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The discussion explores ethical issues associated with medical "gatekeeping" in relation to psychosocial health research associated with serious illness and loss. "Gatekeeping" is defined as the process whereby health-care providers prevent access to eligible patients for research recruitment. The impact of this practice on the research process is explored, including issues of sample representation, selection bias, and wastage of time and resources. The reflection of ethical issues is set in the context of research on clinical empathic responsiveness and accuracy, paternalism, and the ethical principles of autonomy, beneficence, and justice. [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]

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]

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]

Purpose: This paper responds to the call for more research to fully understand out of pocket (OOP) costs for cancer patients by providing a detailed discussion of such costs for adult haematology patients from Queensland, Australia.Methods: The descriptive qualitative research was based on in-depth interviews with 45 (n = 45) haematology patients from regional, rural and remote areas.Results: The discussion itemises the OOP costs under four categories including the costs associated with travel and accommodation, the costs associated with family and friends during relocation, the costs associated with diagnosis and treatment, and the costs of parking.Conclusions: The paper provides evidence of the categories of financial burden experienced by haematology patients who have to relocate for specialist treatment by detailing the extensive range of OOP costs. The expectation is that the itemisation of OOP cost variables will contribute to future efforts of quantification. [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]

This article contributes to the literature on the financial impact of cancer by presenting findings on the use of credit cards as a response to the financial crisis of relocation for specialist treatment for patients diagnosed with a hematological malignancy. The findings are from a study, funded by the Leukaemia Foundation of Queensland, examining the financial impact of relocation for specialist treatment for hematology patients in Queensland. To date, there has been no work on financial management strategies for hematology patients or research on the use of credit cards by cancer patients. The findings on the use of credit cards as a response to the financial crisis of serious illness are discussed in terms of income profile, gender, financial management strategy, and a sense of urgency and need. [ABSTRACT FROM AUTHOR]

The article presents original research findings on informal financial assistance for hematological patients; that is, the gifts from family, friends, and communities that help patients cope with the financial hardship associated with cancer. The qualitative study involved interviews with 45 hematology patients that were audio-recorded, transcribed, coded, and then thematically analyzed. The findings examine the differing perspectives that individuals and families bring to the notion of informal financial aid, provide examples of individuals who require and receive informal financial assistance, and conclude with descriptions of those who require informal financial assistance but it is not available. The implications of the findings for oncology social work practice are explored. [ABSTRACT FROM PUBLISHER]

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]

Objective: The aim of the present study was to document the financial and psychosocial impact of relocation for specialist haematology treatment in Queensland. Methods: This study was a qualitative exploratory study comprising 45 in-depth interviews with haematology patients supported by the Leukaemia Foundation of Queensland. Results: The findings indicate that decentralisation of treatment is assisting haematology patients to overcome the profound difficulties associated with travelling to the metropolitan area for treatment. Conclusion: Fostering specialist outreach and building capacity in regional cancer centres are service delivery strategies that are greatly appreciated by regional, rural and remote haematology patients who are stressed by the many challenges associated with leaving home to travel distances for specialist treatment. It is the hope and expectation that these findings will make a contribution to informing future health policy and service delivery planning. What is known about the topic? Internationally, there is evidence of the benefits of visiting specialists and the development of local specialist services for cancer patients in regional and rural areas, but there is limited research on the topic in Australia. What does this paper add? The findings herein make a contribution to this area of research through an up-to-date, in-depth consumer perspective on non-metropolitan oncology hospital services for haematology patients in Queensland. The evidence indicates that the opportunity to avoid travel to the metropolitan treating hospitals for regional, rural and remote haematology patients is increasingly an option in Queensland and greatly appreciated by many of those who have this option. What are the implications for practitioners? The findings applaud the work of the health professionals providing the opportunity for regional specialist care for haematology patients. With regard to service delivery and health policy decision making, it is important to note that for patients positive about access to local treatment, psychosocial concerns (e.g. remaining at home, connection with family, avoidance of financial hardship) predominate in their reasoning about benefit. Thus, it is important that regional, rural and remote patients are offered greater choice in treatment options and have more involvement in decision making about specialist care. [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]

