Search

Objectives Voluntary assisted dying (VAD) was legalized in Victoria, Australia, in June 2019. Victoria was the first jurisdiction in the world to require doctors to undertake training before providing VAD. This study examines data from doctors who completed the mandatory training in the first 2 years of the VAD system's operation (up to 30 June 2021). It describes the doctors who are undertaking VAD training, their post-training attitudes toward VAD participation, and their experiences of the mandatory training. Methods Through the online training, doctors completed a short demographic survey and undertook formal assessment of knowledge (90% pass mark). They also were invited to complete an optional survey evaluating the training. Results In total, 289 doctors passed the training, most commonly males (56%) aged 36–65 years (82%) from an urban location (72%). Most were more than 10 years post fellowship (68%) and practising as general practitioners (51%) or medical oncologists (16%). The training most commonly took 6 h (range 2 h to over 9 h). Most doctors passed the assessment at the first (65%) or second (19%) attempt. Almost all participants (97%) found the training helpful or very helpful and most reported being confident or very confident in their knowledge (93%) and application (88%) of the VAD legislation. Significance of results Doctors reported the training was helpful and improved their confidence in knowing the law and applying it in clinical practice. The profile of trained doctors (particularly their location and specialty) suggests continued growth of participating doctors is needed to facilitate patient access to VAD. It is important that this safeguard does not discourage doctors’ participation.

Background: For a patient’s legal right to make end-of-life treatment decisions to be respected, health care practitioners, patients and their substitute decision-makers must know what rights exist and how to assert them (or support others to assert them). Yet very little is known about what enhances or obstructs the operationalization of legal rights from the perspective of patients, family members and substitute decision-makers. Aim: To explore barriers and facilitators to the operationalization of rights in end-of-life decision-making from the perspectives of terminally-ill patients and family members and substitute decision-makers of terminally ill patients in Australia. Design: Semi-structured interviews (face to face and telephone) with patients, family or substitute decision-makers experienced in end-of-life decision-making completed between November 2016 and October 2017. A thematic content analysis of interview transcripts. Setting/participants: Purposive sampling across three Australian states provided 16 terminally-ill patients and 33 family and/or substitute decision-makers. Results: Barriers and facilitators emerged across three overlapping domains: systemic factors; individual factors, influenced by personal characteristics and decision-making approach; and communication and information. Health care practitioners play a key role in either supporting or excluding patients, family and substitute decision-makers in decision-making. Conclusion: In addition to enhancing legal literacy of community members and health practitioners about end-of-life decision-making, support such as open communication, advocacy and help with engaging with advanced care planning is needed to facilitate people operationalizing their legal rights, powers and duties. Palliative care and other support services should be more widely available to people both within and outside health systems.

Unlawful assisted dying practices have been reported in Australia for decades. Voluntary assisted dying (VAD) is now lawful in Victoria and Western Australia in limited circumstances and will soon be lawful in a further four Australian States. This article examines nine cases involving unlawful assisted dying practices in Victoria in the 12 months prior to the commencement of the Voluntary Assisted Dying Act 2017 (Vic) in 2019. It explores whether, if that Act had been in operation at the relevant time, these patients would have been eligible to request VAD, having regard to their decision-making capacity and their disease, illness or medical condition. Many of these patients would not have been eligible to request VAD had the legislation been operational, primarily because they lacked decision-making capacity. As VAD is lawful only in a narrow set of circumstances, unlawful assisted deaths may continue to occur in those States where voluntary assisted dying is legal.

Colonic goblet cells are specialized epithelial cells that secrete mucus to physically separate the host and its microbiota, thus preventing bacterial invasion and inflammation. How goblet cells control the amount of mucus they secrete is unclear. We found that constitutive activation of autophagy in mice via Beclin 1 enables the production of a thicker and less penetrable mucus layer by reducing endoplasmic reticulum (ER) stress. Accordingly, genetically inhibiting Beclin 1-induced autophagy impairs mucus secretion, while pharmacologically alleviating ER stress results in excessive mucus production. This ER-stress-mediated regulation of mucus secretion is microbiota dependent and requires the Crohn's-disease-risk gene Nod2. Overproduction of mucus alters the gut microbiome, specifically expanding mucus-utilizing bacteria, such as Akkermansia muciniphila, and protects against chemical and microbial-driven intestinal inflammation. Thus, ER stress is a cell-intrinsic switch that limits mucus secretion, whereas autophagy maintains intestinal homeostasis by relieving ER stress. Appendix on pages e1–e4.

