Martin Tattersall - Academia.edu (original) (raw)

Papers by Martin Tattersall

The Medical journal of Australia, Jan 18, 2007

Cancer, 2005

BACKGROUND. The difficulty of negotiating the concerns of family members while also respecting th... more BACKGROUND. The difficulty of negotiating the concerns of family members while also respecting the needs of the patient adds complexity to the task of discussing prognosis and end-of-life (EOL) issues with terminally ill cancer patients. The informational needs of caregivers may be different from those of the patients themselves with regard to these topics. However, to the authors' knowledge, this issue has received relatively little research attention.

Journal of Pain and Symptom Management, 2007

Little research has compared the perceptions of health professionals (HPs), patients, and caregiv... more Little research has compared the perceptions of health professionals (HPs), patients, and caregivers about the communication of prognostic information. The objectives of this literature review were to determine 1) patient and caregiver perceptions of levels of information received about prognosis and end-of-life (EoL) issues regarding a life-limiting illness; 2) patient perceptions of and factors related to their understanding and awareness of prognosis; 3) HPs' perceptions of patients' wishes about disclosure of prognosis and factors related to their decision whether to disclose; and 4) concordance between HPs and patients/ caregivers regarding the information given by HPs about prognostic and EoL issues. Relevant studies meeting the inclusion criteria were identified by searching computerized databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Cochrane Register of Controlled Trials [Central]) up to November 2004. The reference lists of identified studies were hand searched for further relevant studies. Inclusion criteria were studies of any design evaluating communication of prognostic information that included adult patients with an advanced, life-limiting illness; their caregivers; and qualified HPs. Fifty-one studies were identified.

Information contained in letters of referral and reply often does not meet the information needs ... more Information contained in letters of referral and reply often does not meet the information needs of letter recipients. ■ Missing reports of previous investigations and insufficient detail in the referral letter to specialists are the most serious and common problems. ■ General practitioners prefer structured, computer- generated letters to unstructured, dictated letters. ■ Referring surgeons and GPs identify delay in

Psycho-oncology, Jan 20, 2015

Patients with advanced cancer may benefit from end of life (EOL) planning, but there is evidence ... more Patients with advanced cancer may benefit from end of life (EOL) planning, but there is evidence that their willingness and desire to engage in advance care planning (ACP) varies. The reasons for this remain poorly understood. Previous reviews on ACP most commonly report outcome measures related to medical interventions and type of care. Synthesis of the literature, which aims to illuminate the salient characteristics of ACP and investigates the psychological and social features of preparation for the EOL, is required. We searched Medline, EMBASE, PsychINFO, CINAHL, and the Cochrane Central Register of Controlled Trials for studies on perceptions or experiences regarding ACP of adults with cancer, family, friends, or professionals caring for this group. Databases were searched from earliest records to 19 November 2014. A thematic analysis of the literature generated conceptual themes. Of the 2483 studies identified, 40 were eligible for inclusion. Studies addressed the relational na...

The deoxyuridine suppression test and labeled deoxyuridine incorporation studies assume a stable ... more The deoxyuridine suppression test and labeled deoxyuridine incorporation studies assume a stable level of deoxyuridine phosphorylase (thymidine:orthophosphate deoxyribosyltransfer- ase, EC 2.4.2.4) activity. We report a large increase in deoxyu ridine phosphorylase activity in three of five cultured lymphoblast lines treated with 10~7M methotrexate. In two of these lines, a parallel increase in tritiated deoxyuridine incorporation into RNA was seen following

The rescue of lymphocytes from methotrexate (MIX) growth inhibition by 5-methyltetrahydrofolate (... more The rescue of lymphocytes from methotrexate (MIX) growth inhibition by 5-methyltetrahydrofolate (5-methyl-THF) and 5- formyltetrahydrofolate (5-formyl-THF) has been studied. Res cue by 5-methyl-THF is selective for cells with high levels of homocysteine:5-methyl-THF methyl-transferase (methyltrans- ferase). At MTX concentrations which inhibited growth 3=85% in both leukemic T-lymphocytes (CCRF-CEM) and Epstein- Barr-transformed B-lymphocytes (LAZ-007), 5 JUM5-formyl- THF rescued more effectively than did

The modulation of MTX cytotoxicity by purines has been studied in a number of mammalian cell line... more The modulation of MTX cytotoxicity by purines has been studied in a number of mammalian cell lines. In each case, it was found that exogenous purines (guanosine, deoxyguano- sine, adenosine, deoxyadenosine, and hypoxanthine) both re duced and potentiated MTX cytotoxicity depending on the MTX concentration. At low MTX concentrations (less than 6 x 10~8 M), purines reduced MTX toxicity and

