Adequacy of health message tailoring for ethnic minorities: Pasifika communities in Sydney, Australia, during COVID-19.

Ethnic minorities, such as Pasifika, residing in high-income countries were at higher risk of COVID-19 infection during the pandemic. To understand the experiences of Pasifika, including message dissemination and barriers to tailored public health messaging during the pandemic, a qualitative study was undertaken, underpinned by Laswell's Model of Communication and Bandura's social cognitive theory with data collected using Pasifika methods. Pasifika adults (n = 65) were recruited across Sydney from July 2020 to March 2022. Health care professionals (HCP) (n = 17) employed by four local health districts (LHDs) and Pasifika community-based organizations delivering multicultural COVID-19-related work within the study catchment, were also recruited. Five themes were constructed from the data of: (i) prevailing fear and uncertainty over COVID-19 infection and losing employment; (ii) limited knowledge of government perpetuating distrust in Government as a benevolent source of information; (iii) faith and trust as priorities for health decision-making; (iv) 'Coconut wireless'-the role of family, friends and community in disseminating public health messages through word of mouth; and (v) limited health literacy affecting compliance with public health orders. Community members identified important messages and resources had not been sufficiently distributed. Most HCPs understood the necessity of grassroots-level engagement but reported existing approaches were inadequate to navigate challenges. These findings highlight the need for public health promotion and communication strategies that consider both the social and cultural determinants of health. We propose a 7-point checklist as a cultural appropriateness lens to assist the development and rating of existing or new health promotion messaging and resources.

Prospective cohort study investigating quality of life outcomes following multi-speciality robotic-assisted surgery.

INTRODUCTION: Despite recent evidence on the surgical outcomes of robotic-assisted surgery (RAS), other patient centre outcomes, including quality of life (QOL), are lacking. This study aims to examine changes in QoL trajectories following RAS across different surgical specialities. PATIENTS AND METHODS: A prospective cohort study was conducted for patients undergoing urologic, cardiothoracic, colorectal or benign gynaecological RAS, between June 2016 and January 2020 at a tertiary referral hospital in Australia. QoL was measured using the 36-item Short-Form Health Survey at pre-operative, 6 weeks and 6 months postoperatively. Physical and mental summary scores and utility index were primary outcomes, and sub-domains were secondary outcomes. STATISTICAL ANALYSIS USED: Mixed-effects linear regressions were used to determine changes in QoL trajectories. RESULTS: Of the 254 patients undergoing RAS, 154 underwent urologic, 36 cardiothoracic, 24 colorectal and 40 benign gynaecological surgery. Overall, the average age was 58.8 years and most patients were male (75.1%). Physical summary scores significantly decreased from pre-operative to 6 weeks' post-operative in urologic and colorectal RAS; with all surgical specialities at least returning to pre-operative levels within 6 months postoperatively. Mental summary scores consistently increased from pre-operative to 6 months postoperatively for colorectal and gynaecological RAS. CONCLUSIONS: RAS contributed to positive changes in QoL, with physical health returning to the pre-operative level and mental health improvements across specialities, in the short term. While degrees of post-operative changes varied amongst specialities, significant improvements demonstrate benefits in RAS.

Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study.

BACKGROUND: Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery. METHODS: The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if > 70% of participants indicated agreement on each research priority. RESULTS: A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery. CONCLUSIONS: This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery.

Depression, Anxiety, Stress and Distress Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Results of a Prospective Cohort Study.

The aim of this study was to describe the levels of depression, anxiety, stress, and distress in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The 21-item Depression, Anxiety and Stress Scale (DASS-21) and Distress Thermometer were administered preoperatively, postoperatively day 10, and at hospital discharge to 169 patients with peritoneal carcinomatosis undergoing CRS and HIPEC. The mean preoperative values for DASS-21 subscale scores were 4.7 (depression), 4.2 (anxiety), and 8.4 (stress), and the mean preoperative Distress Thermometer rating was 4.0. No significant changes in levels of depression, stress, or distress were noted thereafter. The DASS-21 anxiety subscale score significantly increased at hospital discharge (p = .005). Higher levels of preoperative psychological depression, anxiety, stress and distress were associated with worse mental component scores. Higher preoperative depression levels were associated with the provision of more clinical psychologist occasions of service, and higher preoperative distress levels were associated with younger age. Preoperative psychological measures are important for ensuring CRS and HIPEC patients that require additional support are identified and provided with ongoing psychological interventions.

