Chapter 5 - Gynaecological cancers education for the Medical Community
One of the key issues in improving gynaecological cancer care is the
management of the disease by the medical community and their level of knowledge
about gynaecological cancers.
Members of the medical community and individuals spoke about the ongoing
need for better information about gynaecological cancers and improved
educational opportunities for all professionals.
Education for the medical community was identified as a priority by many
and an effective way to tackle the issues that caused delays between symptom
presentation and definitive treatment.
The Committee heard that one of the biggest challenges was targeting
information about gynaecological cancers more appropriately and making it more
visible and accessible.
Education for the medical community on gynaecological oncology matters was
argued to be particularly important because it is a relatively new
sub-specialty. Although there was some indication that awareness of the
sub-specialty was growing, evidence to the Committee suggested that whilst
medical professionals knew about gynaecological cancers, many lacked
understanding regarding appropriate referrals to gynaecological oncologists,
optimal treatment and associated issues that women may experience.
This lack of knowledge could be attributed to the fact that women with gynaecological
cancers often present with non-descript symptoms which in turn could delay
diagnosis in a large proportion of cases.
Dr Lewis Perrin, Secretary and Treasurer of the Australian Society
of Gynaecologic Oncologists (ASGO) argued that improving the knowledge of the medical
profession, particularly general practitioners, was just as important as public
I do not think the practitioners are deliberately poorly
treating their patients, but they are not aware of the now documented evidence
showing significant improved survival going into one of these units. Of course
education is needed for the public, but I would say it is mainly for the
The importance of education
Women turn to medical professionals for certainty about uncertain
aspects of their health. Professionals, particularly general practitioners,
play a pivotal role in providing care and advice to women. It is therefore critical
that they have the knowledge and resources necessary to give the best possible care
to women with, or at risk of, gynaecological cancers.
Although there is a lower incidence of gynaecological cancers in Australia
relative to other tumour types, the Committee heard that education was vital in
ensuring that the professionals themselves maintained and expanded their
knowledge of, and core skills in, gynaecological oncology. With evidence
informing best practice constantly evolving and changing, it was argued that
the medical profession needed to keep pace with the standards and mechanisms to
ensure that women could access quality treatment and care.
The Committee was told that education about gynaecological cancers
should not only focus on technical medical concepts and developments, but
should improve awareness of the psychosocial and emotional needs of women and
hone other professional skills, such as communication with patients.
Witnesses and submitters emphasised that a measured approach to
education was needed to:
- ensure delivery of programs and information in a timely fashion;
match the messages and activities with the needs of the target
improve retention of key messages;
increase rates of participation in continuing professional education
- to improve service delivery for women.
The medical community
The extent to which members of the medical profession required education
of risk factors, symptoms and treatment of gynaecological cancers varied across
the professions and across the individuals within those professions.
Some educational issues were profession-specific, hence some professions
have been examined separately. Some issues – such as the need for improved
coordination of educational strategies – apply across the board and have been
considered in the latter part of this chapter.
Particular attention was given to the education of general practitioners
and nurses because of the roles they play in the detection of gynaecological
cancers and referral to specialist care. Education for allied health
professionals, gynaecologists and gynaecological oncologists is also considered
In the context of gynaecological cancer, general practitioners practise
in a very different setting and context to other medical professionals, and as
such have different relationships with patients and different learning and
General practitioners were described as the 'gatekeepers' of the medical
profession because of their role in detection, referral, follow up and care for
In this role, it has been said that they need to be masters of uncertainty because
symptoms were ill-defined and infrequently presented (perhaps one or two per
Mr John Gower, Chief Executive of the Gynaecological Cancer Society
The GPs have a hell of a job to do and they are not used to
seeing gynaecological cancer, which can be 50 other things...They know their
stuff; they know the symptoms; it is just not front of mind.
In the case of ovarian cancer, the Committee heard stories of women for
whom the diagnostic process was long, leading to delayed
treatment and poorer survival rates.
