HighlightsTelehealth serviced a range of ages, cancer diagnoses and treatment intents.Tele-radiation oncology consultations reduced travel and time burden for patients.Patients reported an overall high level of satisfaction with telehealth consultation.

Implementation of the QReCS model across a large geographic region is feasible with acceptable safety profiles. Leadership by and collaboration among clinicians and managers, adequacy of resources and common governance are key enablers.

BackgroundLung cancer referral pathways aim to reduce delays and improve referral patterns of people with suspected lung cancer.AimAs part of implementing a lung cancer referral pathway at a regional Australian hospital, this study aimed to explore the experiences and perceptions of people with lung cancer and their carers.MethodsIn‐depth interviews were used to elicit data for thematic analysis in this cross‐sectional descriptive qualitative study. Patients with newly diagnosed lung cancer and their carers at a regional academic cancer centre were invited to participate in interviews. Five interviews were conducted face‐to‐face, and 14 interviews were conducted by telephone (as per interviewee preference). Interviews were audiorecorded, transcribed and qualitatively analysed. Descriptive phrases were used to generate initial inductive codes and themes.ResultsNineteen participants approached agreed to take part in the study. Factors that positively impacted the care experience were good communication, timeliness and patient advocacy and support. Improper communication, long waiting times for investigations and appointments, uncertainty about the process and inconsistent advice from providers negatively impacted the care experience. Participants preferred face‐to‐face or video‐linked consultations over telephone consultations.ConclusionsUnderstanding the experiences of rural and regional patients and carers with the lung cancer referral pathway is important to improve quality of care. Implementing changes to the referral pathway to improve patient and carer experiences needs to be an ongoing quality improvement exercise.

Background: Research is central to high functioning health services alongside clinical care and health professional training. The impact of embedded research includes delivery of high-quality care and improved patient outcomes. Evaluations of research impact help health service leadership ensure investments lead to the greatest healthcare benefits for patients. This study aimed to retrospectively evaluate the impact of research investment from 2008 to 2018 at Townsville Hospital and Health Service (THHS), a regional Hospital and Health Service in Queensland, Australia. The evaluation also sought to identify contextual conditions that enable or hinder intended impacts. Methods: A mixed-methods realist-informed evaluation was conducted using documentation, interviews with 15 staff and available databases to identify and measure research investments, impacts and contextual conditions influencing impact outcomes. Results: Between 2008 and 2018, THHS increased resources for research by funding research projects, employing research personnel, building research-enabling facilities, hosting research events, and providing research education and training. Clinical practice, policy and workforce impacts were successful in isolated pockets, championed by individual researchers and facilitated by their policy and community-of-practice networks. However, there was little organisational-level support for continuity of research and implementation into practice and policy. Availability of research supports varied geographically across THHS, and across disciplines. Conclusion: Definitive steps in the development of THHS as a credible and productive research centre and leading hospital research centre in Northern Australia are evident. Continuing investments should address support for the research continuum through to translation and establish ongoing, systematic processes for evaluating research investment and impact.

Background: Health systems in Australia and worldwide are increasingly expected to conduct research and quality improvement activities in addition to delivering clinical care and training health professionals. This study aims to inform a research impact evaluation at a regional Australian Hospital and Health Service by developing a programme theory showing how research investment is expected to have impact. Methods: This qualitative study, representing the first phase of a larger mixed methods research impact evaluation at the Townsville Hospital and Health Service (THHS), adopts a realist-informed design involving the development of a programme theory. Data were obtained between February and May 2019 from strategic documentation and interviews with six current and former health service executives and senior employees. Inductive themes were integrated into a conceptual framework to visually represent the programme theory.Results: Research at THHS has developed organically as the service has matured into a regional tertiary referral service serving a diverse rural and remote population across northern Queensland. Throughout this journey, individual THHS leaders often adopted a research development mantle despite disincentives arising from a performance-driven reporting and activity-based funding service context. Impact expectations from research investment at THHS were identified in the categories of enhanced research activity and capacity among clinicians, and improved clinical practice, health workforce capability and stability, and patient and population health. Seven contextual factors were identified as potential enablers or obstacles to these impact expectations and ambitions.Conclusions: By identifying both relevant impact types and key contextual factors, this study offers programme theory to inform a planned research impact evaluation at THHS. The conceptual framework may be useful in other regionally based health service settings. More broadly, there are opportunities for future research to test and refine hybrid versions of linear and realist research impact evaluation models that combine resource-intensive, theory-driven approaches with policy practicality.

No abstract

Introduction Patient experiences and preferences of image‐guidance procedures in prostate cancer radiotherapy are largely unknown. This study explored experiences and preferences of patients undergoing both fiducial marker (FM) insertion and Clarity ultrasound (US) procedures. Methods A sequential explanatory mixed method approach was used. A questionnaire (n = 40) ranked experiences from 0 to 10 (worst) in the domains of invasiveness; pain; physical discomfort; and psychological discomfort. Responses were analysed with descriptive and inferential statistics. Semi‐structured interviews (n = 22) obtained further insights into their perspectives and preferences and were thematically analysed. Results Perceptions of invasiveness varied with 46% reporting FMs more invasive than US and 49% the same for the two procedures. The mean score for FM was 3.6 and 2.1 for US. Mean scores for pain, physical and psychological discomfort were higher for FMs with 3.3, 3.2 and 2.9, respectively, and 1.1, 1.2 and 1.7 respectively for US, only pain achieved significance (P < 0.05). Three themes emerged from the interviews: Expectations versus Experience; Preferences linked to Priorities; and Motivations. Eleven patients (50%) preferred US; however, 10 (45%) could not illicit a preference. Conclusion Participants found both of the FM and US image‐guidance procedures tolerable and acceptable. Men’s preference was elusive, suggesting a more rigorous preference methodology is required to understand preferences in this population.

To compare the parenting and career patterns of female and male gynecology subspecialists. Design: Cross-sectional survey study (Canadian Task Force classification II-3). Setting: Survey administered electronically in February 2015 to physician members of the Society of Gynecologic Oncology, the American Society for Reproductive Medicine, and the American Urogynecologic Society. Participants: All physician members of the 3 national gynecology subspecialty organizations listed above. Measurements and Main Results: There were 75 questions in 4 domains: demographics, mentoring issues, work−life balance, and caregiving responsibilities. Data were analyzed for survey sampling weights. Six hundred seventy-seven physicians completed the survey, 62% of whom were women (n = 420; 20.2% response rate). Sixty-four percent were aged 36 to 55 years. Eighty-two percent of respondents had at least 1 child, and men had more children than women (42% of men had 3 or more children compared with 20% of women, p <.0001). Thirty-seven percent of women reported that career plans affected the decision to become a parent somewhat or very much compared with 23% of men (p = .0006). Eighty-three percent of women believed career affected the timing of becoming a parent somewhat or very much compared with 48% of men (p <.0001). In addition, 76% of female physicians perceived that having children decreased their academic productivity compared with 54% of male physicians (p <.0001). Most men and women believed having children had no effect or increased their clinical performance (76% and 65%, respectively), but this was significantly lower in women (p = .01). Conclusion: Female gynecology subspecialists perceive that their career impacted decisions on parenting more frequently than their male counterparts. They were also more likely than men to report that having children had a negative impact on academic and, to a lesser extent, clinical performance. Increased support for combining childbirth and parenting with training and academic careers is needed.