Decentralized Clinical Trials as a New Paradigm of Trial Delivery to Improve Equity of Access

Organisation/s: Border Medical Oncology Research Unit

Summary: Importance The need to maintain clinical trial recruitment during the COVID-19 pandemic has precipitated the rapid uptake of digital health for the conduct of clinical trials. Different terms are used in different jurisdictions and clinical contexts, including digital trials, networked trials, teletrials (TT), and decentralized clinical trials (DCT) with a need to agree to terms. Observations This clinical care review summarized publications and grey literature, including government policies for the safe conduct of clinical trials using digital health. It compares 2 frequently used methodologies, DCT and TT, first developed before the COVID-19 pandemic by trialists and stakeholders in Australia to improve access to cancer clinical trials for geographically dispersed populations. TT uses a networked approach to implement clinical trials to share care between facilities and uses an agreement between sites or a supervision plan to improve governance and safety. Government regulators have adapted existing regulations and invested in the rollout of the TT model. The term DCT emerged in the northern hemisphere and has been the subject of guidance from regulatory agencies. DCT uses digital health to deliver care in non-traditional sites, such as participants’ homes, but does not mandate a networked approach between health facilities or require a supervision plan to be in place. Conclusions and Relevance TT can be considered as a specific type of DCT with several potential advantages, including upskilling across a network. DCT is a new paradigm for the use of digital health in the safe conduct of clinical trials and is a transformative issue in cancer care, addressing disparities in access to clinical trials and improving clinical outcomes. Citation JAMA Oncol. 2024;10(4):526-530. doi:10.1001/jamaoncol.2023.6565

Telehealth in oncology: a cost analysis to evaluate the financial impact of implementing regional trial hubs within a phase 3 cancer clinical trial

Organisation/s: Border Medical Oncology Research Unit and Regional Trials Network Victoria

Summary: This cost analysis, from a societal perspective, compared the cost difference of a networked teletrial model (NTTM) with four regional hubs versus conventional trial operation at a single metropolitan specialist centre. The Australian phase 3 cancer interventional randomised controlled trial included 152 of 328 regional participants (patient enrolment 2018–2021; 6-month primary end point). The NTTM significantly reduced (AU$2155 per patient) patient travel cost and time and lost productivity. https://onlinelibrary.wiley.com/doi/10.1111/imj.16292

Design and implementation characteristics of research training for rural health professionals: a qualitative descriptive study

Organisation/s: Grampians Health

Research project commencement date: 29/11/2019

Summary: Background: Research capacity and capability of rural health professionals is essential to the delivery of evidence-based care and for informing strategies to address rural health inequities. Effective implementation of research education and training is fundamental to building rural health professional research capacity and capability. The aim of this qualitative descriptive study was to identify characteristics of the design and implementation of current research training for rural health professionals in Victoria, Australia, to inform a future model for rural health professional research capacity and capability building. Results: Participants suggested that research training varied in quality and relevance to rural health professionals. Training costs and lack of tailoring to the rural context were key barriers, whereas experiential learning and flexible modes of delivery enabled training uptake. Health service and government policies, structures, and processes both enabled or stifled implementation opportunities, with rural health professional networks from different regions offering capacity for research training development, and government departmental structures hampering training coordination. Tension between research activities and clinical practice, and health professional knowledge and beliefs, shaped the delivery of training programs. Conclusions: To optimise research training for rural health professionals and increase the quality and quantity of relevant rural health research, a systematically planned, implemented, and resourced region-wide research training model is required. Citation: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-023-04169-5#Ack1

The importance of ‘place’ and its influence on rural and remote health and well-being in Australia

Summary: Butterworth et al 2024 This article explores the crucial role of ‘place’ as an ecological, social and cultural determinant of health and well-being, with a focus on the benefits and challenges of living rurally and remotely in Australia. The health system, including health promotion, can contribute actively to creating supportive environments and places that foster health and well-being among individuals residing in rural and remote locations. For First Nations peoples, living on Country, and caring for Country and its people, are core to Indigenous worldviews, and the promotion of Aboriginal and Torres Strait Islander health and well-being. Their forced removal from ancestral lands has been catastrophic. For all people, living in rural and remote areas can deliver an abundance of the elements that contribute to a ‘liveable’ community, including access to fresh air, green and blue space, agricultural employment, tight-knit communities, a sense of belonging and identity, and social capital. However, living remotely also can limit access to employment opportunities, clean water, affordable food, reliable transport, social infrastructure, social networks and preventive health services. ‘Place’ is a critical enabler of maintaining a healthy life. However, current trends have led to a reduction in local services and resources, and increased exposure to the impacts of climate change.  

