A randomized controlled trial of a nurse-led supportive care package (SurvivorCare) for survivors of colorectal cancer

INTRODUCTION: Colorectal cancer (CRC) and its treatments can cause distressing sequelae. We conducted a multicenter randomized controlled trial aiming to improve psychological distress, supportive care needs (SCNs), and quality of life (QOL) of patients with CRC. The intervention, called SurvivorCare (SC), comprised educational materials, needs assessment, survivorship care plan, end-of-treatment session, and three follow-up telephone calls.

METHODS: At the end of treatment for stage I-III CRC, eligible patients were randomized 1:1 to usual care (UC) or to UC plus SC. Distress (Brief Symptom Inventory 18), SCNs (Cancer Survivors' Unmet Needs measure), and QOL (European Organization for Research and Treatment of Cancer [EORTC] QOL questionnaires C30 and EORTC CRC module CR29) were assessed at baseline and at 2 and 6 months (follow-up 1 [FU1] and FU2, respectively). The primary hypothesis was that SC would have a beneficial effect on distress at FU1. The secondary hypotheses were that SC would have a beneficial effect on (a) SCN and QOL at FU1 and on (b) distress, SCNs, and QOL at FU2. A total of 15 items assessed experience of care.

RESULTS: Of 221 patients randomly assigned, 4 were ineligible for the study and 1 was lost to FU, leaving 110 in the UC group and 106 in the SC group. Patients' characteristics included the following: median age, 64 years; men, 52%; colon cancer, 56%; rectal cancer, 35%; overlapping sites of disease, 10%; stage I disease, 7%; stage II, 22%; stage III, 71%. Baseline distress and QOL scores were similar to population norms. Between-group differences in distress at FU1 (primary outcome) and at FU2, and SCNs and QOL at FU1 and FU2 were small and nonsignificant. Patients in the SC group were more satisfied with survivorship care than those in the UC group (significant differences on 10 of 15 items).

CONCLUSION: The addition of SC to UC did not have a beneficial effect on distress, SCNs, or QOL outcomes, but patients in the SC group were more satisfied with care.

IMPLICATIONS FOR PRACTICE: Some survivors of colorectal cancer report distressing effects after completing treatment. Strategies to identify and respond to survivors' issues are needed. In a randomized controlled trial, the addition of a nurse-led supportive care package (SurvivorCare) to usual posttreatment care did not impact survivors' distress, quality of life, or unmet needs. However, patients receiving the SurvivorCare intervention were more satisfied with survivorship care. Factors for consideration in the design of subsequent studies are discussed.

Nurse-led group consultation intervention reduces depressive symptoms in men with localised prostate cancer: a cluster randomised controlled trial

BACKGROUND: Radiotherapy for localised prostate cancer has many known and distressing side effects. The efficacy of group interventions for reducing psychological morbidity is lacking. This study investigated the relative benefits of a group nurse-led intervention on psychological morbidity, unmet needs, treatment-related concerns and prostate cancer-specific quality of life in men receiving curative intent radiotherapy for prostate cancer.

METHODS: This phase III, two-arm cluster randomised controlled trial included 331 men (consent rate: 72 %; attrition: 5 %) randomised to the intervention (n = 166) or usual care (n = 165). The intervention comprised four group and one individual consultation all delivered by specialist uro-oncology nurses. Primary outcomes were anxious and depressive symptoms as assessed by the Hospital Anxiety and Depression Scale. Unmet needs were assessed with the Supportive Care Needs Survey-SF34 Revised, treatment-related concerns with the Cancer Treatment Scale and quality of life with the Expanded Prostate Cancer Index -26. Assessments occurred before, at the end of and 6 months post-radiotherapy. Primary outcome analysis was by intention-to-treat and performed by fitting a linear mixed model to each outcome separately using all observed data.

RESULTS: Mixed models analysis indicated that group consultations had a significant beneficial effect on one of two primary endpoints, depressive symptoms (p = 0.009), and one of twelve secondary endpoints, procedural concerns related to cancer treatment (p = 0.049). Group consultations did not have a significant beneficial effect on generalised anxiety, unmet needs and prostate cancer-specific quality of life.

CONCLUSIONS: Compared with individual consultations offered as part of usual care, the intervention provides a means of delivering patient education and is associated with modest reductions in depressive symptoms and procedural concerns. Future work should seek to confirm the clinical feasibility and cost-effectiveness of group interventions.

