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Internationally, lead agencies and consumer movements emphasise the need for high-level research participation in mental health. However, evidence suggests that people with lived experience tend to be recruited as subjects rather than as active agents in research, or are consulted in tokenistic ways. Although participatory research has the potential to rectify epistemic disparities, few studies have grappled with how to move from exclusion and tokenism to high-level research participation. This paper describes a qualitative co-evaluation of a co-produced model of research partnership, Raising the Bar, which involved deliberate establishment and facilitation of six participatory research teams, comprising 28 lived experience and 'conventional' mental health researchers. Findings indicate that the theoretical elements of the model set the bar high from the outset, supporting research teams to address inconsistencies in knowledge about participation. It also provided researchers with the competencies and resources to undertake participatory research in egalitarian team structures, and to negotiate new forms of non-traditional research outputs - thereby challenging whom research might be for and how it might be made accessible. Finally, the model shifted collective meanings about research, lending credibility to participatory practices, which came to be seen as essential for meeting the needs of affected communities. Nonetheless, systemic barriers to participatory research remain, and need to be recognised and acted upon to promote a culture that supports high-level research participation. [ABSTRACT FROM AUTHOR]

Alcohol and other drugs (AOD) use is a significant public health issue and is associated with high mortality and morbidity rates. Despite this, people who use drugs are often reluctant to seek care due to the lack of trauma‐informed treatment and harm reduction treatment options, as well as experiences of stigma and discrimination in health services. Arguably, AOD education that is co‐produced with people who use alcohol and drugs can enhance future health professionals' ability to practice in ways that support the needs of this population. This paper reports on a qualitative co‐evaluation of a co‐produced undergraduate nursing AOD subject. The AOD subject was co‐planned, co‐designed, co‐delivered, and co‐evaluated with experts by experience, who have a lived experience of substance dependence and work as advocates and peer workers. Following the delivery of the subject in 2021 and 2022, focus groups were undertaken with 12 nursing students. Focus group data indicate that the co‐produced subject supported participants to understand and appreciate how stigma impacts on nursing care and how to recognize and undertake 'good' nursing care that was oriented to the needs of service users. Student participants noted that being co‐taught by people who use drugs was particularly powerful for shifting their nursing perspectives on AOD use and nursing care and took learning beyond what could be understood from a book. Findings indicate that co‐produced AOD education can shift nursing students' perceptions of AOD use by providing access to tacit knowledge and embodied equitable and collaborative relationships with people who use drugs. [ABSTRACT FROM AUTHOR]

Internationally, lead agencies and consumer movements emphasise the need for high-level research participation in mental health. However, evidence suggests that people with lived experience tend to be recruited as subjects rather than as active agents in research, or are consulted in tokenistic ways. Although participatory research has the potential to rectify epistemic disparities, few studies have grappled with how to move from exclusion and tokenism to high-level research participation. This paper describes a qualitative co-evaluation of a co-produced model of research partnership, Raising the Bar, which involved deliberate establishment and facilitation of six participatory research teams, comprising 28 lived experience and 'conventional' mental health researchers. Findings indicate that the theoretical elements of the model set the bar high from the outset, supporting research teams to address inconsistencies in knowledge about participation. It also provided researchers with the competencies and resources to undertake participatory research in egalitarian team structures, and to negotiate new forms of non-traditional research outputs - thereby challenging whom research might be for and how it might be made accessible. Finally, the model shifted collective meanings about research, lending credibility to participatory practices, which came to be seen as essential for meeting the needs of affected communities. Nonetheless, systemic barriers to participatory research remain, and need to be recognised and acted upon to promote a culture that supports high-level research participation. [ABSTRACT FROM AUTHOR]

