Davina Porock

Background: Clinician predicted survival for cancer patients is often inaccurate, and prognostic tools may be helpful, such as the Palliative Prognostic Index (PPI). The PPI development study reported that when PPI score is greater than 6, it predicted survival of less than 3 weeks with a sensitivity of 83% and specificity of 85%. When PPI score is greater than 4, it predicts survival of less than 6 weeks with a sensitivity of 79% and specificity of 77%. However, subsequent PPI validation studies have evaluated various thresholds and survival durations, and it is unclear which is most appropriate for use in clinical practice. With the development of numerous prognostic tools, it is also unclear which is most accurate and feasible for use in multiple care settings. Aim: We evaluated PPI model performance in predicting survival of adult cancer patients based on different thresholds and survival durations and compared it to other prognostic tools. Design: This systematic review and meta-analysis was registered in PROSPERO (CRD42022302679). We calculated the pooled sensitivity and specificity of each threshold using bivariate random-effects meta-analysis and pooled diagnostic odds ratio of each survival duration using hierarchical summary receiver operating characteristic model. Meta-regression and subgroup analysis were used to compare PPI performance with clinician predicted survival and other prognostic tools. Findings which could not be included in meta-analyses were summarised narratively. Data sources: PubMed, ScienceDirect, Web of Science, CINAHL, ProQuest and Google Scholar were searched for articles published from inception till 7 January 2022. Both retrospective and prospective observational studies evaluating PPI performance in predicting survival of adult cancer patients in any setting were included. The Prediction Model Risk of Bias Assessment Tool was used for quality appraisal. Results: Thirty-nine studies evaluating PPI performance in predicting survival of adult cancer patients were included ( n = 19,714 patients). Across meta-analyses of 12 PPI score thresholds and survival durations, we found that PPI was most accurate for predicting survival of <3 weeks and <6 weeks. Survival prediction of <3 weeks was most accurate when PPI score>6 (pooled sensitivity = 0.68, 95% CI 0.60–0.75, specificity = 0.80, 95% CI 0.75–0.85). Survival prediction of <6 weeks was most accurate when PPI score>4 (pooled sensitivity = 0.72, 95% CI 0.65–0.78, specificity = 0.74, 95% CI 0.66–0.80). Comparative meta-analyses found that PPI performed similarly to Delirium-Palliative Prognostic Score and Palliative Prognostic Score in predicting <3-week survival, but less accurately in <30-day survival prediction. However, Delirium-Palliative Prognostic Score and Palliative Prognostic Score only provide <30-day survival probabilities, and it is uncertain how this would be helpful for patients and clinicians. PPI also performed similarly to clinician predicted survival in predicting <30-day survival. However, these findings should be interpreted with caution as limited studies were available for comparative meta-analyses. Risk of bias was high for all studies, mainly due to poor reporting of statistical analyses. while there were low applicability concerns for most (38/39) studies. Conclusions: PPI score>6 should be used for <3-week survival prediction, and PPI score>4 for <6-week survival. PPI is easily scored and does not require invasive tests, and thus would be easily implemented in multiple care settings. Given the acceptable accuracy of PPI in predicting <3- and <6-week survival and its objective nature, it could be used to cross-check clinician predicted survival especially when clinicians have doubts about their own judgement, or when clinician estimates seem to be less reliable. Future studies should adhere to the reporting guidelines and provide comprehensive analyses of PPI model performance.

e20540 Background: Physical activity (PA) in prostate cancer (PC) survivors improves general QOL and fatigue, but the relationship between PA and genitourinary symptoms in PC survivors is unknown. The incidence of sexual dysfunction may be as high as 68% during active surveillance and 78% in men receiving conventional therapies. PA has mitigated erectile dysfunction in non-prostate cancer populations. Objective: To determine the relationships among PA, age, co-morbidities, mental and physical health and symptoms, particularly related to sexual dysfunction, experienced by men with PC prior to therapy. Methods: Study Design: Correlational/cross sectional secondary analysis of de-identified data from 258 men with early stage PC prior to initiation of therapy. Variables: Habitual PA (Baecke Questionnaire- BAQ), physical (PCS) and mental health (MCS) (SF-36) and urinary, bowel and sexual dysfunctional symptoms (UCLA Prostate Cancer Index). Analysis: Descriptive statistics; correlations; hierarchical regressions to assess moderating and mediating relationships. Results: Mean Age = 63.2 + 8.1 yrs. BAQ activity scores, ranged from 2.2 to 12.1 (M and SD= 6.8+1.9), indicating low levels of PA. PCI mean scores = 92+13, urinary; 88 +13, bowel; 52 +29 for sexual. PA was negatively correlated with sexual symptoms (r=0.31; p<0.001). Physical health was negatively associated with all symptoms and age, but positively correlated with PA (r=0.21; p=0.001). Physical health mediates effects of age for urinary symptoms and partially for sexual symptoms. PA’s relationship to sexual dysfunctional symptoms was independent of age and was at least partially mediated by physical health. Conclusions: Urinary, bowel and sexual symptoms experienced by men at time of diagnosis were similar to men of similar age without PC, indicating age as the dominant predictor of symptoms. This study identified potential mechanisms of symptoms in early stage PC that warrant further testing. Symptoms related to sexual dysfunction may be especially amenable to PA.

