Sanchia Aranda - Academia.edu (original) (raw)

Papers by Sanchia Aranda

International Journal of Public Health, Jul 5, 2018

To appraise improvement strategies adopted by low and middle income countries to increase access ... more To appraise improvement strategies adopted by low and middle income countries to increase access to cancer treatments and palliative care; and identify the facilitators and barriers to implementation. Methods A systematic review was conducted and reported in accordance with PRISMA statement. MEDLINE, CINAHL and the Cochrane Library databases were searched. Bias was assessed using the Standards for Quality Improvement Reporting Excellence, and evidence graded using the Australian National Health and Medical Research Council system. Results Of 3069 articles identified, 18 studies were included. These studies involved less than a tenth (n=12, 8.6%) of all low and middle income countries. Most were case reports (58%), and the majority focused on palliative care (n=11, 61%). Facilitators included: stakeholder engagement, financial support, supportive learning environment, and community networks. Barriers included: lack of human resources, financial constraints, and limited infrastructure. Conclusions There is limited evidence on sustainable strategies for increasing access to cancer treatments and palliative care in low and middle income countries. Future strategies should be externally evaluated and be tailored to address service delivery; workforce; information; medical products, and technologies; financing; and leadership and governance.

Supportive Care in Cancer, Oct 23, 2017

Purpose This report describes the views of front-line health professionals who participated in a ... more Purpose This report describes the views of front-line health professionals who participated in a randomised controlled trial examining a model of care in which depressed cancer patients received a brief psychosocial intervention. Health professionals from four cancer centres received focused training, skill development and clinical supervision in order to deliver the intervention. Methods We interviewed 20 health professionals asking them about their perceptions of participation in the study and their views about more widespread implementation of this model of care. Results Participants strongly advocated for widespread implementation of this model of care; however, their ability to deliver the intervention varied depending on clinical roles and responsibilities. Many oncology nurses expressed conflict about delivering a psychosocial intervention when their clinical unit was busy. Finding a private area in which to talk was a frequent barrier in busy clinical units. Participants reported that they applied the skills and insights acquired in the study in their routine clinical work. Supervision was highly valued and was feasible to provide in clinical settings. Conclusion Psychosocial care can be provided by a range of health professionals if they receive focused training and have access to supervision, but competing clinical demands are likely to limit their ability to routinely provide psychosocial care. This suggests that training should target professionals who have greater autonomy and flexibility in their work roles. Trial registration number ANZCTR1260000448044

Journal of Oncology Pharmacy Practice, Jul 30, 2012

Preventable medication errors impact substantially on the Australian healthcare system. Where ‘po... more Preventable medication errors impact substantially on the Australian healthcare system. Where ‘poor communication of medical information at transition points is responsible for as many as 50% of all medication errors’, a leading contributor for this type of medication error is lack of consumer knowledge about medicines information. This study was aimed at designing and testing the effectiveness of a consumer–healthcare professional partnership model towards effective medication reconciliation. This model aims to empower consumers about their medicines information, so that they would contribute more effectively to medication reconciliation and thereby minimise medication errors occurring at transition points. Components of this model were informed by qualitative data gleaned from patient opinion surveys, focus group sessions involving nurses, doctors and pharmacists working at the hospital and results of a literature search of medication safety tools. Programme development was informed by health improvement approaches centred on a Plan-Do-Study-Act cycle. Evaluation for effectiveness was conducted within a framework of a controlled before and after study. Results revealed that there was a 1.4-fold increase in the reporting rate of pharmacists intervention. The study could not demonstrate that the designed intervention was effective in minimising near-misses. However, there is statistically insignificant reduction in errors for patients that were correctly exposed to the intervention. Anecdotal evidence suggests there is utility for a patient population keen to claim greater ownership of their medicines information. Further, we advocate that patient education about medicines and the establishment of a consumer–healthcare professional model occur prior to ward admission.

