Establishing national diagnostic reference levels in radiography, mammography, and dual-energy x-ray absorptiometry services in Ireland and comparing these with European diagnostic reference levels.

OBJECTIVES: The aim of this work was to establish national diagnostic reference levels (DRLs) in Ireland and compare these to existing European DRLs where available. This work surveyed all radiological facilities providing radiography, mammography, and dual-energy x-ray absorptiometry (DXA) services in Ireland. METHODS: A list of common procedures and clinical tasks was established. A national database of service providers was used to identify the appropriate medical radiological facilities providing these services. These facilities were issued with an online survey. National DRLs were set as the 75th percentile of the distribution of median values obtained. A national median dose was also established. The broad categorisation of equipment type was also considered. Where differences between DRLs established using different detector types were deemed statistically significant, equipment-specific national DRLs were established. RESULTS: National DRLs were established for 12 adult radiography projections. Equipment-specific (computed radiography and digital radiography) adult DRLs were established for four radiography projections. Paediatric DRLs were established for 11 radiography projections, including two based on clinical indications, for a range of paediatric weight categories. National DRLs were established for unilateral two-view mammography and breast tomosynthesis as well as for four DXA clinical indications and projections. All but one Irish DRL figure was found to be below or equal to European data. CONCLUSIONS: This work provided a unique opportunity to establish national DRLs based on census data for a range of procedures and clinical tasks across radiography, mammography and DXA and compare these with European levels. CLINICAL RELEVANCE STATEMENT: This work established national diagnostic reference levels (DRLs) based on census data for a range of procedures and clinical tasks across radiography, mammography and dual-energy x-ray absorptiometry. The establishment of national DRLs is an essential component in the optimisation of patient radiation dose. KEY POINTS: • Diagnostic reference levels are easily measured quantities intended for use as an aid to optimise patient dose and to identify when levels of patient dose are unusually high. • Data from all medical radiological facilities in Ireland was obtained to establish national diagnostic reference level (DRL) values and national median dose values in radiography, x-ray breast imaging and dual-energy x-ray absorptiometry (DXA) scanning and these were compared to existing European DRLs where available. • National DRL values were established for the first time in breast tomosynthesis, DXA scanning, and paediatric radiography.

What do radiation therapists know about health literacy and the strategies to improve it for patients? A qualitative study.

PURPOSE: Low health literacy leads to poor knowledge and understanding of health information, delayed diagnosis, lower use of preventative medicines/health services, increased likelihood of hospitalisation, and increased patient anxiety. Effective communication facilitates patient understanding and helps patients to manage the adverse side-effects associated with treatment. It is not yet known whether radiation therapists in Ireland tailor their communication to match a patient's health literacy level. The purpose of this research was to investigate radiation therapists' knowledge and awareness of health literacy and perceptions of their role in supporting patients with low health literacy. METHODS: Semi-structured interviews were conducted with sixteen radiation therapists working in four radiotherapy departments in Ireland. Data were analysed using the framework approach. RESULTS: Through discussions with participants, it was apparent that radiation therapists had limited knowledge of the concept of health literacy. Common themes arose from the interviews with four key themes identified: 1. Strategies used to identify patients' health literacy 2. Perceived effect of low health literacy 3. Obstacles faced when addressing low health literacy 4. Recommendations to support lower health literacy groups CONCLUSION: Currently, radiation therapists show some knowledge and awareness of health literacy, but an increased awareness of the prevalence of low health literacy and a structured approach to supporting patients would allow radiation therapists to more effectively communicate with patients, thus improving their treatment experience and reducing the risk of adverse outcomes.

A Literature Review of Patient Education: Is IT Time to Move Forward?

INTRODUCTION: Patient education is fundamental to high-quality care, enabling patient empowerment and improving outcomes and quality of life. Therefore, identifying the most effective education method should take precedence. Modern society relies heavily on technology and the Internet. Consequently, computer-based learning systems (CBLSs) have been introduced to increase information efficacy. This review aims to establish whether CBLSs should replace standard education for cancer populations. METHODS: A systematic review of up-to-date studies comparing CBLSs and standard education for cancer patients was conducted. Results were assessed in terms of outcomes (knowledge, satisfaction, and decision making) and patient characteristics (age, sex, and socioeconomic status). RESULTS: Results are conflicting. Although CBLSs scored highly in certain outcomes, standard education was more suited to some patient characteristics. Additionally, subgroups of society (older and low socioeconomic populations) were poorly represented in studies. CONCLUSIONS: Up-to-date research on cancer patient education is lacking. Results indicate that although CBLSs for cancer education show promise, further research is required.

