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Biomedical subjects

A Girgis

Publications and source records attributed to A Girgis.

At least 19 recordsLinked to original sources
PubMed2006

Does routine assessment and real-time feedback improve cancer patients' psychosocial well-being?

This study examined the effectiveness of giving medical oncologists immediate feedback about cancer patients' self-reported psychosocial well-being in reducing those patients' levels of anxiety, depression, perceived needs and physical symptoms. Cancer patients attending one cancer centre for their first visit were allocated to intervention (n = 42) or control (n = 38) groups. All patients completed a computerized survey assessing their psychosocial well-being while waiting to see the oncologist. Intervention patients' responses were immediately scored and summary reports were placed in each patient's file for follow-up. A total of 48 participants (25 intervention and 23 control) completed the survey four times. Intervention patients who reported a debilitating physical symptom at visit 2 were significantly less likely to report a debilitating physical symptom at visit 3 compared with control patients (OR = 2.8, P = 0.04). Reductions in levels of anxiety, depression and perceived needs among intervention patients were not significantly different to control patients. Repeated collection and immediate feedback of patient-reported health information to oncologists has potential to improve patients' symptom control, but has little impact upon emotional well-being, including those at high risk. Future research should consider providing the feedback to other health professionals and patients, and monitor the impact on the process of individual patient care.

Adult↗
PubMed2005

Solaria compliance in an unregulated environment: the Australian experience.

This study aimed to explore compliance with international recommendations on solaria use in a unregulated setting. Simulated customers visited 176 solaria operating in Australia and two face-to-face visits and one telephone contact were made for each establishment. From the survey, establishments compliant with the recommendations ranged from: 1.1% refusing access to the customer with skin type I; 9.7% recommending to the customer with skin type I against solaria use and up to 87.5% assessing skin type and recommending eye protection. Few (15.9%) were compliant with more than 10 of the 13 recommendations. Establishment type and number of sunbeds were significantly associated with compliance. This study has shown that a much higher level of compliance with recommendations, particularly those excluding higher-risk groups, is required to reduce the harm associated with use of solaria. While new legislation may be useful, other harm minimisation strategies including mandatory staff training and taxation should be considered.

Adult↗
PubMed2005

How to recognize and manage psychological distress in cancer patients.

Psychological distress is common in cancer patients, however, it is often unrecognized and untreated. We aimed to identify barriers to cancer patients expressing their psychological concerns, and to recommend strategies to assist oncologists to elicit, recognize, and manage psychological distress in their patients. Medline, Psychlit, and the Cochrane databases were searched for articles relating to the detection of emotional distress in patients. Patients can provide verbal and non-verbal information about their emotional state. However, many patients may not reveal emotional issues as they believe it is not a doctor's role to help with their emotional concerns. Moreover, patients may normalize or somatize their feelings. Anxiety and depression can mimic physical symptoms of cancer or treatments, and consequently emotional distress may not be detected. Techniques such as active listening, using open questions and emotional words, responding appropriately to patients' emotional cues, and a patient-centred consulting style can assist in detection. Screening tools for psychological distress and patient question prompt sheets administered prior to the consultation can also be useful. In conclusion, the application of basic communication techniques enhances detection of patients' emotional concerns. Training oncologists in these techniques should improve the psychosocial care of cancer patients.

Anxiety↗
PubMed2004

The psychosocial needs of breast cancer survivors; a qualitative study of the shared and unique needs of younger versus older survivors.

Due to improvements in medical treatment and survival following breast cancer, researchers have turned their attention to investigating the needs of breast cancer survivors. There is disagreement about the extent to which survivors continue to experience psychological morbidity after treatment ends. Whilst the majority of women adjust well to breast cancer, some may have continued psychosocial needs. Available research suggests that younger pre-menopausal women are at increased risk of psychological morbidity following breast cancer. The present study aimed to gather preliminary qualitative data on the psychosocial needs of breast cancer survivors and to identify the shared and unique needs of younger versus older survivors. A qualitative methodology was chosen as this was a relatively unexplored area of enquiry. Patients treated for early-stage breast cancer who had completed their hospital-based treatment 6-24 months prior to participation were recruited. Sampling was discontinued when informational redundancy was achieved. Eighteen telephone interviews were conducted. A wide variety of on-going psychosocial and information needs were reported by breast cancer survivors including support needs, psychological needs, practical needs, physical needs and information needs. Younger women reported more needs than their older counterparts. Several needs reported by younger women were directly related to being of younger age or pre-menopausal at the time of diagnosis. Clinical implications are discussed.

