The EMPOWER programme appears to be both acceptable and valued by targeted parents and a potentially effective means of supporting high-risk families to prevent their children from developing obesity. An exploratory randomized controlled trial is now underway to ascertain the feasibility of conducting a definitive phase 3 trial.
BackgroundThe Australian Cancer Trials website (ACTO) was publicly launched in 2010 to help people search for cancer clinical trials recruiting in Australia, provide information about clinical trials and assist with doctor-patient communication about trials. We describe consumer involvement in the design and development of ACTO and report our preliminary patient evaluation of the website.MethodsConsumers, led by Cancer Voices NSW, provided the impetus to develop the website. Consumer representative groups were consulted by the research team during the design and development of ACTO which combines a search engine, trial details, general information about trial participation and question prompt lists. Website use was analysed. A patient evaluation questionnaire was completed at one hospital, one week after exposure to the website.ResultsACTO's main features and content reflect consumer input. In February 2011, it covered 1, 042 cancer trials. Since ACTO's public launch in November 2010, until the end of February 2011, the website has had 2, 549 new visits and generated 17, 833 page views. In a sub-study of 47 patient users, 89% found the website helpful for learning about clinical trials and all respondents thought patients should have access to ACTO.ConclusionsThe development of ACTO is an example of consumers working with doctors, researchers and policy makers to improve the information available to people whose lives are affected by cancer and to help them participate in their treatment decisions, including consideration of clinical trial enrolment. Consumer input has ensured that the website is informative, targets consumer priorities and is user-friendly. ACTO serves as a model for other health conditions.
BackgroundCurrent international consensus is that ‘early’ referral to palliative care services improves cancer patient and family carer outcomes; however, in practice, these referrals are not routine. Uncertainty about the ‘best time’ to refer has been highlighted as contributing to care variation. Previous work has identified clear disease-specific transition points in the cancer illness which heralded subsequent poor prognosis (less than 6 months) and which, we contest, represent times when palliative care should be routinely introduced as a standardised approach, if not already in place, to maximise patient and carer benefit. This protocol details a trial that will test the feasibility of a novel standardised outpatient model of early palliative care [Standardised Early Palliative Care (STEP Care)] for advanced cancer patients and their family carers, with referrals occurring at the defined disease-specific evidence-based transition points.The aims of this study are to (1) determine the feasibility of conducting a definitive phase 3 randomised trial, which evaluates effectiveness of STEP Care (compared to usual best practice cancer care) for patients with advanced breast or prostate cancer or high grade glioma; (2) examine preliminary efficacy of STEP Care on patient/family caregiver outcomes, including quality of life, mood, symptoms, illness understanding and overall survival; (3) document the impact of STEP Care on quality of end-of-life care; and (4) evaluate the timing of palliative care introduction according to patients, families and health care professionals.MethodsPhase 2, multicenter, open-label, parallel-arm, randomised controlled trial (RCT) of STEP Care plus standard best practice cancer care versus standard best practice cancer care alone.DiscussionThe research will test the feasibility of standardised palliative care introduction based on illness transitions and provide guidance on subsequent development of phase 3 studies of integration. This will directly address the current uncertainty about palliative care timing.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12617000534381.
Most of the papers in this issue speak, one way or another, to the question of how physical activity is, or might be, related to the built environment. This question was at the heart of a recent National Research Council (NRC) a study, which culminated in the report, Does the Built Environment Influence Physical Activity?: Examining the Evidence. 1 The study was motivated by deep concern, especially within the public health community, about the lack of sufficient participation in physical activity among Americans and by curiosity about the extent to which changes to the built environment might help to increase levels of activity. The NRC study highlighted the pressing need for research along several lines if the built environment-physical activity relationship is to be understood sufficiently well to know if and how changes in the built environment might effect large-enough changes in population-level physical activity to be worth the cost of making such changes. My goals in this brief commentary are first, to provide an overview of the NRC study and its recommendations and second, to assess the ways in which the papers in this issue help to close the research gaps that the NRC study identified. The NRC Study In 2002, the Robert Wood Johnson Foundation (RWJF) and the Centers for Disease Control and Prevention (CDC) requested the NRC to conduct a study on physical activity and the built environment. The NRC study process is well established within the National Academies. Following the formation of a committee of experts, a study committee deliberates and prepares a report summarizing its findings, conclusions, and recommendations. Reports are published only after an extensive review process. In their deliberations, committee members are instructed to separate fact from opinion and analysis from advocacy, to apply rigorous standards of evidence, and to reach consensus if possible. In response to the request from the RWJF and CDC, the Transportation Research Board (TRB) and Institute of Medicine (IOM) formed the Committee on Physical Activity, Transportation, and Land Use, a committee of 14 experts
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.