Search

Background: Chronic, non-malignant diseases (CNMD) like chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and dementia in advanced stages are very burdensome for patients. Timely palliative care with strong collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams can reduce symptom burden, hospitalization rates, hospitalization costs and overall healthcare costs. The KOPAL-study on strengthening interprofessional collaboration for patients with palliative care needs tested the effect of an intervention comprising of a SPHC nurse assessment and an interprofessional case conference. This qualitative evaluative study explores patients', proxies' and their associates' motivation to participate in the KOPAL-study and views on the (benefits of the) intervention. Methods: We interviewed 13 male and 10 female patients as well as 14 proxies of patients with dementia and six associates of study participants using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim and analysed with deductive-inductive qualitative content analysis. Results: Motivation for participation was driven by curiosity, the aim to please the GP or to support research, respectively to help other patients. Few interviewees pointed out to have expected positive effects for themselves. The nurse visit was evaluated very positively. Positive changes concerning health care or quality of life were reported sparsely. Most study participants did not prepare for the SPHC nurse assessment. They had no expectations concerning potential benefits of such an assessment, the interdisciplinary case conference and an early integration of palliative care. The majority of interviewees reported that they did not talk about the nurse visit and the interprofessional case conference with their GPs. Conclusion: Our results lead to the conclusion that SPHC nurses can serve as an advocate for the patient and thereby support the patients' autonomy. GPs should actively discuss the results of the interdisciplinary case conference with patients and collaboratively decide on further actions. Patient participation in the interdisciplinary case conference could be another way to increase the effects of the intervention by empowering patients to not just passively receive the intervention. Trial registration: DRKS00017795 German Clinical Trials Register, 17Nov2021, version 05. [ABSTRACT FROM AUTHOR]

Implicit (i.e. unconscious) racial biases held by health professionals negatively affect patient–practitioner communication and health outcomes. Implicit biases are typically assessed through implicit association tests (IATs). We extracted cross‐sectional IAT data originating in Australia from two large publicly available data sets hosted by Project Implicit. In total, IATs were available from 1956 healthcare workers (1249 of European ethnicity; 829 professionals/technicians as opposed to support workers). All had participated between 2006 and 2022. Levels of implicit skin tone bias were found to be moderate according to Project Implicit guidelines and substantially greater than zero (d = 0.87). Participants of European ethnicity and older age scored higher, but there were no differences across occupation types (professional vs. support worker) or over years. Consistent with findings around the world, the findings highlight a need for interventions that could reduce implicit bias and thereby improve the healthcare experiences of people from minority groups. [ABSTRACT FROM AUTHOR]

Background: The unprecedented increase in telehealth use due to COVID-19 has changed general practitioners' (GP) and patients' engagement in healthcare. There is limited specific advice for effective communication when using telehealth. Examining telehealth use in practice in conjunction with perspectives on telehealth as they relate to communication allows opportunities to produce evidence-based guidance for optimal use of telehealth, while also offering practitioners the opportunity to reflect on elements of their communicative practice common to both styles of consultation. The objective of this research was to develop evidence-based resources to support effective, person-centred communication when GPs and patients use telehealth. This included examination of interactional practices of recorded telehealth consultations, exploration of GP and patient perspectives relating to telehealth, and identifying priorities for guidance informed by these analyses as well as participant co-design. Methods: This study involved recording telehealth consultations (n = 42), conducting patient surveys (n = 153), and interviewing patients (n = 9) and GPs (n = 15). These were examined using interaction analytic methods, quantitative analysis, and thematic analyses, to create a robust, integrated picture of telehealth practice and perspectives. The process of research translation involved a co-design approach, engaging with providers, patients, and policy makers to facilitate development of evidence-based principles that focus on supporting effective communication when using telehealth. Results: Three key themes relating to communication in telehealth were identified across the different analyses. These were relationship building, conversational flow, and safety netting. The draft best practice principles drawn from these themes were modified based on co-design feedback into five Best Practice Principles for Communication between GPs and Patients using Telehealth. Conclusions: Effective communication is supported through relationship building and attention to conversational flow in telehealth consultations, which in turn allows for safety netting to occur. In telehealth, GPs and patients recognise that not being co-present changes the consultation and use both intuitive and strategic interactional adjustments to support their exchange. The mixed-method examination of experiences through both a detailed analysis of telehealth consultations in practice and comparative exploration of GP and patient perspectives enabled the identification of principles that can support effective communication when using telehealth. Co-design helped ensure these principles are ready for implementation into practice. [ABSTRACT FROM AUTHOR]

The ward round (WR) is an important opportunity for interprofessional interaction and communication enabling optimal patient care. Pharmacists' participation in the interprofessional WR can reduce adverse drug events and improve medication appropriateness and communication. WR participation by clinical pharmacists in Australia is currently limited. This study aims to explore what is impacting clinical pharmacists' participation in WRs in Australian hospitals. A self-administered, anonymous national survey of Australian clinical pharmacists was conducted. This study describes the outcomes from qualitative questions which were analyzed thematically in NVivo-2020 according to Braun and Clarke's techniques. Five themes were constructed: "Clinical pharmacy service structure", "Ward round structure", "Pharmacist's capabilities", "Culture" and "Value". A culture supportive of pharmacist's contribution with a consistent WR structure and flexible delivery of clinical pharmacy services enabled pharmacists' participation in WR. Being physically "absent" from the WR due to workload, workflow, and self-perception of the need for extensive clinical knowledge can limit opportunities for pharmacists to proactively contribute to medicines decision-making with physicians to improve patient care outcomes. Bidirectional communication between the interprofessional team and the pharmacist, where there is a co-construction of each individual's role in the WR facilitates consistent and inter-dependent collaborations for effective medication management. [ABSTRACT FROM AUTHOR]

Summary: Coordinating healthcare activities between fracture liaison services (FLS) and primary care is challenging. Using a Delphi technique, we developed 34 consensus statements to support improved care coordination across this healthcare transition. Purpose: Evidence supporting an optimal coordination strategy between fracture liaison services (FLS) and primary care is lacking. This study aimed to develop consensus statements to support consistency and benchmarking of clinical practice to improve coordination of care for patients transitioning from FLS to primary care following an osteoporotic fracture. Methods: A Delphi technique was used to develop consensus among a panel of experts, including FLS clinicians (medical and non-medical), general practitioners (GPs), and consumers. Results: Results of a preparatory questionnaire (n = 33) informed the development of 34 statements for review by expert panellists over two Delphi rounds (n = 25 and n = 19, respectively). The majority of participants were from New South Wales (82%), employed as FLS clinicians (78.8%) and working in metropolitan centres (60.6%). Consensus was achieved for 24/34 statements in round one and 8/10 statements in round two. All statements concerning patient education, communication, and the GP-patient relationship achieved consensus. Expert opinions diverged in some areas of clinician roles and responsibilities and long-term monitoring and management recommendations. Conclusion: We found clear consensus among experts in many key areas of FLS integration with primary care. While experts agreed that primary care is the most appropriate setting for long-term osteoporosis care, overall confidence in primary care systems to achieve this was low. The role of (and responsibility for) adherence monitoring in a resource-limited setting remains to be defined. [ABSTRACT FROM AUTHOR]