Journal of geriatric oncology, Jan 23, 2015

The aim of this study is to determine the frequency of geriatric assessment in patients aged over... more The aim of this study is to determine the frequency of geriatric assessment in patients aged over 70years in Australian medical oncology clinics. This was a multicentre audit in two parts: a retrospective file review of initial consultations with an oncologist and prospective audit of case presentations at multidisciplinary meetings (MDMs). Patients aged over 70years presenting to a medical oncology clinic or being discussed at an MDM were eligible. Data was collected at six oncology centres in Victoria, NSW and Canberra from October 2009 to March 2010. Data was collected from 251 file reviews and 108 MDM discussions in a total of 304 patients. Median age was 76years (range 70-95). The geriatric assessment (GA) domains most frequently assessed during an initial consultation were the presence of comorbidities (92%), social situation-living alone or with someone (80%), social supports (63%), any mention of at least one Activity of Daily Living (ADL) (50%) and performance status (49%)....

Seminars in oncology, 2011

Most patients with incurable cancer want information about the impact cancer will have on their f... more Most patients with incurable cancer want information about the impact cancer will have on their future, and many want specific estimates of the most likely, best case, and worst case scenarios for survival. With improved understanding of life expectancy, patients are better equipped to make appropriate treatment decisions and plans for the future. Although physicians acknowledge that patients with incurable cancer want prognostic information and benefit from this, most struggle to provide it and experience difficulty in making reliable estimates, communicating them, and tailoring the information to the individual patient. In this review we address some of the implications that arise from thinking and talking about life expectancy with people who have incurable cancer, particularly those considering first- or second-line chemotherapy.

The Medical journal of Australia, Jan 19, 2009

To seek the views of patients attending general practice about doctors' interactions with the... more To seek the views of patients attending general practice about doctors' interactions with the pharmaceutical industry and their wishes for disclosure of this information. 906 patients attending three general practices in metropolitan Sydney during October -November 2007 completed an 18-item anonymous survey exploring their perceptions of doctors' competing interests. Most patients (76%) were unaware of any relationship their doctor may have with pharmaceutical companies. Patients wanted to know if their doctor obtained any benefits in cash or kind from the pharmaceutical industry (71%), financial incentives for research participation (69%) or sponsorship to attend conferences (61%). Most agreed that disclosure of competing interests by doctors is important (84%), believing this disclosure would help patients make better informed treatment decisions (78%). Eighty per cent of patients stated that they would have more confidence in their doctor's decisions if interests were...

British journal of cancer, Jan 6, 2008

This study provides an analysis of the structure of the initial cancer consultation, the consulta... more This study provides an analysis of the structure of the initial cancer consultation, the consultation styles of medical and radiation oncologists, and their effect on patient outcomes. One hundred and fifty-five cancer patients attending their first consultation with either a medical or radiation oncologist were audiotaped and the transcripts were analysed using the Cancode computer interaction analysis system. Findings revealed that medical oncologists allowed patients and their families more input into the consultation and were rated as warmer and more patient-centred compared with radiation oncologists. However, radiation oncologists spent a longer period discussing, and were more likely to bring up, social support issues with patients. Both medical and radiation oncologists varied their consultation style according to the patient's gender, age, anxiety levels, prognosis, and education. Patients seeing an oncologist who was rated as warmer and discussed a greater number of ps...

British journal of cancer, Jan 2, 2007

Most cancer patients in westernised countries now want all information about their situation, goo... more Most cancer patients in westernised countries now want all information about their situation, good or bad, and many wish to be involved in decision-making. The attitudes to and use of shared decision-making (SDM) by cancer doctors is not well known. Australian cancer clinicians treating breast, colorectal, gynaecological, haematological, or urological cancer were surveyed to identify their usual approach to decision-making and their comfort with different decision-making styles when discussing treatment with patients. A response rate of 59% resulted in 624 complete surveys, which explored usual practice in discussing participation in decision-making, providing information, and perception of the role patients want to play. Univariate and multivariate analyses were performed to identify predictors of use of SDM. Most cancer doctors (62.4%) reported using SDM and being most comfortable with this approach. Differences were apparent between reported high comfort with SDM and less frequen...

The Medical journal of Australia, Jan 3, 2006

Medical education in Australia: changes are needed 52 How not to effect change in curricula Bogda... more Medical education in Australia: changes are needed 52 How not to effect change in curricula Bogda Koczwara, Michael B Barton, Martin H Tattersall, David R Turner, Ian N Olver, Darren L Starmer 52 Return to workforce-based training Geoffrey A Couser 53 National exit exam ...