Compliance to exercise-oncology guidelines in prostate cancer survivors and associations with psychological distress, unmet supportive care needs, and quality of life

Objective The purpose of this study was to determine prevalence of Australian prostate cancer survivors meeting contemporary exercise-oncology guidelines and identify associations with distress, unmet supportive care needs, and quality of life. Methods A population-based cohort of 463 prostate cancer survivors who were on 10.8 months post-curative therapy was assessed for compliance with current exercise guidelines for cancer survivors, motivational readiness for physical activity, psychological distress, unmet supportive care needs, and quality of life. Results Only 57 men (12.3%) reported sufficient exercise levels (150 min of moderate intensity or 75 min of strenuous exercise per week and twice weekly resistance exercise), 186 (40.2%) were insufficiently active, and 220 (47.5%) were inactive. Among inactive men, 99 (45.0%) were in the contemplation or preparation stage of motivation readiness. Inactive men had higher global distress (p=0.01) and Brief Symptom Inventory-Anxiety (p<0.05) than those who were insufficiently active. Total Supportive Care Needs and International Prostate Cancer Symptom scores were higher in inactive than insufficiently and sufficiently active men (p<0.05). Lack of physical activity contributed to poorer quality of life. Conclusions Only a small proportion of Australian prostate cancer survivors met contemporary exercise-oncology recommendations despite increasing recognition of exercise to improve patient outcomes. Strategies are urgently required to increase prostate cancer survivors' participation in aerobic and resistance exercise training.

Can multimedia meet tertiary educational needs better than the conventional lecture? A case study

Educational researchers have long derided the university lecture as an effective mode of delivery of educational materials, but currently there are many reports on the advantages offered by computer. In this study a multimedia solution was sought to replace existing face to face lectures because it appeared to offer a close 'media versus need' match. Consequently, a decision was made to develop a design template for an interactive computer based program that would be suitable for a range of subject content. In order to personalise the instruction, a large video insert was incorporated as the main screen's most prominent design feature. From here the learner could navigate to support material including interactive simulations. The program was piloted with a small group of students and, in particular, the student tracking data that the program automatically generates yield some interesting learning style information.

Drug education with special needs populations : identifying and understanding the challenges

Students with special developmental needs (e.g. learning disabilities, attentional disorders, intellectual disability, conduct disorders, sensory deficits, acquired brain injury) face particular challenges with respect to academic achievement and psychosocial development, whether they are educated in mainstream settings, special settings, or a combination of these. These groups are typically poorly researched with respect to drug and alcohol use and education, however there is some evidence to indicate that they face an elevated risk of experiencing drug-related harms. The aim of the present paper is to highlight the particular challenges facing this heterogeneous population with respect to access to school-based drug education. Special learning challenges facing such students are described, and some suggestions are provided for researchers and practitioners in the drug education field.

Basic Needs, Property Rights and Degradation Of Commons

A major problem in many developing countries is the degradation of commons. This degradation has occurred on account of the lack of fulfilment of the basic needs of the poor, free riding and ill–defined property rights. As these goods are essential for the survival of these people, they have to access these items from commons. This results in regular raids to common land for resources and also to private houses (for example, in New Delhi) which are not guarded for water. A variant of the agricultural household model is used to analyse the above problem. Several propositions are established and it is demonstrated that degradation can occur at both a low and high price of basic needs. This result has important policy implications as it demonstrates that land or common degradation cannot be solved by just using the price system. Properly defined property rights and provision of basic goods in kind may resolve the problem of degradation of commons.

The education needs of caregivers of stroke survivors in acute and community settings

Stroke is a major cause of chronic illness in Australia, where it is estimated that between 200,000 and 250,000 people live with disabilities due to stroke. Given stroke's effect on survivors and the accompanying burden on caregivers, attention should be given to addressing the needs of caregivers of stroke survivors because they are central to supporting survivors living in the community. Research has shown that the information needs of caregivers are not being met across healthcare settings. Thus, some attention must be given to the development of educational materials that address caregiver needs. In this study we interviewed caregivers to determine their perspectives on support and educational needs at two different stages in the recovery of the stroke survivor: the acute hospital and the community. Despite a high level of uncertainty among caregivers in the acute and community settings, limited information was provided to assist them in their new role. A multifaceted approach would involve the development and implementation of specifically designed educational materials for caregivers, the use of a tool such as a patient-held record to assist in and improve the continuity and communication of care, and the provision of ongoing support from a stroke nurse practitioner who would follow stroke survivors from the acute setting to the community. This approach should be evaluated so that the important issue of addressing caregiver needs is given its due attention.

An analysis of the environment as a means of assessing training needs in the Insurance industry in Australia

In the five years leading up to 2002 there were many significant changes in
the insurance industry in Australia that brought about a range of training
needs. These training needs arose from matters as diverse as mergers, increased competition, corporate failures, and legislative changes. This study includes findings from a survey of the insurance industry in Australia in the period 2000·2002 asa means of exploring the importance of the environment (marketplace) in predicting aspects of training needs. The findings demonstrate that an environmental analysis approach to training needs analysis can predict the type of training that organisations will subsequently need to provide, and thus has the potential to produce a more accurate assessment of training needs in the future. The findings also have application to more broadly based businesses operating in the financial services sector of the economy

Reality therapy and the human energy field : working with needs that influence mind and body

There is accumulating evidence that body and mind, or rather the physical and the non-physical, are intrinsically connected. The mechanisms through which reality therapy works on mind and body may be explained via positive dynamics in the central nervous system, the body's biochemistry and the human energy field. The purpose of this paper is to show the relationship between choice theory and the nature of the power centers in the human energy field. Understanding the drivers behind human behavior and facilitating the choice to think realistically and to make responsible choices assists wholeness and enhances the physical, mental and spiritual health.