Adaptation, Psychological↗
PubMed2004

Direct telemarketing of smoking cessation interventions: will smokers take the call?

AIMS: Few smokers currently make use of available and effective cessation strategies, despite their expressed desire to quit and reported interest in cessation support. This study aimed to explore the feasibility of a telephone-based direct-marketing approach to delivering cessation strategies. DESIGN, SETTING, MEASUREMENTS AND PARTICIPANTS: A community survey was conducted to explore the views of current adult smokers regarding the acceptability, likely uptake and barriers to uptake of smoking cessation services offered by direct telephone marketing. FINDINGS: Three quarters (73.8%) of smokers contacted agreed to be surveyed. Of the 194 study participants, 75.3% reported that they would utilize vouchers for discount nicotine replacement therapy (NRT), 66.5% would use a mailed self-help booklet, 57.2% would take up the offer of regular mailings of personalized letters and self-help materials and 46.4% would utilize a 'we-call-you' telephone counselling service. The characteristics of those indicating likely uptake of these services were also explored. The two major barriers to uptake of services were preferring to quit without help and a belief that a particular service would not help the participant. CONCLUSIONS: The data suggest strong support for the direct marketing of smoking cessation strategies; they also highlight the need for further study of the cost-effectiveness of telephone-based direct marketing of smoking cessation strategies as a population-based strategy for reducing the prevalence of smoking in the community.

Australia↗
PubMed2001

Preventive and other interactional skills of general practitioners, surgeons, and physicians: perceived competence and endorsement of postgraduate training.

BACKGROUND: Perceived competencies and support for formal postgraduate training across a range of preventive and other interactional skills were examined in three medical groups. METHODS: All eligible final year students and recent graduates of the three major Australian medical colleges (n = 767) were mailed a questionnaire examining communication skills in four domains: preventive, educational, therapeutic, and general. RESULTS: Overall consent rate was 45%. For most items, at least one-third of each group reported low competence. On preventive items, low competence ratings ranged from 5 to 39% in general practice, 38 to 67% in surgery, and 33 to 51% in the speciality physician group. Significant intergroup differences occurred on eight competence items. Agreement with training on preventive topics ranged from 80 to 91% in general practice, 48 to 69% in surgery, and 72 to 82% in the specialty physician group. On all 11 training items where significant differences occurred, the general practice group reported the highest level and the surgeon group the lowest level of endorsement for formal training and assessment. CONCLUSIONS: Substantial proportions in the general practice, surgery, and the physician specialty report lack of competence in common interactional skills. There were high levels of support for formal training in preventive and other interactional skills. The strong endorsement supports the development of effective, tailored interactional skills training programs.

Adult↗
PubMed2001

The effect of a community action intervention on adolescent smoking rates in rural australian towns: the CART project. Cancer Action in Rural Towns.

BACKGROUND: This paper describes one outcome of a randomized controlled trial of community action for cancer prevention, Cancer Action in Rural Towns. The aims are to [1] explore the effectiveness of community action in decreasing adolescent smoking in rural Australian towns; and [2] describe the relationship between adolescent smoking rates and demographic variables. METHODS: In 1992, 20 rural Australian towns were selected. Community action involved formation of community committees and utilization of access-point networks to initiate and maintain intervention strategies. Cross-sectional surveys of smoking behaviors for all Year 9 and Year 10 students (13-16 years) in each town were conducted pre- and posttest. The main outcome measure was self-reported smoking in the past 4 weeks. SUDAAN software was used to look at differences between treatment. RESULTS: The results showed strong secular trends toward increased adolescent smoking, regardless of treatment group, particularly for females. There was no significant intervention effect. CONCLUSIONS: Increasing adolescent smoking rates found in this and other studies highlight that the definitive strategy to stem the adolescent smoking epidemic has not been found. Hope may remain for recent legislative strategies, but rigorous evaluation is essential, and compliance with legislation should be carefully monitored.

Adolescent↗
PubMed2000

Evaluation of an instrument to assess the needs of patients with cancer. Supportive Care Review Group.

