhat well." CONCLUSIONS: Health care providers should consider providing additional education and skills-based interventions to support persons who experience increased symptoms of depression.

Have we got the selection process right? The validity of selection tools for predicting academic performance in the first year of undergraduate medicine.

This article was migrated. The article was marked as recommended. Content: There remains much debate over the 'best' method for selecting students in to medicine. This study aimed to assess the predictive validity of four different selection tools with academic performance outcomes in first-year undergraduate medical students. Methods: Regression analyses were conducted between admission scores on previous academic performance - the Australian Tertiary Admission Rank (ATAR), the Undergraduate Medicine and Health Sciences Admission Test (UMAT), Multiple-Mini Interview (MMI) and the Personal Qualities Assessment (PQA) with student performance in first-year assessments of Multiple Choice Questions, Short Answer Questions, Objective Structured Clinical Examinations (OSCE) and Problem-Based Learning (PBL) Tutor ratings in four cohorts of students (N = 604, 90%). Results: All four selection tools were found to have significant predictive associations with one or more measures of student performance in Year One of undergraduate medicine. UMAT, ATAR and MMI scores consistently predicted first year performance on a number of outcomes. ATAR was the only selection tool to predict the likelihood of making satisfactory progress overall. Conclusions: All four selection tools play a contributing role in predicting academic performance in first year medical students. Further research is required to assess the validity of selection tools in predicting performance in the later years of medicine.

How can we help haematological cancer survivors cope with the changes they experience as a result of their cancer?

Haematological cancer often necessitates that individuals make significant lifestyle and behaviour changes to protect themselves against infections. It is essential that haematological cancer survivors receive the support and information they require to adjust to such changes. This cross-sectional survey of 259 haematological cancer survivors found that over two thirds of haematological cancer survivors would like to receive more detailed information or help with: diet and nutrition that takes into account their diagnosis and treatment, how to manage the symptoms from the cancer and/or treatment, signs and symptoms to be aware of that may indicate a possible infection and appropriate exercise. Over a third of survivors reported that they had to make changes to reduce their chance of infection, with social restriction the most commonly reported area of change survivors made. Improving communication and access to care and providing additional emotional support may assist survivors in making these additional changes. Healthcare providers should use this information to better support haematological cancer survivors in dealing with the effects haematological cancer has on their life.

To adhere or not to adhere: Rates and reasons of medication adherence in hematological cancer patients.

To conduct a comprehensive review to examine among hematological cancer patients: (1) rates of adherence to self-administered cancer treatments; and (2) factors impacting on their adherence. Fifty two eligible publications were identified. The majority focused on Chronic Myeloid Leukaemia (CML) (n=40) and Acute Lymphoid Leukaemia (ALL) (n=11) patients. Adherence rates varied and depended on the definition and measures used. Patient understanding about their disease and treatment, and forgetting to take their medication impacted on patients' level of adherence; while the use of reminders reduced forgetfulness. There is a lack of valid and reliable information relating to medication adherence of hematological cancer patients. Based on the limited data available we provide a profile of CML and ALL patients at potential risk of medication non-adherence, as well as a proposed checklist that can be used by health care providers in assessing and supporting patients in adhering to their medication.

Attitudes and Beliefs of Nonspecialist and Specialist Trainee Health and Physical Education Teachers Toward Obese Children: Evidence for "Anti-Fat" Bias.

BACKGROUND: The aim of this study was to assess the beliefs and attitudes of preservice health and physical education (HPE) specialist and nonspecialist schoolteachers toward obese children. METHODS: A total of 177 nonspecialist and 62 HPE specialist trainee teachers completed a series of pen-and-paper validated measures of attitudes and beliefs toward obese children. RESULTS: Both groups of preservice teachers reported strong implicit and moderate explicit anti-fat bias. Enrollment in the HPE specialist degree was found to be a significant predictor of both implicit bad/good anti-fat bias (ß = 3.97, p = .002) and implicit bias on the stupid/smart scale (ß = 2.983, p = .016) of the IAT. Beliefs that obese children were less healthy, more self-conscious, and less satisfied with themselves were strongly endorsed by the majority of participants. HPE specialists were found to have significantly lower expectations for obese children in regard to "reasoning" (mean difference = 0.21, p = .0107) and "cooperation" skills (mean difference = 0.25, p = .0354) compared to nonspecialist trainees. CONCLUSIONS: This study is the first to document the strong anti-fat bias of both preservice nonspecialist and HPE specialist teachers. It is also the first to find that preservice HPE specialist teachers have stronger anti-fat biases and differential expectations regarding particular abilities of obese children, compared to nonspecialists.

Targeting multiple health risk behaviours among vocational education students using electronic feedback and online and telephone support: protocol for a cluster randomised trial.