British journal of cancer, 2003

Question prompt lists (QPLs) have been shown to be an inexpensive and effective communication too... more Question prompt lists (QPLs) have been shown to be an inexpensive and effective communication tool for patients in oncology consultations. We aimed to develop and pilot a QPL for palliative care (PC) patients. In order to identify suitable questions for inclusion in the QPL, we conducted focus groups and individual interviews with 19 patients, 24 carers and 22 PC health professionals. A further 21 health professionals reviewed the draft document. The draft QPL was piloted in 23 patients. In total, 112 questions were identified and grouped into eight categories. All participants felt that the QPL, in booklet form, could be a useful tool. Out of 23 patients in the pilot study, 22 agreed that the QPL was helpful, contained useful questions, was easy to understand and would be useful in the future. State anxiety (STAI) decreased after receiving the booklet and seeing the doctor in 16 out of 19 patients (overall anxiety decreased by a median of 8, IQR 1-13). Participants in the pilot stu...

British journal of cancer, 1999

Active participation in the medical consultation has been demonstrated to benefit aspects of pati... more Active participation in the medical consultation has been demonstrated to benefit aspects of patients' subsequent psychological well-being. We investigated two interventions promoting patient question-asking behaviour. The first was a question prompt sheet provided before the consultation, which was endorsed and worked through by the clinician. The second was a face to face coaching session exploring the benefits of, and barriers to, question-asking, followed by coaching in question-asking behaviour employing rehearsal techniques. Sixty patients with heterogeneous cancers, seeing two medical oncologists for the first time, were randomly assigned to one of three groups: two intervention groups and one control group. Sociodemographic variables and anxiety were assessed prior to the intervention which preceded the consultation. The consultations were audiotaped and subsequently analysed for question-asking behaviour. Anxiety was assessed again immediately following the consultation...

Australian and New Zealand journal of medicine, 1995

Combination chemotherapy for metastatic breast cancer will palliate symptoms in the majority of p... more Combination chemotherapy for metastatic breast cancer will palliate symptoms in the majority of patients but only a small percentage will have prolonged survival. Higher doses of doxorubicin lead to increased response rates in breast cancer and early studies have shown that epirubicin could be tolerated in higher doses with less relative toxicity than doxorubicin. This study was initiated to assess the dose of epirubicin that could be tolerated by escalating its dose while maintaining a fixed dose of cyclophosphamide. Simultaneously tumour response rate, spectrum of toxicities, duration of response and overall survival in patients with metastatic breast cancer were assessed. Patients with metastatic breast cancer commenced chemotherapy with a starting dose of epirubicin of 120 milligram per metre squared (mg/m2) and cyclophosphamide 600 mg/m2. The dose of epirubicin was to be escalated or reduced depending on toxicity. Forty female patients were entered into this study and three pat...

Annals of oncology : official journal of the European Society for Medical Oncology / ESMO, 1994

Active participation and asking questions are important ways in which patients can ensure they un... more Active participation and asking questions are important ways in which patients can ensure they understand what the doctor has said. This study evaluated a question prompt sheet designed to encourage patients to ask questions in the cancer consultation. Patients (n = 142) were randomised to receive (i) a question prompt sheet or (ii) a general sheet informing patients of services available through the regional Cancer Council. Recall of information was assessed in a structured interview 4-20 days after the consultation. Questionnaires to assess patient satisfaction and adjustment to cancer were sent by mail. The question prompt sheet had a significant effect in one content area: prognosis. Thirty-five percent of patients who received the question handout asked questions about prognosis compared to 16% of those receiving the information handout. The prompt sheet did not increase the mean number of questions asked overall. Age, in/out-patient status, gender and involvement preference we...

European journal of cancer & clinical oncology, 1983

Linear analogue self-assessment (LASA) scales were used to measure general well-being and specifi... more Linear analogue self-assessment (LASA) scales were used to measure general well-being and specific factors (mood, pain, nausea and vomiting, appetite, breathlessness, physical activity) in patients receiving therapy for malignant melanoma, small cell bronchogenic carcinoma (SCBC) or ovarian cancer. Among the patients with SCBC and melanoma, high correlations were observed between LASA scores for general well-being, mood and appetite. There was a significant relationship between performance status and LASA scores for general well-being, pain and appetite. Among patients with ovarian cancer, there was a significant association between performance status and LASA scores for general well-being, breathlessness and physical activity. Objective response category was related to change in LASA scores for pain. Changes in LASA scores during treatment reflected increased morbidity during radiotherapy in patients also receiving chemotherapy for SCBC. The LASA technique provides a convenient met...