Determining the Research Priorities for Adult Primary Brain Tumours in Australia and New Zealand: A Delphi Study with Consumers, Health Professionals, and Researchers.

The aim of this project was to determine research priorities, barriers, and enablers for adult primary brain tumour research in Australia and New Zealand. Consumers, health professionals, and researchers were invited to participate in a two-phase modified Delphi study. Phase 1 comprised an initial online survey (n = 91) and then focus groups (n = 29) which identified 60 key research topics, 26 barriers, and 32 enablers. Phase 2 comprised two online surveys to (1) reduce the list to 37 research priorities which achieved consensus (>75% 2-point agreement) and had high mean importance ratings (n = 116 participants) and (2) determine the most important priorities, barriers, and enablers (n = 90 participants). The top ten ranked research priorities for the overall sample and sub-groups (consumers, health professionals, and researchers) were identified. Priorities focused on: tumour biology, pre-clinical research, clinical and translational research, and supportive care. Variations were seen between sub-groups. The top ten barriers to conducting brain tumour research related to funding and resources, accessibility and awareness of research, collaboration, and process. The top ten research enablers were funding and resources, collaboration, and workforce. The broad list of research priorities identified by this Delphi study, together with how consumers, health professionals, and researchers prioritised items differently, and provides an evidence-based research agenda for brain tumour research that is needed across a wide range of areas.

Investigating the Primary Care Management of Low Back Pain: A Simulated Patient Study.

UNLABELLED: A limitation of existing studies of primary care for low back pain (LBP) is that they are not based on direct observation of the clinical encounter and so may underestimate or overestimate the extent of evidence-practice gaps. This was a cross-sectional observational study that observed the management recommendations for LBP provided in primary care using a simulated patient approach. Trained actors requested an over-the-counter medicine or asked for management advice for 1 of 2 simulated patient scenarios: nonspecific LBP (NSLBP) or vertebral compression fracture. Visits were audiorecorded to allow data capture, validation, and review. We evaluated concordance with key recommendations provided in evidence-based LBP guidelines on pain medicines, patient self-care advice, and referral. Visits were conducted across 534 pharmacies comprising 336 nonspecific scenarios and 198 fracture scenarios. Recommendations for pain medicines, but not patient self-care advice and referral, were typically consistent with guidelines. For the NSLBP scenario, the concerns were infrequent provision of reassurance of favorable outcome (8%), advice to stay active (5%), advice to avoid bed rest (0%), advice to use superficial heat (24%), and excessive endorsement of referral (57.4%) and imaging (22.7%). For the fracture scenario, the concerns were a low rate of prompt medical referrals (50.0%) and low endorsement of rest (1.0%). PERSPECTIVE: We observed primary care that aligned closely with some aspects, but was at odds with other aspects, of evidence-based LBP guidelines. Problems included inadequate self-care advice and failing to appropriately recommend imaging or prompt medical review when indicated. These results can inform implementation strategies to improve primary care management of LBP.