Men account for approximately 75% of the one million annual suicide deaths worldwide. Emerging research indicates a link between suicide and men's active pursuit of hegemonic masculinity via emotional restriction. However, little is known of the continuum of suicidal men's emotional practice, and particularly how men mobilise emotions to actively pursue or resist hegemonic masculine ideals. This theorised life‐history study aimed to explore the emotional lives of 18 Australian men who had attempted suicide. Findings indicate that men in this study experienced a range of emotions. However, during childhood, they learned that expressing emotions such as sadness reduced masculine standing, whereas expressing emotions such as anger through acts of violence could enhance masculine status. Although the gendering of emotions offered participants multiple avenues of action to pursue or contest masculine ideals, they remained vulnerable to suicide. For some men, it became impossible to conceal escalating feelings of distress. For other men, displays of anger and violence resulted in job loss, relationship breakdown or criminal conviction. Many participants indicated that suicide presented a means of ending painful emotions. Paradoxically, suicide could also become an alternative means of demonstrating masculinity, whereby the body became both the vehicle and object of violence. [ABSTRACT FROM AUTHOR]

This article explores the implementation of an innovative approach to mental health care in a private health setting. Open Dialogue is a recovery-oriented approach to mental health that emerged in Finland, which emphasises family involvement, interdisciplinary collaboration and a flexible, needs-adapted approach. Early research is promising; however, little research has explored Open Dialogue outside Finland. This study aimed to explore the introduction of this approach at a private, inpatient young-adult mental health unit in Australia. Drawing on data from a long-term ethnographic field study that included 190 hours of observation and qualitative interviews, the findings show that despite staff members being inspired by and supportive of Open Dialogue, the existing ideology and organisational structures of the unit conflicted with the integration of Open Dialogue principles. Dialogical ways of working were challenged by medical dominance and emphasis on economic efficiencies. This study emphasises the importance of a 'good' fit between organisational cultures and innovations. It also highlights the challenges of moving towards recovery-oriented and family-focused models of care in the Australian neoliberal health care context. There is a need for organisational and ideological change in health services that is receptive to, and meaningfully supports, efforts to implement recovery-oriented care. [ABSTRACT FROM AUTHOR]

There is little understanding of how recovery‐oriented approaches fit within contemporary mental healthcare systems, which emphasise biomedical approaches to care, increased efficiency and cost‐cutting. This article examines the established models of service delivery in a private, youth, mental health service and the impacts of the current system on staff. It explores whether the service is prepared or capable of adopting recovery‐oriented approaches to care. Qualitative interviews were undertaken with staff and thematically analysed to understand the everyday practices on the unit. Data suggest that economic efficiencies and biomedical dominance largely shaped how health care was organised and delivered, which was perceived by staff as inflexible to change. Additionally, findings suggest that market‐oriented principles associated with neoliberalism restricted the capacity of individuals to transform services in line with alternative models of care and lowered staff morale. These finding suggest that, while neoliberal ideologies and biomedical approaches remain dominant in organisations, there will be challenges to adopting alternative recovery‐oriented models of care and promoting healthcare systems that understand mental health issues in broader socio‐political contexts and can flexibly respond to the needs of service users. [ABSTRACT FROM AUTHOR]

Aim: To examine the experiences of internationally qualified nurses, including those from culturally and linguistically diverse backgrounds, transitioning to and working in the aged care sector of high-income countries. Design: A scoping review. Data Sources: CINAHL, MEDLINE and PSychINFO databases were searched to find eligible literature published from January 2010 onwards. Review Methods: This scoping review was based on the framework by Arksey and O'Malley and the PRISMA-ScR guidelines. The literature search was conducted by the first author, and all three authors reviewed the retrieved studies for eligibility and inclusion. Results: Fourteen articles were eligible. Data was categorized into three broad themes: stress of migration and transition; miscommunication, racism and discrimination; and aged care specific challenges which included two sub-themes ‘shock of aged care’ and ‘bottom care’. Conclusion: Internationally qualified nurses, particularly if they are culturally and linguistically diverse, face unique stresses and challenges in aged care and face barriers in the recognition of skills and qualifications. The under-utilization of skills is not only a loss in terms of patient care but is linked to fears of de-skilling, losing professional development and opportunities for career progression. Impact: Internationally qualified nurses are positioned as a solution to aged care shortages in high-income countries; however, there is a scarcity of research exploring their experiences. In the context of the global aged care staffing crisis, an understanding of the stresses and challenges faced by internationally qualified nurses will further strengthen efforts to recruit, support and retain skilled nurses in aged care. [ABSTRACT FROM AUTHOR]