Background: Aboriginal culture stands as the oldest continuous culture in the world. It gives paramount importance to a harmonious balance between personal connections to the body, spirit, and mind, as well as collective relationships with family, land, and community, integral to the wellbeing of Aboriginal people. However, obstacles can emerge for patients due to language barriers, cultural differences, or a historical lack of trust in the healthcare system. The establishment of Aboriginal Community Controlled Health Organisations (ACCHOs) has undoubtedly improved the healthcare experience for Aboriginal patients, yet there is limited research on the specific approaches utilised by general practitioners (GPs) working in these clinics. Methods: Twelve semi-structured interviews were conducted with two groups of GPs working in Aboriginal health. Each GP was presented with three scenarios and asked questions related to each scenario. Braun and Clarke's method of thematic analysis was applied to transcribed interviews. Results: Patient-doctor relationship, health literacy, and engagement with the health system emerged as key factors influencing communication with Aboriginal patients. Experienced GPs, despite differing clinical backgrounds, shared concise yet similar ideas to their less experienced counterparts. Notably, experienced GPs prioritised non-medical conversations and mindful body language, emphasising the importance of building strong patient relationships over other consultation aspects. Conclusions: This research provides initial insights for GPs in Aboriginal health, comparing experienced GPs with more than 10 years experience to novices. However, further research involving Aboriginal patients is needed to validate GP strategies and understand their significance from the patients' perspective. Communicating health information can be a challenging skill to clinicians especially when working in Aboriginal health. Despite Aboriginal Health Community Controlled Health Organisations having enriched the experience of Aboriginal patients, there is limited research on the approaches adopted by general practitioners (GPs) working in these clinics. Our research combines thoughts from experienced and novice GPs who worked in Aboriginal Health, and shares some of their experiences related to communicating medical information with Aboriginal patients in this highly complex field. [ABSTRACT FROM AUTHOR]

Context: In vitro fertilisation (IVF) is now a common assisted reproductive technology (ART) procedure globally, with 8 million children alive today having been conceived utilising IVF. For many patients, IVF is a difficult experience with many discontinuing treatment because of emotional, relationship and financial stress, or intolerable physical side effects of hormone treatments. Design and Participants: A qualitative study, in which 31 professionals and 25 patients from the ART sector in Australia were interviewed. The interviews were analysed using codebook thematic analysis. Results: Our data indicates there are 'silences' within the therapeutic relationship of IVF, which may limit the capacity for patients to prepare emotionally, financially, or medically for the procedure, and may contribute to psychological distress and dissatisfaction with care. These 'silences' include what the patient 'is not told' by their clinician or 'does not hear' and what the patient feels they 'cannot say'. Discussion: Drawing upon the work of Jay Katz, Charis Thompson, and Miles Little on 'silences' and performance in clinical practice, we argue that although IVF is a complex and multifaceted procedure that is often conducted in a commercial setting, the clinical and therapeutic relationship between doctor and patient remains pivotal to the experiences of patients. The 'silences' within this relationship may impact negatively on decision‐making, and on the delivery and experience of care. Conclusions: Careful attention to the realities of IVF treatment in the clinic room (and awareness of the performances that hide them) should allow for more present and compassionate care. Such care may leave patients more satisfied with their experience and their choices, regardless of treatment outcomes. Patient or Public Contribution: This article draws on interviews with patients who had undergone or were currently undergoing IVF, as well as a range of representatives from the ART community (including reproductive medicine specialists, general practitioners, fertility nurses, counsellors, administrators in ART businesses and embryologists). [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) have played an integral role in Australia's coronavirus disease 2019 (COVID-19) pandemic response. However, little is known about how GPs themselves have been impacted by the COVID-19 pandemic. This study aimed to increase our understanding of the experiences of GPs working during the COVID-19 pandemic. Methods: A qualitative study was conducted using semi-structured interviews. Using purposive sampling, 15 GPs from South-Eastern Australia were asked to reflect on their experiences during the first year of the COVID-19 pandemic. Interview transcripts underwent thematic analysis. Results: Five main themes were identified: fear of infection; uncertainty and information overload; impacts on the government–GP relationship; impacts on the patient–doctor relationship; and teamwork within practices and among GPs. Conclusions: The 15 GPs interviewed in this study provided valuable insights into their experiences working during the first year of the COVID-19 pandemic. From these insights, four recommendations propose what could be done to help support GPs to respond to a pandemic while continuing to deliver primary health care. Although general practitioners (GPs) have played a crucial role in Australia's COVID-19 pandemic response, few studies have explored the impact of the COVID-19 pandemic on GPs themselves. In this qualitative study, 15 GPs from South-Eastern Australia were asked to reflect on their experiences working during the first year of the COVID-19 pandemic in semi-structured interviews. Their reflections enhance our understanding of the experience of GPs working during the COVID-19 pandemic and may help guide future research and work to support GPs. [ABSTRACT FROM AUTHOR]

Patient-centered care (PCC) is the prevailing model of care globally. However, most research on PCC has been conducted in Westernized countries or has focused on only two facets of PCC: decision-making and information exchange. Our study examined how culture influences patients' preferences for five facets of PCC, including communication, decision-making, empathy, individualized focus, and relationship. Participants (N = 2071) from Hong Kong, the Philippines, Australia, and the U.S.A. completed an online survey assessing their preferences for exchange of information, autonomy in decision-making, expression and validation of their emotions, focus on them as an individual, and the doctor-patient relationship. Participants from all four countries had similar preferences for empathy and shared decision-making. For other facets of PCC, participants in the Philippines and Australia expressed somewhat similar preferences, as did those in the U.S.A. and Hong Kong, challenging East–West stereotypes. Participants in the Philippines placed greater value on relationships, whereas Australians valued more autonomy. Participants in Hong Kong more commonly preferred doctor-directed care, with less importance placed on the relationship. Responses from U.S.A. participants were surprising, as they ranked the need for individualized care and two-way flow of information as least important. Empathy, information exchange, and shared decision-making are values shared across countries, while preferences for how the information is shared, and the importance of the doctor-patient relationship differ. [ABSTRACT FROM AUTHOR]

While animals have long been a focus in therapeutic spaces for young people via approaches such as animal-assisted therapies, there is a sense in which such approaches overlook the broader contribution that animals play by being present in young people's lives. In this article, we explore how the presence of animals (both physical and psychological) in interactions with healthcare professionals may hold specific meaning for trans young people living in Australia. Participants were recruited through Parents of Gender Diverse Children. Interviews were conducted in November 2021 with 17 trans young people and one of each of their parents living in Australia. All interviews were audio recorded, transcribed, and analyzed using thematic analysis. Two main themes were developed: (1) how healthcare professionals respond to conversations about animals and (2) the beneficial role of the presence of animals. The article concludes by discussing the importance of thinking about the presence of animals beyond existing frameworks and recognizing the value placed on the presence of animals by trans young people. [ABSTRACT FROM AUTHOR]

Background: Prior research suggests that the quality of communication between doctors and patients influences the quality of medical care and adherence to treatment regimens, but little is known about factors that contribute to successful interactions between doctors and patients. Aim: To examine the quality of communication across the different medical specialties. Methods: A survey questionnaire was undertaken at a large metropolitan‐based hospital in Brisbane, Australia. In this initial study we surveyed 67 doctors across various specialties on a range of social cognition and personality measures. We then rated each of the specialties on the degree to which they rely on both procedures and diagnostics, as well as the extent to which they involve patient communication. Results: A regression analysis using spss 26.0 was undertaken to ascertain if doctor's satisfaction with their communication was related to these three aspects of the various specialties. Results revealed that communication satisfaction was negatively related to the degree to which the specialty relies on diagnostics. No relationship emerged between reliance on procedures and communication satisfaction. Last, communication frequency was positively related to communication satisfaction. Conclusions: We propose two possible accounts for this finding regarding diagnostics: (i) the cognitive demands of diagnosis disrupt communication; and/or (ii) diagnoses are interpreted by patients as opinions with which they are sometimes motivated to disagree. Further research is needed to replicate these findings and establish the underlying mechanism. [ABSTRACT FROM AUTHOR]