Co-designed, culturally tailored cervical screening education with migrant and refugee women in Australia: a feasibility study.

BACKGROUND: Participation of culturally and linguistically diverse (CALD) women from migrant and refugee backgrounds in cervical screening is crucial to eliminate cervical cancer as a public health problem within the next 20 years. However, CALD women report low participation in cervical screening. Barriers to participation can be addressed with culturally tailored, community-based programs. There is a need for research to explore the process, feasibility, acceptability and barriers to cultural tailoring in the delivery and evaluation of cervical screening health education. METHODS: CALD community health workers took part in a 2 day training program then co-designed, culturally tailored and co-facilitated cervical screening health promotion forums within their communities. Forums were delivered to a total of seven groups, involving 12 sessions and 71 CALD women. The forums were evaluated for feasibility, acceptability, implementation and effectiveness using a survey, interviews and observations. Data were collected from CALD women, facilitators and researchers. RESULTS: The co-design and co-delivery of cervical screening health promotion forums was time and resource intensive however allowed for deeper cultural tailoring resulting in engagement with 'hard to reach' CALD women, improved health literacy and intention to screen. Flexibility in the intervention implementation was crucial to ensure forums were responsive to community interests and needs. Online delivery of the forums in response to the COVID-19 pandemic was acceptable to most groups. CONCLUSIONS: Co-designed, culturally tailored cervical screening health promotion forums are feasible and acceptable to CALD women, in both face-to-face and online formats. Adjustments to the intervention protocol were recommended to improve future implementation.

Barriers and enablers of weight management after breast cancer: a thematic analysis of free text survey responses using the COM-B model.

BACKGROUND: Weight gain is common after breast cancer. The aim of this study was to identify and describe the barriers to and enablers of successful weight management for women with breast cancer. METHODS: This was a combined inductive and deductive framework analysis of free text responses to an anonymous cross-sectional survey on weight after breast cancer. Women were recruited mainly through the Breast Cancer Network Australia Review and Survey Group. We applied deductive thematic analysis to free text responses to questions on barriers, enablers, research priorities, and one open-ended question at the end of the survey using the Capability, Opportunity, Motivation and Behaviour (COM-B) model as a framework. Subthemes that arose from the inductive analysis were mapped onto the COM-B model framework. Findings were used to identify behaviour change intervention functions. RESULTS: One hundred thirty-three women provided free text responses. Most women were of Caucasian origin and had been diagnosed with non-metastatic breast cancer, with a mean age of 59.1 years. Women's physical capability to adopt and sustain healthy lifestyle habits was significantly affected by treatment effects and physical illness, and some lacked psychological capability to self-regulate the face of stress and other triggers. Limited time and finances, and the social impact of undergoing cancer treatment affected the ability to control their diet. Frustration and futility around weight management were prominent. However, some women were confident in their abilities to self-regulate and self-monitor lifestyle behaviours, described support from friends and health professionals as enablers, and welcomed the physical and psychological benefits of being active in the context of embracing transformation and self-care after cancer. CONCLUSION: Women need specific advice and support from peers, friends and families and health professionals. There is a substantial gap in provision of supportive care to enable women to adopt and sustain healthy lifestyles. Environmental restructuring (including financial support), incentivization (creating an expectation of looking and feeling better), persuasion and coercion (aiming to prevent recurrence), and equipping women with specific knowledge and skills, would also facilitate optimal lifestyle behaviours and weight management.

Implementation of robotic-assisted total knee arthroplasty in the public health system: a comparative cost analysis.

