Bereavement support for families and carers in rural Australian settings often fails to meet well-established and longstanding guidelines in key areas, subsequently causing undue mental distress for many individuals and potentially leading to the development of prolonged grief disorder (PGD), a debilitating psychiatric disorder of intensified grief and additional physical health detriments. In this paper, we consider the literature surrounding rural bereavement care in Australia and identify factors that contribute to poorer bereavement care in these locations, including issues of lacking policy elements to guide bereavement support and deficiencies in training and staffing which create difficulties between competing healthcare priorities. We synthesise recommendations of several guidelines to propose an individualised, multi-disciplinary, and pathway-based approach to rural bereavement care, and finally suggest several key areas that can be targeted and improved to help improve rural bereavement care in Australia without creating significant strain on the already thin resources of rural healthcare settings.
Findings This retrospective audit of 320 patients found low Advance Care Planning invitation and utilisation rates, especially in the patients who received chemotherapy in their last 2-weeks of life. In the oncology setting, completion of Acute Resuscitation Plans and Advance Health Directives significantly differed between the control, <2-weeks, and 2-4 weeks groups, identifying the <2-weeks patient group as the lowest utiliser.Meaning The low utilisation of Advance Care Planning in patients with advanced cancer decreases the scope of recognising their preferences at end-of-life care that indicates a need for an embedded framework along with education and training for the staff and patients.
Mindfulness is a state of awareness characterized by open and non-judgmental recognition of thoughts and sensations and an ability to resist the usual wandering of an individual’s attention. Usually achieved by meditation, mindfulness is recognized as a treatment for chronic pain. Evidence, thus far, has been characterized by poor quality trials and mixed results, but a growing body of research is further investigating its effectiveness. Despite inconclusive evidence, the inherent difficulties of mindfulness research, and problems of accessibility in rural settings, mindfulness meditation is an emerging treatment strategy for many chronic pain patients. This report presents the case of a patient admitted to a rural hospital in New South Wales, whose quality of life was severely impacted by chronic pain.
Background: Advance Care Planning (ACP) has been reported to be of value in maintaining patients’ autonomy and dignity; reducing patient and family anxiety; improving end-of-life care and reducing futile interventions. But in Australia participation rate in advance care directives is 14%, and research is limited on ACP invitations and uptake among the patients with advanced cancer (PwAC). This study identifies the prevalence and types of documented ACP discussions in PwAC who died within two or four weeks of receiving chemotherapy.
Methods: A retrospective audit was conducted in Gold Coast University Hospital, Australia, and the records of 339 patients were examined and 320 patients were found eligible. Descriptive statistics were calculated in SPSS. The difference in ACP invitation and utilisation between three groups [control, <2-weeks, and –4 weeks] was measured by the Kruskal-Wallis test and Chi-square (or Fisher-Exact) test. Post-hoc follow-up pair-wise comparisons were performed. Adjusted prevalence ratios were estimated using two logistic regression models, and the significance of the coefficients was assessed using Wald test.
Results: Of the 320 PwAC [male: 55%; median age: 65 years], 227 (71%) received ACP invitation, and among the invited patients, 89% used Acute Resuscitation Plan; 54% used Enduring Power-of-Attorney; and 20% completed Advance Health Directive. From 7.5% [n=24] of the patients who received chemotherapy in their last 2-weeks of life, 42% had not received an ACP invitation, 29% didn’t have Acute Resuscitation Plan and only 4% completed Advance Health Directive. There were significant differences among the Control, <2-weeks, and 2–4 weeks groups in completing Acute Resuscitation Plan (p=0.003) and Advance Health Directives (p=0.045). A significant difference was also observed between control and <2-weeks groups in number of days since Acute Resuscitation Plan used. Completing an Acute Resuscitation Plan was associated with a lower risk of dying within two-weeks of chemotherapy (OR=0.246; p=0.008).
Conclusions: The low rates of ACP invitation and use in PwAC, especially who received chemotherapy in 2-weeks of dying confirm a need of embedding and regular revisiting the ACP framework in cancer care and educating staff, patients, and their family caregivers to increase the uptake.
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