BACKGROUND: This study aimed to assess the face, content, and construct validity and the internal reliability of a tool for assessing the generic needs of patients with cancer (the Supportive Care Needs Survey). METHODS: A total of 1,492 consecutive patients attending the surgical, radiation, or medical oncology departments of 9 cancer treatment centers in New South Wales, Australia, were asked to participate. Of the 1,370 eligible patients, 1,354 (99%) consented to participate and 888 (65%) completed the survey. Eligible consenting patients were given a Supportive Care Needs Survey to complete at home and return by mail within 7 days. RESULTS: In the assessment of construct validity, the principal components method of factor analysis identified 5 factors with eigenvalues greater than 1, which together accounted for 64% of the total variance (patients' needs in the domains of psychologic, health system and information, physical and daily living, patient care and support, and sexuality). Face and content validity were found to be high following pilot tests and tests of reading ease. Internal reliability coefficients (Cronbach alpha) of all 5 factor-based scales were found to be substantial, ranging from 0.87 to 0.97. CONCLUSIONS: These findings suggest that the Supportive Care Needs Survey provides a reliable and valid index of the global needs of oncology patients. The standardized and widespread application of this instrument is recommended following further refinement and evaluation.

Activities of Daily Living↗
PubMed2000

The unmet supportive care needs of patients with cancer. Supportive Care Review Group.

BACKGROUND: The aim of this study was to determine the prevalence and predictors of the perceived unmet needs of cancer patients undergoing treatment for their disease at public treatment centers. METHODS: A total of 1,492 consecutive patients attending the surgical, radiation, or medical oncology departments of 9 major public cancer treatment centers in New South Wales, Australia, were asked to participate. Of the 1,370 eligible patients, 1,354 (99%) consented to participate and 888 (65%) returned completed surveys. Eligible consenting patients were given a Supportive Care Needs Survey to complete at home and return by mail within 7 days. RESULTS: Patients' perceived needs were assessed across the following five areas: psychologic, health system and information, physical and daily living, patient care and support, and sexuality. Patients' perceived needs were highest in the psychologic, health system and information, and physical and daily living domains. Logistic regression modeling revealed subgroups of patients with different types of needs. The significant predictors of reporting some unmet need for help varied according to the domain examined. CONCLUSIONS: This statewide study shows that cancer patients experience high levels of unmet needs across the range of domains examined. The study provides information that may be valuable in identifying areas where interventions could be tested and evaluated in an attempt to address the unmet needs of people living with cancer.

Adult↗
PubMed2000

Consumer participation in the development of psychosocial clinical practice guidelines: opinions of women with breast cancer.

Clinical practice guidelines are playing an increasingly important role in defining quality care and consumers have a considerable interest in participating in the development of guidelines. The objective of this study was to explore consumer's perceptions of guideline items relating to psychosocial care of women with breast cancer, developed by Australia's National Health and Medical Research Council National Breast Cancer Centre. Women diagnosed with breast cancer in the previous 2 years (n = 313) received a letter about the study via their radiation oncologist. Consenting women were contacted by the researchers to complete a telephone survey. The survey asked women to rate the importance of draft guidelines items, including discussing prognosis, providing information and choice, doctor-patient communication, preparation for surgery, providing emotional support, providing social support, dealing with practical and cultural issues and continuity of care. One hundred and forty women (45%) completed the survey. The results indicated that at least 50% of respondents rated 28 of the 52 items as 'essential' components, with respondents identifying providing information and choice, and doctor-patient communication as the most important aspects of psychosocial care. The findings suggest the guidelines adequately reflect consumer opinions and identify priority areas for clinicians to address in providing psychosocial support to women with breast cancer.

Adaptation, Psychological↗
PubMed2000

Perceived needs of women diagnosed with breast cancer: rural versus urban location.