The Committee also heard similar experiences from women diagnosed with other
The Committee heard that general practitioners experienced the following
problems surrounding the management of women with gynaecological cancers:
- given the breadth of clinical encounters in general practice,
general practitioners often did not have ready access to detailed information
about gynaecological cancers and their treatment;
- general practitioners needed to be more aware of gynaecological
oncology resources in their region and the evidence associated with treatment,
to minimise referrals being made on less evidenced-based approaches;
- insufficient education about the benefits of treatment by a
gynaecological oncologist, compounded by the lack of an academic base in the
sub-specialty and resultant inadequate undergraduate training;
- the structure of general practice itself often does not allow
much time for, and unless the general practitioner is very motivated, investigation
and management of vague and ill-defined symptoms; and
- insufficient support and incentives for the average general
practitioner to up-skill in gynaecological cancer related issues as he or she
only sees one or two new cases of a gynaecological cancer a year (particularly
when so much of the person's care is undertaken by others medical
professionals, such as gynaecological oncologists).
The referral process gave rise to particular concerns. It was argued
that opportunities to improve referral pathways through education were
important as the initial referrals of women to specialist services (widely
agreed to be a critical role for general practitioners) were not always made. A
number of reasons were put forward, with the main one being a lack of available
information about referral pathways to specialist services. It was argued this
meant general practitioners did not necessarily know who to refer patients to
or they simply continued referring them to specialists to whom they had
historical referral patterns.
Current education strategies
A large proportion of the educational material and programs produced for
professionals by government, non-government and community-based organisations
were aimed at general practitioners. The Commonwealth Department of Health and
Ageing (the Department) and the National Breast Cancer Centre (NBCC) emphasised
that their activities and efforts to raise awareness about gynaecological
cancers had targeted general practitioners because they were the first point of
contact for women with symptoms.
The NBCC has produced various educational programs and products on
ovarian cancer for general practitioners. In 2005, the NBCC developed a guide –
Assessing symptoms that may be ovarian cancer – to assist general
practitioners to assess women with a step-by-step process to follow in the
investigation of symptoms. According to the NBCC:
This guide was disseminated to over 22,000 GPs across Australia.
It continues to be the most widely disseminated guide from the whole NBCC
resource list, with nearly 2,000 copies disseminated in 2005-06. It is
regularly requested as the key resource for GP education sessions...
The NBCC has also provided input into national seminars and a range of
products, such as fact sheets, clinical practice guidelines and development
packages, which target general practitioners and medical professionals more
generally. Of note, is the Directory of Gynaecological Cancer Services
which is an online resource that provides general practitioners with contacts
for referrals to gynaecological treatment centres and gynaecological
The Cancer Council Australia and its State and Territory bodies also
have educational strategies for general practitioners. In recognition of the
fact that general practitioners are an important source of information for women,
the Cancer Council Western Australia has held many GP cancer education programs
events since 2001 with a gynaecological focus.
Many community-based organisations and professionals acting in a
volunteer capacity also conduct educational activities. For example, the NSW
Psychosocial Support Project at the Westmead Hospital developed a new learning
course for general practitioners with seven modules on psychosocial issues.
Dr Yee Leung, a Western Australian gynaecological oncologist, said he
and his colleagues made efforts to inform general practitioners on
gynaecological cancers through lectures, workshops and seminars.
ASGO also said that most gynaecological cancer centres in Australia run
education programs on an 'ad-hoc basis' for general practitioners in their
catchment area which were 'usually extremely well attended and very
Is the current level of education
The Committee heard that if the right decision regarding referral was to
be made the right information needs to be available to general practitioners. General
practitioners need to know what information is available, what information to
seek and where to seek it.
It was difficult to judge the success of current education strategies
without the presentation of empirical evidence, but anecdotally, the NBCC said
that it had received positive feedback on its ovarian cancer guidelines from
Dr Helen Zorbas, Director of the NBCC said that one way to measure the
success of the NBCC's approach was to examine changes in the referral patterns
of general practitioners. Anecdotal evidence from one gynaecological oncologist
suggested that the referrals he had been getting over recent times were growing
in number and were 'much more appropriate'.
Dr Zorbas argued:
It would seem to us from the feedback that we are getting that,
drip by drip, we are getting through to the general practitioners, and they are
vital in this process.
