Parents' concerns about Leavers celebrations: A cross-sectional study.

ISSUE ADDRESSED: "Schoolies' or "Leavers' is a mass celebration of the end of compulsory schooling where excessive drinking is considered integral to the experience. Leavers are at risk of alcohol-related harms. This paper reports the concerns of parents for their Year 12 students (age 17 years) when attending Leavers celebrations. METHODS: Parents of Year 12 students (n = 87) were asked to complete a survey in relation to their eldest school-aged child. Six items relating to parents' level of "concern' about Leavers celebrations were measured on a 5-point scale. RESULTS: Parents were concerned about their child experiencing peer pressure to consume alcohol (60%), 30% were neutral or unconcerned about peer pressure. Almost two thirds of parents were concerned about their child being injured as a result of their own alcohol use (66.7%). Parental concern relating to their child being injured because of others' alcohol use rated most highly (88.5%). CONCLUSIONS: Findings suggested that parents were more concerned with harm caused to their child by others than the use of alcohol by their own child. Parents were somewhat less concerned with peer pressure to drink, though given peer influence is a major factor in young people's decisions regarding alcohol, parents' apparent confidence in their children's capacity to resist peer pressure may be inflated. SO WHAT?: Future interventions reinforcing the important role that parents play in the decisions that young people make while at Leavers have the potential to reduce their alcohol intake and subsequent alcohol-related harm.

Combining whole-school and targeted programs for the reduction of bullying victimization: A randomized, effectiveness trial.

Despite the extensive evaluation of school-based interventions for bullying, victimization remains a significant problem in schools. Bullying victimization is significantly predicted by contextual (school-related) factors. As a consequence whole-school programs have been commonly used to prevent and reduce bullying victimization. Evidence also points to individual risk factors (such as emotional distress) in predicting victimization, yet programs to prevent bullying victimization by changing these individual risks are far less developed. Few studies have approximated "real-world" implementation conditions in their trials. The current effectiveness trial evaluated the combination of a whole-school program designed to prevent bullying perpetration and victimization together with a targeted intervention for at-risk students, teaching them individual and dyadic strategies to reduce their anxiety and manage victimization, allowing schools some latitude to implement programs as they typically would. Students from Grades 3 and 4 (N = 8,732) across 135 schools were randomly assigned to one of four conditions: combined intervention; whole-school intervention only; individual intervention only; and care as usual. Victimization decreased significantly and similarly across all four conditions at 12 and 24 months following baseline. Similar reductions and failure to discriminate conditions were found on other key constructs: anxiety; bullying perpetration; and depression. Possible reasons for the failure to demonstrate victimization prevention differences and lessons learned from this large, effectiveness trial are considered.

The provision of alcohol and breastfeeding information by maternal health practitioners in the Australian setting.

BACKGROUND: In the 2009 National Health and Medical Research Council (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking, a guideline specific to lactating women was included. For the first time the effect of alcohol at this important developmental stage was nationally and internationally acknowledged. AIMS: To determine the degree to which maternal health practitioners adopted an Australian national policy guideline (Guideline 4B) on alcohol and breastfeeding into their everyday health practice and the factors associated with adoption. MATERIALS AND METHODS: A convenience sample of participants completed an online survey based on the Nursing Practice Questionnaire (NPQ) to elicit measures of knowledge, awareness and practice implementation. RESULTS: In total, 240 maternal health practitioners completed the online survey. All statistical analyses clearly indicated a higher adoption of Guideline 4B by the child health nurses, midwives and general practitioners (GPs) than was the case for paediatricians and obstetricians. A mean adoption score (range 0-4) indicative of 'some' practice implementation of 3.13, 3.04 and 2.73 was obtained by child health nurses, midwives and GPs, respectively. Obstetricians and paediatricians scored a mean of 2.0, indicating they remain to be 'persuaded about the practice' of incorporating discussions around alcohol and breastfeeding into their practice. CONCLUSION: Despite the existence of a national alcohol guideline for breastfeeding women, maternal health practitioners are not incorporating this advice into their everyday practice with lactating women. Opportunities exist for all maternal practitioners along the reproductive continuum to protect long-term breastfeeding duration using an evidence-based harm minimisation approach to alcohol consumption.

