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Objective. Herein we record the experience of clinical supervisors of international medical graduates (IMGs) working as junior staff in a district hospital by examining supervisor perspectives on IMG performance, the factors affecting their performance and the requirements of supervision under these circumstances. Methods. The present study had an open-ended exploratory qualitative design. Thirteen 13 open-ended, in-depth interviews were undertaken with supervisors of IMGs employed in a public district hospital in Queensland, Australia. Results. The supervisors reported that, although performance was an individual and variable characteristic, IMGs tended to perform less well than Australian graduates and required more intensive supervision. Factors that affected performance were motivation and experience, and specifically lack of familiarity with the Australian healthcare system, lack of recent of practice, education, language, communication and cultural factors. English language proficiency was regarded as crucial to performance. Conclusions. The additional work required to supervise IMGs in order to enable them to perform at a satisfactory level and successfully integrate into the Australian healthcare system needs to be recognised and resourced. Assistance with attaining proficiency in English and with communication skills over and above the standard required to pass the International English Language Testing System examination should be seriously considered as a means of improving performance. [ABSTRACT FROM AUTHOR]

Many individuals diagnosed with cancer can experience a crisis associated with the challenge of returning to work posttreatment. To date, there is limited work on this topic. This article makes a contribution to this area by providing a subset of findings from a qualitative study that documents the role of the employer during posttreatment return to work from the perspective of individuals diagnosed with a hematological cancer. The study involved 45 in-depth interviews with individuals diagnosed with a hematology cancer that were audio-recorded, transcribed verbatim, coded and thematically analyzed. The findings indicate that the crisis posed by return to work after treatment for a hematological malignancy was ameliorated for individuals with supportive links to prior employers. There are a number of strategies that supportive employers used to facilitate the return to work, including keeping the position open, staging the return, and changing the work role if necessary. The practical implications of the findings for posttreatment supportive care are explored. [ABSTRACT FROM AUTHOR]

AIMS: This article examines findings on the need for, awareness of, and critical time for referral to financial assistance for patients who have to relocate for specialist care for hematological malignancies. DESIGN: The study involved descriptive qualitative research based on in‐depth interviews that were audio‐recorded, transcribed verbatim, coded, and thematically analyzed. PARTICIPANTS: Forty‐five hematology patients purposively selected from the client database of the Leukaemia Foundation of Queensland were interviewed for the study. RESULTS AND CONCLUSION: The findings indicate that there is a critical period at the initial point of diagnosis and start of treatment when patients are experiencing shock, confusion, and a sense of being overwhelmed by stress, fear, and uncertainty about the future. The stress can be exacerbated by the loss of work and a period of waiting to access income (e.g., from superannuation or approval to receive a pension). For some patients, this is a critical period when individuals need support and advice to avoid long‐term financial problems. However, at this point in time, many individuals do not know how to access financial advice or assistance from leading cancer supportive care organizations. The findings have practical implications to inform the work by many nurses who provide psychosocial care to hematology patients. [ABSTRACT FROM AUTHOR]

Objective: To date, there is limited research to inform an understanding of cancer patients' choice as to location of treatment. This paper makes a contribution by providing findings on a group of regional, rural and remote cancer patients, namely those diagnosed with a haematological malignancy, who have to relocate for specialist care in Queensland, Australia. Methods: Adescriptive qualitative method was used based on 45 in-depth interviews with haematology patients living in Queensland who were supported by the Leukaemia Foundation of Queensland. Results: Four key factors were found to affect the decision making of patients who prefer to travel to metropolitan hospitals for specialist haematology treatments, namely access to own doctor, bonds and familiarity with metropolitan staff, desire for 'quality' specialist care and a distrust of local clinical care and, for some, the absence of usual barriers to visiting the metropolitan area. Conclusions: There are a group of patients who have experiences that lead them to distrust non-metropolitan hospitals and motivate them to travel long distances to attend specialist treating centres for 'quality' care. The literature affirms the concerns of this group. It is the hope and expectation in publishing this article that these patients' concerns will be taken into consideration in the development of health services and policy so that eventually all regional, rural and remote patients will be provided with equitable choice with regard to the location of accessing specialist care. [ABSTRACT FROM AUTHOR]

