Effectiveness of a theory-based sun-safe randomised behavioural change trial among Australian adolescents.

OBJECTIVE: Sun safety is crucial for preventing skin cancer. This study evaluated a school-based intervention based on the theory of planned behaviour (TPB), which aimed to encourage sun-protective behaviour among adolescents. METHODS: Secondary school students (N = 382; 61.1% female; Mage  = 13.73 y) in Queensland, Australia, participated in the study. Schools were randomly allocated to an intervention or control group. The intervention focussed on fostering positive attitudes, increasing perceptions of normative support, and strengthening control perceptions. Participants completed questionnaires assessing the TPB variables and sun-protective behaviour (weekday and weekend) 1 week before intervention (time 1), 1 week after intervention (time 2), and 4 weeks after intervention (time 3). RESULTS: With baseline between-group differences in TPB variables matched, repeated-measures multivariate analysis of variance was used to evaluate the Time × Condition effects across time. Multigroup comparisons using path models traced the intervariable changes. From times 1 to 3, a significant improvement in weekend sun-protective behaviour was identified in the intervention group (but not the control group), whereas cognitions showed no significant changes across time for either conditions. Multigroup comparisons on path coefficients between the intervention and control group participants indicated that the intervention group members formed stronger positive associations between perceived behavioural control and intention at time 2 and between perceived control and behaviour at time 3. CONCLUSION: The significant behavioural change on weekends highlights the value of targeting control perceptions, which may encourage adolescents' sun-protective behaviour. Further studies are needed to understand the absence of significant changes in weekday sun-safe behaviour among this at-risk cohort.

Unmet supportive care needs of Australian Aboriginal and Torres Strait Islanders with cancer: a prospective, longitudinal study.

PURPOSE: The purposes of the present study are to describe changes over time in the prevalence of unmet supportive care needs of Indigenous Australians newly diagnosed with cancer and to identify factors associated with greater needs at diagnosis. METHODS: Unmet needs were assessed by the Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) within 3 months and at 6 months post-diagnosis. Overall needs and specific need domains were modelled using generalized estimating equations. Associations between risk factors and moderate-high unmet needs at diagnosis were assessed using multivariable logistic regression analyses. RESULTS: Over half (54%) of the participants (n = 82) experienced at least one moderate-high unmet need at diagnosis which reduced to 34% at 6 months post-diagnosis. This improvement mainly reflected the decrease in needs from the physical/psychological domain (p = 0.042). The median overall unmet need score and most domain scores were significantly lower at 6 months. Eighteen percent experienced multiple (5+) moderate-high unmet needs at diagnosis (60% continued to report needs at 6 months). The top unmet needs at diagnosis were money worries (27%), concerns about the worries of those close to you (16%) and worry about your illness spreading/getting worse (15%). Having a higher education and having received cancer treatment in the last 30 days were significantly associated with greater needs at diagnosis. CONCLUSIONS: While unmet needs decreased over time, some patients continued to experience moderate-high unmet needs. This study indicates that needs should be monitored throughout the patient's journey. Coordination of support, particularly for those with multiple needs, may be important for this group.

Keeping kids sun safe: exploring parents' beliefs about their young child's sun-protective behaviours.

OBJECTIVES: Melanoma of the skin is the third most commonly diagnosed cancer in Australia. Given the high incidence of sunburn in children and the level of sun protection provided by parents is often infrequent and/or insufficient, this research employed qualitative methodology to examine parents' beliefs about their young child's sun safe behaviour. METHODS: Parents (N = 21; n = 14 mothers, n = 7 fathers) of children aged 2-5 years participated in focus groups to identify commonly held beliefs about their decision to sun protect their child. Data were analysed using thematic content analysis. RESULTS: Parents generally had knowledge of the broad sun safe recommendations; however, the specific details of the recommendations were not always known. Parents reported adopting a range of sun-protective measures for their child, which depended on the time of year. A range of advantages (e.g. reducing the risk of skin cancer, developing good habits early and parental peace of mind), disadvantages (e.g. false sense of safety and preventing vitamin D absorption), barriers (e.g. child refusal) and facilitators (e.g. routine and accessibility) to performing sun safe practices were identified. Normative pressures and expectations also affected parents' motivation to be sun safe for their child. CONCLUSIONS: These identified beliefs can be used to inform interventions to improve sun safe behaviours in young children who reside in a region that has the highest skin cancer incidence in the world.