Objective: Health consumers (patients, their family, friends and carers) are frequently using their smartphones to record hospital clinical encounters. However, there is limited research which has explored the social interaction surrounding this behaviour. Understanding the consumer perspective is key to informing policy and practice. This study explored consumer attitudes and experiences regarding patient‐led recordings. Methods: Semistructured interviews were undertaken with 20 hospital consumers. Participants were recruited via advertising, posters and invitation letters. Interviews were digitally recorded and transcribed. Data were analysed using thematic analysis. Findings: Four main themes were identified relating to participant perspectives of patient‐led recordings: (1) consumers viewed clinician consent as important, although they reported different experiences of the consent process, (2) consumers indicated that a clinician refusing the recording had the potential to undermine the consumer–clinician relationship, (3) consumers were both uninformed and misinformed regarding relevant policy and legislation and (4) consumers expressed a number of expectations regarding their rights to record and of the health service in supporting this practice. Conclusion: Consumers want to record their clinical encounters with the consent of their clinician but are unprepared to navigate consent discussions. Health services and clinicians should inform consumers who want to record about their rights and responsibilities, to support the consent process and safe recording environments. Clinician refusal to consent to a patient‐led recording may not lead to increased covert recording; however, clear communication about the reasons for refusing a recording is needed to protect the consumer–clinician relationship. Patient or Public Contribution: A health consumer was part of the research team and was involved in all stages of this study, including the design, data analysis and reviewing of the manuscript. [ABSTRACT FROM AUTHOR]

Background: Pregnant women are at increased risk for severe COVID‐19 and are a priority group for vaccination. The discrepancy in vaccination rates between pregnant and non‐pregnant cohorts is concerning. Aims: This study aimed to assess the perceptions and intentions of pregnant women toward COVID‐19 vaccination and explored vaccine uptake and reasons for vaccine hesitancy. Materials and method: A cross‐sectional exploratory design was performed evaluating pregnant women receiving care in two metropolitan maternity units in Western Australia. The main measurable outcomes included vaccination status, intention to be vaccinated, and reasons for delaying or declining vaccination. Results: In total, 218 women participated. Of these, 122 (56%) had not received either dose of the COVID‐19 vaccine. Sixty (28%) claimed that vaccination was not discussed with them and 33 (15%) reported being dissuaded from vaccination by a healthcare practitioner. Compared to vaccinated women, those who had not accepted vaccination were less likely to have had vaccination discussed by maternity staff, less aware that pregnant women are a priority group, and less aware that pregnancy increased the risk of severe illness. Unvaccinated women were concerned about the side effects of the vaccine for their newborn and their own health, felt there was inadequate information on safety during pregnancy, and felt that a lack of community transmission in Western Australia reduced the necessity to be vaccinated. Conclusion: Vaccine delay and hesitancy is common among pregnant women in Western Australia. Education of healthcare professionals and pregnant women on the recommendation for COVID‐19 vaccination in pregnancy is required. [ABSTRACT FROM AUTHOR]

Aims It is recommended that patients and clinicians discuss end-of-life deactivation of their implantable cardioverter defibrillator (ICD) prior to device implantation and throughout the illness trajectory to facilitate shared decision-making. However, such discussions rarely occur, and little is known about patients' openness to this discussion. The purpose of this study was to explore factors associated with patients' openness to discussing end-of-life ICD deactivation with clinicians. Methods and results This cross-sectional study recruited 293 patients with an ICD from outpatient clinics in the USA, Australia, and South Korea. Patients were classified into an open or resistant group based on their desire to discuss device deactivation at end of life with clinicians. Multivariable logistic regression was used to explore factors related to patients' openness to this discussion. About half of the participants (57.7%) were open to discussing such issues with their clinicians. Factors related to patients' openness to discussing device deactivation at end of life were living with someone, not having severe comorbid conditions (cancer and/or chronic kidney disease), greater ICD knowledge, and more experience discussing end-of-life issues with clinicians (odds ratio: 0.479, 0.382, 1.172, 1.332, respectively). Conclusion Approximately half of the ICD recipients were reluctant to discuss device deactivation at end of life with clinicians. Unmodifiable factors were their living arrangement and severe comorbidity. ICD knowledge and prior experience discussing end-of-life issues were potentially modifiable factors in the future. These factors should be addressed when assessing patients' readiness for a shared discussion about device deactivation at end of life. [ABSTRACT FROM AUTHOR]

End-of-life care involves treatment and support offered to terminally ill individuals and their caregivers. Effective communication and decision-making, illness and symptom management, relationship with doctors, characteristics of the health care team, and the involvement and needs of caregivers have all been proposed to contribute to the quality of the end-of-life experience. This study sought to establish bereaved caregivers' experiences of the quality of the elements of end-of-life care delivered to their loved ones. Bereaved caregivers who had lost a loved one who was cared for in an acute care University-affiliated hospital, with 670 beds, located in the Australian Capital Territory during the previous 6−12 months (N=91), were surveyed using a modified version of the Canadian Health Care Evaluation Project questionnaire. The findings indicated that the bereaved caregivers were generally very satisfied with their loved one's end-of-life care. The age of the caregiver, the preferred location of death for both patient and caregiver, if death was expected, and religious affiliation were associated with satisfaction of the end-of-life care delivered. Key areas for improvement of end-of-life care included factors related to the relationships between doctors and those receiving care, characteristics of the health care team, illness management, communication and decision-making, and the involvement of caregivers. These findings have significant implications for this hospital and those seeking to improve outcomes in end-of-life care settings more widely, by providing baseline data on caregiver-evaluated care quality and identifying high-priority areas for targeted intervention. [ABSTRACT FROM AUTHOR]

Background: Communicating about medications across transitions of care is important in older patients who frequently move between health care settings. While there is increasing interest in understanding patient communication across transitions of care, little is known about older patients' involvement in formal and informal modes of communication regarding managing medications. Objective: The aim of this paper was to explore how older patients participated in managing their medications across transitions of care through formal and informal modes of communication. Methods: The study was conducted across two metropolitan hospitals: an acute hospital and a geriatric rehabilitation hospital in metropolitan Melbourne, Australia. A focused ethnographic design was used involving semi‐structured interviews (n = 50), observations (203 h) and individual interviews or focus groups (n = 25). Following thematic analysis, data were analysed using Fairclough's Critical Discourse Analysis. Results: Data analysis revealed two major discursive practices, which comprised of an interplay between formal and informal communication and environmental influences on formal and informal communication. Self‐created patient notes were used by older patients to initiate informal discussion with health professionals about medication decisions, which challenged traditional unequal power relations between health professionals and patients. Formal prompts on electronic medication administration records facilitated the continuous information discourse about patients' medications across transitions of care and encouraged health professionals to seek out older patients' preferences through informal bedside interactions. Environmental influences on communication comprised health professionals' physical movements across private and public spaces in the ward, their distance from older patients at the bedside and utilization of the computer systems during patient encounters. Conclusion: Older patients' self‐created medication notes enabled them to take on a more active role in formal and informal medication communication across transitions of care. Older patients and family members did not have continuous access to information about medication changes during their hospital stay and systems often failed to address older patients' key concerns about their medications, which hindered their active involvement in formal and informal communication. Patient or Public Contribution: Older adults, family members and health professionals volunteered to be interviewed and observed. [ABSTRACT FROM AUTHOR]

