8 results on '"Young, Jane"'
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2. A wicked problem
- Author
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Young, Jane
- Published
- 2020
3. Changing attitudes towards management of men with locally advanced prostate cancer following radical prostatectomy: A follow-up survey of Australia-based urologists.
- Author
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Brown, Bernadette, Egger, Sam, Young, Jane, Kneebone, Andrew B, Brooks, Andrew J, Dominello, Amanda, and Haines, Mary
- Subjects
PROSTATE cancer treatment ,PROSTATECTOMY ,PROSTATE surgery ,RADIOTHERAPY ,ADJUVANT treatment of cancer ,UROLOGISTS ,PROSTATE tumors treatment ,HEALTH attitudes ,LONGITUDINAL method ,MEDICAL protocols ,PROSTATE tumors - Abstract
Introduction: This study examined whether there has been change among Australia-based urologists' knowledge, attitudes and beliefs relating to guideline-recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy since a prior survey in 2012 and investigated associations between attitudes and treatment preferences.Methods: A nationwide survey of Australia-based urologist members of the Urological Society of Australia and New Zealand.Results: Ninety-six respondents completed the 2015 survey (30% response rate) compared with 157 (45% response rate) in 2012. There was no significant change in awareness of national clinical practice guidelines for the management of prostate cancer. When considering adjuvant against salvage radiotherapy, urologists were significantly less favourable towards adjuvant radiotherapy in 2015 than in 2012 for two of three hypothetical clinical case scenarios with a high 10-year risk of biochemical relapse according to Memorial Sloan Kettering Cancer Center nomograms (P < 0.001 for both cases). In 2015, urologists were less positive overall towards the recommendation for post-operative adjuvant radiotherapy for men with locally advanced prostate cancer than in 2012 (P < 0.001), reflecting a significant change across a number of attitudes and beliefs. Of note, urologists felt other urologists would more likely be critical if they routinely referred the target patient group for radiotherapy in 2015 compared with 2012 (P = 0.007).Conclusion: In 2015 Australia-based urologists were less favourable towards adjuvant radiotherapy over watchful waiting for men with high-risk pathologic features post-prostatectomy than in 2012. We could find no new published research that precipitated this change in attitude. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
4. How to decide to undertake a randomized, controlled trial of stent or surgery in colorectal obstruction.
- Author
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Suen MK, Zahid A, Young JM, Rodwell L, Solomon MJ, and Young CJ
- Subjects
- Adult, Attitude of Health Personnel, Australia, Colectomy statistics & numerical data, Colorectal Neoplasms pathology, Colorectal Neoplasms therapy, Confidence Intervals, Decision Making, Female, Follow-Up Studies, Humans, Intestinal Obstruction pathology, Intestinal Obstruction therapy, Male, Middle Aged, Minimally Invasive Surgical Procedures methods, Minimally Invasive Surgical Procedures statistics & numerical data, New Zealand, Patient Selection, Practice Patterns, Physicians', Societies, Medical, Treatment Outcome, Colectomy methods, Colorectal Neoplasms surgery, Intestinal Obstruction surgery, Stents statistics & numerical data, Surveys and Questionnaires
- Abstract
Background: Colorectal stents have been available as a management option in obstruction for 23 years, yet there is little randomized evidence of their effectiveness. This study investigated current surgeon-related barriers to conducting a randomized, controlled trial (RCT) of colorectal stent insertion for obstruction in patients with colorectal cancer., Methods: A binational survey of current members of the Colorectal Surgical Society of Australia and New Zealand was conducted by a mailed questionnaire assessing perceived barriers to adoption of colonic stents and willingness to participate in future multicentre randomized controlled trials, and surgeons' treatment preferences in 16 hypothetical clinical scenarios., Results: Of 148 eligible surgeons, 96 (65%) responded. Colonic stenting was available to 98% of respondents. In the clinical setting of colorectal obstruction, only 29% (95% CI, 20-39%) of surgeons expressed a willingness to participate in a RCT involving colonic stents in the curative setting. More than 70% of surgeons preferred the use of stents in unfit patients for palliation, and preferred surgery in fit patients with curable disease. In the curative setting, most respondents considered colonic stents not cost effective (90%; 95% CI, 82-94%) and believed that their patients would not prefer stents over surgery (80%; 95% CI, 71-87%)., Conclusion: This study highlights the limitation to conducting a future randomized controlled trial to assess the efficacy of colonic stenting, especially in the curative setting, based on surgeon preference, despite the lack of level I evidence., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
