Dr Carla Saunders is a Senior Lecturer in the Centre for Health Services Management. She has over 35 years professional experience in regional, state and national level roles in health management, health planning, health services research, and health policy and program development and oversight. With a background in health care and teaching, Dr Saunders investigates health care from society's perspective, as well as conducting health policy and health management research. Carla holds a Master of Medical Science (Epidemiology) and a doctorate in health service management. She has worked extensively in government, non-government and private health systems in Australia.
Can supervise: YES
- Health consumerism
- Health and social policy
- Primary health care
- Health management
- Health service planning
Carla teaches in the areas of health management, planning, policy and health consumerism.
Saunders, CM, Palesy, D & Lewis, J 2019, 'Systematic review and conceptual framework for health literacy training in health professions education', Health Professions Education, vol. 5, no. 1, pp. 13-29.View/Download from: UTS OPUS or Publisher's site
Anazodo, A, Laws, P, Logan, S & Saunders, CM 2019, 'How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care', Human Reproduction Update, vol. 25, no. 2, pp. 159-179.View/Download from: UTS OPUS or Publisher's site
Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs.
OBJECTIVE AND RATIONALE
The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services.
A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
A total of 846 potentially relevant studies were identified after the removal of duplicates. All titles and abstr...
Anazodo, A, Laws, P, Logan, S, Saunders, C, Travaglia, J, Gerstl, B, Bradford, N, Cohn, R, Birdsall, M, Barr, R, Suzuki, N, Takae, S, Marinho, R, Xiao, S, Chen, Q-H, Mahajan, N, Patil, M, Gunasheela, D, Smith, K, Sender, L, Melo, C, Almeida-Santos, T, Salama, M, Appiah, L, Su, I, Lane, S, Woodruff, TK, Pacey, A, Anderson, RA, Shenfield, F, Sullivan, E & Ledger, W 2019, 'The Development of an International Oncofertility Competency Framework: A Model to Increase Oncofertility Implementation.', The oncologist, vol. 24, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. Currently, oncofertility competencies do not exist. The aim of this study was to develop an oncofertility competency framework that defines the key components of oncofertility care, develops a model for prioritizing service development, and defines the roles that health care professionals (HCPs) play. MATERIALS AND METHOD:A quantitative modified Delphi methodology was used to conduct two rounds of an electronic survey, querying and synthesizing opinions about statements regarding oncofertility care with HCPs and patient and family advocacy groups (PFAs) from 16 countries (12 high and 4 middle income). Statements included the roles of HCPs and priorities for service development care across ten domains (communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, oncofertility training, reproductive survivorship care and fertility-related psychosocial support, supportive care, and ethical frameworks) that represent 33 different elements of care. RESULTS:The first questionnaire was completed by 457 participants (332 HCPs and 125 PFAs). One hundred and thirty-eight participants completed the second questionnaire (122 HCPs and 16 PFAs). Consensus was agreed on 108 oncofertility competencies and the roles HCPs should play in oncofertility care. A three-tier service development model is proposed, with gradual implementation of different components of care. A total of 92.8% of the 108 agreed competencies also had agreement between high and middle income participants. CONCLUSION:FP guidelines establish best practice but do not consider the skills and requirements to implement these guidelines. The competency framework gives HCPs and services a structure for the training of HCPs and implementation of care, as well as defining a model for prioritizing oncofertility service development....
Saunders, C, Carter, DJ & Brown, J 2019, 'Primary care experience of older Australians with chronic illness', Australian Journal of Primary Health, vol. 25, no. 1, pp. 13-18.View/Download from: UTS OPUS or Publisher's site
This large (>1000) cross-sectional study investigates patient-reported primary care experiences of older people with chronic illness. Previous research has found that only around half of patients with chronic illness receive optimal chronic illness care and outcomes in Australian general practice. A survey was administered via a double opt-in panel method to people aged fifty-five years and older who have one or more self-reported major chronic diseases (diabetes and/or chronic heart, kidney, lung, mental health and/or musculoskeletal conditions). Health professionals were found to be important to the majority of Australians surveyed. Well known chronic illness support resources such as care plans and recalls/reminders were reported to be wanting by up to fifty percent of respondents. Across all chronic illness groups less than forty-two percent of respondents reported the provision of information on community resources and twenty-five percent reported not having a sound understanding about their medications. Regular local surveys for older people with chronic illness would allow a timely understanding of primary care experiences, needs and preferences of this group, to support quality improvement and drive enhanced patient outcomes.
