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Objective: Many cancer care services (CCS) provide pragmatic models of emergent care for their patients as part of 'business as usual' without understanding the scope of this work. We aimed to describe an Australian CCS-led model of emergent care and quantify and profile emergent care provided over a 6-month period to understand scope and demand. Methods: This prospective cohort study was performed at a large tertiary hospital on the eastern coast of Australia in 2016. The study explored emergent care provided during business hour and after-hours, including telephone advice, unplanned care and unplanned admissions. Data were collected via electronic hospital records and clinical nurses regarding who accessed care, why care was accessed, what care was provided and how the episode of care ended. Results: Between March and September 2016, 1412 episodes of unplanned care were provided in the CCS-led model of care, including 307 episodes of telephone advice (237 patients; min max 1–4 episodes per patient; 825 episodes of unplanned care (484 patients; min max 1–9 episodes per patient) and 280 unplanned admissions (233 patients; min max 1–6 episodes per patient). During the same time, an additional 459 unplanned admissions (361 patients) occurred via the emergency department (ED), of which 125 (27.2%) occurred during business hours which could have been managed by the CCS. Most people who received care experienced issues associated with disease or treatment and had received systemic anticancer therapy in the past 30 days. Conclusions: The data demonstrate that a significant volume of emergent care was provided within the CCS over the study period, in addition to planned cancer treatment. Due to the ever-increasing demands on EDs and the significant need for emergent care for people with cancer, there is need for CCS-led models of care to provide specialist emergent care specifically for people who are receiving systemic anticancer therapy. Such models must be adequately resourced to meet the needs of patients, carers and healthcare professionals. What is known about the topic?: There is increasing focus on innovative models of emergent care for people with cancer in the out-patient setting to relieve pressure on EDs and improve patient experiences. Limited literature has focused on such models in the Australian context. What does this paper add?: This paper describes, quantifies and profiles care provided in a pragmatic CCS-led model of emergent care in a large tertiary hospital in Australia over 6 months. The data demonstrate significant demand for emergent care within business hours, as well as out of hours, predominantly for people undergoing systemic anticancer therapy. What are the implications for practitioners?: The findings of this study highlight the need for CCS to develop pragmatic models of emergent care. Appropriate resources, infrastructure, policies and procedures are required to adequate meet the needs of patients and carers. [ABSTRACT FROM AUTHOR]

This study summarises research- and practice-based evidence on home-based chemotherapy, and explores existing delivery models. A three-pronged investigation was conducted consisting of a literature review and synthesis of 54 papers, a review of seven home-based chemotherapy programmes spanning four countries, and two case studies within the Canadian province of Ontario. The results support the provision of home-based chemotherapy as a safe and patient-centred alternative to hospital- and outpatient-based service. This paper consolidates information on home-based chemotherapy programmes including services and drugs offered, patient eligibility criteria, patient views and experiences, delivery structures and processes, and common challenges. Fourteen recommendations are also provided for improving the delivery of chemotherapy in patients' homes by prioritising patient-centredness, provider training and teamwork, safety and quality of care, and programme management. The results of this study can be used to inform the development of an evidence-informed model for the delivery of chemotherapy and related care, such as symptom management, in patients' homes. [ABSTRACT FROM AUTHOR]