A number of comments were made in relation to the barriers that general
practitioners faced specifically in absorbing the information provided and/or
pursuing educational opportunities.
- It is hard to educate general practitioners about something with
vague symptoms, particularly when many diseases have similar symptoms.
- General practitioners are trained to look at the 'most likely
cause of the disease before looking at the least common cause of the symptoms',
which could be a gynaecological cancer.
- ASGO argued that education programs were often conducted on an ad
hoc basis by individuals and organisations in addition to their already heavy workload.
- Gynaecological cancer education is usually a sub-set of cancer
education and current gynaecological cancer educational strategies often focused
on ovarian cancer and cervical cancer.
- Most general practitioners generally do not see a large number of
individual patients with cancer, let alone gynaecological cancers, so it is
hard to put a numerically uncommon tumour on the work plans of the Australian Divisions of General Practice.
- General practitioners are inundated with information on a daily
basis and it is hard for them to make sense of it all.
- Educational opportunities are difficult to take due to lack of
available time. When it is taken, technical training is generally more
attractive to general practitioners than communication skills training.
- There is a lack of communication between professionals from the
gynaecological oncologists down about gynaecological cancers preventing
On this last point about communication, Mrs Vickie Hardy from the
National Ovarian Cancer Network (ACT and region) argued:
There is a lack of communication between all the agencies, from
your gynaecologist down. Your GP is your first port of call and he has to be
informed but quite often the GP was not informed on anything; he did not get
information. So there are a lot of areas that need to improve, to help the
The broad message to the Committee was that although current educational
strategies were well-intentioned and executed, much more needed to be done to
support general practitioners.
The way forward
Dr Zorbas from the NBCC argued that 'educating general
practitioners is No. 1'.
Many also argued that educating general practitioners was equal in priority to
educating women and the broader community.
Evidence to the Committee cautioned that a number of changes were needed
to improve the effectiveness of future educational strategies and therefore maximise
the health outcomes for women.
ASGO stressed that increased funding was needed to ensure that general
practitioners had sufficient and current knowledge of gynaecological cancers, had
access to a referral system and had access to educational material and the support
they needed to care for patients.
The Cancer Council Australia stressed that research into getting the
message across to general practitioners should be a high priority. It was
argued that feedback and input from general practitioners should guide the
content and direction of future activities, particularly because of the many
different methods of delivery available.
Professor Ian Olver, Chief Executive Officer of The Cancer Council Australia
The difficulty these days is that there are so many methods to
choose from in terms of web-based things and pod casts and whatever, but nobody
knows what the most effective method is. People sort of guess and go along a
line, but there needs to be research done. At least, if you get funding to
disseminate information some of that funding should be used...to evaluate the
impact that information.
Professor Olver and Dr Kendra Sundquist, also representing The Cancer
Council Australia, emphasised the importance of coordination and planning in
overcoming the current challenges posed by ad hoc approaches.
They argued that the development of nationally coordinated targeted messages
for general practitioners on gynaecological cancers would bring many
In relation to ovarian cancer, representatives from the National Ovarian Cancer
Network argued strongly for an awareness campaign for general practitioners. Mrs Erica
Harriss from the National Ovarian Cancer Network (ACT and region) argued:
...it needs to be a nationally coordinated ovarian cancer
awareness campaign to make sure that GPs are very aware and consider the
possibility of ovarian cancer. I was told my symptoms were vague, and that is
what they say about ovarian cancer. But nobody considered it, and I knew
nothing about ovarian cancer.
ASGO also argued that existing programs needed to be better coordinated,
better advertised, and more frequent. Whilst there were some gaps in the
current approach (for example, referral guidelines for general practitioners),
it was argued that the present distribution and communication channels needed
to be fine-tuned.
Witnesses also stressed the importance of leveraging existing processes
to maximise access and penetration in the general practice community.
Recently, The Cancer Council Western Australia used the Royal Australian College
of General Practitioners' (RACGP) web-based learning tool to give general
practitioners messages about gynaecological cancers as part of their continuing
The Cancer Council Victoria suggested that the NBCC guide, The
investigation of a new breast symptom – a guide for General Practitioners,
was a 'highly commended' resource that could be used for general practitioners to
assist them in identifying, investigating and appropriately referring women
with a suspected gynaecological cancer.