PURPOSE: Robotic-assisted total knee arthroplasty (TKA) may improve the precision of bone preparation and component alignment when compared to the conventional surgical approach; however, the detailed cost analysis of robotic-assisted TKA is lacking. This study aims to compare in-hospital costs between robotic-assisted and computer-navigated TKA. METHODS: Patients undergoing primary TKA at a public hospital in Sydney between October 2018 and June 2019 were included. Patient demographics, surgical outcomes and in-hospital cost variables including, staff, critical care, emergency department, diagnostic, prosthesis, operating room, ward and other related costs until the discharge to the community were collected. Differences across in-hospital costs between robotic-assisted and computer-navigated TKA were compared using independent Student's t-tests. RESULTS: Of the 258 primary TKAs, 181 (70.2%) were computer-navigated and 77 (29.8%) robotic-assisted. Surgical time (p < 0.001) and operating time (p < 0.001) were both significantly shorter in computer-navigated TKA, while robotic-assisted TKA cases were more likely to be discharged directly home without extended in-patient rehabilitation (p = 0.014). When removing the capital costs of surgical equipment and maintenance, there was no difference in total in-hospital cost between computer-navigated ($19,512.3) and robotic-assisted TKA ($18,347.1; p = 0.179). When these capital costs were included, the mean in-hospital cost of robotic-assisted surgery was $21,507.6 compared to $19,659.7 for computer-navigated TKA (p = 0.034). CONCLUSIONS: The total in-hospital cost, during the implementation period of robotic-assisted TKA, is comparable with computer-navigated TKA. Robotic-assisted TKA was significantly more expensive when the upfront cost of the robotic system and maintenance costs were included. Longer term cost benefit of robotic-assisted TKA should be investigated in future studies.

Surgical outcomes for people with serious mental illness are poorer than for other patients: a systematic review and meta-analysis.

OBJECTIVE: To assess the association between having a serious mental illness and surgical outcomes for adults, including in-hospital and 30-day mortality, post-operative complications, and hospital length of stay. STUDY DESIGN: Systematic review and meta-analysis of publications in English to 30 July 2018 of studies that examined associations between having a serious mental illness and surgical outcomes for adults who underwent elective surgery. Primary outcomes were in-hospital and 30-day mortality, post-operative complications, and length of hospital stay. Risk of bias was assessed with the Quality in Prognosis Studies (QUIPS) tool. Studies were grouped by serious mental illness diagnosis and outcome measures. Odds ratios (ORs) or mean differences (MDs), with 95% confidence intervals (CIs), were calculated in random effects models to provide pooled effect estimates. DATA SOURCES: MEDLINE, EMBASE, PsychINFO, and the Cochrane Library. DATA SYNTHESIS: Of the 3824 publications identified by our search, 26 (including 6 129 806 unique patients) were included in our analysis. The associations between having any serious mental illness diagnosis and having any post-operative complication (ten studies, 125 624 patients; pooled effect: OR, 1.44; 95% CI, 1.15-1.79) and a longer stay in hospital (ten studies, 5 385 970 patients; MD, 2.6 days; 95% CI, 0.8-4.4 days) were statistically significant, but not those for in-hospital mortality (three studies, 42 926 patients; OR, 1.21; 95% CI, 0.69-2.12) or 30-day mortality (six studies, 83 013 patients; OR, 1.85; 95% CI, 0.86-3.99). CONCLUSIONS: Having a serious mental illness is associated with higher rates of post-operative complications and longer stays in hospital, but not with higher in-hospital or 30-day mortality. Targeted pre-operative interventions may improve surgical outcomes for these vulnerable patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018080114 (prospective).

Surgical experience for patients with serious mental illness: a qualitative study.

BACKGROUND: People with serious mental illness (SMI) have significantly worse surgical outcomes compared to the general population. There are many contributing factors to this complex issue, however consideration of the surgical experience from the patient's own perspective has never been undertaken. This lack of understanding prevents the provision of truly patient centred care and may limit the impact of potential improvement initiatives. Therefore this study aims to describe and better understand the surgical experience from the perspective of patients with SMI. METHODS: Within this qualitative study, semi-structured, audio-recorded interviews were conducted between August 2019 - June 2020, with 10 consenting participants with SMI who had surgery in the previous 2 years. A thematic analysis approach was used to explore both the positive and negative aspects of the participant's surgical experience commencing from pre-operative consultation to hospital discharge and follow-up. RESULTS: Four main themes and related subthemes emerged including i) the perceived lack of mental ill health recognition, ii) highly variable patient and clinician interactions, iii) the impact of healthcare services, and iv) strategies for improvement. CONCLUSION: Surgical patients with SMI want to be treated like everyone else whilst still having their mental ill health acknowledged and proactively managed despite this rarely occurring, which is valuable information for all surgical teams to consider and learn from. Participants were able to describe several readily implementable strategies to potentially improve their care and overall surgical experience, and as such highlight considerable opportunities for these to be tested and evaluated for this underserved patient group.

Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload.

BACKGROUND: A barrier to the uptake of robotic-assisted surgery (RAS) continues to be the perceived high costs. A lack of detailed costing information has made it difficult for public hospitals in particular to determine whether use of the technology is justified. This study aims to provide a detailed description of the patient episode costs and the contribution of RAS specific costs for multiple specialties in the public sector. METHODS: A retrospective descriptive costing review of all RAS cases undertaken at a large public tertiary referral hospital in Sydney, Australia from August 2016 to December 2018 was completed. This included RAS cases within benign gynaecology, cardiothoracic, colorectal and urology, with the total costs described utilizing various inpatient costing data, and RAS specific implementation, maintenance and consumable costs. RESULTS: Of 211 RAS patients, substantial variation was found between specialties with the overall median cost per patient being $19,269 (Interquartile range (IQR): $15,445 to $32,199). The RAS specific costs were $8828 (46%) made up of fixed costs including $4691 (24%) implementation and $2290 (12%) maintenance, both of which are volume dependent; and $1848 (10%) RAS consumable costs. This was in the context of 37% robotic theatre utilisation. CONCLUSIONS: There is considerable variation across surgical specialties for the cost of RAS. It is important to highlight the different cost components and drivers associated with a RAS program including its dependence on volume and how it fits within funding systems in the public sector.

Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Early Results from a Prospective Cohort Study of 115 Patients.

BACKGROUND: This study aimed to describe short- and medium-term longitudinal quality-of-life (QoL) outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: Consecutive patients undergoing CRS and HIPEC were recruited. The primary outcome was QoL, measured using the short-form 36 questionnaire and expressed as a physical component score (PCS) and a mental component score (MCS), with higher scores representing better QoL. Data were collected prospectively at baseline and before discharge, then 3, 6, and 12 months postoperatively. Trajectories of the PCS and MCS were described for the study period and grouped according to a peritoneal carcinomatosis index (PCI) (≤ 12 vs. ≥ 13) and a completeness of cytoreduction (CC) score (CC0 vs. CC1-CC3). RESULTS: Overall, 117 patients underwent CRS and HIPEC and 115 (98.3%) of the 117 patients participated in the study. The main primary pathology was colorectal in 52 (45%) of the 115 patients and appendiceal in 27 (23.5%) of the 115 patients. The median baseline PCS [48.16; interquartile range (IQR), 38.6-54.9] had decreased at pre-discharge (35.34; IQR, 28.7-41.8), then increased slightly at 3 months (42.54; IQR, 37.6-51.6), before returning to baseline within 6 months (48.35; IQR, 39.1-52.5) and remaining unchanged 12 months after surgery (48.55; IQR, 40.8-55.5). The MCS remained unchanged during the study period. The patients with a PCI of 13 or higher had worse PCS and MCS during the postoperative period than the patients with a PCI of 12 or lower. CONCLUSIONS: The CRS and HIPEC procedures impaired PCS, with scores returning to baseline within 6 months after surgery, whereas MCS remained unchanged. The patients with a lower PCI had better postoperative QoL outcomes. For patients with peritoneal malignancy, CRS and HIPEC can be performed with acceptable short- to medium-term QoL outcomes.

"We need a one-stop-shop": co-creating the model of care for a multidisciplinary memory clinic with community members, GPs, aged care workers, service providers, and policy-makers.