Background: Autistic adults experience barriers to accessing health care, such as service provider communication not meeting their needs, healthcare facilities causing sensory discomfort and feeling fear or anxiety regarding their healthcare visit. The Academic Autism Spectrum Partnership in Research and Education (AASPIRE) developed and trialled an online healthcare toolkit to reduce such barriers and improve healthcare interactions between autistic adults and their primary care providers in the United States. This preliminary study aimed to explore experiences of autistic adults using the AASPIRE Healthcare Toolkit in Australia. Methods: Semi-structured interviews were conducted with six autistic adults about their experiences and perceptions of utilising the toolkit in an Australian healthcare setting. Results: Participants identified that the toolkit facilitated their interactions with health professionals by providing structure to appointments, supplementing new knowledge and increasing individual confidence. They also offered suggestions to tailor the toolkit for use in Australia. Conclusions: Future research should seek to explore the experiences of autistic adults using a version of the toolkit adapted for Australian use, as well as exploring the views of health professionals utilising it. Autistic adults often experience barriers to accessing health care and have negative healthcare experiences. We wanted to know if an online healthcare toolkit developed with autistic adults to improve healthcare interactions between them and their primary care providers in the US, could be used in Australia. We interviewed six Australian autistic adults about using the toolkit, with positive feedback. An Australian-adapted healthcare toolkit may potentially improve the healthcare experiences of autistic adults living in Australia. [ABSTRACT FROM AUTHOR]

This paper explores the critical roles of researchers in research involving vulnerable populations. Its purpose is to reflect on the complex nature of vulnerability of Bhutanese refugee women who had resettled in Australia involved in research looking at the barriers to accessing preventive cancer screening. First, we describe the vulnerabilities considered prior to the research study and the actions taken to protect participants while the study was conducted. Second, we discuss those vulnerabilities that we did not anticipate, but were subsequently revealed during the study and consequently included in the study findings. These vulnerabilities should be considered for future research involving similar populations. It is important for researchers to use appropriate research designs that enable the voice of vulnerable people to be heard and to use research strategies that ensure findings are robust and participants are protected and empowered. Potential implications include the development of research practices that take account of the sources of vulnerabilities and consideration of how different vulnerabilities can evolve and affect findings and research recommendations. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative condition of the central nervous system that commonly strikes in young adulthood and has no cure. Many people living with MS (PwMS) will have significant contact with a range of healthcare professionals (HCPs). To achieve optimal health outcomes in MS, it is important to understand factors that contribute to positive or negative healthcare experiences. Previous studies have shown that PwMS want clear communication and in‐depth relationships with their HCPs. However, many studies have lacked qualitative feedback from HCPs. Objective: This study aimed to investigate healthcare experiences of PwMS and HCPs and identify areas that are working well and areas that could be improved. Methods: Semistructured interviews with 15 PwMS and 11 HCPs (seven neurologists, four MS nurses) from across Australia were conducted. Interviews were transcribed verbatim and analysed thematically. Results: Both PwMS and HCPs valued clear communication, recognized uncertainties associated with MS and highlighted the importance of rapport. PwMS focused on decision‐making, understanding roles and expectations, self‐directed management and their needs for support. HCPs discussed issues related to medical management, providing hope and reassurance, barriers to healthcare and multidisciplinary care. Conclusion: Greater transparency and communication, particularly around the approach to care and the roles played by HCPs, is likely to enhance healthcare experiences and contribute to better health outcomes for PwMS. Public Contribution: PwMS and HCPs volunteered to be interviewed, and PwMS assisted with the development of interview content and structure. [ABSTRACT FROM AUTHOR]

Background: In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia's Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. Methods: This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. Results: Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. Conclusions: Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research. [ABSTRACT FROM AUTHOR]

Objectives: While current antiretroviral and care strategies can effectively suppress HIV, achieving optimal quality of life (QoL) requires a wider consideration of clients' well‐being, the complexity of individuals' lives and social determinants of health. The objective of this commentary was to develop a definition of client‐led care in the Australian context and its key supporting principles for people living with HIV (PLHIV). Methods: The authors used two sources of evidence to support their HIV community experience with client‐led care: (1) a scoping review of the literature, and (2) consultations with colleagues who were PLHIV advocates or HIV specialist physicians. The findings from the scoping review and consultations were summarised and the key principles of client‐led care compared with those identified by the authors. Results: Seven articles met the inclusion criteria for qualitative analysis in the scoping review. Five PLHIV advocates and three HIV specialist physicians were consulted. Key principles supporting client‐led care identified by the authors based on their experience centred around the themes of: (1) clients and healthcare providers working in partnership, (2) information and communication, (3) coordinating access to care, (4) building trust, and (5) respect for client's needs and preferences. The principles identified by the authors were supported by those of the scoping review and colleague consultations. Conclusions: A client‐led approach can complement conventional HIV care strategies and enable empowerment and greater engagement with care, potentially improving the care continuum and overall QoL for individuals living with HIV who can, and want to, lead their own care. [ABSTRACT FROM AUTHOR]

Objectives: To examine in a sample of nurses working in acute-care wards, self-reported perceptions of the: 1) patient; family; nurse; doctor; and health system-related barriers to the provision of optimal end-of-life care to people who are dying in hospital; and 2) five barriers which, if removed, would lead to the greatest improvements in hospital-based end-of-life care. Background: Nurses play a central role in caring for dying patients and can offer a unique perspective about the factors that impact the quality of end-oflife care delivered in hospitals. Study design and methods: Two hundred and fifteen registered and enrolled nurses from three metropolitan and three rural hospitals across three health services completed a questionnaire-based, cross-sectional study between April 2016 and June 2017. Results: Nurses perceive that doctors continue to treat for too long (79% ranked as a large barrier); families have unrealistic expectations about a patient's prognosis (73%); junior doctors are unwilling to alter the decision of senior doctors (67%); doctors do not adequately explain the dying process (66%); and doctors have inadequate training in end-of-life care (66%). Nurses indicated that doctors reducing the length of active treatment and families having a more realistic expectation about life-expectancy would lead to the greatest improvement in end-oflife care in hospitals. Discussion: In this study of nurses working in a wide range of acute care settings across rural and metropolitan locations, substantial barriers to the provision of high-quality end-of-life care were perceived across all facets of healthcare provision. Important barriers included the continuation of potentially futile treatment, inadequacy of symptom control, and poor communication between doctors, patients and their families. Conclusion: Nurses perceive a range of patient; family; provider; and health system-related challenges to the provision of optimal end-of-life care in hospital. Findings highlight potential areas for improvement as part of a coordinated approach to optimising the provision of end-of-life care in hospitals. Future goals should include larger-scale, longitudinal studies across various states and territories to inform the development of interventions that can help to address the identified gaps in service provision. Implications for research, policy, and practice: This study has highlighted the need to involve all stakeholders when designing interventions to improve end-of-life care. Nurses can provide valuable insight into the factors that can make the greatest impact in improving care provision. It suggests that the provision of high-quality end-oflife care in hospitals is complex, and that there is substantial overlap between items nurses perceive to be barriers in each of the five domains of care provision. To achieve sustainable improvement in the quality of end-of-life care provided in hospitals, a multi-factorial, and collegial, approach to designing interventions will be needed. What is already known about the topic? • End-of-life care is increasingly being provided in hospital settings. • Nurses are an important source of information and support for dying patients and their families. • Few studies have explored nurses' perceptions of the barriers to the provision of high-quality end-oflife care across all domains of healthcare provision. What this paper adds: • Important barriers include continuation of potentially futile treatment, adequacy of symptom control, and poor communication between doctors, patients, and their families. • Findings can support the design of more effective intervention strategies to mitigate identified barriers and achieve improvements in the quality of end-of-life care delivered in hospital. [ABSTRACT FROM AUTHOR]

