Academic literature on the topic 'Aboriginal Australians Treatment History'

AbstractIntroduction: Aboriginal People have inhabited the Australian continent since the beginning of time, but archaeologists and anthropologist’s state there is evidence for approx. 51,000 to 71,000 years of continual habitation. During this time, the Australian continent has experienced many environmental and climatic changes i.e. fluctuating temperatures, ice ages, fluctuating CO2 levels, extremely high dust levels, high ice volume, high winds, large scale bush fires, glacial movement, low rain fall, extreme arid conditions, limited plant growth, evaporation of fresh water lakes, and dramatic sea level fluctuations, which have contributed to mass animal extinction.Method: The skeletal remains of Aboriginal Australians were examined for evidence of bone spurring at the calcaneus, which may be indicative of fast running which would assist survival. The skull and mandible bones were examined for signs evolutional traits related to survival. Aboriginal culture, knowledge of medical treatment and traditional medicines were also investigated. Discussion: Oral story telling of factual events, past down unchanged for millennia contributed to survival. Aboriginal Australians had to seek refuge, and abandon 80% of the continent. Physical ability and athleticism was paramount to survival. There is evidence of cannibalism by many Aboriginal Australian tribes contributing to survival. The Kaurna People exhibited evolutionary facial features that would have assisted survival. Kaurna People had excellent knowledge of medicine and the capacity to heal their community members.Conclusion: The Australian continent has experienced many environmental and climatic changes over the millennia. Navigating these extremely harsh, rapidly changing conditions is an incredible story of survival of Aboriginal Australians. The findings of this investigation suggest that Aboriginal Australians survival methods were complex and multi-faceted. Although this paper could not examine every survival method, perhaps Aboriginal Peoples knowledge of flora and fauna, for nourishment and medicine, was paramount to their survival.

Australian Aboriginal people have a long history of relying on plants for the treatment of various ailments and illnesses. Our ongoing collaborative research project initiated by Chuulangun Aboriginal Corporation (Cape York, Australia) has recently focussed on revealing whether Kuuku I’yu plant medicines possess anticancer-related activities and the chemistry responsible for this. Here, we present results from a study of the plant Litsea glutinosa, used traditionally for the treatment of gastrointestinal disorders. Four known aporphine alkaloids N-methylactinodaphnine (1), boldine (2), N-methyllaurotetanine (3), and isoboldine (4) were isolated by activity-guided fractionation and tested for cytotoxicity against HT29, SKMEL28, and primary human keratinocytes. Compound 1 was the most cytotoxic and this observation may be explained by the presence of a 1,2-methylenedioxy group. In silico docking revealed that a plausible mechanism for the observed cytotoxicity is the stabilization of a topoisomerase II (β) DNA–enzyme complex. The ethnopharmacological relevance of this study is discussed in the context of researching and using traditional knowledge in biomolecular discovery.

BackgroundThere is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates.AimsTo examine whether community treatment orders (CTOs) reduce admission rates, using a two-stage design of matching and multivariate analyses to take into account socio-demographic factors, clinical factors, case complexity and previous psychiatric and forensic history.MethodSurvival analysis of CTO cases and controls from three linked Western Australian databases of health service use, involuntary treatment and forensic history. We used two control groups: one matched on demographic characteristics, diagnosis, past psychiatric history and treatment setting, and consecutive controls matched on date of discharge from in-patient care.ResultsWe matched 265 CTO cases with 265 matched controls and 224 consecutive controls (totaln=754). The CTO group had a significantly higher readmission rate: 72%v.65% and 59% for the matched and consecutive controls (log-rank χ2=4.7,P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates.ConclusionsCommunity treatment orders alone do not reduce admissions.