International Journal of Palliative Nursing, Feb 1, 2004

International Journal of Palliative Nursing, Dec 1, 2001

I have previously argued that palliative care is in danger of suffering from ideological stagnati... more I have previously argued that palliative care is in danger of suffering from ideological stagnation (Aranda, 1998). By this I meant that the philosophy of palliative care had become so enshrined in rhetoric that practitioners are able to claim that they provide whole person, family-centred and multidisciplinary care, while failing to explore the limits to which this is achieved within the context of contemporary health-care delivery. The words of palliative care philosophy role off the tongue but we rarely challenge what we do. However, in today’s health-care world, and with increasing governmental funding of palliative care services, demands to be accountable for the outcomes of palliative care are growing. The challenge is no longer one of proving the place of palliative care, but rather of demonstrating the effect of our interventions so that they can be taken up more broadly in health care. Some of the forces preventing this I have labelled the tyrannies of palliative care. The word tyranny means oppressive action or behaviour. In this context though it refers to the ways in which our behaviours limit the extent to which palliative care can be self-critical and reflective. The three tyrannies I have identified are not exhaustive but can perhaps begin us on a process of self-critique that will be essential to our continued growth as an integral part of contemporary health care.

Progress in Palliative Care, 2000

Evidence-based practice is the current buzz-word of healthcare practice. lt draws on a positivist... more Evidence-based practice is the current buzz-word of healthcare practice. lt draws on a positivist approach to research centred on the randomised controlled trial. While it is imperative that palliative care embrace evidence-based approaches to patient and family care, at Ieast two key barriers exist. Firstly, palliative care developed as a reaction against positivist science and its approaches to healthcare provision. Consequently, its field of inquiry, and what it counts as evidence, is significantly broader than can be assessed using randomised controlled trials. Secondly, even when appropriate, attempts to conduct randomised controlled trials in palliative care have largely failed. This paper explores the relationship between palliative care and evidence-based practice through a critique of randomised controlled trials as the benchmark for evidence in palliative care.

Collegian, Feb 1, 2008

The development of nursing interventions that demonstrate the link between nursing actions and pa... more The development of nursing interventions that demonstrate the link between nursing actions and patient outcomes is a high priority for nursing research. The development of intervention research frequently focuses on the methods used to test the intervention while less attention is placed on rigor in intervention development and design. The purpose of this paper is to provide thinking points for researchers considering the development of nursing interventions. The thinking points were developed from the limited literature on this topic in synthesis with the authors own experiences of designing nursing interventions. Adoption of a systematic approach to intervention testing is advocated along with a step-wise intervention development process. This process calls for attention to problem definition, conceptual underpinnings, desired outcomes and measures and evidence-based content along with careful consideration of delivery methods, dose and attention to protecting the integrity of the intervention during testing. The approach advocated will help to ensure that nursing intervention research makes a useful contribution to the development of nursing practice.

Cancer Nursing, Feb 1, 1999

The modern hospice movement had its formal beginnings in the United Kingdom with the 1967 opening... more The modern hospice movement had its formal beginnings in the United Kingdom with the 1967 opening of the St. Christopher's Hospice in London by Dame Cicely Saunders. Global uptake of the hospice principles and, more recently, palliative care, is widespread. However, the movement has shifted from charismatic, charity-based, and independent hospices to routinized and increasingly bureaucratized palliative care. Global differences exist around the degree to which hospice and palliative care are established components of the health care system. Access appears to increase with the integration of services into mainstream health funding. The downside of this is increased regulation, competition, and a potential loss of specificity for those who are dying. This article explores the changing face of palliative care, with particular emphasis on palliative care delivery in the developing world. These issues for developing countries include access to services, access to morphine, and professional access to information and education.

International Journal of Palliative Nursing, Mar 1, 2005

Sanchia Aranda reflects on the strange nature of the term ‘specialist’ in relation to palliative ... more Sanchia Aranda reflects on the strange nature of the term ‘specialist’ in relation to palliative nursing.