Where possible, advances in technology (particularly web-based) should
be utilised to assist in message delivery to general practitioners, whilst
remembering the value in face-to-face discussions.
To address concerns that referrals were largely ad hoc, the development
of referral guidelines for general practitioners with information on who best
to refer women to should be investigated. The NBCC's online directory of
gynaecological oncology services was thought to be a valuable resource, but
that more was needed to increase the profile and use of this product and the
sub-specialty more generally amongst general practitioners.
The overall aim of general practitioner education is to bring
gynaecological cancers to 'front of mind' and where a general practitioner
suspects a gynaecological cancer is present, he or she has the knowledge to
refer the woman to a gynaecological oncologist for further assessment (including
diagnosis) and treatment.
Nurses from a very wide range of practice settings care for and support
women with gynaecological cancers. Ms Tish Lancaster from Cancer Nurses
Society of Australia (CNSA) argued:
...that the intimate nature of nursing care that is involved for
women with gynaecological cancer well places nurses to identify the needs of
women, to address some of those needs and to make appropriate referrals to
other health practitioners that may also assist in addressing those needs.
Among their many roles, nurses provide education to women about
gynaecological cancers and Ms Lancaster said that 'nurses are very well
placed in a health promotion role for all gynaecological cancers'.
Current education about
The Committee heard about a number of educational programs for nurses on
Since 2004, the Greater Metropolitan Clinical Taskforce (GMCT) in New
South Wales has conducted 'highly successful' annual nurses' study days that
were 'well attended by hundreds of nurses from both metropolitan areas and the
Another successful initiative for nurses developed by the CNSA was the
publication of a textbook on gynaecological cancers for nurses and allied
In highlighting the positive feedback on this product, Ms Lancaster said:
...it has not just been a local thing. It has had this enormous
spin-off that we did not ever anticipate. The nurses who come to the study
days, the nurses who work in our units and even the junior medical staff really
love it, because it is a practical, evidence based, woman centred approach to
Representatives from the National Ovarian Cancer Network also told the
Committee about a resource kit that was initially prepared for women recently
diagnosed with ovarian cancer, but has also been of considerable use for oncology
nurses. Ms Jane Harriss, Director of National Ovarian Cancer Network (ACT
and region) said that nurses:
...were crying out for that information themselves. We talked with
them about it, and they said that they were ready and waiting for us to provide
them with that level of support.
The Committee heard from the CNSA and the GMCT that there was no
specific formal education in gynaecological oncology offered for nurses and
that the current post graduate studies, at least in New South Wales, tended to
focus on cancer nursing more generally. Ms Jayne Maidens the GMCT's
Gynaecological Oncology Group said:
Currently there is a graduate oncology nursing certificate that
is run by the College of Nursing in Sydney. Some of the universities also have
graduate certificates. They cover cancer nursing under a large umbrella, but
there is nothing that is specific to gynaecological cancer...
Is the current level of education
Evidence to the Committee showed that nurses wanted more education in
gynaecological oncology and many nurses funded themselves to go on courses and attend
conferences. Ms Lancaster from the CNSA argued:
I think nurses in general are very keen for educational
opportunities and it is something that, in general, they do not get. They more
junior you are the less likely you are to get out to those sorts of things.
The results of a 2004 study of 150 nurses (from a variety of
settings in New South Wales) who attended the GMCT's nurses' study day showed
that 66 per cent of nurses were either very or moderately confident
about talking to women about gynaecological cancers in general and also about
'common practical issues', such as bladder and bowel problems.
However, results showed that many nurses lacked confidence in their ability to
manage more complex, yet still common issues experienced by women such as
infertility, lymphoedema and psychosexual dysfunction.
Despite the 'considerable experience and formal qualifications' of the
nurses surveyed, many did not feel confident in addressing specialised gynaecological
cancer issues. The CNSA said:
...only 12% felt very confident in discussing the management of gynaecological
cancers, while 5% felt very confident in addressing genetic susceptibility, 8%
for fertility issues, 12% for lymphoedema prevention and 15% for sexuality and
body image (Maidens et al. 2004). Reports suggest that health care
professionals require development of skills in psychosocial assessment and
care. Nurses, like other health professionals require development of competency
in this area...