Background: To optimise medication use in older people, it is recommended that clinicians evaluate evidence on potential benefits and harms of medicines in light of the patients' overall health, values and goals. This suggests general practitioners (GPs) should attempt to facilitate patient involvement in decision-making. In practice this is often challenging. In this qualitative study, we explored GPs' perspectives on the importance of discussing patients' goals and preferences, and the role patient preferences play in medicines management and prioritisation. Methods: Semi-structured interviews were conducted with GPs from Australia (n = 32). Participants were purposively sampled to recruit GPs with variation in experience level and geographic location. Transcribed audio-recordings of interviews were coded using Framework Analysis. Results: The results showed that most GPs recognised some value in understanding older patients' goals and preferences regarding their medicines. Most reported some discussions of goals and preferences with patients, but often this was initiated by the patient. Practical barriers were reported such as limited time during busy consultations to discuss issues beyond acute problems. GPs differed on the following main themes: 1) definition and perception of patients' goals, 2) relationship with the patient, 3) approach to medicines management and prioritisation. We observed that GPs preferred one of three different practice patterns in their approach to patients' goals in medicines decisions: 1) goals and preferences considered lower priority – 'Directive'; 2) goals seen as central – 'Goal-oriented'; 3) goals and preferences considered but not explicitly elicited – 'Tacit'. Conclusions: This study explores how GPs differ in their approach to eliciting patients' goals and preferences, and how these differences are operationalised in the context of older adults taking multiple medicines. Although there are challenges in providing care that aligns with patients' goals and preferences, this study shows how complex decisions are made between GPs and their older patients in clinical practice. This work may inform future research that investigates how GPs can best incorporate the priorities of older people in decision-making around medicines. Developing practical support strategies may assist clinicians to involve patients in discussions about their medicines. [ABSTRACT FROM AUTHOR]

To inform the development of automated summarization of clinical conversations, this study sought to estimate the proportion of doctor-patient communication in general practice (GP) consultations used for generating a consultation summary. Two researchers with a medical degree read the transcripts of 44 GP consultations and highlighted the phrases to be used for generating a summary of the consultation. For all consultations, less than 20% of all words in the transcripts were needed for inclusion in the summary. On average, 9.1% of all words in the transcripts, 26.6% of all medical terms, and 27.3% of all speaker turns were highlighted. The results indicate that communication content used for generating a consultation summary makes up a small portion of GP consultations, and automated summarization solutions—such as digital scribes—must focus on identifying the 20% relevant information for automatically generating consultation summaries. [ABSTRACT FROM AUTHOR]

Background: End-of-life discussions often are not initiated until close to death, even in the presence of life-limiting illness or frailty. Previous research shows that doctors may not explicitly verbalize approaching end-of-life in the foreseeable future, despite shifting their focus to comfort care. This may limit patients' opportunity to receive information and plan for the future. General Practitioners (GPs) have a key role in caring for increasing numbers of patients approaching end-of-life.Objective: To explore GPs' thought processes when deciding whether to initiate end-of-life discussions.Methods: A qualitative approach was used. We purposively recruited 15 GPs or GP trainees from South-East Queensland, Australia, and each participated in a semi-structured interview. Transcripts were analyzed using inductive thematic analysis.Results: Australian GPs believe they have a responsibility to initiate end-of-life conversations, and identify several triggers to do so. Some also describe caution in raising this sensitive topic, related to patient, family, cultural and personal factors.Conclusions: These findings enable the development of approaches to support GPs to initiate end-of-life discussions that are cognizant both of GPs' sense of responsibility for these discussions, and factors that may contribute to caution initiating them, such as anticipated patient response, cultural considerations, societal taboos, family dynamics and personal challenges to doctors. [ABSTRACT FROM AUTHOR]

Background As doctors who provide care across the life-course, general practitioners (GPs) play a key role in initiating timely end-of-life discussions. Nonetheless, these discussions are often not initiated until close to death. Given the ageing of the population, GPs will be confronted with end-of-life care more often, and this needs to become a core skill for all GPs. Objective To describe GPs' approach to initiating end-of-life discussions. Methods Fifteen GPs or GP trainees from South-East Queensland, Australia, were purposively recruited to participate in a semi-structured interview. We analysed transcripts using a thematic analysis. Results GPs' approach to initiating end-of-life discussions was summarized by four themes: (1) Preparing the ground; (2) finding an entry point; (3) tailoring communication and (4) involving the family. Conclusions Emphasis on the doctor–patient relationship; assessing patient readiness for end-of-life discussions; and sensitive information delivery is consistent with factors previously reported to be important to both GPs and patients in this context. Our findings provide a framework for GPs initiating end-of-life discussions, which must be tailored to patient and GP personality factors. Further research is required to evaluate its outcomes. [ABSTRACT FROM AUTHOR]

Purpose: A cancer diagnosis is an emotive and challenging time for patients. This study aimed to systematically explore patients' accounts of experiencing their cancer diagnosis. The purpose of this article is to offer a typology of patient responses to receiving a cancer diagnosis as a means through which to affirm the range of patients' experiences and to guide clinicians' practice.Methods: Qualitative semi-structured interviews were conducted between 2015 and 2017 with 80 patients living with cancer: 34 females and 46 males, aged between 31 and 85, diagnosed with a range of cancer types, stages and treatment trajectories, from two metropolitan hospitals on the east coast of Australia. Interview data were analysed thematically, using the framework approach.Results: A typology of responses to the cancer diagnosis was derived from the analysis and included (1) the incongruent diagnosis, unexpected because it did not 'fit' with the patient's 'healthy' identity; (2) the incidental diagnosis, arising from seemingly unrelated or minor medical investigations; (3) the validating diagnosis, as explanation and confirmation of previously unexplained symptoms, pain or feelings; (4) the life context diagnosis, where the cancer diagnosis was positioned relative to other challenging life events, or as relatively inconsequential compared with the hardship of others.Conclusions: A diagnosis of cancer is not always (or only) experienced by patients with shock and despair. Diagnosis is perceived and experienced in diverse ways, shaped by broader social or life contexts, and with important implications for the clinical encounter and communication from an oncology perspective. [ABSTRACT FROM AUTHOR]

Objective: The barriers and enablers to the uptake of advance care plans has been well documented but more so in metropolitan health services. Rural and regional areas have their own challenges of higher rates of chronic illness and an aging population when considering end of life care. This study aimed to explore the creation of advance care plans in a regional location that has service links to smaller health services. Design: A qualitative study involving thematic analysis of interview data. Setting: A regional local government area in Victoria, Australia. Participants: Twelve representatives from rural and regional health services, including hospital, private practice and community organisation staff. Main outcome measures: Barriers and enablers to the creation of advance care planning documents. Results: The data analysis yielded two main identified themes around Plan creation and communication of patient wishes: system and societal challenges to the creation and communication in advance care planning; and rural communities' expectation of the health service‐patient relationship and advance care planning. Conclusion: Although barriers to advance care planning are well known, rural and regional practitioners need to be aware of the effect long‐term continuity of care from health practitioners and connections with health services has on advance care plan creation, and whether the paucity of written Plans effects end‐of‐life care. A potential solution was seen in the pending linkages to the national electronic patient record. [ABSTRACT FROM AUTHOR]

Purpose: To explore the experiences of haematological cancer outpatients in obtaining information about their cancer and its treatment.Methods: A cross-sectional survey of adult haematological cancer outpatients was conducted. Participants completed two pen-and-paper questionnaires: the first examined demographics and disease characteristics; the second, completed four weeks later, asked about the cancer information received. Participants indicated whether they received the information they needed about medical procedures and self-management, experiences regarding doctor-patient communication, and self-efficacy in seeking information and support. Where possible, items were derived from Australian psychosocial cancer care guidelines.Results: Two hundred and ninety-three (84%) patients consented to participate, with 170 (58%) completing both questionnaires. Most participants reported receiving information in accordance with guidelines. Areas identified as requiring improvement included difficulty recalling information (28%); information overload (26%); insufficient opportunity to ask questions (23%); and insufficient information about managing anxiety related to medical procedures (20%).Conclusion: While many haematological cancer patients report receiving adequate information, there is room for improvement. Implementation of evidence-based strategies, such as decision aids or audiotapes of the consultation, may help to improve information experiences.Practice Implications: A patient-centred approach to information provision is essential for ensuring information addresses the needs and preferences of the patient. [ABSTRACT FROM AUTHOR]