The law regulating medical end-of-life decisions aims to support patients to receive high-quality health care. It does so through ensuring treatment received reflects the person's wishes and values and protecting health professionals who provide adequate pain and symptom relief even if that treatment may coincidentally hasten death. However, good decision-making is predicated by those involved, including patients themselves and those supporting patients, being familiar with the law and the role it plays in the decision-making process. This article reports on a study exploring the role that law plays in end-of-life decision-making from the perspective of terminally-ill patients, their substitute decision-makers and family members. While participants' decision-making practices were often underpinned by a legal framework, the role of the law was largely invisible. Community education is needed for the public to know their legal rights and responsibilities, and to understand that the law plays a role in supporting end-of-life decision-making.

Background Voluntary assisted dying is lawful in Victoria in limited circumstances and commences in Western Australia in mid-2021. There is evidence that in rare cases unlawful assisted dying practices occur in Australia. Aims To determine whether assisted dying practices occurred in Victoria in the 12 months prior to the commencement of the Voluntary Assisted Dying Act 2017 (Vic) ('VAD Act'), and to examine features of any identified cases. Methods Exploratory case series of adult patients in Victoria who died between May 2018 and 18 June 2019 as a result of medication administered with the primary intention of hastening death. Cases were identified from a self-administered survey about medical end-of-life decisions for adult patients, completed by Victorian specialists treating adults at the end of life. We examined reported use of medication with the primary intention of hastening the patient's death; characteristics of assisted dying cases, including doctors' classification of such practices. Results Nine cases met the inclusion criteria. Death did not occur immediately after providing medication with the intention of hastening death. In eight cases, it was framed as palliative or terminal sedation and/or continuous deep sedation. Most doctors used language that distanced their practices from assisted dying. Conclusions Unlawful assisted dying practices seem to have occurred in a small number of deaths in Victoria prior to commencement of the VAD Act. These practices typically occurred within the context of palliative or terminal sedation and may be difficult to distinguish from lawful palliative care practice. Some survey responses possibly reflect ambiguity in doctors' intentions when providing medication. This article is protected by copyright. All rights reserved.

BackgroundInsufficient knowledge about end-of-life law can impede the provision of safe and high-quality end-of-life care. Accurate legal knowledge across health professions is critical in palliative and end-of-life settings given the reliance on multidisciplinary care. Most research has focused on doctors, finding significant knowledge gaps. The limited evidence about other health professions also suggests legal knowledge deficits.ObjectiveTo determine and compare levels of knowledge about end-of-life law across a broad sample of Australian health professionals and medical students, and to identify predictors of legal knowledge.MethodsAn online pre-training survey was completed by participants enrolled in a national training programme on end-of-life law. The optional survey collected demographic data and measured baseline legal knowledge and attitudes towards end-of-life law.ResultsResponse rate was 67% (1653/2456). The final sample for analysis (n=1564, 95% of respondents), included doctors, medical students, nurses and a range of allied health professionals. Doctors and nurses had slightly higher levels of legal knowledge than did medical students and allied health professionals; all had critical knowledge gaps. Demographic and professional characteristics predicted knowledge levels, with experience of end-of-life law in practice, confidence applying law and recent continuing professional development being positively associated with legal knowledge.ConclusionsThis study provides new evidence about legal knowledge across a broad range of health professions. While knowledge levels varied somewhat across professions, knowledge gaps were observed in all professional groups. Education and training initiatives to enhance knowledge of end-of-life law should be tailored to meet the specific needs of each profession.