The CNSA noted that the nurses who cared for women outside of specialist
cancer centres indicated that they wished to provide better supportive care for
women but that 'inadequate education hinders their efforts to do so'.
The CNSA argued that there was a clear demand for better educational
opportunities for nurses. It stressed that when looking at offering skilling opportunities
for nurses, a number of barriers existed, including:
- workforce shortages, high workloads and competing demands leading
to problems associated with back-filling positions;
- poor links between education and career pathways;
the cost of further education at university;
- the geographical location of nurses (greater barriers for nurses
in rural areas); and
insufficient training places, especially in the university
The Committee also heard that the formality of training to become a
specialist gynaecological oncology nurse could be a barrier to many nurses who
would be competent at the role. Ms Elizabeth Chatham, Director of Women's
Services at The Royal Women's Hospital stated:
The hurdles to get over to be able to become a gynae-onc nurse
are so high that they actually cut out a lot of the people that may be
interested; but it still has to be credible and structured.
The way forward
To ensure that nurses have the skills required to give women optimal
care and to work effectively within the gynaecological oncology system, including
knowledge of appropriate referral and communication pathways, the current
educational strategies for nurses need to be reviewed. Nurses caring for women
with gynaecological cancers need to be adequately prepared to assess the physical
as well as emotional needs of women and thus be able to collaborate with other medical
professionals. Education is the key to achieving this outcome.
Formal education for nurses is currently tailored to general cancer
issues, with very little focus on gynaecological oncology.
The CNSA argued that steps ought to be taken to examine the content of curricula
at undergraduate and graduate levels of training to better prepare nurses.
The CNSA noted that Commonwealth government funding for nursing training
through a program called 'EdCaN' is 'going a long way' towards addressing
current training issues.
The Royal Women's Hospital argued that 'post-graduate specialist
gynaecology nursing courses significantly improve workforce capacity'.
Ms Jayne Maidens said that work by the GMCT was already underway to
raise the profile of gynaecological oncology in tertiary nursing curricula.
We hope to have some affiliation with either one of the
universities or the College of Nursing to promote a package specific to
gynae-oncology so that at the end of the day they will come out with a
certificate or with some sort of recognition that they have this speciality in
gynae-oncology. We are working through that at the moment.
The CNSA argued that the specific needs of nurses need to be taken into
account in the development of future educational strategies in gynaecological
oncology. Ms Lancaster highlighted that the needs of specialist nurses
would differ from the needs of nurses in non-specialist and rural settings.
As I said, the difficulty is probably in finding something that
is tailored to the needs of a particular nurse. And to be fair, nurses in
specialist gynaecological cancer centres will be looking at very specific
educational opportunities but those in rural centres are probably seeing not
just women but all sorts of patients with all sorts of cancers, so their needs
Opportunities to pursue training to become specialist gynaecological
oncology nurses was also supported by the CNSA, particularly because of the
successful care coordinator role that specialist breast cancer nurses play for
breast cancer patients.
While the evidence that specialist nurses contribute to improve
patient outcomes comes from the field of breast cancer, it is likely that the
same outcomes could be achieved if specialist nurses roles are supported for
women with gynaecological cancers.
Nurses are an important source of information for women with
gynaecological cancers and according to the CNSA there are 'no nursing
education programs relating specifically to gynaecological cancer in Australia'.
For nurses to provide the required support, it is important that they are
supported to pursue educational opportunities, and have better access to
appropriate, authoritative information. The Committee heard that this would not
only bring professional gains to the nurses, but also benefit women with, or at
risk of, gynaecological cancers.