Background: As modern medicine extends the life expectancy of patients with life-limiting illnesses and health system resource pressures intensify, palliative care physicians increasingly need to transfer stable patients from specialist palliative care units to nursing homes. The experience of palliative care physicians in decision-making and communicating with patients and families about the need for this transition is underexplored in the literature. Aim: This study aimed to explore the experiences of and communication techniques used by palliative care physicians as they consider and discuss nursing home placements for their patients. Design: A qualitative approach using semi-structured interviews was used. Interviews were transcribed verbatim and analysed using thematic analysis. Setting/participants: Purposive sampling was used to recruit 18 Australian palliative care physicians known for their interest or strength in communication skills across a range of palliative care settings. Results: Themes emerged from domains of physician experience (abandonment, systemic pressures, prognostic uncertainty, exacerbation of loss, and restoring resilience) and communication strategies (forecasting, checking in, provide context, and acknowledging grief). Conclusion: This study highlights the tension Australian palliative care physicians experience when transferring palliative care patients to nursing home and the complexity involved in decision-making. Physicians identified several communication strategies to engage patients and families to ease the transition. [ABSTRACT FROM AUTHOR]

The language used by healthcare professionals can have a profound impact on how people living with diabetes, and those who care for them, experience their condition and feel about living with it day‐to‐day. At its best, good use of language, both verbal and written, can lower anxiety, build confidence, educate and help to improve self‐care. Conversely, poor communication can be stigmatizing, hurtful and undermining of self‐care and can have a detrimental effect on clinical outcomes. The language used in the care of those with diabetes has the power to reinforce negative stereotypes, but it also has the power to promote positive ones. The use of language is controversial and has many perspectives. The development of this position statement aimed to take account of these as well as the current evidence base. A working group, representing people with diabetes and key organizations with an interest in the care of people with diabetes, was established to review the use of language. The work of this group has culminated in this position statement for England. It follows the contribution of Australia and the USA to this important international debate. The group has set out practical examples of language that will encourage positive interactions with those living with diabetes and subsequently promote positive outcomes. These examples are based on a review of the evidence and are supported by a simple set of principles. What's new?: The use of language by healthcare professionals can have a profound impact on people living with diabetes.Our working group, which represents people with diabetes and key stakeholders, has developed a set of principles to guide healthcare professionals, with the goal of improving interactions with those living with diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe characteristics of ED admissions that resulted in unsolicited complaints and compare with overall ED admissions. The site utilised is an inner city tertiary hospital, with 630 beds, with approximately 82 600 annual presentations, where 32.5% were children. Methods: Complaints between the dates of 27 November 2012 and 10 March 2016 were reviewed. Performance indicators and the distribution of presentations by diagnostic code were reviewed. Results: A total of 572 different complaint reasons were found and grouped into 12 categories. The most common reasons for complaints were treatment (33.2%) and communication (28.3%), and most complaints concerned medical staff. Other variables including wait times have no effect on patient complaints. Utilising aggregate numbers, the overall paediatric complaint ratio was 0.98:1000 presentations, and the total adult department complaints were 1.78:1000 presentations. Conclusion: As seen in this study the vast majority of patient complaints were associated with treatment and communication issues and skewed towards doctors. It may be feasible for medical staff to undertake communication training as clinician‐patient communication in the ED is an important aspect in the improvement of patient satisfaction and in decreasing patient complaints as waiting times and triage categories had no major influence on patient complaints. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents and young adults (AYA) with cancer are a cohort requiring specialized healthcare models to address unique cognitive and physical challenges. Advance care planning (ACP) discussions likely warrant age-appropriate adaptation, yet, there is little Australian research data available to inform best practice for this group. The goal of this work is to inform future models of ACP discussions for AYA. Methods: Retrospective medical record audit of AYA patients and an adult comparison group, diagnosed with a malignancy and referred to a community hospice service, in Western Australia, in the period between January 1, 2012 and December 1, 2015. Information was collected regarding end-of-life care discussions, documentation of agreed plan of care, and care received. Results: Twenty-seven AYA and 37 adult medical records were reviewed. Eighteen (66.7%) AYA patients died at home, compared with 19 (51.4%) adults ( p = 0.028). Desire to pursue all available oncological therapies, including clinical trials, was documented for 14 (51.9%) AYA patients compared with 9 (24.3%) of the adult group ( p = 0.02). Eleven AYA patients (40.7%) received chemotherapy during the last month of life compared with two (5.4%) adults ( p = 0.001). Conclusions: The results indicate that end-of-life care preferences for this unique cohort may differ from those of the adult population and need to be captured and understood. An ACP document incorporating a discussion regarding goals of care, preferred location of care, preference for place of death, and consent to future intervention, including cardiopulmonary resuscitation and prompts for review, could assist in pursuing this objective. [ABSTRACT FROM AUTHOR]

Somatic mutations in key oncogenes in non-small cell lung cancer ( NSCLC) and melanoma are important determinants of tumour sensitivity to targeted therapies. Molecular screening for these predictive biomarkers is routinely used to inform treatment decisions; however, little is known about how best to communicate testing and results to patients. This qualitative study aimed to explore advanced cancer patients' attitudes and experiences regarding somatic tumour screening to identify their information and support needs. Sixteen NSCLC and eight melanoma patients who had undergone screening participated in a semi-structured face-to-face or telephone interview exploring their understanding, views, preferences and needs regarding screening. Interviews were audiotaped, transcribed and analysed for thematic patterns. Participants expressed positive views and unequivocal acceptance of screening, and understood its role in guiding treatment selection. They preferred to receive information verbally through simple, non-technical language from their oncologist with additional take-home materials. Patients were interested in learning about their test results, but wanted discussion to be focused on practical matters relevant to treatment. While receiving their screening results was not considered burdensome, information overload and cancer-related distress were identified as barriers to test comprehension. Patients may benefit from information and decision-related tools to better understand genomic information and adequately support psychosocial outcomes. [ABSTRACT FROM AUTHOR]

Background: Public policy in many health systems is currently dominated by the quest to find ways to 'do more with less'-to achieve better outcomes at a reduced cost. The success or failure of initiatives in support of this quest are often understood in terms of an adversarial dynamic or struggle between the professional logics of medicine and of management. Here, we use the case of the introduction of information and communication technology (ICT) to a well-established ritual of medical autonomy (the medical ward round) to articulate a more nuanced explanation of how and why new ways of working with technology are accepted and adopted (or not).Methods: The study was conducted across four intensive care units (ICUs) in major teaching hospitals in Sydney, Australia. Using interviews, we examined 48 doctors' perceptions of the impact of ICT on ward round practice. We applied the concept of institutional logics to frame our analysis. Interview transcripts were analysed using a hybrid of deductive and inductive thematic analysis.Results: The doctors displayed a complex engagement with the technology that belies simplistic characterisations of medical rejection of managerial encroachment. In fact, they selectively welcomed into the ward round aspects of the technology which reinforced the doctor's place in the healthcare hierarchy and which augmented their role as scientists. At the same time, they guarded against allowing managerial logic embedded in ICT to de-emphasise their embodied subjectivity in relation to the patient as a person rather than as a collection of parameters.Conclusion: ICT can force the disruption of some aspects of existing routines, even where these are long-established rituals. Resistance arose when the new technology did not fit with the 'logic of care'. Incorporation of the logic of care into the design and customisation of clinical information systems is a challenge and potentially counterproductive, because it could attempt to apply a technological fix to what is essentially a social problem. However, there are significant opportunities to ensure that new technologies do not obstruct doctors' roles as carers nor disrupt the embodied relationship they need to have with patients. [ABSTRACT FROM AUTHOR]