Palesy, DL, Jakimowicz, S, Saunders, C & Lewis, J 2018, 'Australian Home Care Work: an Integrative Review', Home Health Care Services Quarterly, vol. 37, no. 2, pp. 113-139.View/Download from: UTS OPUS or Publisher's site
The home care sector comprises one of Australia's fastest growing workforces, yet few papers capture the overall landscape of Australian home care. This integrative review investigates home care work with the aim of better understanding care recipients and their needs, funding and regulation, care worker skills, tasks, demographics, employment conditions and training needs. Over 2,700 pieces of literature were analysed to inform this review. Results suggest sector fragmentation and a home care workforce who, although well placed to improve outcomes for care recipients, are in need of better training and employment support. Suggestions for future research regarding Australian home care include studies that combine both aged and disability aspects of care, more research around care recipients, priority needs and strategies for addressing them, and how best to prepare home care workers for their roles.
Carter, DJ, Brown, J & Saunders, C 2018, 'The Patient's Voice: Australian Health Care Quality and Safety Regulation from the Perspective of the Public', Journal of Law and Medicine, vol. 25, no. 2, pp. 408-428.View/Download from: UTS OPUS
The quality and safety of health care is a topic of permanent debate in the field of health services policy and regulation. Often absent from this debate, however, are the views and values of the public. These are excluded by a dominant narrative of health care regulation which understands the regulation of quality and safety in health care as principally a technical and instrumental undertaking. This approach constrains the application of law and legal regulation, devaluing their normative and expressive function in this field. In-part as a form of corrective, we offer an analysis based on recent survey data, of the attitudes and perceptions held by the Australian public towards stakeholder responsibility for, and the regulation of, health care quality and safety.
Roche, MA, Duffield, C, Smith, J, Kelly, D, Cook, R, Bichel-Findlay, J, Saunders, C & Carter, DJ 2018, 'Nurse-led primary health care for homeless men: a multimethods descriptive study.', International Nursing Review, vol. 66, no. 3, pp. 392-399.View/Download from: UTS OPUS or Publisher's site
To explore the primary healthcare needs and health service use of homeless men in inner Sydney.People experiencing homelessness have greater health needs than the general population and place high demands on tertiary care, which is expensive and may not be the optimum service for their needs. Accessible, approachable and affordable primary healthcare services could improve the health of homeless persons and potentially decrease costs to the healthcare system.A multimethod design using a cross-sectional survey (n = 40) and administrative data (n = 2 707 daily summaries) collected from a nurse-led primary healthcare clinic for homeless men in Sydney.Survey respondents were aged 27-76 years. Health problems reflected multimorbidity, with mental health issues present in almost all respondents. The majority had attended the clinic more than 20 times in the past year and said the services, treatments and referrals helped them avoid the emergency department. Administrative data indicated that medication administration was the most frequent service provided. Referrals to other health services doubled over the 7-year period.Multiple morbidities, particularly mental health issues, are associated with homelessness. A proactive approach by nurses including preventative services appeared to overcome barriers to health service use.This nurse-led primary healthcare clinic highlights the importance of providing services to homeless men with multiple comorbidities. Respect and trust in addition to easy access to health services appear to be important facilitators of health service use.A greater number of primary health services that collaborate with specialist services, including nurse-led clinics, may facilitate health care for persons who are homeless, reducing the burden on acute services.
Saunders, CM, Brown, J, Carter, D & Lapkin, S 2018, 'Chronic disease management support in Australian workplaces – low base, rising need', Health Promotion Journal of Australia, vol. 29, no. 3, pp. 257-264.View/Download from: UTS OPUS or Publisher's site
This study investigates the current nature, levels and perceived need for workplace support among mature age Australian workers with chronic illness.
A cross‐sectional population survey was conducted via a double opt‐in panel sample of Australian workers aged 45 years and older with one or more of six major chronic diseases (diabetes and/or chronic heart, kidney, lung, mental health and/or musculoskeletal conditions).
Three hundred and fourteen respondents reported being in the workforce and having at least one of the chronic conditions under investigation, of which almost one third reported having more than one of the conditions. The findings reveal a number of considerable gaps in Australian workplace support for employees 45 years and older with chronic illness, including workplace flexibility, supportive policies and co‐worker support.
This research adds to a scarce existing literature base on workplace support for workers with chronic illness in Australia. Future research is needed to identify opportunities for effective public policy and implementation of workplace interventions to better support this cohort.