Moral Disengagement of Pure Bullies and Bully/Victims: Shared and Distinct Mechanisms.

The vast majority of adolescents recognize that bullying is morally wrong, yet bullying remains a problem in secondary schools, indicating young people may disengage from their moral values to engage in bullying. But it is unclear whether the same mechanisms enabling moral disengagement are active for bully/victims (who both bully and are bullied) as for pure bullies (who are not targets of bullying). This study tested the hypotheses that mechanisms of moral disengagement, including blaming the victim and minimizing the impact of bullying, may operate differently in bully/victims compared to pure bullies. From a sample of 1895 students from grades 7-9 (50.6% female; 83.4% from English speaking homes), 1870 provided self-reports on bullying involvement and mechanisms of moral disengagement associated with bullying. Two cut-offs were compared for bullying involvement (as perpetrator and as target of bullying) during the previous school term: a conservative cut-off (every few weeks or more often) and a liberal cut-off (once-or-twice). Using the conservative cut-off, both pure bullies and bully/victims enlisted moral disengagement mechanisms to justify bullying more than did uninvolved students and pure victims, with no significant difference in scores on any of the moral disengagement scales between pure bullies and bully/victims. For the liberal cut-off, bully/victims reported lower overall moral disengagement scores than did pure bullies, and specifically less distortion of consequences, diffusion of responsibility, and euphemistic labeling. This study advances bullying research by extending the role of moral disengagement in bullying episodes beyond pure bullies to victims, both pure victims and bully/victims. Examination of specific moral disengagement mechanisms and the extent of involvement in bullying enabled a more nuanced differentiation between the bullying groups. These results will inform future interventions aimed at reducing the use of moral disengagement mechanisms that sustain bullying and victimization. Targeted interventions are needed to challenge specific moral disengagement mechanisms from the perspectives of pure bullies and bully/victims.

RT Prepare: a radiation therapist-delivered intervention reduces psychological distress in women with breast cancer referred for radiotherapy.

BACKGROUND: The aims of this study were to determine whether a radiation therapist-led patient education intervention (RT Prepare) reduced breasts cancer patients' psychological distress (primary endpoint); anxiety, depression and concerns about radiotherapy, and increased knowledge of radiotherapy and preparedness (secondary endpoints). Patient health system usage and costs were also assessed. METHODS: A multiple-baseline study across three sites. The RT Prepare intervention comprised two consultations with a radiation therapist: prior to treatment planning and on the first day of treatment. Radiation therapists focused on providing sensory and procedural information and addressing patients' pre-treatment anxiety. Usual care data were collected prior to intervention commencement. Data collection occurred: after meeting their radiation oncologist, prior to treatment planning, first day of treatment and after treatment completion. Multilevel mixed effects regression models were used. RESULTS: In total, 218 usual care and 190 intervention patients participated. Compared with usual care, intervention participants reported lower psychological distress at treatment commencement (p = 0.01); lower concerns about radiotherapy (p < 0.01); higher patient knowledge (p < 0.001); higher preparedness for procedural concerns (p < 0.001) and higher preparedness for sensory-psychological concerns at treatment planning (p < 0.001). Mean within-trial costs per patient were estimated at $AU159 (US$120); mean ongoing costs at $AU35 (US$26). CONCLUSION: The RT Prepare intervention was effective in reducing breast cancer patients' psychological distress and preparing patients for treatment. This intervention provides an opportunity for radiation therapists to extend their role into providing patients with information and support prior to treatment to reduce psychological distress.

Does the Risk Outweigh the Benefits? Adolescent Responses to Completing Health Surveys.