Background: Access to most contraceptives in Australia requires a prescription from a doctor, and it has been shown that doctors can influence women's decision-making with respect to contraception. However, little research has documented how women experience their interactions with doctors within the context of a contraceptive consultation. Understanding such experiences may contribute to our knowledge of factors that may influence women's contraceptive decisions more broadly. Methods: We report on findings from the Contraceptive Use, Pregnancy Intentions and Decisions (CUPID) survey of young Australian women, a large-scale longitudinal study of 3,795 women aged 18-23 years. We performed a computer-assisted search for occurrences of words that indicated an interaction within the 1,038 responses to an open-ended question about contraception and pregnancy. We then applied a combination of conventional and summative content analysis techniques to the 158 comments where women mentioned an interaction about contraception with a doctor. Results: Our analysis showed that women desire consistent and accurate contraception information from doctors, in addition to information about options other than the oral contraceptive pill. Some young women reported frustrations about the choice limitations imposed by doctors, perceived by these women to be due to their young age. Several women expressed disappointment that their doctor did not fully discuss the potential side-effects of contraceptives with them, and that doctors made assumptions about the woman's reasons for seeking contraception. Some women described discomfort in having contraception-related discussions, and some perceived their doctor to be unsupportive or judgmental. Conclusions: Both the content and the process of a contraceptive consultation are important to young Australian women, and may be relevant contributors to their choice and ongoing use of a contraceptive method. These findings provide useful insights into aspects of the patient-provider interaction that will enhance the efficacy of the contraceptive consultation. It is recommended that doctors adopt patient-centred, shared decision-making strategies to support women in making choices about contraception that suit their individual circumstances. We also acknowledge the need to involve other health care providers, other than doctors, in educating, informing, and assisting women to make the best contraceptive choice for themselves. [ABSTRACT FROM AUTHOR]

The article focuses on the needs of adolescents and young adults (AYAs) undergoing cancer treatment, doctor-patient relationship and the importance of health literacy among the patients and cancer community.

The lay caregiving role is integral to advanced cancer care but places carers' health at risk. A supportive General Practitioner ( GP) can help primary lay carers manage their health, if they disclose their concerns. A Needs Assessment Tool for Caregivers ( NAT-C) was developed for carers to self-complete and use as the basis of a GP consultation, then tested in a randomised controlled trial. This paper reports a qualitative research study to determine the usefulness and acceptability of the NAT-C in the Australian primary care setting. Convenience samples of 11 carers and 5 GPs were interviewed between September 2010 and December 2011 regarding their experiences with and perceptions of the NAT-C. Open-ended questions were used, and the transcripts were analysed qualitatively to identify themes and patterns. Three major themes were identified: (a) Acceptability of the intervention; (b) Impact of the intervention on the GP-patient relationship; and (c) Place of the intervention in advanced cancer care. This simple checklist was acceptable to carers, although some were uncertain about the legitimacy of discussing their own needs with their GP. Carer-patients could not be certain whether a GP would be willing or equipped to conduct a NAT-C-based consultation. Such consultations were acceptable to most GPs, although some already used a holistic approach while others preferred brief symptom-based consultations. Although the NAT-C was acceptable to most carers and GPs, supportive consultations take time. This raises organisational issues to be addressed so carers can seek and benefit from their GP's support. [ABSTRACT FROM AUTHOR]

Background: The Australian after-hours house-call (AHHC) services has grown rapidly in the past few years. Even though recent studies have looked at aspects of the service as it concerns the medical personnel involved, no national study has explored patient satisfaction with the service.Objective: This study aims to assess patient satisfaction with Australian AHHC services and its predictors, with the hope of improving quality and patient outcomes. The findings might also have international relevance, given the developing nature of the AHHC in most countries.Methods: A cross-sectional survey of all 10838 patients known to have patronized the AHHC service in Australia over a 1-week period. The main outcome measure was the Patient Satisfaction Questionnaire 18 (PSQ-18).Results: A total of 1228 questionnaires were returned. General Satisfaction (GS) level was found to be 85.2% (mean 4.16/5). Other Scales of Satisfaction, in decreasing order, were 'Financial Aspects, FA' (87.4%; 4.36/5), 'Communication, CM' (87.3%; 4.18), 'Technical Quality, TA' (82.1%; 4.09), 'Time Spent with Doctor, TSD' (77.7%; 3.91), 'Interpersonal Manner, IM' (75.7%; 3.87) and 'Accessibility and Convenience, A&C' (72.9%; 3.82). The major predictor of increased satisfaction was the time it took the doctor to arrive, with increased satisfaction on GS (T < 4 hours; P < 0.01), IM (T < 30 minutes; P = 0.03), FA (T < 2 hours; P = 0.01), TSD (T < 2 hours; P < 0.01) and A&C (T < 4 hours; P < 0.01). Other positive predictors of aspects of satisfaction included 'being a student', 'age of patient ≤ 16' and 'being Australian born', while 'being on a pension' was negatively associated with Communication (P = 0.03). No associations were found with gender, marital status, employment status, family income or having children in the household.Conclusions: This study concludes that satisfaction in Australian AHHC is high on all scales but recommends that the service providers should aim to attend to patients within 4 hours of their initial calls. [ABSTRACT FROM AUTHOR]

This study examined factors influencing decision-making on complementary and alternative medicine ( CAM) use for back pain and back pain sufferers' communication about CAM use. A cross-sectional postal survey was conducted in 2011/2012 as a sub-study of the Australian Longitudinal Study on Women's Health ( ALSWH). The sample contained 1620 women from the 1945-1951 cohort of the ALSWH, aged 60-65 years who were eligible for the sub-study, as they had experienced back pain during 12 months prior to the survey. Of these, 1310 (80.9%) returned completed questionnaires. A significant proportion of women consulted a CAM practitioner (76%, n = 1001) and/or had self-prescribed CAM treatment (75%, n = 985). Of the women who used CAM for their back pain, 20% consulted their general practitioner ( GP) prior to using CAM and 34% always informed their GP following CAM use. Forty-three per cent of the women were influenced by their doctors, 39% by friends/colleagues, 36% by family/relatives, 33% by their partner, 30% by a CAM practitioner, 20% by a pharmacist, 16% by a book/magazine, 11% by mass media, 10% by an allied health worker and 6% by the Internet. Our results show that information sources used by women for their decision-making on CAM use differed according to the symptoms. While non-professional information sources (e.g. family/relatives) positively influenced women in their decision to use CAM for a range of back pain-related symptoms (e.g. headaches/migraines), doctors and allied health workers (e.g. nurses) negatively influenced women in their decision to consult a CAM practitioner for a range of back pain-related symptoms (e.g. headaches/migraines, neck pain). Women seek information from a wide range of professional and non-professional sources with regard to their decision-making around CAM use for back pain. Back pain care providers need to ensure effective communication with their back pain patients regarding safe, effective and co-ordinated back pain care options. [ABSTRACT FROM AUTHOR]

Objective: Little is known about how family are involved in cancer treatment decision-making. This study aimed to qualitatively explore Australian oncology clinicians', patients', and family members' attitudes towards, and experiences of, family involvement in decision-making.Methods: Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used.Results: Three main themes were uncovered: (i) how family are involved in the decision-making process: specific behaviours of family across 5 (extended) decision-making stages; (ii) attitudes towards family involvement in the decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and decision.Conclusion: This study highlighted many specific behaviours of family throughout the decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in decision-making.Practice Implications: Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in decision-making. Given the important role of family in the decision-making process, family inclusive consultation strategies are needed. [ABSTRACT FROM AUTHOR]

