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The purpose of this paper is to provide discourse regarding awareness of institutional racism, from a non-Indigenous, Australian nursing student's perspective. The discussion has a focus on the presence of institutional racism in the Australian healthcare system, its impact on the health of First Nation Peoples and a commitment to ensuring culturally safe practice. It will be argued that institutional racism is pervasive in healthcare as a consequence of three factors: exclusion of First Nations Peoples from governance roles, inherent racism impacting on socio-cultural treatment bias, and institutional racism influencing key relationships in healthcare delivery. [ABSTRACT FROM AUTHOR]

The landscape of cancer is changing, with earlier detection and the emergence of new treatment options signalling the potential reconfiguration of cancer (for some) as a chronic condition. Cancer is increasingly experienced in terms of chronicity, incorporating both ongoing episodes of acute treatment alongside the long-term management of disease, symptoms, and side effects. This emphasis refocuses attention toward living-with, as well as beyond, cancer. Yet, how cancer chronicity is understood and experienced by both patients and healthcare professionals remains underexplored. While sociological scholarship has critically analysed how chronic illness has been positioned as a problem of/for the person and/or the healthcare system, less attention has been paid to instances like cancer, where chronicity might be viewed as reflective of forms of success (e.g. through the deferral of mortality even in the absence of 'cure'). In this paper we draw on qualitative interview data from a large study of cancer survivorship including patients, their family carers and health professionals, across two Australian hospitals. We critically analyse the dimensions of chronicity in the cancer sphere, understanding cancer-as-chronicity as producing a particular form of subjectivity, shaped by the everyday management and experience of treatment, impairment, symptoms, and side-effects. We posit that constructions of cancer as chronic, and associated imperatives linked to longevity, commitment, and resilience, are placing new demands on patients, family carers, and professionals alike. [ABSTRACT FROM AUTHOR]

Inclusive education remains a challenge for Australian tertiary education, particularly specialized pedagogical approaches like work-integrated learning (WIL) and service learning. Critiques of mainstream pedagogical approaches raise questions about the predominant models of educating students (Butin, 2010; Howard, 1998). There is a definitive need to recognize the diversity of the student population within course structures, rather than integrating diverse student needs into a static curriculum (Harrison & Ip, 2013) Wise practice takes WIL objectives - professional skills development and professional experience - and positions inclusion and transformation at the center of the learning experience. This paper explores inclusive education in WIL and service learning and examines how a wise practice approach can help all students equally benefit from the transformative potential of service learning. [ABSTRACT FROM AUTHOR]

Work-integrated learning (WIL) experiences rely heavily on the development of relationships between the university, industry and often community organizations. As participation in WIL is increasing, the issue of sustainability becomes paramount, requiring processes and practices for effective collaborations and partnerships. This paper reports on an action research project to develop a framework to represent the critical success factors for sustainable WIL relationships. Drawing on reflections from WIL practitioners on what they considered were the critical success factors and a review of literature, a framework was developed, prioritizing three key themes: communication, commitment and compatibility. Within these themes, nine key factors were identified and then evaluated by academic and industry stakeholders in New Zealand, Canada and Australia. Trust, expectations, reciprocity, coordination, vision, learning, resources, reputation, and recognition were confirmed as important factors for sustainable WIL relationships. The framework provides good practice guidelines for all WIL stakeholders. [ABSTRACT FROM AUTHOR]

