Identifying and addressing the support needs of family caregivers of people with motor neurone disease using the Carer Support Needs Assessment Tool.

OBJECTIVE: Family caregivers of people with motor neurone disease (MND) experience adverse health outcomes as a result of their caregiving experience. This may be alleviated if their support needs are identified and addressed in a systematic and timely manner. The objective of the present study was to assess the feasibility and relevance of the Carer Support Needs Assessment Tool (CSNAT) in home-based care during the period of caregiving from the perspectives of the family caregivers of people with MND and their service providers. METHOD: The study was conducted during 2014 in Western Australia. Some 30 family caregivers and 4 care advisors participated in trialing the CSNAT intervention, which involved two visits from care advisors (6-8 weeks apart) to identify and address support needs. The feedback from family caregivers was obtained via telephone interviews and that of care advisors via a self-administered questionnaire. RESULTS: A total of 24 caregivers completed the study (80% completion rate) and identified the highest support priorities as "knowing what to expect in the future," "knowing who to contact if concerned," and "equipment to help care." The majority found that this assessment process adequately addressed their needs and gave them a sense of validation, reassurance, and empowerment. Care advisors advocated the CSNAT approach as an improvement over standard practice, allowing them to more clearly assess needs, to offer a more structured follow-up, and to focus on the caregiver and family. SIGNIFICANCE OF RESULTS: The CSNAT approach for identifying and addressing family caregivers' support needs was found to be relevant and feasible by MND family caregivers and care advisors. The tool provided a formal structure to facilitate discussions with family caregivers and thus enable needs to be addressed. Such discussions can also inform an evidence base for the ongoing development of services, ensuring that new and improved services are designed to meet the explicit needs of the family caregivers of people with a motor neurone disease.

Lymphedema Quality of Life Inventory (LyQLI)-Development and investigation of validity and reliability.

PURPOSE: The purpose of this study was to reduce the 188-item Swedish Lymphedema Quality of Life Inventory (SLQOLI) to an abbreviated, clinically useful version (phase 1) and to test it for reliability and validity (phase 2). METHODS: In phase 1 correlation analysis, factor analysis, content validity assessment and expert panels were used to reduce the number of items in SLQOLI to 45 items, which was named, Lymphedema Quality of Life Inventory (LyQLI). In phase 2, LyQLI was sent to 200 patients with lymphedema. 126 patients completed the questionnaire twice to determine stability of the instrument over time. SF-36 was sent to the patients once, correlations between the three domains in LyQLI and the two sum scores Physical Health (PCS) and Mental Health (MCS) in SF-36 were used to assess concurrent validity. RESULTS: The 188-item SLQOLI was reduced to 45-item LyQLI. Four domains were reduced to three: physical, psychosocial and practical. Reliability estimates using ICC for the physical and psychosocial domains were 0.88 (p < 0.01) and 0.87 (p < 0.01), for the practical domain 0.87 (p < 0.01). Cronbach's alpha coefficients for the three domains were 0.88, 0.92 and 0.88, respectively. The physical domain correlated highly significantly with PCS, psychosocial highly significantly with MCS and practical equally highly significantly to both PCS and MCS. Using skewness coefficients, small floor effects in the items were found. CONCLUSION: The shorter LyQLI demonstrated good reliability and validity with potential use to assess quality of life in clinic settings and in further cross-sectional studies of patients with lymphedema.

Dignity therapy for people with motor neuron disease and their family caregivers: a feasibility study.