Background: The community prevalence of advance care directives (ACDs) is low despite known benefits of advance care planning for patients, families and health professionals. Aim: To determine the community prevalence of instructional and appointing ACDs in New South Wales, Victoria and Queensland and factors associated with completion of these documents. Methods: A telephone survey of adults living in New South Wales, Victoria and Queensland (n=1175) about completion of instructional ACDs (making their own decisions about future health care) and appointing ACDs (appointing another to decide). Quota sampling occurred based on population size by state, gender and age, with oversampling in smaller jurisdictions (Victoria and Queensland). Results: Overall response rate was 33%. Six per cent of respondents reported completing an instructional ACD while 12% reported completing an appointing ACD. Female gender, higher educational level, personal experience of a major health scare and being widowed were significant predictors of completing an instructional ACD. Older age, higher educational level and being widowed were significant predictors of completing an appointing ACD. Conclusions: Despite long-standing efforts to increase advance care planning, community prevalence of ACDs remains low, particularly for instructional ACDs. This study found some different predictors for instructional ACDs compared with appointing ACDs, and also a potential role for experiential factors in triggering uptake. These findings suggest supplementing general community awareness campaigns with more nuanced and targeted efforts to improve ACD completion.

Speech and/or language difficulties (SaLD) can potentially compromise a child’s health-related quality-of-life (HRQoL). Very few studies have examined associations between SaLD, other child and family factors and HRQoL and none have been undertaken in Australia. We explore these associations using data from a nationally representative Australian sample of 4–5 year old children, extracted from the Longitudinal Study of Australian Children (LSAC) (n = 4386). The Disability-Stress-Coping Model informed variable selection. Three domains of HRQoL were examined, and assessed on physical, emotional and social functioning subscales of the Pediatric Quality of Life Inventory (PedsQL). SaLD measures included parent concern about speech/language (Parents’ Evaluation of Developmental Status) and receptive vocabulary ability (adapted Peabody Picture Vocabulary Test-III). Multiple regression analyses revealed that various child and family factors representing all constructs from the Disability-Stress-Coping Model were significantly associated with HRQoL. Specifically, HRQoL was positively associated with parental warmth and child’s general health and negatively associated with parent speech/language concerns and maternal depression across all domains. Parents with concerns about their pre-school child’s speech and language rate the quality of their child’s health more poorly across physical, emotional and social domains. Associations between parent speech/language concerns and HRQoL were notable for being apparent in a (non-clinical) population sample and for persisting independent of factors such as maternal depression, parenting style and the child’s general health.

This article provides evidence of the prevalence of wills and the principles underpinning the intended distribution of estates in Australia. Intentions around wealth transfers and the social norms that underpin them occur in the context of predicted extensive intergenerational transfers from the ageing baby boomer generation, policies of self provision and user pays for care in old age, broader views on what constitutes ‘family’, the increased importance of the not-for-profit sector in the delivery of services, and the related need for philanthropy. A national telephone survey conducted in 2012 with 2,405 respondents aged 18 and over shows that wills are predominantly used to distribute assets to partners and/or equally to immediate descendants. There is little evidence that will makers are recognising a wider group of relationships, obligations and entitlements outside the traditional nuclear family, or that wills are being replaced by other mechanisms of wealth transfer. Only a minority consider bequests to charities as important. These findings reflect current social norms about entitlements to ‘family’ money, a narrow view of what and who constitutes ‘family’, limited obligation for testators to recompense individuals or organisations for care and support provided, and limited commitment to charitable organisations and civil society.

Background Advance care planning is regarded as integral to better patient outcomes, yet little is known about the prevalence of advance directives (AD) in Australia. Aim To determine the prevalence of AD in the Australian population. Methods A national telephone survey about estate and advance planning. Sample was stratified by age (18–45 and >45 years) and quota sampling occurred based on population size in each state and territory. Results Fourteen per cent of the Australian population has an AD. There is state variation with people from South Australia and Queensland more likely to have an AD than people from other states. Will making and particularly completion of a financial enduring power of attorney are associated with higher rates of AD completion. Standard demographic variables were of limited use in predicting whether a person would have an AD. Conclusions Despite efforts to improve uptake of advance care planning (including AD), barriers remain. One likely trigger for completing an AD and advance care planning is undertaking a wider future planning process (e.g. making a will or financial enduring power of attorney). This presents opportunities to increase advance care planning, but steps are needed to ensure that planning, which occurs outside the health system, is sufficiently informed and supported by health information so that it is useful in the clinical setting. Variations by state could also suggest that redesign of regulatory frameworks (such as a user-friendly and well-publicised form backed by statute) may help improve uptake of AD.