Purpose: Demand for complementary and alternative medicine (CAM) is high among cancer patients. This, alongside growing evidence for the efficacy of some CAM therapies, is driving change within cancer centres, where evidence-based CAM therapies are increasingly provided alongside standard cancer treatments. In Australia, commitment to equitable access to healthcare is strong, and some cancer centres are now providing integrative services at no cost to the patient. This represents a significant shift in healthcare provision. This study aimed to examine health professional and patient dynamics in an integrated cancer service where CAM is provided at no cost to patients alongside standard cancer treatments. It specifically sought to understand what might drive or hinder further integration of CAM with standard treatment in the cancer context.Methods: Qualitative interviews were undertaken with twenty key stakeholders-cancer patients, cancer nurses, and oncologists-who were delivering or receiving care in an Australian public hospital where acupuncture services are provided at no cost to patients alongside standard chemotherapy and radiation treatments.Results: Findings point to key areas where the concerns and priorities of cancer patients, cancer nurses, and oncologists converge and diverge in ways that reflect core personal and professional interests regarding patient care needs, the evidence base for CAM efficacy and safety, and rising healthcare costs.Conclusions: Understanding points of convergence and divergence could assist clinicians and service providers in negotiating ways forward for integrative cancer services. [ABSTRACT FROM AUTHOR]

Aims and objectives: To synthesise the literature on the experiences of giving or receiving care for traumatic brain injury for people with traumatic brain injury, their family members and nurses in hospital and rehabilitation settings. Background: Traumatic brain injury represents a major source of physical, social and economic burden. In the hospital setting, people with traumatic brain injury feel excluded from decision‐making processes and perceive impatient care. Families describe inadequate information and support for psychological distress. Nurses find the care of people with traumatic brain injury challenging particularly when experiencing heavy workloads. To date, a contemporary synthesis of the literature on people with traumatic brain injury, family and nurse experiences of traumatic brain injury care has not been conducted. Design: Integrative literature review. Methods: A systematic search strategy guided by the PRISMA statement was conducted in CINAHL, PubMed, Proquest, EMBASE and Google Scholar. Whittemore and Knafl's (Journal of Advanced Nursing, 52, 2005, 546) integrative review framework guided data reduction, data display, data comparison and conclusion verification. Results: Across the three participant categories (people with traumatic brain injury/family members/nurses) and sixteen subcategories, six cross‐cutting themes emerged: seeking personhood, navigating challenging behaviour, valuing skills and competence, struggling with changed family responsibilities, maintaining productive partnerships and reflecting on workplace culture. Conclusions: Traumatic brain injury creates changes in physical, cognitive and emotional function that challenge known ways of being in the world for people. This alters relationship dynamics within families and requires a specific skill set among nurses. Relevance to clinical practice: Recommendations include the following: (i) formal inclusion of people with traumatic brain injury and families in care planning, (ii) routine risk screening for falls and challenging behaviour to ensure that controls are based on accurate assessment, (iii) formal orientation and training for novice nurses in the management of challenging behaviour, (iv) professional case management to guide access to services and funding and (v) personal skill development to optimise family functioning. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore different stakeholder perspectives on the MYPLAN app for suicide prevention safety planning. The study was a comparative analysis of 4 focus groups with Danish MYPLAN stakeholders, young users, adult users, relatives, and clinicians. The focus groups were audio recorded, transcribed, and subjected to a thematic analysis. The analysis contextualized the participants' experiences of the benefits and limitations of MYPLAN. While participants believed that MYPLAN could potentially interrupt early stages of a suicidal process, clinicians' involvement in safety planning was considered important. MYPLAN could potentially give users a sense of increased personal control but learning how to effectively safety plan was not perceived to be simple and additional support should be considered for MYPLAN users. [ABSTRACT FROM AUTHOR]

