- Title
- Increasing the implementation of evidence based care for head and neck cancer patients
- Creator
- McCarter, Kristen
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2017
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Patients with head and neck cancer (HNC) have a significant mortality rate and unique challenges associated with the malignancy and its treatment. One component of this disease burden is the prevalence of modifiable health risk behaviours and affect, in particular, tobacco smoking, harmful alcohol consumption and depression. Additionally, the provision of evidence based care for HNC patients by clinicians is an important priority. Despite this, there are existing gaps regarding the occurrence and comorbidity of health risk behaviours and affect components in HNC and effective approaches to increase the provision of evidence based care for HNC patients in cancer settings. To address these evidence gaps, the aims of this thesis were to: 1. Describe the rates and co-occurrence of tobacco smoking, alcohol use and depressive symptoms in a sample of HNC patients undergoing radiotherapy; 2. Systematically review the literature to determine the impact of interventions to improve clinician provision of screening and appropriate referral of patients with cancer for distress; 3. Assess the effectiveness of clinical practice change strategies in improving dietitian implementation of best practice guideline recommendations for HNC patients; 4. Systematically review the literature to examine the effectiveness of smoking cessation interventions on smoking cessation rates in adult HNC patients. These four aims have been addressed in a series of studies that includes: a crosssectional study of 307 HNC patients’ baseline assessments from an intervention trial involving four hospitals across Australia; a systematic review describing the results of five studies aimed at improving the rates of distress screening and/or referral in cancer patients; a multi-site stepped-wedge randomised controlled trial (RCT) including clinical practice change strategies; and a systematic review that presents the current evidence for smoking cessation interventions in HNC patients. The work included in this thesis has contributed to addressing evidence gaps and advancing research in the field in a number of ways. Firstly, the findings include current rates of co-occurring health risk behaviours and affect factors in HNC as well as some of the first evidence for the prevalence of co-occurrence of these problems in this population. Secondly, despite the high prevalence of these issues in HNC, my systematic review findings highlight the sub-optimal level of evidence based care delivery for distress in oncology and the astounding lack of evidence based treatments for smoking cessation in this cancer subgroup. Finally, the clinical practice change strategies employed in the multi-site stepped-wedge RCT is the first known effective HNC implementation intervention for improving care according to dietetic guidelines. Overall, this thesis has identified a need to increase the provision of evidence based care to address high prevalence health risk behaviours and depression in patients with HNC and has trialled an effective approach to improving best practice care within oncology dietetic services. Future research considerations include identification of the specific support strategies that increase the provision of best practice care for HNC patients, implementation of multiple guidelines corresponding to co-occurring issues and sustainability of such approaches.
- Subject
- head and neck cancer; evidence based care; tobacco smoking; alcohol consumption; depression
- Identifier
- http://hdl.handle.net/1959.13/1353487
- Identifier
- uon:31104
- Rights
- Copyright 2017 Kristen McCarter
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 15 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 650 KB | Adobe Acrobat PDF | View Details Download |