title: How do colorectal cancer patients rate their GP: a mixed methods study

authors: Blackmore, Tania Louise

subjects: Science & Technology

abstract: Background: New Zealand (NZ) has a high incidence of colorectal cancer (CRC) and low rates of early diagnosis. With screening not yet nationwide, the majority of CRC is diagnosed through general practice. A good patient-general practitioner (GP) relationship can facilitate prompt diagnosis, but when there is a breakdown in this relationship, delays can occur. Delayed diagnosis of CRC in NZ receives a disproportionally high number of complaints directed against GPs, suggesting deficits in the patient-GP connection. We aimed to investigate patient-reported confidence and ratings of their GP following the diagnostic process. 
Methods: This study is a mixed methods analysis of responses to a structured questionnaire and free text comments from patients newly diagnosed with CRC in the Midland region of NZ. A total of 195 patients responded to the structured questionnaire, and 113 patients provided additional free text comments. Descriptive statistics were used to describe the study population and chi square analysis determined the statistical significance of factors possibly linked to delay. Free text comments were analysed using a thematic framework. 
Results: Most participants rated their GP as ‘Very good/Good’ at communication with patients about their health conditions and involving them in decisions about their care, and 6.7% of participants rated their overall level of confidence and trust in their GP as ‘Not at all’. Age, gender, ethnicity and a longer diagnostic interval were associated with lower confidence and trust. Free text comments were grouped in to three themes: 1. GP Interpersonal skills; (communication, listening, taking patient symptoms seriously), 2. Technical competence; (speed of referral, misdiagnoses, lack of physical examination), and 3. Organisation of general practice care; (appointment length, getting an appointment, continuity of care). 
Conclusions: Māori, females, and younger participants were more likely to report low confidence and trust in their GP. Participants associate a poor diagnostic experience with deficits in the interpersonal and technical skills of their GP, and health system factors within general practice. Short appointment times, access to appointments and poor GP continuity are important components of how patients assess their experience and are particularly important to ensure equal access for Māori patients.

text: How do colorectal cancer patients rate their GP: a mixed methods study Background: New Zealand (NZ) has a high incidence of colorectal cancer (CRC) and low rates of early diagnosis. With screening not yet nationwide, the majority of CRC is diagnosed through general practice. A good patient-general practitioner (GP) relationship can facilitate prompt diagnosis, but when there is a breakdown in this relationship, delays can occur. Delayed diagnosis of CRC in NZ receives a disproportionally high number of complaints directed against GPs, suggesting deficits in the patient-GP connection. We aimed to investigate patient-reported confidence and ratings of their GP following the diagnostic process. 
Methods: This study is a mixed methods analysis of responses to a structured questionnaire and free text comments from patients newly diagnosed with CRC in the Midland region of NZ. A total of 195 patients responded to the structured questionnaire, and 113 patients provided additional free text comments. Descriptive statistics were used to describe the study population and chi square analysis determined the statistical significance of factors possibly linked to delay. Free text comments were analysed using a thematic framework. 
Results: Most participants rated their GP as ‘Very good/Good’ at communication with patients about their health conditions and involving them in decisions about their care, and 6.7% of participants rated their overall level of confidence and trust in their GP as ‘Not at all’. Age, gender, ethnicity and a longer diagnostic interval were associated with lower confidence and trust. Free text comments were grouped in to three themes: 1. GP Interpersonal skills; (communication, listening, taking patient symptoms seriously), 2. Technical competence; (speed of referral, misdiagnoses, lack of physical examination), and 3. Organisation of general practice care; (appointment length, getting an appointment, continuity of care). 
Conclusions: Māori, females, and younger participants were more likely to report low confidence and trust in their GP. Participants associate a poor diagnostic experience with deficits in the interpersonal and technical skills of their GP, and health system factors within general practice. Short appointment times, access to appointments and poor GP continuity are important components of how patients assess their experience and are particularly important to ensure equal access for Māori patients.