Psychometric properties of an Australian supportive care needs assessment tool for Indigenous patients with cancer.

BACKGROUND: There are significant disparities in cancer outcomes between Indigenous and non-Indigenous Australians. Identifying the unmet supportive care needs of Indigenous Australians with cancer is imperative to improve their cancer care. The purpose of the current study was to test the psychometric properties of a supportive cancer care needs assessment tool for Indigenous people (SCNAT-IP) with cancer. METHODS: The SCNAT-IP was administered to 248 Indigenous Australians diagnosed with a range of cancer types and stages, and who received treatment in 1 of 4 Queensland hospitals. All 39 items were assessed for ceiling and floor effects and were analyzed using exploratory factor analysis to determine construct validity. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools. RESULTS: Exploratory factor analysis revealed a 4-factor structure (physical and psychological, hospital care, information and communication, and practical and cultural needs) explaining 51% of the variance. Internal consistency of the 4 subscales was good, with Cronbach alpha reliability coefficients ranging from .70 to .89. Convergent validity was supported by significant correlations between the SCNAT-IP with the National Comprehensive Cancer Network Distress Thermometer (correlation coefficient [r] = 0.60; P<.001) and the Cancer Worry Chart (r = 0.58; P<.001) and a moderately strong negative correlation with the Assessment of Quality of Life questionnaire (r = -0.56; P<.001). CONCLUSIONS: These data provide initial support for the SCNAT-IP, a measure of multiple supportive care needs domains specific to Indigenous Australian patients with cancer undergoing treatment.

Predicting Australian adults' sun-safe behaviour: examining the role of personal and social norms.

OBJECTIVES: To address the scarcity of comprehensive, theory-based research in the Australian context, this study, using a theory of planned behaviour (TPB) framework, investigated the role of personal and social norms to identify the key predictors of adult Australians' sun-safe intentions and behaviour. DESIGN: The study used a prospective design with two waves of data collection, 1 week apart. METHODS: Participants were 816 adults (48.2% men) aged between 18 and 88 years recruited from urban, regional, and rural areas of Australia. At baseline, participants completed a questionnaire assessing the standard TPB predictors (attitude, subjective norm, and perceived behavioural control [PBC]), past behaviour, behavioural intention, and additional measures of group norm for the referent groups of friends and family, image norm, personal norm, personal choice/responsibility, and Australian identity. Seventy-one per cent of the participants (n = 577) reported on their sun-safe behaviour in the subsequent week. RESULTS: Via path modelling, past behaviour, attitude, group norm (friends), personal norm, and personal choice/responsibility emerged as independent predictors of intentions which, in turn, predicted sun-safe behaviour prospectively. Past behaviour, but not PBC, had direct effects on sun-safe behaviour. The model explained 61.6% and 43.9% of the variance in intention and behaviour, respectively. CONCLUSIONS: This study provides support for the use of a comprehensive theoretical decision-making model to explain Australian adults' sun-safe intentions and behaviours and identifies viable targets for health-promoting messages in this high-risk context. Statement of contribution What is already known on this subject? Identifying determinants of sun-safe behaviour is vital in high-risk cancer areas like Australia. For young Australians, friendship group norm is a key influence of intentions and behaviour. Little is known about drivers of sun safety, especially norms, among Australian adults in general. What does this study add? This study drew on qualitative data and reconceptualized norms for Australians' sun-safe decisions. Friendship group norm and personal norm, not family group norm, influence sun-safe intentions. Perceived responsibility and choice to be sun safe also impact on people's intentions.