Background: Students from a range of health disciplines need to learn from people with lived experience of mental distress and recovery to develop recovery capabilities for mental health practice. Aims: The aims of this study are to describe the co‐design of a teaching resource, to explore the experience of people with lived experience during the resource development, and to evaluate the outcome of the resource on student recovery capabilities. Method: Using a sequential mixed method, a project group consisting of six people with lived experience and 10 academics from five health disciplines was convened to co‐develop teaching resources. People with lived experience met independently without researchers on several occasions to decide on the key topics and met with the research team monthly. The teaching resource was used in mental health subjects for two health professional programmes, and the Capabilities for Recovery‐Oriented Practice Questionnaire (CROP‐Q) was used before and after to measure any change in student recovery capabilities. Scores were compared using the Wilcoxon signed rank test. The people with lived experience were also interviewed about their experience of being involved in constructing the teaching resources. Interviews were audiotaped, transcribed, and analysed thematically. Results: The finished resource consisted of 28 short videos and suggested teaching plans. Occupational therapy and nursing student scores on the CROP‐Q prior to using the educational resource (n = 33) were 68 (median) and post scores (n = 28) were 74 (median), indicating a statistically significant improvement in recovery capability (P = 0.04). Lived experience interview themes were (i) the importance of lived experience in education; (ii) personal benefits of participating; (iii) co‐design experience; and (iv) creating the resource. Conclusion: Co‐design of teaching resources with people with lived experience was pivotal to the success and quality of the final product, and people with lived experience described personal benefits of participating in resource development. More evidence to demonstrate the use of the CROP‐Q in teaching and practice is needed. [ABSTRACT FROM AUTHOR]

Purpose: To investigate trends and socio-economic determinants of suicide in India over the period of 2001-2013.Method: Suicide rates between 2001 and 2013 were calculated using suicide statistics provided by National Crime Records Bureau (NCRB) and census data provided by Census of India, stratified by sex, age group, and geographical region, to investigate trends in suicide over the study period. Multilevel negative binomial regression models were specified to investigate associations between state-level indicators of economic development, education, employment and religious factors and sex-specific suicide rates.Results: Male suicide rates remained relatively steady (~ 14 per 100,000) while female suicide rates decreased over the study period (9 to 7 per 100,000). The age group of 45-59 years had the highest suicide rate among males while the age group of 15-29 years had the highest suicide rate among females. On average, higher male and female suicide rates were observed in states with: higher levels of development, higher levels of agricultural employment, higher levels of literacy, and higher proportions of people identifying with Hinduism. Higher male suicide rates were also observed in states with higher levels of unemployment.Conclusion: The process of modernization might be contributing towards higher suicide risk in more developed parts of India. Also, increase in farmer suicides since economic liberalization might be contributing towards higher suicide rates among more agricultural regions. Furthermore, ancient sanctions towards religious suicide are possibly still influencing modern Hindu suicides. [ABSTRACT FROM AUTHOR]

It is well understood that men are reticent in seeking help for mental health concerns. In the wake of government-funded campaigns across many Western nations that have sought to address this, noticeably absent have been the active development, promotion, dissemination, and rigorous evaluation of male-centered treatment styles. We argue that next-generation approaches must actively counteract unhelpful stereotypes, instead promoting diverse and healthy masculinities. The current article makes the case for the development of a masculinities model of mental health care, offering recommendations to advance clinical practice and research toward this goal. We propose that updated help-seeking campaigns and clinician training, gender-sensitive service provision, and comprehensive cost analyses will provide the groundwork for such a model to better target the diversity in men and reduce any reluctance to engage with mental health treatment. [ABSTRACT FROM AUTHOR]