While studies of interpreted medical interactions are common, there is relatively little research on bilingual doctors who choose to consult in the first language of their migrant patients. This paper presents a case study of one such language-concordant consultation conducted in Italian in the outpatients' clinic of an Australian hospital, a triadic encounter where the patient was accompanied by her Italian-speaking daughter. In this consultation English medical terms were sometimes introduced but Italian was the main language of the consultation. The communication between all parties was notably very smooth and we reflect on reasons for this. These include the commitment of all parties to using Italian and the proactive role played by the patient's Italian-speaking daughter in supporting and occasionally challenging her mother's account of affairs. We conclude by reflecting on issues that bilingual doctors need to be aware of before undertaking to consult in more than one language. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to focus on the development of Keep Safe, a manualised group intervention for adolescents with intellectual disabilities (ID) who display harmful sexual behaviour (HSB) as the initial phase of a feasibility study. National reports have highlighted the need for the development of specialist programmes, as adolescents with ID make up a significant proportion of young people referred to specialist HSB services and there is a lack of evidence or practice-based interventions for them. Aims included taking account of adolescents’ and families’ needs, motivations and practical commitments, integrating best- practice and being accessible and appropriate across different types of services.Design/methodology/approach Keep Safe development progressed from the practitioner/researcher collaborative young sex offender treatment services collaborative-ID through a project team, Keep Safe development group, comprising a range of practitioners with a variety of clinical expertise across services and an Advisory Group of people with ID. An expert-consensus methodology based on the Delphi method was used. The iterative process for the manual draws on the slim practice-based evidence from UK, New Zealand, North America and Australia.Findings Keep Safe comprises six modules distributed through 36 term-time young people’s sessions, alongside 16 concurrent parental/ carer sessions (some joint). The main focus of Keep Safe is to enhance well-being and reduce harm. Four initial sites volunteered as feasibility leads, and two more were added as recruitment was more difficult than foreseen.Originality/value National reports have highlighted the need for the development of specialist programmes, as adolescents with ID make up a significant proportion of young people referred to specialist HSB services and there is a lack of evidence or practice-based interventions for them. This study is innovative and valuable given the recognition that research and practice is significantly lacking in this area. [ABSTRACT FROM AUTHOR]

Objective. Examine the distribution of funding for suicide prevention in Australia from 2021-22 to 2026-27. Methods. Government websites were reviewed to locate budget documents related to suicide prevention funding. Information was extracted on the program/service to be funded, and the funder entity, duration, and year allocation. Extracted data was reviewed to identify commonly targeted sub-populations. Results. The majority of suicide prevention-related funding was allocated to aftercare for persons who have attempted suicide, consistent with the effectiveness of these services, followed by programs targeting the general population. Little funding was allocated to other specific sub-populations, such as young people and Aboriginal and Torres Strait Islander peoples. The amount of funding allocated to suicide prevention varied across jurisdictions, which is only partially explained by suicide rates. Conclusions. There is a need for greater investment in care for specific sub-populations who are at higher risk of suicide. This study provides a baseline for comparing future investments in suicide prevention in Australia. [ABSTRACT FROM AUTHOR]

Immigration brings particular challenges to older Chinese immigrants' wellbeing because they make a new home in a foreign country. Based on 30 semi-structured in-depth interviews, this study aims to understand the immigration history of this specific group and unravel the complex links between family relationships and wellbeing. Four themes emerged from the interviews. First, the decision to immigrate is the result of the combined influence of family values, affinities and the need for aged care. Second, after immigration, housework normally negatively influences their wellbeing. The third theme pertains to the interactions amongst family members. The final theme shows that Chinese immigrants' perceived wellbeing is influenced by family relationships, an independent lifestyle and social networks. This research highlights older Chinese immigrants' complex feelings of family commitment, personal values and the need for aged care. Practical implications for policymakers to better facilitate this group's wellbeing are provided. [ABSTRACT FROM AUTHOR]

This article explores staff work patterns in an Australian residential aged care facility and the implications for high‐quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to explore the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector. [ABSTRACT FROM AUTHOR]

Post‐diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, healthcare, and social care sectors. The aim of this project was to test the feasibility and potential effectiveness of a learning collaborative implementation strategy for improving the cross‐sector integration of care for people with YOD and to generate data to refine the implementation strategy for scaleup. We conducted a longitudinal mixed methods process evaluation and recruited one representative from three Australian aged care organisations, three disability care organisations and three organisations (n = 9) contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six‐module online education package incorporating written resources, webinars, collaboration and expert mentoring. Participants identified gaps in services in their region and barriers to care integration and developed a shared plan to implement change. Normalisation Process Theory was applied to understand the acceptability, penetration and sustainability of the implementation strategy as well as barriers and enabling factors. Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (mean = 39.67, SD = 9.84) and did not change by the end (mean = 39.67, SD = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action towards integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative. Learning collaboratives hold promise as a strategy to improve cross‐sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change. [ABSTRACT FROM AUTHOR]

