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Men in rural areas are at an increased risk of obesity and chronic diseases. A mixed method study tested the feasibility and impact of a multiphase self-management program at reducing risk factors for chronic disease for 87 men across six worksites in regional Western Australia. The intervention was effective at targeting key health outcomes. Applied strategies were acceptable and are transferable to other male groups in rural areas, where access to interventions is often limited.

Introduction: There is limited information about the experiences and educational needs of health professionals who may be required to provide care for people with Motor Neurone Disease(MND) especially in the later stages of the disease. The aim of this study was to determine the experiences of, and need for, education of these health professionals. Methods: Interviews and focus groups were conducted with 31 health professionals with some experience in providing palliative care for people with MND. Thematic content analysis was used to identify common themes. Results: A key theme, Just One Step Ahead, emerged, that describes the central capability health professionals identified as necessary to help individuals plan and prepare for disease and lifestyle changes just before they arise. Two subthemes also emerged: Expertise in MND and Bespoke Communication. Expertise in MND described the required understanding of the disease and the particular individual’s version of the disease to allow the health professional to plan, advise, support and anticipate the needs of the person living with MND. Bespoke Communication was the facility to tailor care messages sensitively and effectively to the range of people involved in care (patients, family, healthcare team members).Conclusions: Care of people with MND requires up-to-date expertise about the disease and skilled communication abilities to manage complexity and change. Timely and focused education and specialist MND support for care providers are essential to tailored and responsive care and a widely available education programme has been developed to address these needs.

Aim: This study aimed to obtain perspectives from key stakeholders to inform the development of Australian national guidelines for a palliative approach to aged care in the community setting. Methods: A descriptive, exploratory qualitative design was used. Sampling was purposive. Data were collected during audiotaped, semistructured, individual and focus group interviews that addressed the need for the guidelines and aimed to identify practice areas for inclusion. Thematic analysis was undertaken. Results: Interviews were conducted across Australia and included 172 participants: health-care providers, consumers, volunteers and researchers/educators. Themes emerging from the data were: Provision of a Palliative Approach in Community Aged Care, Carer Support, Advance Care Planning, Physical and Psychological Symptom Assessment and Management, Psychosocial Support, Spiritual Support, Issues for Aboriginal or Torres Strait Islander People, Older People from Diverse Cultural and Language Groups, and Clients with Special Needs. Conclusion: Findings underpinned development of new guideline documents.

In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families.

Background: Typically, dementia involves progressive cognitive and functional deterioration, leading to death. A palliative approach recognizes the inevitable health decline, focusing on quality of life. The approach is holistic, proactive, supports the client and the family, and can be provided by the client’s usual care team. In the last months of life, distressing symptoms, support needs, and care transitions may escalate. This project trialed a strategy intended to support a consistent, high quality, palliative approach for people with dementia drawing close to death. The strategy was to implement two communities of practice, drawn primarily from service provider organizations across care sectors, supporting them to address practice change. Communities comprised practitioners and other health professionals with a passionate commitment to dementia palliative care and the capacity to drive practice enhancement within partnering organizations. Project aims were to document: (i) changes driven by the communities of practice; (ii) changes in staff/practitioner characteristics during the study (knowledge of a palliative approach and dementia; confidence delivering palliative care; views on death and dying, palliative care, and a palliative approach for dementia); (iii) outcomes from perspectives of family carers, care providers, and community of practice members; (iv) the extent to which changes enhanced practice and care continuity; and (v) barriers to and facilitators of successful community of practice implementation.Methods/design: This action research project was implemented over 14 months in 2010/11 in metropolitan Perth, Western Australia and regional Launceston, Tasmania. Each state based community of practice worked with the researchers to scope existing practice and its outcomes. The research team compiled a report of existing practice recommendations and resources. Findings of these two steps informed community of practice action plans and development of ad

A palliative approach promotes quality of life for older people with life limiting illnesses or who are becoming increasingly frail; it is a holistic approach addressing physical, psychosocial, and spiritual needs and can be provided by the usual care team. This project provided guidance for delivering a palliative approach for older people in the community setting. The project was funded by the Australian Government Department of Health and Ageing.

Background: People living in rural areas who have a diagnosis of cancer have poorer outcomes than people living in urban centers. The reasons for this are unclear. Little is known about the impact that living in a rural area has on the diagnosis and treatment decisions of these people and how these may in turn impact on care outcomes. Objectives: This study explored the reasons why people living in rural areas may delay diagnosis and what issues affected the decisions they made regarding their cancer treatment. Methods: In depth, semistructured interviews were conducted with 18 participants from 3 rural Western Australian health regions. Content analysis was used to develop themes.Results: Four themes were identified to describe the rural cancer experience. The first 3 themes, Experiences of Diagnosis and Referral, The Treatment Journey, and Managing your own Care, relate to the experiences of rural cancer patients during their journey through the health care system. The final overarching theme, Implicit Faith, described the level of confidence that rural cancer patients had in the health system, often despite delays and inconveniences. Conclusions: There is a need to improve primary health care and care coordination for rural cancer patients living in Australia and to promote self-advocacy and consumer empowerment for rural cancer patients. Implications for Practice: Rural patients need help and support throughout their cancer journey, including through the process of diagnosis.

Pain is a complex phenomenon that can be challenging for staff working in residential aged care facilities (RACFs) (Fisher et al., 2002; Twycross, 2002). A high prevalence of pain reported by older individuals has been reported and suggests that further study in this area is warranted (Higgins, Madjar & Walton, 2004). Research suggests that a significant barrier to effective pain management in the elderly is the provision of primary care by care staff who have little or no education about pain, pain assessment or pain management (Allcock, McGarry & Elkan, 2002). Studies have identified personal carers as being in a unique position to improve pain management, because of their working relationship with residents (Ferrell, 1996; Horgas & Dunn, 2001). However, there is a lack of literature which specifically examines personal carers' perspectives of providing care to residents in pain on a daily basis. This thesis presents a study of personal carers working in RACFs in regional Western Australia. A descriptive and explorative qualitative approach has been applied to examine the experience personal carers' have had with older residents in pain. A purposive, convenience sampling method allowed access to six personal carers currently employed in regional Western Australia. Data was generated by in-depth interviews focusing on the personal carers' experiences of caring for older people in pain. Interviews were audiotape recorded, transcribed and coded to ensure confidentiality and anonymity of participants. The findings of this study provide an understanding of the complex care needs of older residents in pain and illuminate the role of personal carers in the pain management process. A constant comparison method of analysis was used to develop a central theme and a sub-theme with associated categories. The central theme, Perfect Positioning, emerged from the data to encompass all aspects of the position personal carers have in the pain management process. Five associated ca