OBJECTIVE: To assess the prevalence and predictors of perceived unmet needs among women diagnosed with breast cancer, with a particular focus on the impact of location (rural/urban). METHOD: A random sample of women in NSW diagnosed with breast cancer was surveyed during 1995-96. The Breast Cancer Patients' Needs Questionnaire (BR-CPNQ) explores patients' perceived needs across five domains: psychological, health information, physical/daily living, patient care/support and interpersonal communication. Items assessing breast cancer specific needs and access to services and resources were included. Of 235 eligible rural women, 134 (57%) consented to participate and 129 (55%) returned completed surveys. Of 196 eligible urban women, 102 (52%) consented to participate and 100 (51%) returned completed surveys. RESULTS: For 12 of the 52 items, at least one-third of the sample reported ever having a moderate/high need for help. Of the 15 highest moderate or high unmet needs, 10 related to health information and three to psychological needs. There were few differences in the prevalence of needs reported by rural and urban women. Only in the physical/daily living domain were rural women more likely than urban women to report some need for help (OR = 2.59, 95% CI 1.21-5.52). CONCLUSIONS: Unmet needs, particularly in the information and psycho-social domains, are reported by both rural and urban women with breast cancer, with sub-groups experiencing different types of needs. IMPLICATIONS: There is a need to develop and trial targeted and innovative strategies to meet the health information and psychological needs of women with breast cancer, and the physical/daily living needs of rural women diagnosed with breast cancer.

Activities of Daily Living↗
PubMed2000

Accuracy of patients' recall of Pap and cholesterol screening.

OBJECTIVES: This study was undertaken in mid-1994 and assessed how accurately patients recall the recency and result of their most recent cholesterol and Papanicolaou (Pap) tests. METHODS: A cross-sectional, door-to-door community survey was used to gather self-report and, subsequently, pathology laboratory data for 195 individuals. RESULTS: In regard to cholesterol screening, 30% of individuals who reported being adequately screened were actually inadequately screened, 45% who reported normal cholesterol levels actually had elevated levels, and 21% of inadequately screened individuals and 56% of individuals with elevated levels were not identified by self-report. In terms of Pap screening, 28% of women who reported being adequately screened were actually inadequately screened, 11% of patients who reported a normal Pap test actually had abnormal or inadequate results, and 55% of inadequately screened individuals and 53% of individuals with abnormal or inadequate results were not identified by self-report. CONCLUSIONS: This study revealed self-report to be a less-than-adequate measure of individuals' recall of cholesterol and Pap screening. Relying exclusively on self-report surveys as indicators of screening coverage is likely to result in significant underestimations of the proportion of people who are inadequately screened or whose results indicate a need for intervention.

Adolescent↗
PubMed1999

The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review.

OBJECTIVE: To critically review the literature concerning the accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease among the general population. METHOD: A literature search was conducted on three major health research databases: MEDLINE, HealthPLAN, and PsychLit. The bibliographies of located articles were also checked for additional relevant references. Studies meeting the following five inclusion criteria were included in the review: They were investigating the accuracy of self-report among the general population, as opposed to among clinical populations. They employed an adequate and appropriate gold standard. At least 70% of respondents consented to validation, where validation imposed minimal demands on the respondent; and 60% consent to validation was considered acceptable where validation imposed a greater burden. They had a sample size capable of estimating sensitivity and specificity rates with 95% confidence intervals of width +/-10%. The time lag between collection of the self-report and validation data for physical measures did not exceed one month. RESULTS: Twenty-four of 66 identified studies met all the inclusion criteria described above. In the vast majority, self-report data consistently underestimated the proportion of individuals considered "at-risk." Similarly, community prevalences of risk factors were considerably higher according to gold standard data sources than they were according to self-report data. CONCLUSIONS: This review casts serious doubts on the wisdom of relying exclusively on self-reported health information. It suggests that caution should be exercised both when trying to identify at-risk individuals and when estimating the prevalence of risk factors among the general population. The review also suggests a number of ways in which the accuracy of individuals' self-reported health information can be maximized.

Cardiovascular Diseases↗
PubMed1999

The physical and psycho-social experiences of patients attending an outpatient medical oncology department: a cross-sectional study.

The aim of this study was to assess the prevalence and predictors of physical symptoms, anxiety, depression and perceived needs among patients receiving treatment at an outpatient medical oncology department using a cross-sectional survey. It was carried out at the outpatient clinic of an academic medical oncology department, which sees around 150-180 outpatients each week; 201 patients were selected. These patients answered questions to assess their levels of anxiety and depression (Hospital Anxiety and Depression Scale), perceived needs (Cancer Needs Questionnaire) and the frequency and severity of 15 physical symptoms. Fatigue, nausea, appetite loss and vomiting were the most commonly experienced and most debilitating physical symptoms. Approximately 25% of participants had borderline or clinical levels of anxiety and depression. Although relatively low levels of perceived needs were reported, physical and psychological needs were the most common. Levels of each outcome measure tended to be predictive of each other. Medical oncology outpatients experience a wide range of physical and psycho-social problems which appear, to some extent, interrelated.

