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Background: The constraining prison culture is not, for the most part, conducive to the provision of palliative care for people in prison. Aim: This study aimed to explore patterns of palliative and end-of-life care provision for hospitalised prison patients. Design: A retrospective qualitative review of hospital medical records to explore the quality of end-of-life care provision for patients experiencing incarceration who died within hospital. Qualitative inductive analysis of record extracts of each patients final 3-months of life was undertaken. Setting/participants: An Australian metropolitan hospital responsible for providing secondary and tertiary health services for people experiencing incarceration. This study included a systematic sample of male patients experiencing incarceration who died in hospital between 2009 and 2019. Results: Medical record extracts of 15 male patients revealed two broad themes: (1) barriers to equitable access to palliative care for incarcerated hospitalised patients; and (2) factors that facilitated quality end-of-life care for patients and families. Barriers included: tensions between balancing risk and humanity; and limited agency over place and death. Conversely, early recognition of deterioration and anticipated dying provided patients and families opportunity to focus on end-of-life goals. Conclusions: Institutional influences of security and control challenged the provision of equitable end-of-life care for people experiencing incarceration. Further research is required to inform, and incorporate, best approaches to identifying patient wishes and advance planning into care within, or despite, the constrains of incarceration. Policy reform and a coordinated, best practice approach to the management of end-of-life care for people experiencing incarceration is needed. [ABSTRACT FROM AUTHOR]

Background: Lack of access, late engagement and limited referral for palliative care remain critical issues in supporting Indigenous Australians with life limiting illness. Aim: To explore the experiences and perspectives of Indigenous and non-Indigenous health professionals regarding the provision of palliative care for Indigenous people with advanced disease. Design: Qualitative study involving semi-structured focus groups/interviews with analysis following an inductive thematic approach. Setting/participants: A purposive sample (n = 54) of medical, nursing, allied health and Indigenous Hospital Liaison Officers engaged in caring for Indigenous patients at a metropolitan teaching hospital in Australia. Results: Four overarching themes were identified regarding provision of palliative care for Indigenous patients. These were (1) the intersection of cultures – Indigenous peoples, health and palliative care, (2) bridging the cultural divide: the integral role of Indigenous Hospital Liaison Officers, (3) health professionals devolve their responsibility to provide culturally appropriate care and (4) building towards a more holistic, culturally aware provision of palliative care. Conclusions: For many Indigenous people, the health system may be experienced as inflexible, narrowly focused and even prejudiced and traumatising. For Indigenous patients at the end of life, these challenges are heightened. The Indigenous Hospital Liaison Officers, working at the intersections of these two cultures, are key to negotiating such challenges as they seek opportunities to facilitate communication and understanding between firmly held cultural needs. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander people experience significant disparities in accessing cancer care and in cancer outcomes when compared with non-Indigenous Australians. Social workers and Aboriginal Hospital Liaison Officers from an inner-city hospital partnered with local Aboriginal organisations to develop, implement, and evaluate a culturally informed model of supportive cancer care. The initiative adopted an "appreciative inquiry" approach and engagement with Indigenous stakeholders, drawing on the Aboriginal and Torres Strait Islander Quality Improvement Framework and Toolkit for Hospital Staff (AQIFTHS, 2015). Using a process of codesign, strategies were developed with consumers to address the social and cultural determinants of health across the cancer journey. The new evidence-based model of care incorporated culturally informed identification of needs, culturally appropriate engagement, and maintenance of respectful connections to develop codesigned care plans with tailored information and provide practical support and advocacy. Findings illustrate the complex challenges faced by Aboriginal and Torres Strait Islander people living with cancer as well as their strengths. AQIFTHS processes and model of care provide guidance for social workers and other health professionals seeking to partner with stakeholders to promote health equity and improve supportive cancer care in accordance with optimal care guidelines and national quality standards. IMPLICATIONS Supportive care needs of Aboriginal and Torres Strait Islander people living with cancer are often complex and multifaceted, but links with community and culture are noted strengths. Social workers in Australian health settings have an important role in improving access and promoting a culturally responsive model of care for this population. Appropriate support can only occur when it is codesigned with the individual patient and their family members, Aboriginal Hospital Liaison Officers, and community. [ABSTRACT FROM AUTHOR]