BACKGROUND: There are calls to explore psychological interventions to reduce distress in patients with motor neuron disease (MND) and their family caregivers. Dignity therapy is a short-term psychotherapy intervention shown to alleviate distress for people with life-limiting illnesses. OBJECTIVES: To assess the acceptability, feasibility, and effectiveness of dignity therapy to reduce distress in people with MND and their family caregivers. METHODS: The study used a repeated-measures design pre- and post-intervention. Acceptability and feasibility were assessed using participants' ratings of the helpfulness of the intervention across several domains and time and resources required. Effectiveness measures for patients included: dignity-related distress, hopefulness, and spiritual well-being; and those for family caregivers included burden, hopefulness, anxiety, and depression. RESULTS: Twenty-seven patients and 18 family caregivers completed the intervention. Dignity therapy was well accepted, including those patients who required assisted communication devices. The feasibility may be limited in small or not well-resourced services. There were no significant differences in all outcome measures for both groups. However, the high satisfaction and endorsement of dignity therapy by patients suggests it has influenced various important aspects of end-of-life experience. Family caregivers overwhelmingly agreed that the dignity therapy document is and will continue to be a source of comfort to them and they would recommend dignity therapy to others in the same situation. CONCLUSIONS: This is the first dignity therapy study to focus on MND and on home-based caregiving. RESULTS established the importance of narrative and generativity for patients with MND and may open the door for other neurodegenerative conditions.

A prospective evaluation of Dignity Therapy in advanced cancer patients admitted to palliative care.

BACKGROUND: Dignity Therapy is a brief, psychosocial intervention for patients with incurable disease. AIM: To investigate participation in and evaluation of Dignity Therapy and longitudinal changes in patient-rated outcomes. DESIGN: A prospective (pre/post) evaluation design was employed. Evaluation questionnaires were completed when patients received the generativity document (T1) and 2 weeks later (T2). Changes from baseline (T0) were measured in sense of dignity, Structured Interview for Symptoms and Concerns items, Patient Dignity Inventory, Hospital Anxiety and Depression Scale and European Organisation for Research and Treatment of Cancer QLQ-C15-PAL (ClinicalTrials.gov number: NCT01507571). SETTING/PARTICIPANTS: Consecutive patients with incurable cancer, ≥18 years, informed of prognosis and not having cognitive impairment/physical limitations precluding participation were included at a hospice and a hospital palliative medicine unit. RESULTS: Over 2 years, 80 of 341 eligible patients completed Dignity Therapy. At T1, 55 patients completed evaluations, of whom 73%-89% found Dignity Therapy helpful, satisfactory and of help to relatives; 47%-56% reported that it heightened their sense of purpose, dignity and will to live. Quality of life decreased (mean = -9 (95% confidence interval: -14.54; -2.49)) and depression increased (mean = 0.31 (0.06; 0.57)) on one of several depression measures. At T2 (n = 31), sense of dignity (mean = -0.52 (-1.01; -0.02)) and sense of being a burden to others (mean = -0.26 (-0.49; -0.02)) improved. Patients with children and lower performance status, emotional functioning and quality of life were more likely to report benefit. CONCLUSIONS: This study adds to the growing body of evidence supporting Dignity Therapy as a valuable intervention in palliative care; a substantial subset of patients facing end of life found it manageable, relevant and beneficial.

Palliative care needs of terminally ill people living alone: a service provider perspective.

BACKGROUND: Community-based palliative care services face challenges in meeting the needs of terminally ill clients who live alone without a primary caregiver. Yet, there is a dearth of literature on the perceptions of health service providers (HSPs) regarding the care needs and possible management options to assist this growing group to remain at home. OBJECTIVE: This paper investigated the support needs of people living alone with a terminal illness from a service provider perspective. DESIGN: In depth semi-structured interviews were conducted with nine HSPs from community based services in three Australian states. RESULTS: Four main themes emerged: care challenges, differences in care provision, appropriate approaches to care and essentials for an effective service such as 24 h care, cost-free provision of personal alarm systems, supported and coordinated housekeeping services, funded respite care and financial care packages. HSPs expressed a respect for the autonomy and independence of the clients, yet felt pressured to ensure that safe and attentive care was possible. HSPs recognised the central importance of maintaining the independence and autonomy of palliative care clients living alone. CONCLUSIONS: This study is the first in-depth account of what HSPs perceive they need to effectively look after home alone dying clients. The study provided directions to inform service planning for this growing and challenging population group regarding adequate and timely services that will lead to more complying with the clients' wishes, more care being delivered at home, a reduction in hospitalisations, a better quality of life and a capacity to die at home.