Purpose: To date, there has been limited research on the topic of vulvar cancer. This paper provides findings from a qualitative study conducted with Indigenous women in East Arnhem Land, Northern Territory, Australia on the psychosocial impact of diagnosis and treatment for vulvar cancer. The insights from the study outlined in this paper not only make a contribution to deepening our understanding of the experience of vulvar cancer for Indigenous women, but provide practical recommendations to ensure effective and early engagement for diagnosis and treatment. Methods: A qualitative research method was employed through in-depth, open-ended interviews. The participants of the study were a purposive sample of Indigenous women with the condition, health professionals, and Aboriginal health workers. There were a total of 40 participants; with twelve ( n = 12) Indigenous women affected with the condition, fourteen ( n = 14) Aboriginal Health Workers, ten ( n = 10) nurses, three ( n = 3) doctors, and one ( n = 1) community member. Results: This paper addresses three key issues highlighted by the participants which include the fact that the private nature of the disease makes the condition 'women's business', that there is a sense of shame associated with the condition, and that there is fear and worry generated by the seriousness of the condition. Conclusion: The private nature of the disease and the sense of shame associated with the condition impact upon the diagnosis and treatment for many Indigenous women. In addition, the limitation of resources for health service delivery for East Arnhem Land exacerbates the problems faced by these communities. This paper puts forward suggestions to facilitate early diagnosis and treatment for women affected with the condition. [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]

Purpose: Despite the personal and economic importance of the issue of returning to work after cancer treatment, there are major limitations in the research literature on the topic. Indeed, in relation to the focus of the present article, the experience of return to work for Australian haematology patients, there is little research available. Methods: The return-to-work findings are a sub-set from a study examining survivorship issues conducted through in-depth, qualitative interviews with a state-wide sample ( n = 50) of individuals who were at least 1 year post-treatment for haematological malignancy. Results: There were three groups identified in relation to employment: (1) those who were retired and work was not an issue, (2) those who had successfully re-entered the workforce and (3) those who wanted to work but were finding the process of return-to-work difficult. It is the third group that is the major focus for this paper. Conclusions: The clear indications are that group 3 requires assistance with return-to-work and were vulnerable to a range of psychosocial distress caused by inability to return to employment. Supportive care strategies to assist return to employment are provided. Relevance of manuscript to inform research, policies and/or programs Current improvements in cancer treatments have not only increased the number of cancer survivors but also peoples' ability to work during and following treatment. Maximising opportunities for cancer patients to return to work is a significant concern not only for individuals and employers but also economically for society. The findings reported in this article explored the individual story of a range of individuals with haematological malignancies in relation to their desire and efforts to return to work. Importantly, the findings not only provide insights on the work re-entry challenges faced by such individuals but also posit supportive care service delivery solutions to assist those who are vulnerable and frustrated in their efforts to find employment. [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]

Purpose: To date, the research on relocation has been conducted in countries such as Australia where there are vast distances that need to be travelled by regional, rural and remote patients to access specialist metropolitan treatment. This research considers the issue of relocation for specialist treatment in a New Zealand context. Methods: The exploration of the experience of relocation from the consumers' perspective was conducted through an iterative, qualitative research methodology using open-ended interviews conducted by speaker-phone at the time and location of each participant's choice. Results: The three factors that underpin the phenomenon of 'travel-based' accommodation in New Zealand are the strong desire to return home, the small geographical distances that make this possible for many and the strong determination to endure hardship associated with travel when distances are long. Conclusions: Any understanding of relocation for specialist treatment needs to be informed by two concepts: 'travel-based' relocation and 'accommodation-based' relocation. Relevance of manuscript to inform research, policies and/or programs: The focus needs to be on providing supportive travel arrangements where possible. In New Zealand, as elsewhere, cancer supportive care organisations are increasingly providing volunteers to assist with travel. Such practical volunteer assistance is important, as is financial support through government subsidies to cover the cost of such travel. The insights from the study affirm the importance of health professionals who are supportive and creative in their efforts to assist people to return home. Supportive clinical care such as addressing issues in relation to nausea and pain management for those travelling must also be considered. [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]

The Building Babies' Brains (BBB) program aims to educate new parents, particularly parents of children considered psychologically 'at risk', about the vital impact their interactions have on their child's brain development and mental health. BBB offers a comprehensive support package which includes recruitment into the 'Getting to Know You' (GTKY) parent education workshops, 12 months Mater Aide follow-up support and 18 months subscription to Noah's Ark services. This paper presents research findings on an evaluation of the GTKY workshop that indicates that such a program has the potential to be a significant proactive mental health initiative for parents and infants. Factors associated with positive outcomes include the provision of social support and normalisation of the parenting experience, self-esteem and confidence building through networking with peers, self expression in a non-judgemental group environment, and parental education through information provision. Limitation and suggestions for further developments of the program are included. The hope and expectation is that the findings will help encourage the further development of such programs elsewhere. [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]

