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Background: Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging., Aim: To understand the experiences and perspectives of older people regarding advance care planning., Design: A systematic review of qualitative studies and meta-synthesis was conducted., Data Sources: CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched., Results: A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care., Conclusion: Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.

Background: The right of children to have their voice heard has been accepted by researchers, and there are increasing numbers of qualitative health studies involving children. The ethical and methodological issues of including children in research have caused worldwide concerns, and many researchers have published articles sharing their own experiences., Objectives: To systematically review and synthesise experts' opinions and experiences about ethical and methodological issues of including children in research, as well as related solution strategies., Research Design: The research design was a systematic review of opinion-based evidence, based on the guidelines by Joanna Briggs Institute., Methods: A search of five computerised databases has been conducted in April 2014 and 2271 articles were found. After screening the titles, abstracts, full texts and appraising the quality, 30 articles were finally included in the review. A meta-aggregative approach was applied in the data analysis and synthesis process., Ethical Considerations: Ethical approval is not needed as it is a systematic review of published literature., Results: Six themes were identified, including evaluating potential risks and benefits, gaining access, obtaining informed consent/assent, protecting confidentiality and privacy, building rapport and collecting rich data. The similarities and differences between research involving children and that involving adults were indicated., Conclusion: All potential incentives should be justified when designing the study. Further studies need to research how to evaluate individual capacity of children and how to balance protecting children's right to participate and their interests in the research. Cultural differences related to researching children in different regions should also be studied., (© The Author(s) 2014.)

This article describes the process of developing a suicide guideline in palliative care. Little literature was available, but utilizing the partnership model, a working party consulted with each discipline regarding specific requirements. The working party experienced significant challenges in creating policy that would adequately cover the diverse needs of all members of the palliative care team, as it was recognized that all staff needed guidance. The final guideline incorporated specific action plans for each discipline; mandatory training for all staff was endorsed through a recognized suicide alertness training program; advanced training in suicide intervention skills for key clinical staff will be required; and a "Rapid Plan Team" was recommended. This policy development has required significant work and the combined expertise of many disciplines., (© The Author(s) 2014.)

Background: Despite a recognized need for a palliative approach to caring for people with motor neurone disease (MND), access to palliative care is often limited., Aim: This project aimed to improve the knowledge of health professionals about a palliative approach to MND care., Design: A three-phase study was undertaken to develop, implement and evaluate an education program for health professionals that promoted a palliative approach to MND care. This paper discusses the second and third phases: the implementation and evaluation of the project. Education workshops were held for health professionals. Their knowledge of palliative care was measured before and after the workshops and one month later. Attitudes to providing MND care were also measured., Setting: Workshops were held in South Australia and Western Australia. Participants were health professionals working in the areas of MND care or palliative care. Some aged care and generalist health professionals were included if they had a role in providing care to people with MND., Results: The participants demonstrated an improvement in MND knowledge (χ(2) = 64.13(2), p = 0.000) and palliative care knowledge (χ(2) = 17.24(2), p = 0.000); both were sustained at one month. Attitudes to providing MND care also improved (χ(2) = 11.85(2), p = 0.003) and were maintained at the six-month follow-up. Participants indicated that the knowledge gained positively influenced their clinical practice., Conclusions: A targeted education program for health professionals improved understanding about end-of-life care for people with MND. Health care providers also reported having made improvements in the care provided to patients and carers, particularly communication, psychosocial care and symptom management.

Qualitative research methods are an appropriate way to address questions on understandings, feelings and experiences of people in the context of palliative care. They make an assumption that language reflects objective reality. An alternative position is taken by discourse analysis methods, which are concerned with investigating how language and written texts are used to shape and influence behaviours, and provide ways of constructing the world. This paper argues that discourse analysis has benefits in revealing taken-for-granted and hidden aspects of palliative care. These advantages include revealing how common words and terms are used to invoke social practices, knowledge and power, which shape the meaning and delivery of palliative care in different contexts. Advice on conducting discourse analysis is provided, along with two exemplar studies. Finally, we indicate the potential contributions, the disadvantages and the ethical considerations required in using this approach to research.