Objective. To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009–10 and 2021–22. Method. We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Schedule (MBS) program. All dollar figures are expressed in constant 2021 Australian dollars. Results. Radiotherapy and nuclear therapeutic medicine MBS claims increased by 78% whereas MBS funding increased by 137% between 2009–10 and 2021–22. The main driver of Medicare funding growth has been the Extended Medicare Safety Net, which has increased by 404%. Over the 13 year observation period, the percentage of bulk-billed claims peaked in 2017–18 at 76.1% but fell to 69.8% in 2021–22. For non-bulk billed services, average OOP costs per claim increased from $20.40 in 2009–10 to $69.78 in 2021–22. Conclusion. Despite increased Medicare funding, patients face increasing financial barriers to access radiation oncology services. Policies with regard to funding radiotherapy services should be reviewed to ensure that services are easily accessible and affordable for all those needing treatment and at a reasonable cost to Government. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe patterns of health service utilisation among the Australian population with cancer compared with the general population. Methods: Data for all respondents aged ≥25 years from two successive National Health Surveys conducted between 2011 and 2014 were analysed. Respondents with a history of cancer were identified as the cancer group, whereas all other respondents who did not report having had a cancer were included in the non-cancer control group. Comparisons were made between the two groups using logistic regression models. Results: The population with cancer was more likely to report having consulted their general practitioner, specialist, chemist, dietician, naturopath, nurse, optometrist, dentist, audiologist and other health professionals than the non-cancer population. The cancer population was also more likely to be admitted to hospital and to have visited an out-patient clinic, emergency department and day clinic. The presence of comorbidity and a current cancer were associated with a greater likelihood of receiving health services among the population with cancer. Conclusion: The population with cancer used health services significantly more than the non-cancer population. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation. What is known about the topic?: Multimorbidity is highly prevalent among the cancer population due to risk factors shared between cancer and other chronic diseases, and the development of new conditions resulting from cancer treatment and cancer complications. However, the Australian healthcare system is not set up optimally to address issues related to multimorbidity. What does this paper add?: This study is the first step in quantifying health services use by the population with cancer compared with the general population without cancer. Cancer survivors have an increased need for specific health services, particularly among those with multimorbidity. What are the implications for practitioners?: The development of integrated care models to manage multiple chronic diseases aligned with the Australian National Strategic Framework for Chronic Conditions is warranted. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation. [ABSTRACT FROM AUTHOR]

Aim: This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people. Design: Integrative review. Data Sources: An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted. Results: Forty‐two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person‐centred cancer care services that address practical needs. Conclusion: Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs. Patient or Public Contribution: Our team includes both First Nations people, non‐First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work. Implications for Nursing Practice: Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up‐to‐date cultural safety training and stand together with Indigenous and non‐Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP. [ABSTRACT FROM AUTHOR]

The present paper reports on a qualitative research project designed to expose the presently unrecognised minutiae of community nurses’ work with cancer patients at home, and to identify the ways in which these, combined to form comprehensive care episodes, contribute to physical and psychosocial well-being. The project was conducted in two locations in New South Wales, Australia, one metropolitan and one rural. The research model focused on particular nurse–patient encounters, and involved pre- and post-encounter interviews with nurses, post-encounter interviews with patients and carers, and observation of the encounters themselves. Participants included generalist community nurses, cancer patients being cared for at home, and their primary carers where appropriate. This research demonstrates that regular contact with generalist community nurses is associated with a strong sense of security about the immediate situation for home-based cancer patients and their primary carers. This sense of security is a significant component of patient and carer physical and psychosocial well-being, and may have implications for health services utilisation. In the present paper, the authors outline the factors underpinning this sense of security, and argue that these findings contribute important new knowledge that is vital for contemporary debates about role responsibilities and continuity of care for cancer patients. [ABSTRACT FROM AUTHOR]

Few rigorous studies provide a clear description of the methodological approach of developing an evidence-based implementation intervention, prior to implementation at scale. This study describes the development, mapping, rating, and review of the implementation strategies for the Care to Quit smoking cessation trial, prior to application in nine cancer services across Australia. Key stakeholders were engaged in the process from conception through to rating, reviewing and refinement of strategies and principles. An initial scoping review identified 21 barriers to provision of evidence-based smoking cessation care to patients with cancer, which were mapped to the Theoretical Domains Framework and Behaviour Change Wheel (BCW) to identify relevant intervention functions. The mapping identified 26 relevant behaviour change techniques, summarised into 11 implementation strategies. The implementation strategies were rated and reviewed against the BCW Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety, and Equity criteria by key stakeholders during two interactive workshops to facilitate a focus on feasible interventions likely to resonate with clinical staff. The implementation strategies and associated intervention tools were then collated by form and function to provide a practical guide for implementing the intervention. This study illustrates the rigorous use of theories and frameworks to arrive at a practical intervention guide, with potential to inform future replication and scalability of evidence-based implementation across a range of health service settings. [ABSTRACT FROM AUTHOR]