BACKGROUND: Technical and Further Education (TAFE) colleges are the primary provider of vocational education in Australia. Most TAFE students are young adults, a period when health risk behaviours become established. Furthermore, high rates of smoking, risky alcohol consumption, inadequate fruit and vegetable intake and insufficient physical activity have been reported in TAFE students. There have been no intervention studies targeting multiple health risk behaviours simultaneously in this population. The proposed trial will examine the effectiveness of providing TAFE students with electronic feedback regarding health risk behaviours and referral to a suite of existing online and telephone services addressing smoking, risky alcohol consumption, fruit and vegetable intake, and physical activity levels. METHODS/DESIGN: A two arm, parallel, cluster randomised trial will be conducted within TAFE campuses in New South Wales (NSW), Australia. TAFE classes will be randomly allocated to an intervention or control condition (50 classes per condition). To be eligible, students must be: enrolled in a course that runs for more than 6 months; aged 16 years or older; and not meet Australian health guideline recommendations for at least one of the following: smoking, alcohol consumption, fruit and/or vegetable intake, or physical activity. Students attending intervention classes, will undertake via a computer tablet a risk assessment for health risk behaviours, and for behaviours not meeting Australian guidelines be provided with electronic feedback about these behaviours and referral to evidence-based online programs and telephone services. Students in control classes will not receive any intervention. Primary outcome measures that will be assessed via online surveys at baseline and 6 months post-recruitment are: 1) daily tobacco smoking; 2) standard drinks of alcohol consumed per week; 3) serves of fruit consumed daily; 4) serves of vegetables consumed daily; and 5) metabolic equivalent minutes of physical activity per week. DISCUSSION: Proactive enrolment to existing online and telephone services has the potential to address modifiable determinants of disease. This trial will be the first to examine a potentially scalable intervention targeting multiple health risk behaviours among students in the vocational training setting. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615000105549; Registered 5/2/15.

What do haematological cancer survivors want help with? A cross-sectional investigation of unmet supportive care needs.

BACKGROUND: This study aimed to identify the most prevalent unmet needs of haematological cancer survivors. METHODS: Haematological cancer survivors aged 18-80 years at time of recruitment were selected from four Australian state cancer registries. Survivors completed the Survivor Unmet Needs Survey. The most frequently reported "high/very high" unmet needs items were identified, as well as characteristics associated with the three most prevalent "high/very high" unmet needs reported by haematological cancer survivors. RESULTS: A total of 715 eligible survivors returned a completed survey. "Dealing with feeling tired" (17%), was the most frequently endorsed "high/very high" unmet need. Seven out of the ten most frequently endorsed unmet needs related to emotional health. Higher levels of psychological distress (e.g., anxiety, depression and stress) and indicators of financial burden as a result of cancer (e.g., having used up savings and trouble meeting day-to-day expenses due to cancer) were consistently identified as characteristics associated with the three most prevalent "high/very high" unmet needs. CONCLUSIONS: A minority of haematological cancer survivors endorsed a "high/very high" unmet need on individual items. Additional emotional support may be needed by a minority of survivors. Survivors reporting high levels of psychological distress or those who experience increased financial burden as a result of their cancer diagnosis may be at risk of experiencing the most prevalent "high/very high" unmet needs identified by this study.

Are Australian clinicians monitoring medication adherence in hematological cancer survivors? Two cross-sectional studies.

BACKGROUND: Hematological cancer survivors are growing in number and increasingly rely on oral therapy. Given known poor outcomes associated with non-adherence and previous evidence that many patients do not fully adhere to their treatment regimen, this study aimed to determine the degree to which clinicians monitor adherence to oral medication in hematological cancer survivors. METHODS: Data was combined from two cross-sectional surveys of a heterogeneous sample of 431 hematological cancer survivors recruited from three outpatient hematology clinics in three different states (n = 215) and one state cancer registry (n = 216) in Australia. Participants completed a self-administered survey that included demographic characteristics and a 7-item measure of medication adherence developed by the researchers specifically for the purpose of the studies. RESULTS: Of the 431 participants, 37 % (n = 160) reported currently taking daily cancer-related medication. Of these, 14 % (n = 23) were found to be non-adherent with 'missing a dose' being the most commonly reported non-adherent behaviour. Only 41 % of survivors indicated that their hematologist or cancer clinician had 'always' asked about their cancer-related medication during their last six visits. CONCLUSIONS: Non-adherence to oral therapy remains a problem in hematological cancer survivors, yet clinicians in Australia do not appear to be regularly monitoring adherence in their patients. Given an increasing dependence on oral therapy in clinical hematology and medical oncology and the importance of medication adherence to optimising health outcomes, greater effort should be invested in developing effective interventions to improve support and adherence monitoring by cancer clinicians and GPs.

The Survivor Unmet Needs Survey (SUNS) for haematological cancer survivors: a cross-sectional study assessing the relevance and psychometric properties.