The findings presented in this article are from qualitative research, funded by the Leukaemia Foundation of Queensland, which explored the financial impact of relocation for specialist treatment for hematology patients living in Queensland, Australia. The findings describe the factors that contribute to the lack of, or erosion of, a buffer to the financial distress created by diagnosis and relocation for treatment for a hematological malignancy. Individuals vulnerable to financial distress are those who lose or reduce employment, have restricted or no access to work cover or leave (sick, recreation or long service), have limited savings, and who have major repayments (e.g., home and car repayments). A combination of these factors can facilitate a spiral to acute and irreversible financial distress. The implications of the findings to social work are explored. [ABSTRACT FROM AUTHOR]

Objective This paper contributes to the literature on relocation for specialist care by providing findings on specific issues impacting on rural farmers and property owners who have to travel to the metropolitan area for specialist care for a haematological malignancy. Design and setting This paper uses descriptive qualitative research based on 45 interviews with patients with haematology in Queensland. The interviews were audio-recorded, transcribed verbatim, coded and thematically analysed. Results In addition to issues of distance, farmers and rural property owners who have to relocate for specialist care must deal with problems associated with the lack of opportunity to take absence from the property because of the inescapable pressure of daily farm and property responsibilities and the high cost of, or lack of opportunity to, outsource daily maintenance. Further concerns include the cost of relocation in the context of continuing drought, serious problems sustaining the travel and time away required, and the lack of choice for some but to deal with treatment alone. Conclusion In recent years there has been considerable progress with regard to overcoming the distance barrier for rural and remote patients with cancer through innovative clinical models using technology and telemedicine. However, there has been limited uptake of such models for patients with haematology. The present findings indicate that from the perspective of rural farmers and property owners there are important reasons why the use of innovative strategies should be fostered and expanded. [ABSTRACT FROM AUTHOR]

This paper explores the bioethical issues associated with the diagnosis and treatment of vulvar cancer for Indigenous women in East Arnhem Land, Northern Territory, Australia. Based on a qualitative study of a vulvar cancer cluster of Indigenous women, the article highlights four main topics of bioethical concern drawn from the findings: informed consent, removal of body parts, pain management, and issues at the interface of Indigenous and Western health care. The article seeks to make a contribution towards Indigenous health and bioethics and bring to light areas of further research. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To present the findings from recent research on the experience of relocation for specialist treatment for patients in the hematology/oncology population. Research Approach: Descriptive, qualitative study based on exploratory, in-depth interviews that were recorded, transcribed, coded, and thematically analyzed. Setting: Leukaemia Foundation of Queensland, Australia. Participants: A purposive sample of 45 individuals with hematologic cancer who had to relocate for specialist treatment. Methodologic Approach: A descriptive, qualitative methodology actioned through open-ended, in-depth interviews with 45 participants who relocated for specialist treatment. Findings: The findings indicate that relocation happens at a time when patients are particularly emotionally vulnerable from the shock of their diagnosis or relapse and the confrontation with a potentially life-threatening condition. During this time, when the need for the comfort and support of home and family is heightened, patients have to separate from their family and travel to metropolitan specialist centers. For patients from regional, rural, and remote locations, which are lengthy distances from metropolitan hospitals, the choice to return home during treatment is not a realistic option. Distance also can be a barrier that prevents family from visiting the hospital to provide support. Conclusions: Individuals who have to relocate require psychosocial support. Because of the stresses associated with relocation for specialist care, many patients from regional, rural, and remote areas would prefer to be treated locally. Interpretation: Understanding and responding to family issues associated with relocation for specialist treatment is an important aspect of oncology nursing care for patients who have to relocate from regional, rural, and remote areas. Because centralization of specialist hematology treatment is a worldwide trend, the findings have relevance to an international nursing audience. [ABSTRACT FROM AUTHOR]

