Lisa Vaccaro

The University of Sydney, Faculty of Health Sciences, Department Member

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Address: Sydney, New South Wales, Australia

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Papers by Lisa Vaccaro

Australian women’s intentions and psychological outcomes related to breast density information

Patient Education and Counseling

Australian General Practitioners’ Current Knowledge, Understanding, and Feelings Regarding Breast Density Information and Notification: A Cross-Sectional Study

International Journal of Environmental Research and Public Health

Background: There is a lack of evidence around Australian general practitioners’ (GPs) views of i... more Background: There is a lack of evidence around Australian general practitioners’ (GPs) views of issues surrounding breast density. The current study aimed to quantitatively assess GPs’ current knowledge, understanding, and feelings around breast density information and notification. Methods: This study involved a cross-sectional survey using an online platform to collect quantitative data from Australian GPs. Survey data were analysed with descriptive statistics. Results: A total 60 responses from GPs were analysed. Most (n = 58; 97%) had heard or read about breast density and nearly 90% (n = 52; 87%) have had discussions about breast density with patients. Three-quarters (n = 45; 75%) were supportive of making breast density notification mandatory for patients with dense tissue and a similar proportion (n = 45/58; 78%) felt they need or want more education on breast density. Conclusions: There is strong support for notifying patients of breast density, and interest in further educa...

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A systematic assessment of online international breast density information

The Breast

Making community-based shared care for depression in cancer a reality: addressing the barriers and facilitators to support sustainable implementation

Australian Women’s Intentions and Psychological Outcomes Related to Breast Density Notification and Information

JAMA Network Open

IMPORTANCE Whether the benefits of notifying women about breast density outweigh the potential ha... more IMPORTANCE Whether the benefits of notifying women about breast density outweigh the potential harms to inform current and future mammogram screening practice remains unknown. OBJECTIVE To assess the effect of mammographic breast density notification and information provision on women's intention to seek supplemental screening and psychological outcomes.

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Immigrants' perceptions of the quality of their cancer care - An Australian comparative study, identifying potentially modifiable factors

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Additional file 3: of Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression

Table S3. Assessment of Bias and Outcomes. (DOCX 16 kb)

Additional file 2: of Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression

Table S2. Reasons for study exclusion from the review at both title and abstract and fulltext scr... more

Additional file 1: of Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression

Table S1. example search strategy PsycINFO search. (DOCX 13 kb)

Estimating survival in advanced cancer: a comparison of estimates made by oncologists and patients

Supportive Care in Cancer, 2019

Purpose To compare estimates of expected survival time (EST) made by patients with advanced cance... more Purpose To compare estimates of expected survival time (EST) made by patients with advanced cancer and their oncologists. Methods At enrolment patients recorded their "understanding of how long you may have to live" in best-case, most-likely, and worst-case scenarios. Oncologists estimated survival time for each of their patients as the "median survival of a group of identical patients". We hypothesized that oncologists' estimates of EST would be unbiased (~50% longer or shorter than the observed survival time [OST]), imprecise (< 33% within 0.67 to 1.33 times OST), associated with OST, and more accurate than patients' estimates of their own survival. Results Twenty-six oncologists estimated EST for 179 patients. The median estimate of EST was 6.0 months, and the median OST was 6.2 months. Oncologists' estimates were unbiased (56% longer than OST), imprecise (27% within 0.67 to 1.33 times OST), and significantly associated with OST (HR 0.88, 95% CI 0.82 to 0.93, p < 0.01). Only 41 patients (23%) provided a numerical estimate of their survival with 107 patients (60%) responding "I don't know". The median estimate by patients for their most-likely scenario was 12 months. Patient estimates of their most-likely scenario were less precise (17% within 0.67 to 1.33 times OST) and more likely to overestimate survival (85% longer than OST) than oncologist estimates. Conclusion Oncologists' estimates were unbiased and significantly associated with survival. Most patients with advanced cancer did not know their EST or overestimated their survival time compared to their oncologist, highlighting the need for improved prognosis communication training. Trial registration ACTRN1261300128871 This research has been presented in part by Smith-Uffen MES, Martin AJ, Johnson SB et al: Estimating survival in advanced cancer: a comparison of estimates made by oncologists and patients.

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The Efficacy of Exposure and Response Prevention for Geriatric Obsessive Compulsive Disorder: A Clinical Case Illustration

License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Obsessive compulsive disorder (OCD) is one of the most frequently occurring psychiatric conditions in older adults. While exposure and response prevention (ERP) is considered the most effective psychological treatment for children and adults with OCD, research investigating its effectiveness for older adults is scarce. This clinical case study investigates the effectiveness of ERP in an 80-year-old man with a 65-year history of OCD. The client received 14 individual, 50-minute ERP treatment sessions. Clinician-based Y-BOCS scores reduced by 65 % from 20 (moderate) at pretreatment to 7 (subclinical) at 7-month posttreatment followup. OCI-R total scores reduced by 45 % from 38 at baseline to 21 at 7-month follow-up. Despite his long history of the disorder, ERP was effective and well tolerated. The application of ERP for older adults with OCD, including ...