This article presents the findings from a pilot study conducted as a first step in understanding the myriad psychological and psychiatric sequelae stemming from the use of steroids for hematology patients. Descriptions of the side effects experienced by 10 hematology patients undergoing steroid treatment are documented and discussed. Steroid usage can have a range of physical and emotional side effects on patients, including hematology patients. The insights are a serious reminder to all who care for hematology patients that the psychological and psychiatric side effects of steroids need to be taken seriously. [ABSTRACT FROM AUTHOR]

McGrath P, Phillips E, Vaughan G. International Journal of Nursing Practice 2010; 16: 274–281 Vaginal birth after Caesarean risk decision-making: Australian findings on the mothers' perspective The purpose of this paper is to explore, from the mothers' perspective, the decision-making experience with regard to subsequent birth choice for women who had previously delivered by Caesarean section. A qualitative methodological approach was taken to the exploration of mothers' knowledge of the risks of vaginal birth after Caesarean (VBAC) or elective Caesarean following a prior birth by Caesarean section. This paper presents the insights provided by the four women who chose VBAC. The health professionals' attitude to birth, and thus the support they offer to mothers, is predominantly pro-Caesarean. In view of the declining numbers of VBACs and the fact that the clinical literature documents risks for both elective Caesarean and VBAC, it is important for health professionals to be very sensitive and balanced in the information and support offered for the VBAC birth option. [ABSTRACT FROM AUTHOR]

This article presents the findings of qualitative research exploring the psycho-social effects of corticosteroid use in pediatric hematology patients during continuation therapy for Acute Lymphoblastic Leukemia (ALL). The findings are from a 5-year longitudinal study that documented the experience of treatment for childhood leukemia and related disorders from the perspective of the child patient and their family from the point of diagnosis to 1 year post-treatment. To date, scant information on the serious emotional side-effects of corticosteroid administration for children with ALL during the continuation period is available. This is concerning in light of the many serious challenges corticosteroid use poses to families of children with ALL. For this group of parents, dealing with the impact of corticosteroids on their child was reported as the major and only treatment-related stress during the continuation period of treatment for ALL. The impact of these drugs, described in very negative terms, was considered exacerbated by the fact that during the continuation period they are repeatedly administered in 5-week cycles. Anger and aggression, both passive and in acts of physical violence, in combination with temper tantrums and uncontrollable behavior were major concerns. Under the influence of corticosteroids the children could be moody, grumpy, confused, emotionally labile, depressed, sullen and withdrawn. The children could quickly switch from one emotional state to another, such as from aggression to emotionality. They could experience trouble with sleeping and talk excessively. The parents outlined a range of positive strategies for coping with the difficult behavior. The authors make a number of recommendations aimed at assisting parents to deal with the impact of the administration of corticosteroids in continuation therapy, including increasing the awareness on the part of health care providers of the side-effects of these drugs and their impact on the child with ALL and their family; provision of information to families on the effects of corticosteroid use; and, ensuring that professional counseling assistance is available when required. [ABSTRACT FROM AUTHOR]

There is scant research available on the psycho-social aspects of births subsequent to Caesarean Section (CS). In particular, there is little psycho-social research available in regard to women who seek to have a Vaginal Birth After Caesarean (VBAC). To address this lack of information in the literature, this article explores, from a phenomenological perspective, the reasons motivating women to try for a VBAC, from the perspectives of four women who have tried for or achieved a VBAC. The findings indicate that these mothers differed to other women interviewed in the study who opted for repeat CS. The VBAC mothers expressed a strong belief in the importance of a natural birth as the best start for their infant, strived to reduce where possible drug interventions during labour and birth and believed in the importance of breastfeeding. The VBAC mothers viewed achieving a natural birth as a significant aspect of their femininity and a major life event for a woman. [ABSTRACT FROM AUTHOR]