ABSTRACTBackground:The overarching cultural context of the brain injury survivor, particularly that related to minority peoples with a history of colonisation and discrimination, has rarely been referred to in the research literature, despite profoundly influencing a person’s recovery journey in significant ways, including access to services. This study highlights issues faced by Australian Aboriginal traumatic brain injury (TBI) survivors in terms of real-life consequences of the high incidence of TBI in this population, current treatment and long-term challenges.Method:A case study approach utilised qualitative interview and file review data related to five male Aboriginal TBI survivors diagnosed with acquired communication disorders. The five TBI survivors were from diverse areas of rural and remote Western Australia, aged between 19 and 48 years at the time of injury, with a range of severity.Case Reports:Common themes included: significant long-term life changes; short-term and long-term dislocation from family and country as medical intervention and rehabilitation were undertaken away from the person’s rural/remote home; family adjustments to the TBI including permanent re-location to a metropolitan area to be with their family member in residential care; challenges related to lack of formal rehabilitation services in rural areas; poor communication channels; poor cultural security of services; and lack of consistent follow-up.Discussion and Conclusion:These case reports represent some of the first documented stories of Aboriginal Australian TBI survivors. They supplement available epidemiological data and highlight different contexts for Aboriginal people after TBI, contributing to an overall profile that is relevant for rehabilitation service planning.

Human awareness of plants in Australia goes back 50,000 years when the aboriginal first began using plants to treat, clothe and feed themselves. The European influence came in 1778 with the First Fleet landing in New South Wales. Australia's earliest records of using horticulture for therapy and rehabilitation were in institutions for people with intellectual disabilities or who were incarcerated. Eventually, legislation created greater awareness in the government and community for the needs of persons with disabilities, and many worthwhile projects, programs and organizations were established or gained greater recognition. Horticultural therapy programs may be found in nursing homes, rehabilitation centers, adult training support services, hospitals, day centers, community centers and gardens, educational institutions, supported employment, and the prisons system. This article reviews the history and development of Australian horticulture as a therapy in the treatment of disabilities and social disadvantaged groups, and includes an overview of programs offered for special populations and of Australia's horticultural therapy associations. It also discusses opportunities for research, teaching and extension for horticultural therapy in Australia.

Objective: Immunotherapy is a novel treatment that can cause autoimmune diabetes in rare cases. More cases occur following use of the inhibitor to the protein programmed cell death-1 rather than the inhibitor to programmed cell death-ligand 1. Methods: We report a unique case of autoimmune diabetes following atezolizumab use. Results: A 55-year-old, Aboriginal Australian female with no prior history of diabetes was commenced on atezolizumab for recurrent squamous cell lung carcinoma. Two months following its commencement, there was the onset of fatigue, polyuria, polydipsia, and new hyperglycemia. Subsequently she was found to have a borderline-low C peptide level of 0.6 nmol/L (reference range is 0.5 to 1.0 nmol/L), and positive zinc transporter-8 antibodies. Following the diagnosis of autoimmune diabetes, 5 units of glargine insulin was commenced which maintained euglycemia and resolved her symptoms of hyperglycemia. Conclusion: There are few case reports of atezolizumab-induced autoimmune diabetes. We present the first case associated with zinc transporter-8 antibodies, and a unique case of autoimmune diabetes in a patient of Aboriginal Australian background.

Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.

PurposeThis paper aims to outline the possibilities of intersectional history as a novel method for management history. Intersectional history combines intersectionality and the study of the past to examine discrimination in organizations over time. This paper explores the need for intersectional work in management history, outlines the vision for intersectional history and provides a brief example analyzing the treatment of Australian Aboriginal people in a historical account of Qantas Airways.Design/methodology/approachThis paper contends that intersectionality is a discursive practice, and it adopts a relational approach to the study of the past to inform the method. This paper focuses on the social construction of identities and the enduring nature of traces of the powerful in organizations over time.FindingsThe example of Qantas Airways demonstrates that intersectional history can be used to interrogate powerful traces of the past to reveal novel insights about marginalized peoples over time.Originality/valueIntersectional history is a specific and reflexive method that allows for the surfacing of identity-based marginalization over time. The paper’s concentration on identity as socially constructed allows a particular focus on notions or representations of the marginalized in traces of the past. These traces may otherwise mask the existence and importance of marginalized groups in organizations’ dominant histories.

THE DISPUTE OVER THE HISTORY OF THE CONTINENT AND THE WAY TO RECONCILIATION – ABORIGINES IN MULTICULTURAL AUSTRALIAThe article is dedicated to difficult relations between Australian Aborigines and the Australian mainstream society. Over the centuries these relations were marked with white group’s domination and humiliation of the autochthons. The first decades of the 21st century, however, brought significant changes, but still not sufficient enough, in treatment of Australia’s first inhabitants. The text reflects on the most important solutions elaborated by both sides: the state and the Aborigines, aiming to improve the situation of disadvantaged minority.