Participation of people with lived experience (LE) in mental health research is vital for improving the quality and relevance of research priorities, outcomes, and knowledge translation. Inclusion of people with LE is also recognized as central for achieving health service reform including commitments to human rights, social, and epistemic justice. Although a lack of research training is cited as a barrier to LE participation, few studies have examined the value of training for, or the specific requirements of, people with LE. This study seeks to address this gap. It reports on a longitudinal, qualitative study examining shifts in experience and knowledge, and unmet needs, of people with LE over the course of a coproduced research training programme. Findings indicate that the programme enabled participants to understand the role, value, and levels of LE participation in research. Participants also stressed the importance of the 'embodied lived expertise' of LE researchers who co‐delivered the training programme. Nonetheless, participants indicated that they felt unprepared for the challenges of working in systems where LE knowledge is subordinated, and experiences of being silenced and powerless could mirror those previously experienced in mental health services and the community. Participants indicated a need for training that provided them with the epistemic resources to render such experiences intelligible. Findings also indicate that training in participatory research is required for conventional mental health researchers, to support them to navigate power asymmetries and value LE knowledge contributions. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe a novel form of qualitative inquiry, dialogical inquiry, which allows for multiple investigators from different positions or traditions to collaboratively interpret qualitative data, engaging in a process of mutual influence to enrich both themselves and the process of analysis. We provide a clearly operationalized method, which is inspired by the philosophy of Bakhtin, as reimagined through practices from Open Dialogue, a social network–based approach to dialogical psychotherapy. Drawing on a specific text analysis of Jay Neugeboren's novel "Imagining Robert," we demonstrate how our dialogical inquiry approach can bring reflexive practice in qualitative research to life through mutual reflections among investigators. We show how dialogical inquiry can generate appreciation for multiple perspectives, awareness of affective and epistemic positions, and new knowledge production. This approach could be particularly suited for research teams that wish to actively generate new kinds of knowledge, or to privilege the voices of coresearchers from diverse social, political, and epistemic positions. [ABSTRACT FROM AUTHOR]

Problem: The mistreatment of medical and nursing students and junior health professionals has been reported internationally in research and the media. Mistreatment can be embedded and normalized in hierarchical healthcare workplaces, limiting the effectiveness of policies and reporting tools to generate change; as a result, some of those who experience mistreatment later perpetuate it. We used a novel, creative approach, verbatim theater, to highlight the complexity of healthcare workplaces, encourage critical reflection, and support long-term culture change. Intervention: Verbatim theater is a theater-for-change documentary genre in which a playscript is devised using only the words spoken by informants. In 2017, 30 healthcare students and health professionals were recruited and interviewed about their experience of work and training by the multidisciplinary Sydney Arts and Health Collective using semi-structured interviews. Interview transcripts became the primary material from which the script for the verbatim theater play 'Grace Under Pressure' was developed. The performing arts have previously been used to develop the communication skills of health professional students; this esthetic expression of the real-life effects of healthcare workplace culture on trainees and students was implemented to stimulate consciousness of, and dialogue about, workplace mistreatment in healthcare work and training. Context: The play premiered at a major Sydney theater in October 2017, attended by the lay public and student and practicing health professionals. In November 2017, three focus groups were held with a sample of audience members comprising healthcare professionals and students. These focus groups explored the impact of the play on reflection and discussion of healthcare culture and/or promoting culture change in the health workplace. We analyzed the focus group data using theoretical thematic analysis, informed by Turner's theory of the relation between 'social' and 'esthetic' drama to understand the impact of the play on its audience. Impact: Focus group members recognized aspects of their personal experience of professionalism, training, and workplace culture in the play, Grace Under Pressure. They reported that the play's use of real-life stories and authentic language facilitated their critical reflection. Participants constructed some learning as 'revelation,' in which the play enabled them to gain significant new insight into the culture of health care and opened up discussions with colleagues. As a result, participants suggested possible remedies for unhealthy aspects of the culture, including systemic issues of bullying and harassment. A small number of participants critiqued aspects of the play they believed did not adequately reflect their experience, with some believing that the play over-emphasized workplace mistreatment. Lessons Learned: Verbatim theater is a potent method for making personal experiences of healthcare workplace and training culture more visible to lay and health professional audiences. In line with Turner's theory, the play's use of real-life stories and authentic language enabled recognition of systemic challenges in healthcare workplaces by training and practicing health professionals in the audience. Verbatim theater provides a means to promote awareness and discussion of difficult social issues and potential means of addressing them. [ABSTRACT FROM AUTHOR]

