Clinician perspectives on voluntary assisted dying and willingness to be involved: a multisite, cross-sectional survey during implementation in New South Wales, Australia.

BACKGROUND: In the context of nationwide law reform, New South Wales (NSW) became the last state in Australia to legalise voluntary assisted dying (VAD) - commencing 28 November 2023. Clinicians have divergent views regarding VAD, with varying levels of understanding, support, and willingness to be involved, and these may have a significant impact on the successful implementation. AIMS: To understand levels of support, understanding and willingness to be involved in VAD among clinical staff across NSW during implementation of VAD. METHODS: A multisite, cross-sectional online survey of clinicians across four local health districts, assessing relevant demographics, awareness of and support for VAD legislation and willingness to be involved in different levels of VAD-related clinical activities. RESULTS: A total of 3010 clinical staff completed the survey. A majority of participants were aware of VAD legislation in NSW (86.35%) and supportive of it (76%), with nursing and allied health clinicians significantly more likely than medical specialists to express support. Among medical specialists, support was statistically more likely in those who did not care for patients at the end of life and those with limited knowledge of the legislation. Willingness of medical specialists to perform key roles was significantly lower, with 41.49% willing to act in coordinating or consulting roles, and only 23.21% as administering practitioners. CONCLUSIONS: The majority of clinical staff surveyed across NSW supported VAD legislation. While many eligible clinicians were reluctant to be actively involved, sufficient numbers appear willing to provide VAD services, indicating that successful implementation should be possible.

Cancer care pathways mapping and dissemination toolkit: lessons learnt from cancer services in NSW, Australia.

OBJECTIVE: Gaps and complexities exist in cancer referral and diagnosis in Australia, leading to delays in cancer treatments. Developing evidence-based referral pathways is important for promoting better and more timely cancer diagnosis and care. Type of program or service: This paper describes a toolkit endorsed by the Cancer Institute NSW as a guide for promoting best practice in localising cancer referral and diagnosis pathways in line with the national Optimal Care Pathways. Use of toolkit: Employing methods in the toolkit yielded an increased understanding of cancer care pathways, strengthened collaboration between tertiary and primary sector stakeholders, and enhanced the project skills of Cancer System Innovation Managers. The toolkit has become a valuable guide for consolidating referral pathways for various cancers in the NSW local health districts and could apply to cancer services in other jurisdictions. LESSONS LEARNT: The pilot project showed that the toolkit is useful in developing referral pathways and reflects best stakeholder engagement practices. Local evidence should be generated to support systematic change and should include the perspectives of cancer patients and clinicians. NSW local health districts continue to use the toolkit methods to optimise care to improve outcomes for people living with cancer.

Being away from home for cancer treatment: a qualitative study of patient experience and supportive care needs during radiation therapy.

INTRODUCTION: Supportive care needs (SCN) refer to support required by patients and their families to better cope with cancer. Many rural radiation therapy (RT) patients stay away from home for significant periods, which can lead to the negative effects of both social isolation and cultural disparity. They may demonstrate complex SCN. This study aimed to explore experiences of being away from home by considering patient perspectives of their own SCN. The objectives were to provide a deeper understanding of how these patients think and feel and present a foundation of patient-centred insights for further research. METHODS: Thirteen patients participated in semi-structured interviews; all stayed away from home for RT at the North Coast Cancer Institute for >3 days a week for >3 weeks. The data were subject to interpretive phenomenological analysis: a thorough process of understanding and analysis that is accompanied by reflection to improve researcher transparency. RESULTS: Two themes influenced patient experiences of their care: values and identity, and expectations. Patients discussed the value they place on rural life, community connections and health care and referred to information for managing expectations. SCN discussed fell into practical, physical and psycho-social needs. CONCLUSIONS: Experiences of culturally appropriate patient-centred supportive care improve control and confidence. Patient well-being is influenced by compassionate, caring and respectful connections with others. Several practical ways of managing expectations and promoting the psycho-social well-being of patients are discussed, for example, tailored packing lists and easy access to green spaces. Future research can be shaped by lived experiences.

Complementary and alternative therapy use in a regional radiation oncology treatment centre: Can staff knowledge, views, confidence and documentation be improved?

INTRODUCTION: Complementary and alternative therapies (CATs) are widely used by cancer patients but are infrequently disclosed and documented. This study aimed to improve radiation therapy staff knowledge, confidence, views and documentation of radiation oncology patients' use of CATs. METHOD: Participants completed a baseline questionnaire regarding their knowledge, confidence, views and documentation relating to patients' CAT use. An intervention was undertaken whereby participants attended an educational session and a CAT screening tool was implemented simultaneously. Participants immediately completed a post-intervention questionnaire and later a 6-month follow-up questionnaire. A patient record audit was conducted to measure the documentation of CAT use pre- and post-intervention. RESULTS: From baseline to post-intervention, there was a statistically significant shift in staff knowledge and confidence (P = 0.001-0.01). The observed shift was sustained over a 6-month period, (P = 0.453-1.00). Participants' perceived views of CATs did not change as a result of the intervention (P = 0.261-1.000). The post-intervention audit compared to the baseline audit yielded a statistically significant increase in documentation. There was an increase in CAT use mentioned in patient records from 14% (15/108) to 40% (35/88) (P < 0.001). CONCLUSIONS: The implementation of a screening tool and staff education increased radiation therapy staff knowledge of CATs and increased staff confidence when discussing CAT use with patients. Documentation of CATs in the patient record increased post-intervention. These changes positively affected radiation therapy staff understanding the use of CATs by cancer patients.

Application of an incident taxonomy for radiation therapy: Analysis of five years of data from three integrated cancer centres.

AIM: To develop and apply a clinical incident taxonomy for radiation therapy. BACKGROUND: Capturing clinical incident information that focuses on near-miss events is critical for achieving higher levels of safety and reliability. METHODS AND MATERIALS: A clinical incident taxonomy for radiation therapy was established; coding categories were prescription, consent, simulation, voluming, dosimetry, treatment, bolus, shielding, imaging, quality assurance and coordination of care. The taxonomy was applied to all clinical incidents occurring at three integrated cancer centres for the years 2011-2015. Incidents were managed locally, audited and feedback disseminated to all centres. RESULTS: Across the five years the total incident rate (per 100 courses) was 8.54; the radiotherapy-specific coded rate was 6.71. The rate of true adverse events (unintended treatment and potential patient harm) was 1.06. Adverse events, where no harm was identified, occurred at a rate of 2.76 per 100 courses. Despite workload increases, overall and actual rates both exhibited downward trends over the 5-year period. The taxonomy captured previously unidentified quality assurance failures; centre-specific issues that contributed to variations in incident trends were also identified. CONCLUSIONS: The application of a taxonomy developed for radiation therapy enhances incident investigation and facilitates strategic interventions. The practice appears to be effective in our institution and contributes to the safety culture. The ratio of near miss to actual incidents could serve as a possible measure of incident reporting culture and could be incorporated into large scale incident reporting systems.

Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards.

Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of our conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients.