Adherence to dietary guidelines and associated factors among rural Australian cancer survivors: a cross-sectional study.

PURPOSE: This study aimed to explore levels of adherence to dietary guidelines, and factors associated with dietary guideline adherence, among rural Australian cancer survivors. METHODS: A cross-sectional study was undertaken. We recruited a convenience sample of adults with cancer who attended the chemotherapy day unit or allied health appointments at a rural hospital in Baw Baw Shire, Victoria, Australia, between August 2017 and December 2021. Dietary guideline adherence was assessed by cross-referencing participants' responses to an adapted version of the Dietary Questionnaire for Epidemiological Studies with dietary recommendations in Australian dietary guidelines. Binary logistic regression was used to assess factors associated with dietary guideline adherence for fruits and whole red meats. RESULTS: There were 107 rural cancer survivors (median age, 67 years). Dietary guideline adherence was highest for alcohol (88%) followed by whole red meats (63%), fruits (56%), processed red meats (24%), cereals/breads/grains (7%), and vegetables (4%). Relative to those aged < 65 years, 65-74-year-olds had 5.7-fold greater odds (adjusted odds ratio (aOR) = 5.74, 95% confidence interval (CI) = 1.91-17.17) of adhering to the dietary guideline for fruits. Relative to those who had completed/ceased treatment, participants who were currently receiving treatment had 78% lower odds (aOR = 0.22, 95% CI = 0.09-0.59) of adhering to the dietary guideline for fruits. CONCLUSION: This study contributes preliminary data on adherence to dietary guidelines and associated factors among rural Australian cancer survivors. Dietary guideline adherence varied across food groups and was mostly low, albeit not markedly worse than Australia's national population for the fruits and vegetables groups. The mostly low adherence in our sample suggests a potential need to increase provision of dietary information, supportive care screening, and, wherever necessary, dietetics referrals, assessments, and interventions among rural cancer survivors. Larger, longitudinal studies of adherence to dietary guidelines and/or tailored, cancer-specific dietary recommendations should be undertaken in future.

Physical activity, obesity, and quality of life among rural Australian cancer survivors: a cross-sectional study.

PURPOSE: We aimed to describe physical activity (PA), obesity, and quality of life (QoL) among rural Australian cancer survivors, assess whether total and item-specific QoL are associated with sufficient PA and obesity, and assess whether PA and obesity interact with respect to QoL. METHODS: In a cross-sectional study, convenience sampling was used to recruit adult cancer survivors via a chemotherapy day unit and allied health professionals at a rural hospital in Baw Baw Shire, Australia. Exclusion criteria were acute malnutrition and end-of-life care. PA and QoL were measured using Godin-Shephard and 7-item Functional Assessment of Cancer Therapy (FACT-G7) questionnaires, respectively. Factors associated with total and item-specific QoL were assessed via linear and logistic regression, respectively. RESULTS: Among 103 rural cancer survivors, the median age was 66 years, 35% were sufficiently physically active, and 41% presented with obesity. Mean/median total QoL scores were 17 on the FACT-G7 scale (0-28; higher scores indicate better QoL). Sufficient PA was associated with better QoL ([Formula: see text]=2.29; 95% confidence interval [CI] = 0.26, 4.33) and more energy (odds ratio [OR] = 4.00, 95% CI = 1.48, 10.78) while obesity was associated with worse QoL ([Formula: see text]=-2.09; 95% CI = -4.17, -0.01) and more pain (OR = 3.88, 95% CI = 1.29, 11.68). The PA-obesity interaction was non-significant (p-value = 0.83). CONCLUSIONS: This is the first known study conducted among rural survivors of any cancer to find sufficient PA and obesity are associated with better and worse QoL, respectively. PA, weight management, and QoL-including energy and pain-should be considered when targeting and tailoring supportive care interventions for rural cancer survivors.

Rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to palliative and end-of-life clients and carers.

OBJECTIVE: This study examined rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to rural residing palliative and end-of-life clients and carers. We further sought to determine correlates of knowledge gaps to inform workforce education and planning. METHOD: Nurses from a rural area of Victoria, Australia, were invited to complete an electronic questionnaire rating their knowledge against 6 national palliative care standards and 10 screening and assessment tools. A 5-point scale of (1) No experience to (5) Can teach others was used to rate knowledge. Results were classified into three categories: practice gaps, areas of consolidation, and strengths. Descriptive and logistical regression was used to analyze data. RESULTS: A total of 122 of 165 nurses (response rate = 74%) completed the survey. Of these nurses, 87% were Registered Nurses, 43% had ≥10 years' experience in palliative care, and 40% had palliative care training. The majority of practices across the standards and screening and assessment tools were rated as knowledge strengths (N = 55/67, 82%). Gaps and areas of consolidation were in the use of client and carer assessment tools, the care of specific populations such as children, supporting carers with appropriate referrals, resources, and grief, and facilitating the processes of reporting a death to the coroner. Lack of formal training and lower years of experience were found to be associated with practice gaps. SIGNIFICANCE OF RESULTS: Our study found rural nurses were confident in their knowledge and skills in the majority of psychosocial care. As generalist nurses make up the majority of the rural nursing workforce, further research should be undertaken on what educational strategies are needed to support and upskill rural community-based nurses to undertake formal training in palliative care.