Purpose: Communication of a mental health diagnosis can be a difficult process and is a poorly understood area of service provision. The aim of this qualitative study was to examine clinicians' perceptions of barriers and helpful strategies to discussing information about a mental health condition.Method: Qualitative interviews with 19 Australian clinicians (general practitioners, mental health nurses, psychiatrists, and psychologists) working in several settings (community, hospital inpatient, outpatient, accident and emergency) and locations (urban, suburban and rural) were conducted and analysed thematically.Results: After theme saturation was reached, four primary themes relating to barriers and facilitators to communication at the time of diagnosis were identified in the data. Outside a recognised lack of focus on this area in training, themes included (1) engagement and timing of conversations; (2) stigma and its reduction; (3) perceived and desired knowledge for diagnostic information; and (4) working with distress. The synthesis of themes is demonstrated in a flowchart of suggestions for communicating news of mental health diagnosis that tracks the patient journey in receiving information from initial engagement to follow-up.Conclusions: Talking with an individual about a mental health diagnosis is a non-linear, complex and changeable situation. However, health professionals report using specific strategies to aid this communication process, to meet the specific individual's needs. Strategies such as tailoring to the person's situation, utilising collaborative practice, effective coordination, and addressing stigma may be useful to inform clinician training and support whilst diagnosis remains a key feature of the mental health system in Australia. [ABSTRACT FROM AUTHOR]

The article discusses ways to intervene clients with alcohol and drug issues. Topics covered include the implementation of brief interventions as face-to-face conversations with people who have problems with the consumption of alcoholic beverages and illegal drugs. Also mentioned is the use of the technique to cut the lifetime risks of alcoholic people as well as those who have smoking problems.

Purpose: This study evaluates a pilot implementation of the Liverpool Care Pathway (LCP), a clinical tool used to guide the care of dying patients in the last days of life, on the end-of-life care for dying patients in three regions in rural Australia.Methods: The LCP was implemented at 13 participating sites: nine hospitals (general wards), one community-based palliative care service, and three in-hospital palliative care units. To evaluate the implementation of the LCP, 415 eligible patient records were examined: 223 pre-implementation and 192 post-implementation (116 on the LCP and 76 receiving usual care). The primary analysis compared all patients pre-implementation of the LCP versus all patients post-implementation.Results: Increases were found post-implementation for communication with other health professionals and with patients or family (pre-69 %, post-87 %; p ≤ 0.000), use of palliative medications (pre-87 %, post-98 %; p ≤ 0.000) and frequency of symptom assessments (pre-66 %, post-82 %; p ≤ 0.000). Fewer blood and radiological investigations were conducted and venous access devices used in the post-implementation groups than in the pre-implementation period.Conclusions: This study suggests that when rigorously implemented, the LCP improves important components of end-of-life care for dying patients and their families. [ABSTRACT FROM AUTHOR]

Objective.To increase Aboriginal participation in mainstream health services, it is necessary to understand the factors that influence health service usage. This knowledge can contribute to the development of culturally appropriate health services that respect Aboriginal ways of being. Design.We used a community-based participatory approach to examine the reasons for underutilization of health services by Aboriginal Australians. Results.Based on three focus groups and 18 interviews with Aboriginal health professionals, leaders, and community members in rural, regional, and urban settings, we identified five factors that influenced usage, including (1) negative historical experiences, (2) cultural incompetence, (3) inappropriate communication, (4) a collective approach to health, and (5) a more holistic approach to health. Conclusion.Given that these factors have shaped negative Aboriginal responses to health interventions, they are likely to be principles by which more appropriate solutions are generated. Although intuitively sensible and well known, these principles remain poorly understood by non-Aboriginal health systems and even less well implemented. We have conceptualized these principles as the foundation of an empathic health system. Without empathy, health systems in Australia, and internationally, will continue to face the challenge of building effective services to improve the state of health for all minority populations. [ABSTRACT FROM AUTHOR]

This study developed a new scale, The Medical Social Self-efficacy Scale (MSSES), to assess social self-efficacy within a medical context for patients of diverse cultural and linguistic backgrounds. Validation of the MSSES with a sample of 113 persons indicated that the scale has good internal consistency, with a Cronbach's alpha coefficient of .85. A factor analysis yielded two factors ( confidence in seeking medical information, confidence in stating my view) which accounted for 64 % of the total variance. Split-half reliability of the MSSES was .84. Predictive validity of the MSSES and its factorial structure was found for the mental component summary and general health subscale of the 12-item Short-Form Health Survey. Evidence of concurrent validity was found with the active coping, planning and positive reframing subscales of the Brief COPE. Concurrent validity was also found for the MSSES and its factors, in regard to the emotion-focused coping composite subscale of the Brief COPE. The results indicate that the MSSES appears to be a psychometrically sound instrument. [ABSTRACT FROM AUTHOR]

The article reports a study which discusses the effects of an individualized training program regarding end-of-life communication on the doctor's acceptability, confidence and communication skills in hospital settings. The results revealed that the training was useful for the doctors. It was also observed that significant improvements were found in doctor's communication skills and sense of personal accomplishment after the program.

Patients commonly experience some physicians’ ways of interacting with them as detached and indicating a lack of concern for their welfare. This is likely to add to the distress experienced by a person seeking healing, as well as interfering with the exchange of information required for good medical care. Despite contemporary medical schools’ focus on clinical communication, and on training for ‘patient-centred’ practice, problems with the relations between doctors and patients are still widely acknowledged. The importance of demonstrating empathy, compassion and caring has been highlighted in the literature. In this article I draw on a clinical narrative to elucidate my interpretation of engagement, which entails practices of attentiveness, respectful dialogue and commitment. I propose that practising engagement may help medical students and doctors to infuse their clinical encounters with empathy and compassion, with the aim of providing care that is experienced as being more humane. This practice has the potential to contribute to innovative pedagogical approaches to clinical communication. [ABSTRACT FROM PUBLISHER]

Purpose: This study aimed to explore the effect of physician endorsement of question-asking on advanced cancer patients' question-asking behaviour during consultations about palliative care and to explore other potential predictors of patient question-asking. Methods: Data were obtained from 80 control group patients from a randomised controlled trial of standard palliative care (PC) consultation (control group) versus provision of a question prompt list (QPL) before the consultation. Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC centres participated. Baseline measures were obtained from patients; consultations were audiotaped, transcribed and analysed by blinded coders; and physicians estimated the patients' survival. Results: Endorsement of question-asking by the physician was not related to the number of patient questions. Patients with the highest anxiety levels asked 3.5 times as many questions as those with least anxiety (incidence rate ratio (IRR) = 3.54, 95% confidence interval (CI) 1.90-6.59, P = 0.001). After allowing for the effect of anxiety, patients with an estimated survival of >12 weeks asked 76% more questions (IRR = 1.76, 95% CI 1.03-3.00, P = 0.04), whereas age, sex, educational background, occupation, information and involvement preferences and presence of a caregiver were not related to patient question-asking behaviour. Conclusion: Physician endorsement of question-asking alone does not appear to increase questions by advanced cancer patients during consultations about PC. Additional resources such as QPLs may be needed to facilitate patient question-asking. [ABSTRACT FROM AUTHOR]

The article presents a a qualitative study investigating patients' experiences of ongoing smoking or smoking cessation after hospitalisation for an acute coronary syndrome and describes how study participants spoke about the role of their doctors in smoking cessation. It invited individuals who had been admitted to an Australian public hospital in 2005 with a discharge diagnosis of an acute cardiac syndrome and who were smokers at the time of their hospitalisation to participate.