This article presents the findings of a cross-cultural research project that explored similarities and differences between palliative care service provision in Kerala, India and South-East Queensland, Australia, to inform a process of mutual learning for service development. Three major points of difference that can inform this process of mutual learning were identified: 1) an understanding of the significance of honesty in information-giving to the patient, 2) recognition of the importance of palliative care specialists providing education to mainstream health professionals, and 3) appreciation of the need for palliative care to be cognizant of the socio-economic impact of dying--especially for families experiencing poverty--by embracing strategies for financial and material support. The findings highlight the effectiveness of a cross-cultural collaboration between health professionals and researchers in South-East Queensland, Australia and Kerala, India. [ABSTRACT FROM AUTHOR]

The article reports on the study on the mothers' perspective and decision-making with regards to infant feeding following a previous caesarean section (CS) birth. Tape recorded interviews of the 20 newly CS mother were conducted. It notes that identifying and understanding the three different attitudinal groups with respect to mothers' approaches to feeding their new born will enhance midwives' ability to adopt their breastfeeding support during the initial postnatal period.

The article presents insights collected from a qualitative research project in Australia which aims to explore factors that contribute to recovery in mental illness from a consumer's perspective. It notes that an important factor cited by those who participated in the study in relation to initiating and sustaining the recovery process is that of taking personal responsibility for recovery. The findings of the study suggest some strategies that can be used in the recovery process, such as involving in self-affirming and diversional activities.

The rich data drawn from a study to develop an innovative model for Indigenous palliative care are presented to help address the paucity of authentic Indigenous voices describing their grief practices. Interviews with patients, carers, Aboriginal health care workers, health care workers and interpreters were conducted in four geographical areas of the Northern Territory in Australia. Insights and descriptions of the cultural processes and beliefs that follow the death of an Aboriginal person led to the identification of a number of key themes. These included: the emotional pain of grief; traditionalist ways of dealing with grief; the importance of viewing the body; the sharing of grief among large family and community networks, with crying, wailing, ceremonial singing, telling stories and dealing with blame all playing a part in the bereavement processes. Ways for Westerners to offer assistance in culturally sensitive ways were also identified by the participants, and are reported here to enable health workers to begin to understand and respond appropriately to traditionalist ways of experiencing and reacting to grief. [ABSTRACT FROM AUTHOR]

The cultural differences between the dominant Anglo-Australian and the Aboriginal Australian groups are significant, particularly in the way death is dealt with. It is thus extremely important for health care professionals caring for Aboriginal people with a terminal illness to be informed as fully as possible on Indigenous spiritual beliefs associated with death and dying. This article shares findings on Aboriginal spiritual perspectives relevant to the care of individuals coping with a terminal illness from a study in the Northern Territory. The findings emphasize the multiplicity of Aboriginal spiritual perspectives on serious illness and dying, which can juxtapose both Christian and traditional beliefs, as well as the importance for the well-being of Aboriginal persons of respecting these beliefs. The role and importance of traditional healing, the medicine man, and the preferred place of death are also discussed. [ABSTRACT FROM AUTHOR]

There is a significant cultural gap between westernized Australian and Aboriginal cultures, especially in regards to care of the dying. Thus, cultural sensitivity and respect, coupled with knowledge of the traditions and practices in respect of the death and dying, are of utmost importance in communicating with Aboriginal peoples. In order to make a contribution to furthering cultural safety in nursing practice, this article provides important insights on a wide range of Aboriginal cultural practices in relation to the clothing, hair, possessions and name of deceased persons that impact on the nursing care of the dying Aboriginal person. [ABSTRACT FROM AUTHOR]

This article presents the findings of a five-year longitudinal study exploring the treatment experience for families coping with leukemia and lymphoma to address the dearth of psycho-social research documenting the experience of childhood lymphoma patients. The participants noted that the predominant differences for lymphoma families, as compared with other childhood hematological conditions, center around the issues of, firstly, the intensity of treatment. While the treatment protocol is comparatively shorter, the parents perceive it to be more arduous due to the intense and continuous nature of treatment. Important issues noted in this regard were the negative impact of the toxicity of the chemotherapeutic drugs, the stress associated with the invasiveness of accessing the child's veins for blood samples and to inject medications and the experience of undergoing lumbar punctures. Secondly, the relatively rare occurrence of pediatric lymphoma was reported to result in feelings of isolation from other families with children with a hematological malignancy and the unavailability of information and support services focusing specifically on childhood lymphoma. Thirdly, the relatively high curative success rate of lymphomas can have the effect that the parents feel that their angst is somewhat trivialized by other parents at the hospital. Recommendations include the importance of the availability of the full range of supportive care services, attention to the difficult emotional states the child patients experience, clinical strategies that lessen the trauma of treatment, and the use of positive role models by way of contact with or information of children who have successfully completed treatment. [ABSTRACT FROM AUTHOR]