Across the globe, people are not equitably included or respected by health services. This results in some people being 'hardly reached' and having less access to safe and appropriate care. While some health services have adopted specific agendas to increase inclusion, these services can struggle to implement such strategies because the underlying reasons for exclusion have not been addressed. This calls for preparation prior to implementation of inclusion approaches that deconstructs discourses and practices of exclusion. This paper presents a pre-inclusion framework that seeks to deconstruct exclusion in health services. Authors developed this framework from action research in four 'mainstream' regional health services in southeast Australia over five years. Research identified dominant discourses of exclusion among staff in these services. The study also identified common experiences of residents hardly reached by these services. Following, a range of change activities were undertaken within these services to deconstruct exclusion. Researchers also kept journals, reflected on their impact, and identified lessons learned from trying to deconstruct exclusion. Triangulating these analyses, researchers developed an interdisciplinary framework that weaves together Foucauldian theory on power/discourse with continuous quality improvement processes to embed cultural humility and voices of the hardly reached in health care. The framework outlines five foundational concepts (power as productive, deconstruction, use of continuous quality improvement processes, cultural humility and voices of service users), followed by six principles (a journey, expect resistance, whole of service approach, make visible the reasons for change, we are all cultural beings and people centred care) and six actions undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement). Until such approaches to deconstruct exclusion are implemented, inclusive agendas are likely to be ineffective. • Before inclusion can be achieved, reasons for exclusion must be challenged. • Pre-inclusion readies a health service for engagement with those hardly reached. • This framework weaves Foucault, cultural humility, those hardly reached and CQI. • The framework aims to rupture power relations to privilege discourses of service users. • Health practitioners learn about their privilege and actions of exclusion. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to examine the effect of organizational identification on safety voice behaviour, focusing on the mediating role of safety motivation and the moderating role of management commitment to safety and psychological safety. Design: The study used a cross‐sectional questionnaire and a convenience sampling method. Method: Data were collected online during November 2019 from 165 staff members from a disability healthcare organization in Australia that employs over 800 staff. Nearly 80% of the study sample were healthcare workers without supervisory responsibilities, and the remainder were senior staff with some operational duties. Measures of organizational identification, safety motivation, perceived management commitment to safety, psychological safety and safety voice were collected. Data were analysed using a moderated mediation model available with the SPSS PROCESS macro. Results: Findings show that organizational identification interacted with management commitment to safety to predict safety motivation, such that only healthcare employees who identified with their organization and perceived that their management cares about safety would feel that safety was personally important to them. In turn, safety motivation predicted safety voice. However, the effect of safety motivation on safety voice was only significant when psychological safety was low. Conclusion: These findings offer initial evidence for the important role of organizational identification in prompting safety voice, how the relationship is contingent on management commitment to safety and psychological safety. Impact: Healthcare professionals' discretionary sharing of ideas and suggestions are crucial to organizational performance and both staff and patient safety. However, safety voice involves inherent social risks because speaking up might not always be perceived positively by co‐workers and leaders. We recommend that managers implement specific strategies to cultivate employee identification with the organization and demonstrate a genuine and visible commitment to safety so that employees will be motivated to raise safety concerns. [ABSTRACT FROM AUTHOR]

The author proposes an unvalidated straw poll, the University Rural Commitment Score (URCS), to help determine whether a university is actually committed to its regional, rural and remote communities. Key factors considered in the URCS include location of the vice chancellor's office, allocation of rural student revenue, and rural communities' engagement in the decision making about the rural activities of the university.