A randomized controlled trial of a multiple health behavior change intervention delivered to colorectal cancer survivors: effects on sedentary behavior.

BACKGROUND: Sedentary behavior may independently contribute to morbidity and mortality among survivors of colorectal cancer. In the current study, the authors assessed whether a telephone-delivered multiple health behavior change intervention had an effect on the sedentary behavior of recently diagnosed colorectal cancer survivors. METHODS: A total of 410 participants were recruited through the Queensland Cancer Registry and randomized to the health coaching (intervention) or usual-care (control) group. Eleven health coaching sessions addressing multiple health behaviors, including sedentary behavior, were delivered over a period of 6 months. Data were collected at baseline (before randomization), at 6 months, and at 12 months via a telephone interview. RESULTS: At 12 months, there was a significant decrease noted in the hours per day of sedentary time in both the health coaching (-1.21; 95% confidence interval [95% CI], -1.71 to -0.70) and usual-care groups (-0.55; 95% CI, -1.06 to -0.05), but the between-group difference was not found to be statistically significant (-0.65; 95% CI, -1.37 to 0.06 [P = .07]). In stratified subgroup analyses, the multiple health behavior change intervention was found to have a significant effect on total sedentary time (hours/day) at 12 months in survivors of colorectal cancer who were aged > 60 years (-0.90; 95% CI, -1.80 to -0.01 [P = .05]), male (-1.33; 95% CI, -2.44 to -0.21 [P = .02]), and nonobese (-1.10; 95% CI, -1.96 to -0.25; [P = .01]). CONCLUSIONS: Incorporating simple messages about limiting sedentary behaviors into a multiple health behavior change intervention was found to have modest effects on sedentary behavior. A sedentary behavior-specific intervention strategy may be required to achieve substantial changes in sedentary behavior among colorectal cancer survivors.

Effects of a multiple health behavior change intervention for colorectal cancer survivors on psychosocial outcomes and quality of life: a randomized controlled trial.

BACKGROUND: Multiple health behavior change can ameliorate adverse effects of cancer. PURPOSE: The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life. METHODS: A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months. RESULTS: Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p < 0.001) and 12 months (4.1, p = 0.033), spirituality at 6 months (1.8, p = 0.011), acceptance at 6 months (0.2, p = 0.005), and quality of life at 6 (0.8, p = 0.049) and 12 months (0.9, p = 0.037). CONCLUSIONS: The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. ( TRIAL REGISTRATION NUMBER: ACTRN12608000399392).

Study protocol: a randomised controlled trial of a theory-based online intervention to improve sun safety among Australian adults.

BACKGROUND: The effects of exposure to ultraviolet radiation are a significant concern in Australia which has one of the highest incidences of skin cancer in the world. Despite most skin cancers being preventable by encouraging consistent adoption of sun-protective behaviours, incidence rates are not decreasing. There is a dearth of research examining the factors involved in engaging in sun-protective behaviours. Further, online multi-behavioural theory-based interventions have yet to be explored fully as a medium for improving sun-protective behaviour in adults. This paper presents the study protocol of a randomised controlled trial of an online intervention based on the Theory of Planned Behaviour (TPB) that aims to improve sun safety among Australian adults. METHODS/DESIGN: Approximately 420 adults aged 18 and over and predominantly from Queensland, Australia, will be recruited and randomised to the intervention (n = 200), information only (n = 200) or the control group (n = 20). The intervention focuses on encouraging supportive attitudes and beliefs toward sun-protective behaviour, fostering perceptions of normative support for sun protection, and increasing perceptions of control/self-efficacy over sun protection. The intervention will be delivered online over a single session. Data will be collected immediately prior to the intervention (Time 1), immediately following the intervention (Time 1b), and one week (Time 2) and one month (Time 3) post-intervention. Primary outcomes are intentions to sun protect and sun-protective behaviour. Secondary outcomes are the participants' attitudes toward sun protection, perceptions of normative support for sun protection (i.e. subjective norms, group norms, personal norms and image norms) and perceptions of control/self-efficacy toward sun protection. DISCUSSION: The study will contribute to an understanding of the effectiveness of a TPB-based online intervention to improve Australian adults' sun-protective behaviour. TRIALS REGISTRY: Australian and New Zealand Trials Registry number ACTRN12613000470796.

Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial.

PURPOSE: Colorectal cancer survivors are at risk for poor health outcomes because of unhealthy lifestyles, but few studies have developed translatable health behavior change interventions. This study aimed to determine the effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes among colorectal cancer survivors. METHODS: In this two-group randomized controlled trial, 410 colorectal cancer survivors were randomly assigned to the health coaching intervention (11 theory-based telephone-delivered health coaching sessions delivered over 6 months focusing on physical activity, weight management, dietary habits, alcohol, and smoking) or usual care. Assessment of primary (ie, physical activity [Godin Leisure Time Index], health-related quality of life [HRQoL; Short Form-36], and cancer-related fatigue [Functional Assessment of Chronic Illness Therapy Fatigue Scale]) and secondary outcomes (ie, body mass index [kg/m(2)], diet and alcohol intake [Food Frequency Questionnaire], and smoking) were conducted at baseline and 6 and 12 months. RESULTS: At 12 months, significant intervention effects were observed for moderate physical activity (28.5 minutes; P = .003), body mass index (-0.9 kg/m(2); P = .001), energy from total fat (-7.0%; P = .006), and energy from saturated fat (-2.8%; P = .016). A significant intervention effect was reported for vegetable intake (0.4 servings per day; P = .001) at 6 months. No significant group differences were found at 6 or 12 months for HRQoL, cancer-related fatigue, fruit, fiber, or alcohol intake, or smoking. CONCLUSION: The CanChange intervention was effective for improving physical activity, dietary habits, and body mass index in colorectal cancer survivors. The intervention is translatable through existing telephone cancer support and information services in Australia and other countries.

Effect of a telephone-delivered coronary heart disease secondary prevention program (proactive heart) on quality of life and health behaviours: primary outcomes of a randomised controlled trial.

BACKGROUND: Participation in coronary heart disease secondary prevention programs is low. Innovative programs to meet this treatment gap are required. PURPOSE: To aim of this study is to describe the effectiveness of a telephone-delivered secondary prevention program for myocardial infarction patients. METHODS: Four hundred and thirty adult myocardial infarction patients in Brisbane, Australia were randomised to a 6-month secondary prevention program or usual care. Primary outcomes were health-related quality of life (Short Form-36) and physical activity (Active Australia Survey). RESULTS: Significant intervention effects were observed for health-related quality of life on the mental component summary score (p = 0.02), and the social functioning (p = 0.04) and role-emotional (p = 0.03) subscales, compared with usual care. Intervention participants were also more likely to meet recommended levels of physical activity (p = 0.02), body mass index (p = 0.05), vegetable intake (p = 0.04) and alcohol consumption (p = 0.05). CONCLUSIONS: Telephone-delivered secondary prevention programs can significantly improve health outcomes and could meet the treatment gap for myocardial infarction patients.

Can colorectal cancer survivors recall their medications and doctor visits reliably?