Aim: To describe Aboriginal peoples' post-death cultural practices in the Northern Territory. Methods: The data were collected from 72 qualitative interviews conducted throughout the regional, rural and remote areas of the Northern Territory, Australia, with Aboriginal patients and carers, and the health professionals who cared for them. Results: The findings indicated the importance to Aboriginal peoples of viewing the body, and post-death bereavement practices of group wailing, which can be coupled with physical expressions of self-mutilation and removal of clothing. Special ceremonies are reported for times when the body is returned home and there are strong relationship-based practices about which persons are able to handle the body. Conclusion: The findings provide useful information for palliative care nurses working with Aboriginal peoples to ensure appropriate cultural understanding and an informed response to practice. [ABSTRACT FROM AUTHOR]

Objective: The present article provides findings from a two-year study on Indigenous palliative care conducted in the Northern Territory that explored and documented wishes in relation to place of death for rural and remote Aboriginal people. Design: Qualitative, open-ended interviews, audio-recorded, transcribed verbatim, and thematically analysed. Participants: There were a total of 72 interviews completed with Indigenous patients (n = 10), Indigenous caregivers (n = 19), Indigenous and non-Indigenous health care workers (n = 41), and interpreters (n = 2). Results: The findings provide a clear articulation of the wish of Aboriginal people from rural and remote areas to die at home connected to land and family. Strong cultural reasons were given for this preference, including the strong connection with land and community, a belief in ‘death country’, the importance of passing on sacred knowledge to the appropriate family member, the significance of ensuring that the dying individual's ‘animal spirit’ is able to return to the land, and the imperative that the ‘right person’ in the family network is available to provide the care. Conclusion: The strong wish to die at home informs the importance of building up local health and palliative care services and avoiding, where possible, the need for relocation for health care to the major metropolitan hospitals during end-of-life care. [ABSTRACT FROM AUTHOR]

TOPIC. Nursing insights on the experience of using standardized questionnaires during hospice care. PURPOSE. To explore and describe the experience of hospice staff using questionnaires on hospice clients: whether such instruments help or hinder the holistic, compassionate hospice practice and to set this topic on the research agenda in the hope of generating critical reflection on this important aspect of hospice care. SOURCES. A cross-section of hospice staff interviewed about their experience with administering the questionnaires. (Findings from research conducted with hospice clients on their experience of questionnaires are published separately.) CONCLUSIONS. The initial findings indicate that staff perceive questionnaires as negatively impacting on their efforts to engage in holistic and compassionate hospice practice and point to a major irony that questionnaires, designed for the supportive care of the vulnerable, actually make the vulnerable more vulnerable. [ABSTRACT FROM AUTHOR]

To date, there is scant research literature that explores the provision of end-of-life care to Aboriginal peoples in Australia. In particular, there is a lack of published research available on issues at the interface of Aboriginal languages and English during palliative care. The complexity and importance of the issue for palliative care provision, however, is demonstrated by the fact that in Australia, Aboriginality is itself a very broad category, containing many distinct language groups and subcultures. Thus, although to date there is some mention of the problems associated with language in the literature, there is scant research on the topic of the provision of palliative care to Aboriginal peoples in remote areas. The following findings from a recent two-year National Health and Medical Research Council (NHMRC) study are provided to address this hiatus. The findings provide insights on the impact of language difference on palliative care practice for Aboriginal peoples in the Northern Territory of Australia. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To present a model for end-of-life care in adult hematology that has been developed from nursing insights. Data Sources: Insights obtained from 25 nursing interviews during a two-year, qualitative, Australian National Health and Medical Research Council research study. Data Synthesis: The nursing insights indicate that an understanding of end-of-life care in hematology needs to be set in a trilogy of overlapping models (labeled functional, evolving, and refractory) that address the complexity of issues associated with professional and hospital culture. Conclusions: The authors have used the findings of their national research study to develop a useful, working model to assist with the integration of palliative care into adult hematology. Implications for Nursing: The model develops a new language for understanding and fostering the integration of palliative care and hematology. [ABSTRACT FROM AUTHOR]