year: 2021-04-08

title: Ha ora: Improving access to early diagnosis of lung cancer for Maori and rural communities. Understanding patient experiences in General Practice

authors: Lawrenson, Ross

abstract: There were two main objectives for this report. The first was to identify the barriers to early diagnosis of lung cancer experienced by Māori lung cancer patients and whānau. Second was to co-design a multi-pronged intervention alongside rural Māori communities to improve early diagnosis of lung cancer for whānau in their localities.
The team worked in the Waikato, Lakes, Bay of Plenty and Tairāwhiti districts of the Midland Region. Semi-structured interviews were carried out with 23 Māori lung cancer patients and whānau recruited through respiratory or cancer nurse specialists (CNSs) based at the hospitals of each district. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities: Te Kuiti, Opōtiki, Te Kaha, Rotorua and Gisborne. Community hui included cancer patients, whānau, and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Study data were thematically analysed.
Findings of the study highlight:
1. Barriers in primary care, including symptom ambiguity, accumulating costs, barriers and enablers relating to GP – patient relationships
2. Barriers in secondary care, including a lack of access to diagnostic tests, long waiting times, barriers and enablers relating to communication between HCPs and patients.
3. The importance of whānau as carers and advocates for Māori patients on their lung cancer journey.
The interventions co-designed with each community included a Hā Ora website, a series of lung cancer awareness videos (entitled ‘wharo wharo wharo’), a kaiawhina training programme and a ‘pou pupuru oranga’ (cancer navigator).
We suggest strategies that aim to improve early diagnosis of lung cancer for rural Māori communities. We welcome your feedback to us regarding these recommendations.

text: Ha ora: Improving access to early diagnosis of lung cancer for Maori and rural communities. Understanding patient experiences in General Practice There were two main objectives for this report. The first was to identify the barriers to early diagnosis of lung cancer experienced by Māori lung cancer patients and whānau. Second was to co-design a multi-pronged intervention alongside rural Māori communities to improve early diagnosis of lung cancer for whānau in their localities.
The team worked in the Waikato, Lakes, Bay of Plenty and Tairāwhiti districts of the Midland Region. Semi-structured interviews were carried out with 23 Māori lung cancer patients and whānau recruited through respiratory or cancer nurse specialists (CNSs) based at the hospitals of each district. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities: Te Kuiti, Opōtiki, Te Kaha, Rotorua and Gisborne. Community hui included cancer patients, whānau, and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Study data were thematically analysed.
Findings of the study highlight:
1. Barriers in primary care, including symptom ambiguity, accumulating costs, barriers and enablers relating to GP – patient relationships
2. Barriers in secondary care, including a lack of access to diagnostic tests, long waiting times, barriers and enablers relating to communication between HCPs and patients.
3. The importance of whānau as carers and advocates for Māori patients on their lung cancer journey.
The interventions co-designed with each community included a Hā Ora website, a series of lung cancer awareness videos (entitled ‘wharo wharo wharo’), a kaiawhina training programme and a ‘pou pupuru oranga’ (cancer navigator).
We suggest strategies that aim to improve early diagnosis of lung cancer for rural Māori communities. We welcome your feedback to us regarding these recommendations.

year: 2021

title: Ecological and physical characteristics of the Te Awa O Katapaki Stream, Flagstaff, Waikato

authors: Hicks, Brendan J.

subjects: Te Awa O Katapaki Stream

abstract: 1. The fish, macroinvertebrates, aquatic vegetation, and water quality indicate that the Te Awa O Katapaki Stream is an unpolluted, pastureland stream that is typical of the Waikato region.
2. The stream has very high nutrient concentrations that probably result from the dairy farming upstream.
3. The fish fauna is dominated by the native shortfinned eels. The presence of the migratory common smelt indicates that swimming fish species also have free access to the stream from the Waikato River.
4. Fish of high conservation value, such as giant or banded kokopu (Galaxias argenteus or G. fasciatus) were absent, which is predictable given the warm, unshaded nature of the stream.
5. Fish and invertebrates would soon recolonise the restored stream following any work in the streambed.

text: Ecological and physical characteristics of the Te Awa O Katapaki Stream, Flagstaff, Waikato 1. The fish, macroinvertebrates, aquatic vegetation, and water quality indicate that the Te Awa O Katapaki Stream is an unpolluted, pastureland stream that is typical of the Waikato region.
2. The stream has very high nutrient concentrations that probably result from the dairy farming upstream.
3. The fish fauna is dominated by the native shortfinned eels. The presence of the migratory common smelt indicates that swimming fish species also have free access to the stream from the Waikato River.
4. Fish of high conservation value, such as giant or banded kokopu (Galaxias argenteus or G. fasciatus) were absent, which is predictable given the warm, unshaded nature of the stream.
5. Fish and invertebrates would soon recolonise the restored stream following any work in the streambed.

year: 2001