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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

What's good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change.

BACKGROUND: The use of financial incentives or pay-for-performance programs for health care providers has triggered emerging interest in the use of financial incentives for encouraging health behaviour change. PURPOSE: This paper aims to identify key conditions under which the use of financial incentives for improvements in public health outcomes is most likely to be effective and appropriate. METHODS: We review recent systematic reviews on their effectiveness in changing health behaviour and identify existing moral concerns concerning personal financial incentives. RESULTS: Current evidence indicates that incentives can be effective in driving health behaviour change under certain provisos, while a number of misgivings continue to be deliberated on. We outline a number of key principles for consideration in decisions about the potential use of incentives in leading to public health improvements. CONCLUSION: These key principles can assist policy makers in making decisions on the use of financial incentives directed at achieving improvements in public health.

On-line information and support for supporters and carers of haematological cancer patients: is access an issue?

PURPOSE: This study aimed to assess levels of internet access, likelihood of using various sources of information or support, and sociodemographic characteristics related to high internet access among support persons of haematological cancer patients. METHODS: A cross-sectional sample of haematological cancer survivors was recruited via a state cancer registry in Australia. Participating survivors invited their support persons to complete a survey. Of the 268 survivors, 68% had a support person return a survey. Approximately 80% of support persons reported having internet access. RESULTS: Almost three quarters (74%) reported having 'high' access. Support persons reported their likelihood of using internet-based forms of information and support (59% and 26%, respectively) was lower than for other sources, including those delivered face-to-face (80% and 75%) or through print (87% and 70%). Participants who were older or had less education were less likely to report a high level of internet access or likelihood of using web-based sources. CONCLUSIONS: The results demonstrate the need to continue to provide information and support via multiple modes. Support persons who potentially are more vulnerable due to age and lower education are the least likely to use internet-based options. Consequently, these groups may require alternatives, including face-to-face or print-based information and support.

An RCT protocol of varying financial incentive amounts for smoking cessation among pregnant women.

BACKGROUND: Smoking during pregnancy is harmful to the unborn child. Few smoking cessation interventions have been successfully incorporated into standard antenatal care. The main aim of this study is to determine the feasibility of a personal financial incentive scheme for encouraging smoking cessation among pregnant women. DESIGN: A pilot randomised control trial will be conducted to assess the feasibility and potential effectiveness of two varying financial incentives that increase incrementally in magnitude ($20 vs. $40AUD), compared to no incentive in reducing smoking in pregnant women attending an Australian public hospital antenatal clinic. METHOD: Ninety (90) pregnant women who self-report smoking in the last 7 days and whose smoking status is biochemically verified, will be block randomised into one of three groups: a. No incentive control group (n=30), b. $20 incremental incentive group (n=30), and c. $40 incremental incentive group (n=30). Smoking status will be assessed via a self-report computer based survey in nine study sessions with saliva cotinine analysis used as biochemical validation. Women in the two incentive groups will be eligible to receive a cash reward at each of eight measurement points during pregnancy if 7-day smoking cessation is achieved. Cash rewards will increase incrementally for each period of smoking abstinence. DISCUSSION: Identifying strategies that are effective in reducing the number of women smoking during pregnancy and are easily adopted into standard antenatal practice is of utmost importance. A personal financial incentive scheme is a potential antenatal smoking cessation strategy that warrants further investigation. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12612000399897.

Paying women to quit smoking during pregnancy? Acceptability among pregnant women.

INTRODUCTION: There is growing international interest in the use of financial incentives in smoking cessation, yet little research on public opinion of the scheme. This paper reports on the acceptability of incentives for reducing smoking in pregnant women and the perceived size of incentive that would encourage smoking cessation during pregnancy. METHODS: A cross-sectional survey was conducted on a convenience sample of 213 women attending the antenatal clinic of a large public hospital in Australia. Participants completed a questionnaire on their views on the use of incentives with responses measured on a 5-point Likert scale. RESULTS: The majority of participants (60%) did not agree that paying pregnant smokers to quit is a good idea. Opinions regarding the likely effectiveness were mixed with 30% of respondents in agreement and 22% undecided. Most (62%) were not willing to pay smokers any amount to quit. Smokers were more likely to have more favorable views about incentives than nonsmokers (p < .0001) and considered payments of between $100 and >$1,000 acceptable as reward for quitting smoking. CONCLUSIONS: Acceptability for the use of financial incentives in reducing antenatal smoking is low among pregnant women. Future research should explore views of a wider audience and continue to gather stronger evidence of the efficacy of rewards for reducing smoking in pregnancy.

Improving access to information and support for patients with less common cancers: hematologic cancer patients' views about Web-based approaches.

BACKGROUND: Meeting the psychosocial needs of vulnerable groups such as cancer survivors remains an ongoing challenge. This is particularly so for those who have less access to the usual forms of medical specialist and in-person support networks. Internet-based approaches offer an opportunity to better meet patients' information and support needs by overcoming the barrier of geographic isolation. OBJECTIVE: The aim of the study was to assess the reported level of access to the Internet, preferred sources of information, and preferred sources of support among survivors of hematologic cancers. METHOD: A population-based, Australian state cancer registry invited eligible survivors to complete a survey about psychosocial needs, including items measuring Internet access and patterns of use. Of the 732 eligible survivors invited to participate, 268 (36.6%) completed and returned the pen-and-paper-based survey. RESULTS: The majority of participants (186/254, 73.2%) reported a high level of access to the Internet, with higher Internet access associated with a higher level of education, larger household, younger age, and being married or employed. A total of 62.2% (156/251) of survivors indicated they were likely to use the Internet for accessing information, with the percentage much lower (69/251, 28%) for accessing support via the Internet. Likelihood of using the Internet for support was associated with feeling anxious and being employed. CONCLUSIONS: While the Internet appears to offer promise in increasing equitable access to information and support for cancer survivors for both metropolitan and regional areas, it is viewed less favorably for support and by particular subgroups (eg, older people and those without a university degree) within the survivor population. Promoting greater understanding of this mode of support may be required to achieve its potential. Information and support options other than Web-based approaches may continue to be needed by vulnerable groups of cancer survivors.

Alcohol-related harm: perceptions of ambulance officers and health promotion actions they do and would do.

ISSUE ADDRESSED: Health care providers play a pivotal role in preventing and reducing the burden associated with the misuse of alcohol, yet one group whose role in the alcohol offensive has not yet been systematically explored is ambulance officers. This study attempted to firstly, measure the prevalence and type of alcohol-related incidents attended by ambulance officers, and secondly, identify both current practice and perceived role in reducing alcohol-related harms. METHODS: A cross-sectional, descriptive survey of 264 NSW Ambulance Officers was conducted in June and July 2006. RESULTS: Results indicated that alcohol plays a significant role in the work of ambulance officers with estimates of 20% of all call-outs involving alcohol. Though the majority of officers indicated that they usually or always asked patients whether they have been drinking, far fewer asked about quantity and frequency of alcohol use and only small proportions undertook formal screenings, offered brief advice or referred patients to an appropriate drug and alcohol service. CONCLUSION: Officers indicated that they are willing to undertake a number of other actions as part of alcohol-harm reduction efforts, suggesting that many ambulance officers consider health promotion to be integral to the role of an ambulance officer.

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.