Davina Porock | Edith Cowan University (original) (raw)

Papers by Davina Porock

Journal of the American Medical Directors Association, May 1, 2005

Palliative Medicine, Jun 13, 2023

Background: Clinician predicted survival for cancer patients is often inaccurate, and prognostic ... more Background: Clinician predicted survival for cancer patients is often inaccurate, and prognostic tools may be helpful, such as the Palliative Prognostic Index (PPI). The PPI development study reported that when PPI score is greater than 6, it predicted survival of less than 3 weeks with a sensitivity of 83% and specificity of 85%. When PPI score is greater than 4, it predicts survival of less than 6 weeks with a sensitivity of 79% and specificity of 77%. However, subsequent PPI validation studies have evaluated various thresholds and survival durations, and it is unclear which is most appropriate for use in clinical practice. With the development of numerous prognostic tools, it is also unclear which is most accurate and feasible for use in multiple care settings. Aim: We evaluated PPI model performance in predicting survival of adult cancer patients based on different thresholds and survival durations and compared it to other prognostic tools. Design: This systematic review and meta-analysis was registered in PROSPERO (CRD42022302679). We calculated the pooled sensitivity and specificity of each threshold using bivariate random-effects meta-analysis and pooled diagnostic odds ratio of each survival duration using hierarchical summary receiver operating characteristic model. Meta-regression and subgroup analysis were used to compare PPI performance with clinician predicted survival and other prognostic tools. Findings which could not be included in meta-analyses were summarised narratively. Data sources: PubMed, ScienceDirect, Web of Science, CINAHL, ProQuest and Google Scholar were searched for articles published from inception till 7 January 2022. Both retrospective and prospective observational studies evaluating PPI performance in predicting survival of adult cancer patients in any setting were included. The Prediction Model Risk of Bias Assessment Tool was used for quality appraisal. Results: Thirty-nine studies evaluating PPI performance in predicting survival of adult cancer patients were included ( n = 19,714 patients). Across meta-analyses of 12 PPI score thresholds and survival durations, we found that PPI was most accurate for predicting survival of <3 weeks and <6 weeks. Survival prediction of <3 weeks was most accurate when PPI score>6 (pooled sensitivity = 0.68, 95% CI 0.60–0.75, specificity = 0.80, 95% CI 0.75–0.85). Survival prediction of <6 weeks was most accurate when PPI score>4 (pooled sensitivity = 0.72, 95% CI 0.65–0.78, specificity = 0.74, 95% CI 0.66–0.80). Comparative meta-analyses found that PPI performed similarly to Delirium-Palliative Prognostic Score and Palliative Prognostic Score in predicting <3-week survival, but less accurately in <30-day survival prediction. However, Delirium-Palliative Prognostic Score and Palliative Prognostic Score only provide <30-day survival probabilities, and it is uncertain how this would be helpful for patients and clinicians. PPI also performed similarly to clinician predicted survival in predicting <30-day survival. However, these findings should be interpreted with caution as limited studies were available for comparative meta-analyses. Risk of bias was high for all studies, mainly due to poor reporting of statistical analyses. while there were low applicability concerns for most (38/39) studies. Conclusions: PPI score>6 should be used for <3-week survival prediction, and PPI score>4 for <6-week survival. PPI is easily scored and does not require invasive tests, and thus would be easily implemented in multiple care settings. Given the acceptable accuracy of PPI in predicting <3- and <6-week survival and its objective nature, it could be used to cross-check clinician predicted survival especially when clinicians have doubts about their own judgement, or when clinician estimates seem to be less reliable. Future studies should adhere to the reporting guidelines and provide comprehensive analyses of PPI model performance.

