Fifteen years of shared care for paediatric oncology, haematology and palliative patients across Queensland: The role of Regional Case Managers.

OBJECTIVE: A shared care model was implemented in 2006 in Queensland to facilitate paediatric oncology, haematology and palliative care patients receiving care as close to home as possible. Following initial diagnosis, care planning and treatment at the tertiary children's hospital, appropriate local care was coordinated by Regional Case Managers (RCMs) established at each of 10 Shared Care Units (SCUs). This enabled safe and quality regional care supported by a statewide network providing clinical governance and education. This paper examines learnings from 15 years of this shared care. SETTING: Ten hospitals throughout Queensland facilitated a statewide model of shared care for paediatric oncology, haematology and palliative care patients, supported by a tertiary hub in Brisbane. PARTICIPANTS: Regional Case Managers in Shared Care Units and their supporting staff. DESIGN: Staff from SCUs were surveyed and focus group interviews conducted. RESULTS: The paper reviews the attributes, knowledge and experience required for RCMs. Standards of care were supported through education workshops, clinical placements, chemotherapy credentialing, guidelines and standards. RCMs facilitated communication and information sharing with the tertiary centre, advocated for their cohort of patients locally and streamlined and supported the family's experience of care. CONCLUSION: The RCM role provided invaluable clinical leadership for the care of paediatric oncology, haematology and palliative patients across Queensland. As new treatments evolve, the expertise and coordination provided by the RCMs will be even more critical. Achieving high-quality shared care outcomes is underpinned by the RCMs drive to achieve statewide safety and support for this cohort of children.

Unravelling reciprocal effects among young adults' binge drinking, stress, and anticipated regret.

Problematic alcohol consumption represents a critical risk to young adults' mental and physical health (WHO, 2018). As a result, understanding negative consequences that stem from young adults' binge drinking and inter-related factors that may mitigate increases in binge drinking has much to offer scholars and practitioners. In the current study, a two-wave random intercept cross-lagged panel design was used to examine the reciprocal inter-relations among stress, anticipated regret, and binge drinking within a lab-based study of young adults (N = 109, Mage = 19.85). Within-person findings indicated that high life stress and low anticipated regret predicted subsequent increases in binge drinking three months later, accounting for between-person stability in these constructs. All told, findings point to life stress as a robust predictor of increased binge drinking, and anticipated regret as a protective factor associated with reductions in binge drinking among young adults. Given that anticipated regret signalled subsequent drinking reductions, future research should consider ways to foreground anticipation of regret as a protective factor mitigating binge drinking increases.

Safety and efficacy of telephone clinics during the COVID-19 pandemic in the provision of care for patients with cancer.

BACKGROUND: Due to the COVID-19 pandemic, telephone clinics have been utilised to reduce the risk of transmission. Evidence supporting its quality and safety is required. AIMS: Assess the efficacy and safety of telephone clinics in delivering care to established oncology patients and assess patient and health professionals' preference (telephone vs face-to-face clinics). METHODS: Retrospective chart audit in the month preceding and month following the introduction of telephone clinics at the Gold Coast University Hospital and a patient and health professional questionnaire. RESULTS: In total, 1212 clinical encounters occurred in the month post the introduction of telephone clinics (vs 1208 encounters prior). There were no statistically significant differences in 24-h (18 vs 22, P = 0.531) or 7-day admissions (50 vs 46, P = 0.665) comparing encounters in the month prior to the introduction of telephone clinics versus the month post, but there was a statistically significant difference in 30-day mortality post systemic therapy in favour of the post-telephone clinic period (7 vs 0 patients, P = 0.008). Of the 222 patients who undertook the questionnaire, 42.3% preferred telephone clinics (95% confidence interval (CI) 35.97-48.97), 25.2% preferred face-to-face clinics (95% CI 19.92-31.39) and 32.4% did not prefer one method over another. Of the 24 health professionals who undertook the questionnaire, 70.8% felt patients preferred phone clinics. CONCLUSIONS: Generally, patients and clinicians viewed telephone clinics favourably. Nevertheless, a large portion of patients still prefer face-to-face clinics. Services should be tailored to individual preferences. Although there were no 'red flags' in terms of mortality or admission rates, further longitudinal research is required.

Management of febrile neutropenia in pediatric oncology across Queensland, Australia: a retrospective review on variations between locations.

Febrile neutropenia (FN) is a common complication in pediatric oncology with intravenous antibiotics being given routinely for decades. This study aimed to compare the management of FN in children in different locations across Queensland, Australia. FN episodes were identified from 4 settings: tertiary oncology outpatient department (OD), tertiary emergency department (ED), regional ward (RW), and regional emergency department (RED) between July 2009 and June 2011. Retrospective data were extracted from medical records, collated, and then analyzed to identify differences in outcomes attributable to location. Sixty-one episodes of FN were reviewed: 5 cases from OD, 28 from ED, 19 from RW, and 5 from RED. Statistically significant differences occurred in the time taken for medical review for cases depending on location of presentation. Patients who presented to the ED or the RW were more likely to be seen within 30 minutes than in other locations (P = .014), and patients who presented to the tertiary hospital in either the OD or ED were more likely to commence antibiotics within 120 minutes of presentation (P = .023). Antibiotics were commenced within 60 minutes (the gold standard) on only 10 occasions. Despite education input emphasizing the importance of early commencement of antibiotics, this study identified that this objective was not met in the majority of cases. Further study is needed to look at reasons for the delay in beginning treatment for pediatric oncology patients in Queensland and what measures may assist with improving the time from presentation with FN to antibiotic administration across all settings.