Cancer has become a prevalent disease, affecting millions of new patients globally each year. The COVID-19 pandemic is having far-reaching impacts around the world, causing substantial disruptions to health and health care systems that are likely to last for a prolonged period. Early data have suggested that having cancer is a significant risk factor for mortality from severe COVID-19. A diverse group of medical oncologists met to formulate detailed practical advice on systemic anticancer treatments during this crisis. In the context of broad principles, issues including risks of treatment, principles of prioritizing resources, treatment of elderly patients, and psychosocial impact are discussed. Detailed treatment advice and options are given at a tumor stream level. We must maintain care for patients with cancer as best we can and recognize that COVID-19 poses a significant competing risk for death that changes conventional treatment paradigms. [ABSTRACT FROM AUTHOR]

Objective: Understanding the way therapy works is a complex undertaking. Historically, such enquiry has been dominated by "outcomes" leading to a lack of discourse about clinical processes. In the cancer setting, identifying clinical process can be even more complex because of the added challenges of an ongoing illness. This study investigated the therapeutic processes used in a meaning-based intervention developed for the advanced cancer setting: Meaning and Purpose therapy.Method: Four sessions of therapy were delivered to 24 participants. Transcribed sessions (n = 96) of the intervention were analyzed by two independent researchers to describe participant themes, therapeutic processes, and patterns of change related to common points in the intervention.ResultAlthough both suffering and meaning were present in all sessions, when we tracked the focus of the content across sessions, there was a clear progressive shift toward meaning-centered content for all participants. This finding is in spite of the fact that all participants had progressive disease and were living with ongoing challenges.Significance of resultsProcesses such as focusing on meaning, reflecting a sense of significance, joining with participants to explore their unique meaning, and directing them away from a preoccupation with suffering were identified as clear influences of a shift toward a meaning-based focus. These processes offer a fresh focus on meaning and a buffer to the distress of advanced cancer. [ABSTRACT FROM AUTHOR]

Objective: Meaning and Purpose (MaP) therapy aims to enhance meaning-based coping through a life review that focuses on the value and worth of the person, key relationships, sources of fulfillment, roles, and future priorities in living life out fully. We sought to test the feasibility and acceptability of a six-session model of MaP therapy against a wait-list control cohort in a pilot study seeking effect sizes on measures of adaptation.Method: We randomized patients with advanced cancer to MaP therapy or wait-list control, with measures administered at baseline and after 6-8 weeks. Wait-list patients could then crossover to receive therapy, with further measures collected postintervention. Adherence to the manualized model was sustained through weekly supervision and fidelity coding of recorded sessions. We used generalized estimating equations to control for baseline and any correlation of data.ResultFrom 134 eligible participants, 57 (43%) consented, and 40 of 45 (89%) offered therapy completed 6 sessions. Key barriers to consenting patients were poor health (15 refusers and 4 withdrawals) and death intervened in 6 participants. MaP therapy generated adequate effect sizes in posttraumatic growth (new possibilities, appreciation of life, and personal strength) and life attitudes (choices and goal seeking) to permit calculation of power for a formal randomized, controlled trial.Significance of resultsDelivery of this model of existentially oriented therapy is feasible and acceptable to patients. A properly powered randomized controlled trial is justified to examine the efficacy of this intervention. [ABSTRACT FROM AUTHOR]