Aims This study set out to explore the attitudes toward a ' Patient Stories' DVD as a psychosocial support initiative for patients diagnosed with a hematological malignancy. Design A qualitative research design was employed through a series of open-ended interviews and one focus group. Participants Participants were purposively sampled from a database of patients maintained by the Leukaemia Foundation of Queensland. In total, there were 50 participants ( n = 26 male, n = 24 female), which represented the following major hematological diagnostic groups: multiple myeloma ( n = 15), lymphoma ( n = 14), leukemia ( n = 17), and other ( n = 4). Of the overall cohort, 11 participants had undergone a bone marrow transplant, and 15 had undergone a stem cell transplant (allogeneic and autologous transplants). Results and Conclusion Most participants believed that a ' Patient Stories' DVD would be a beneficial and effective way for nurses delivering psychosocial support to hematology patients. Such benefits included a sense of normalization from hearing similar stories and providing convenient support that did not require travel or potentially uncomfortable social situations. However, some participants did not show interest in the idea for reasons such as already having a local support system and not wanting to watch potentially frightening stories. [ABSTRACT FROM AUTHOR]

This article presents findings that highlight the significance of the tension between the focus on disease and treatment verses the focus on re-engaging with life for individuals facing the crisis of being diagnosed with a haematology malignancy. The findings are from a study on survivorship conducted throughout Queensland, Australia. The research was based on a qualitative design involving a series of open-ended interviews (n = 50) and one focus group which were recorded, transcribed verbatim, and then coded and thematically analysed for the research. The findings affirm the importance of a sense of normalcy and the process of re-positioning the central role of the disease in the lives of those diagnosed with a haematological cancer. There are key points when a focus on treatment and disease is unavoidable. However, after treatment the need for supportive care and the consequent reminder of the disease and treatment can 'taper off.' The challenge is to know when to provide support and when to respect the individual's need to let go of a focus on issues associated with treatment and the disease. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To explore the use of routine telephone follow-up as a supportive care strategy for patients with hematologic malignancies from the patients' perspectives.Research Approach: A qualitative design based on a series of open-ended interviews and one focus group.Setting: Leukaemia Foundation of Queensland, Australia.Participants: 50 participants recruited from the Leukaemia Foundation of Queensland database that represented a sample of major diagnostic groups, age, gender, and geographic location of patients with hematologic malignancies.Methodologic Approach: Interviews and focus groups were open-ended and were recorded, transcribed verbatim, coded, and thematically analyzed to form the basis of the findings.Findings: The majority of participants in the study saw a perceived benefit in regular telephone follow-up as a supportive care service. Benefits included the positive aspects of individualized attention, potential support created for those not open to conventional types of support, and the positive effects of allowing support organizations to keep track of patient progress. However, some participants did not want to receive regular telephone follow-up support because of a desire to move on and access to other support through friends, family, or healthcare professionals.Conclusions: The results from the current study affirm previous research. Attitudes toward a telephone follow-up support service vary from patient to patient. Research demonstrates that patients with cancer responded with attitudes that range from favorable to unfavorable toward the benefits and usefulness of telephone support.Interpretation: Oncology nurses provide supportive care for patients with hematologic malignancies, and they serve as a key professional group to provide follow-up telephone supportive care. Based on the findings from the current article, oncology nurses who provide supportive care should be aware of differing attitudes among patients with hematologic malignancies toward telephone follow-up support. Nurses participating in support initiatives should recognize the notion of patient receptivity and how it affects telephone support strategies. [ABSTRACT FROM AUTHOR]

Vulvar cancer is a serious condition that requires a range of specialist treatments including surgery, chemotherapy, and radiation. In Australia, such treatments are only available in major metropolitan hospitals. Thus, women diagnosed with this condition in rural and remote areas must relocate to the metropolitan specialist centers for treatment. The focus of this article is on the experience of relocation for specialist care for Indigenous women diagnosed with vulvar cancer from East Arnhem Land, Northern Territory, Australia. The findings presented in this article explore a range of issues that affect the experience of relocation such as community concerns, cultural distress, loneliness, fear, worry, and physical concerns associated with the condition. [ABSTRACT FROM PUBLISHER]

There is an increasing international movement of physicians, with substantial numbers of International Medical Graduates (TMGs) now seeking jobs outside the countries in which they were educated. For IMGs there are potential elements of crisis and loss associated with this transition. This article presents findings from Australian-based research which explores the LMGs' experience during entry to their chosen country and posits the need for a designated liaison officer to help support the transition. The research was based on thirty open-ended, qualitative interviews which were coded and thematically analyzed. The findings document factors associated with the decision to leave their country of origin, psycho-social aspects of stress experienced upon arrival in Australia, and the participants' perspective on the suggestion for the appointment of a hospital-based liaison officer to assist IMGs during the transition process. [ABSTRACT FROM AUTHOR]

