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BACKGROUND/AIMS: This study compared rates of clinical trial participation and perceived adequacy of information provided prior to consent in migrant and Australian-born cancer patients, and explored factors associated with being approached and agreeing to participate. METHODS: We utilized data from a larger cross-sectional survey assessing disparities in patient-reported outcomes in Chinese, Arabic, or Greek migrant versus English-speaking Australian-born cancer patients. Participants completed a questionnaire eliciting demographic and disease details, communication challenges, whether invited and consented to a clinical trial, and if so, adequacy of information received. RESULTS: A total of 566 migrants (142 Arabic, 251 Chinese, and 173 Greek) and 270 English-speaking Australian-born patients participated. Overall, 25% were approached to participate in clinical trials, and of these, 74% consented. Migrants were significantly less likely to consent if asked to participate in clinical trials (P = .009), and fewer migrants (67.2%) reported receiving sufficient information prior to deciding on trial participation (82.1%; P = .04). Perceived understanding of the health system (odds ratio [OR] = 0.71), confidence in speaking (OR = 0.75), ability to understand English (OR = 0.80), and communicate with doctors in English (OR = 0.81) were significantly related to patients' likelihood of being approached to participate in clinical trials. Perceived understanding of the health system (OR = 0.66) was significantly associated with patients agreeing to take part in cancer clinical trials. CONCLUSIONS: Our findings identified that barriers to migrants' self-reported participation in clinical trials include perceived lack of understanding of the health system and low English proficiency. Strategies that address these barriers are needed to increase migrant patients' participation in cancer clinical trials.

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OBJECTIVES: This study aimed to describe the levels of health literacy and experience of care coordination among Chinese migrant patients with cancer and their carers in Australia, and to examine factors associated with these. METHODS: Patients' self-reported data were collected using the Health Literacy and Cancer Care Coordination questionnaires. We conducted multivariate linear regression analyses to investigate predictors of patients' health literacy and their care experience. Canonical correlation analysis was used to examine the relationship between patients' health literacy and their care experience. RESULTS: A total of 68 patients and eight carers participated in the survey. Patients and carers reported similar levels of health literacy, with the lowest scores being in the "Having sufficient information to manage health" and "Navigating the health system" subscales. Gender (P = 0.026, partial η2  = 0.281) and educational attainment (P = 0.015, partial η2  = 0.250) had significant and large effects on patients' health literacy, after controlling for each other. Educational attainment showed a significant and medium association with patients' experience of cancer care coordination (P = 0.041, partial η2  = 0.101). A large and positive correlation was found between patients' health literacy and experience of cancer care coordination (canonical correlation = 0.81). CONCLUSIONS: Our findings reveal the health literacy and care coordination needs of Chinese migrant patients with cancer in Australia, especially those with lower educational attainment. Future efforts are necessary to enhance Chinese migrants' health literacy and establish an accessible and easy-to-navigate care environment.

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OBJECTIVES: Chinese migrant cancer survivors and carers face multiple barriers to accessing quality cancer information and support. This study aimed to explore the challenges and unmet needs experienced by the Australian Chinese community affected by cancer, and understand the contexts that hindered optimal care for this community. METHODS: Adult cancer survivors and carers, whose native language is Mandarin or Cantonese, were recruited through community cancer support organizations. Bilingual researchers conducted focus groups with participants in either Mandarin or Cantonese. Focus groups were audio-recorded, transcribed, translated into English and thematically analyzed using qualitative methods. FINDINGS: 62 Chinese-speaking participants (34 cancer survivors and 28 carers) participated in one of the eight focus groups conducted. The three main themes were (1) unmet information and support needs (trust, wellness, and rights); (2) barriers compounding unmet needs (language, health literacy, culture); and (3) participants' recommendations regarding cancer information and support provision. Seven subthemes of unmet needs were also identified: Trust (e.g., communication barriers, health system barriers, comparison regarding the care received), wellness (e.g., cultural differences produce conflict on views about wellness, need for psychological, community, and spiritual support), and rights (e.g., low awareness of financial and legal assistance, other factors increasing or reducing vulnerability). CONCLUSIONS: This study highlights the needs and provides new insights into the impact of language, culture and health literacy barriers on the unmet information and support needs of the Chinese community affected by cancer. The key findings will inform the development of culturally targeted information and support resources for this community.