Moral appeals consistent with an individual's values affect their propensity to take action against inequality and its deleterious effects. Accordingly, moral foundations such as harm, fairness, loyalty, authority, or purity concerns could also affect perceptions of inequality and attributions regarding who is to blame for it. For instance, individuals high in loyalty concerns, who are typically more conservative, may show in‐group favoritism toward their own country by expressing less moral judgment of inequality in their own country versus other countries. Further, research germane to the belief in a just world has shown that conservatives are more likely to blame the poor for their poverty. The current research investigated the degree to which participants' moral reactions to a high degree of economic inequality are influenced by the country in which that inequality exists as well as the degree to which liberals (Democrats) versus conservatives (Republicans) blame inequality on different target groups. A mixed‐design experiment tested participants' degree of blame for equality across all targets (the poor, the rich, corporations, the government) for one of three randomly assigned countries (the United States, Australia, or China). Results were consistent with predictions related to moral concerns and ideological differences in attributions. [ABSTRACT FROM AUTHOR]

Background: Socially-accountable health professional education (SAHPE) is committed to achieving health equity through training health-workers to meet local health needs and serve disadvantaged populations. This research assesses the biomedical and socially-accountable competencies and work-readiness of first year graduates from socially-accountable medical schools in Australia, the United States and Sudan. Method: A self-administered survey to hospital and community health facility staff closely associated with the training and/or supervision of first year medical graduates from three SAHPE medical schools. Main outcome measure: Likert scale ratings of key competencies of SAHPE graduates (as a group) employed as first-year doctors, compared to first year doctors from other medical schools in that country (as a group). Findings: Supervisors rated medical graduates from the 3 SAHPE schools highly for socially-accountable competencies ('communication skills', 'teamwork', 'professionalism', 'work-readiness', 'commitment to practise in rural communities', 'commitment to practise with underserved ethnic and cultural populations'), as well as 'overall performance' and 'overall clinical skills'. Interpretation: These findings suggest SAHPE medical graduates are well regarded by their immediate hospital supervisors, and SAHPE can produce a medical workforce as competent as from more traditional medical schools, but with greater commitment to health equity, working with underserved populations, and addressing local health needs. [ABSTRACT FROM AUTHOR]

Purpose: Existing research has explored the barriers and facilitators of physical activity participation for young people with disability from the perspective of young people and their families. However, little research has investigated the views of clinicians who facilitate access to physical activity programs and compared this with their child client's perspectives. Method: Interviews were conducted with six allied health and sports development professionals associated with a programme which supports access to recreation and sporting activities. Interviews explored facilitators and barriers to physical activity experienced by their clients. Open-ended survey questions investigating barriers and facilitators of physical activity participation were also completed by 28 young people with disability aged 10–17 years who were clients of this programme. Results: The most salient facilitator of participation described by clinicians was "planning programs to promote success and inclusion." Young people described two main facilitators; "the right people make physical activity fun!" and, similar to clinicians, "appropriate and inclusive opportunities to be active." The most salient barriers identified by clinicians were "practical limitations" and "time constraints and priorities," and a novel barrier raised was "whose choice?" The "lack of accessible and inclusive opportunities" was the most pertinent barrier for young people. Conclusions: Clinicians should determine both parent and young person commitment to a physical activity before enrolment. Lack of commitment can act as a barrier to physical activity and a more appropriate intervention could focus on increasing awareness of the benefits of being active, drawing on a Stages of Change based model of service delivery. Rehabilitation professionals seeking to increase physical activity participation for young people with physical disability should discuss readiness and motivation to change prior to any activity/sports referral. Different behaviour change processes are required for young people and for their parents and both are important to achieve physical activity participation. Regular monitoring is important to identify on-going physical and psychological barriers to participation, even for those who were already active. Clinicians should be aware that teenagers may be more ready to be active as they develop greater independence and should raise awareness of the benefits of physical activity. [ABSTRACT FROM AUTHOR]