The aim of this study is to describe the self-reported experiences of adolescents in population-based samples when completing health-related surveys on topics with varying potential for evoking distress. Survey data were collected in three school-based studies of bullying behaviors (N = 1,771, 12-14 years), alcohol use (N = 823, 12, 15, and 17 years), and electronic image sharing (N = 274, 13 years). Between 5% and 15% of respondents reported being upset at survey completion, but at most 1.4% were entirely negative in their evaluation. Age was not associated with being upset, but younger adolescents were more likely to see benefit in participation. Although concurrent mental health symptoms increased the risk of being upset, this was mostly mitigated by perceived benefits from participation.

Beyond the reactive-proactive dichotomy: Rage, revenge, reward, and recreational aggression predict early high school bully and bully/victim status.

The role of reactive and proactive aggression in school bullying perpetration remains unclear. In this study, we explore the predictive value of an expanded model of aggression motives based on the Quadripartite Violence Typology (QVT), which distinguishes between motivational valence (appetitive or aversive) and recruitment of deliberative self-control to derive four classes of motives: Rage, Revenge, Reward, and Recreation. With a sample of 1,802 students from grades 7-9, we assessed aggression motives via self-report, along with self-report of bullying perpetration and victimization, which were used to assign students into categories of Pure Bully, Bully/Victim (B/V), Pure Victim, and Uninvolved. Two structural models were computed to examine the relationship between these four categories of bullying involvement and aggression motives, using conservative and liberal bullying cutoffs. As predicted, B/V status was more strongly related to Rage and Revenge motives. However, B/Vs had higher scores than Pure Bullies for almost all aggression motives, including Recreation. We discuss the implications of addressing Revenge and Recreation, as well as Reward and Rage (which map most clearly to proactive and reactive aggression, respectively) aggression motives, for bullying prevention and intervention strategies, especially among adolescents for whom extant bullying prevention strategies may be ineffective or counterproductive.

Feasibility Testing and Refinement of a Supportive Educational Intervention for Carers of Patients with High-Grade Glioma - a Pilot Study.

The aim of this pilot study was to test the feasibility and acceptability of a family carer intervention for carers of patients with high-grade glioma (HGG). The intervention consisted of: (1) an initial telephone assessment of carer needs; (2) a personalised tabbed resource file; (3) nurse-led home visit; and (4) ongoing telephone support. Two consumer representatives reviewed the intervention resources. The intervention was then piloted with participants who were the primary carer for patients undergoing treatment for HGG in Western Australia. Two consumers provided feedback on the resource, and 10 carers participated in the pilot. Positive feedback was received about the resource manual and intervention. Suggestions were also made for changes which were implemented into the trial. The surveys were shortened based on feedback. Participants identified a large range of issues during nursing assessments which would not otherwise be identified or addressed for carers receiving routine care. As a result of providing the intervention, the nurse was able to make referrals to address needs that were identified. This pilot study enabled us to refine and test the Care-IS intervention and test the feasibility and acceptability of proposed survey instruments. We were also able to estimate recruitment and retention and the overall study timeline required for the randomised controlled trial we are now conducting. It has also demonstrated the role of the nurse who delivered the intervention and allowed us to refine communication and referral pathways.

Child-parent agreement on alcohol-related parenting: Opportunities for prevention of alcohol-related harm.