Surgery for breast cancer – Barriers and enablers to engagement with prehabilitation.

Organisation/s: Barwon Health

Summary: Breast cancer is the most common cancer in Australia. Unfortunately, breast surgery can commonly result in loss of shoulder and neck movement, increased pain, and limited ability to participate in everyday life. Actively engaging in clinician-led exercise before surgery for breast cancer (prehabilitation) offers an opportunity to improve fitness, reduce long-term issues with shoulder movement, arm strength, and pain. Despite established benefits, the Barwon Health prehabilitation service was poorly utilised. This research aims to investigate why, with the goal of shaping a service that facilitates more people to access prehabilitation and potential improvements in patient outcomes relating to fitness, neck and upper limb pain, and dysfunction.

The rapid adoption of telehealth by a regional community-based palliative care service due to COVID-19: Patient and Health Care Professional perspectives and opportunities for service enhancement

Organisation/s: Barwon Health

Research project commencement date: 01/01/2020

Summary:

Background/objective: The COVID-19 pandemic has brought the use of telehealth to the fore, as many people have been unable to interact directly with healthcare professionals (HCP). For community palliative care (CPC) services, this has meant a sudden change from a predominantly face-to-face model of care to one that incorporates telehealth. Understanding patient and HCP experiences with telehealth and how telehealth compares to ‘usual’ care will be crucial in planning future CPC services.

Methodology: All patients of the Barwon Health CPC service between 1 April and 31 May 2020 were invited to complete a questionnaire evaluating their interactions with the palliative care service and specifically their involvement with telehealth consultations. Palliative care HCP who provided clinical services during the same time period were also surveyed.

Results/conclusion: Seventy-four patients (response rate 36%) and 22 HCP returned surveys. Both groups felt comfortable using telehealth, however, also encountered a range of issues when undertaking telehealth consultations. Despite reporting issues, the preference of both groups was for a CPC service model, which combined face-to-face and telehealth consultations. This study is one of the first to directly ask this question and as such provides useful guidance for health services when planning future CPC service models.

Associate Investigators: Anna Dowd, Jacqui White, Matthew Ely, Jill Carter

Dying at home: enablers and barriers

Organisation/s: Barwon Health

Research project commencement date: 01/01/2023

Summary:

Background: According to the Grattan Institute in 2014, 70% of Australians indicated a preference to die at home, however, only 14% of all deaths were at home.

Aims: To identify how patients can be supported to die at home if that is their preference.

Methods: A retrospective medical record audit of eligible Community Palliative Care (CPC) patients who indicated a wish to die at home was undertaken.

Findings: Out of a total of 114 patients, 74% indicated a preference to die at home. Of these, 66% achieved a home death, and most lived with a carer. Enablers for home death included family support, regular nursing visits and equipment. People who attended an emergency department in their last month of life, lived alone or were undergoing oncological treatment were more likely to die elsewhere.

Conclusion: A range of enablers and barriers to home death were found, with many of the enablers being factors that prevented hospital presentations

Citation: Int J Palliat Nurs. 2023 Jul 2;29(7):326-333. doi: 10.12968/ijpn.2023.29.7.326

Authors: Anna Dowd, Melanie Davies, Sarah Short, Ruth Morrison, Cheryl Spiller, Jill Carter, Peter Eastman

Empowering The Mind, Strategies for Coping with Cancer: a Low Out of Pocket Expense Pilot Program

Organisation/s: South West Health

Research project commencement date: February 2021

Summary: Receiving news of a cancer diagnosis has the potential to cause elevated distress for individuals which may manifest as a range of feelings including vulnerability, loss of control, anxiety, and depression, further compounded by the potential adverse effects of cancer treatments. Providing support to psychologically vulnerable patients is an important element of supportive cancer care. To date, there has been no specific program designed to address the psychological requirements of cancer patients in the South Western (SW) region of Victoria, other than private psychologist services which result in patients incurring high out-of-pocket expenses if not covered by private health insurance. In addition, the availability of psychologists in the SW region of Victoria fails to meet service demand. A feasibility study was undertaken to assess the benefit of conducting a low-cost program incorporating six group therapy sessions delivered by a clinical psychologist aimed at providing tools and coping strategies for patients experiencing a cancer diagnosis.It is proposed that group therapy sessions could be an alternative to the lack of psychology services for cancer patients in SW Victoria at low out-of-pocket expense.