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BackgroundProviding optimal palliative and end-of-life care for people in prison with advanced progressive disease is a growing challenge. This study aimed to examine hospital and palliative care utilisation for people in prison who are hospitalised during the final 3 months of life and to compare with a disease-matched non-incarcerated patient cohort.MethodsA retrospective cohort study of people in prison who died between 2009 and 2019 in an Australian public hospital that provides tertiary-level healthcare for 18% of Australia’s prison population. Demographic, clinical and service use data were extracted from medical records of eligible patients experiencing incarceration (prison group) and a disease-matched, non-incarcerated patient comparator group (comparator group).ResultsAt the time of death, patients in the prison group were aged a median of 20 years younger than the comparator group (median age 58 vs 78 years, p<0.01). The prison group experienced more than double the mean length of acute care hospital stay at the end of life. A higher proportion of patients in the prison group experienced an intensive care unit episode (22% vs 12%). More than two-thirds (71%) of the prison group patients were seen by palliative care prior to death, similar to the comparator group (p=0.44). Those transferred to the palliative care unit had a shorter length of stay and were admitted later, just prior to death (median 5 vs 8 days).ConclusionsPeople in prison have prolonged acute care public hospital stays and are more likely to experience escalation of care at the end of life. Future opportunity may exist for increased access to formal subacute care settings for people in prison with life-limiting illness to receive optimal palliative and end-of-life care.

ObjectivesCarers of patients with high-grade primary malignant glioma (PMG) are known to face extraordinary challenges, as they care for patients with multiple profound and often devastating physical, cognitive and behavioural changes. This study aimed to understand the supportive and palliative care needs in this setting, with a particular focus upon care at the end-of-life, which has hitherto been neglected.MethodsThis prospective qualitative study undertook in-depth interviews with 23 current and bereaved carers of adults with PMG. Carers were recruited from outpatient and inpatient services of two Australian metropolitan hospitals, including neurosurgery, oncology and palliative care. Thematic analysis was conducted by three independent researchers, using methods informed by grounded theory.ResultsCarers described significant needs in relation to three distinct domains: the challenge of caring; the lack of support available to carers and the suffering of caring. The need for care coordination was highlighted as it may enable a series of recommendations for improved care, including: navigation between health providers, individualised, staged information; routine, proactive telephone needs-assessment and emotional support; and early routine integration of palliative care services.ConclusionsThe results of this study shed new light on providing timely information and palliative care to support carers. We call for health services to reconsider the current medical model for this patient group, where patients are the centre of care, information and support, towards a more collaborative model which places carers and patients into a partnership.

Social workers have a unique role to play in the care of hospitalised patients facing the end of their lives. This paper explores the use of the arts in helping people to 'finish up', and the nature of the finishing-up process. The emphasis is on the practical skills which the author has developed in her interactions with clients. Writing, video, music and visual images can all be used as tools in the process of reminiscence and in consolidating memories. The paper also explores the idea of a 'legacy' of memories, sometimes given more tangible form, and the role this may play in the bereavement process for surviving family and friends.

'Practice Forum' is intended to provide a forum for social work practitioners to share their practice with others; to describe what they are doing and assess its effectiveness.We extend an invitation to all social work practitioners to submit articles for 'Practice Forum' and we look forward to receiving your contribution.The Anti-Cancer Council of Victoria has instituted a Writer-in-Residence program to help practising social workers and other professionals in oncology to document and to publish their often considerable practical experience and knowledge. This article traces a number of points that have come out of that program, including the process of writing a professional paper, stylistic considerations, taking account of readers' needs and expectations, and the power of language not only to describe, but to shape experience. The article also considers other fields of writing within social work, and ways in which the profession and the workplace might encourage practitioners to write. 'Shaping Our Ends', an article in this edition of Australian Social Work, is a product of the Writer-in-Residence program.