Responding to a diagnosis of localized prostate cancer: men's experiences of normal distress during the first 3 postdiagnostic months.

BACKGROUND: Men experience localized prostate cancer (PCa) as aversive and distressing. Little research has studied the distress men experience as a normal response to PCa, or how they manage this distress during the early stages of the illness. OBJECTIVES: The objective of this study was to explore the experience of men diagnosed with localized PCa during their first postdiagnostic year. METHODS: This constructivist qualitative study interviewed 8 men between the ages of 44 and 77 years, in their homes, on 2 occasions during the first 3 postdiagnostic months. Individual, in-depth semistructured interviews were used to collect the data. RESULTS: After an initial feeling of shock, the men in this study worked diligently to camouflage their experience of distress through hiding and attenuating their feelings and minimizing the severity of PCa. CONCLUSIONS: Men silenced distress because they believed it was expected of them. Maintaining silence allowed men to protect their strong and stoic self-image. This stereotype, of the strong and stoic man, prevented men from expressing their feelings of distress and from seeking support from family and friends and health professionals. IMPLICATIONS FOR PRACTICE: It is important for nurses to acknowledge and recognize the normal distress experienced by men as a result of a PCa diagnosis. Hence, nurses must learn to identify the ways in which men avoid expressing their distress and develop early supportive relationships that encourage them to express and subsequently manage it.

Information needs and preferences of women as they proceed through radiotherapy for breast cancer.

OBJECTIVE: While radiotherapy is commonly employed in the treatment of breast cancer, many women know little about treatment and experience treatment related anxiety. The aims of this study were to: Prioritise breast cancer patients' radiotherapy related information needs and concerns; determine unmet information needs; ascertain which information sources patients prefer to receive; and explore whether information provision reduces anxiety and depression. METHODS: A longitudinal survey was administered at four time points: after initial consultation with radiation oncologist, after the planning appointment, within first week of treatment and after treatment completion. Data was analysed using generalised estimating equations. RESULTS: 123 women participated. Women were most concerned about the impact treatment would have on their health in the future. Women identified high information needs prior to treatment planning and commencing treatment. Women's anxiety at baseline (mean=6.07, SD=3.89) did not significantly drop until after treatment commencement (mean=5.33, SD=4.15). CONCLUSION: This study demonstrates that women's information needs and anxiety levels are high until treatment commencement. PRACTICE IMPLICATIONS: In order to reduce patients' psychological distress, information needs and concerns we recommend that a greater focus is placed on providing information to patients prior to treatment planning and prior to treatment.

Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial.