The evidence for efficacy of family‐based approaches for psychological problems is extensive, although model‐specific effects have not been established. However, implementation of family therapy approaches in tertiary mental health settings has been challenging due to factors such as negative staff attitudes and difficulties engaging families. Open Dialogue is an emerging network‐based therapy that has a focus on genuine collaboration, flexibility, authenticity, and openness. This study describes the experiences and perspectives of clinicians, service users and families, following training in Open Dialogue, within a child and adolescent mental health service, and an adolescent inpatient unit in public mental health services. A total of 16 participants (11 clinicians and five service users and family members) took part in semi‐structured interviews regarding their experiences with Open Dialogue. Interpretative phenomenological analysis was used to analyse interview transcripts. Four major themes were identified from interviews with clinicians: valuing responses from families, learning from families and privileging their expertise, hesitation about doing family therapy, and engaging with authenticity and flexibility. Three themes emerged from family interviews: hesitation about doing family therapy, valuing collaboration and openness, and opening space for more talk. These themes are relevant to challenges of family therapy in public mental health settings and future directions for implementation. [ABSTRACT FROM AUTHOR]

Abstract: Open Dialogue is a resource‐oriented approach to mental health care that originated in Finland. As Open Dialogue has been adopted across diverse international healthcare settings, it has been adapted according to contextual factors. One important development in Open Dialogue has been the incorporation of paid, formal peer work. Peer work draws on the knowledge and wisdom gained through lived experience of distress and hardship to establish mutual, reciprocal, and supportive relationships with service users. As Open Dialogue is now being implemented across mental health services in Australia, stakeholders are beginning to consider the role that peer workers might have in this model of care. Open Dialogue was not, initially, conceived to include a specific role for peers, and there is little available literature, and even less empirical research, in this area. This discussion paper aims to surface some of the current debates and ideas about peer work in Open Dialogue. Examples and models of peer work in Open Dialogue are examined, and the potential benefits and challenges of adopting this approach in health services are discussed. Peer work in Open Dialogue could potentially foster democracy and disrupt clinical hierarchies, but could also move peer work from reciprocal to a less symmetrical relationship of ‘giver’ and ‘receiver’ of care. Other models of care, such as lived experience practitioners in Open Dialogue, can be conceived. However, it remains uncertain whether the hierarchical structures in healthcare and current models of funding would support any such models. [ABSTRACT FROM AUTHOR]

Despite growing numbers of patients with cancer receiving chemotherapy in outpatient settings and the corresponding increase in care demands on family and close friends, little is known about the experiences of those informal carers supporting people with cancer during their chemotherapy trajectories. Using an interpretivist theoretical framework, this study explored the experiences of primary support persons of chemotherapy outpatients through in-depth interviews with 17 participants nominated as their primary support persons by people receiving chemotherapy at a large tertiary hospital in Australia. The study demonstrates that primary support persons of chemotherapy outpatients face distinct challenges, being at the frontline of treatment and managing side effects with minimal support at home. This role involves sensitive provision of complex medical and social care in circumstances that profoundly challenge the everyday worlds of both patient and carer. From the moment of diagnosis, informal carers in this context face the 'double whammy' of needing to 'manage' the cancer diagnosis experience as well as the chemotherapy trajectory experience. This study points to the significant level of responsibility that primary support persons take on, and the extent to which patients and clinicians rely on their support and management skills. It also points, however, to the lack of recognition they receive for assuming this role, and their sense of frustration in the face of this invisibility. The conceptualisation of the informal carer role as a 'shadowing' role explicitly represents the protective, vigilant, but almost invisible, support role described by the participants in this study. [ABSTRACT FROM AUTHOR]

