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The healthcare experience is a multifaceted and varied process, particularly for people living with complex conditions such as primary progressive aphasia (PPA). Different experiences influence pathways through the health system, impacting client outcomes. To our knowledge, no previous studies have directly explored the healthcare experiences of people with PPA and their families. This study aimed to explore the experiences of people living with PPA from the perspective of both the person with PPA and their families during diagnostic and post-diagnostic phases, and to identify factors influencing service access and perceptions of quality of care. The study followed an Interpretive Phenomenological Analysis (IPA) approach. In-depth, semi-structured interviews were completed with three people with PPA and their primary care partner, and two further care partners of people with PPA. Five superordinate themes were identified: characterising the assessment experience, getting a diagnosis, moving beyond the diagnosis, participant interactions with clinicians, and overall service provision. The five superordinate themes comprised 14 subthemes. The study provides preliminary insights into the complexity of the PPA healthcare journey, and the need for increased accessibility of information and supports following diagnosis. The findings inform recommendations for improving quality of care and the development of a PPA service framework or care pathway. [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]

Sociological health research on the concept of trust has been bedevilled by its multivocalities. This article extends Luhmann's attempts to clarify a sociology of trust. Luhmann argued a semantic distinction between trust and confidence. In this article, we use empirical data on patient ‘trust’ in doctors to argue that there is also a semantic distinction between trust and dependence. We conducted 37 semi-structured interviews with patients with coronary heart disease in Adelaide, Australia in 2008 and 2009. Our findings indicate that risk, familiarity and time were critical to understand the distinction between trust and dependence. We argue that patients in situations of emergency (heightened risk) ‘depended’ on, rather than trusted, doctors, given the patients lack of familiarity with their doctors. Time was a mediating factor, as the more ‘urgent’ the situation, the more likely it was that dependence came into play, since the situation was ‘unfamiliar’. Rather than juxtaposing trust and dependence, in this article we show how dependence may coexist with trust in the health care system in times of emergency. [ABSTRACT FROM PUBLISHER]

This article reports a qualitative study investigating patients' experiences of ongoing smoking or smoking cessation after hospitalisation for an acute coronary syndrome (myocardial infarction or unstable angina) and describes how study participants spoke about the role of their doctors in smoking cessation. We 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. Participants underwent a semi-structured interview and ongoing smokers also completed a 'stages of change' questionnaire. In total, 35 participants were interviewed, including 14 who were no longer smoking at least 12 months after their admission and 21 who were. Findings gave insight into the ways that cardiac patients perceive smoking cessation advice from their doctors, the perceived stigma of smoking and how lay understandings about smoking and smoking cessation emphasise the role of choice and individual responsibility. Our findings also indicate considerable scope for GPs and other doctors to offer better smoking cessation support to patients with established cardiovascular disease, particularly after a period of hospitalisation when the majority are highly motivated to stop smoking. [ABSTRACT FROM AUTHOR]