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Introduction In July 2025, Australia will introduce a national Lung Cancer Screening Program (LCSP). Pulmonary nodule assessment and patient management are Program aspects anticipated to have major workforce implications. Aims * Demonstrate safe, advanced practice nursing relative to pulmonary nodule assessment and patient management * Improve capacity in respiratory physicians to attend to high-risk cases in a timelier manner Methodology Early 2023, clinical redesign of a regional public outpatients respiratory medicine specialist service in New South Wales included streamlined general practice referral pathways, nurse-led triage, rapid access pathway and pulmonary nodule assessment and surveillance, and consistency in diagnostic radiology reporting. During April-July 2023, two lung cancer nurse consultants evaluated all incidentally-found pulmonary nodules against evidence-based guidelines, provided recommendation for nodule management (with governance review), and communicated the plan to patients and their general practitioner. A 22-item validated Likert scale, with free text capability, was implemented to elicit multidisciplinary team members' perceptions of the value and safety of the clinic to patients, the team and broader outpatients service. Sentiment scores reflecting the level of respondents' perceptions of the clinic and the advanced practice role were generated. Content analysis helped to interpret some neutral and mildly negative sentiments. Results Eighteen respondents completed the questionnaire (August-September 2023). A sentiment score of 4.7 (out of a possible 5) suggests team members are very positive about the value and safety of the clinic to patients, team functioning and service efficiency. This score was affected by mildly negative responses to item 1 ("I fully understand the Specialist Lung Cancer Nurse Pulmonary Nodule Assessment Clinic"). This 12-week pilot was perceived to be too brief for team members to fully understand the scope of both the clinic and role. Conclusions This project highlights the critical importance of definition in the lung cancer nurse consultant role relative to Australia's imminent LCSP. [ABSTRACT FROM AUTHOR]

Importance: Chronic breathlessness is common in people with chronic obstructive pulmonary disease (COPD). Regular, low-dose, extended-release morphine may relieve breathlessness, but evidence about its efficacy and dosing is needed.Objective: To determine the effect of different doses of extended-release morphine on worst breathlessness in people with COPD after 1 week of treatment.Design, Setting, and Participants: Multicenter, double-blind, placebo-controlled randomized clinical trial including people with COPD and chronic breathlessness (defined as a modified Medical Research Council score of 3 to 4) conducted at 20 centers in Australia. People were enrolled between September 1, 2016, and November 20, 2019, and followed up through December 26, 2019.Interventions: People were randomized 1:1:1 to 8 mg/d or 16 mg/d of oral extended-release morphine or placebo during week 1. At the start of weeks 2 and 3, people were randomized 1:1 to 8 mg/d of extended-release morphine, which was added to the prior week's dose, or placebo.Main Outcomes and Measures: The primary outcome was change in the intensity of worst breathlessness on a numerical rating scale (score range, 0 [none] to 10 [being worst or most intense]) using the mean score at baseline (from days -3 to -1) to the mean score after week 1 of treatment (from days 5 to 7) in the 8 mg/d and 16 mg/d of extended-release morphine groups vs the placebo group. Secondary outcomes included change in daily step count measured using an actigraphy device from baseline (day -1) to the mean step count from week 3 (from days 19 to 21).Results: Among the 160 people randomized, 156 were included in the primary analyses (median age, 72 years [IQR, 67 to 78 years]; 48% were women) and 138 (88%) completed treatment at week 1 (48 in the 8 mg/d of morphine group, 43 in the 16 mg/d of morphine group, and 47 in the placebo group). The change in the intensity of worst breathlessness at week 1 was not significantly different between the 8 mg/d of morphine group and the placebo group (mean difference, -0.3 [95% CI, -0.9 to 0.4]) or between the 16 mg/d of morphine group and the placebo group (mean difference, -0.3 [95%, CI, -1.0 to 0.4]). At week 3, the secondary outcome of change in mean daily step count was not significantly different between the 8 mg/d of morphine group and the placebo group (mean difference, -1453 [95% CI, -3310 to 405]), between the 16 mg/d of morphine group and the placebo group (mean difference, -1312 [95% CI, -3220 to 596]), between the 24 mg/d of morphine group and the placebo group (mean difference, -692 [95% CI, -2553 to 1170]), or between the 32 mg/d of morphine group and the placebo group (mean difference, -1924 [95% CI, -47 699 to 921]).Conclusions and Relevance: Among people with COPD and severe chronic breathlessness, daily low-dose, extended-release morphine did not significantly reduce the intensity of worst breathlessness after 1 week of treatment. These findings do not support the use of these doses of extended-release morphine to relieve breathlessness.Trial Registration: ClinicalTrials.gov Identifier: NCT02720822. [ABSTRACT FROM AUTHOR]

Objective: To ascertain palliative physicians' and consultation-liaison psychiatrists' perceptions of depression care processes in patients with very poor prognoses, exploring key challenges and postulating solutions. Methods: A qualitative focus group study involving three 1-h online focus groups (2 palliative medicine and 1 psychiatry) were conducted between November-December 2020. Fellows and trainees were recruited from Australian and New Zealand Society of Palliative Medicine (n = 11) and Royal Australian and New Zealand College of Psychiatrists (n = 4). Data underwent conventional qualitative content analysis. Results: Participants perceived depression care to be complex and challenging. Perceived barriers included: inadequate palliative care psychiatry skills with variation in clinical approaches; lack of supportive health infrastructure (poor access to required interventions and suboptimal linkage between palliative care and psychiatry); lack of research support; and societal stigma. Suggested solutions included integrating care processes between palliative care and psychiatry to improve clinician training, establish supportive health systems and promote innovative research designs. Conclusions: Developing clinician training, supportive health systems and innovative research strategies centering on integrating palliative care and psychiatry care processes may be integral to optimising depression care when providing care to people with very poor prognoses. [ABSTRACT FROM AUTHOR]