ISSUE ADDRESSED: Excessive alcohol consumption places adolescents at increased risk of preventable, acute alcohol-related injury. Parental attitudes and behaviours influence adolescents' alcohol use. This study examined alignment in parent and child reports of alcohol-related parenting and whether misalignment related to the child ever having drunk alcohol. METHODS: A cross-sectional online survey was conducted in five secondary schools in [information removed for blinding in Perth, Western Australia] in 2015. All students in Years 7, 10 and 12 and their parents were eligible, and data were matched for 124 child-parent dyads. Alignment of parent-child reports was assessed using kappa statistics. In dyads where the parent reported protective attitudes and behaviours, the association between misalignment and alcohol use was tested in logistic regressions. RESULTS: Overall, child-parent reports were aligned on parents' expectations, knowledge and actions (65% and higher agreed). While alignment on parental expectations seemed to decrease with age, alignment on parental communication and rule-setting increased. Misalignment on reports of parents' expectations was associated with increased odds of the child reporting having ever had alcohol (OR = 5.5; 95% CI = 2.7-47.7), as was parental supply (OR = 20.2; 95% CI = 3.3-121.5), but misalignment on parental communication, rule-setting and knowledge were not. CONCLUSIONS: Parent nonsupply of alcohol and disapproval of use were most important in terms of associations with ever drinking. SO WHAT?: These findings call for interventions that support parents to expect no alcohol use and enable parents to communicate their expectation in a manner that resonates with their child. Effective parenting will contribute to reducing alcohol-related harm in adolescents.

Distress and psychological morbidity do not reduce over time in carers of patients with high-grade glioma.

PURPOSE: This study aimed to determine how carer distress and psychological morbidity change over time following a patient's diagnosis of high-grade glioma (HGG) and identify factors associated with changes in carers' psychological status. METHODS: Carers of patients with HGG planned for chemoradiotherapy were recruited to this longitudinal cohort study. Carers completed questionnaires during patients' chemoradiotherapy and 3 and 6 months later including the following: the Distress Thermometer (DT); General Health Questionnaire-12 (GHQ-12); and three single-item questions about understanding of information presented by health professionals, confidence to care and preparedness to care for their relative/friend. Linear latent growth models were applied. RESULTS: The time 1 questionnaire was completed by 118 carers, of these 70 carers provided responses to the third time point. Carer distress and psychological morbidity were most prominent proximal to diagnosis, but remained high over time. Sixty-two percent of participants had moderate or high distress on the DT at time 1, 61% at time 2 and 58% at time 3. Scores on the DT and the GHQ-12 correlated significantly at all time points as did changes in scores over time (p < .001). However, for individual carers, the DT or GHQ-12 scores at one time point did not strongly predict scores at subsequent time points. CONCLUSION: In carers of patients with HGG, distress levels are consistently high and cannot be predicted at any time point. Carers should be monitored over time to identify evolving psychological morbidity. The single-item DT correlates highly with GHQ-12 scores and is a suitable tool for rapid repeated screening.

Disentangling functions of online aggression: The Cyber-Aggression Typology Questionnaire (CATQ).

Aggression in online contexts has received much attention over the last decade, yet there is a need for measures identifying the proximal psychological drivers of cyber-aggressive behavior. The purpose of this study was to present data on the newly developed Cyber-Aggression Typology Questionnaire (CATQ) designed to distinguish between four distinct types of cyber-aggression on dimensions of motivational valence and self-control. A sample 314 undergraduate students participated in the study. The results confirmed the predicted four-factor structure providing evidence for distinct and independent impulsive-aversive, controlled-aversive, impulsive-appetitive, and controlled-appetitive cyber-aggression types. Further analyses with the Berlin Cyberbullying Questionnaire, Reactive Proactive Aggression Questionnaire, and the Behavior Inhibition and Activation Systems Scale provide support for convergent and divergent validity. Understanding the motivations facilitating cyber-aggressive behavior could aid researchers in the development of new prevention and intervention strategies that focus on individual differences in maladaptive proximal drivers of aggression. Aggr. Behav. 43:74-84, 2017. © 2016 Wiley Periodicals, Inc.

Longitudinal impact of the Cyber Friendly Schools program on adolescents' cyberbullying behavior.