Although much has been published in the literature on how to perform a Q methodological study, the use of interviews within this process has received little attention. The purpose of this review is to explore the use of interviews in a Q methodological study. An introduction to Q methodology is provided. The aims of an interview within a Q methodological study are described, and how these aims lend themselves to a particular method of analysis is explored. How to perform this analysis is outlined. The use of interviews can increase the validity of a Q methodological study by providing the participant's rationale for analysis of the factor arrays. When to perform the interviews is still under debate, and further study is required to determine whether the timing affects the results.

ObjectivesTo examine the relationship between structural characteristics of Australian residential aged care facilities (RACFs) and breaches of the aged care quality standards.MethodsFacility‐level analysis of audits, sanctions and non‐compliance notices of all accredited Australian RACFs between 2015/16 and 2018/19. Structural factors of interest included RACF size, remoteness, ownership type and jurisdiction. Two government data sources were joined. Each outcome was analysed to calculate time trends, unadjusted rates and relative risks.ResultsNon‐compliance notices were imposed on 369 RACFs (13%) and 83 sanctions on 75 RACFs (3%). Compared with New South Wales (NSW), non‐compliance notices were less likely in Victoria, Queensland and the Northern Territory (NT), more likely in South Australia (SA), and comparable in Western Australia (WA), Tasmania and the Australian Capital Territory (ACT). RACFs with more than 100 beds and RACFs located in remote and outer regional areas (vs. major cities) also increased the likelihood of non‐compliance notices. Compared with NSW, sanctions were less likely in Victoria, Queensland, NT and WA and comparable in SA, Tasmania and ACT. Additionally, the likelihood of sanctions was higher for RACFs with more than 40 beds. For both non‐compliance notices and sanctions, no significant relationship was found with RACF ownership type.ConclusionsWe partially confirmed other Australian findings about the relationship between RACF structural characteristics and regulatory sanctions and reported new findings about non‐compliance notices. Routine and standardised public reporting of RACF performance is needed to build trust that Australia's latest aged care reforms have led to sustained quality improvements.

Debate holds a special place in the history of the RCN Research Society annual conference. It enables important issues to be explored thoroughly in a manner which is unashamedly competitive but which gives an equal amount of time to both sides of the argument. Debating is considered to be a game of logic and eloquence and it takes place in the style of the British Parliament, hence the audience is referred to as the house. The players (proposers and opposers) make their speeches in turn, alternating between ‘‘government’’ making the case for the motion and ‘‘opposition’’ opposing it. The motion is selected around a topic which is important but around which there may be polarised positions. The proposers are asked to take a position (for or against the motion) and to make a short speech aimed at convincing the house of the cogency of their position. The speeches should be characterised by rigorous logic, be elegant and contain humour. Unlike debate in the houses of parliament, the speakers may be asked to take a position which they do not in fact subscribe to. The skill in such a situation is to prepare arguments which may be contrary to your beliefs and to present them to the house convincingly. In the debate which follows there is at least one player who took a position contrary to the one they believed in!