Claire G. Coleman’s science fiction novel The Old Lie (2019) evokes the blemished chapters of Australia’s history as the basis of a dystopian futuristic Earth. By using the metaphor of a secular apocalypse (Weaver) wrapped in the form of a space opera, she interrogates historical colonialism on a much larger scale to bring to the fore the distinctive Indigenous experience of Australia’s terra nullius and its horrific offshoots: the Stolen Generations, nuclear tests on Aboriginal land and the treatment of Indigenous war veteran, but this time experienced by the people of the futuristic Earth. Following a brief introduction of the concept of the “Native Apocalypse” (Dillon) in the framework of Indigenous futurism, the paper discusses Coleman’s innovative use of space opera embedded in Wilfred Owen’s famous WWI poem “Dulce et Decorum Est”. The analysis focuses on four allegedly separate stories in the novel which eventually interweave into a single narrative about “the old lie”. In keeping with the twenty-first-century Indigenous futurism, Coleman’s novel does not provide easy answers. Instead, the end brings the reader to the beginning of the novel in the same state of disillusionment as Owen’s lyrical subject.

In 1948, after twenty years in the Papuan administration, Stanley Middleton became the Western Australian Commissioner of Native Affairs. State and Federal governments at that time had a policy of social assimilation towards Aboriginal people, who were expected to live in the same manner as other Australians, accepting the same responsibilties, observing the same customs and influenced by the same beliefs, hopes and loyalties. European civilization was seen as the pinnacle of development. Thus both giving Aboriginal people the opportunity to reach this pinnacle and believing they were equally capable of reaching this pinnacle was viewed as a progessive and humanitarian act. Aboriginal cultural beliefs and loyalties were not considered important, if they were recognized at all, because they were seen as primitive or as having being abandoned in favour of a Western lifestyle.

Law controls our everyday. It regulates our lives. It tells us what is and is not acceptable behaviour, it confers and protects our rights, and it punishes us for our indiscretions. But law does much more than this. It creates normative standards which shape the way people are treated and the way that we relate to each other and to society generally. The law defines people. It constructs identity. And it creates the 'other'. This is a legacy of positivism's insistence on identifying that which is 'inside' law, and so accorded legitimacy, and that which is not. That which does not conform to law's constructed standards and values is identified as 'other' and marginalised and silenced. In this thesis, I demonstrate the way that the law constructs 'other', in particular, the Aboriginal 'other'. I consider the way that Aborigines have been defined by the law to show the consequences that this has had for Aboriginal people beyond the purely legal. I argue that law's construction of Aboriginality has contributed to the marginalisation of Aboriginal people and their exclusion from many aspects of the legal and the social, and that it has silenced them within the dominant domain, denying them the ability to challenge the wrongs perpetrated against them. I examine these issues through the medium of literature. I argue that literature's contribution to exposing, critiquing and challenging law's construction of 'other' is invaluable. It informs the reader about the way that the law has treated Aboriginal people and, more generally, about the structures and limitations of our positivist legal system. It thereby contributes to the community's perception and understanding of the way the law works, and the impact that it has on the lives of its subjects. Perhaps most importantly, it also educates towards social change and reform.