BACKGROUND: The evidence on the agreement between self-reported health resource use and administrative records is mixed and no gold standard exists. The objective of this study was to assess self-reported general practitioner (GP) and specialist doctor visits, as well as medication use via telephone interview against national insurance administrative data for colorectal cancer survivors. METHODS: In a sample of 76 adults recently diagnosed with colorectal cancer, data was abstracted from telephone survey items on GP visits, specialist visits and medication use over the previous six months and compared with data on the same individuals from administrative data. Intraclass correlation coefficients (ICC) were used to assess the reliability of frequency of visits and kappa statistics were derived for four broad categories of medicines used for gastrointestinal conditions, cardiovascular disease, psychological conditions and chronic obstructive pulmonary disease. Logistic regression was undertaken to assess factors associated with agreement (yes/no) between the two data sources for doctors' visits. RESULTS: Good agreement was found for GP visits (ICC 0.62, 95%CI: 0.38, 0.86) and specialist visits (ICC 0.73, 95%CI: 0.56, 0.91) across the two data sources. When costs were assigned to frequencies, mean costs for the two methods were not significantly different over six months. Over-reporting was more common among men and participants with frequent doctor encounters. Large discrepancies between self-reports and administration records were found for broad types of medications used (44% agreement, kappa 0.13). CONCLUSION: Self-reported frequency of doctor's visits using telephone interviews may be a reasonable substitute for administratively recorded data however, medication use by self-report appears to be unreliable. Administrative records are preferable to self-report for health service use in colorectal cancer survivors with high and complex service needs.

CanPrevent: a telephone-delivered intervention to reduce multiple behavioural risk factors for colorectal cancer.

BACKGROUND: This pilot study aimed to test the acceptability and short-term effectiveness of a telephone-delivered multiple health behaviour change intervention for relatives of colorectal cancer survivors. METHODS: A community-based sample of 22 first-degree relatives of colorectal cancer survivors were recruited via a media release. Data were collected at baseline and at six weeks (post-intervention). Outcome measures included health behaviours (physical activity, television viewing, diet, alcohol, body mass index, waist circumference and smoking), health-related quality of life (Short Form-36) and perceived colorectal cancer risk. Intervention satisfaction levels were also measured. The intervention included six telephone health coaching sessions, a participant handbook and a pedometer. It focused on behavioural risk factors for colorectal cancer [physical activity, diet (red and processed meat consumption, fruit and vegetable intake), alcohol, weight management and smoking], and colorectal cancer risk. RESULTS: From baseline to six weeks, improvements were observed for minutes moderate-vigorous physical activity (150.7 minutes), processed meat intake (-1.2 serves/week), vegetable intake (1 serve/day), alcohol intake (-0.4 standard drinks/day), body mass index (-1.4 kg/m2), and waist circumference (-5.1 cm). Improvements were also observed for physical (3.3) and mental (4.4) health-related quality of life. Further, compared with baseline, participants were more likely to meet Australian recommendations post-intervention for: moderate-vigorous physical activity (27.3 vs 59.1%); fruit intake (68.2 vs 81.8%); vegetable intake (4.6 vs 18.2%); alcohol consumption (59.1 vs 72.7%); body mass index (31.8 vs 45.5%) and waist circumference (18.2 vs 27.3%). At six weeks participants were more likely to believe a diagnosis of CRC was related to family history, and there was a decrease in their perceived risk of developing CRC in their lifetime following participation in CanPrevent. The intervention retention rate was 100%, participants reported that it was highly acceptable and they would recommend it to others at risk of colorectal cancer. CONCLUSIONS: Positive behaviour change achieved through this intervention approach has the potential to impact on the progression of CRC and other cancers or chronic diseases. A large scale randomised controlled trial is required to confirm the positive results of this acceptability and short-term effectiveness study. TRIAL REGISTRATION: ACTRN12612000516886.

Identifying critical sun-protective beliefs among Australian adults.

We investigated critical beliefs to target in interventions aimed at improving sun-protective behaviours of Australian adults, a population at risk for skin cancer. Participants (N = 816) completed a Theory of Planned Behaviour belief-based questionnaire and a 1-week follow-up of sun-protective behaviour. A range of behavioural, normative and control beliefs correlated with sun-protective behaviour, with no and only minimal differences observed in correlations between beliefs and behaviour by gender and age, respectively. A range of key beliefs made independent contributions to behaviour; however, the behavioural belief about being less likely to tan (ß = 0.09); normative belief about friends (ß = 0.20); and control beliefs about forgetfulness (ß = -0.14), inconvenience (ß = -0.17), knowing I will be in the sun for a long time (ß = 0.16) and more fashionable sun-protective clothing (ß = 0.13) were significant critical beliefs guiding people's sun-protective behaviour. Our study fills a gap in the literature by investigating an at-risk population for skin cancer and using an established theoretical framework to identify critical beliefs that guide Australian adults' decisions to sun protect. Attention to these critical beliefs will assist health campaigns and interventions aimed at combating the increasing rates of skin cancer for adults.