Objectives: Health care professionals (HCPs) caring for people with primary malignant glioma (PMG) and their carers see many of the profound challenges facing this group, yet their perspectives are not documented. This study aimed to understand and document the unique perspective of HCPs in relation to the supportive and palliative care needs of patients with PMG and their carers, with a view to developing a model of care.Methods: Qualitative study involving semi-structured focus groups and interviews with 35 medical, nursing and allied health staff actively engaged in providing care for this patient group. Purposive and theoretical sampling from two major metropolitan hospitals and one community palliative care service in Australia was utilised to seek perspectives from a variety of disciplines and health care settings. Thematic analysis was conducted by three independent researchers, using a constant comparative method influenced by grounded theory.Results: Key themes relating to the needs of people with PMG which were apparent from the HCPs included: The difference in the illness course of glioma compared to other cancers; Limitations of current medical care; Challenges in balancing hope with reality of the illness; and Recommendations to improve care, including recognising the role of family and moving from a model where services are offered in response to demonstrated needs. Significance of the results: Current models of care based upon the classic cancer trajectory are unresponsive to the needs of people with PMG. Care may be enhanced by moving towards a proactive approach, extending the goals of care beyond medical needs and broadening the focus of care to include family needs. [ABSTRACT FROM AUTHOR]

Objective:The objective of this study was to describe the experience of undertaking meaning and purpose (MaP) therapy for patients with advanced cancer, with an aim of refining therapeutic processes involved prior to pilot testing. Specifically, we were interested in examining the themes arising from participation in the intervention in relation to our therapeutic goals, and how acceptable both the number of sessions and processes used were.Method:A convenience sample of people living with advanced cancer was recruited to participate in this process, resulting in 24 therapy sessions for analysis.Results:A thematic analysis of each session illustrated that the process of MaP therapy is one that encourages reflection, offers insights, and can be confrontational, but can also allow participants to “shift” their perspective and focus onto meaningful goals. Results illustrate how the therapist creates a therapeutic frame that holds up a poignant portrayal of the meaning of life lived, and mirrors this to the patient, such that they grasp its rich texture. Participants' descriptions showed how they were buoyed forward as a result, with renewed vigor and enthusiasm, despite their illness and any physical restrictions that it imposed.Significance of results:A planned pilot test of this intervention will enable us to determine potential effect sizes of this therapy in reducing distress and increasing meaning prior to a full randomized controlled trial. Understanding the processes involved and the experiences of participation in meaning-based therapies is crucial to the future strength of this area of psychotherapy. [ABSTRACT FROM PUBLISHER]

The article presents a study which examined the use of a telephone-based interviews to ascertain the level of distress among patients with colorectal cancer (CRC) at selected public and private health services in Melbourne, Victoria from June 15, 2008-September 22, 2008. The Hospital Anxiety and Depression Scale (HADS) is used to assess the levels of anxiety and depression among patients. The study also considers the demographic profile and descriptive statistics to evaluate the outcome.

Objectives:In the clinical setting of cancer, meaning may well have a central role in the life changes the illness experience brings about. As health care professionals working with people with life-threatening illness, we are exposed to one of the major turning points in life and the ways people confront this transition. Meaning can assist coping by offering a framework, perspective, and counterbalance to the challenge of illness. However, the absence of meaning can be a precursor to profound despair.Methods:This article brings together the clinical implications of two studies conducted by the authors that explored the role of meaning in adjustment to cancer, presenting a theoretical understanding of the experience of meaning in cancer and identifying some potential approaches to intervention.Results:Our findings point to some specific goals of care as well as a number of therapeutic modalities aimed to meet these goals. We examine four goals of care—acknowledging suffering, encouraging a search for meaning, strengthening connection with others, and ensuring optimal physical care—as foundational in any clinical approach and then examine the key models of therapy that assist the clinician in pursuing these goals.Significance of results:Our aim is to create an integrated approach to care provision that locates meaning centrally in any patient's adaptation. [ABSTRACT FROM PUBLISHER]