Cancer has become one of the major chronic diseases among Aboriginal and Torres Strait Islander people of Australia, and was declared a health priority in the National Aboriginal and Torres Strait Islander Health Strategy in 2001. Since then efforts have been instigated to improve the epidemiological information with regard to cancer among Aboriginal Australians in several jurisdictions. Specific issues related to cancer have been identified. Aboriginal Australians compared with non-Aboriginal people have higher occurrence of preventable cancers and are less likely to access cancer screening, are diagnosed at a more advanced stage, have poor continuity of care, lower compliance with treatment and lower five-year survival rates. Several risk factors for higher incidence of some cancers have also been noted. However, these do not adequately explain the reasons behind the delayed presentation, poor compliance and different treatment outcomes of cancer among Aboriginal Australians compared to the total population.To investigate and explore the variations in Aboriginal Australians’ beliefs, understanding and perceptions around cancer and their experiences with cancer services, an exploratory, in-depth qualitative study was undertaken in several locations of Western Australia (WA). This was done with a view to understanding Aboriginal decision-making processes in relation to accessing cancer care in WA. The study was approved by the Human Research Ethics Committee (HREC) of Curtin University, the Western Australian Aboriginal Health Information and Ethics Committee (WAAHIEC), the Royal Perth and Sir Charles Gairdner Hospitals, and by the local Aboriginal Community Controlled Health Services (ACCHS) in regions where the research was conducted.The study adopted a hermeneutic phenomenological research design and used qualitative methods. A hermeneutic phenomenological approach was chosen as this allowed understanding to emerge from the experiences of the participants through interpreting the situated meaning of humans in the world. The views of 30 Aboriginal participants – including patients, survivors and close family members who had lost someone to cancer in their families – were gathered through in-depth interviews. The fieldwork was conducted between March 2006 and September 2007. Interview data were tape-recorded, transcribed and analysed using NVivo7 Software. Thematic analysis was carried out from the information.The findings from the study suggest that many factors affect Aboriginal people’s willingness and ability to participate in cancer-related screening and treatment services. Late diagnoses were not only due to late presentations, as some delayed diagnoses occurred in patients who had regular contact with medical services. Participation in treatment is affected by beliefs and fatalistic attitudes towards cancer; limited understanding of the biomedical aspects of cancer and treatment processes; preference of Aboriginal people to use other approaches to healing such as traditional healers and bush medicine; unwillingness to be separated from family and country, and several infrastructural and logistical issues such as cost, transport and accommodation. It was found that fear of death, shame, beliefs such as cancer is contagious and other spiritual issues affected Aboriginal people’s decisions around accessing services.Moreover, miscommunication between Aboriginal patients and health care providers, lack of cultural security and culturally appropriate support services, lack of Aboriginal staff within the hospital to personally support Aboriginal patients, and the alienating environment of oncology treatment services were also mentioned as barriers. Factors important for effective patient-provider communication such as language, shared understanding, knowledge and use of medical terminology require particular attention. Lack of a reliable and on-going relationship with service providers also came up quite persistently. All of these issues were underpinned by the historical context which includes past discriminatory treatment and experiences of racism by Aboriginal people within mainstream medical institutions. These factors contribute to fear of the medical system, feelings of disempowerment, and mistrust towards the system which constrain Aboriginal participation in cancer treatment and other support services.The results of this study indicate that an understanding of the complex “layers” (from micro to macro) of factors and the interactions between them is required to elucidate Aboriginal people’s decision-making processes around engaging and participating in mainstream cancer services. This research identified gaps in knowledge and understanding and a lack of support services within Aboriginal communities.The findings from the research have been shared with relevant cancer-specific and Aboriginal Community Controlled Health Services with a vision to utilise the study outcomes for the benefit of Aboriginal individuals and communities. Aboriginal people were invited to be co-presenters and co-authors wherever the study findings were presented. An Indigenous Women’s Cancer Support Group (IWCSG) was established in Geraldton after the completion of fieldwork there. This support group has been working to raise awareness of cancer in local Aboriginal people.Some suggestions and recommendations to improve services and cancer outcomes for Aboriginal Australians came out of the study. These include: employment of Aboriginal staff in services and involvement of them in decision-making, maintenance of culturally sensitive, empathetic person-to-person contact, provision of infrastructural and institutional support to involve Aboriginal families within the treatment domain; acknowledgement of holistic concepts of health and well-being; and increase Aboriginal health literacy with regard to cancer.

Thesis (Ph.D.) -- La Trobe University, 2006.
Research. "A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy, La Trobe Law, Faculty of Law and Management, La Trobe University, Bundoora, Victoria". Includes bibliographical references (leaves 318-338). Also available via the World Wide Web.

The Tiwi are the indigenous people of the Tiwi Islands, located off the Northern Territory mainland. In 1919, as a unique and distinct people they appeared to be in a position to maintain their identity, to resist absorption into western culture and to avoid some of the serious social problems that came to affect some other Indigenous communities. While aspects of the Tiwi culture and lifestyle were gradually modified or abandoned through contact with outside societies between 1919 and 2000, other traits remained strong or were strengthened. These included their relationship with the land, the local language, dancing and singing, and adoption customs. Forms of visual art, some introduced, brought fame to the Tiwi. Government policies on Indigenous matters changed dramatically over the twentieth century. The earlier ones, including assimilation programmes were discriminatory and restrictive. Later approaches to Aboriginal and Islander welfare, including land rights, had significant consequences for the Islanders, some beneficial, others detrimental in nature. From the 1970s, the departure of resident missionaries and government officers from the islands led to an influx of private European employees. The exposure to these people added to that which the Tiwi experienced as they travelled far beyond their islands. After 1972, the policies of self-determination and, then, self-management placed enormous strains on the Tiwi as they strove to meet the requirements of government, private enterprise and the wider society. New forms of land and local government controls replaced the law of the elders. A younger, western-educated generation now spoke on behalf of the people. Ultimately, under the influence of outside pressures, degrees of socio-cultural absorption occurred in the islands even though the official policy of assimilation had been abandoned. Fortunately, the strong identity of the Tiwi ensured a level of social cohesion capable of combating full assimilation into a wholly western lifestyle.
Doctor of Philosophy