BACKGROUND: Relevant and psychometrically sound needs assessment tools are necessary for accurate assessment of haematological cancer survivors unmet needs. No previous study has developed nor psychometrically evaluated a comprehensive needs assessment tool for use with population-based samples of haematological cancer survivors. This study aimed to assess the validity and reliability of the Survivor Unmet Needs Survey (SUNS) with haematological cancer survivors. METHODS: The relevance, content and face validity of the SUNS to haematological cancer survivors was assessed using qualitative interviews. Psychometric evaluation was conducted using data collected from haematological cancer survivors, aged 18-80 years at recruitment and recruited from four Australian cancer registries. Construct, convergent and discriminant validity; internal reliability and floor and ceiling effects were assessed. A second survey was completed by a sub-sample of survivors recruited from two of the four registries to assess test-retest reliability. RESULTS: Results from 17 qualitative interviews confirmed the relevance, face and content validity of the original items of the SUNS for use with haematological cancer survivors. Overall, 1,957 eligible haematological cancer survivors were contacted by the cancer registries. Of these 1,280 were sent a survey, and 715 returned a survey (37% of eligible survivors contacted and 56% of survivors sent a survey). A total of 529 survivors completed all 89 items of the SUNS and were included in the exploratory factor analysis. Exploratory factor analysis supported the original five-factor structure of the SUNS. Evidence for convergent validity was established, with all five domains of the SUNS illustrating a moderate positive correlation with all three subscales of the Depression Anxiety and Stress Scale (DASS-21). All Cronbach's alpha values were above 0.9 and all corrected item-total correlations were acceptable (>0.2). Criteria for discriminant validity was not met, with only 10 of the 15 (67%) a-priori hypotheses supported. Test-retest reliability was acceptable for 40 of the 89 items (45%) and for three of the five domains. Significant floor effects were evident for all five domains. CONCLUSIONS: The SUNS demonstrates evidence for multiple features of validity and reliability as a measure of unmet needs for haematological cancer survivors. However, evidence supporting some psychometric properties was limited.

Factors associated with haematological cancer survivors experiencing a high level of unmet need across multiple items of supportive care: a cross-sectional survey study.

PURPOSE: This study aimed to identify subgroups of haematological cancer survivors who report a "high/very high" level of unmet need on multiple (≥7) items of supportive care. METHODS: Haematological cancer survivors, aged 18 to 80 years at recruitment were selected from four Australian state-based cancer registries. Eligible survivors were sent a survey containing the Survivor Unmet Needs Survey (SUNS). Logistic regression analysis was used to identify characteristics associated with haematological cancer survivors reporting a "high/very high" level of unmet need on ≥7 items of the SUNS. RESULTS: Of the 696 survivors included in this study, 175 (n = 25 %) reported a "high/very high" level of unmet need on seven or more items of the SUNS. Survivors who: had relocated due to their cancer (OR: 2.04; 95 % CI: 1.18, 3.52), had difficulty paying bills (OR: 2.42; 95 % CI: 1.34, 4.38), had used up their savings as a result of cancer (OR: 1.90; 95 % CI: 1.06, 3.40), and were classified as having above normal symptoms of depression (OR: 3.65; 95 % CI: 2.17, 6.15) and stress (OR: 5.94; 95 % CI: 3.22, 10.95) on the Depression Anxiety and Stress Scale-21 (DASS-21) had statistically significantly higher odds of reporting seven or more "high/very high" unmet needs. CONCLUSIONS: Additional and intensive supportive care may be needed for this subgroup of haematological cancer survivors experiencing multiple "high/very high" unmet needs. Assistance with accessing relevant financial support and highly accessible services that provide emotional and information support, such as online and telephone peer support programs may prove beneficial in addressing the needs of this subgroup of haematological cancer survivors. It is suggested that future, methodologically rigorous intervention studies assess such strategies.

Keeping the 'goose' on the menu: response to commentaries on financial incentives in health behaviour change.

We welcome the commentaries by Hagger et al.and Stephens and consider their observations to be timely and constructive. Hagger et al. raise concerns regarding the sustainability of behaviour change once incentives have been removed and their influence on intrinsic motivation. We concur that questions regarding both of these issues remain but argue that, in the case of sustainability, there is some evidence to support long-term behaviour change, given particular conditions. Given that the question of maintenance is applicable to any health intervention, we propose that the role of incentives may be better matched with motivating initial behaviour change, and researchers should explore other mechanisms for sustaining behaviour change and intrinsic motivation, over a longer period of time. Stephens highlights the complexity of health behaviours and warns of the dangers associated with taking an individualised approach to health promotion. We support the need for both downstream and upstream approaches to reducing health inequalities and contend that financial incentives still have a potential role to play in encouraging health behaviour change.