Many contemporary support services for children and young people (CYP) in out-of-home-care have adopted a collaborative approach to service provision in order to best meet the complex needs of clients. The purpose of this study was to gain a better understanding of the perceptions of Evolve Behaviour Support Services (EBSS) frontline and managerial staff delivering services to CYP in out-of-home-care with disability and complex behaviours regarding interagency/stakeholder collaboration. Views about the number and nature of collaborative partnerships, factors which facilitate or hinder effective relationships and advantages (including unintended benefits) of collaboration were sought. Qualitative interviews with 21 participants highlighted issues around: (1) general and agency/stakeholder specific issues and barriers, and (2) benefits of collaboration. The collaborative approach to service provision was seen as greatly enhancing the effectiveness of EBSS' response and ability to meet the range of CYP's complex needs, as well as having benefits for carers and service providers. Nevertheless, difficulties with collaboration were also encountered. Frequently identified challenges included reduced stakeholder engagement, differences in professional backgrounds and practice frameworks, unequal initiation of contact and follow-up, organisational disparities, communication and information sharing problems, frequent stakeholder turnover and geographical barriers in rural/remote areas.

Early intervention (EI) for children with physical disabilities is advocated as a means of enhancing child outcomes and family functioning. The issues confronted by service providers in delivering this support have received relatively little attention. The purpose of this study was to gain an understanding of the experiences of frontline EI staff delivering services to children with physical disabilities and their families. Researchers sought views about the ways in which EI programs provide services, how programs build and maintain relationships with families and team members, the prevalence of changing and unmet family needs, the presence of barriers to optimal service delivery, and recommendations for service improvement. Qualitative interviews with 10 staff members highlighted both positive aspects of service quality and issues encountered in the provision of services. Staff commented favorably on family-centered practice; aspects of service structure/delivery, including offering a wide range of supports, flexible service provision, and the focus on intervening early; and provider-related aspects including teamwork and interagency coordination and appropriate personal qualities and skills. Despite the strong endorsement of EI, participants also identified several challenges: meeting the high demand for services, under and unmet needs, and inadequate funding and staffing.

Objective The aim of the present study was to identify online resources community members may access to inform themselves about their legal duties and rights in end-of-life decision making. Methods Resource mapping identified online resources that members of the public in New South Wales, Victoria and Queensland are likely to identify, and assessed the ease or difficulty in locating them. Resources were then critically analysed for accessibility of language and format using the Patient Education Materials Assessment Tool (PEMAT). Results Identified resources differed considerably based on whether search terms identified by community members or experts were used. Most resources focused on advance directives, enduring powers of attorney and substitute decision making. Relatively few provided information about legal duties (e.g. powers and responsibilities of substitute decision makers) or resolving conflict with health practitioners. Accessibility (understandability and actionability) of resource content varied. Conclusions Although numerous resources on end-of-life law are available online, community members may not be able to identify relevant resources or find resource content accessible. What is known about the topic? Research on participation by patients in decision making about their treatment has focused primarily on medical rather than legal knowledge. What does this paper add? The present study investigated which online resources community members may access to inform themselves about the law on end-of-life decision making. The resources identified were analysed for ease of location and content accessibility. What are the implications for practitioners? Authors of online resources on end-of-life decision making should consider whether their resources can be: (1) identified by search terms used by the public; (2) understood by a general audience; and (3) readily used to promote reader action.