If timely progress is not made in this area, the projected increase in the aged population and scheduled public policy changes impacting retirement age will multiply potential adverse effects on the health of employees with chronic illness and Australia's labour market productivity.
Saunders, C & Carter, DJ 2017, 'Is health systems integration being advanced through Local Health District planning?', Australian Health Review, vol. 41, pp. 154-161.View/Download from: UTS OPUS or Publisher's site
Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned.Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans.Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care.Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW.What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems.What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to as...
Saunders, C & Carter, DJ 2017, 'Right care, right place, right time: improving the timeliness of health care in New South Wales through a public-private hospital partnership.', Australian health review : a publication of the Australian Hospital Association, vol. 41, no. 5, pp. 511-518.View/Download from: UTS OPUS or Publisher's site
Objective The overall aim of the study was to investigate and assess the feasibility of improving the timeliness of public hospital care through a New South Wales (NSW)-wide public-private hospital partnership.Methods The study reviewed the academic and professional grey literature, and undertook exploratory analyses of secondary data acquired from two national health data repositories informing in-patient access and utilisation across NSW public and private hospitals.Results In 2014-15, the NSW public hospital system was unable to deliver care within the medically recommended time frame for over 27400 people who were awaiting elective surgery. Available information indicates that the annual commissioning of 15% of public in-patient rehabilitation bed days to the private hospital system would potentially free up enough capacity in the NSW public hospital system to enable elective surgery for all public patients within recommended time frames.Conclusions The findings of the study justify a strategic whole-of-health system approach to reducing public patient wait times in NSW and highlight the need for research efforts aimed at securing a better understanding of available hospital capacity across the public and private hospital systems, and identifying and testing workable models that improve the timeliness of public hospital care.What is known about the topic? There are very few studies available to inform public-private hospital service partnerships and the opportunities available to improve timely health care access through such partnerships.What does this paper add? This paper has the potential to open and prompt timely discussion and debate, and generate further fundamental investigation, on public-private hospital service partnerships in Australia where opportunity is available to address elective surgery wait times in a reliable and effective manner.What are the implications for practitioners? The NSW Ministry of Health and its Local Health Districts have th...
Saunders, C, Carter, D, Jordan, A, Duffield, CM & Bichel-Findlay, J 2016, 'Cancer patient experience measures - an evidence review', Journal of Psychosocial Oncology, vol. 34, no. 3, pp. 200-222.View/Download from: UTS OPUS or Publisher's site
Objectives: This research investigates the instruments currently available to measure the cancer patient experience of health care. An investigation of the number of instruments, the domains covered by the instruments, and the structure and psychometric performance of instruments is undertaken. Methods: A narrative synthesis approach is used to gather evidence from multiple studies and explain the findings. Purposely broad search terms and strategies are used to capture studies with cancer patients at all stages of disease and across a range of cancer types and health care settings. Results: The majority of identified instruments were originally designed for the oncology field. Twelve of the studies developed new cancer patient measures; eight studies adapted existing or utilized items from existing instruments, and seven studies assessed the psychometric properties of existing instruments or assessed validated tools under different conditions (e.g., cross-cultural adaptation). The number of instruments assessing cancer patient experience that have sound psychometric properties across items was found to be low. The properties least tested are test–retest reliability, construct, convergent and discriminant validity, scale variability (floor/ceiling effects), and interpretability. Conclusion: This review examined 10 years of research on the development of instruments to measure the cancer patient experience of health care. It found that research in this area is still in early stages of development. Further inquiry based on development and validation of cancer patient experience measures is required to support improvements in cancer care based on the perspective of cancer patients.
BACKGROUND: There is a growing amount of literature to support the view that active involvement in research by consumers, especially informed and networked consumers, benefits the quality and direction of research itself, the research process and, most importantly, people affected by cancer. Our exploratory project focuses on identifying their priorities and developing a process to assess the research needs of Australian cancer consumers which may be useful beyond the cancer scenario. METHODS: This project was consumer initiated, developed and implemented, with the assistance of a leading Australian cancer consumer advocacy group, Cancer Voices NSW (CVN). Such direct involvement is unusual and ensures that the priorities identified, and the process itself, are not influenced by other interests, regardless how well-intentioned they may be. The processes established, and data collection via a workshop, followed by a questionnaire to confirm and prioritise findings, and comparison with a similar UK exercise, are detailed in this paper. RESULTS: Needs across five topic areas reflecting cancer control domains (prevention and risk; screening and diagnosis; treatment; survivorship; and end of life) were identified. Cancer consumers high priority research needs were found to be: earlier diagnosis of metastatic cancers; the extent of use of best practice palliative care guidelines; identifying barriers to cancer risk behaviour change; and environmental, nutrition and lifestyle risk factors for people with cancer. A process for identifying consumers' research priorities was developed and applied; this may be useful for further investigation in this under-studied area. CONCLUSION: The findings provide a model for developing a consumer derived research agenda in Australia which can be used to inform the strategic direction of cancer research. Consumers have been seeking a workable method to achieve this and have worked in collaboration with a major cancer charity, which fund...