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OBJECTIVE: The information needs of patients and carers from culturally and linguistically diverse backgrounds, including from the Chinese community, are not well understood, and there has been no previous synthesis of the literature. We conducted a systematic review of the information needs of the Chinese community affected by cancer. METHODS: Database, reference list, and author searches were conducted to identify studies reporting information needs of the Chinese community affected by cancer. Data synthesis was undertaken to define categories of information needs. RESULTS: Initial searches yielded 2558 articles. Out of the 40 full-text articles reviewed, 26 met all the eligibility criteria. Cancer-specific, treatment, and prognosis information were the most frequently reported information needs across the cancer care continuum. Similarly, this information was the most commonly reported information needs across different health systems, migration statuses, and Chinese cultural values. Though less frequent, information needs related to interpersonal/social, financial/legal, and body image/sexuality were also raised. Thirteen studies quantified the prevalence of unmet needs, and the most frequently reported unmet needs were related to health system and information, followed by psychological, patient care and support, physical daily living, and sexuality needs. Language and cultural factors were identified in all studies involving Chinese migrants living in English-speaking countries. CONCLUSIONS: Failing to meet the information needs of the Chinese community members affected by cancer increases the risk for poor cancer outcomes. Potential interventions such as translated resources, bilingual advocates, an online information portal, and communication aids can be helpful in addressing the unmet needs for this community.

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AIMS: Our study sought to optimize the identification and investigate the impact of comorbidity in cancer patients using routinely collected hospitalization data. METHODS: We undertook an iterative process of classification of important clinical conditions involving evaluation of relevant literature and consultation with clinicians. Patients diagnosed with colon, rectal, breast, ovarian, uterine, stomach, liver, renal or bladder cancers (n = 14,096) between 2006 and 2008 were identified from the New Zealand Cancer Registry. Conditions were identified using data on diagnoses from hospital admissions for 5 years prior to cancer diagnosis. Patients were followed up until end of 2009 using routine mortality data. Prevalence estimates for each condition by site were calculated. All-cause mortality impact of common conditions was investigated using Cox regression models adjusted for age and stage at diagnosis. RESULTS: Patients with liver and stomach cancers tended to have higher comorbidity and those with breast cancer, lower comorbidity than other cancer patients. Of the 50 conditions, the most common were hypertension (prevalence 8.0-20.9%), cardiac conditions (2.1-13.5%) and diabetes with (2.3-13.3%) and without (2.9-12.9%) complications. Comorbidity was associated with higher all-cause mortality but the impact varied by condition and across cancer site, with impact less for cancers with poor prognoses. Conditions most consistently associated with adverse outcomes across all cancer sites were renal disease, coagulopathies and congestive heart failure. CONCLUSION: Comorbidity is highly prevalent in cancer populations, but prevalence and impact of conditions differ markedly by cancer type.

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OBJECTIVE: We aimed to develop and validate a pharmacy-based instrument to measure comorbidity among cancer patients. METHODS: Patients diagnosed with colorectal, breast, gynecologic, stomach/liver, or renal/bladder cancers were identified from the New Zealand Cancer Registry between July 2006 and June 2008 for a development cohort (n=14096) and from July 2008 to December 2009 for a validation cohort (n=11014). Nineteen conditions were identified using community pharmaceutical data collected in the year before cancer diagnosis; 10 conditions were validated against hospital record data. A pharmacy-based comorbidity index (PBCI) was developed with each identified condition weighted according to their log hazard ratios from age-adjusted and stage-adjusted Cox regression models with noncancer death as the outcome. For each individual the weights were summed to give a score. Predictive abilities of PBCI were compared with the Charlson and C3 (hospitalization-based) comorbidity indices. RESULTS: Kappa coefficients for conditions identified in notes review compared with pharmaceutical data ranged from 0.83 (diabetes) to 0.26 (anxiety/depression). Correlation coefficients with the Charlson ranged from 0.37 to 0.45 across cancers. All comorbidity indices were significant predictors of mortality, and differences between models were small. The PBCI generally performed as well or better than the Charlson index for predicting noncancer death within all cancer sites and slightly outperformed other indices in predicting noncancer mortality for breast cancer. CONCLUSIONS: The PBCI provides a valid alternative to measuring comorbidity in cancer patients. Researchers can use either hospitalization-based or pharmacy-based comorbidity measures for risk adjustment purposes.