Objective: Chronic pain can significantly impair functioning of children and adolescents; however, evidence suggests that current psychological approaches have limited effect on functioning post treatment. The objective of this review is to present the current evidence for the personal and contextual factors that affect functioning and disability of children and adolescents with chronic pain, to support the evolution of new treatments. Method: Key word searches were conducted in PsycINFO, MEDLINE via Ovid, CINAHL, and PubMed from 1995 to October 2014. Studies were included if they (1) were written in English, (2) included children or adolescents with chronic pain (>3 mo), (3) had at least 1 personal attribute or 1 contextual factor, (4) had 1 measure of functional ability, and (5) had reported correlations between personal or contextual factors and functional measure. Results: Thirty-three studies were identified which met all inclusion criteria. Several personal factors (depression, anxiety, pain intensity, and catastrophizing) and contextual/environmental factors (parenting characteristics) were consistently associated with higher levels of disability, whereas evidence for other factors was less consistent. Complex interactions between personal and contextual factors were reported. Child physical/cognitive capacities, teacher/peer behaviors, and broader cultural and environmental social systems, received little attention. Conclusion: Several parent and child factors were consistently linked with functional disability, whereas better family functioning was associated with functional ability. Applying an ecological framework, assisted identification of areas for further research, and provides direction for treatments that may be mote effective in optimizing long-term functional outcomes, extending current psychological approches.

Purpose: The trajectory of health-related quality-of-life (HRQoL) for children aged 4–9 years and its relationship with speech and language difficulties (SaLD) was examined using data from the Longitudinal Study of Australian Children (LSAC). Method: Generalized linear latent and mixed modelling was used to analyse data from three waves of the LSAC across four HRQoL domains (physical, emotional, social and school functioning). Four domains of HRQoL, measured using the Paediatric Quality-of-Life Inventory (PedsQL™), were examined to find the contribution of SaLD while accounting for child-specific factors (e.g. gender, ethnicity, temperament) and family characteristics (social ecological considerations and psychosocial stressors). Result: In multivariable analyses, one measure of SaLD, namely parent concern about receptive language, was negatively associated with all HRQoL domains. Covariates positively associated with all HRQoL domains included child’s general health, maternal mental health, parental warmth and primary caregiver’s engagement in the labour force. Conclusion: Findings suggest that SaLD are associated with reduced HRQoL. For most LSAC study children, having typical speech/language skills was a protective factor positively associated with HRQoL.

Context In Australia, government policies support therapeutic interventions for children and young people (CYP) with challenging behaviours related to or secondary to disability, who are in out-of-home care. The aims of interventions are to enhance the skills of both CYP and foster caregivers/parents in order to enhance placement stability, community participation and the overall well-being of the CYP. These interventions are costly and time consuming for CYP, their foster caregivers/parents and the professionals/agencies involved, and evaluation of their effectiveness is warranted. Objectives To review the effectiveness of current practices and interventions for CYP in out-of-home care who have challenging behaviours related to disabilities. Data sources Databases searched included: PsycINFO (1840–September 2010), ERIC (1966–September 2010), MEDLINE (1950–September 2010), CINAHL (1982–September 2010), Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2010), Social Services Abstracts (1979–September 2010), PAIS international (1972–September 2010), PsycARTICLES (1894–September 2010), Sociological abstracts (1952–September 2010). Study selection Randomised or quasi-randomised controlled trials (RCT), non-randomised controlled trials, and cohort studies of interventions or programs for CYP with complex psychological and/or behavioural issues, and/or a disability in foster care were included. Data extraction Details of study characteristics, population demographics and intervention content were tabulated. Qualitative analysis was performed by two independent raters using the Physiotherapy Evidence Database (PEDro) scale for RCTs and an adapted version of The Downs and Black Checklist for Measuring Study Quality (DB Scale) for non-randomised control trials. Data synthesis Four studies met inclusion criteria (two RCTs and two non-randomised control trials). The two RCTS were of moderate methodological quality, each scoring five points (out of a maximum of 10) on the PEDro Scale. The two non-randomised control trials were of similar methodological quality, scoring 14–17 points (out of a maximum of 28) on the adapted Downs and Black Checklist. Content The included studies evaluated a variety of interventions which differed considerably with respect to services offered, approach/philosophy, service delivery models and intensity/duration. Two of the four studies were of behaviourally based parent training interventions. Whilst the other two studies also involved parent training, the primary focus of intervention was the implementation of individualised case management plans by key stakeholders in the CYP's life. The frequency of intervention and length of follow-up in the included studies varied greatly. Three of the reviewed studies reported positive outcomes for children and young people, as well as their caregivers/parents, whilst the fourth found no significant change. Conclusions Studies generally demonstrated gains from the interventions provided, however the nature and extent of these benefits differed greatly across the various outcomes measured. Further, studies often did not take into account other factors which may have contributed towards the observed outcomes. In light of the complexity of providing services to CYP with behavioural issues and/or disability who are in out-of-home care, the costs associated with these services, and the risks if these are not effective, this review highlights the need the need for further research of the efficacy of support services for this group.