Cyberbullying is a major public health problem associated with serious mental, social, and academic consequences for young people. To date, few programs addressing cyberbullying have been developed and empirically tested. The Cyber Friendly Schools (CFS) group-randomized controlled trial measured the longitudinal impact of a whole-school online cyberbullying prevention and intervention program, developed in partnership with young people. Non-government secondary schools in Perth, Western Australia, (N = 35; 3,000+ students) were randomized to an intervention (n = 19) or usual practice control group (n = 16 schools). Students completed online questionnaires in 2010, 2011, and at 1-year follow-up in 2012, measuring their cyberbullying experiences during the previous school term. The intervention group received the program in Grades 8 and 9 (aged 13-14 years). Program effects were tested using two-part growth models. The program was associated with significantly greater declines in the odds of involvement in cyber-victimization and perpetration from pre- to the first post-test, but no other differences were evident between the study conditions. However, teachers implemented only one third of the program content. More work is needed to build teacher capacity and self-efficacy to effectively implement cyberbullying programs. Whole-school cyberbullying interventions implemented in conjunction with other bullying prevention programs may reduce cyber-victimization more than traditional school-based bullying prevention programs alone. Aggr. Behav. 42:166-180, 2016. © 2015 Wiley Periodicals, Inc.

The use of PDSA methodology to evaluate and optimise an inner city memory clinic: a quality improvement project.

The Memory Services National Accreditation Programme states that memory services should provide "timely access to assessment and diagnosis" of dementia. We undertook a quality improvement project using Plan-Do-Study-Act methodology to improve patient access to an inner city memory service. This report focuses on the third Plan-Do-Study-Act cycle where, in 2012, we aimed to shorten the time from memory service referral to assessment and to diagnosis. The time from referral to assessment increased but the time from referral to diagnosis and to treatment decreased. Other memory clinics could use Plan-Do-Study-Act to enable faster diagnosis and better care for patients with dementia.

Does the nature of schools matter? An exploration of selected school ecology factors on adolescent perceptions of school connectedness.

BACKGROUND: Connectedness to school is a significant predictor of adolescent health and academic outcomes. While individual predictors of connectedness have been well-described, little is known about school-level factors which may influence connectedness. A school's ecology, or its structural, functional, and built aspects, coupled with interpersonal interactions, may also help to enhance adolescent connectedness. AIM: This study aims to identify school ecological characteristics which predict enhanced connectedness in secondary school. SAMPLE: Data from 5,159 Grade 8 students (12-13 years) from 39 randomly selected schools were tracked until the end of Grade 9 (13-14 years). METHOD: Students' self-reported school, teacher, and family connectedness, mental health and peer relationships were measured at two time points. Accounting for school-level clustering, student- and school-level ecological characteristics were modelled on self-reported school connectedness in Grades 8 and 9. RESULTS: Students' higher school connectedness in Grades 8 and 9 was influenced by greater levels of family connectedness, fewer classroom and peer problems, less difficult secondary school transition, fewer emotional problems, and greater prosocial skills. Seven school-level ecological variables were significantly associated with school connectedness after controlling for student-level predictors. At the school-level, priority for pastoral care and students' aggregated writing skills scores significantly predicted concurrent and future enhanced connectedness. CONCLUSIONS: Interventions to improve students' school connectedness should address individual student characteristics and school functional features such as pastoral care strategies and helping students to achieve greater academic outcomes. Future studies should focus on the cumulative longitudinal influence of school ecological and student-level predictors of school connectedness.

The impact of a parent-directed intervention on parent-child communication about tobacco and alcohol.

INTRODUCTION AND AIM: Given the likelihood of engaging in the hazardous use of tobacco and alcohol increases during teenage years, pre-adolescence is a critical time to implement prevention programmes. While social factors other than those associated with parenting play a role in determining a child's risk for initiation of tobacco and alcohol use, parents can have a significant influence on their children's decisions about these issues. The aim of this study was to assess the impact of an in-home parent-directed drug education intervention on parent-child communication about tobacco and alcohol. DESIGN AND METHODS: A group randomised intervention trial was conducted in Perth, Western Australia. Schools were selected using stratified random sampling and randomised to three study conditions. A total of 1201 parents of 10- 11-year-old children were recruited from 20 schools. The impact of a self-help intervention, comprised of five communication sheets containing information and activities designed to encourage parents to talk with their 10- 11-year-old child about issues related to smoking cigarettes and drinking alcohol, was assessed. RESULTS: Intervention-group parents were more likely to have spoken with their children, to have spoken more recently, to have engaged the child during the discussion and to have addressed the topics identified as being protective of children's involvement in tobacco and alcohol. In addition, the duration of talks about alcohol was longer than for parents in the comparison group. DISCUSSION AND CONCLUSIONS: Parents of 10- 11-year-old children appear to be receptive to participating in a home-based drug-related educational intervention and the parent-directed intervention seems to have enhanced parent-child tobacco- and alcohol-related communication.