Appearance matters: the frame and focus of health messages influences beliefs about skin cancer.

OBJECTIVES: This study sought to ascertain whether the health message 'framing effect', which has been observed for several diseases, occurs for messages concerning the consequences of skin cancer for one's appearance or one's health. Specifically, the effect of the frame and focus of health messages on intentions to perform skin protection behaviours and the perceived threat of skin cancer was investigated. DESIGN: Consistent with previous research and to avoid carry-over effects, a two-factor, between-groups (message frame: gain vs. loss × message focus: appearance vs. health) design was used. METHODS: Participants (N= 390) were recruited using convenience sampling and presented with one of four health messages, which were embedded in a questionnaire concerning beliefs about skin cancer (intentions to perform different skin protection behaviours, the perceived threat of skin cancer) and body consciousness. The health messages were framed in terms of loss (risks of sun exposure) or gain (benefits of skin protection) and focused on the consequences of sun exposure for one's appearance or one's health. The primary outcome measures were responses on rating scales concerning the perceived threat of skin cancer, intentions to perform different skin cancer protection behaviours, and body consciousness. RESULTS: Perceived threat of skin cancer was found to be greater for appearance-focused messages and intentions to perform different skin protection behaviours were greater for loss-framed messages. These findings held when individual differences in body consciousness were controlled for. CONCLUSIONS: These findings suggest that, for the communication of information about skin cancer to be effective, messages must focus on the impact of sun exposure and inadequate skin protection for people's appearance, not just their health. Moreover, to maximize effectiveness, health messages about skin cancer should take account of dispositional differences in the importance placed upon one's appearance.

The relationship between prostate cancer knowledge and beliefs and intentions to attend PSA screening among at-risk men.

OBJECTIVE: To examine the level of knowledge regarding prostate cancer and screening, to investigate prostate cancer illness perceptions, and to test the efficacy of the theory of planned behaviour (TPB) for understanding intentions to attend prostate-specific antigen (PSA) screening, when offered by a doctor or self-initiated. METHODS: Two hundred and twenty three men completed the PROCASE knowledge scale, the Revised Illness Perceptions Questionnaire and a questionnaire developed to assess attitudes, subjective norms and perceived control over intentions to attend for PSA testing. RESULTS: Participants had a high level of knowledge and accurate perceptions of prostate cancer. Controlling for knowledge and experience with prostate cancer, the TPB accounted for 49% (p<0.001) of the variation in intentions to attend if recommended by a doctor. CONCLUSION: The sample of at-risk men were characterised by good knowledge, accurate mental representation of prostate cancer, and positive beliefs towards the PSA test. Components of the TPB accounted for statistically significant amounts of variation in intentions to attend for testing. PRACTICE IMPLICATIONS: Beliefs about prostate cancer do not appear to influence PSA testing intentions; healthcare providers' recommendations may have the strongest influence on decisions to attend for PSA testing.

A national survey of telemedicine in the Republic of Ireland.

We conducted a national survey of hospitals in the Republic of Ireland to assess their use of telemedicine. Information was sought from 187 hospitals and replies were received from 157, a response rate of 84%. Activity was identified in a total of 40 hospitals (25% of the respondents). The main disciplines using telemedicine were radiology, pathology, neurosurgery, oncology and paediatrics, and the main applications were teleradiology (25 hospitals), videoconferencing (16) and telepathology (5). Dublin, the capital city, was found to act as a centre for telemedicine activity for the whole country. A number of regional networks had developed in the east, but the pattern of development in the west was very different where there were mainly isolated links. One fully operational national network was found but this was only used for consultation in one discipline (neurosurgery). It appears that the development of telemedicine in the Republic of Ireland has been unplanned. A national telemedicine strategy might lead to an integrated national network in the future, which could help to provide more equitable access to health care.