e20588 Background: Decision making process related to cancer treatment is complex, influenced by tumour factors, patients and clinicians, and may affect outcomes eg quality of life (QOL). Studies are scarce in exploring this subject in the older population. This pilot study aimed to investigate this in older (≥70 years) women newly diagnosed with clinically T0-2N0-1M0 breast cancer. Methods: Patients as described were invited to participate. Actual treatment planning was made by the clinical team and was not part of the study. Semi-structured interviews were conducted within 6 weeks and at 6 months, alongside Comprehensive Geriatric Assessment (CGA) and QOL assessment using EORTC QLQ-C30. Interview recordings were transcribed (intelligent verbatim) and then analysed by (i) identifying themes; and (ii) comparing them with CGA and QOL measures. Results: Forty-one patients took part at the time of analysis. The following themes emerged in different patient combinations, at both time points. 1) Symptoms - The majority presented symptomatically (87%, 21/31). At 6 months, 45% (18/40) reported a negative feeling, but 81% (22/27) said they would choose the same treatment again. 2) Knowledge - Most patients (80%, 28/35) knew someone with a cancer diagnosis, but did not know much about breast cancer or treatment (87%, 18/24). 3) Reactions - At diagnosis, only 48% (10/23) felt ‘shocked’ or ‘surprised,’ while the remainder had ‘no reaction’ or ‘were prepared’. The majority (91%, 29/32) felt that they had received enough information about treatment options or that they did not have an option. 4) QOL - Most patients (88%, 15/17) thought they had made the right treatment choice. The majority (86%, 6/7) were not worried about the future and 91% (10/11) reported no change in QOL. No relationship was seen between these interview findings and the treatment modalities received. These findings were consistent with the results of CGA and QOL assessment. Conclusions: These preliminary findings suggest that these patients were generally happy with the decision made for their treatments and had a fairly good QOL and future outlook. The study has now entered into a second stage where more in-depth interviews are being conducted.

Section 1 Preparation for Practice Placement Experience: Understanding the concepts of being an Older person Chapter 1 Exploring the concept of older people nursing Chapter 2 Policy related to working with older people in nursing practice Chapter 3 Attitudes to working with older people Chapter 4 Valuing diversity Chapter 5 Theories of ageing Chapter 6 Dementia and delirium Chapter 7 Core philosophies of care for older people Chapter 8 Preparation for practice learning experience Section 2 Placement learning opportunities : general principles of care Chapter 9 Communication, assessment and planning care Chapter 10 Dignity in care for older people Chapter 11 Safeguarding older adults Chapter 12 Family care in old age Chapter 13 The concept of independence in old age Chapter 14 Planning multi-disciplinary discharge Section 3 Reflecting on the Older patient experience: Case studies Chapter 15 Case study 1 - Caring for a patient following a stroke (cerebral vascular accident or CVA) Chapter 16 Case study 2 - Falls prevention Chapter 17 Case study 3 - Caring for an older patient and their family at the end of life Chapter 18 Case study 4 - Mental health and Older people Section 4 Consolidating Learning Chapter 19 Reflection and future learning

e19518 Background: CGA is an analytical tool measuring physical and psychosocial function. Breast cancer is primarily a disease of the elderly. A pilot study was conducted evaluating a cancer-specific CGA tool in older women with primary operable breast cancer. METHODS Newly diagnosed women attending the Primary Breast Cancer Clinic for Older Women in Nottingham were invited to participate. CGA was completed within 6 weeks. The decision of primary treatment followed consultation with the clinical team and was not guided by CGA. 47 patients have thus far been recruited (mastectomy (Mx) n=20, breast conserving surgery (BCS) n=9, primary endocrine therapy (PET) n=17, primary radiotherapy n=1). RESULTS Patients were mostly widowed (52%); living with someone (54%); retired (96%); of white ethnicity (91%); had completed primary/secondary education (65%), with a mean age of 80 (range 68-92), Body Mass Index (BMI) of 27.4, and good scores for Activities of Daily Living (21/34), Karnofsky self-reported (6/8) and physician-rated (80/100) performance, mood measured by the Hospital Anxiety and Depression Scale (79/102), social activities (14/20) and support (49/60) measured by the Medical Outcomes Study Social Activity Limitations and Support measures. On average participants took 4 daily medications and scored 5 (out of 51) on the Physical Health Section measuring comorbidity. 25% had experienced a fall in the last 6 months and 2 had signs of cognitive impairment based on the Blessed Orientation-Memory-Concentration test. Average completion of the timed 'up and go' (TUG) was 16 seconds. Statistical significant association was found between PET (as opposed to surgery) and increasing age (p=0.001), greater comorbidity (p=0.022), more daily medications (p=0.002) and slower TUG (p=0.014). Logistic regression showed only age to be independently significant (p=0.016; odds ratio=12.69, 95% CI 1.60-100.69). Factors showing correlation to BCS rather than Mx were better mood (p=0.05) and higher BMI (p=0.033). CONCLUSIONS There was an association between CGA factors and surgical treatment patterns in this cohort of older adults with breast cancer.

Background The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care. Methods Publicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that...