08 - Public and Allied Health and Health Sciences
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Browsing 08 - Public and Allied Health and Health Sciences by Author "Abernethy, Amy Pickar"
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Item The Australia-modified Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative care clinical practice [ISRCTN81117481](2005) Woods, David A; Abernethy, Amy Pickar; Shelby-James, Tania Maree; Fazekas, Belinda Susan; Currow, David ChristopherBackground : The Karnofsky Performance Status (KPS) is a gold standard scale. The Thorne-modified KPS (TKPS) focuses on community-based care and has been shown to be more relevant to palliative care settings than the original KPS. The Australia-modified KPS (AKPS) blends KPS and TKPS to accommodate any setting of care. Methods : Performance status was measured using all three scales for palliative care patients enrolled in a randomized controlled trial in South Australia. Care occurred in a range of settings. Survival was defined from enrollment to death. Results : Ratings were collected at 1600 timepoints for 306 participants. The median score on all scales was 60. KPS and AKPS agreed in 87% of ratings; 79% of disagreements occurred within 1 level on the 11-level scales. KPS and TKPS agreed in 76% of ratings; 85% of disagreements occurred within one level. AKPS and TKPS agreed in 85% of ratings; 87% of disagreements were within one level. Strongest agreement occurred at the highest levels (70–90), with greatest disagreement at lower levels (≤40). Kappa coefficients for agreement were KPS-TKPS 0.71, KPS-AKPS 0.84, and AKPS-TKPS 0.82 (all p < 0.001). Spearman correlations with survival were KPS 0.26, TKPS 0.27 and AKPS 0.26 (all p < 0.001). AKPS was most predictive of survival at the lower range of the scale. All had longitudinal test-retest validity. Face validity was greatest for the AKPS. Conclusion : The AKPS is a useful modification of the KPS that is more appropriate for clinical settings that include multiple venues of care such as palliative care.Item Bereavement help-seeking following an 'expected' death: a cross-sectional randomised face-to-face population survey(2008) Plummer, John Lewis; Currow, David Christopher; Allen, Katrina; Aoun, Samar M; Hegarty, Margaret Mary; Abernethy, Amy PickarBackground : This study examines the prevalence and nature of bereavement help-seeking among the population who experienced an "expected" death in the five years before their survey response. Such whole population data are not limited by identification through previous access to specific services nor practitioners. Methods : In a randomised, cross-sectional, state-wide population-based survey, 6034 people over two years completed face-to-face interviews in South Australia by trained interviewers using piloted questions (74.2% participation rate). Respondent demographics, type of grief help sought, and circumstantial characteristics were collected. Uni- and multi-variate logistic regression models were created. Results : One in three people (1965/6034) had experienced an 'expected' death of someone close to them in the last five years. Thirteen per cent sought help for their grief from one or more: friend/family members (10.7%); grief counselors (2.2%); spiritual advisers (1.9%); nurses/doctors (1.5%). Twenty five respondents (1.3%) had not sought, but would have valued help with their grief. In multi-variate regression modeling, those who sought professional help (3.4% of the bereaved) had provided more intense care (OR 5.39; CI 1.94 to14.98; p < 0.001), identified that they were less able to 'move on' with their lives (OR 7.08; CI 2.49 to 20.13; p = 0.001) and were more likely not to be in full- or part-time work (OR 3.75; CI 2.31 – 11.82; p = 0.024; Nagelkerke's R2 = 0.33). Conclusion : These data provide a whole-of-population baseline of bereavement help-seeking. The uniquely identified group who wished they had sought help is one where potentially significant health gains could be made as we seek to understand better any improved health outcomes as a result of involving bereavement services.Item Caresearch: finding and evaluating Australia's missing palliative care literature(2005) Tieman, Jennifer; Abernethy, Amy Pickar; Fazekas, Belinda Susan; Currow, David ChristopherItem Comfort in the last 2 weeks of life: relationship to accessing palliative care services(2008) Currow, David Christopher; Bruera, Eduardo; Abernethy, Amy Pickar; Ward, Alicia M; Plummer, John LewisItem A comparison of methodologies from two longitudinal community-based randomized controlled trials of similar interventions in palliative care: what worked and what did not?(2005) Mitchell, Geoffrey K; Abernethy, Amy PickarItem Creating a research culture in a palliative care service environment: A qualitative study of the evolution of staff attitudes to research during a large longitudinal controlled trial (ISRCTN81117481)(Centre de Recherche Institut Universitaire de Gériatrie de Montreal, 2008) Fazekas, Belinda Susan; Currow, David Christopher; Grbich, Carol Frances; Abernethy, Amy Pickar; Shelby-James, Tania MareeThis study investigated the impact of a three-year randomized control trial of different models of service provision on palliative care staff associated with the hospice where the trial was being conducted. Eleven open access de-identified qualitative focus groups were held over a period of three years: three months into the trial, one year after its inception, and at the end of the trial. Four staff groups were involved: inpatient hospice nurses, palliative care outreach nurses, medical palliative specialists, and administrative staff and social workers. Initially the impact of the trial produced high levels of staff stress which largely diminished over time, to be replaced by enthusiasm for the changes achieved and sadness that post trial the perceived benefits gained would be lost. When attempting to change a clinical culture to incorporate research, and in particular where increased staff workload is involved, highly interactive levels of communication and valuing of staff input are required to minimize the stress and burden of this imposition.Item Do terminally ill people who live alone miss out on home oxygen treatment? An hypothesis generating study(2008) Lewin, Gill; Currow, David Christopher; Christou, Toula; Smith, Joanna; Carmody, Steve; Aoun, Samar M; Abernethy, Amy PickarItem The impact of conducting a regional palliative care clinical study(2006) Currow, David Christopher; Abernethy, Amy Pickar; Shelby-James, Tania Maree; Phillips, Paddy AndrewItem Palliative oxygen for non-hypoxaemic chronic obstructive pulmonary disease(2007) Uronis, H E; McCrory, D C; Samsa, G; Currow, David Christopher; Abernethy, Amy PickarItem Place of death for people with noncancer and cancer illness in South Australia: a population-based survey(2008) Currow, David Christopher; Burns, Catherine Mary; Abernethy, Amy PickarItem Populations who die without specialist palliative care: does lower uptake equate with unmet need?(2008) Abernethy, Amy Pickar; Currow, David Christopher; Agar, Meera Ruth; Sanderson, Christine RuthItem Preference for place of care and place of death in palliative care: are these different questions?(2008) Agar, Meera Ruth; Currow, David Christopher; Shelby-James, Tania Maree; Plummer, John Lewis; Sanderson, Christine Ruth; Abernethy, Amy PickarItem Promoting patient centred palliative care through case conferencing(2007) Williams, Helena; Shelby-James, Tania Maree; Currow, David Christopher; Phillips, Paddy Andrew; Abernethy, Amy PickarItem Specialist palliative care needs of whole populations: a feasibility study using a novel approach(2004) Fazekas, Belinda Susan; Abernethy, Amy Pickar; Currow, David ChristopherItem Specialized palliative care services are associated with improved short- and long-term caregiver outcomes(2008) Abernethy, Amy Pickar; Currow, David Christopher; Fazekas, Belinda Susan; Luszcz, Mary Alice; Wheeler, Jane L; Kuchibhatla, Maragatha