Journal of Clinical Oncology, May 20, 2013

e20540 Background: Physical activity (PA) in prostate cancer (PC) survivors improves general QOL ... more e20540 Background: Physical activity (PA) in prostate cancer (PC) survivors improves general QOL and fatigue, but the relationship between PA and genitourinary symptoms in PC survivors is unknown. The incidence of sexual dysfunction may be as high as 68% during active surveillance and 78% in men receiving conventional therapies. PA has mitigated erectile dysfunction in non-prostate cancer populations. Objective: To determine the relationships among PA, age, co-morbidities, mental and physical health and symptoms, particularly related to sexual dysfunction, experienced by men with PC prior to therapy. Methods: Study Design: Correlational/cross sectional secondary analysis of de-identified data from 258 men with early stage PC prior to initiation of therapy. Variables: Habitual PA (Baecke Questionnaire- BAQ), physical (PCS) and mental health (MCS) (SF-36) and urinary, bowel and sexual dysfunctional symptoms (UCLA Prostate Cancer Index). Analysis: Descriptive statistics; correlations; hierarchical regressions to assess moderating and mediating relationships. Results: Mean Age = 63.2 + 8.1 yrs. BAQ activity scores, ranged from 2.2 to 12.1 (M and SD= 6.8+1.9), indicating low levels of PA. PCI mean scores = 92+13, urinary; 88 +13, bowel; 52 +29 for sexual. PA was negatively correlated with sexual symptoms (r=0.31; p<0.001). Physical health was negatively associated with all symptoms and age, but positively correlated with PA (r=0.21; p=0.001). Physical health mediates effects of age for urinary symptoms and partially for sexual symptoms. PA’s relationship to sexual dysfunctional symptoms was independent of age and was at least partially mediated by physical health. Conclusions: Urinary, bowel and sexual symptoms experienced by men at time of diagnosis were similar to men of similar age without PC, indicating age as the dominant predictor of symptoms. This study identified potential mechanisms of symptoms in early stage PC that warrant further testing. Symptoms related to sexual dysfunction may be especially amenable to PA.

Nursing Research, Jul 1, 2010

Although much has been published in the literature on how to perform a Q methodological study, th... more Although much has been published in the literature on how to perform a Q methodological study, the use of interviews within this process has received little attention. The purpose of this review is to explore the use of interviews in a Q methodological study. An introduction to Q methodology is provided. The aims of an interview within a Q methodological study are described, and how these aims lend themselves to a particular method of analysis is explored. How to perform this analysis is outlined. The use of interviews can increase the validity of a Q methodological study by providing the participant's rationale for analysis of the factor arrays. When to perform the interviews is still under debate, and further study is required to determine whether the timing affects the results.

Australasian Journal on Ageing, Mar 14, 2023

ObjectivesTo examine the relationship between structural characteristics of Australian residentia... more ObjectivesTo examine the relationship between structural characteristics of Australian residential aged care facilities (RACFs) and breaches of the aged care quality standards.MethodsFacility‐level analysis of audits, sanctions and non‐compliance notices of all accredited Australian RACFs between 2015/16 and 2018/19. Structural factors of interest included RACF size, remoteness, ownership type and jurisdiction. Two government data sources were joined. Each outcome was analysed to calculate time trends, unadjusted rates and relative risks.ResultsNon‐compliance notices were imposed on 369 RACFs (13%) and 83 sanctions on 75 RACFs (3%). Compared with New South Wales (NSW), non‐compliance notices were less likely in Victoria, Queensland and the Northern Territory (NT), more likely in South Australia (SA), and comparable in Western Australia (WA), Tasmania and the Australian Capital Territory (ACT). RACFs with more than 100 beds and RACFs located in remote and outer regional areas (vs. major cities) also increased the likelihood of non‐compliance notices. Compared with NSW, sanctions were less likely in Victoria, Queensland, NT and WA and comparable in SA, Tasmania and ACT. Additionally, the likelihood of sanctions was higher for RACFs with more than 40 beds. For both non‐compliance notices and sanctions, no significant relationship was found with RACF ownership type.ConclusionsWe partially confirmed other Australian findings about the relationship between RACF structural characteristics and regulatory sanctions and reported new findings about non‐compliance notices. Routine and standardised public reporting of RACF performance is needed to build trust that Australia's latest aged care reforms have led to sustained quality improvements.

Whurr eBooks, 2004

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,... more All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of Whurr Publishers Limited. This publication is sold subject to the conditions that it shall not, by way of trade or otherwise, be lent, resold, hired out, or otherwise circulated without the Publisher's prior consent, in any form of binding or cover other than that in which it is published, and without a similar condition including this condition being imposed upon any subsequent purchaser.