Aim: To evaluate characteristics of job‐related meaningfulness, and to assess its potential to moderate the relationship between over‐commitment and emotional exhaustion in nurses. Background: Increased demands on nurses may induce vulnerability to emotional exhaustion, decrease job satisfaction, and increase their intention to quit the job. The experience of job‐related meaningfulness through meaning‐centred logotherapy and counseling could be a resource to prevent emotional exhaustion. Method: Nurses (n = 466; 73% female) at an Austrian tertiary‐care hospital participated in a cross‐sectional survey for assessment of job‐related meaningfulness by the newly developed CERES (Concern, Enthusiasm, Relevance, Efficacy, Satisfaction) scale. CERES was tested for its moderating interaction with over‐commitment (assessed by the Effort‐Reward Imbalance Questionnaire) to prevent emotional exhaustion (as measured by the Maslach Burnout Inventory) by structural equation modelling. Results: The CERES scale consisting of five items has satisfactory internal consistency (Cronbach's alpha:.78). Over‐commitment correlated significantly (p < .001) with emotional exhaustion. A moderating interaction of CERES with over‐commitment on emotional exhaustion was found overall (p < .001), and separately for males (p = .002) and females (p < .001). Conclusions: CERES is suitable for assessing experienced job‐related meaningfulness and it moderates emotionally exhausting effects of over‐commitment in nurses. Implications for Nursing Management: Nursing managers may improve nurses' awareness of job‐related meaningfulness by focusing on meaning‐centred feed‐back and counselling and thereby strengthening perception of concern, enthusiasm, relevance, efficacy, and satisfaction regarding their caring behaviour. [ABSTRACT FROM AUTHOR]

The complexities of being an academic mean that there is often no time or space to reflect on teaching, and on academic life in general. In this study, four academics set up a private blog to share reflections on teaching. While initial commitment to the reflective blogging process was good, over time this declined. After 9 months of intermittent communication, we decided to wrap up the project and examine the experience. A qualitative analysis of the group's reflective posts and related emails revealed themes related to emotions, space and time in academic experience. We discuss why the blog space did not work as anticipated, and how such 'troublesome' spaces may, paradoxically, be viewed as transformative. [ABSTRACT FROM AUTHOR]

Internships are becoming more relevant to universities as they provide students with practical skills that can be aligned with their career aspirations. Typically, successful undergraduate internship programs depend on the efficiency and design of the university internship program; the student commitment to the internship; and host organization's level of resource commitment to the program. Currently, there is very little empirical research conducted to examine how host organization based factors influence the quality of a good internship from a student interns' perspective. The Transaction Cost Economic (TCE) model was the theoretical lens used to address this research. The study used a survey (n=83) of an undergraduate internship program at a university in Australia. The findings indicate that the host organizations' resource commitment has a significant positive influence on the interns' perceived success of the internship. Findings from this research can help to align organizational resource commitment with the students' expectations. [ABSTRACT FROM AUTHOR]

The author reflects on the importance of the surgical capacity building program supported by the Royal Australasian College of Surgeons in East Timor. He recounts how the East Timorese people supported the Australian military in repulsing Japanese forces during World War II. He also describes the program as challenging and a story of collaboration and commitment.

Aim To examine the impact of an individual resource factor (psychological capital) and an organizational resource (management support) on nurses' intentions to quit. Background Nursing work can be stressful and as a consequence, nurses suffer greater stress and stress-related sickness, including depression, than the general population. Stress can be mitigated in the workplace depending on the availability of resources in the workplace. Resources can come from the organization or the individual themselves. Design The study is quantitative using a cross-sectional design. Methods The study analysed data from 242 nurses working in five Australian hospitals in the one regional network during 2013. Findings The predictors explained almost half of the variance of nurses' intent to quit. Psychological capital had the dual benefits of reducing nurses' perceptions of psychological distress and simultaneously increasing their job satisfaction. Conclusion Psychological capital is an example of the personal resources a nurse brings to work. Nurse managers can now understand the impact of a new form of protective resources that influence the levels of strain felt by nurses. If nurses present with low psychological capital, then up-skilling nurses with these personal attributes will positively impact on their health and well-being and, in turn, enhance the care of patients. [ABSTRACT FROM AUTHOR]

