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Biomedical subjects

Carole B Pinnock

Publications and source records attributed to Carole B Pinnock.

7 recordsLinked to original sources
PubMed2005

Communicating prostate cancer risk: what should we be telling our patients?

Until definitive evidence of the effectiveness of prostate cancer screening is available, most guidelines advocate that men make their own decisions about testing, after being fully informed. A man's perception of his personal risk is a key element in the decision-making process. In this decision-making, the current routine use of population risk estimates may be misleading. Risk estimates need to be relevant to the man making the choice. In particular, they should be age-specific and, where possible, include adjustments for known risk factors such as family history. As an example, although the population risk of lung cancer mortality is twice that of prostate cancer, for a non-smoking man with a family history of prostate cancer the direction of this comparison would be reversed. A man aged 50 diagnosed with prostate cancer has a greater likelihood (60%) of dying prematurely (before 80 years) from prostate cancer than a man diagnosed when aged 70 (38%). This can be attributed to the longer time available for the prostate cancer to progress, and the increased effect of competing causes of death among older men. This suggests that the oft-used statement "men are more likely to die with prostate cancer than from prostate cancer" is misleading, particularly for men diagnosed in their 50s or 60s. Decisions need to be made by men based on the best possible understanding of their personal vulnerability, and the individualisation of risk provides a more realistic appraisal of potential threat posed by the disease.

Adult↗
PubMed2005

Prostate cancer, the PSA test and academic detailing in Australian general practice: an economic evaluation.

OBJECTIVES: To evaluate whether introduction of a national education program for GPs to improve decision making relating to the use of prostate specific antigen (PSA) testing for screening represents 'value-for-money' from the perspective of the Australian Government. METHODS: The annual equivalent costs and consequences of a proposed national program in steady state operation are estimated for Australia using 1996 as the reference year. Because of the controversy about the efficacy of screening using PSA testing, two scenarios are modelled. Uncertainty in the model is examined using Monte Carlo simulation methods. RESULTS: In scenario one, our model predicts that the national program would cost dollars 12.5 million (gross) or dollars 6.6 million (net), would reduce the burden of disease by 4.7% of total DALYs due to prostate cancer in those aged 70 and over, with no loss of life and an incremental cost effectiveness ratio (ICER) of dollars 16,000/DALY (gross) and dollars 8,500/DALY (net). In scenario two, the proposed program would cost dollars 12.5 million (gross) or dollars 7.1 million (net), would reduce the burden of disease by 3.1% of total, increase by 44 the prostate cancer deaths at an ICER of dollars 24,000/DALY (gross) and dollars 14,000/DALY (net). CONCLUSIONS: These findings, with an overall health benefit at moderate cost and acceptable ICER, support the case for consideration of a national education program on the assumption that prostate cancer screening over age 70 does not reduce mortality. A larger Australian study currently being conducted should provide stronger evidence on the value of implementing a full national program.

Australia↗
PubMed2003

Meeting the information needs of Australian men with prostate cancer by way of the internet.

OBJECTIVES: To assess the information preferred by Australian men for a prostate cancer website, to establish such a website, and to assess whether the first 2 years of use of the website reflected those needs. Successful patient information programs must be relevant to the target group's needs. METHODS: In phase 1, we surveyed Australian prostate cancer support group members asking for the preferred functions and content of an Australian website. In phase 2, a website was developed (http://www.prostatehealth.org.au) with the requested content derived from a urology service, state Cancer Councils, and medical directory and support group organizations. In phase 3, usage patterns of the site were analyzed using Web-Trends software for the first 2 years (2000 to 2002). RESULTS: The phase 1 survey of 54 men (response rate 69.2%) showed the most preferred pages were understanding diagnosis/understanding treatment (59%), on-line help-line (49%), and news sections (44%) with listings of Australian support groups (22%). Credible, up-to-date Australian-oriented content was requested. In phase 2, the site developed had five searchable databases with requested medical content from a urology service, support group and treatment center listings, and an on-line help-line run by a cancer council. In phase 3, after 2 years of operation, the site averaged 150,000 hits and 15,000 page views per month, with 46% of visitors from Australian domains. Most visited sections closely followed the needs assessment. CONCLUSIONS: Needs assessment is an important precursor to targeted web-based education programs. Nonmedical, community-based information is important to men with prostate cancer, as is information on diagnosis and treatment.

Adult↗
PubMed2002

Coping with prostate cancer: a quantitative analysis using a new instrument, the centre for clinical excellence in urological research coping with cancer instrument.

OBJECTIVES: To assess the reliability (internal and interrater) and validity (concurrent) of a new interview measure for assessing patients' ability to cope with cancer, the Centre for Clinical Excellence in Urological Research Coping with Cancer Instrument (CCCI), and to determine whether there is an underlying structure to the various coping strategies used by patients with prostate cancer. METHODS: Eighty patients with prostate cancer were interviewed using the CCCI. The participants also completed measures of quality of life and anxiety and depression. RESULTS: The psychometric properties of the CCCI were acceptable. Factor analysis revealed that coping with prostate cancer can be described along five dimensions: positive problem solving (fighting against the illness, seeking information); self-reliance (developing a lay explanation, distrusting doctors); emotional availability (not withdrawing from others); distress (brooding, self-pity); and solace (taking alcohol or drugs to improve mood). These coping styles were correlated with age, quality of life, self-reported prostate-specific antigen level, and measures of anxiety and depression. CONCLUSIONS: The results of the present study have led to a greater understanding of the underlying coping styles used by patients with prostate cancer. Although some of these are similar to those found in other cancer populations, others, such as self-reliance and solace, represent unique and potentially clinically significant responses to prostate cancer diagnosis and treatment. A larger scale longitudinal study is needed to determine the wider clinical implications associated with each coping style.

Adaptation, Psychological↗
PubMed2002

Effectiveness of off-line and web-based promotion of health information web sites.

The relative effectiveness of off-line and web-based promotional activities in increasing the use of health information web sites by target audiences were compared. Visitor sessions were classified according to their method of arrival at the site (referral) as external web site, search engine, or "no referrer" (i.e., visitor arriving at the site by inputting URL or using bookmarks). The number of Australian visitor sessions correlated with no referrer referrals but not web site or search-engine referrals. Results showed that the targeted consumer group is more likely to access the web site as a result of off-line promotional activities. The properties of target audiences likely to influence the effectiveness of off-line versus on-line promotional strategies include the size of the Internet using population of the target audience, their proficiency in the use of the Internet, and the increase in effectiveness of off-line promotional activities when applied to locally defined target audiences.

Australia↗