Challenges Associated with Anticipatory Medications in Rural and Remote Settings.

BACKGROUND: Anticipatory medications (AM) have been widely used in various settings across many countries in people approaching end of life. Access to palliative care in rural and remote areas of Australia is lacking as are other medical services when compared with the metropolitan setting. Our aim is to identify challenges with the administration and access to AM in rural and remote communities with outcomes to guide improved delivery of care. METHODS: An online survey administered using Qualtrics, a secure survey platform was distributed to a total of 18 managers from 18 rural and remote organizations across the South East of Victoria in Australia. The survey was distributed to a total of 108 nurses working in these organizations. RESULTS: A total of 29 nurses completed the survey (response rate 28%). Most of the nurses were working in a mixed practice providing community palliative and district nursing. A significant number of nurses (n = 9, 31%) were working in remote settings and the remainder were located in regional areas. Almost a third of all nurses surveyed did not have specific guidance regarding the use of AM for their patients. Opioids (55%) were by far the most commonly used AM followed by antiemetics (45%). The most common decisions taken by nurses to administer AM were cited as patient deterioration or in their terminal phase with a fluctuating level of anxiety, and patients agitation. Access to AM and lack of staff education were major challenges in rural and remote areas. CONCLUSIONS: Provision of timely AM has the potential to improve the quality of life of patients and their caregivers. Key barriers to access AM can be overcome with community-level planning and nurses' education. Advanced nurses' roles have the opportunity to provide specialized care where access to specialist physicians is challenging.

A qualitative study of rural women's views for the treatment of early breast cancer.

AIM: Identify what factors rural women perceived to influence their surgical choice for EBC. BACKGROUND: Higher rates of mastectomy still remain for women with early breast cancer (EBC) in rural areas. While access to radiotherapy is a commonly identified barrier, there is growing debate around other factors which are also important influences on surgical choice. METHODS: Qualitative study with 70 interviews with women diagnosed with EBC in rural Gippsland, Australia. Twenty-nine women had a mastectomy and 41 had breast conserving surgery (BCS). RESULTS: Patient led psychosocial and surgeon led factors influenced surgical choice. Psychosocial factors were a greater influence for the mastectomy group. These included a high fear of cancer recurrence and radiotherapy, negative views of the body and breast, a family history of cancer, wanting to avoid the negative treatment experiences they had seen significant others go through, and not wanting to travel for treatment. Surgeon led factors were a greater influence for the BCS group, in particular, the direct recommendation made by the surgeon for BCS. For both groups, urgency to act was a shared psychosocial factor. Trust and confidence in the expertise and reputation of the surgeon and their consultation style were surgeon led factors shared by the groups. CONCLUSIONS: To ensure women achieve the best treatment outcome, patients and clinicians need to work together to identify how important and influential the various factors are for the women and, if necessary, to seek support to ensure informed decisions are made.

Communicating about breast cancer: rural women's experience of interacting with their surgeon.

OBJECTIVE: This study examined rural women's satisfaction with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Differences in satisfaction were investigated between treatment groups (mastectomy and breast conservation surgery) and demographic variables (age, marital status, education level, employment status and place of residence). Practice was compared with clinical practice guidelines. DESIGN: The study was designed as a cross-sectional survey. SETTING: The study was set in Eastern regional Victoria, Australia. PARTICIPANTS: Seventy women diagnosed with early breast cancer participated in the study. MAIN OUTCOME MEASURES: The main outcome measures used by the study were satisfaction in three areas of practice: (i) telling a woman she has breast cancer; (ii) providing information and involving the woman in the decision-making; and (iii) preparing the woman for specific management. RESULTS: No differences in satisfaction were found between treatment groups and demographic variables. Overall, women in this study were highly satisfied (>93%) with the interaction and communication with their surgeon. Women reported that the surgeon created a supportive environment for discussion, that they were provided with adequate information and referrals, and that they were actively involved in the decision-making. Practice could have been improved for women who were alone at diagnosis as women without a partner made a quicker decision about treatment. CONCLUSION: Rural women in Victoria Australia were largely satisfied with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Current practice was predominately in line with clinical practice guidelines.