Objective: The COVID‐19 pandemic has accelerated the rapid expansion of telehealth, affording opportunities to study its impact on oncology care. Our qualitative study explored physician and patient perspectives of telehealth in cancer care. Methods: Semistructured interviews were conducted with seven physicians and eleven patients, recruited from an Australian hospital oncology department. Two authors independently coded the transcripts with emerging themes identified and refined iteratively in a thematic analysis. Results: Telehealth offered broadened possibilities by allowing continuity of care in the pandemic and revealing advantages of convenience in consultations. It also highlighted core elements of in‐person care that were unavailable. These included the information communicated through formal and informal physical examination, the collaboration between patient and physician in shaping outcomes and building rapport and the confidence in decisions made and physician performance. While patients and physicians envisioned the continuation of telehealth postpandemic, logistical steps are necessary to address these challenges. Conclusion: This study highlights the unprecedented opportunities that telehealth presents in widening access to oncology care and simultaneously reveals that it cannot always reach equivalence in quality of care. Further research is required to identify when and for whom telehealth is most acceptable as future care models are considered. [ABSTRACT FROM AUTHOR]

A diagnosis of ovarian cancer is a crisis for any woman. Ovarian cancer has the highest mortality of all the gynaecological cancers. In addition to the very real threat of death, such a diagnosis raises critical issues concerning femininity, motherhood and sexuality. The high mortality associated with this disease is due (in part) to problems associated with early diagnosis. Women frequently experience non-specific symptoms, which may be attributed to other, less alarming causes. The lack of specific symptoms experienced by women, as well as the lack of effective mass screening strategies, make early detection difficult. This makes it crucial that nurses involved in the care of women be alert to the insidious and non-specific onset of this serious condition. [ABSTRACT FROM AUTHOR]

Background: Traditional and complementary medicines (T&CM) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being. Alongside conventional cancer treatments, T&CM usage is increasing; with 19% of indigenous Australians with cancer reporting using T&CM. There is limited evidence surrounding T&CM use and disclosure by indigenous patients. Our aim was to explore healthcare providers' views about usage, disclosure/non-disclosure of T&CM by Indigenous cancer patients. Methods: Semi-structured, in-depth interviews with 18 healthcare providers, including three indigenous providers, at a large urban hospital providing care to Indigenous cancer patients were conducted to explore providers' experiences and attitudes towards T&CM use by Indigenous cancer patients. An interpretive phenomenological approach was used to thematically analyse the data. Results: Analysis revealed six themes: concern about risk; no 'real' benefits; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; 'patients' choice' a double-edged sword; and providers' lack of knowledge about T&CM. Healthcare providers perceived discord between T&CM and conventional medicine. Most lacked knowledge of T&CM, and had concerns around negative-interactions with conventional treatments. They considered T&CM outside their role, citing this as reasoning for their lack of knowledge. Indigenous healthcare providers had greater understanding and openness towards T&CM. Conclusions: Given the potential usage of T&CM by Indigenous cancer patients, providers need a more comprehensive understanding of T&CM in order to inform discussion and facilitate effective disclosure on this topic. If indigenous Australians with cancer feel that cancer care providers are unreceptive to discussing T&CM, patient care risks being compromised; particularly given the potential for negative interactions between T&CM and conventional cancer treatments. Fostering health care interactions where indigenous patients feel comfortable to discuss T&CM usage should be a priority for all cancer care services. [ABSTRACT FROM AUTHOR]