As a follow-up to a recent study which highlighted the existence of medical dominance in multi-disciplinary team (MDT) meetings, this paper presents research findings from an Australian study which shows that medico-centrism is a key cause of tension within MDTs. The findings are from a 1-year qualitative study in a regional hospital that explored the ethical decision-making of health professionals within an acute care medical unit. This exploration was conducted through an iterative, phenomenological, qualitative research methodology that consisted of open-ended interviews with a multi-disciplinary representation of health professionals and a sample of consumers for whom they care. The paper situates the notion of nursing advocacy within the context of medico-centrism and examines how the nursing profession interfaces with other disciplines. The findings indicate that the professional framework of nursing includes the language of advocacy, whilst the framework of doctors centres around the medical decision-making process. All professional groups made reference to the MDT as the modus operandi for patient-centred care. All participants noted that time and familiarity with patients and their families is essential for patient-centred care and this could be achieved through MDT collaboration. However, doctors who have scant time to spend with patients saw it as their responsibility to direct the decisions of the MDT and viewed the MDT as adding confusion to the decision-making process. Nurses reported that the limited amount of time spent by doctors in patient consultation translated into the need for advocacy. Professional and clinical confidence and experience are noted as necessary to successfully engage in the process of advocacy. The findings of this article indicate that the adoption of an advocacy role by nurses represents an important means through which MDT operation can be enhanced, medico-centrism limited and patient-centred care improved. [ABSTRACT FROM AUTHOR]

There is now extensive consumer research to indicate that patients with haematological malignancies are not receiving appropriate or timely referrals to the palliative system. This paper begins to explore the issue from the professional perspective by presenting findings from haematology nurses on their experience with terminal care. The nursing insights have been gathered through open-ended interviews with a national sample of nurses with extensive experience in haematology in both public and private hospitals throughout Australia. The findings resonate with the previous consumer research in that all the acute care nurses affirmed that it is their belief, based on their professional experience, that patients from these diagnostic groups typically die in the acute ward dealing with escalating technology and invasive treatments. For some, the statements could be qualified by the satisfaction that they worked in a haematology unit, aware of the death-denying issues, trying to address the problem. Others, caught in a ‘refractory’ subculture (i.e. a subculture with a negative perception of palliative care), outlined the factors driving the lack of integration for their specific hospital. The focus of the discussion of findings is on the latter. [ABSTRACT FROM AUTHOR]

It is now common in health care for a diverse range of professions and disciplines to work together in regular and close contact. Thus, there are now calls in the literature for research that documents insights on the ethical dimension of multidisciplinary relationships. Recent Australian research has responded to this call by examining how a multidisciplinary team of health professionals define and operationalize the notion of ethics in an acute ward hospital setting. This article provides findings from the research study that indicate that, although there is a shared conceptualization of ethics as "patient-centered care," there can be times of conflict and tension in determining what is best for the patient. The discussion begins to build an understanding of how a multidisciplinary mix of health professionals responds to ethical conflict and tension. The authors' hope and expectation is that, by keeping the research focus on what health professionals in a multidisciplinary team (MDT) actually do, rather than exclusively on how they philosophically think about ethical dilemmas, the insights can be translated into practical strategies that can be utilized to strengthen the process of ethical decision making within the health care system. [ABSTRACT FROM AUTHOR]

The following discussion presents findings from a National Health and Medical Research Council (NHMRC) study that documents the importance to Indigenous people of including the network of extended family and community in health care communication. In particular the discussion explores the data relating to the importance of communicating through family meetings with Aboriginal people during end-of-life care. The data was collected through a series of open-ended, qualitative interviews (n=72) conducted with a cross-section of members of the Aboriginal community and health professionals within the Northern Territory, Australia. Acknowledging Aboriginal peoples' relationship rules and communicating through family meetings are practices that demonstrate respect for Indigenous cultural processes of information sharing. Anger on the part of Aboriginal people about lack of information can be the outcome when such processes are ignored or not understood. Respecting the need to ‘share the story’ broadly with appropriate people in the extended family and community network through family meetings is noted as vitally important in health care, especially during the dying trajectory. The discussion explores the practical issues associated with, the different reasons for, and the positive outcomes from, incorporating family meetings for Indigenous people along the illness trajectory. [ABSTRACT FROM AUTHOR]