Family-centered early childhood services for children with physical disability and their families can afford developmental advantage for children and avert unnecessary stress for families. This study aimed to determine how characteristics of children and families and perceptions of family-centered practice (FCP) relate to satisfaction with early childhood services. Participants comprised parents or carers of children up to 9 years with a physical disability who were accessing early childhood services. Participants completed The European Parent Satisfaction Scale about Early Intervention, Functional Independence Measure for Children, Measure of Processes of Care, and a sociodemographic parent survey. Overall, families (n = 112) reported being relatively satisfied with early childhood services. There was a significant positive relationship between parent perceptions of FCP (coordinated and comprehensive care and providing general information) and satisfaction (β = 3.13 and 1.75, respectively). These aspects of FCP accounted for 68% of the variance in satisfaction scores. Children's level of disability and families' sociodemographic characteristics were not related to satisfaction ratings. These findings suggest that not all aspects of FCP contribute equally to overall satisfaction. Service providers need to pay particular attention to the information needs of families and ensuring that services are well-coordinated and appropriate.

The benefits of providing early intervention services (including multidisciplinary therapy and family support) for children with physical disabilities and their families are widely acknowledged. Evidence, however, of their efficacy is not well documented. Furthermore, many studies fail to adequately describe the programs being evaluated and how these programs have been implemented by service provider organisations. From a policy perspective, evaluators need to be mindful of contextual variations in program implementation when examining initiatives and determining their efficacy. In this paper we discuss how implementation of a cross-organisational early intervention initiative policy for children with physical disabilities was enacted by three different service providers. In the present study, program logic was employed to identify and explore these variations in implementation. While each individual agency provided services and identified outcomes that were consistent with policy objectives, program delivery varied considerably across service providers.

This systematic review examined the psychometric properties and application of assessments used to evaluate participation outcomes and environmental factors for children with acquired brain injury (ABI). An electronic search of eight databases for articles published up to June 2009 revealed reference to 98 outcome measures. According to inclusion criteria based on the International Classification of Functioning, Disability and Health (ICF: Child and Youth version), five were identified as measures of participation (Children's Assessment of Participation and Enjoyment [CAPE], Child and Adolescent Scale of Participation [CASP], Assessment of Life Habits for Children [LIFE-H], Participation Index of the Mayo-Portland Adaptability Index [M2PI], and the Participation Subscale of the School Function Assessment [SFA-PS]). Six were identified as measures of environment (Child and Adolescent Scale of Environment [CASE], Craig Hospital Inventory of Environmental Factors [CHIEF], European Child Environment Questionnaire [ECEQ], Family Inventory of Life Events and Changes [FILE], HOME Inventory, and the Multidimensional Scale of Perceived Social Support Scale [MSPSS]). The measures were critiqued in relation to content, validity, reliability, clinical utility, responsiveness, and overall strengths/weaknesses. These measures need to be evaluated more extensively with children who have ABI to further determine their psychometric properties and clinical usefulness with this population.

Measuring parent satisfaction with services is essential in the evaluation of early intervention programs. However, there is a paucity of satisfaction measures specifically developed for this purpose, and the psychometric properties of existing measures have not been widely examined. The aim of this study was to further investigate the internal consistency of 1 such measure, the European Parent Satisfaction Scale about Early Intervention (EPASSEI). A slightly modified version of the EPASSEI was completed by 112 carers (mainly mothers) of children with physical disabilities receiving early intervention services in Queensland, Australia. Internal consistency of the measure was examined using the Cronbach α. Internal consistency among items was very high (the Cronbach α = .98), with little evidence of item redundancy. Individual subscales were also shown to have a high degree of internal consistency and internal consistency was similar across the 3 service provider organizations participating in this study. The present study examined the internal consistency of an instrument measuring parent satisfaction with early intervention services. While additional examination of the validity of the measure is required, this study lends further support to the use of this measure in evaluating early intervention services for children with physical disabilities.

