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H. Zorbas



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    O25 - Stigma and Nihilism (ID 139)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O25.05 - Stigma and nihilism in lung cancer: the perspective of Australian health professionals and consumers (ID 2653)

      16:15 - 17:45  |  Author(s): H. Zorbas

      • Abstract
      • Presentation
      • Slides

      Background
      It has been proposed that stigma and nihilism surrounding lung cancer may influence lung cancer outcomes. A clear understanding of the impact of lung cancer related stigma and nihilism from the perspectives of health professionals and consumers will assist in informing best practice lung cancer care and health promotion messages in Australia. As part of a national lung cancer program, Cancer Australia commissioned Cancer Council Queensland, in partnership with Griffith University, to undertake a three-phase research project on stigma and nihilism about lung cancer in the Australian context.

      Methods
      Phase 1: A systematic literature review examined the evidence on the influence of stigma and nihilism on lung cancer patterns of care; patients' psychosocial and quality of life (QOL) outcomes; and how this may link to public health programs. Phase 2: The perspectives of health professionals on the impact of stigma and nihilism on diagnosis and disease management were investigated. Semi-structured interviews and a Delphi process with 31 key informants developed a consensus view, which was then tested with 323 health professionals in a national online survey. Phase 3: The perspectives of lung cancer patients and carers on the effects of stigma and nihilism on their cancer experience were investigated. Qualitative interviews were undertaken with 17 patients and 11 carers followed by a cross-sectional survey with 147 lung cancer patients in QLD and NSW.

      Results
      Systematic review: Stigma relating to lung cancer was reported by both patients and health professionals and was related to poorer QOL and higher psychological distress in patients. Empirical explorations of nihilism were not evident. Qualitative evidence from patients’ perspectives suggested that public health programs contribute to stigma about lung cancer. Health professionals’ perspectives: Health-related stigma and the need for positive messaging about lung cancer and smoking cessation were priorities. Geographical barriers to access and a lack of rural/regional services were described. Barriers for Aboriginal and Torres Strait Islander people included fear of dying away from community and poor cancer knowledge. Patient and carer perspectives: Qualitative data were consistently indicative of stigma amongst patients due to perceived personal responsibility in the smoking-lung cancer relationship and perceived links between lung cancer and negative outcomes. Quantitative data revealed high levels of psychological distress but low help seeking; health-related stigma was significantly related to poorer psychological and QOL outcomes.

      Conclusion
      Health-related stigma has negative impacts on people affected by lung cancer in Australia and may contribute to poorer psychological health and QOL outcomes. The research helps to build the evidence about factors influencing lung outcomes in Australia. It provides an important foundation for further research and the development of strategies to ameliorate the effects of stigma on patients and carers.

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    P2.20 - Poster Session 2 - Early Detection and Screening (ID 173)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P2.20-008 - Investigating symptoms of lung cancer: an evidence-based guide for general practitioners (ID 2632)

      09:30 - 16:30  |  Author(s): H. Zorbas

      • Abstract

      Background
      Early diagnosis and referral to specialist treatment are critical factors in the management of lung cancer. Survival is improved when lung cancer is diagnosed at an early stage and the patient is referred to a multidisciplinary specialist lung cancer team for diagnosis, staging and treatment planning. However, as symptoms can be non-specific and often present similarly to other chronic health issues, an early diagnosis of lung cancer may be missed. Patients with symptoms of lung cancer are likely to present to their general practitioner (GP). Therefore, it is important to enhance awareness of the risk factors, signs and symptoms of lung cancer, and provide GPs with the most recent evidence to facilitate timely and effective assessment and appropriate referrals. Cancer Australia commissioned Monash University (MU) to develop an evidence-based guide for GPs (the Guide), and to develop strategies for promoting uptake of the Guide.

      Methods
      An Expert Advisory Panel (EAP) was established to oversee development of the Guide, using the ADAPTE framework for guideline adaptation. Following a search of the literature to identify potentially relevant guidelines and shortlisting using the Appraisal of Guidelines for Research and Evaluation instrument (AGREE), three international guidelines (UK, NZGG, USA) were selected to inform development of the GP Guide. MU conducted interviews with GPs to assess the feasibility of incorporating the Guide into a computerised decision support tool for the GP setting. An evidence-based, multifaceted approach to promoting the Guide and supporting uptake of best practice cancer care within the general practice setting is ongoing, in consultation with a Project Working Group. The approach includes development and implementation of an Active Learning Module (ALM) and workshops for primary care providers and organisations.