Keeping the 'Goose' on the Menu: Response to Commentaries on Financial Incentives in Health Behaviour Change.

We welcome the commentaries by Hagger et al. and Stephens and consider their observations to be timely and constructive. Hagger et al. raise concerns regarding the sustainability of behaviour change once incentives have been removed and their influence on intrinsic motivation.We concur that questions regarding both of these issues remain but argue that, in the case of sustainability, there is some evidence to support long-term behaviour change, given particular conditions. Given that the question of maintenance is applicable to any health intervention, we propose that the role of incentives may be better matched with motivating initial behaviour change, and researchers should explore other mechanisms for sustaining behaviour change and intrinsic motivation, over a longer period of time.Stephens highlights the complexity of health behaviours and warns of the dangers associated with taking an individualised approach to health promotion.We support the need for both downstream and upstream approaches to reducing health inequalities and contend that financial incentives still have a potential role to play in encouraging health behaviour change.

Supportive care needs of hematological cancer survivors: a critical review of the literature.

The purpose of this review was to determine the perceived supportive care needs of hematological cancer survivors, and the patient characteristics associated with higher levels of need. Medline, PsychInfo, CINAHL, EMBASE and PsycEXTRA, were searched for eligible articles published between 1979 and 2011. Ten full-text articles were identified. Extensive variation among study populations, methodologies and needs assessment measures used, made it difficult to synthesize results. Consequently, we could not confidently determine the most prevalent perceived needs of hematological cancer survivors. However, the limited data loosely suggests that concerns surrounding cancer recurrence and survival may be predominant needs experienced by hematological cancer survivors. Younger survivors were also identified by several studies as reporting higher levels of several areas of need. Future research is needed to assess the supportive care needs of large heterogeneous, population-based samples of hematological cancer survivors, utilizing valid, reliable and standardized measures of supportive care needs.

Unmet needs of Australian and Canadian haematological cancer survivors: a cross-sectional international comparative study.

OBJECTIVE: Few population-based studies have assessed the needs of haematological cancer survivors or conducted international comparisons. We aimed to assess and compare the unmet needs of Australian and Canadian haematological cancer survivors. METHODS: Two cross-sectional datasets were analysed. Survivors were recruited from population-based cancer registries and sent a self-report survey containing the Survivors Unmet Needs Survey. Australians were aged 18-80 years at the time of study and diagnosed in the last 3 years. Canadians were diagnosed 1-5 years prior and aged 19 years and over at diagnosis. RESULTS: A total of 268 Australian and 169 Canadian survivors returned a completed survey. 'Dealing with feeling tired' was identified as the highest concern by survivors. Country (LRχ(2)=4.0(1), p=0.045) was associated with survivors reporting a 'high/very high' unmet need with 'worry about earning money,' with Australians reporting marginally nonsignificantly higher odds than Canadians (OR 2.1; 95% CI; 0.99, 4.3). Country was not significantly associated with any other outcome. Having a personal expense in the last month as a result of having cancer, younger age at diagnosis, female sex, vocational or other level education, and consulting a health care professional for cancer treatment or concerns about cancer in the last month were associated with multiple areas of need. CONCLUSIONS: Australian and Canadian haematological cancer survivors were found to experience similar levels of unmet needs. Overall, haematological cancer survivors may require additional assistance in dealing with feeling tired.

Format and readability of an enhanced invitation letter did not affect participation rates in a cancer registry-based study: a randomized controlled trial.

OBJECTIVES: To assess the effectiveness of an "enhanced" invitation letter in increasing participation in an Australian cancer registry-based study and assess the representativeness of the study sample. STUDY DESIGN AND SETTING: Eight hundred hematological cancer survivors, diagnosed within the last 3 years and aged 18-80 years at recruitment, were selected from one Australian state-based cancer registry. Half were randomly allocated to receive the standard invitation letter (control group). The remaining half received a modified invitation letter, incorporating content and design characteristics recommended to improve written communication (intervention group). RESULTS: Of the 732 eligible survivors, 268 (37%) returned a completed survey. There was no difference in participation between the intervention (n = 131, 36%) and control groups (n = 137, 38%; P = 0.53). Participants were representative of the population for characteristics assessed, except for age group at diagnosis. Survivors 50 years or older at diagnosis had higher odds of returning a completed survey, 50-59 (odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.47, 4.35), 60-69 (OR: 2.69; 95% CI: 1.58-4.58), and 70-80 (OR: 1.90; 95% CI: 1.07-3.35), than survivors aged 15-39 years at diagnosis. CONCLUSION: An enhanced invitation letter was not effective in increasing participation of hematological cancer survivors in an Australian cancer registry study. The study sample was moderately representative on variables assessed, with age group at diagnosis the only variable associated with participation. Research should evaluate strategies to increase participation in registry studies and focus on tailoring techniques to patient's age.