Allied health professionals
Allied health professionals have a significant role in treating and
caring for women with gynaecological cancers. Professionals such as psychologists,
social workers and physiotherapists, have contact with women at different
points along their journey with gynaecological cancers, but not at the same level
of frequency or closeness as others. Nevertheless, some level of interaction
necessitates a degree of awareness and understanding of the symptoms, treatment
and the latest developments in gynaecological oncology, and oncology more
The Cancer Council Australia, the Clinical Oncological Society (COSA)
and the National Aboriginal Community Controlled Health Organisation (NACCHO)
argued that general education programs for allied health professionals should
include a focus on cancer management:
...particularly as incidence rates rise and as the trend towards multidisciplinary
care creates increased opportunities for a wider range of healthcare professionals
to participate in patient care.
The Committee heard that many of the allied health professions were
experiencing funding and resource shortages and this impacted their ability to
pursue clinical and other education.
The evidence presented suggested that education about gynaecological
cancers was not an area of significant focus for government and organisations that
instead targeted their educational activities and programs at general
practitioners and nurses. The GMCT emphasised it sponsored once or twice yearly
educational sessions for 'health care practitioners' on gynaecological oncology,
but little else was presented during the inquiry about education for allied
The Royal Women's Hospital argued that 'allied health staff working in
cancer services would benefit from structured training and professional
development programs' in gynaecological oncology.
It was thought that education of members of more specialised health
disciplines (that have small numbers in comparison to medicine and nursing) was
still critical to the system's ability to provide a comprehensive level of care
The Committee received little evidence on the educational needs of
gynaecologists, however it heard it was important for them to develop
sub-specialised skills in gynaecological cancers to ensure appropriate referral
to a gynaecological oncologist and their multidisciplinary team.
Professor David Allen, representing The Cancer Council Victoria's
Gynaecological Cancer Committee and Victorian Cooperative Oncology Group, said
that it was 'not uncommon' for gynaecologists or general surgeons to refer
women with a gynaecological cancer to a medical oncologist rather than a
He argued that national protocols be established to counter this.
I mentioned in the opening statement getting rid of a lot of the
variation in the current practice. Only state-wide or national protocols and
expectations and outcomes that can be written into practice are going to get
rid of those variations and get people to the right centres.
The GMCT said some of its educational sessions on gynaecological oncology
were targeted at gynaecologists.
A gynaecological oncologist is a specialist in obstetrics and
gynaecology, who has been assessed as being competent in the comprehensive
management of women with a gynaecologic cancer, awarded the Fellowship of the
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
(FRANZCOG), completed a formal three year training program in gynaecological
cancer care, and passed the examination for the Certificate of Gynaecological
Evidence to the Committee suggested that gynaecological oncologists did
not have any specific or urgent educational needs pertaining to risk factors,
symptoms and treatment of gynaecological cancers.
The Royal Women's Hospital did argue though that gynaecological oncology
suffered from a lack of academic support.
There are only two full professorial positions in gynaecological
oncology in New South Wales, one in Victoria, one in Western Australia and none
in Queensland, South Australia or Tasmania.
A number of issues apply more generally across the medical and allied
health communities and these warrant separate discussion.
The following were presented as barriers to the success of current
- poor coordination and communication leading to duplication and
high workloads and workforce shortages that increased the burden
The following were issues that needed to be considered in the
development and direction of future education strategies:
- development and distribution of new clinical practice guidelines;
- dissemination of messages and awareness about medical advances;
- improvements to professional communication skills through more
attractive training packages;
- short-term skills enhancement training; and
the role of the Internet in the provision of education.
Coordination and communication
To achieve better education and training outcomes, improved coordination
of organisations within the gynaecological oncology sector, and between this sector
and health and educational institutions were thought to be needed.
There was also a clear need for individuals and groups with
responsibility for education planning and delivery to improve communication
with relevant players in order to ascertain: who was doing what; what was
actually working and what needed to be done in future. A complete picture
across the board was needed. There was widespread recognition of the need for
improvements in the information base to better coordinate and manage
The fragmented approach has meant that the medical community,
particularly general practitioners, cannot easily receive and retain
educational messages. Disconnected strategies in the delivery of education and
training have had a negative effect on the capacity of the medical community to
pursue skilling opportunities in the sub-specialty of gynaecological oncology.
The extent to which the medical community has input into the development
of educational programs was also seen as important for ensuring the capacity of
medical professionals to recognise and deal with gynaecological oncology issues.