BACKGROUND: Dignity therapy is a unique, individualised, short-term psychotherapy that was developed for patients (and their families) living with life-threatening or life-limiting illness. We investigated whether dignity therapy could mitigate distress or bolster the experience in patients nearing the end of their lives. METHODS: Patients (aged ≥18 years) with a terminal prognosis (life expectancy ≤6 months) who were receiving palliative care in a hospital or community setting (hospice or home) in Canada, USA, and Australia were randomly assigned to dignity therapy, client-centred care, or standard palliative care in a 1:1:1 ratio. Randomisation was by use of a computer-generated table of random numbers in blocks of 30. Allocation concealment was by use of opaque sealed envelopes. The primary outcomes--reductions in various dimensions of distress before and after completion of the study--were measured with the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale, Patient Dignity Inventory, Hospital Anxiety and Depression Scale, items from the Structured Interview for Symptoms and Concerns, Quality of Life Scale, and modified Edmonton Symptom Assessment Scale. Secondary outcomes of self-reported end-of-life experiences were assessed in a survey that was undertaken after the completion of the study. Outcomes were assessed by research staff with whom the participant had no previous contact to avoid any possible response bias or contamination. Analyses were done on all patients with available data at baseline and at the end of the study intervention. This study is registered with ClinicalTrials.gov, number NCT00133965. FINDINGS: 165 of 441 patients were assigned to dignity therapy, 140 standard palliative care, and 136 client-centred care. 108, 111, and 107 patients, respectively, were analysed. No significant differences were noted in the distress levels before and after completion of the study in the three groups. For the secondary outcomes, patients reported that dignity therapy was significantly more likely than the other two interventions to have been helpful (χ(2)=35·50, df=2; p<0·0001), improve quality of life (χ(2)=14·52; p=0·001), increase sense of dignity (χ(2)=12·66; p=0·002), change how their family saw and appreciated them (χ(2)=33·81; p<0·0001), and be helpful to their family (χ(2)=33·86; p<0·0001). Dignity therapy was significantly better than client-centred care in improving spiritual wellbeing (χ(2)=10·35; p=0·006), and was significantly better than standard palliative care in terms of lessening sadness or depression (χ(2)=9·38; p=0·009); significantly more patients who had received dignity therapy reported that the study group had been satisfactory, compared with those who received standard palliative care (χ(2)=29·58; p<0·0001). INTERPRETATION: Although the ability of dignity therapy to mitigate outright distress, such as depression, desire for death or suicidality, has yet to be proven, its benefits in terms of self-reported end-of-life experiences support its clinical application for patients nearing death. FUNDING: National Cancer Institute, National Institutes of Health.

Measuring symptom distress in palliative care: psychometric properties of the Symptom Assessment Scale (SAS).

Given the variety of palliative care settings within which symptom distress must be assessed, development of a valid and reliable clinical tool that can be simply applied in every day practice is needed. The Symptom Assessment Scale (SAS) uses a 0-10 numerical scale with zero being no symptom and 10 being the worst possible. The key symptoms included in the scale are breathing, bowel problems, appetite problems, pain, insomnia, nausea and fatigue. The instrument is structured to allow either the patient, family member or nurse to assess the symptoms. The scale was tested on 572 cancer patients recruited from five palliative care services in Western Australia. Results indicated that the instrument was brief, clinically useful and was administered with minimal missing data. Internal consistency reliability estimates of the scale ranged from 0.64-0.92 as measured by the Cronbach's alpha co-efficient. Test-retest reliabilities of 0.84-0.92 were obtained using Pearson's correlation co-efficient. The instrument does not provide an in-depth assessment of individual symptoms, but serves as a screening tool to identify troublesome symptoms that warrant attentive and immediate investigation and comprehensive assessment.

Testing the feasibility of the Dignity Therapy interview: adaptation for the Danish culture.

BACKGROUND: 'Dignity Therapy' (DT) is a brief, flexible intervention, which allows patients to complete an interview and create a document regarding their life, identity and what they want to leave in writing for their loved ones. DT is based on the DT Question Protocol. Developed and tested in English speaking settings, DT has proven to be a feasible and effective way to enhance patient dignity, while diminishing suffering and depression. The aim of this study was to test the acceptability and feasibility of the DT Question Protocol among Danish health professionals and cancer patients, and to obtain preliminary estimates of patient uptake for DT. These results will be used to inform a larger evaluation study. METHOD: Ten professionals were interviewed about their perception of DT and the Question Protocol. It was then tested with 20 patients at two palliative care sites and one gynecologic oncology department. Data was analyzed using content analysis techniques to evaluate the protocol for relevance, acceptability and comprehension. The interest and relevance of the intervention was also determined by examining the preliminary participation rate. RESULTS: Overall, DT was perceived to be comprehensible and relevant. Professionals highlighted six concerns that might warrant modification. These issues were examined using patient data. Some of their concerns overlapped with those raised by the professionals (e.g. 'unacceptable self-praise' and 'interference with the lives of others'). Tailoring DT to Danish culture required easily accommodated adjustments to the procedures and the DT Question Protocol. Some concerns expressed by health professionals may have reflected protectiveness toward the patients. While the intervention was relevant and manageable for patients admitted to palliative care, DT was less easily implemented at the gynecologic oncology department. CONCLUSION: Based on patients' and professionals' reaction to the DT Question Protocol, and based on the preliminary proportion of participants accepting DT, the DT question protocol - with minor adaptations - appears to be a manageable, acceptable and relevant intervention for Danish patients admitted to palliative care.

