Reduced prevalence of pain and distress during 4 years of screening with QUICATOUCH in Australian oncology patients.

While psychosocial screening has been recommended in oncology for some time, widespread adoption in clinical practice has lagged. The QUICATOUCH program is one example of sustained clinic-level screening, assessment and referral. We examined whether this program was associated with reductions in pain or distress. Oncology outpatients completed a brief, computerised assessment using Distress and Pain Thermometers. We describe population levels of pain and distress and model pain and distress scores over 4 years of the program. 9,133 patients were screened on 26,385 occasions over 48 months (October 2007-September 2011). Pain over threshold (1/10) reduced over time, from 33% in the first 3 months to 16% in the final quarter of the evaluation. Distress over threshold (4/10) reduced from 28% to 10%. A reduction was also observed when restricted to patients screened for the first time. Our analysis demonstrated this effect was not explained by measured potential confounders (gender, age, treatment status) and was unlikely to be attributable to regression to the mean. Observational studies cannot prove causation. However, the significant reduction in pain and distress levels in the 48 months following commencement of QUICATOUCH is consistent with a beneficial effect of the program.

Mental health and other clinical correlates of euthanasia attitudes in an Australian outpatient cancer population.

A majority of patients with cancer have been reported to endorse euthanasia and physician assisted suicide (PAS) in general and a substantial proportion endorse these for themselves. However, the potential influence of mental health and other clinical variables on these decisions is not well understood. This study of 228 outpatients attending an oncology clinic in Newcastle, Australia used a cross-sectional design and logistic regression modelling to examine the relationship of demographic, disease status, mental health and quality of life variables to attitudes toward euthanasia and PAS. The majority reported support for euthanasia (79%, n=179), for PAS (69%, n=158) and personal support for euthanasia/PAS (68%, n=156). However, few reported having asked their doctor for euthanasia (2%, n=5) or PAS (2%, n=5). Three outcomes were modelled: support for euthanasia was associated with active religious belief (adjusted odds ratio (AOR) 0.21, 95% CI: 0.10-0.46); support for PAS was associated with active religious belief (AOR 0.35, 95% CI: 18-0.70) and recent pain (AOR 0.87, 95% CI: 0.0.76-0.99); and personal support for euthanasia/PAS was associated with active religious belief (AOR 0.26, 95% CI: 0.14-0.48). Depression, anxiety, recent suicidal ideation, and lifetime suicide attempt were not independently associated with any of the three outcomes modelled.

Factors associated with waiting time for surgery.

OBJECTIVE: To explore the factors associated with waiting times for surgery in public hospitals. SETTING: Three major acute care public hospitals in one Area Health Service. PARTICIPANTS: 691 adult patients entered onto the computerised booking list between 16 and 22 November 1994, and then between 16 January and 12 February 1995, were interviewed prospectively and followed up over a minimum of 18 months. Data were obtained from the Area Health Service's computerised booking system and patient self-report. RESULTS: Relevant surgical specialty, urgency rating, employment status and health insurance status were significantly associated with waiting time. Age, hospital, sex, country of birth, education, marital status and holding a Health Care Card were not significantly associated with waiting time. Self-reported health status (as measured by the SF-36) was not associated with waiting time for surgery. CONCLUSIONS: Waiting time for surgery was not simply determined by how urgently patients need surgery, but also by the type of surgery needed and patient's employment and health insurance status. The extent of disability experienced by patients, as measured by the SF-36, was not reflected in waiting times for surgery.

Promotion of attendance for mammographic screening through general practice: a randomised trial of two strategies.

OBJECTIVE: To compare the effectiveness of two strategies--patient education and practitioner recommendation--in encouraging women to attend for mammographic screening. DESIGN: The study was a prospective randomised controlled trial. Women aged between 40 and 70 years attending a general practitioner participated in the study. Consenting, eligible women were randomly allocated to one of the two strategy groups. SETTING: The study was conducted in private general practice in Newcastle, New South Wales. PARTICIPANTS: The general practitioners who took part in the study were a non-random sample of practitioners: 20 were approached, two declined to participate, and five failed to begin recruitment, leaving 13 practitioners who took part in the study. A total of 302 women aged 40-69 were recorded as attending the surgeries during recruitment sessions. Twenty women did not consent to the study and 73 were ineligible. Thirty-four women were not given the intervention because the general practitioner forgot or did not have time. There were 92 women in the simple recommendation group and 83 women in the patient education group. INTERVENTIONS: An intensive patient education approach based on health belief principles was compared with a simple recommendation by the general practitioner that the woman have a mammogram. MAIN OUTCOME MEASURE: Attendance rates were calculated from screening service attendance records. RESULTS: No significant difference in attendance rates was observed between the two groups, 82% of the simple recommendation group and 91% of the patient education group attended for screening. CONCLUSIONS: These results suggest that mammographic screening can be effectively promoted in general practice without extensive patient education.