A randomised controlled trial of a theory-based intervention to improve sun protective behaviour in adolescents ('you can still be HOT in the shade'): study protocol.

BACKGROUND: Most skin cancers are preventable by encouraging consistent use of sun protective behaviour. In Australia, adolescents have high levels of knowledge and awareness of the risks of skin cancer but exhibit significantly lower sun protection behaviours than adults. There is limited research aimed at understanding why people do or do not engage in sun protective behaviour, and an associated absence of theory-based interventions to improve sun safe behaviour. This paper presents the study protocol for a school-based intervention which aims to improve the sun safe behaviour of adolescents. METHODS/DESIGN: Approximately 400 adolescents (aged 12-17 years) will be recruited through Queensland, Australia public and private schools and randomized to the intervention (n = 200) or 'wait-list' control group (n = 200). The intervention focuses on encouraging supportive sun protective attitudes and beliefs, fostering perceptions of normative support for sun protection behaviour, and increasing perceptions of control/self-efficacy over using sun protection. It will be delivered during three × one hour sessions over a three week period from a trained facilitator during class time. Data will be collected one week pre-intervention (Time 1), and at one week (Time 2) and four weeks (Time 3) post-intervention. Primary outcomes are intentions to sun protect and sun protection behaviour. Secondary outcomes include attitudes toward performing sun protective behaviours (i.e., attitudes), perceptions of normative support to sun protect (i.e., subjective norms, group norms, and image norms), and perceived control over performing sun protective behaviours (i.e., perceived behavioural control). DISCUSSION: The study will provide valuable information about the effectiveness of the intervention in improving the sun protective behaviour of adolescents.

Television viewing time of colorectal cancer survivors is associated prospectively with quality of life.

OBJECTIVE: To examine prospective associations of television viewing time with quality of life, following a colorectal cancer diagnosis. METHODS: One thousand, nine hundred and sixty-six colorectal cancer survivors were recruited through the Queensland Cancer Registry. Interviews were conducted at 5, 12, 24, and 36 months post-diagnosis. Generalized linear mixed models estimated the effects of television viewing time on quality of life. RESULTS: Participants who watched ≥5 h of television per day had a 16% lower total quality of life score than did participants reporting ≤2 h per day. Deleterious associations of television viewing time were found with all quality of life subscales: functional well-being showed the strongest association (23% difference in quality of life scores between highest and lowest television viewing categories), and social well-being the weakest association (6% difference). Participants who increased their television viewing by one category (e.g., ≤2 h, increasing to 3-4 h per day) had a proportional decrease of some 6% in their quality of life score (intra-individual effect). CONCLUSIONS: The deleterious associations of television viewing time with quality of life were clinically significant and consistent over time. Decreasing sedentary behavior may be an important behavioral strategy to enhance the quality of life of cancer survivors.

A randomised, feasibility trial of a tele-health intervention for acute coronary syndrome patients with depression ('MoodCare'): study protocol.