Reliability testing of the FAMCARE-2 scale: measuring family carer satisfaction with palliative care.

Measuring carers' perceived satisfaction with services is crucial if services are going to continually improve their responsiveness to the needs of those they serve. The aim of this study was to assess the reliability of the next generation FAMCARE tool, which was adapted to reflect inpatient and team-based care using palliative care services who are participating in the Australian Palliative Care Outcomes Collaboration. FAMCARE-2 was distributed to a consecutive cohort of carers whilst in the caregiving role nationally. Analyses of internal consistency, generated structure and relationships of satisfaction with service provision by three demographic variables were undertaken. A total of 497 carers were recruited from 29 palliative care services across Australia, a mix of inpatient and community services. The scale achieved a high level of internal consistency (Cronbach's alpha coefficient of 0.93) and item-to-total correlation coefficient of 0.49-0.72. Factor analysis of FAMCARE-2 revealed a 4-factor structure (management of physical symptoms and comfort, provision of information, family support and patient psychological care). Results of the survey indicated satisfaction with service provision across the FAMCARE-2 subscales. Older, female carers without a culturally and linguistically diverse background were more satisfied with service provision. We conclude that FAMCARE-2 is a psychometrically sound instrument useful for measuring family carer satisfaction with service provision in a variety of palliative care settings.

Learning from dying patients during their final days: life reflections gleaned from dignity therapy.

Dignity therapy is a novel therapeutic approach designed to decrease suffering, enhance quality of life and bolster a sense of dignity for patients approaching death. The benefits of dignity therapy were previously documented in a sample of 100 terminally ill patients. One of the products of dignity therapy is a transcript of the edited therapy session(s). In this qualitative study, 50 of the 100 (17 from Winnipeg, Manitoba, Canada, and 33 from Perth, Australia) dignity therapy transcripts were randomly drawn, and independently coded and analysed by three investigators using a grounded theory approach. The transcripts revealed that dignity therapy serves to provide a safe, therapeutic environment for patients to review the most meaningful aspects of their lives in such a manner that their core values become apparent. The most common values expressed by the patients included 'Family', 'Pleasure', 'Caring', 'A Sense of Accomplishment', 'True Friendship', and 'Rich Experience'. Exemplars of each of these values illustrate the pervasive, defining role of values in our lives. The findings are discussed in terms of values theory, the role of dignity therapy, and consideration of values clarification in clinicians' efforts to enhance the dignity of terminally ill patients.

Predictors of complicated grief: a systematic review of empirical studies.

A systematic review of the literature on predictors of complicated grief (CG) was undertaken with the aim of clarifying the current knowledge and to inform future planning and work in CG following bereavement. Predictors of CG prior to the death include previous loss, exposure to trauma, a previous psychiatric history, attachment style, and the relationship to the deceased. Factors associated with the death include violent death, the quality of the caregiving or dying experience, close kinship relationship to the deceased, marital closeness and dependency, and lack of preparation for the death. Perceived social support played a key role after death, along with cognitive appraisals and high distress at the time of the death. Inconsistent definitions of CG and measurement tools were noted in the earlier studies reviewed. Limitations identified in the studies included use of cross-sectional designs, heterogeneous samples, high attrition, demographic differences between cases and controls, differences in length of time since death, and differences in types of death experienced. Notwithstanding these limitations, some consistent findings have emerged. Further research into conceptualizations of CG in terms of attachment theory and constructivist and cognitive-behavioral concepts of finding purpose and meaning after bereavement is warranted.

The prevalence of anxiety and depression in palliative care patients with cancer in Western Australia and New South Wales.