BACKGROUND: Timely diagnosis of dementia has a wide range of benefits including reduced hospital emergency department presentations, admissions and inpatient length of stay, and improved quality of life for patients and their carers by facilitating access to treatments that reduce symptoms, and allow time to plan for the future. Memory clinics can provide such services, however there is no 'gold standard' model of care. This study involved the co-creation of a model of care for a new multidisciplinary memory clinic with local community members, General Practitioners (GPs), policy-makers, community aged care workers, and service providers. METHODS: Data collection comprised semi-structured interviews (N = 98) with 20 GPs, and three 2-h community forums involving 53 seniors and community/local government representatives, and 25 community healthcare workers. Interviews and community forums were audio-recorded, transcribed verbatim, and coded by thematic analysis using Quirkos. RESULTS: GPs' attitudes towards their role in assessing people with dementia varied. Many GPs reported that they found it useful for patients to have a diagnosis of dementia, but required support from secondary care to make the diagnosis and assist with subsequent management. Community forum participants felt they had a good knowledge of available dementia resources and services, but noted that these were highly fragmented and needed to be easier to navigate for the patient/carer via a 'one-stop-shop' and the provision of a dementia key worker. Expectations for the services and features of a new memory clinic included diagnostic services, rapid referrals, case management, education, legal services, culturally sensitive and appropriate services, allied health, research participation opportunities, and clear communication with GPs. Participants described several barriers to memory clinic utilisation including transportation access, funding, awareness, and costs. CONCLUSION: This study demonstrates the importance of working with stakeholders to co-design models of care for people with dementia that take into account the local communities' needs. Findings pave the way for the development of a potential new "gold standard" memory clinic model of care and operationalise new national clinical guidelines.

Diabetes, its risk factors and readiness to change lifestyle behaviours among Australian Samoans living in Sydney: Baseline data for church-wide interventions.

OBJECTIVES: To describe the current prevalence of type 2 diabetes (diabetes) and readiness to change diet and physical activity among Samoans associated with churches in Sydney. METHODS: Residents aged ≥18 years attending four Samoan churches in Sydney were invited to participate in a church-wide lifestyle intervention. Participants completed questionnaires, anthropometric measurements, provided a non-fasting blood sample for HbA1c and random blood glucose (RBG) measurement, and performed a 6-minute walk test. Obesity was defined using a Pacific body mass index (BMI) threshold ≥32 kg/m2 and diabetes if HbA1c was ≥6.5%. RESULTS: In total, 131/187 (70%) of Samoans (mean age of 44.1 ± 15 years; Female 52%) participated. Diabetes was present in 33% of the population which included 20% previously diagnosed diabetes, duration 13.4 ± 6.7 years, (HbA1c 8.3 ± 2.5% and RBG 10.2 ± 4.1 mmol/L) and 13% had undiagnosed diabetes (HbA1c 8.1 ± 2.7% and RBG 10.3 ± 4.7 mmol/L). The overall baseline prevalence of obesity, high blood pressure and meeting the physical activity recommendation of ≥150 min/wk were 77%, 44% and 38% respectively. Over 90% of participants were contemplating, if not already taking action towards healthier diet choices and increasing physical activity. CONCLUSIONS: Prevalence of diabetes and its risk factors were high among Samoans in Sydney with a high proportion with undiagnosed diabetes. SO WHAT?: These findings highlight the need to prioritise the delivery of culturally appropriate interventions tailored to the needs of the Samoan community. The high level of healthy lifestyle contemplation suggests that the community would be receptive to such interventions.

Samoan migrants' perspectives on diabetes: A qualitative study.

ISSUE ADDRESSED: The Samoan community in Australia has one of the highest rates of diabetes in Australia. We explored the experiences and perceptions of Samoan patients living with diabetes and their family members. METHODS: Semi-structured interviews were conducted with adults from a Samoan background living in Australia who had diabetes and their family members. Participants were recruited from a single general practice with a high proportion of Pacific Islander patients, through self-response to waiting room flyers. Inductive thematic analysis was conducted using a constructivist-grounded theory approach. This qualitative project was part of the developmental phase of a larger project aiming to promote healthy lifestyles and decrease diabetes in the Samoan community in Sydney, Australia. RESULTS: Twenty participants, aged 36-67 years, were interviewed. The majority was men (n = 13) and all were migrants to Australia. Participants reported a range of barriers to early detection and self-management of diabetes, including dietary practices common within their culture and the role of church and religion. They identified that pride in their heritage and role within families could be a barrier to care but also provided an opportunity for health promotion. CONCLUSIONS: The cultural factors which influence the risk and management of diabetes in the Samoan community in Australia can be the barriers to health change but also provide opportunities for culturally targeted diabetes education and health promotion. SO WHAT?: These findings will inform the development of approaches for the prevention and management of diabetes within the Samoan-Australian community. These include health-promotion initiatives which take into account the role of cultural dietary practices, diabetes stigma, cultural pride and working with churches.

