The importance of ‘place’ and its influence on rural and remote health and well-being in Australia

Summary: Butterworth et al 2024 This article explores the crucial role of ‘place’ as an ecological, social and cultural determinant of health and well-being, with a focus on the benefits and challenges of living rurally and remotely in Australia. The health system, including health promotion, can contribute actively to creating supportive environments and places that foster health and well-being among individuals residing in rural and remote locations. For First Nations peoples, living on Country, and caring for Country and its people, are core to Indigenous worldviews, and the promotion of Aboriginal and Torres Strait Islander health and well-being. Their forced removal from ancestral lands has been catastrophic. For all people, living in rural and remote areas can deliver an abundance of the elements that contribute to a ‘liveable’ community, including access to fresh air, green and blue space, agricultural employment, tight-knit communities, a sense of belonging and identity, and social capital. However, living remotely also can limit access to employment opportunities, clean water, affordable food, reliable transport, social infrastructure, social networks and preventive health services. ‘Place’ is a critical enabler of maintaining a healthy life. However, current trends have led to a reduction in local services and resources, and increased exposure to the impacts of climate change.  

Surgery for breast cancer – Barriers and enablers to engagement with prehabilitation.

Organisation/s: Barwon Health

Summary: Breast cancer is the most common cancer in Australia. Unfortunately, breast surgery can commonly result in loss of shoulder and neck movement, increased pain, and limited ability to participate in everyday life. Actively engaging in clinician-led exercise before surgery for breast cancer (prehabilitation) offers an opportunity to improve fitness, reduce long-term issues with shoulder movement, arm strength, and pain. Despite established benefits, the Barwon Health prehabilitation service was poorly utilised. This research aims to investigate why, with the goal of shaping a service that facilitates more people to access prehabilitation and potential improvements in patient outcomes relating to fitness, neck and upper limb pain, and dysfunction.

The rapid adoption of telehealth by a regional community-based palliative care service due to COVID-19: Patient and Health Care Professional perspectives and opportunities for service enhancement

Organisation/s: Barwon Health

Research project commencement date: 2020-01-01

Summary:

Background/objective: The COVID-19 pandemic has brought the use of telehealth to the fore, as many people have been unable to interact directly with healthcare professionals (HCP). For community palliative care (CPC) services, this has meant a sudden change from a predominantly face-to-face model of care to one that incorporates telehealth. Understanding patient and HCP experiences with telehealth and how telehealth compares to ‘usual’ care will be crucial in planning future CPC services.

Methodology: All patients of the Barwon Health CPC service between 1 April and 31 May 2020 were invited to complete a questionnaire evaluating their interactions with the palliative care service and specifically their involvement with telehealth consultations. Palliative care HCP who provided clinical services during the same time period were also surveyed.

Results/conclusion: Seventy-four patients (response rate 36%) and 22 HCP returned surveys. Both groups felt comfortable using telehealth, however, also encountered a range of issues when undertaking telehealth consultations. Despite reporting issues, the preference of both groups was for a CPC service model, which combined face-to-face and telehealth consultations. This study is one of the first to directly ask this question and as such provides useful guidance for health services when planning future CPC service models.

Associate Investigators: Anna Dowd, Jacqui White, Matthew Ely, Jill Carter

Dying at home: enablers and barriers

Organisation/s: Barwon Health

Research project commencement date: 2023-01-01

Summary:

Background: According to the Grattan Institute in 2014, 70% of Australians indicated a preference to die at home, however, only 14% of all deaths were at home.

Aims: To identify how patients can be supported to die at home if that is their preference.

Methods: A retrospective medical record audit of eligible Community Palliative Care (CPC) patients who indicated a wish to die at home was undertaken.

Findings: Out of a total of 114 patients, 74% indicated a preference to die at home. Of these, 66% achieved a home death, and most lived with a carer. Enablers for home death included family support, regular nursing visits and equipment. People who attended an emergency department in their last month of life, lived alone or were undergoing oncological treatment were more likely to die elsewhere.

Conclusion: A range of enablers and barriers to home death were found, with many of the enablers being factors that prevented hospital presentations

Citation: Int J Palliat Nurs. 2023 Jul 2;29(7):326-333. doi: 10.12968/ijpn.2023.29.7.326

Authors: Anna Dowd, Melanie Davies, Sarah Short, Ruth Morrison, Cheryl Spiller, Jill Carter, Peter Eastman

Empowering The Mind, Strategies for Coping with Cancer: a Low Out of Pocket Expense Pilot Program

Organisation/s: South West Health

Research project commencement date: February 2021

Summary: Receiving news of a cancer diagnosis has the potential to cause elevated distress for individuals which may manifest as a range of feelings including vulnerability, loss of control, anxiety, and depression, further compounded by the potential adverse effects of cancer treatments. Providing support to psychologically vulnerable patients is an important element of supportive cancer care. To date, there has been no specific program designed to address the psychological requirements of cancer patients in the South Western (SW) region of Victoria, other than private psychologist services which result in patients incurring high out-of-pocket expenses if not covered by private health insurance. In addition, the availability of psychologists in the SW region of Victoria fails to meet service demand. A feasibility study was undertaken to assess the benefit of conducting a low-cost program incorporating six group therapy sessions delivered by a clinical psychologist aimed at providing tools and coping strategies for patients experiencing a cancer diagnosis.It is proposed that group therapy sessions could be an alternative to the lack of psychology services for cancer patients in SW Victoria at low out-of-pocket expense.