OBJECTIVES: To examine the prevalence and predictors of depression and anxiety in palliative care patients with cancer in Western Australia and New South Wales. DESIGN, SETTING AND PARTICIPANTS: A descriptive study of 266 consecutive patients at a range of inpatient and outpatient settings including home care, hospices, and private and tertiary care hospitals in WA and NSW from 1 March to 30 June 2002. MAIN OUTCOME MEASURES: Self-reported anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) at a cut-off score of > or = 8 on each subscale (depression and anxiety) for possible cases, and of > or = 11 for probable cases; a cut-off score of > or = 19 was used for probable combined depression and anxiety. RESULTS: Patients included 200 in WA and 66 in NSW. For the whole sample, 45.8% of patients were possibly depressed and 22.7% probably depressed; 36.9% were possibly anxious and 19.8% probably anxious. About 25% of patients had probable combined depression and anxiety. Logistic regression analyses indicated that past anxiety in the family predicted probable depression, while age, marital status and past depression predicted probable anxiety. Age and past depression predicted probable combined depression and anxiety. CONCLUSIONS: These findings underscore the need for routine screening for anxiety and depression in palliative care settings, including questions about past personal and family history of anxiety and depression, and the need for a range of interventions and support services.

The landscape of distress in the terminally ill.

Understanding the complexities of distress and knowing who is most vulnerable is foundational to the provision of quality, palliative end-of-life care. Although prior studies have examined the prevalence of symptom distress among patients nearing death, these studies have tended to largely focus on physical and, to a lesser extent, psychological challenges. The aim of this study was to use the Patient Dignity Inventory (PDI), a novel, reliable, and validated measure of end-of-life distress, to describe a broad landscape of distress in patients who are terminally ill. The PDI, a 25-item self-report, was administered to 253 patients receiving palliative care. Each PDI item is rated by patients to indicate the degree to which they experience various kinds of end-of-life distress. Palliative care patients reported an average of 5.74 problems (standard deviation, 5.49; range, 0-24), including physical, psychological, existential, and spiritual challenges. Being an inpatient, being educated, and having a partner were associated with certain kinds of end-of-life problems, particularly existential distress. Spirituality, especially its existential or "sense of meaning and purpose" dimension, was associated with less distress for terminally ill patients. A better appreciation for the nature of distress is a critical step toward a fuller understanding of the challenges facing the terminally ill. A clear articulation of the landscape of distress, including insight regarding those who are most at risk, should pave the way toward more effective, dignity-conserving end-of-life care.

Professional relationships in palliative care decision making.

BACKGROUND: Decision making in the context of palliative care is particularly complex given the unpredictable illness trajectories experienced by patients and the number of individuals who may be part of decision-making processes. This study aimed to describe the significant issues that influence the processes of care decision making, from the perspective of patients with advanced illness. METHODS: Patients (14), family members (7) and health professionals (18) were interviewed and field observations (100 h) of decision-making practices were undertaken in two Australian palliative care services. A systematic approach using grounded theory to collect and analyse the data was used to develop a theory of decision making from the patient's perspective. RESULTS: The main issue experienced by palliative care patients was identified as a lack of involvement in decision making. One of the significant factors affecting the decision process is the type of relationship with health professionals that patients believe enhances their involvement in decision making. This was determined by the manner and focus of the health professional, their trustworthiness as well as the healthcare culture and environment. This paper provides a greater understanding of the perspective of patients in relation to their involvement in decisions related to palliative care.

Emotional care experienced by hospitalised patients: development and testing of a measurement instrument.