The purpose of this article is to provide recent findings on the perceptions and experiences about end-of-life care for individuals with a hematological malignancy. A qualitative design based on a series of open-ended interviews and one focus group was utilized to explore and document the experience of survivorship from the perspective of adult patients diagnosed with a hematological malignancy. Fifty participants (n = 26 male;n = 24 female) were interviewed representing the major hematological diagnostic groups: Multiple Myeloma, Lymphoma, and Leukemia. The interviews and focus group were recorded, transcribed verbatim, coded, and thematically analyzed. The findings presented are from the participants' experiences with end-of-life care. The findings indicated that those fortunate enough to know about the benefits of palliative care are more likely to access palliative care during end-of-life care. However, for many hematology patients there are still problems with timely referrals to the palliative system. Within the context of an Australian research program, the findings provide a useful “snapshot” of current issues for Australian hematology patients and their families. [ABSTRACT FROM PUBLISHER]

Purpose: The use of the word 'survivor' is now widely accepted in academic and clinical oncology culture. However, despite such prevalence, there is limited research exploring the meaning of the term survivor for the very individuals to which the term is applied. The article provides insights on the term survivor from a sub-set of findings taken from a Queensland study exploring the experience of survivorship for individuals diagnosed with a haematological malignancy. Methods: The qualitative study involved in-depth interviews with 50 individuals diagnosed with a haematological malignancy. The interviews were transcribed verbatim, coded and then analysed thematically. Results: The results indicated that the majority of participants actively disliked the term and did not embrace the notion of survivor in their post-diagnosis identity. Only a small number actively embraced the term. Conclusion: The word survivor had a multiplicity of meanings depending on the individual interpretation of the term. Relevance of manuscript to inform research, policies and/or programmes: The clear message from the research is that the term survivor needs to be used with care and sensitivity. The strong recommendation is that caution should be used when applying the term to individuals diagnosed with a haematological malignancy. The naming of support groups and newsletters should be sensitive to the wide range of meanings that individuals bring to this term. Indeed, the findings indicate that many do not identify with the term and require a more appropriate language to respond to their supportive care needs. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To present findings on the impact of diagnosis and treatment on sexuality for those diagnosed with a hematologic malignancy.Research Approach: A qualitative design based on a series of open-ended interviews and one focus group.Setting: Queensland, Australia.Participants: 50 participants representing the major hematologic diagnostic groups.Methodologic Approach: Interviews were recorded, transcribed verbatim, and then coded and thematically analyzed for the research.Findings: The impact of the disease and treatment on sexuality ranged from participants experiencing no problems or having a brief impact that passes over time, to those who reported serious problems that significantly affected their life satisfaction. Some concerns were raised about the taboo nature of sexuality and the lack of discussion on the topic.Conclusions: The findings contradict prior research that all patients with cancer will experience an impact on their sexuality by diagnosis and treatment. The current study indicates that a small subgroup of individuals diagnosed with hematologic malignancies are acutely distressed about issues regarding sexuality and require follow-up.Interpretation: Individuals diagnosed with a hematologic malignancy may have difficulties with their sexuality and will, therefore, require follow-up or assistance. A subset of individuals will require understanding, support, and, for some, referral to follow-up with a specialist. As major obstacles still exist for patients accessing appropriate professional support and advice on sexuality, oncology nursing can provide leadership in this area. [ABSTRACT FROM AUTHOR]

This paper presents a sub-set of findings from the first interview (T1) of an Australian longitudinal study that documents the living donor's experience with renal transplant. There has been limited Australian research on this topic to date. A qualitative methodological approach was used, involving open-ended interviews with prospective living kidney donors (n = 20) from the Renal Transplantation Unit at the Princess Alexandra Hospital in Brisbane, Queensland, Australia. The interviews were analysed using qualitative research methods of coding and thematic analysis. A significant majority of participants reported that the decision to become a living kidney donor was a positive, easy and spontaneous decision. It was driven by their natural instincts and they offered to be a donor at the earlier opportunity, rather than waiting to be asked. The offer was based on their desire to relieve the recipient's suffering and possible death associated with dialysis and kidney failure. While concerns associated with the medical operation for donation (nephrectomy) were a consideration, this was significantly overshadowed by their desire to improve the recipient's quality of life and avoid their possible death. In the face of such suffering and death, the donation of a kidney was considered ‘no big deal’. Such findings can be used to inform the assessment process for live donor screening. [ABSTRACT FROM PUBLISHER]