Saunders, CM & Girgis, A 2011, 'Enriching health research through consumer involvement: learning through atypical exemplars', Health Promotion Journal of Australia, vol. Vol. 22, no. Issue 3, pp. 196-202.View/Download from: UTS OPUS
Saunders, C & Girgis, A 2010, 'Status, challenges and facilitators of consumer involvement in Australian health and medical research.', Health research policy and systems, vol. 8, pp. 34-34.View/Download from: Publisher's site
The emergent international practice of involving consumers in health research is driven, in part, by the growing share of health research that can only be applied in and emerge from knowledge that is shaped by human values and societal contexts. This is the first investigation of its kind to identify the current prevalence, challenges, enabling factors and range of approaches to consumer involvement in health and medical research in Australia.A nation-wide survey of research funding organisations and organisations that conduct research was performed during 2008-2009.Marked variation in consumer involvement experience and perceptions exists between research funders and researchers. Research funders were over eight times more likely than organisations conducting research to involve consumers in identifying research needs and prioritising research topics. Across both groups, practical and time constraints were reported as key challenges to involving consumers, while guidelines on consumer involvement and evidence of effect were the most important potential enablers. More than a third of research organisations indicated that when consumer involvement was a condition of research funding, it was an important facilitator of involvement.It is no longer simply enough to keep society informed of important scientific breakthroughs. If Australian health research is to take into account important social contexts and consequences, it must involve consumers. A set of minimum consumer involvement standards and associated guidelines, that are agreed and routinely adopted, could ensure that consumers and the Australian community they represent, are given an opportunity to shed light on experiences and local circumstance, and express views and concerns relevant to health research.
Saunders, C, Gooden, H, Robotin, M & Mumford, J 2009, 'As the bell tolls: a foundation study on pancreatic cancer consumer's research priorities.', BMC research notes, vol. 2, pp. 179-179.View/Download from: Publisher's site
This is the first investigation of its kind to explore the views of people affected by pancreatic cancer with regard to research priorities. Pancreatic cancer has an extremely poor outlook in terms of early diagnosis, effective treatment and survival. Those affected by the disease generally lack opportunities to voice their needs or concerns in an organised manner, link with others affected by the condition and take part in research.This qualitative study adopts a self-selected telephone focussed discussion group approach. Information was obtained from distinct carer and patient groups after adequate controls such as the 'safe space' technique (repeatedly enquiring on and respecting the emotional needs) were implemented to protect participants from undue physical and psychological distress.Five themes emerged overall, with three themes being common between the patients and carers groups. Early detection, clinician communication and public awareness were areas of recurring discussion and consensus for both groups. The fourth theme to emerge for the patient group centred on quality of care, while the fourth theme of the carer group focused on the need for more and improved treatment options.Research priorities for pancreatic cancer consumers have been identified via an investigation that was tailored to meet exceptional needs. This research gives us a primary understanding of the role that pancreatic cancer patients can play in identifying areas of research that are responsive to their needs and priorities when suitably planned. Importantly it also provides a much greater understanding of the grim realities of the disease for those affected. This work is likely to be of value to anyone planning to work with those with a time limited, challenging condition.
Saunders, C, Girgis, A, Butow, P, Crossing, S & Penman, A 2008, 'From inclusion to independence--training consumers to review research.', Health research policy and systems, vol. 6, pp. 3-3.View/Download from: Publisher's site
Health and medical research invariably impacts on the lives of everyday people. Organisations in the developed world are increasingly involving the public in health research projects, and research governance structures and processes. The form the involvement takes varies, as does the level of involvement, from individuals, to groups, to the wider community. Lay community members can be trained to independently review health and medical research, and wider societal involvement in funding decisions, can be effectively fostered. The theoretical foundation, design and development of a task based consumer-training program, including a number of enabling factors to support the success of such training are presented. This work is likely to be of value to those planning to train consumers in technical or complex areas.