Aim: To systematically review the literature on the effectiveness of early intervention programmes for children with physical disabilities. Methods: Twelve electronic databases were searched for articles published between 1990 and April 2008. The quality of articles was appraised using an adapted version of the Checklist for the Evaluation of Research Articles and the Physiotherapy Evidence Database (PEDro) scale. Results: Ten studies were included in the review. Cross-sectional and interrupted time-series studies were of moderate methodological quality, whereas the non-randomised control trial was of moderate-to-high methodological quality. Studies differed considerably with respect to participants, types of intervention and outcomes measured. Conclusions: Positive outcomes for both children and families have resulted from early intervention. However, methodological limitations hamper a more rigorous analysis of findings across studies.

Wills are important social, economic, and legal documents. Yet little is known about current will making practices and intentions. A comprehensive national database on the prevalence of will making in Australia was developed to identify who is or is not most likely to draw up a will and triggers for making and changing wills. A national survey of 2,405 adults aged above 18 years was administered by telephone in August and September 2012. Fifty-nine percent of the Australian adult population has a valid will, and the likelihood of will making increases with age and estate value. Efforts to get organized, especially in combination with life stage and asset changes trigger will making; procrastination, rather than a strong resistance, appears to explain not making a will. Understanding will making is timely in the context of predicted significant intergenerational transfers of wealth, changing demographics, and a renewed emphasis on retirement planning.

Increased longevity and the need to fund living and care expenses across late old age, greater proportions of blended and culturally diverse families and concerns about the increasing possibility of contestation of wills highlight the importance of understanding current will making practices and intentions. Yet, there is no current national data on the prevalence of wills, intended beneficiaries, the principles and practices surrounding will making and the patterns and outcomes of contestation. This project sought to address this gap. This report summarises the results of a four year program of research examining will making and will contestation in Australia. The project was funded by the Australian Research Council (LP10200891) in conjunction with seven Public Trustee Organisations across Australia. The interdisciplinary research team with expertise in social science, social work, law and social policy are from The University of Queensland, Queensland University of Technology and Victoria University. The project comprised five research studies: a national prevalence survey, a judicial case review, a review of Public Trustee files, an online survey of will drafters and in-depth interviews with key groups of interest. The report outlines key findings. On the basis of the evidence provided recommendations are presented to support the achievement of these policy goals: increasing will making in the Australian population, ensuring that the wills of those Australians who have taken this step reflect their current situation and intentions, and reducing will contestation.

Objective Ahead of the convergence of two major paediatric services, we examined evidence-based practice (EBP) self-efficacy, outcome expectancy, knowledge and use among allied health (AH) staff in two major Queensland (Qld) paediatric services. This was to determine whether any differences existed based on organisational affiliation, profession and any previous training to inform a strategy to enhance AH EBP within the new organisational setting. Methods All AH staff from the two Brisbane (Qld) tertiary paediatric hospitals were invited to participate in the survey. Using a cross-sectional design, EBP self-efficacy, outcome expectancy, knowledge and use, as well as previous EBP training, were assessed with an online survey. Background demographic information obtained included professional discipline and hospital. Results One hundred and thirty-eight health practitioners completed the survey (37% response rate). Most practitioners had accessed EBP training. Mean scores for EBP attitudes (self-efficacy and outcome expectancy) and knowledge were higher than for EBP use scores. Greater variation was observed across professional disciplines than organisations. Training impacted positively on EBP measures but explained a small proportion of total variance in regression models. Conclusions The results underscore the need to provide organisational supports to AH staff for EBP implementation. Strategies other than training are required to maximally enhance EBP attitudes. The new organisational structure provides an opportunity for this cultural shift to occur. What is known about the topic? Factors affecting the EBP capabilities of AH professionals are complex and are associated with institutional culture and barriers, personal self-belief and individual experience and ability, and can exist at clinician, team and organisational levels. What does this paper add? The data from the present study confirm the emerging literature examining various AH professional groups’ EBP behaviours and ratings with a large and diverse cohort from a variety of backgrounds and across organisations. Respondents possessed a positive attitude towards EBP and moderate EBP knowledge, with these scores exceeding EBP use scores. Organisational affiliation had little impact on EBP measures. What are the implications for practitioners? Although the results of the present study highlight the importance of training in literature searching, EBP and research design and/or analysis, the findings also indicated that strategies other than training are required to maximally enhance EBP attitudes and use by AH staff. To harness the positive approach AH staff have to EBP, strategies such as incorporation of EBP principles and plans in departmental meetings and strategic reviews, as well as strengthening organisational governance in relation to EBP and research, must be developed within the new organisational structure and context; a powerful, but often overlooked, enabler of EBP.