European Journal of Cancer Care, Sep 1, 2004

Just go with the flow: a qualitative study of fatigue in biotherapy The purpose of this qualitati... more Just go with the flow: a qualitative study of fatigue in biotherapy The purpose of this qualitative study was to describe and explore the experience of fatigue in patients who had received biotherapy or biochemotherapy. A one-time face-to-face interview was conducted with 10 patients who had consented to be in a larger quantitative study of fatigue. Seven were men and all but two were currently receiving treatment. The study took place at a midwestern cancer centre in the USA. A content analysis of the transcribed interviews was undertaken. The two investigators coded the transcripts independently and then compared and discussed the codes and themes until consensus was reached. Four themes emerged: (i) life-disrupting severity of the fatigue, (ii) altered sleep patterns, (iii) informational needs met, and (iv) advice for other patients. The strongest theme was the advice to 'be strong and go with the flow' was meaningful for these patients and the only wisdom they could pass on to future patients. Boredom associated with cognitive fatigue and the inability to accomplish work and other tasks was also revealed. Conclusions drawn from this study relate to the degree of suffering patients experienced in undergoing biotherapy as they reported fatigue and other problems and also the strong desire to complete treatment despite the difficulties that they experienced.

한국간호과학회 학술대회, Nov 1, 2007

Background: Pain is one of the most disturbing and distressing symptoms experienced by cancer pat... more Background: Pain is one of the most disturbing and distressing symptoms experienced by cancer patients, and it is the most stressful factor affecting all aspects of patients and their families' lives. Understanding the barriers to effective cancer pain management in home setting is essential for designing programs to improve the quality of the patients and their families' lives. Aim: Exploring family caregivers' and cancer patients' experiences of barriers to pain management at home. Design: Qualitative exploratory descriptive study. Setting/Participants: Twenty patients and 32 family caregivers were recruited from oncology wards and palliative medicine clinics in hospitals affiliated to Iran University of Medical Sciences. Method: In-depth interviews were conducted with each participant, and audio-recorded and transcribed interviews were analyzed using thematic analysis. Results: Ten major themes emerged regarding barriers to cancer pain management in home setting: "Drug dependence and addiction," "Malingering," "Negative attitudes towards opioid analgesia," "Concealing pain," "Painful comorbidities," "Conflict in family members' perspectives," "Inaccessibility of pain relief facilities," "Poor skill and knowledge," "Patients' feelings of depression and hopelessness," and "Caregiver burden." Conclusion: The study documented the need for supportive and educational programs for cancer patients and their family caregivers in an attempt to improve the effectiveness of pain managment and cancer patients' quality of life.

Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses, 1999

Routledge eBooks, Oct 8, 2018

Journal of the American Medical Directors Association, May 1, 2005

Palliative Medicine, Jun 13, 2023

Background: Clinician predicted survival for cancer patients is often inaccurate, and prognostic ... more Background: Clinician predicted survival for cancer patients is often inaccurate, and prognostic tools may be helpful, such as the Palliative Prognostic Index (PPI). The PPI development study reported that when PPI score is greater than 6, it predicted survival of less than 3 weeks with a sensitivity of 83% and specificity of 85%. When PPI score is greater than 4, it predicts survival of less than 6 weeks with a sensitivity of 79% and specificity of 77%. However, subsequent PPI validation studies have evaluated various thresholds and survival durations, and it is unclear which is most appropriate for use in clinical practice. With the development of numerous prognostic tools, it is also unclear which is most accurate and feasible for use in multiple care settings. Aim: We evaluated PPI model performance in predicting survival of adult cancer patients based on different thresholds and survival durations and compared it to other prognostic tools. Design: This systematic review and meta-analysis was registered in PROSPERO (CRD42022302679). We calculated the pooled sensitivity and specificity of each threshold using bivariate random-effects meta-analysis and pooled diagnostic odds ratio of each survival duration using hierarchical summary receiver operating characteristic model. Meta-regression and subgroup analysis were used to compare PPI performance with clinician predicted survival and other prognostic tools. Findings which could not be included in meta-analyses were summarised narratively. Data sources: PubMed, ScienceDirect, Web of Science, CINAHL, ProQuest and Google Scholar were searched for articles published from inception till 7 January 2022. Both retrospective and prospective observational studies evaluating PPI performance in predicting survival of adult cancer patients in any setting were included. The Prediction Model Risk of Bias Assessment Tool was used for quality appraisal. Results: Thirty-nine studies evaluating PPI performance in predicting survival of adult cancer patients were included ( n = 19,714 patients). Across meta-analyses of 12 PPI score thresholds and survival durations, we found that PPI was most accurate for predicting survival of <3 weeks and <6 weeks. Survival prediction of <3 weeks was most accurate when PPI score>6 (pooled sensitivity = 0.68, 95% CI 0.60–0.75, specificity = 0.80, 95% CI 0.75–0.85). Survival prediction of <6 weeks was most accurate when PPI score>4 (pooled sensitivity = 0.72, 95% CI 0.65–0.78, specificity = 0.74, 95% CI 0.66–0.80). Comparative meta-analyses found that PPI performed similarly to Delirium-Palliative Prognostic Score and Palliative Prognostic Score in predicting <3-week survival, but less accurately in <30-day survival prediction. However, Delirium-Palliative Prognostic Score and Palliative Prognostic Score only provide <30-day survival probabilities, and it is uncertain how this would be helpful for patients and clinicians. PPI also performed similarly to clinician predicted survival in predicting <30-day survival. However, these findings should be interpreted with caution as limited studies were available for comparative meta-analyses. Risk of bias was high for all studies, mainly due to poor reporting of statistical analyses. while there were low applicability concerns for most (38/39) studies. Conclusions: PPI score>6 should be used for <3-week survival prediction, and PPI score>4 for <6-week survival. PPI is easily scored and does not require invasive tests, and thus would be easily implemented in multiple care settings. Given the acceptable accuracy of PPI in predicting <3- and <6-week survival and its objective nature, it could be used to cross-check clinician predicted survival especially when clinicians have doubts about their own judgement, or when clinician estimates seem to be less reliable. Future studies should adhere to the reporting guidelines and provide comprehensive analyses of PPI model performance.

