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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]

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]

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]