Opportunities to improve coordination could also be made during the consultation
and planning stages to enhance the effectiveness of material and the effort
that groups put in (particularly community-based groups operating on minimal
The Committee heard that the gynaecological cancer care workforce was
not immune to the workforce shortages that exist in almost every medical and
allied health professional field at the moment. The shortages in the
gynaecological cancer sector often reflected the more general shortage, for
example, in the nursing profession, but were also caused by the nature of gynaecological
oncology training and time required to complete formal training.
Workforce shortages have meant that medical professionals typically have
less time outside of their normal working hours to absorb information and also
fewer opportunities to pursue further education. The shortages, particularly of
gynaecological oncologists, have shown themselves more acutely in areas outside
of capital cities, particularly Sydney and Melbourne.
Clinical practice guidelines
The Guidelines for the management of women with epithelial ovarian cancer
were widely distributed to medical professionals. The Cancer Council of
Australia, COSA and NACCHO argued that similar guidelines should be developed for
other gynaecological cancers.
It was also suggested that a quality assurance framework be put in place
to ensure that the management of gynaecological cancers followed a national evidence-based
and patient-centred approach.
Education on emerging issues
Educating the medical profession about 'breakthroughs' and other
emerging issues in a timely fashion was argued to be important, particularly to:
- ensure changes to best practice are known as early as possible
and to increase acceptance and compliance of the changes;
- enable delivery of accurate and consistent messages;
educate women; and
- encourage broad uptake of new medicines, such as the HPV vaccine.
Encouragement and incentives for all care providers to undertake
training and education to improve communication skills – from gynaecological
oncologists to general practitioners – was argued to be a priority. The
Committee heard it was essential that members of the medical community improve
their ability pick up relevant cues from women, particularly in response to
psychosocial and psychosexual effects of treatment.
Mr Terry Slevin, Director of Education and Research at The Cancer
Council Western Australia commented:
We have programs in place where we try and bring people in and
weave in communication skills, listening skills, as part of the more technical
training that we offer. Certainly, it is the technical training that is generally
more attractive to general practitioners. Those who are interested in
communication skills training tend to be the ones who are at the higher end of
that skill spectrum anyway.
The Committee heard that formal communication training would make a positive
difference to the ability of professionals to recognise and respond to patient
needs, particularly emotional issues.
Ms Connie Nikolovski, an ovarian cancer survivor, stressed the
importance for medical professionals to have strong communication skills in
order to draw information from their patients.
Medical people do not extract enough information; maybe they are
not educated to. So perhaps there is the need for more education about people
skills; I understand that they are skilled at what they do, but that is just
another area I noticed when my mother was being cared for that needed to
Communication skilling should include a focus on catering for cultural
sensitivities to raise awareness of the needs of people from culturally and
linguistically diverse backgrounds.
Skills enhancement training
Given it takes many years to train in gynaecological oncology, the
importance of providing opportunities for short-term fellowships for those
wanting to improve their knowledge was recommended. Professor J Norelle
Lickiss, a palliative medicine specialist, argued this short-term measure
would have high yield.
Professor Lickiss also suggested:
...there should be clinical fellowships in improving understanding
of symptoms alone...If we had those we would actually get some advance, because
that is the bottom line. The rest can build on that.
More recently, the Internet has created an additional source of medical
and general information that medical professionals can look to and rely on. The
Committee heard that there were credible information sites developed by
government and non-government health organisations for medical professionals
that contain freely available information on gynaecological cancers.
This rich resource of information is presently under-utilised by both
women and professionals. In assisting women who choose to access online
information distinguish between unbiased information and the information
designed to push a product or service, professionals themselves need to feel
comfortable enough with the Internet to guide their patients' online searches
for medical information. As such, there is a clear need for professionals to be
educated about, and be aware of, trusted and quality information websites.
Future education strategies need to empower professionals and women to
use the Internet as part of a total health care strategy. For professionals,
where possible, education should be as interactive and personalised as
Roles and responsibilities
Evidence to the Committee suggested that the 'plethora of funders and
providers of health promotion...has resulted in some confusion about roles and
responsibilities, and about leadership'.