BACKGROUND: Coronary heart disease (CHD) and depression are leading causes of disease burden globally and the two often co-exist. Depression is common after Myocardial Infarction (MI) and it has been estimated that 15-35% of patients experience depressive symptoms. Co-morbid depression can impair health related quality of life (HRQOL), decrease medication adherence and appropriate utilisation of health services, lead to increased morbidity and suicide risk, and is associated with poorer CHD risk factor profiles and reduced survival. We aim to determine the feasibility of conducting a randomised, multi-centre trial designed to compare a tele-health program (MoodCare) for depression and CHD secondary prevention, with Usual Care (UC). METHODS: Over 1600 patients admitted after index admission for Acute Coronary Syndrome (ACS) are being screened for depression at six metropolitan hospitals in the Australian states of Victoria and Queensland. Consenting participants are then contacted at two weeks post-discharge for baseline assessment. One hundred eligible participants are to be randomised to an intervention or a usual medical care control group (50 per group). The intervention consists of up to 10 × 30-40 minute structured telephone sessions, delivered by registered psychologists, commencing within two weeks of baseline screening. The intervention focuses on depression management, lifestyle factors (physical activity, healthy eating, smoking cessation, alcohol intake), medication adherence and managing co-morbidities. Data collection occurs at baseline (Time 1), 6 months (post-intervention) (Time 2), 12 months (Time 3) and 24 months follow-up for longer term effects (Time 4). We are comparing depression (Cardiac Depression Scale [CDS]) and HRQOL (Short Form-12 [SF-12]) scores between treatment and UC groups, assessing the feasibility of the program through patient acceptability and exploring long term maintenance effects. A cost-effectiveness analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the government. DISCUSSION: This manuscript presents the protocol for a randomised, multi-centre trial to evaluate the feasibility of a tele-based depression management and CHD secondary prevention program for ACS patients. The results of this trial will provide valuable new information about potential psychological and wellbeing benefits, cost-effectiveness and acceptability of an innovative tele-based depression management and secondary prevention program for CHD patients experiencing depression. TRIAL REGISTRATION NUMBER: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000386235.

Acceptability of the Distress Thermometer and Problem List to community-based telephone cancer helpline operators, and to cancer patients and carers.

BACKGROUND: Cancer can be a distressing experience for cancer patients and carers, impacting on psychological, social, physical and spiritual functioning. However, health professionals often fail to detect distress in their patients due to time constraints and a lack of experience. Also, with the focus on the patient, carer needs are often overlooked. This study investigated the acceptability of brief distress screening with the Distress Thermometer (DT) and Problem List (PL) to operators of a community-based telephone helpline, as well as to cancer patients and carers calling the service. METHODS: Operators (n = 18) monitored usage of the DT and PL with callers (cancer patients/carers, >18 years, and English-speaking) from September-December 2006 (n = 666). The DT is a single item, 11-point scale to rate level of distress. The associated PL identifies the cause of distress. RESULTS: The DT and PL were used on 90% of eligible callers, most providing valid responses. Benefits included having an objective, structured and consistent means for distress screening and triage to supportive care services. Reported challenges included apparent inappropriateness of the tools due to the nature of the call or level of caller distress, the DT numeric scale, and the level of operator training. CONCLUSIONS: We observed positive outcomes to using the DT and PL, although operators reported some challenges. Overcoming these challenges may improve distress screening particularly by less experienced clinicians, and further development of the PL items and DT scale may assist with administration. The DT and PL allow clinicians to direct/prioritise interventions or referrals, although ongoing training and support is critical in distress screening.

Lifestyle factors associated concurrently and prospectively with co-morbid cardiovascular disease in a population-based cohort of colorectal cancer survivors.