Prevalence and management of adjustment disorder in cancer patients

Building bridges: addressing the barriers and facilitators to support sustainable implementation of community-based shared care for depression in cancer

Successful treatment of an 80-year old man with a 65 year history of obsessivecompulsive disorder: A case study

It's about our bodies… we have the right to know this stuff": A qualitative focus group study on Australian women's perspectives on breast density

OBJECTIVE This study aimed to explore Australian women's current knowledge, perspectives and ... more OBJECTIVE This study aimed to explore Australian women's current knowledge, perspectives and attitudes about breast density (BD); and information needs to inform effective evidence-based communication strategies. METHODS Fourteen online focus group sessions with a total of 78 women in New South Wales and Queensland, Australia aged 40-74 years without a personal diagnosis of breast cancer were conducted. Audio-recorded data was transcribed and analysed thematically. RESULTS Women had a very limited knowledge of BD. Overall, women expressed a preference for more frequent mammograms and/or supplemental screening should they be told they had dense breasts, despite being presented with information on potential downsides of additional testing. The majority of women were supportive of the notion of BD notification, often suggesting they had a 'right to know' and they would prefer to be educated and informed about it. CONCLUSION The potential of being informed and notified of BD...

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Exploring the nature of obsessive compulsive checking

While people with Obsessive Compulsive Disorder (OCD) may present with a range of obsessions and ... more While people with Obsessive Compulsive Disorder (OCD) may present with a range of obsessions and compulsions, for many, excessive, ritualised, time consuming checking behaviours and related obsessions are dominant expressions of the condition (e.g. Fullana et al., 2009; Samuels et al., 2006). Sub-typing by predominant symptom presentation has been suggested to be important since qualitative differences between OCD subtypes mean that when conducting research into the origin, nature and treatment of OCD, findings may not be generalisable across the different subtypes (McKay et al., 2004). In this study we investigated the nature of Obsessive-Compulsive Checking (OC-Ch) by examining the type and frequency of obsessions and compulsions experienced in a large sample of people diagnosed with this subtype. As part of a comprehensive pre-treatment assessment the Yale-Brown Obsessive Compulsive Scale and checklist (Goodman et al., 1989) were administered to 50 people with OC-Ch subtype. Addi...

Is care really shared: a systematic review of collaborative care interventions for adult cancer patients suffering from depression

Background: Collaborative care involves active engagement of primary care and hospital physicians... more Background: Collaborative care involves active engagement of primary care and hospital physicians in shared care of patients beyond usual discharge summaries. This enhances community-based care and reduces dependence on specialists and hospitals. The model, successfully implemented in chronic care management, may have utility for treatment of depression in cancer. The aim of this systematic review was to identify components, delivery and roles and responsibilities within collaborative interventions for depression in the context of cancer. Methods: Medline, PsycINFO, CINAHL, Embase, Cochrane Library and Central Register for Controlled Trials databases were searched to identify studies of randomised controlled trials comparing a treatment intervention that met the definition of collaborative model of depression care with usual care or other control condition. Studies of adult cancer patients with major depression or a non-bipolar depressive disorder published in English between 2005 and January 2018 were included. Cochrane checklist for risk of bias was completed (Study Prospero registration: CRD42018086515). Results: Of 8 studies identified, none adhered to the definition of 'collaborative care'. Interventions delivered were multidisciplinary , with care coordinated by nurses (n = 5) or social workers (n = 2) under the direction of psychiatrists (n = 7). Care was primarily delivered in cancer centres (n = 5). Care coordinators advised primary care physicians (GPs) of medication changes (n = 3) but few studies (n = 2) actively involved GPs in medication prescribing and management. Conclusions: This review highlighted joint participation of GPs and specialist care physicians in collaborative care depression management is promoted but not achieved in cancer care. Current models reflect hospital-based multidisciplinary models of care. Protocol registration: The protocol for this systematic review has been registered with PROSPERO. The registration number is CRD42018086515.