Objectives: This study builds on previous work that explored the lived experience of meaning in advanced cancer. The aims were to explore the associations of suffering (physical and existential distress) and coping (via social support) with psychological distress and global meaning using a battery of instruments among adults attending an Australian metropolitan cancer service (n=100).Methods: The contribution of suffering and coping via social support to psychological distress and meaning were examined using a variety of statistical methods. Multiple regression analyses were conducted to further examine relative contributions to both psychological distress and global meaning.Results: Physical and existential distress were found to be positively associated with psychological distress whereas high social support and personal meaning are related to lower levels of psychological distress. Social support was the strongest correlate of global meaning whereas high levels of existential distress were related to lower levels of global meaning. On the basis of this study, it is concluded that the factors related to suffering clearly promote psychological distress, and the reverse is true for global meaning for those living with cancer.Significance Of Results: This study speaks to the clinical complexity of the dynamic experience of suffering and meaning in cancer. We need to better understand the impact of physical suffering and meaning in the lives of this population and to actively work toward the enhancement of social support and connection with others for this group. Optimal palliative and family-centered care blended with therapies that promote a sense of meaning of life lived appear crucial to ameliorate suffering. [ABSTRACT FROM AUTHOR]

The article explores on how the experience of meaning in people with advanced cancer can be understood within an integrated framework of assumptive world, sense of coherence and meaning based coping. A conversational style of interviewing has been used for the study. Assumptive world, sense of coherence and meaning based coping domains interact dynamically in a way that patients can harness courage to counterfeit the commitment to make the most of their remaining life. Meaning moderates the assumptions that have been formed from a person's view of the world and mediates healing which is needed to restore a coherent self.

This article discusses a psychoeducational intervention for women after adjuvant treatment for early stage breast cancer. Living through early stage breast cancer is not simply about overcoming a short-term crisis. The lived experience of women at the completion of adjuvant treatment calls for a reconsideration of the timing and type of psychosocial interventions provided. A Post Adjuvant Treatment Support Program was developed and piloted over a nine-month period with pleasing results. The program aims to mark the end of treatment and promotes active coping through sharing common experiences, normalizing responses to completion of treatment, encouraging consideration of the meaning of the experience and facilitating the use of stress management and cognitively based coping skills. Innovative methods to encourage focused group discussion are being developed. The intervention addresses the specific and previously unmet needs of women at the end-of-treatment phase of early stage breast cancer.

A clear percentage of women with early breast cancer cope with the active period of treatment and then struggle to adjust as medical support becomes less intensive. This study highlights issues that can arise in a phase of illness relatively neglected previously. Recognition of the needs of women at completion of adjuvant chemotherapy and radiotherapy necessitates a new approach to delivery of care with a targeted intervention that specifically addresses their adjustment to potential survivorship. [ABSTRACT FROM AUTHOR]

Lack of palliative care education is being identified by many universities as a deficiency in their undergraduate medical teaching programme which requires urgent implementation into the undergraduate curriculum. A comprehensive teaching programme in palliative care was devised and commenced at our institution at the beginning of 1991. This consists of seven one and half hour modules given to students in the last years of their course. The modules cover the broad range of aims of the course (as outlined) by using a diverse range of educational principles and methods and only a minimum of traditional non-interactive didactic teaching. Students complete anonymous evaluation form at the completion of the course and responses from the medical students have been overwhelmingly positive. 89 percent of students rated the course ‘very useful’ or ‘extremely useful’. The students' rating placed this course above all other components of their undergraduate teaching programme. However, written comments from students have provided us with even more significant insights into the importance of the programme, such as ‘why weren't we taught this before’ and ‘I would like to see more space given to discussion on how to cope with the stress of the medical profession.’ The skills involved in palliative care are basic to good doctoring generally and we believe that this teaching programme could help form the basis for futore medical undergraduate teaching programmes in palliative care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

‘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. [ABSTRACT FROM PUBLISHER]