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BACKGROUND: This article presents findings from a prospective, longitudinal cohort educational study investigating empathy communication in clinical consultations. It reports on changes in students' self-report empathy during medical undergraduate training, investigates how well peers can assess student competence in motivational interviewing/brief interventions (MI/BI) skills and explores the relationship between students' self-report empathy and peer- or tutor-assessments of competence. METHODS: 72 medical students completed the Jefferson Scale of Physician Empathy at three time points: at the beginning of their fifth year medical training (Time 1), after a specific MI/BI training session during their fifth year medical training (Time 2) and 1 year later during a revision session in year 6. Competence in BI/MI consultation was assessed using the validated tool Behaviour Change Counselling Index. RESULTS: A significant decline in medical students' empathy scores was observed from year 5 to year 6, consistent with international findings. Peer assessments and tutor ratings of competence in MI/BI skills performance were moderately correlated, but peer assessments were negatively correlated with medical students' self-rated empathy. Senior medical students who self-rated as more empathic received lower competence evaluations of MI/BI skills from their peers. Interventions to further investigate teaching and learning of empathy are discussed.

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INTRODUCTION: Information about the impact of addiction on New Zealand (NZ) families is scarce. A good understanding of the nature and extent of family problems is essential to help families become more resilient and minimise the consequences. This study aimed to explore experiences of NZ families living with addiction, identify impacts on non-addicted family members, their coping strategies and barriers to help seeking. METHODS: Literature and key stakeholder interviews informed the development of an interview schedule for 29 family participants recruited through health and social services. Interviews were recorded for analysis of central themes and critical elements that underpin those. Key stakeholders and informal informants were again consulted to discuss findings and interpretation. FINDINGS: Addiction has widespread effects on NZ families. The coping strategies described by the participants in this project lacked the positive connotations of resilience, namely positive adaptation under significant adversity. CONCLUSION: Family impacts of addiction are complex, and similar family problems arise regardless of the substance(s) involved. This small exploratory study indicates that the implications for NZ families deserve further investigation. Future research is also required to further characterise the impact of behavioural addictions on families, addiction in particular ethnic groupings and the implications of the findings for clinical practice, other social and health services, and for public health and social policy.

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BACKGROUND: The communication of empathy is key in physician-patient interactions. We introduced drama training in "How to act-in-role" to medical students and evaluated the effect of this. METHODS: A quasi-experimental design was employed, with 72 students in the control and 77 students in the intervention group. The students' empathy scores were obtained using the Jefferson Scale of Physician Empathy (JSPE) during the introductory course. Both groups received tutorials in motivational interviewing and brief intervention skills. The students in the intervention group also received training in "How to act-in-role". The JSPE was repeated for both groups. The students subsequently undertook observed structured clinical examinations (OSCE). Both tutors and students evaluated the student's OSCE performance as well as their motivational interviewing skills using the Behavior Change Counseling Index (BECCI). RESULTS: Our findings show that while the students in both groups did not significantly differ in baseline empathy scores, the intervention group reported significantly higher empathy scores post-intervention. The intervention group also received significantly higher tutor ratings for their motivational interviewing (BECCI score) and overall OSCE performances. In conclusion, the teaching innovation "How to act-in-role" was effective not only in increasing medical students' self-reported empathy but also their competence in consultation skills.

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