Journal of Clinical Oncology, May 20, 2013

e20540 Background: Physical activity (PA) in prostate cancer (PC) survivors improves general QOL ... more e20540 Background: Physical activity (PA) in prostate cancer (PC) survivors improves general QOL and fatigue, but the relationship between PA and genitourinary symptoms in PC survivors is unknown. The incidence of sexual dysfunction may be as high as 68% during active surveillance and 78% in men receiving conventional therapies. PA has mitigated erectile dysfunction in non-prostate cancer populations. Objective: To determine the relationships among PA, age, co-morbidities, mental and physical health and symptoms, particularly related to sexual dysfunction, experienced by men with PC prior to therapy. Methods: Study Design: Correlational/cross sectional secondary analysis of de-identified data from 258 men with early stage PC prior to initiation of therapy. Variables: Habitual PA (Baecke Questionnaire- BAQ), physical (PCS) and mental health (MCS) (SF-36) and urinary, bowel and sexual dysfunctional symptoms (UCLA Prostate Cancer Index). Analysis: Descriptive statistics; correlations; hierarchical regressions to assess moderating and mediating relationships. Results: Mean Age = 63.2 + 8.1 yrs. BAQ activity scores, ranged from 2.2 to 12.1 (M and SD= 6.8+1.9), indicating low levels of PA. PCI mean scores = 92+13, urinary; 88 +13, bowel; 52 +29 for sexual. PA was negatively correlated with sexual symptoms (r=0.31; p<0.001). Physical health was negatively associated with all symptoms and age, but positively correlated with PA (r=0.21; p=0.001). Physical health mediates effects of age for urinary symptoms and partially for sexual symptoms. PA’s relationship to sexual dysfunctional symptoms was independent of age and was at least partially mediated by physical health. Conclusions: Urinary, bowel and sexual symptoms experienced by men at time of diagnosis were similar to men of similar age without PC, indicating age as the dominant predictor of symptoms. This study identified potential mechanisms of symptoms in early stage PC that warrant further testing. Symptoms related to sexual dysfunction may be especially amenable to PA.

Nursing Research, Jul 1, 2010

Although much has been published in the literature on how to perform a Q methodological study, th... more Although much has been published in the literature on how to perform a Q methodological study, the use of interviews within this process has received little attention. The purpose of this review is to explore the use of interviews in a Q methodological study. An introduction to Q methodology is provided. The aims of an interview within a Q methodological study are described, and how these aims lend themselves to a particular method of analysis is explored. How to perform this analysis is outlined. The use of interviews can increase the validity of a Q methodological study by providing the participant's rationale for analysis of the factor arrays. When to perform the interviews is still under debate, and further study is required to determine whether the timing affects the results.

