Mental health and older adults: the importance of being present

A guest blog post by Felicity Chapman, Mental Health Clinician and Aged Care Specialist

  • 26 November 2020
  • Author: Guest
  • Number of views: 169
  • 0 Comments
Mental health and older adults: the importance of being present

Work with advanced seniors, perhaps more than for any other group of adults, demands an ability to be present first and foremost. In her third and last blog in this series, Felicity Chapman a Mental Health Clinician and Aged Care Specialist highlights the importance of being able to engage with older adults as well as being present with them and discusses how this can be achieved.

End of Life Directions for Aged Care: supporting quality care for older people at the end of life

A guest blog post by Distinguished Professor Patsy Yates and Karen Clifton from Queensland University of Technology (QUT)

  • 24 November 2020
  • Author: Guest
  • Number of views: 403
  • 0 Comments
End of Life Directions for Aged Care: supporting quality care for older people at the end of life

Improving the quality of care for people in residential and community aged care settings is very important, especially with an ageing population. In the 12th blog for our National Palliative Care Project series, Distinguished Professor Patsy Yates and Karen Clifton from Queensland University of Technology discuss how the End of Life Directions for Aged Care (ELDAC) Project will help to support health professionals and aged care workers.

Inequalities in end-of-life palliative care by country of birth in New South Wales, Australia: a cohort study

  • 23 November 2020
  • Author: CareSearch
  • Number of views: 0
  • 0 Comments

Möller H, Assareh H, Stubbs JM, Jalaludin B, Achat HM.

Objective:
This study investigated variation in in-hospital palliative care according to the decedent's country of birth.

Methods:
A retrospective cohort study was performed of 73469 patients who died in a New South Wales public hospital between July 2010 and June 2015 and were diagnosed with a palliative care-amenable condition. Differences in receipt of palliative care by country of birth were examined using multilevel logistic regression models adjusted for confounding.

Results:
In this cohort, 26444 decedents received palliative care during their last hospital stay. In the adjusted analysis, 40% rate differences (median odds ratio 1.39; 95% confidence interval 1.31-1.51) were observed in receipt of palliative care between country of birth groups.

Conclusions:
There are differences in in-hospital palliative care at the end of life between population groups born in different countries living in Australia. The implementation of culturally sensitive palliative care programs may help reduce these inequalities. Further studies are needed to identify the determinants of the differences observed in this study and to investigate whether these differences persist in the community setting.

What is known about the topic?
International studies have reported inequities in access to palliative care between ethnic groups.

What does this paper add?
We observed differences in in-hospital palliative care between decedents from different countries of birth in New South Wales, Australia. These differences remained after adjusting for individual, area and hospital characteristics.

What are the implications for practitioners?
Implementation of culturally sensitive palliative care services and targeting groups with low rates of palliative care can reduce these inequalities and improve a patient's quality of life.

Management of melanoma brain metastases: Evidence-based clinical practice guidelines by Cancer Council Australia

  • 23 November 2020
  • Author: CareSearch
  • Number of views: 0
  • 0 Comments

Hong AM, Waldstein C, Shivalingam B, Carlino MS, Atkinson V, Kefford RF, McArthur GA, Menzies AM, Thompson JF, Long GV.

Introduction:
The brain is a common site of metastatic disease for patients with advanced melanoma. Brain metastasis portends a poor prognosis, often causing deterioration in neurological function and quality of life, and leading to neurological death. Treatment approaches including surgery, radiotherapy and systemic therapy can lead to better control of this problem. Therefore, appropriate guidelines for the management of melanoma brain metastases need to be established, with regular updating when new treatment options become available.

Methods:
A multidisciplinary working party established by Cancer Council Australia has produced up-to-date, evidence-based clinical practice guidelines for the management of melanoma. After selecting key clinical questions, a comprehensive literature search for relevant studies was conducted, followed by systematic review of those studies. Data were summarised and the evidence was assessed, leading to the development of recommendations.

Main recommendations:
Symptomatic lesions are best treated with surgery, when possible; this provides safe and effective local control. For patients with single or a small number of asymptomatic brain metastases, stereotactic radiotherapy is recommended, but in asymptomatic patients who have not previously received systemic treatment, drug therapy can be considered as a first-line treatment option. Whole brain radiotherapy may provide palliative benefits in patients with multiple brain metastases. Whenever possible, melanoma patients with brain metastases should be managed by a multidisciplinary team of melanoma specialists that considers the optimal combination and sequencing of surgery, radiotherapy and systemic therapy.

Nurses' intentions to respond to requests for legal assisted-dying: A Q-methodological study

  • 23 November 2020
  • Author: CareSearch
  • Number of views: 0
  • 0 Comments

Wilson MR, Wiechula R, Cusack L, Wilson M.

Aims:
To explore the intentions of nurses to respond to requests for legal assisted-dying.

Background:
As more Western nations legalize assisted-dying, requests for access will increase across clinical domains. Understanding the intentions of nurses to respond to such requests is important for the construction of relevant policy and practice guidelines.

Design:
Mixed-methods.

Data sources:
A total of 45 Australian nurses from aged, palliative, intensive, or cancer care settings surveyed in November 2018.

Method:
Q-methodology studying nurses' evaluations of 49 possible responses to a request for a hastened death. Data consisted of rank-ordered statements analysed by factor analysis with varimax rotation.

Findings:
Four distinct types of intentions to respond to requests for assisted-dying: a) refer and support; b) object to or deflect the request; c) engage and explore the request; or d) assess needs and provide information.

Conclusion:
The findings underscore the complexity of intentionality in assisted-dying nursing practice and differences from other forms of end-of-life care, particularly regarding patient advocacy and conscientious objection. This study enables further research to explore determinants of these intentions. It can also assist the development of professional guidance by linking policy and clinical intentions.

Impact:
Identified a basic range of nurses' intentions to respond to requests for assisted-dying, as there was no evidence at present. Developed a fourfold typology of intentions to respond with most nurses intending to engage in practices that support the requestor and sometimes the request itself. A minority would object to discussing the request. The relatively low level of advocacy within the intended responses selected also is distinctly different from other end-of-life care research findings. This research could assist nursing associations in jurisdictions transitioning to legal assisted-dying to develop guidance ways nurses can frame their responses to requests.

12345678910Last