AIMS: To assess self-reported lifetime prevalence of cardiovascular disease (CVD) among colorectal cancer survivors, and examine the cross-sectional and prospective associations of lifestyle factors with co-morbid CVD. METHODS: Colorectal cancer survivors were recruited (n=1966). Data were collected at approximately 5, 12, 24 and 36 months post-diagnosis. Cross-sectional findings included six CVD categories (hypercholesterolaemia, hypertension, diabetes, heart failure, kidney disease and ischaemic heart disease (IHD)) at 5 months post-diagnosis. Longitudinal outcomes included the probability of developing (de novo) co-morbid CVD by 36 months post-diagnosis. Lifestyle factors included body mass index, physical activity, television (TV) viewing, alcohol consumption and smoking. RESULTS: Co-morbid CVD prevalence at 5 months post-diagnosis was 59%, and 16% of participants with no known CVD at the baseline reported de novo CVD by 36 months. Obesity at the baseline predicted de novo hypertension (odds ratio [OR]=2.20, 95% confidence intervals [CI]=1.09, 4.45) and de novo diabetes (OR=6.55, 95% CI=2.19, 19.53). Participants watching >4h of TV/d at the baseline (compared with <2h/d) were more likely to develop ischaemic heart disease by 36 months (OR=5.51, 95% CI=1.86, 16.34). CONCLUSION: Overweight colorectal cancer survivors were more likely to suffer from co-morbid CVD. Interventions focusing on weight management and other modifiable lifestyle factors may reduce functional decline and improve survival.

Testing a belief-based intervention encouraging sun-safety among adolescents in a high risk area.

OBJECTIVE: To provide a preliminary test of a theory of planned behavior (TPB) belief-based intervention to increase adolescents' sun-protective behaviors in a high risk area, Queensland, Australia. METHODS: In the period of October-November, 2007 and May-June, 2008, 80 adolescents (14.53 ± 0.69 years) were recruited from two secondary schools (one government and one private) in Queensland after obtaining student, parental, and school informed consent. Adolescents were allocated to either a control or intervention condition based on the class they attended. The intervention comprised three, one hour in-school sessions facilitated by Cancer Council Queensland employees with sessions covering the belief basis of the TPB (i.e., behavioral, normative, and control [barrier and motivator] sun-safe beliefs). Participants completed questionnaires assessing sun-safety beliefs, intentions, and behavior pre- and post-intervention. Repeated Measures Multivariate Analysis of Variance was used to test the effect of the intervention across time on these constructs. RESULTS: Students completing the intervention reported stronger sun-safe normative and motivator beliefs and intentions and the performance of more sun-safe behaviors across time than those in the control condition. CONCLUSION: Strengthening beliefs about the approval of others and motivators for sun protection may encourage sun-safe cognitions and actions among adolescents.

Feasibility of brief psychological distress screening by a community-based telephone helpline for cancer patients and carers.

BACKGROUND: Up to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention. This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. This study investigated the feasibility of community-based telephone helpline operators screening callers affected by cancer for their level of distress using a brief screening tool (Distress Thermometer), and triaging to the appropriate level of care using a tiered model. METHODS: Consecutive cancer patients and carers who contacted the helpline from September-December 2006 (n = 341) were invited to participate. Routine screening and triage was conducted by helpline operators at this time. Additional socio-demographic and psychosocial adjustment data were collected by telephone interview by research staff following the initial call. RESULTS: The Distress Thermometer had good overall accuracy in detecting general psychosocial morbidity (Hospital Anxiety and Depression Scale cut-off score >or= 15) for cancer patients (AUC = 0.73) and carers (AUC = 0.70). We found 73% of participants met the Distress Thermometer cut-off for distress caseness according to the Hospital Anxiety and Depression Scale (a score >or= 4), and optimal sensitivity (83%, 77%) and specificity (51%, 48%) were obtained with cut-offs of >or= 4 and >or= 6 in the patient and carer groups respectively. Distress was significantly associated with the Hospital Anxiety and Depression Scale scores (total, as well as anxiety and depression subscales) and level of care in cancer patients, as well as with the Hospital Anxiety and Depression Scale anxiety subscale for carers. There was a trend for more highly distressed callers to be triaged to more intensive care, with patients with distress scores >or= 4 more likely to receive extended or specialist care. CONCLUSIONS: Our data suggest that it was feasible for community-based cancer helpline operators to screen callers for distress using a brief screening tool, the Distress Thermometer, and to triage callers to an appropriate level of care using a tiered model. The Distress Thermometer is a rapid and non-invasive alternative to longer psychometric instruments, and may provide part of the solution in ensuring distressed patients and carers affected by cancer are identified and supported appropriately.