- Full Text
- View/download PDF
5. Older patients and adjuvant therapy for colorectal cancer: surgeon knowledge, opinions, and practice.
- Author
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Jorgensen ML, Young JM, and Solomon MJ
- Subjects
- Aged, 80 and over, Attitude of Health Personnel, Australia, Clinical Competence, Colorectal Neoplasms pathology, Female, Health Care Surveys, Humans, Male, Middle Aged, New Zealand, Practice Patterns, Physicians', Age Factors, Chemotherapy, Adjuvant, Colorectal Neoplasms therapy, Patient Selection, Radiotherapy, Adjuvant, Referral and Consultation
- Abstract
Background: Increasing patient age independently predicts nonreferral and nonreceipt of adjuvant therapy among patients with colorectal cancer., Objective: This study aimed to identify factors affecting surgeons' decisions to refer older patients for adjuvant therapy., Design/settings/participants: A self-administered survey was sent to all Australian and New Zealand colorectal surgeons (n = 146)., Main Outcome Measures: The survey consisted of 3 sections: 1) knowledge of research evidence, 2) opinions on evidence and adjuvant therapy in older patients, and 3) self-reported practice, or likelihood of patient referral in different scenarios. Demographic information was also obtained., Results: Seventy percent of surgeons responded. Surgeons were significantly less likely to refer older patients than younger patients for adjuvant therapy in all scenarios (P < .001). The difference in referral recommendations was greatest when patients lived a long way from treatment, had a comorbid condition, or had little social support. There was greater variation in referral recommendations for older patients, and marked disagreement between surgeons in knowledge and opinion questions. Surgeon age was the only significant predictor of survey responses. Greater knowledge and more positive opinions predicted similar referral recommendations for older and younger patients (P = .02, P = .01)., Limitations: Although decreased referral and receipt of adjuvant therapy among older patients is most likely multifactorial, this survey focused on the views of one physician group and a number of specific scenarios., Conclusions: Chronological age alone appears to impact colorectal surgeons' decisions to refer patients for adjuvant therapy. Sociodemographic and physiological factors further decrease the likelihood of referral of older patients. A lack of consensus among surgeons suggests that more research is needed both to predict how older patients with cancer will react to treatment, and to determine how information from emerging evidence can be best used to assist physicians' treatment decisions.
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- 2011
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6. Patient preferences between surgical and medical treatment in Crohn's disease.
- Author
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Byrne CM, Solomon MJ, Young JM, Selby W, and Harrison JD
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- Adult, Attitude of Health Personnel, Australia, Chi-Square Distribution, Decision Making, Female, Humans, Interviews as Topic, Male, Medicine, New Zealand, Prospective Studies, Specialization, Statistics, Nonparametric, Surveys and Questionnaires, Crohn Disease surgery, Crohn Disease therapy, Patient Satisfaction
- Abstract
Purpose: Crohn's disease poses difficult choices in which the most appropriate treatment option is not always obvious. When this state of uncertainty exists, patients' preferences should have an increasingly important part of clinical decision making. The purpose of this study was to compare patients' preferences for surgical intervention in Crohn's disease with the preferences of surgeons and gastroenterologists., Methods: Outpatients with Crohn's disease were interviewed to quantify their preferences for six scenarios by using the prospective preference measure. An identical questionnaire was mailed to all Australian and New Zealand colorectal surgeons and a random sample of 300 Australian gastroenterologists., Results: Forty-one of 123 patients with Crohn's disease (33 percent), 92 of 127 colorectal surgeons (72 percent), and 74 of 272 gastroenterologists (27 percent) participated. There were significant differences between patients and gastroenterologists for three of six scenarios and between surgeons and gastroenterologists in four of six scenarios. Seventy-six percent of gastroenterologists were willing to gamble to avoid an ileocolic resection compared with 37 percent of surgeons (chi-squared = 25.44; P < 0.0001) and 39 percent of patients (chi-squared = 15.44; P < 0.001)., Conclusions: Patients and clinicians were able to trade and gamble life expectancy as a measure of preference for varying hypothetical surgical treatments, even though these treatment options impacted on quality of life rather than survival. Patients' preferences did not align with clinicians. For most scenarios, colorectal surgeons' preferences were significantly different to those of gastroenterologists.
