RECRUITING COMMUNITY-DWELLING LIVE-ALONE PERSONS WITH DEMENTIA: AN EXPLORATION OF FIVE GATEKEEPER DOMAINS

Although recruiting persons with dementia into research is challenging enough, finding those who live-alone in the community is even more difficult. Consequently, live-alone persons with dementia are often overlooked and/or deliberately excluded from inquiry despite calls for more inclusive approaches to dementia research. Based on enrollment strategies from an interview-based protocol recruiting 120 live-alone persons with dementia, our National Institute on Aging- funded study identified five domains of gatekeepers imperative to gaining access to community-dwelling, live-alone persons with dementia: 1) housing (e.g., service coordinators), 2) data proprietors (e.g., regulatory specialists), 3) institutional (e.g., review boards), 4) kin (including fictive kin), 5) clinical (e.g., medical providers, clinician practices). In addition, gatekeeper domains are multilayered and serve distinct roles in both facilitating and hindering access to and enrollment of this under-researched vulnerable population. Analysis of our recruitment efforts contribute significant insights into how the dementia research community may engage the various domains of community gatekeepers, providing direction for current and future social science research.

Radiation oncology outpatient medication management needs and service gaps – A cross-sectional study of patients and clinicians

Background Patients receiving radiotherapy for the treatment of cancer can have complex medication requirements related to the management of side-effects and impaired swallowing ability. This study surveyed patients and clinicians to identify service gaps and unmet medication management needs. Methods Patient and clinician surveys were developed by a multidisciplinary team based on previously validated questionnaires. The patient survey focused on medication use and adherence. The clinician survey was based around a clinical case study and focused on identifying service gaps and practice variations. This survey was disseminated to radiation oncologists, pharmacists and nurses involved with the care of head and neck or lung cancer patients in Victoria. Results A total of 93 surveys were completed including 53 patient surveys and 40 clinician surveys. Radiotherapy patients reported high medication usage with up to 53% taking five or more medications daily. When asked the same set of questions relating to medication education requirements, patients receiving polypharmacy reported greater needs (72%) than recognised by the surveyed multidisciplinary clinician group (58%). They also reported a non-adherence rate of 46%. In addition, further disparities were identified in clinician practices and their approach to clinical situations which may result in conflicting advice and confusion for patients. Conclusion While recognising deficiencies relating to the provision of medication information, oncologists, nurses and pharmacists underestimated patient needs for medication information, education and follow-up. Findings support the rationale for integration of pharmacy services within the radiotherapy clinics to support patient care and bridge service gaps relating to medication management.