      Results
      The Guide includes 24 recommendations focusing on key topics including: risk factors and symptoms of lung cancer; appropriate investigations in primary care; and effective referral to a specialist linked to a lung cancer multidisciplinary team and services. The Guide was published on the Cancer Australia website and disseminated to GPs throughout Australia. The feasibility assessment found that GPs’ consultation styles did not support additional online ‘pop-up’ reminders, preferring to access the Guide external to patient consultations. Incorporation of the Guide into an appropriate format is ongoing. The ALM provides a structured learning activity in an online, interactive format, providing further detail and context to using the Guide in the primary care setting. The ALM includes case-based learning, literature for further reading, and reflection and reinforcing activities. Workshops for GPs have been held to promote and support implementation of the Guide, including strategies to adopt the Guide’s recommendations in practice. Train-the-Trainer workshops have commenced with primary care providers. Evaluation of the uptake of the Guide into clinical practice is currently unavailable.

      Conclusion
      A new evidence-based guide is available to support GPs to assess symptoms that may be lung cancer, to undertake appropriate investigations, and to support rapid referral into the cancer care pathway. The evidence-based, multifaceted implementation strategy supports the translation of the evidence into best practice cancer care.

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-043 - Developing an optimal best practice model of care for the management of lung cancer in Australia: a national approach (ID 2598)

      09:30 - 16:30  |  Author(s): H. Zorbas

      • Abstract

      Background
      In 2007, lung cancer was the leading cause of cancer-related mortality and morbidity in Australia for both men and women. Only 14% of those diagnosed with lung cancer survive five years beyond their diagnosis. People living in rural areas, those from lower socio-economic status or from certain cultural and linguistic backgrounds have poorer outcomes. Factors contributing to differences in survival and outcomes are varied. Cancer Australia is developing a best practice model of care for the management of lung cancer that has national relevance and can be implemented locally, with the aim of achieving consistency in approach and improving lung cancer outcomes. This abstract describes how the evidence base has been built to inform the model of care.

      Methods
      A systematic review of international and national literature on patterns and models of care for lung cancer informed themes explored through qualitative and quantitative research. A tiered approach to data collection included: (i) mapping of lung cancer services across Australia; (ii) health service consultation through interviews and site visits; and (iii) consumer consultation through a national survey and targeted interviews. Findings were presented and discussed at a national workshop with clinical leaders, consumers, researchers and service delivery experts to review and define principles and elements of best practice care.

      Results
      The patterns of care literature for lung cancer identified variations in time to diagnosis, access to active treatment, re-treatment and palliative care. Service delivery themes identified through the review and research included multidisciplinary care, specialist involvement in diagnosis and treatment, care coordination, early integration of palliative care, uptake of guidelines and quality measures, involvement of primary care and consideration of supportive care needs. Lung cancer service mapping identified 192 services across Australia providing some elements of lung cancer care. Approximately two-thirds were public and one third private. Multidisciplinary teams were identified in 58 services (30%), the majority in metropolitan locations (n=41, 71%). Consumer consultation identified variations in time to first specialist appointment (two weeks to two months), definitive diagnosis (two weeks to three months); and treatment (one week to two months). Consumers identified that improvements could be made in the way information about lung cancer is communicated across all stages of lung cancer. Health service consultation highlighted challenges and best practice approaches along with a range of systemic issues that influence how care is delivered. Challenges included streamlining a complex diagnostic pathway, managing multidisciplinary teams that include cancer and non-cancer specialists, early referral to palliative care, coordinating care, involvement of primary care, and a lack of standard guidelines for follow-up care. Best practice examples were identified across the diagnostic and treatment pathway. Results informed a set of national principles including: patient-centred care; timely diagnosis and staging; multidisciplinary care; appropriate treatment and supportive care; coordinated care; and collection and monitoring of data.

      Conclusion
      This research identified gaps and variations in the delivery of lung cancer care and has built the evidence base to inform the development of best practice approaches to support the consistent diagnosis and management of lung cancer in Australia.