Bullying and mental health amongst Australian children and young people with cystic fibrosis.

Currently, there is little research investigating how schools can support the mental health and social development of young people with cystic fibrosis (CF), given their heightened risk of mental illness. Few studies have examined the relationship between bullying and mental health in populations of children with CF. This study describes the peer bullying experiences of young people with CF, and examines associations between school bullying and the psychological well-being of these young people. A sequential mixed-methods approach was used to collect data from 26 young people with CF (10-16 years of age). These data were compared with large samples of healthy children. Following an online survey, 11 young people, through online focus groups, expanded on the survey findings, describing their experiences within the school environment. Young people with CF reported lower involvement in bullying victimization and perpetration relative to the comparison population. For older adolescents with CF, victimization was associated with less connectedness to school and less peer support, and more school loneliness, anxiety, and depression. Young people with CF reported they generally liked the school environment, and were happy with their friendships, whereas some older adolescents reported that bullying evoked anxiety and mood problems. Reported bullying was primarily verbal and targeted characteristics of their CF, including their coughing, noninvolvement in certain activities because of shortness of breath, use of medication, and being underweight (for boys only). The findings provide some recommendations for interventions to promote mental health and school engagement among young people with CF. (PsycINFO Database Record

Evaluation of a public education campaign to support parents to reduce adolescent alcohol use.

INTRODUCTION AND AIMS: Mass media education campaigns targeting parents may influence parent factors that reduce adolescent drinking; however few such campaigns have been evaluated. DESIGN AND METHODS: The Parents, Young People and Alcohol campaign included two phases of mass media advertising, Cogs and I See, to deliver consistent messages across multiple media channels. The campaign targeted Western Australian parents of 12-17 year olds with messages describing alcohol's effect on the developing brain and adolescent physical and mental health. The campaign reinforced the National Health and Medical Research Council (NHMRC) Guideline that for under 18s, not drinking is the safest option. Parent knowledge, attitudes and behaviours were assessed via cross-sectional surveys administered before the campaign (Time 1) and at two post-tests (Time 2; Time 3). Post-test campaign awareness and perceptions were also assessed. RESULTS: Campaign awareness was high (48% Time 2; 80% Time 3) and over 86% of parents found the campaign believable and relevant at both post-tests. Increased knowledge of the NHMRC guideline and lower belief in alcohol myths were found at both post-tests compared to Time 1. Less positive attitudes to parental supply were found at Time 2, but were not sustained at Time 3. Parents were more likely to have discussed alcohol risks and limiting drinking with their child at Time 3, but parent-to-child alcohol supply did not change significantly. DISCUSSION AND CONCLUSIONS: The campaign achieved high awareness and positively influenced parental outcomes. Longer term campaign implementation supported by policy and environmental measures may be required to change parental supply.

Does harm minimisation lead to greater experimentation? Results from a school smoking intervention trial.

