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Internationally, non-academic research impact is assessed by governments as part of evaluating the quality of publicly funded research. A case study method was used to investigate the non-academic impact of Australian social work research. Interviews were conducted with fifteen leading researchers about outputs (research products, such as publications and reports), engagement (interaction between researchers and end-users outside academia to transfer knowledge, methods or resources) and impact (social or economic contributions of research). Twelve case studies were prepared using a standardised template. Content analysis highlighted examples of impact, and theoretical and in vivo coding uncovered processes of engagement and impact. Different types of engagements with research end-users influenced impact in three areas: legislation and policy; practices and service delivery; and quality of life of community members. Engagement and impact were intertwined as research altered policy discourses and illuminated hidden social issues, preparing ground for subsequent, more direct impact. Likewise, academic and non-academic impacts were intertwined as research rigour and academic credibility were perceived to leverage influence. There was no evidence of achieving impact simply through the trickle-down effect of scholarly publication. The findings broaden understandings of how research influences policy and practice and iterative and indirect relationships between engagement and impact. [ABSTRACT FROM AUTHOR]

An editorial is presented in which the authors discuss the responsibility of public health and medical care organizations concerning COVID-19 vaccines. The article discusses patient-centered/relationship approaches to establishing rapport in encouraging COVID-19 vaccine uptake, socioeconomic differences in COVID-19 vaccine acceptance, and various vaccine programs.

Context: Patients with terminal illnesses often require surrogate decision makers. Prior research has demonstrated high surrogate stress, and that despite standards promoting substituted judgment, most patients do not want their surrogates to make pure substituted judgments for them. It is not known how best to help loved ones fulfill the surrogate role.Objectives: To test the effectiveness of an intervention to help surrogate decision makers.Methods: One hundred sixty-six patients (41% with amyotrophic lateral sclerosis and 59% with gastrointestinal cancers) and their surrogates at two university medical centers were randomized to an intensive nurse-directed discussion of the end-of-life decision control preferences of the patient (TAILORED) or a discussion of nutrition (CONTROL); 163 completed baseline interviews and underwent the intervention.Results: Twelve patients died during follow-up and 137 dyads completed the study. Post-intervention, using all available data, TAILORED patients and surrogates became more likely to endorse mutual surrogate decision making, that is, a balance of their own wishes and what the surrogate thinks best (adjusted odds compared with baseline for patients = 1.78, P = 0.04; adjusted odds for surrogates = 2.05, P = 0.03). CONTROL patients became 40% less likely to endorse mutual surrogate decision making (P = 0.08), and CONTROL surrogates did not change significantly from baseline (adjusted odds = 1.44, P = 0.28). Stress levels decreased for TAILORED surrogates (impact of events scale = 23.1 ± 14.6 baseline, 20.8 ± 15.3 f/u, P = 0.046), but not for CONTROL (P = 0.85), and post-intervention stress was lower for TAILORED than CONTROL (P = 0.04). Surrogates' confidence was uniformly high at baseline and did not change. Caregiver burden (Zarit) increased from 12.5 ± 6.5 to 14.7 ± 8.1 for TAILORED (P < 0.01), while not changing for CONTROL, yet satisfaction with involvement in decision making was higher at follow-up for TAILORED than for CONTROL (71% vs. 52%, P = 0.03).Conclusion: TAILORED patients and surrogates who completed the study adopted a more mutual decision-making style, balancing their own wishes with what the surrogate thinks would be best for them. Surrogates reported less stress and more satisfaction. Confidence was high at baseline and did not change. There was a modest increase in caregiver burden. These findings suggest that interventions like TAILORED might positively impact surrogate decision making. [ABSTRACT FROM AUTHOR]

Palliative care has been one of the most rapidly growing fields of health care in the United States in the past decade. The benefits of palliative care have now been shown in multiple clinical trials, with increased patient and provider satisfaction, equal or better symptom control, more discernment of and honoring choices about place of death, fewer and less intensive hospital admissions in the last month of life, less anxiety and depression, less caregiver distress, and cost savings. The cost savings come from cost avoidance, or movement of a patient from a high cost setting to a lower cost setting. Barriers to expanded use include physician resistance, unrealistic expectations of patients and families, and lack of workforce. The future of palliative care includes more penetration into other fields such as nephrology, neurology, and surgery; further discernment of the most effective and cost-effective models; and establishment of more outpatient services. [ABSTRACT FROM AUTHOR]