Employing the social‐exchange theoretical framework, we examined the effect of employees' awareness of stress‐reduction interventions on their levels of psychological strain, job satisfaction, organizational commitment, perceptions of senior management trustworthiness and procedural justice. We present longitudinal panel data from 869 employees who completed questionnaires at two time points at 13 Australian universities. Our results show that employees who reported an awareness of stress‐reduction interventions undertaken at their university scored lower on psychological strain and higher on job satisfaction and commitment than those who were unaware of the interventions. The results suggest that simply the awareness of stress interventions can be linked to positive employee outcomes. The study further revealed that senior management trustworthiness and procedural justice mediate the relationship between awareness and employee outcomes. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective Australian Aboriginal and Torres Strait Islander people suffer health inequities, such as high levels of psychological distress and multiple life stressors. These have been shaped by colonisation, racism, discrimination, and government policies and practices. Method Eight Australian psychologists were interviewed with the aim of identifying the professional skills and personal competencies that enable effective service delivery for this client group, and especially those aged 12-25 (i.e., 'youth'). Results Thematic analysis identified that personal and clinical credibility, relationship centrism, contextual understanding, a holistic approach, and flexibility are important to good practice. Not all of these are currently part of standard psychology training, but many are covered by guidelines developed by the Australian Psychological Society. Conclusions Results from this study indicate that ongoing adjustments to university curricula, professional competency requirements for practitioner registration, and continuing professional development will all contribute to best practice. Moreover, for Australian psychologists, the consolidation of cultural competency into a useful framework for professional development is paramount. [ABSTRACT FROM AUTHOR]

Primary objective: To understand how the spouses of individuals with severe TBI experience the process of supporting their partners with decision-making. Design: This study adopted a constructivist grounded theory approach, with data consisting of in-depth interviews conducted with spouses over a 12-month period. Data were analysed through an iterative process of open and focused coding, identification of emergent categories and exploration of relationships between categories. Participants: Participants were four spouses of individuals with severe TBI (with moderate-severe disability). Spouses had shared committed relationships (marriage or domestic partnerships) for at least 4 years at initial interview. Three spouses were in relationships that had commenced following injury. Main outcome and results: Two main themes emerged from the data. The first identified the saliency of the relational space in which decision-making took place. The second revealed the complex nature of decision-making within the spousal relationship. Conclusions: Spouses experience decision-making as a complex multi-stage process under-pinned by a number of relational factors. Increased understanding of this process can guide health professionals in their provision of support for couples in exploring decision-making participation after injury. [ABSTRACT FROM AUTHOR]

Background/aim Growth in the number of occupational therapy programmes in Australia has resulted in a critical shortage of academics. When experienced clinicians are recruited into academia, they may find the transition process difficult. The study aimed to explore clinicians' perspectives of what happens when they transition into academia. Method A constructivist grounded theory approach was used in this qualitative research project. Recruitment was conducted using purposive and theoretical sampling from occupational therapy programmes in Australia. Interview transcripts were analysed using constant comparative method through a process of open, axial, selective and theoretical coding. Results Sixteen participants engaged in semi-structured in-depth interviews. The theory of transition into academia included a process of 'weighing up the commitment' to academia and the core category of 'a good fit for me'. The transition was characterised by the taxing nature of the work, the need to learn multiple aspects of a new role, the different values and beliefs in an academic environment and the amount of time it took to achieve success. Participants underwent a shift in identity to adjust to the academic environment and eventually reached a point where they were able to judge if academia suited them. Conclusion Australian universities have long-standing cultural practices which differ considerably from clinical settings. Transitioning from a clinical to an academic occupational therapy role requires complex adjustments to values, beliefs and identity. The process involved consideration by the new academics of their 'fit' for academia, and how committed they were to stay. [ABSTRACT FROM AUTHOR]

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Background: Few studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs' involvement and challenges in providing palliative and end-of-life care in regional Australia. Methods: A qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia. Results: The rural GPs' central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs' involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more "technical" aspects of care. Conclusions: Rural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges. [ABSTRACT FROM AUTHOR]