Experts identified priorities with a high level of consensus, providing a rigorous foundation for developing prioritised indicators of quality in cancer patient experience.
Background Implementation of routinely collected patient-reported outcome measures (PROMs) ensures patients’ priorities are at the forefront of care planning and helps to standardize approaches to quality improvement. In palliative care, barriers to PROMs are widely known but what are not understood are the clinical and care settings in which patients are more likely to report and when proxy reporting is needed. Objective To examine the incidence of patient-reported symptom distress compared to the incidence of proxy reporting in palliative care and influencing factors. Methods A national observational study using routinely collected PROMs data with influencing factors investigated by logistic regression modelling. Participants were patients with an advanced life-limiting illness receiving palliative care in an inpatient or a community healthcare setting in Australia. Results Sixteen thousand one hundred and fifty-eight reports of symptom distress were collected from 1117 patients seen by 21 palliative care services. The majority of respondents were diagnosed with cancer (76%), were older (≥65 years, 72%) and had nominated English as their first language (88%). The majority of symptom distress reports were completed by patients (61%). The odds of a patient providing a self-report where grater when they were receiving community versus inpatient palliative care (odds ratio (OR): 3.0; 95% confidence interval (CI): 2.25–4.01), for patients diagnosed with malignant versus non-malignant disease (OR 1.7; 95% CI: 1.26–2.31), and for those who required an urgent change in their care plan versus those whose symptoms and problems were adequately managed (OR: 1.38; 95% CI: 1.04–1.83). Conclusion Three factors are associated with an increased likelihood of patient versus proxy reporting in palliative care: healthcare setting, diagnosis, and the acuity and urgency of the patient’s clinical needs. PROMs are feasible in most clinical scenarios in palliative care, including when an urgent clinical response is required.
Background In 2019/20 major bushfires devastated Australia’s East Coast. Shortly afterward the COVID-19 pandemic was declared. Older people are disproportionately affected by disasters and are at high risk from respiratory pandemics. However, little is known about how these events impact on older peoples’ health and well-being and engagement with services such as primary care. Objective To explore the health impacts of the 2019/20 bushfires and the COVID-19 pandemic on older Australians' health and well-being. Methods One hundred and fifty-five people aged over 65 years living in South-eastern New South Wales, Australia participated in an online survey. The survey measured the impacts of the bushfires and COVID-19 on physical and mental health and the capacity of older people to manage these impacts. Results Most respondents felt that the bushfires caused them to feel anxious/worried (86.2%) and negatively affected their physical (59.9%) and mental (57.2%) health. While many participants had similar feelings about COVID-19, significantly fewer felt these physical and mental health impacts than from the bushfires. A significantly greater perceived level of impact was observed for females and those with health problems. More respondents described negative mental health than physical health effects. Those who felt more impacted by the events had lower levels of resilience, social connection and support, and self-rated health. Conclusion The health impacts identified in this study represent an opportunity for primary care to intervene to both ensure that people with support needs are identified and provided timely support and that older people are prepared for future disasters.
An evaluation of the Parent-Taught Driver Education (PTDE) program in Texas was conducted using three different research techniques: (1) focus groups with driver education instructors, teen drivers, and their parents; (2) a statewide mail survey of young drivers; and (3) an analysis of Texas driver records. Differences in Age at LicensingPrior to implementation of the Texas graduated driver licensing (GDL) program in 2002, the PTDE program does not appear to have encouraged earlier licensing, and may have delayed obtaining an instructional permit for a portion of the PT students. Since implementation of the GDL, PT students obtain their instruction permits earlier than commercial/ public school driver education students, suggesting that PT novice drivers are subject to the opportunity for increased exposure to the risks of driving. Differences in Attitudes, Knowledge, and Skills of Novice Drivers Driver education (DE) students and their parents generally agree that the PTDE program offers advantages over commercial and public school modes of DE delivery in terms of cost, comfort, and individualized personal attention to the student. Professional DE instructors believe the negative aspects of the PTDE program outweigh any perceived benefits, due largely to a lack of training, knowledge, and teaching skills on the part of parent-teachers. As measured by stateadministered tests, PT students demonstrate poorer driving knowledge early in the training and licensing process and poorer driving skills at the end of formal driver education. Although only a small proportion of DE students fail to pass either the test required to obtain an instructional permit or the optional in-vehicle road test on the first attempt, significantly more PT drivers require multiple attempts to pass either test. Differences in Driving Errors, Traffic Offenses and Crash InvolvementSelf-reports by young drivers reveal no, or at most very small, differences related to type of DE with regard to driving knowledge and skills, driver errors, traffic convictions, and crashes among drivers subject to the GDL program. Driver records, however, both before and after implementation of the GDL, indicate PT novice drivers committed more traffic offenses and were in more crashes than were commercial or public school-trained drivers. Since implementation of the GDL, traffic convictions and crashes are substantially fewer for all novice drivers. Differences that exist are smaller and favor PT drivers during the period of most supervision (i.e., instructional permit phase of licensing). However, during the period when requirements for adult supervision are reduced (provisional license), and after supervisory and other GDL restrictions are removed (full licensure), PT drivers again experience proportionally more total traffic convictions and more, and more serious, crashes than drivers trained under commercial/public school DE programs. Key WordsNovice drivers, driver education, parent-taught driver education, evaluation ii AcknowledgementsThe authors gr...
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