Search

Ageing with a chronic hepatitis B (HBV) or hepatitis C (HCV) infection is an emerging public health priority. For people living with chronic viral hepatitis, their disease progression into old age is both underpinned by their existing blood borne virus and the potential emergence of other infectious and non-infectious conditions. These twinned pathways bring additional challenges to the care and support for people as they near end of life. This scoping review sought to examine what is known about the experiences of the end-of-life phase of an increasing population ageing with HBV and HCV in studies conducted in high-income settings and published in peer reviewed literature (2010-2021). In interpreting this literature, we found that challenges in determining the end-of life phase for people with lived experience of HBV or HCV are exacerbated by the conflation of aetiologies into a singular diagnosis of end-stage liver disease. Studies overwhelmingly reported the clinical aspects of end-of-life care (i.e. prognosis assessment and symptom management) with less attention paid to educative aspects (i.e. advance care directives and surrogate decision makers, discussion of treatment options and determining goals of care). Psychosocial interventions (i.e. quality of life beyond symptom management, including emotional/spiritual support and family and bereavement support) received limited attention in the literature, though there was some recognition that psychosocial interventions should be part of end-of-life care provision. Given the focus on the prominent disease presentation of liver cirrhosis and/or end-stage liver disease, the social and cultural dimensions of these infections have received less attention in the literature on end-of-life in the context of chronic viral hepatitis., (© 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

The COVID-19 pandemic has affected entire systems of health service provision globally, including health service closure, redeployment of staff and resources and implementation of infection prevention protocols. Harm reduction facilities face particular challenges responding to COVID-19, attempting to continue service provision to people who inject drugs with minimal service disruption whilst protecting their staff. This research assessed the impact of COVID-19 on staff working at harm reduction and alcohol and other drug (AOD) services in Australia in the first 9 months of the pandemic. The research employed mixed methods, using survey data to inform in-depth interviews. Surveys were completed by 207 participants working in the AOD sector and the harm reduction sector nationally. Interviews were conducted with 16 staff at three harm reduction sites in metropolitan Sydney and one regional NSW service. Staff felt able to respond to the trying circumstances of this pandemic, especially as practical messages around the COVID-19 response were similar to those already in place for clients in relation to blood-borne virus prevention. Staff felt that they were still able to provide core services to clients with some modifications in delivery. They were willing to take on additional responsibilities to ensure their own safety and that of clients, including conducting temperature checks and screening questions, whilst also adopting novel service provision strategies to reach clients during lockdowns such as postal services, outreach work and telehealth. NSP and AOD services were able to implement COVID-19 infection control strategies, whilst maintaining and expanding service access through remote and innovative strategies in a manner which supported both clients and service providers, during the first wave of the pandemic in 2020., (© 2022 John Wiley & Sons Ltd.)

It is generally recognised that engaging consumers to participate in policy making, programming, and practice is fundamental to effective alcohol and other drug (AOD) treatment, however, literature continues to document challenges and barriers to its implementation in AOD settings. This study reports on an evaluation of the Consumer Participation Project implemented in key non-government AOD services in Australia. Data collection consisted of an online survey of 86 staff members at the five participating AOD services and 27 consumer interviews. The survey examined staff attitudes towards and beliefs about consumer participation, perceived current levels of consumer participation and service changes as a result of the consumer participation project. The qualitative arm explored consumer's prior knowledge and current experiences of consumer participation. Staff who took part in the consumer participation training offered as part of the project were more likely to believe that service changes could encourage greater consumer participation rather than any barriers associated with consumer circumstances. Additionally, while services offered low-level involvement consumer activities, there were fewer examples of mid- and high-level activities being conducted at the different services. Consumers discussed the significance of being actively involved in their AOD treatment service while stressing the importance of proper training and support for those engaging in consumer participation. This research highlights the benefits of consumer participation in AOD treatment and suggests that most consumer participation activities undertaken at present are "low" level involvement concerned with providing and receiving information from consumers. Importantly, however, our study did demonstrate some support for "high" level involvement activities and service providers being open to doing more to encourage consumer participation., (© 2021 John Wiley & Sons Ltd.)