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The Efficacy of Self-Administered Danger Ideation Reduction Therapy for a 50-year Old Woman with a 20 Year History of Obsessive- Compulsive Disorder: A Case Study

World Academy of Science, Engineering and Technology, International Journal of Social, Behavioral, Educational, Economic, Business and Industrial Engineering, 2012

Obsessive-Compulsive Disorder (OCD) is a common and disabling condition. Therapist-delivered trea... more Obsessive-Compulsive Disorder (OCD) is a common and disabling condition. Therapist-delivered treatments that use exposure and response prevention have been found to be very effective in treating OCD, although they are costly and associated with high rates of attrition. Effective treatments that can be made widely available without the need for therapist contact are urgently needed. This case study represents the first published investigation of a self-administered cognitive treatment for OCD in a 50-year old female with a 20 year history of OCD. The treatment evaluation occurred over 27 weeks, including 12 weeks of self-administration of the Danger Ideation Reduction Therapy (DIRT) program. Decreases of between 23% to 33% on measures from pre-treatment to follow-up were observed. Bearing in mind the methodological limitations associated with a case study, we conclude that the results reported here are encouraging and indicate that further research effort evaluating the effectiveness...

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Danger Ideation Reduction Therapy

This article presents a brief description of the expectancy model that underpins Danger Ideation ... more This article presents a brief description of the expectancy model that underpins Danger Ideation Reduction Therapy and outlines the empirical findings related to this account. It also provides a description of the treatment components of the two Danger Ideation Reduction Therapy (DIRT) packages that have been developed; DIRT for Obsessive Compulsive Washing (OC-W) and the more recently developed DIRT package for people with Obsessive Compulsive Checking (OC-C). The therapeutic effectiveness of DIRT for OC-W and DIRT for OC-C will be discussed by reviewing the treatment trials that have been conducted to date.

Fidelity is fundamental: intervention predictors in advance care plans in terminal cancer

BMJ Supportive & Palliative Care

ObjectivesAssessing whether interventions are implemented as intended (fidelity) is critical to e... more ObjectivesAssessing whether interventions are implemented as intended (fidelity) is critical to establishing efficacy in clinical research yet rarely applied in advance care planning (ACP) interventions. We aimed to develop and implement a fidelity audit tool for an ACP intervention.MethodsWe developed a fidelity audit tool assessing: (A) content; (B) quality (general communication, eliciting EOL preferences and prognostic communication); and (C) family/caregiver involvement. We audited (double-coded) 55 audio-recordings of ACP discussions delivered to advanced cancer patients and caregivers, within a clinical trial.ResultsFidelity to content was high: mean=9.38/11 but lower for the quality of general communication (mean=12.47/20), discussion of patient preferences (mean=4.67/7), prognosis (mean=3.9/6) and family/caregiver involvement (mean=2.67/4). Older patient age and caregiver religiosity were associated with higher fidelity. Higher fidelity to content was associated with the tr...

Australian women’s intentions and psychological outcomes related to breast density information

Patient Education and Counseling

Australian General Practitioners’ Current Knowledge, Understanding, and Feelings Regarding Breast Density Information and Notification: A Cross-Sectional Study

International Journal of Environmental Research and Public Health

Download

A systematic assessment of online international breast density information

The Breast

Making community-based shared care for depression in cancer a reality: addressing the barriers and facilitators to support sustainable implementation

Australian Women’s Intentions and Psychological Outcomes Related to Breast Density Notification and Information

JAMA Network Open

Download

Immigrants' perceptions of the quality of their cancer care - An Australian comparative study, identifying potentially modifiable factors

Download

Additional file 3: of Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression

Table S3. Assessment of Bias and Outcomes. (DOCX 16 kb)

Additional file 2: of Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression

Table S2. Reasons for study exclusion from the review at both title and abstract and fulltext scr... more

Additional file 1: of Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression

Table S1. example search strategy PsycINFO search. (DOCX 13 kb)

Estimating survival in advanced cancer: a comparison of estimates made by oncologists and patients

Supportive Care in Cancer, 2019

Download

The Efficacy of Exposure and Response Prevention for Geriatric Obsessive Compulsive Disorder: A Clinical Case Illustration

Prevalence and management of adjustment disorder in cancer patients

Building bridges: addressing the barriers and facilitators to support sustainable implementation of community-based shared care for depression in cancer

Successful treatment of an 80-year old man with a 65 year history of obsessivecompulsive disorder: A case study

It's about our bodies… we have the right to know this stuff": A qualitative focus group study on Australian women's perspectives on breast density

Download

Exploring the nature of obsessive compulsive checking

Is care really shared: a systematic review of collaborative care interventions for adult cancer patients suffering from depression

Download

The Efficacy of Self-Administered Danger Ideation Reduction Therapy for a 50-year Old Woman with a 20 Year History of Obsessive- Compulsive Disorder: A Case Study

World Academy of Science, Engineering and Technology, International Journal of Social, Behavioral, Educational, Economic, Business and Industrial Engineering, 2012

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Danger Ideation Reduction Therapy

Fidelity is fundamental: intervention predictors in advance care plans in terminal cancer

BMJ Supportive & Palliative Care

Lisa Vaccaro

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