Saunders, C, Robotin, M & Crossing, S 2008, 'By invitation only - the case for breast cancer screening reminders for women over 69 years.', Australia and New Zealand health policy, vol. 5, pp. 23-23.View/Download from: Publisher's site
BACKGROUND: Breast cancer is the leading cause of cancer death in women in Australia. Early detection provides the best chance of reducing mortality and morbidity from the disease. Mammographic screening is a population health strategy for the early detection of breast cancer in Australia. Recruitment strategies such as regular advertising and biannual screening invitations are exclusively targeted at women aged 50 - 69 years. Even though they can participate, women 70 years or over are not invited or actively encouraged to undertake screening. Research has found that a routine letter of invitation increases the number of women participating in breast cancer screening. METHODS: Cancer data analysis and a literature and policy review was conducted to assess age specific breast cancer mortality rates and the legitimacy of rationale used to limit invitations for breast cancer screening to women younger than 70 years. RESULTS: The proportion of women over 69 years participating in the BreastScreen program is significantly less than rate of screening in the target age range (50-69 years). Evidence and data indicate that common justifications for limiting screening reminders to the target age range including life expectancy, comorbidities, effectiveness, treatment and cost are, for many women, unreasonable. CONCLUSION: There is now sufficient data to support a change in the targeted upper age range for breast cancer screening to improve the existing suboptimal surveillance in women aged over 69 years.
Saunders, C, Crossing, S, Girgis, A, Butow, P & Penman, A 2007, 'Operationalising a model framework for consumer and community participation in health and medical research.', Australia and New Zealand health policy, vol. 4, pp. 13-13.View/Download from: Publisher's site
The Consumers' Health Forum of Australia and the National Health and Medical Research Council has recently developed a Model Framework for Consumer and Community Participation in Health and Medical Research in order to better align health and medical research with community need, and improve the impact of research. Model frameworks may have little impact on what goes on in practice unless relevant organisations actively make use of them. Philanthropic and government bodies have reported involving consumers in more meaningful or collaborative ways of late. This paper describes how a large charity organisation, which funds a significant proportion of Australian cancer research, operationalised the model framework using a unique approach demonstrating that it is both possible and reasonable for research to be considerate of public values.
Saunders, C, Saunders, C, Girgis, A, Butow, P, Crossing, S & Penman, A 2007, 'Beyond scientific rigour: funding cancer research of public value.', Health policy (Amsterdam, Netherlands), vol. 84, no. 2-3, pp. 234-242.View/Download from: Publisher's site
To identify the values deemed by cancer consumers and community members to be important in judging research, and develop an appraisal instrument for the inclusion of consumer and community values in cancer research funding decisions in an independent review process.Improvement in the level and quality of consumer involvement in research processes is becoming increasingly recognised as an important area of development in research governance. It was identified that while the current practice of selecting research based on scientific merit satisfies the need to fund research with the best scientific quality and potential for success, this may not necessarily satisfy all the needs and expectations of cancer consumers and the wider community.A research team was established to undertake the qualitative study. A combination of focus groups and semi-structured in-depth telephone interviews were conducted to collect and verify information about the values held by cancer consumers and the wider community with regard to research.Consumer review criteria to guide consumers in judging the value of research, optimal rating scales to use with these criteria and views on how consumer needs should be incorporated into the process of judging and allocating research grants (e.g. the relative weight that should be given to scientific and consumer review) have been formally identified by this research.The findings of this study clarify consumer and community values regarding cancer research funding and offer a means to evaluate research that address these values.
The regulation of health care services has a range of goals. Improving the safety and quality of healthcare is one of them. However, there is a lack of good quality evidence about what members of the Australian community believe and expect in relation to the regulation of healthcare safety. To elicit the Australian public's voice on issues related to the governance of health care quality and safety, we developed a survey tool that reflected these core elements of Australian approach to regulating health care. This Policy Brief describes the results of the survey, highlighting the important areas of difference between the views of the community and existing regulatory frameworks. In summary, the general public expect a graduated approach to stakeholder responsibility, monitoring and regulatory responses to failures in the quality and safety of healthcare. However, Reliance on decentralised accreditation-centric quality improvement mechanisms is not sufficient. The community expects more centralised oversight, including strict norm-referenced monitoring and performance testing – including in-person 'spot inspections', rather than reliance on self-monitoring and reporting.