Effective teaching in universities: are students' basic needs being satisfied in large classes?

In a quest for a more efficient education system, many organizations have opted to increase class size. It is a common perception that large subjects are economical to run and small subjects are not. Many in the tertiary  education system have had concerns with issues involved in the teaching of large classes, including teaching quality and whether there are effective learning outcomes for students. As with any complex issue, there are several approaches that could be utilized to assess whether the needs of  stakeholders are being met. Stakeholders include the institution, the  teaching staff the community and the students. This study aims to assess whether universities are satisfying the needs of students as class size is increased The study focuses on satisfaction with large classes and includes an assessment of the satisfaction of students' psychological needs. These constructs are measured in small, medium and large classes to identify the change in the level of satisfaction. The study used a multi-method approach consisting of a literature review, a qualitative phase involving in depth  interviews, focus groups, and a quantitative survey The results show that while customer satisfaction is being met, the satisfaction of students' psychological needs are not being fully realised. It was also found that there were notable variations between individual students, the subjects being studied and degree streams of students taking the same subject. The implications of these findings and suggestions for further investigation are discussed in this paper.

Accessible information for people with complex communication needs

Information can be empowering if it is accessible. While a number of known information access barriers have been reported for the broader group of people with disabilities, specific information issues for people with complex communication needs have not been previously reported. In this consumer-focused study, the accessibility of information design and dissemination practices were discussed by 17 people with complex communication needs; by eight parents, advocates, therapists, and agency representatives in focus groups; and by seven individuals in individual interviews. Participants explored issues and made recommendations for content, including language, visual and audio supports; print accessibility; physical access; and human support for information access. Consumer-generated accessibility guidelines were an outcome of this study.

Nurses' perceived training needs in child protection issues

Purpose – The purpose of this research is to explore nurses' perceptions of their current skills and knowledge and training needs to identify cases of child abuse and their understanding of their roles and responsibilities in relation to child abuse. Nurses, including health visitors and midwives, have been recognised as having a key role in the protection and care of children, especially in identifying and referring possible cases of child abuse and neglect.

Design/methodology/approach – A structured questionnaire concerning knowledge and training needs in child protection was sent to all nurses employed in a Scottish NHS Primary Care Trust (approximately 1,900), of whom one-third (667) responded. These survey results were complemented by semi-structured interviews with 99 members of the nursing workforce.

Findings – Almost all training in child protection had been confined to health visitors, resulting in the Trust giving an implicit message that child protection is not a role in which other nurses need have any involvement. In general, those nurses who both worked with children and had involvement in child protection issues, considered themselves to be most in need of knowledge around child protection work, to have the greatest level of knowledge and to consider further training a priority.

Research limitations/implications – Nurses who had an interest or involvement in child protection work were more likely to participate in the research, which may have biased the results.

Practical implications – Training strategies need to address the diversity of nurses' involvements in child protection work through the development of training programmes which are appropriate for different workplaces and different occupational groupings. Nurses in some settings will need to be first convinced they have the potential to play an important role in protecting children from abuse and neglect.

Originality/value – Many NHS Trusts have in recent years introduced mandatory training in child protection for all staff in contact with children. However, previously published studies have considered training issues only in respect of nurses identified as working directly with children, whereas this study explores child protection issues for all nurses employed in a primary care NHS Trust.

Addressing training needs for community care assessment in remote Indigenous communities

Access to Home and Community Care services in Australia is based on the assessed needs of individual clients, with individual Home and Community Care organisations generally being responsible for initial assessment of eligibility and need. Home and Community Care funded services are expected to operate within the agency's program guidelines and to adhere to minimum service standards. However, service delivery contexts in remote areas of Australia present particular challenges for staff in the practice of assessment and care planning. This paper discusses the findings of a project which investigated approaches to assessment of client needs in remote Home and Community Care services. Some of the challenges of providing care in remote/Indigenous contexts are discussed. The research project highlighted that there was an inadequate knowledge base to assist staff with assessment and care planning in these cross-cultural contexts; a greater focus on developing the assessment skills of staff was needed. Subsequently, an education program incorporating the International Classification of Functioning, Disability and Health was developed for Home and Community Care assessment staff in remote communities. Rather than focusing on process skills and procedures, the program was designed to equip staff with a solid and consistent conceptual framework to assist with assessment and care planning.

Measuring Australia's well-being using hierarchical needs

A new approach to well-being measurement is presented in this paper based on multidimensional hierarchical human needs and motivation. This paper empirically applies this new measure of well-being to Australia for the period 1985–2000. This hierarchical approach is underpinned by a rigorous psychological theory of human motivation. Hierarchical human needs are classified into five categories. Eight indicators have been chosen to reflect these categories. A composite indicator of these eight indicators is calculated. This paper concludes that it is necessary to consider multidimensional human needs and motivation when analysing and seeking to improve well-being through economic and social development activities.