Background The role and scope of nursing practice has evolved in response to the dynamic needs of individuals, communities, and healthcare services. Health services are now focused on maintaining people in their communities, and keeping them out of hospital where possible. Community based nurse-led clinics are ideally placed to work towards this goal. The initial impetus for these services was to increase patient access to care, to provide a cost-effective and high quality streamlined service. Objectives This systematic review aimed to identify the impact of nurse-led clinics in relation to patient outcomes, patient satisfaction, impact on patient access to services, and cost effectiveness. Methods A review of community based nurse-led clinic research in Medline, CINAHL and Embase was undertaken using MeSH terms: Nurse-managed centres, Practice, Patterns, Nurse, Ambulatory Care, keywords: nurse-led clinic, nurse led clinic, community and phrases primary health care and primary care. Papers were appraised using the Joanna Briggs Appraisal criteria. Results The final review comprised 15 studies with 3965 participants. Most studies explored patient satisfaction which was largely positive towards nurse-led clinics. Patient outcomes reported were typically from self-report, although some papers addressed objective clinical measures; again positive. Access was reported as being increased. Cost-effectiveness was the least reported impact measure with mixed results. Conclusions Nurse-led clinics have largely shown positive impact on patient outcomes, patient satisfaction, access to care and mixed results on cost-effectiveness. Future research evaluating NLCs needs to adopt a standardised structure to provide rigorous evaluations that can rationalise further efforts to set up community based nurse-led clinical services. [ABSTRACT FROM AUTHOR]

Introduction: The integration of health and social care for individual patients depends, in many circumstances, on the involvement (as care providers) of their informal carers or primary support persons. This paper reports on an Australian study exploring the experiences of primary support persons of chemotherapy outpatients. Despite overt reliance on informal/family care provision, and the crucial role of carers in enabling integration of health and social care, little is understood of (i) the impact of this care provision on patient outcomes; (ii) the extent to which primary support persons of chemotherapy outpatients feel the care they provide is well integrated into the overall pattern of service delivery, and (iii) the social, emotional, economic, and physical effects for people providing this care. Theory/Methods: An exploratory, qualitative research design was utilised and a convenience sample of seventeen participants was recruited through the cancer centre at a large tertiary hospital. In face-to face, semi-structured interviews, participants were asked to identify issues of importance to them as a primary support person of someone receiving chemotherapy, and to provide specific information about their experience of the days following chemotherapy administration. Content analysis led to the emergence of three significant themes. Findings: These themes include: (i) frightened novice to reassuring expert - reflecting the urgency with which primary support persons feel they must develop cancer and chemotherapy related skills and knowledge in order to become an effective care provider; (ii) watching and waiting - encapsulating the range of experiences, from intense vigilance to secretive, monitoring of physical and emotional wellbeing, and (iii) discordance and invisibility - highlighting the extent to which participants felt their support role - although clearly critical to patient wellbeing - is not formally recognised by health professionals and not integrated into the overall pattern of service delivery. Discussion: The overarching conceptualisation of the informal carer role as a 'shadowing' role reflects the ways in which the three themes are connected. This study demonstrates that informal carers in this context do not experience their role as being well integrated into established care pathways, or recognised as a significant enabler in the integration of health and social care, including their role in supporting patient self-management strategies, provision of context-specific knowledge, and ensuring that care is person-centred and time efficient. Although this study focuses on one specific clinical area, many aspects of this informal carer experience are likely to be shared by carers of people with other serious health issues. Further research to determine strategies for better recognition of the potential contribution of informal carers to provision of effective integrated care is needed. [ABSTRACT FROM AUTHOR]