International Journal of Palliative Nursing, May 2, 1997

BMC Health Services Research, 2021

Background Improving access to radiotherapy services in low and middle-income countries (LMICs) i... more Background Improving access to radiotherapy services in low and middle-income countries (LMICs) is challenging. Many LMICs’ radiotherapy initiatives fail because of multi-faceted barriers leading to significant wastage of scarce resources. Supporting LMICs to self-assess their readiness for establishing radiotherapy services will help to improve cancer outcomes by ensuring safe, effective and sustainable evidenced-based cancer care. The aim of the study was to develop practical guidance for LMICs on self-assessing their readiness to establish safe and sustainable radiotherapy services. Methods The Access to Radiotherapy for Cancer treatment (ARC) Project was a pragmatic sequential mixed qualitative methods design underpinned by the World Health Organisation’s ‘Innovative Care for Chronic Conditions Framework’ and ‘Health System Building Blocks Framework for Action’ conceptual frameworks. This paper reports on the process of overall data integration and meta-inference from previously...

Journal of Clinical Oncology, May 20, 2015

79 Background: Colorectal cancer (CRC) and its treatments can cause distressing short and long-te... more 79 Background: Colorectal cancer (CRC) and its treatments can cause distressing short and long-term side effects as well as significant functional consequences. Current models of follow-up do not adequately address these issues. We conducted a multi-center RCT of an innovative program (SurvivorCare (SC)); designed to have a beneficial effect on psychological distress, supportive care needs (SCN) and quality of life (QOL). At the end of active treatment for stage I-III CRC, eligible patients ( =18 years, adequate English) were randomized 1:1 to usual care (UC) or to UC+SC. SC comprised educational materials, needs assessment, an individualized survivorship care plan, nurse-led end-of-treatment session and three follow up (FU) phone calls. Distress (BSI-18), SCN (CaSUN) and QOL (EORTC QLQ-C30, CR29) were assessed at baseline, 2 (FU1) and 6 (FU2) months. Primary hypothesis: SC would have a beneficial effect on distress at FU1. Secondary hypotheses: SC would have a beneficial effect on (1) SCN and QOL at FU1; and (2) distress, SCN and QOL at FU2. 15 items assessed satisfaction with survivorship care. Sample size of 180 (90/arm) was based on 80% power, 2-sided alpha of 0.05, to detect a between groups difference of 3.6 on BSI-18 at FU1. Outcome analysis was ITT. Of 221 patients randomized (111 UC, 110 SC), 4 were ineligible and 1 lost to FU, leaving 110 UC, 106 SC. Groups appeared well balanced. Median age was 64, 52% male, 56% colon, 35% rectal cancer, 10% overlap. Stage I 7%, II 22%, III 71%. Intervention fidelity was acceptable. Baseline distress and QOL were similar to population norms. Between groups differences in distress at FU1 (primary outcome), distress at FU2 and SCN and QOL at FU1 and FU2 were small and non-significant. SC patients were more satisfied with survivorship care than UC patients (significant differences on 10 of 15 items). The addition of SC to UC did not have a beneficial effect on distress, SCN or QOL outcomes but SC patients were more satisfied with survivorship care. ACTRN12610000207011.

Trials, Oct 19, 2015

Background: Outpatient chemotherapy is a core treatment for haematological malignancies; however,... more Background: Outpatient chemotherapy is a core treatment for haematological malignancies; however, its toxicities frequently lead to distressing/potentially life-threatening side-effects (neutropenia/infection, nausea/vomiting, mucositis, constipation/diarrhoea, fatigue). Early detection/management of side-effects is vital to improve patient outcomes, decrease morbidity and limit lengthy/costly hospital admissions. The ability to capture patient-reported health data in real-time, is regarded as the 'gold-standard' to allow rapid clinical decision-making/intervention. This paper presents the protocol for a Phase 3 multi-site randomised controlled trial evaluating a novel nurse-led Telehealth intervention for remote monitoring/management of chemotherapy side-effects in Australian haematological cancer patients.