The Public Trustee file review was designed to address research questions relating to will disputes and socio-cultural and family norms, expectations and obligations that underpin challenges to wills. Findings from this review will augment the earlier review of all adjudicated succession law cases in Australia between January and December 2011. The research team obtained 139 cases for the review. Within the reviewed cases, parties generally needed some kind of formalised assistance to resolve disputes and almost a third ended up going to court. Most claims launched to contest wills were successful i.e. led to a change in distribution. The existence of poor and/or complex personal relationships between beneficiaries, disputants and/or the deceased were a feature of most cases involving will disputes, particularly where disputes were escalated to court. There are significant costs of will contestation both for the estate and the individuals involved in disputes. Previous research has identified that in addition to the direct costs is the indirect cost of extending the time for probate of the will. This review highlights that one of the most significant costs of will contestation is the damage to familial relationships that appears to both drive and be worsened by contestation. Findings of this review highlight the role of Public Trustees in providing financial management and advocacy services to protect and support vulnerable people in the community such as those with impaired capacity, as well as offering services such as will drafting and deceased estate administration.

A national online survey of private and public will drafters distributed through State/public trustee offices in seven states/territories and law societies and community legal centres across all states/territories yielded 257 responses. The survey, using questions, scales and case scenarios sought to canvas perceptions of difficulties facing will drafters and the strategies used to address them.

The purpose of this study was to present the application of a logic model in depicting the underlying theory of an undergraduate research scheme for occupational therapy, physiotherapy, and speech pathology university students in Queensland, Australia. Data gathered from key written documents on the goals and intended operation of the research incubator scheme were used to create a draft (unverified) logic model. The major components of the logic model were inputs and resources, activities/outputs, and outcomes (immediate/learning, intermediate/action, and longer term/impacts). Although immediate and intermediate outcomes chiefly pertained to students' participation in honours programs, longer-term outcomes (impacts) concerned their subsequent participation in research higher-degree programs and engagement in research careers. Program logic provided an effective means of clarifying program objectives and the mechanisms by which the research incubator scheme was designed to achieve its intended outcomes. This model was developed as the basis for evaluation of the effectiveness of the scheme in achieving its stated goals.

A review of the literature has been undertaken to examine health-related quality-of-life (HRQoL) of children and adolescents with speech and language difficulties (SaLD), with a particular focus on evidence regarding the domains of HRQoL most affected by SaLD. Twelve electronic databases were searched for articles on this topic published from 1966 to January 2011. Seven studies suitable for inclusion were identified. These papers were reviewed in relation to their participants, sample size, study design, and outcome measures, which differed considerably across studies. From the studies reviewed, there is emerging evidence that HRQoL can be compromised for children and adolescents with SaLD relative to their peers, and some consensus that the social domain of HRQoL is most impacted. Overall, the review highlights a paucity of research in this area and recommendations are made as to how research may advance. Most importantly, studies examining the effect of child and family factors in mediating or moderating the relationship between SaLD and HRQoL are required. This knowledge will support the identification of children with SaLD at risk of poorer HRQoL outcomes and inform intervention strategies through the identification of relevant risk and protective factors.

There are major legal and cultural differences across countries in principles guiding intergenerational transmission of wealth, and individual differences in views on inheritance.1 Australian succession law is based upon English common law, starting with the presumption of testamentary freedom, which allows a testator to dispose of their estate as they see fit. However, this freedom can be limited by family provision laws that allow 'eligible applicants' to contest distributions on the basis of insufficient provision in accordance with legislation of the particular State or Territory. Hence, the legal framework represents a balance between testamentary freedom and familial obligation. Internationally there are significant cultural and legal differences in the degree of will-makers' testamentary freedom.