In evidence, the need for coordination of education was argued to be a priority
because at the moment 'everybody is doing a little bit of everything'.
It was argued that educational initiatives and formal training
opportunities would continue to occur in a piecemeal fashion without the
establishment of a national framework or body to provide direction and
oversight. A national approach would provide an avenue for existing players
from across jurisdictions – governments, non-government organisations and
community-based organisations – to come together to review the current approach
and to develop new initiatives and practical implementations plans as required.
There was uncertainty expressed about the direction and leadership that
Cancer Australia would provide in this area due to lack of understanding about
its roles and responsibilities.
Evidence to the Committee suggested an expansion of the NBCC's role to
cover education about other gynaecological cancers would be a viable approach.
However, the majority of witnesses and submitters thought that funding to set
up a national centre would be an effective mechanism for better coordination of
gynaecological oncology education across Australia. It was thought that a national
centre could provide an overarching framework reflective of national priorities
and the views of all stakeholders. Further discussion on a national approach is
found in Chapter 2.
Associate Professor Anthony Proietto, Chairman of ASGO, argued that
'medical education is as important as public'.
Education is the key to telling the relevant people about the information they
need to know.
The Committee heard that there was a varying degree of knowledge about
gynaecological cancers within the medical community.
A low level of knowledge amongst professionals was linked to poor awareness of
the symptoms and delayed or inappropriate referral of women to specialist care.
Evidence to the Committee stressed that for women with gynaecological cancers,
particularly ovarian cancer, these were barriers to effective diagnosis and
care that could be minimised or overcome with better education.
As gynaecological oncology is a new sub-specialty, it was argued that
its profile needed to be lifted amongst the medical community to ensure that professionals
were aware of the benefits for women of referral to gynaecological oncologists.
Out of all the professions, Dr Lewis Perrin from ASGO said that particular effort
was needed to educate general practitioners who were not aware of the benefits.
The Gynaecological Awareness Information Network (GAIN) believed
education and awareness was a two-way street – the public needed to be better
informed, and the medical community needed greater education on how to diagnose,
treat and manage women with gynaecological cancer.
The Committee recommends that an urgent review of the adequacy and provision
of information to medical and allied health professionals about gynaecological
cancers be undertaken by the Centre for Gynaecological Cancers.
The Committee further recommends that the gynaecological oncology medical
and allied health communities, through the Centre for Gynaecological Cancers,
have greater input into decisions about education strategies for professionals,
women and adolescents.
The Committee recommends that the Centre for Gynaecological Cancers,
with assistance from the gynaecological cancer community, develop culturally
appropriate educational material focusing on the risk factors and symptoms of
gynaecological cancers. Any such material should specifically meet the needs of
general practitioners, nurses (including remote area nurses), Aboriginal health
workers, gynaecologists and allied health professionals
The Committee further recommends that educational materials be provided
to general practitioners to inform them about the sub-specialty of
gynaecological oncology and the circumstances in which it is appropriate to
refer women to gynaecological oncologists.
The Committee recommends that Cancer Australia formally investigate the
referral patterns of general practitioners at a national level and devise
appropriate strategies to address any concerning trends.
The Committee further recommends that accurate and accessible service
directories should be developed in all jurisdictions to support knowledge-based
The Committee recommends the development and distribution of clinical
practice guidelines for all gynaecological cancers (or similar consistent and
authoritative information) to ensure standard practice across the healthcare
The Committee further recommends that the Australian Divisions of
General Practice include gynaecological cancer issues in at least one
professional development seminar per year.
The Committee recommends that all gynaecologists involved in treating
gynaecological cancers associate themselves with a recognised multidisciplinary
specialist gynaecological cancer unit.
The Committee recommends that appropriate educational opportunities be
offered to medical and allied health professionals from all settings to
increase skills in gynaecological oncology. Appropriate financial incentives or
assistance packages should be offered, and given where required.
The Committee recommends that doctors who are training to be general
practitioners be exposed to the concept of multidisciplinary care and the
sub-specialty of gynaecological oncology in their training.
The Committee further recommends that medical professionals receive
instruction and experience, where relevant, in diagnosing malignant
gynaecological cancers through educational programs.
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