Objective. In Australia, 25% of international medical graduates (IMGs) make up the medical workforce. Concern is expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs' education. Although there is literature alluding to difficulties IMGs face with undertaking the Australian Medical Council (AMC) examination, there is little research detailing this experience. We therefore explored IMGs' reflections on facilitators and barriers in undertaking the AMC examination. Methods. After ethics approval, in-depth telephone interviews were conducted with 30 IMGs selected from a hospital in Queensland. Data were coded and analysed using thematic analysis principles. Results. Two facilitating themes were identified: ability to sit for the first part of the examination in country of origin; and having access to resources such as bridging courses and study groups. Three themes represented barriers: not understanding procedural steps; financial issues; and lack of information on examination content and standards. Conclusion. The themes provide new insights and add depth to existing literature that can be used to improve procedural processes and education for IMGs towards successful outcomes in the AMC examination. What is known about the topic? There is concern expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs education. The Australian work that is available only depicts educational experience of fellowships or education and training strategies after IMGs have passed their AMC examination. What does this paper add? The findings indicate that the process of sitting for the AMC examination is perceived as one of the major difficulties associated with entering and integrating into the Australian health system. The findings indicate a range of practical, financial and resource problems faced by IMGs attempting to sit for the AMC examination. What are the implications for practitioners? The detailed accounts from IMGs about their experience with undertaking the AMC examination will provide up-skilling program coordinators with the information they need to better assist IMGs to prepare for the examination. The provision of appropriate medical training and educational support will contribute to more effective integration of IMGs into the healthcare system. [ABSTRACT FROM AUTHOR]

Objective. This paper presents the findings of research which explored how International Medical Graduates (IMGs) understand and integrate with the allied health system in relation to multidisciplinary care. Methods. An open-ended, exploratory qualitative design comprised of thirty (n = 30) open-ended, in-depth interviews with IMGs employed in a public hospital in Queensland, Australia. Results. Many IMGs have no experience with allied health support in their country of origin. Multidisciplinary collaboration is a new concept for IMGs integrating into the Australia healthcare system. Learning about the allied health system, including how to work effectively within the context of the multidisciplinary team, is an important topic that needs to be addressed as a matter of priority. Conclusions. There is a strong need to focus on improving strategies for integrating IMGs into the allied health system. In particular, IMGs require information to help them understand the roles and referral processes associated with interfacing with the allied health system. INSET: What is known about the topic?. [ABSTRACT FROM AUTHOR]

Patients diagnosed with haematologieal malignancies require specialist treatments provided by major metropolitan hospitals. Those living outside the cities where the specialist care is located have to relocate for this specialist treatment. The findings presented in this article are from a program of research that documents the psychosocial impact of relocation on patients and their families. Prior Australian-based research conducted as part of the program indicates that the process of relocation exacerbates the stress of treatment and creates significant practical, emotional, social, and financial disruption to the families involved. The Australian findings provided the basis for a recent comparative study conducted by the program that explores the experience of relocation for haematology from the perspective of patients and their carers in New Zealand. The findings from the comparative study indicate that whilst there is evidence of similar psycho-social distress associated with relocation, there are a number of factors specific to living in New Zealand that ameliorate the impact, including smaller distances, strong community connections, and the participants' personal determination to retain the focus on living. [ABSTRACT FROM AUTHOR]

Recent research has established the important beneficial relationship between exercise and cancer rehabilitation and survivorship. However, the complexities of this interrelationship are as yet underexplored. This article presents the findings of a recent qualitative research study that examined the psychosocial benefits associated with involvement in an exercise club (the Chemo Club) specifically designed for cancer patients during or postchemotherapy from the perspectives of the patients. The findings validate the important benefits involvement in the Chemo Club provides its members and highlight the need for further initiates, hospital based and external, to establish such services for cancer patients. [ABSTRACT FROM AUTHOR]