A systematic review of health promotion intervention studies in the police force: study characteristics, intervention design and impacts on health.

To systematically review studies of health promotion intervention in the police force. Four databases were searched for articles reporting on prepost single and multigroup studies in police officers and trainees. Data were extracted and bias assessed to evaluate study characteristics, intervention design and the impact of interventions on health. Database searching identified 25 articles reporting on 21 studies relevant to the aims of this review. Few studies (n=3) were of long duration (≥6 months). Nine of 21 studies evaluated structured physical activity and/or diet programmes only, 5 studies used education and behaviour change support-only interventions, 5 combined structured programmes with education and behaviour change support, and 2 studies used computer prompts to minimise sedentary behaviour. A wide array of lifestyle behaviour and health outcomes was measured, with 11/13 multigroup and 8/8 single-group studies reporting beneficial impacts on outcomes. High risk of bias was evident across most studies. In those with the lowest risk of bias (n=2), a large effect on blood pressure and small effects on diet, sleep quality, stress and tobacco use, were reported. Health promotion interventions can impact beneficially on health of the police force, particularly blood pressure, diet, sleep, stress and tobacco use. Limited reporting made comparison of findings challenging. Combined structured programmes with education and behaviour change support and programmes including peer support resulted in the most impact on health-related outcomes.

Community-based care needs for adults with class III obesity before and after tertiary weight management: An exploratory study.

Objective: Class 3 obesity (severe obesity) is defined by a body mass index ≥40 kg/m2. Tertiary weight-management programs (WMPs) are hospital-based multidisciplinary services that aim to support individuals with severe obesity. Severe shortage of WMPs has led to waitlists and pressure on clinicians to discharge patients. Community obesity management often fails to support patients in maintaining weight loss/health gains. This study aimed to explore the needs of patients for community-based obesity care. Methods: A qualitative study was undertaken via a tertiary WMP in Sydney, Australia. Semi-structured interviews/focus groups explored perceptions of purposively sampled patients and their clinicians on the community-based support needs of people with severe obesity. Data were audio-recorded, transcribed verbatim, and then thematically analyzed. Results: Eleven patients and seven clinicians were interviewed. Four themes were identified: the importance of accountability and motivation to maintain weight-loss/health gains; limitations within community-based obesity management for those with severe obesity; perspectives on structured community programs for patients transitioning into/out of tertiary WMPs; and impact of mental health, stigma, and social isolation on engagement with community-based services. Conclusions: Community-based programs are needed to support those awaiting access to tertiary WMPs and to help maintain health gains once discharged. Such programs should address issues of social isolation and integrate with current models of tertiary metabolic and primary health care.

Australian surgeon attitudes and experiences towards completing a higher degree by research.

Objective In Australia, there is little evidence exploring why higher degrees by research (HDRs) are undertaken by surgeons. This study aims to describe the attitudes and experiences of surgical trainees and surgeons towards HDRs. Methods A 23-question cross-sectional survey of surgical trainees and consultant surgeons from three Australian public hospitals was undertaken between August and December 2022. Data were analysed according to stage of career and HDR status and assessed using chi-squared test, with P <0.05 considered significant. Results Out of 270 participants, 72 (27%) completed the survey including 30 (42%) trainees and 42 (58%) consultants. Overall, 43 (60%) participants had completed or were undertaking a HDR, which was similar between trainees (n =18) and consultants (N =25; P =0.968). A HDR was associated with more publications (P <0.5). Respondents with a HDR were more likely to have a salaried academic position (50%) than those without (15%). There was no significant difference in academic appointments based on HDR attainment (P =0.192). For surgical trainees, 93% rated the strengthening of resumes as the primary driver, compared with only 60% of consultants. For consultants, academic career aspirations and research interests were ranked the highest at 64% equally. Lack of time and competing nature of surgical training were equally ranked among all as the key barriers to completing a HDR. Conclusions These results provide insight into the academic pursuits of surgeons with an understanding of the role HDRs play, including the different drivers for Masters and Doctorates. This is important for supporting future surgeons who seek to pursue research.