Medical tests: women's reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results

Objective To determine women's preferences for and reported experience with medical test decision‐making. Design Computer‐assisted telephone survey. Setting and participants Six hundred and fifty‐two women resident in households randomly selected from the New South Wales electronic white pages. Main outcome measures Reported and preferred test and treatment (for comparison) decision‐making, satisfaction with and anxiety about information on false results and side‐effects; and effect of anxiety on desire for such information. Results Overall most women preferred to share test (94.6%) and treatment (91.2%) decision‐making equally with their doctor, or to take a more active role, with only 5.4–8.9% reporting they wanted the doctor to make these decisions on their behalf. This pattern was consistent across all age groups. In general, women reported experiencing a decision‐making role that was consistent with their preference. Women who had a usual doctor were more likely to report experiencing an active role in decision‐making. More women reported receiving as much information as they wanted about the benefits of tests and treatment than about the side‐effects of tests and treatment. Most women wanted information about the possibility of false test results (91.5%) and test side‐effects (95.6%), but many reported the doctor never provided this information (false results = 40.0% and side‐effects = 31.3%). A substantial proportion said this information would make them anxious (false results = 56.6% and side‐effects = 43.1%), but reported they wanted the information anyway (false results = 77.6% and side‐effects = 88.1%). Conclusions Women prefer an active role in test and treatment decision‐making. Many women reported receiving inadequate information. If so, this may jeopardize informed decision‐making.     

Synthetic cannabinoid use in an acute psychiatric inpatient unit

In the present study, we explored the prevalence of new psychoactive substance use by people admitted into an Australian acute public mental health facility specializing in comorbid mental health and substance use. These substances have since been banned from retail outlets, but the pattern of uptake and reasons people use them is informative in terms of motivations and the management of substance use more generally. A cross‐sectional study to explore the use of synthetic cannabis by people admitted to an acute adult mental health unit was undertaken. Associations with diagnostic, service use, and demographic profiles were explored. Fifty‐six percent of people reported having used at least one type of new psychoactive substance, including 53.5% who reported using synthetic cannabis alone, and 18.8% who reported using both synthetic cannabis and other new psychoactive substances. Synthetic cannabis use was not associated with any demographic or diagnostic groups. Legality and availability (43% combined) were common reasons for use, along with the feeling of intoxication (20%). The high prevalence of new psychoactive substance use adds weight to the recommendation that clinicians should routinely screen for substances from the time of admission. Accurate information about these substances is required in order to provide accurate guidance and appropriate interventions to people in their care.     

Enhancing health‐care workers' understanding and thinking about people living with co‐occurring mental health and substance use issues through consumer‐led training

Background

Stigma and judgemental assumptions by health workers have been identified as key barriers to accessing health care for people living with co‐occurring mental health and substance use issues (dual diagnosis).

Objective

To evaluate the effectiveness of consumer‐led training by people with dual diagnosis in improving the knowledge, understanding and role adequacy of community health staff to work with this consumer group.

Methods

A controlled before‐and‐after study design with four waves of quantitative data collection was used. Qualitative data were collected to explore participants'' views about training. Participants were staff from two community health services from Victoria, Australia. Recruitment occurred across various work areas: reception, oral health, allied health, counselling and health promotion. At baseline, all participants attended a 4‐h clinician‐led training session. The intervention consisted of a 3‐h consumer‐led training session, developed and delivered by seven individuals living with dual diagnosis. Outcome measures included understanding of dual diagnosis, participants'' feelings of role adequacy and role legitimacy, personal views, and training outcomes and relevance.

Results

Consumer‐led training was associated with a significant increase in understanding. The combination of clinician‐led and consumer‐led training was associated with a positive change in role adequacy.

Conclusions

Consumer‐led training is a promising approach to enhance primary health‐care workers'' understanding of the issues faced by dual‐diagnosis consumers, with such positive effects persisting over time. Used alongside other organizational capacity building strategies, consumer‐led training has the potential to help address stigma and judgemental attitudes by health workers and improve access to services for this consumer group.     

Managing and avoiding delay in operating theatres: a qualitative,observational study

Rationale, aims and objectives A range of strategies have been proposed to identify and address operating theatre delays, including preoperative checklists, post‐delay audits and staff education. These strategies provide a useful starting point in addressing delay, but their effectiveness can be increased through more detailed consideration of sources of surgical delay. Method A qualitative, observational study was conducted at two Australian hospitals, one a metropolitan site and the other a regional hospital. Thirty surgeries were observed involving general, vascular and orthopaedic procedures which ranged in time from 20 minutes to almost 4 hours. Approximately 40 hours of observations were conducted in total. Results The research findings suggest that there are two key challenges involved in addressing operating theatre delays: unanticipated problems in the clinical condition of patients, and the capacity of surgeons to regulate their own time. These challenges create unavoidable delays due to the contingencies of surgical work and competing demands on surgeons' time. The results also found that surgical staff play a critical role in averting and anticipating delays. Differences in professional authority are significant in influencing how operating theatre time is managed. Conclusions Strategies aimed at addressing operating theatre delays are unlikely to achieve their desired aims without a more detailed understanding of medical decision making and work practices, and the intra‐ as well as inter‐professional hierarchies underpinning them. While the nature of surgical work poses some challenges for measures designed to address delays, it is also necessary to focus on surgical practice in devising workable solutions.