The present chapter describes the decline and revitalisation of Australian Aboriginal languages—also called Australian languages. As preliminaries, it looks at the following: (i) a brief history of Aboriginal Australians, (ii) degrees of language viability, (iii) current situation of Australian languages, (iv) value of linguistic heritage, and (v) methods of language revitalisation. It then describes five selected language revitalisation activities, concerning Warrongo, Kaurna, Bandjalang, Thalanyji and Wiradjuri languages. In particular, it provides a detailed account of the Warrongo language revitalisation activity (in which the author has been participating). It finally examines a problem that is frequently encountered in language revitalisation activities: confusion over writing systems. The entire chapter pays careful attention to the changing political climate that surrounds Australian languages and activities for them.

Focusing on Johnno (1975), An Imaginary Life (1978), and Remembering Babylon (1993), this chapter argues that David Malouf’s redeployment of the formal devices of the modernist novel enables a distinctively Australian representation of postcolonial modernity. It explores Malouf’s public and literary advocacy of “imaginative possession” as a means to achieve settler belonging and effect true reconciliation between Indigenous and non-Indigenous Australians. Postcolonial critics, however, have accused Malouf of appropriating Aboriginal history and identity. This chapter argues that modernist investments within Malouf’s fiction enable imaginative possession but also yield enigma. Malouf’s use of Woolf and Faulkner’s shifts in narrative perspective, Proust’s manipulation of time and memory, Proust and Joyce’s reworking of the Bildungsroman, and the modernist intensification of lyrical subjectivity enables the tempering and attuning of settler selves to place. Yet in Johnno modernist resources unravel fixed truths, pointing instead to creative error and the fabrications of the self.

Australian palliative social work is dynamic, responding to changing contexts and system challenges. Work in Australia requires an understanding of the history and experience of Aboriginal and Torres Strait Islander Australians, along with the many other cultural groups who have arrived since 1788 to make up Australia’s multicultural community. Palliative care and bereavement service delivery varies across the country, meaning social workers must be flexible and able to adapt in their roles, while assisting patients and their families to navigate systems in their local context. Therapeutic knowledge and interventions underpin the work of palliative social work in Australia; counseling and therapeutic work are often delivered alongside skilled practical resourcing, care planning, and provision.

Australia’s first Migration Museum in Adelaide recognised from its inception in 1986, that representing migration history could not be done without acknowledging its intimate association with colonisation and the dispossession of indigenous people. Their first move therefore, was to create a distinction between all migrants, a category that included British ‘settlers’, and Indigenous Australians. This was significant not only because it implicated colonisation within migration history but because it made all non-Indigenous Australians migrants. The move though, was not easy to establish, largely because, in the public imagination, migrants were the other to mainstream or ‘British Australia’. In the mid-1990s, however, it seemed to work as Australia was indeed seen as a country that was relatively successful in integrating various waves of migration into its historical narratives while valuing cultural diversity and recognising the prior occupation of the land by Aboriginal people. The ‘War on terror’, the arrival of asylum seekers and the threat of internal terrorist attacks, along with changes in immigration policy and a general climate of fear has changed that, and migration museums are now working to combat a new wave of racism. To do so, I argue, they have developed a new set of curatorial strategies that aim to facilitate an exploration of the complexity of contemporary forms of identity. This chapter provides a history of the development of curatorial strategies that have helped to change the ways in which relations between ‘us and them’ have changed over the years in response to changes in the wider public discourse. My focus will be on both collecting and display practices, from changes to what is collected and how it is displayed, to the changing role of personal stories, the relationship between curators and the communities they work with, and the role of exhibition design in structuring the visitor experience.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.