AIMS AND OBJECTIVES: This paper describes the development and preliminary psychometric testing of an instrument that evaluates the emotional care experienced by patients during hospitalisation. BACKGROUND: Previous qualitative work using the Grounded Theory method identified the characteristics of interpersonal interactions that hospitalised patients perceived to be therapeutic. Three conditions were associated with the patient's experience of emotional comfort: the patient's perceived Level of Security, Level of Knowing and Level of Personal Value. Questions relating to each of these conditions were included in this new instrument. DESIGN: Instrument development and psychometric testing. METHOD: Preliminary psychometric testing was carried out in four phases: construction of the instrument; assessment of face and content validity; testing for clarity and feasibility for use with hospitalised patients; assessment of reliability, construct validity of the tool and assessment of the internal structure. CONCLUSIONS: A hospital-wide survey was carried out and the instrument was completed by a total sample of 132 patients. Two of the three sub-scales achieved an internal consistency estimate of at least 0.70. The construct validity of the tool confirmed the previously identified characteristics of patients in need of additional emotional care. Exploratory factor analysis established two of the sub-scales and identified a fourth sub-scale which was named 'Level of Connection'. Encouraging reliability and validity estimates were obtained and the instrument was improved. Further testing with larger samples is recommended. RELEVANCE TO CLINICAL PRACTICE: This questionnaire, which is completed by hospitalised patients, differs from other instruments because it evaluates the interactions of all hospital staff rather than only nursing staff. This instrument can be used to identify patients who may be in need of additional emotional care and to evaluate the effectiveness of interventions directed at improving the emotional well-being of patients.

How do radiation oncology health professionals inform breast cancer patients about the medical and technical aspects of their treatment?

BACKGROUND AND PURPOSE: Radiation therapy patients need information to make treatment decisions, understand treatment and manage side effects. The purpose of this study was to (1) Identify information about radiation therapy routinely provided to breast cancer patients; (2) Determine which health professionals provide information; (3) Examine whether information is routinely provided at the same time points; and (4) Determine whether health professionals and patients place similar importance on specific information. MATERIALS AND METHODS: Health professionals in radiation therapy departments in Australia and New Zealand completed self-administered questionnaires. Results were analysed and compared to patient responses from a previous study. RESULTS: Forty-one of 52 departments participated in this survey. Information provision was inconsistent between departments in terms of how and when information was given. Although the types of information provided to patients appeared to align with patients' needs, health professionals and patients placed different levels of importance on specific information. CONCLUSIONS: A wide range of information are provided to patients. However, the priority given to different information needs and the focus of information provision may not be optimal from the perspectives of patients. Further research needs to be conducted to determine patients' information needs and to develop specific information resources tailored to meet these needs.

Undertreatment of nausea and other symptoms in hospitalized cancer patients.

OBJECTIVE: This survey aimed to provide a symptom profile, in particular for nausea and its treatment, of advanced cancer patients prior to implementation of a clinical practice guideline for nausea. MATERIALS AND METHODS: An audit of 82 advanced cancer patients admitted to a major Australian teaching hospital was undertaken. While nausea was present in 26 (32%) of respondents, antiemetics were prescribed in 52 (68%), a higher proportion than in the past, and being taken by 32 (39%). RESULTS AND CONCLUSION: Patients reporting moderate-to-severe nausea often missed out on treatment. These findings underscore the need for more attention to education of hospital staff in the assessment and treatment of this frequently bothersome symptom, and raise issues for study design of symptom control research.

Developing recommendations for implementing the Australian Pain Society's pain management strategies in residential aged care.

OBJECTIVE: This study aimed to develop recommendations and a related implementation resource 'toolkit' to facilitate implementation of pain management strategies in Australian Residential Aged Care Facilities (RACFs). METHODS: This qualitative study used written materials, focus groups and individual interviews to gather data from participants. Thirty-four health-care professionals with experience in the aged care sector were recruited from five Western Australian RACFs. General practitioners who had an interest in aged care were contacted via local general practice networks. RESULTS: Findings indicated that focused education sessions were needed to support implementation. A tailored toolkit was developed to assist the process. Funding and workforce constraints were found to be threats to complete implementation in some facilities. CONCLUSIONS: A multifaceted approach is needed to promote the implementation of pain management strategies in RACFs. In particular, unlicensed care workers, who may have responsibility for recognising and reporting signs of pain, require further education to support their role in the pain management process.