Australasian Journal on Ageing, Mar 14, 2023

ObjectivesTo examine the relationship between structural characteristics of Australian residentia... more ObjectivesTo examine the relationship between structural characteristics of Australian residential aged care facilities (RACFs) and breaches of the aged care quality standards.MethodsFacility‐level analysis of audits, sanctions and non‐compliance notices of all accredited Australian RACFs between 2015/16 and 2018/19. Structural factors of interest included RACF size, remoteness, ownership type and jurisdiction. Two government data sources were joined. Each outcome was analysed to calculate time trends, unadjusted rates and relative risks.ResultsNon‐compliance notices were imposed on 369 RACFs (13%) and 83 sanctions on 75 RACFs (3%). Compared with New South Wales (NSW), non‐compliance notices were less likely in Victoria, Queensland and the Northern Territory (NT), more likely in South Australia (SA), and comparable in Western Australia (WA), Tasmania and the Australian Capital Territory (ACT). RACFs with more than 100 beds and RACFs located in remote and outer regional areas (vs. major cities) also increased the likelihood of non‐compliance notices. Compared with NSW, sanctions were less likely in Victoria, Queensland, NT and WA and comparable in SA, Tasmania and ACT. Additionally, the likelihood of sanctions was higher for RACFs with more than 40 beds. For both non‐compliance notices and sanctions, no significant relationship was found with RACF ownership type.ConclusionsWe partially confirmed other Australian findings about the relationship between RACF structural characteristics and regulatory sanctions and reported new findings about non‐compliance notices. Routine and standardised public reporting of RACF performance is needed to build trust that Australia's latest aged care reforms have led to sustained quality improvements.

Whurr eBooks, 2004

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,... more All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of Whurr Publishers Limited. This publication is sold subject to the conditions that it shall not, by way of trade or otherwise, be lent, resold, hired out, or otherwise circulated without the Publisher's prior consent, in any form of binding or cover other than that in which it is published, and without a similar condition including this condition being imposed upon any subsequent purchaser.

European Journal of Cancer Care, Sep 1, 2004

Just go with the flow: a qualitative study of fatigue in biotherapy The purpose of this qualitati... more Just go with the flow: a qualitative study of fatigue in biotherapy The purpose of this qualitative study was to describe and explore the experience of fatigue in patients who had received biotherapy or biochemotherapy. A one-time face-to-face interview was conducted with 10 patients who had consented to be in a larger quantitative study of fatigue. Seven were men and all but two were currently receiving treatment. The study took place at a midwestern cancer centre in the USA. A content analysis of the transcribed interviews was undertaken. The two investigators coded the transcripts independently and then compared and discussed the codes and themes until consensus was reached. Four themes emerged: (i) life-disrupting severity of the fatigue, (ii) altered sleep patterns, (iii) informational needs met, and (iv) advice for other patients. The strongest theme was the advice to 'be strong and go with the flow' was meaningful for these patients and the only wisdom they could pass on to future patients. Boredom associated with cognitive fatigue and the inability to accomplish work and other tasks was also revealed. Conclusions drawn from this study relate to the degree of suffering patients experienced in undergoing biotherapy as they reported fatigue and other problems and also the strong desire to complete treatment despite the difficulties that they experienced.

한국간호과학회 학술대회, Nov 1, 2007

Background: Pain is one of the most disturbing and distressing symptoms experienced by cancer pat... more Background: Pain is one of the most disturbing and distressing symptoms experienced by cancer patients, and it is the most stressful factor affecting all aspects of patients and their families' lives. Understanding the barriers to effective cancer pain management in home setting is essential for designing programs to improve the quality of the patients and their families' lives. Aim: Exploring family caregivers' and cancer patients' experiences of barriers to pain management at home. Design: Qualitative exploratory descriptive study. Setting/Participants: Twenty patients and 32 family caregivers were recruited from oncology wards and palliative medicine clinics in hospitals affiliated to Iran University of Medical Sciences. Method: In-depth interviews were conducted with each participant, and audio-recorded and transcribed interviews were analyzed using thematic analysis. Results: Ten major themes emerged regarding barriers to cancer pain management in home setting: "Drug dependence and addiction," "Malingering," "Negative attitudes towards opioid analgesia," "Concealing pain," "Painful comorbidities," "Conflict in family members' perspectives," "Inaccessibility of pain relief facilities," "Poor skill and knowledge," "Patients' feelings of depression and hopelessness," and "Caregiver burden." Conclusion: The study documented the need for supportive and educational programs for cancer patients and their family caregivers in an attempt to improve the effectiveness of pain managment and cancer patients' quality of life.

Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses, 1999

Routledge eBooks, Oct 8, 2018