Palliative Medicine, Mar 1, 2009

Despite the promotion of family meetings as an essential tool for information sharing and plannin... more Despite the promotion of family meetings as an essential tool for information sharing and planning in palliative care, minimal evidence exists to show their effectiveness. We sought to rectify this gap in evidence-based practice by evaluating recently developed clinical guidelines for facilitating family meetings. Palliative care nurses were trained to conduct family meetings using the guidelines. To assess the effectiveness of the guidelines, primary family carers who attended a family meeting completed a self-report instrument to measure unmet needs at three time periods: immediately before the meeting (T1), immediately after the meeting (T2) and two days after the meeting (T3). Phone interviews with carers were also conducted at T3. Patients, health professionals and family meeting facilitators were also invited to complete an evaluation form at T2. A focus group was conducted at the end of the project to gain reflections from the family meeting facilitators about their role, re-evaluate the family meeting clinical guidelines and discuss barriers and facilitators for ongoing implementation. Twenty family meetings were conducted at St Vincent's Hospital (Melbourne, Australia). A total of 42 participants were involved, including 20 family carers, 4 patients and 18 health professionals. Family carers reported a statistically significant increase in having their care needs met, from T1 to T2, which was maintained at T3; they also reported that the meetings were useful. Health professionals and patients advised that the meetings were well facilitated. The results from this pilot study indicate that family meetings, conducted using specific clinical practice guidelines, were useful and effective. However, more research is required to confirm these findings. Strategies for implementation and further research are outlined.

Asia Pacific journal of health management, Mar 16, 2016

0.99)].-Question: Could this difference be decreased by reducing cultural and language barriers? ... more 0.99)].-Question: Could this difference be decreased by reducing cultural and language barriers? (4) Cancers of pulmonary lobes rather than the main bronchus pose lower risks of LC death. Question: Could outcomes for main bronchus cancers be improved by up-skilling or referral to higher-volume centres? (5) Greater extent of disease is strongly predictive of case fatality-Question: Could LC deaths be reduced by earlier treatment? (6) Use of lobectomies varies-Question: Could survival be increased through greater use of lobectomies for localised NSCLC? Conclusions: Linked cancer registry and hospital data can increase system-wide understanding of local health-service delivery and prompt discussion points on how to improve outcomes.

International Journal of Palliative Nursing, Mar 1, 2000

In a 12-month period six people died from Creutzfeldt-Jakob disease (CJD) in a Melbourne hospice.... more In a 12-month period six people died from Creutzfeldt-Jakob disease (CJD) in a Melbourne hospice. CJD is a rare neurodegenerative disease, which commonly follows an explosive course unabated into the terminal phase. For the purposes of this article the care of six patients was audited using a retrospective chart review and a focus group was conducted with nurses involved in their care. The nurses faced considerable challenges as they endeavoured to provide comfort and support for these patients. The differences in the illness trajectory of CJD in relation to the more common experiences of illness progression in advanced cancer are discussed in the context of palliative care. This review focuses on the particular care issues of six people with CJD and their families at the end of life. The personal issues experienced by the nurses who provided palliative care are also explored. The need for the future development of guidelines for families and health professionals who care for people with CJD is highlighted.

BMC Palliative Care, Aug 19, 2008

Background: Support for family carers is a core function of palliative care. Family meetings are ... more Background: Support for family carers is a core function of palliative care. Family meetings are commonly recommended as a useful way for health care professionals to convey information, discuss goals of care and plan care strategies with patients and family carers. Yet it seems there is insufficient research to demonstrate the utlility of family meetings or the best way to conduct them. This study sought to develop multidisciplinary clinical practice guidelines for conducting family meetings in the specialist palliative care setting based on available evidence and consensus based expert opinion. Methods: The guidelines were developed via the following methods: (1) A literature review; (2) Conceptual framework; (3) Refinement of the guidelines based on feedback from an expert panel and focus groups with multidisciplinary specialists from three palliative care units and three major teaching hospitals in Melbourne, Australia. Results: The literature review revealed that no comprehensive exploration of the conduct and utility of family meetings in the specialist palliative care setting has occurred. Preliminary clinical guidelines were developed by the research team, based on relevant literature and a conceptual framework informed by: single session therapy, principles of therapeutic communication and models of coping and family consultation. A multidisciplinary expert panel refined the content of the guidelines and the applicability of the guidelines was then assessed via two focus groups of multidisciplinary palliative care specialists. The complete version of the guidelines is presented. Conclusion: Family meetings provide an opportunity to enhance the quality of care provided to palliative care patients and their family carers. The clinical guidelines developed from this study offer a framework for preparing, conducting and evaluating family meetings. Future research and clinical implications are outlined.

Journal of Cancer Survivorship, May 14, 2015