- Published
- 2007
- Full Text
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7. Non-entry of eligible patients into the Australasian Laparoscopic Colon Cancer Study.
- Author
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Abraham NS, Hewett P, Young JM, and Solomon MJ
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- Aged, Aged, 80 and over, Australia, Female, Humans, Male, Middle Aged, New Zealand, Oceania, Prospective Studies, Colorectal Neoplasms surgery, Patient Satisfaction statistics & numerical data, Patient Selection, Randomized Controlled Trials as Topic statistics & numerical data
- Abstract
Background: There is currently a need to assess the reasons for non-entry of eligible patients into surgical randomized controlled trials to determine measures to improve the low recruitment rates in such trials., Methods: Reasons for non-entry of all eligible patients not recruited into the Australasian Laparoscopic Colon Cancer Study were prospectively recorded using a survey completed by the participating surgeons for a period of 6 months., Results: In the 6-month period of the study, 51 (45%) out of 113 eligible patients examined by the 18 actively participating surgeons were recruited into the trial. Eighty-nine reasons were recorded for the non-entry of the 62 eligible patients. The most commonly recorded reason was preference for one form of surgery (42%) or the surgeon (31%) by the patient (45 patients (73%) in total). This was followed by lack of time (10 patients (16%)), hospital accreditation (7 patients (11%)) or staffing/equipment (6 patients (10%)). Concern about the doctor-patient relationship or causing the patient anxiety was recorded for three (5%) and two (3%) patients, respectively. Recruitment was positively associated with the availability of a data manager (chi2 = 19.91; P < 0.001, odds ratio (95% confidence interval) = 9.50 (3.53-25.53)) and negatively associated with an increased caseload (more than five eligible patients seen by the surgeon in the study period) (continuity adjusted chi2 = 16.052; P < 0.001, odds ratio (95% confidence interval) = 0.11(0.04-0.30))., Conclusion: Having a preference for one form of surgery by the patient or the surgeon was the most common reason for non-entry of eligible patients in the Australasian Laparoscopic Colon Cancer Study. Concern about the doctor-patient relationship played a minimal role in determining the outcome of recruitment. Patient and surgeon preferences, caseload and the distribution of supportive staff such as data managers according to patient population density should be considered in the planning of future trials.
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- 2006
- Full Text
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8. Clinical trials in head and neck oncology: an evaluation of clinicians' willingness to participate.
- Author
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Young JM, O'brien C, Harrison JD, and Solomon MJ
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- Adult, Aged, Australia, Female, General Surgery, Humans, Male, Medical Oncology, Middle Aged, New Zealand, Surveys and Questionnaires, Attitude of Health Personnel, Head and Neck Neoplasms therapy, Physicians, Practice Patterns, Physicians', Randomized Controlled Trials as Topic
- Abstract
Background: This study investigated the individual and collective ("community") equipoise of surgeons and oncologists and their willingness to take part in each of six hypothetical randomized controlled trials in head and neck oncology., Methods: A survey was mailed to Australasian head and neck specialists., Results: Among 109 respondents (74% response), the scenario with the highest level of individual equipoise pertained to the use of adjuvant interferon for patients with high-risk malignant melanoma, with 45% indicating complete uncertainty between treatment approaches. Significant differences in levels of community equipoise were demonstrated between surgeons and oncologists for three of the scenarios. Willingness to participate in randomized controlled trials ranged from 39% to 72%. Increasing strength of treatment preference was associated with unwillingness to participate in randomized controlled trials for two of six scenarios., Conclusion: High levels of equipoise and willingness to participate in clinical research augur well for future randomized controlled trials in head and neck oncology., ((c) 2005 Wiley Periodicals, Inc.)
- Published
- 2006
- Full Text
- View/download PDF
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