There is little understanding in Australia of the special issues faced by gay, lesbian, bisexual and transgender people in end-of-life care and advance care planning. This exploratory study aimed to achieve an initial understanding of these issues to inform the development of a larger study involving gay, lesbian, bisexual and transgender service users. Consultations were carried out with 19 service providers and 6 gay, lesbian, bisexual and transgender community members in the Northern Rivers and metropolitan Sydney areas of New South Wales, Australia. Participants reported barriers to health care service access due to discrimination, inappropriate care and lack of knowledge among both consumers and health care workers of legal rights at the end of life. While advance care planning can assist with improving end-of-life care, respondents reported a number of obstacles. These included a lack of knowledge and absence of perceived need and the additional obstacle of social isolation, leading to difficulties identifying alternative decision-makers. The study highlighted the need for education for gay, lesbian, bisexual and transgender people and health and aged care providers on existing legal provisions to prevent discrimination in end-of-life care. [ABSTRACT FROM AUTHOR]

Background: Surrogate accuracy in predicting patient treatment preferences (i.e., what patients want) has been studied extensively, but it is not known whether surrogates can predict how patients want loved ones to make end-of-life decisions on their behalf.Objective: To evaluate the ability of family members to correctly identify the preferences of seriously-ill patients regarding family involvement in decision making.Design: Cross-sectional survey.Participants: Twenty-five pancreatic cancer and 27 amyotrophic lateral sclerosis (ALS) patients and their family members (52 dyads total).Main Measures: Patients and family members completed the Decision Control Preferences (DCP) scale regarding patient preferences for family involvement in health care decisions using conscious and unconscious scenarios.Key Results: Patient and family member agreement was 56% (29/52 dyads) for the conscious scenario (kappa 0.29) and 46% (24/52 dyads) for the unconscious scenario (kappa 0.15). Twenty-four family members identified the patient's preference as independent in the unconscious scenario, but six of these patients actually preferred shared decision making and six preferred reliant decision making. In the conscious scenario, preference for independent decision making was associated with higher odds of patient-family agreement (AOR 5.28, 1.07-26.06). In the unconscious scenario, cancer patients had a higher odds of agreement than ALS patients (AOR 3.86; 95% CI 1.02-14.54).Conclusion: Family members were often unable to correctly identify patient preferences for family involvement in end-of-life decision making, especially when patients desired that decisions be made using the best-interest standard. Clinicians and family members should consider explicitly eliciting patient preferences for family involvement in decision making. Additional research is still needed to identify interventions to improve family member understanding of patient preferences regarding the decision-making process itself. [ABSTRACT FROM AUTHOR]

Despite the World Health Organization promoting breastfeeding as the optimal feeding method for infants, the breastfeeding initiation rates within these disadvantaged groups' remains low. It is important to identify the factors that prevent these groups from initiating and establishing successful breastfeeding. This review aims to identify the breastfeeding experiences of teenage mothers and mothers from low income groups. Qualitative research papers were identified using electronic and manual searches by following a systematic methodology. Nine relevant articles were critically analysed using a qualitative Critical Appraisal Skills Programme tool. Coding of the nine papers generated six themes. The benefits of breastfeeding known to these mothers were often superseded by the perceived barriers of breastfeeding, while the decision to breastfeed was frequently influenced by their social support network and prior exposure to breastfeeding. Disadvantaged mothers may require extra input and support to overcome any problems associated with breastfeeding. Developing healthcare professionals' capabilities to educate these disadvantaged groups, their social networks and the public about breastfeeding is crucial if it is to become established within our society. [ABSTRACT FROM AUTHOR]

The author focuses on the issues concerning social and health services for Lesbian Gay Bisexual Transsexual (LGBT) older people in Australia. The need of LGBT older people in gaining access to mainstream services such as social and health services are being emphasized. The author stresses that service providers including social workers should recognize services to the older people.

This article reports on health and aged care services for older lesbian and gay adults in Australia. In interviews, 14 of these individuals reflected on past and anticipated care and presented narratives related to culture, community, and friendship. The article also discusses the recognition and legitimation of gay and lesbian communities and gerontology in Australia. Information is presented on service engagement for older people, social isolation, public and private identity expression, and diversity as well.

Social work with older people is often characterised as low status employment and is dominated by medicalised constructions of old age. Consequently, there is a need for educational responses that address students’ negative attitudes toward older people and enable the development of practice skills in this area. The present paper evaluates an elective course for third year social work students that challenged their perceptions of their own and others’ ageing, and stimulated a reflective approach to practice with older people. Reflective learning techniques were employed in the course, including observations in aged care service settings. Students in the course showed a high degree of interest in working with older people in the future and, although this did not increase much throughout the course, they evaluated it positively, noting greater awareness of issues affecting older people. [ABSTRACT FROM AUTHOR]