Adult↗
PubMed1999

Self-reported cervical screening practices and beliefs of women from urban, rural and remote regions.

This survey aimed to explore women's perceptions of a number of issues relating to the availability and utilisation of cervical cancer screening services in the rural, remote and urban regions of New South Wales (NSW) Australia. The survey involved urban, rural and remote regions of NSW determined by the definition of the Department of Community Services and Health. This was a cross-sectional telephone survey. Of the 339 eligible urban households, 265 (78%) completed interviews; of the 286 eligible rural households, 238 (83%) completed interviews; of the 285 eligible remote households, 230 (81%) completed interviews. Telephone contact was made with randomly selected households in each region. Women in the households were asked to complete a computer-assisted telephone interview. The survey addressed a number of issues relating to cervical screening: cervical cancer risk status; provider of Pap smear service; distance travelled to have a Pap smear; perceived barriers and facilitators to cervical screening. There was no statistically significant difference in the proportions of women from urban (74%), rural (76%), and remote (71%) regions who reported having a Pap smear in the 2 years preceding the survey. General practitioners provided the majority (more than 70%) of tests irrespective of region. Compared with women from urban areas, women from rural and remote areas were almost twice as likely to have had their last Pap smear from a male general practitioner. A greater proportion of women from remote regions had to travel for 60 minutes or more to access providers of Pap smear services. Few differences in the top three reported barriers to, and facilitators for screening were evident between regions and between those women who had and had not been adequately screened. Issues of distance, isolation and access to alternative service providers are a concern to women in rural and remote regions and should be considered by those involved in the implementation of cervical cancer screening services.

Journal Article↗
PubMed1999

Is there consensus between breast cancer patients and providers on guidelines for breaking bad news?

Eighty-four breast cancer patients, 64 oncologists, and 140 oncology nurses rated the importance of 15 general principles and 12 recommended steps to guide clinicians in breaking bad news to patients. At least 70% of the three samples rated 7 of the 15 principles and 6 of the 12 steps as essential. All three groups agreed that patients have a legal and moral right to accurate and reliable information and that patients should be given the diagnosis and prognosis honestly and in simple language, though not bluntly. The groups differed on the relative importance of other items, with less variation about the steps than about the principles. Patients' perceptions of the importance of various guideline steps and principles are probably most important, given that patients receive the troubling news and that research indicates that how the news is delivered is associated with important patient outcomes. Recommendations for further research are discussed.

Adult↗
PubMed1998

How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Data from a survey of five oncologists.

BACKGROUND: Modern cancer treatments can cure or prolong patients' lives. However, the associated physical and psychosocial problems can detrimentally affect patients' compliance with treatment and, ultimately, their outcomes. Therefore, oncologists need to recognize the problems experienced by their patients and, when possible, help resolve these problems. METHODS: The authors conducted a cross-sectional survey of physical symptoms, anxiety, depression, and perceived needs among 204 consenting patients visiting an outpatient medical oncology department. Immediately following consultations with consenting patients, medical oncologists and registrars also completed a survey in which they indicated their perception of each patient's level of each problem. These two data sets were then compared. RESULTS: Five oncologists' perceptions of patients' levels of the major physical symptoms cited in the survey (fatigue, nausea, vomiting, and hair loss) demonstrated the highest levels of awareness, with sensitivity rates up to 80%. Although sensitivity was less than 50% for all other physical symptoms, specificity was greater than 78% for all symptoms except fatigue. Only 17% of patients classified as clinically anxious and 6% of those classified as clinically depressed were perceived as such by their oncologists. However, the oncologists perceived much higher levels of perceived needs than patients reported, resulting in high sensitivity but low specificity rates. Oncologists' knowledge of and rapport with their patients and the pressure of their workloads were associated with their awareness of their patients' reported problems. CONCLUSIONS: Medical oncologists' perceptions may not accurately reflect their patients' reported physical and psychosocial experiences. Further interventions should be developed to assist oncologists in detecting such problems, especially psychosocial ones.

Adult↗