ObjectiveTo explore the experiences of cancer caregivers who live in rural Australia and travel to a metropolitan cancer health service to access cancer treatment.DesignA qualitative study using semistructured, audio-recorded interviews conducted between December 2017 and July 2018 with caregivers and social workers. Thematic analysis using interpretative descriptive techniques performed on textual interview data within a critical realist paradigm to develop understanding of rural caregivers’ lived experiences.SettingParticipants were from rural areas attending a metropolitan cancer centre in Australia and social workers.Participants21 caregivers (16 female) of people with cancer living in rural Australia within a minimum distance of 100 km from the metropolitan cancer centre where they access treatment, and five social workers employed at a metropolitan cancer service with experience of working with rural patients and caregivers.ResultsThematic analysis developed two overarching themes: theme 1:caregiving in the rural settingdescribes the unique circumstance in which caregiving for a person with cancer takes place in the rural setting at considerable distance from the cancer service where the person receives treatment. This is explored in three categories: ‘Rural community and culture’, ‘Life adjustments’ and ‘Available supports’. Theme 2:accessing metropolitan cancer servicescaptures the multiplicity of tasks and challenges involved in organising and coordinating the journey to access cancer treatment in a metropolitan hospital, which is presented in the following categories: ‘Travel’, ‘Accommodation’ and ‘Health system navigation’.ConclusionsCaregivers who live in rural areas face significant challenges when confronting geographic isolation between their rural home environment and the metropolitan setting, where the patient accessed cancer treatment. There is a need for healthcare services to identify this group to develop feasible and sustainable ways to provide interventions that have the best chance of assisting rural caregivers in supporting the patient while maintaining their own health and well-being.

Background:Debate about appropriate and ethically acceptable end-of-life choices is ongoing, which includes discussion about the legalization of voluntary assisted dying. Given health professionals’ role in caring for patients at the end life, their stance towards assisting a person with dying can have implications for policy development and implementation in jurisdictions where law changes are being considered.Aim:To explore end-of-life care professionals’ attitudes towards voluntary assisted dying 6 months prior to vote on legalization.Design:Qualitative study using textual data collected through semi-structured interviews. Purposive sampling strategy used to collect a broad representation of perspectives. Audio-recorded interviews were transcribed verbatim and subjected to qualitative descriptive analysis techniques.Participants:A total of 16 health professionals with experience in caring for people with life-limiting illness.Results:Participants reported two overarching positions grounded in differing moral philosophies with compelling arguments both for and against legalization of voluntary assisted dying. A third and common line of argument emerged from areas of shared concern and uncertainty about the practical consequences of introducing voluntary assisted dying. While a diversity of opinion was evident, all participants advocated for more public education and funding into end-of-life care services to make high-quality care equitable and widely available.Conclusion:Common dedication to reducing suffering and facilitating good dying experiences exists among experts despite their divergent views on voluntary assisted dying. Ongoing engagement with stakeholders is needed for practical resolution in the interest of developing health policy for best patient care.

BackgroundA systematic review and meta-synthesis was conducted to identify, compare and synthesize the published qualitative literature contributing to our understanding of the role of nature in cancer patients’ lives.MethodAn electronic search of Medline, CINAHL, PsycINFO and Cochrane Databases was conducted to identify qualitative studies focused on cancer patients’ nature experiences published between January 1985 and May 2015. Records were assessed according to pre-defined inclusion criteria. Data were extracted on study characteristics and evaluated using the COREQ guidelines for comprehensive quality reporting. Qualitative data from ‘results’ and ‘findings’ sections were entered into data management software NVivo in order to identify recurring themes and facilitate interpretation across studies.ResultsFrom 11 eligible publications, seven inter-related core themes with descriptive themes were identified as follows: connecting with what is valued; being elsewhere, seeing and feeling differently; exploration, inner and outer excursions; home and safe; symbolism, understanding and communicating differently; benefitting from old and new physical activities; and, enriching aesthetic experiences.ConclusionsNature provides patients with unburdened physical and psychic space invested with personal significance. Findings propose nature’s role as a “secure base” offering patients a familiar and nurturing context from which new perspectives can emerge and caring connections can be made with themselves, others, the past, and the future. As such, nature supported patients to navigate the clinical and personal consequences of cancer. Comprehensive representation of cancer patients’ nature experiences identified patient values and care opportunities embedded in clinical and personal environments, which may be considered for future research and care service development.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3366-6) contains supplementary material, which is available to authorized users.

This open case study of severely ill patients with invasive fungal infections demonstrates both excellent efficacy and very low toxicity of caspofungin.