INTRODUCTION AND AIMS: Declines in adolescent smoking prevalence have slowed recently, resulting in increased interest and literature in tobacco harm minimisation. To date, harm reduction strategies have focused largely on modifying the product and alternative (safer) mechanisms of nicotine delivery. There has been little exploration of primary harm minimisation to prevent the onset of regular smoking among young people. A major concern expressed about harm reduction interventions and young people is that they may increase experimentation among non-users. DESIGN AND METHODS: The Smoking Cessation for Youth Project was a 2-year school-based cluster randomised controlled trial conducted in 30 Western Australian schools. Results on the primary outcome showed a significant reduction in regular smoking among 4636 13-15-year-olds receiving a harm minimisaton versus standard intervention. This paper addresses the intervention effects on 2078 students who had not smoked at baseline. RESULTS: At 20-month follow-up, smoking initiation was slightly lower among intervention students than comparison students (who received a largely abstinence-based intervention), although this difference did not attain statistical significance (OR=0.86; 95% confidence interval: 0.68, 1.09). DISCUSSION AND CONCLUSIONS: This study provided limited evidence to suggest that harm minimisation is a superior approach to abstinence-based interventions for non-smokers. However, this intervention did not contribute to increased experimentation among non-smokers. Although more trials are required, these results indicate that fears of potential negative iatrogenic effects from school-based harm minimisation interventions may be unwarranted.

Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients.

UNLABELLED: Current empirical evidence supports claims that pain in sedated, unconscious Intensive Care Unit (ICU) patients is underrated and under-treated. Given the severity of ICU patients' illness pain management, whilst important, may not be considered a priority and therefore can be easily overlooked. The aim of this study was to validate the Behavioural Pain Scale (BPS) for the assessment of pain in critically ill patients by evaluating facial expressions, upper limb movements and compliance with mechanical ventilation. METHODS: A prospective, descriptive repeated measures study design was used to assess the validity and reliability of the BPS for assessing pain in critically ill patients undergoing routine painful (repositioning) and non-painful (eye care) procedures. RESULTS: An average of 73% of BPS scores increased (indicating pain) after patients were repositioned, as opposed to 14% after eye care. This increase was statistically significant for repositioning (p < 0.003) but not for eye care (p > 0.3). The odds of an increase in BPS between pre- and post-procedure assessments was more than 25 times higher for repositioning compared with eye care (p < 0.0001), after controlling for analgesics and sedatives. CONCLUSION: The BPS was found to be a valid and reliable tool in the assessment of pain in the unconscious sedated patient. Results also highlighted that traditional pain indicators, such as fluctuations in haemodynamic parameters, are not always an accurate measure for the assessment of pain in unconscious patients and as such more objective pain assessment measures are essential. Finally, further validation of the BPS and identification of other painful routine procedures is needed to enhance pain management delivery for unconscious patients.

Carers of patients with high-grade glioma report high levels of distress, unmet needs, and psychological morbidity during patient chemoradiotherapy.

BACKGROUND: Few studies have explored the unmet needs of carers of people with high-grade glioma. We aimed to determine carers' levels of distress during treatment, understand their support needs and explore predictors of distress. METHODS: Carers of people with high-grade glioma undergoing chemoradiotherapy were recruited to this prospective, longitudinal cohort study. Carers completed the validated Supportive Care Needs Survey, Brain Tumour Specific Supportive Care Needs Scale, Distress Thermometer (DT), and General Health Questionnaire (GHQ-12). Questionnaires were administered during patients' chemoradiotherapy and 3 and 6 months later. RESULTS: We recruited 118 carers who were mainly female (72%) and caring for spouse (82%). The mean age was 53 years (SD = 13.6; range, 21-89). Thirty-one percent of carers reported moderate distress (DT score 5-6/10) and 31% reported extreme distress (score 7-10/10) during combined chemoradiotherapy. Carer distress was associated with adverse GHQ scores (r = 0.61, P < .001). Seventy-two percent reported a negative financial impact of caring and 51% of those previously working full-time had taken leave or reduced working hours. The top 5 moderate/high unmet needs were: accessing prognostic information; accessing financial support and government benefits; accessible hospital parking; impact of caring on usual life; reducing stress in the patients' life. CONCLUSION: Carers reported substantial distress, and high distress levels were correlated with greater psychological impact and increased self-reporting of unmet needs. Future research should focus on interventions that aid in reducing carer distress.