Latest Australian research

Carter D, Moodie S, Reddi B, Yeo N, Laver H, Sundararajan K.

Abstract: Since 2018, DonateLife South Australia and the Royal Adelaide Hospital (RAH) have collaborated to deliver routine family follow-up after bereavement in the intensive care unit (ICU). This follow-up includes a telephone interview that invites bereaved family members to comment on the quality of care and communication experienced in the ICU. To identify bereaved families' experiences, including how they conceptualise good care and communication in intensive care, an analysis was conducted on all qualitative data collected during 118 interviews completed between 1 February 2018 and 30 May 2019. Reflexive thematic analysis was undertaken in an inductive and semantic way, with coding and theme generation being directed by the explicit content of the data, as conceptualised by Braun and Clarke. Initial codes were based on the interview questions, then additional codes were created during data analysis. Coding was informed by philosophical insights about concepts and the spirit of interpersonal engagement developed by Wittgenstein and Cordner, respectively. A concept map of the relationships observed between patterns of meaning in the data was created. Participants deeply appreciated staff providing them and their loved one with practical expressions of care and hospitality, however modest. These, along with staff sometimes crossing professional boundaries, expressed staff's spirit of engagement, which in turn helped to maintain the patient's dignity. Private space also helped to maintain the patient's dignity, and it helped family to have enough time to say goodbye. Family not feeling rushed and being informed about their loved one dying also helped family to have enough time to say goodbye. Being informed depended on the quality of doctors' communication. When family were not clearly informed, or had to wait long periods, they felt rushed and that they did not have enough time to say goodbye. Documents written to guide the assessment of intensive care comment on almost all of these matters, but the present study newly maps how they interact based on the extensive empirical evidence that it collected. Guidance documents should comment on giving staff scope to occasionally traverse a boundary, such as an institutional border or rule, to better support the patient and family, since families experience exceptionless practice insensitive to context as callous or disruptive of care.

Lovell T, Mitchell M, Powell M, Strube P, Tonge A, O'Neill K, et al.

Background: The provision of end-of-life care (EOLC) is an ongoing component of practice in intensive care units (ICUs). Interdisciplinary, multicomponent interventions may enhance the quality of EOLC for patients and the experience of family members and ICU clinicians during this period.

Objectives: This study aimed to assess the impact of a multicomponent intervention on EOLC practices in the ICU and family members' and clinicians' perceptions of EOLC.

Methods: A before-and-after interventional study design was used. Interventions comprising of EOLC guidelines, environmental and memory-making resources, EOLC education day for nurses, web-based resources, and changes to EOLC documentation processes were implemented in a 30-bed adult tertiary ICU from September 2020 onwards. Data collection included electronic health record audits of care provided post initiation of EOLC and family and clinician surveys. Open-ended survey questions were analysed using content analysis. Data from before and after the intervention were compared using the Chi-squared test for categorical variables, unpaired two-sample t-tests for normally distributed continuous measurements, and Mann-Whitney U tests for non-normally distributed data.

Findings: A reduction in documented observations and medications and an increased removal of invasive devices unrelated to EOLC were observed post the intervention. The mean overall satisfaction of family members improved from 4.5 to 5 (out of 5); however, this was not statistically significant. Statistically significant improvements in clinicians' perception of overall quality of EOLC (mean difference = 0.28, 95% confidence interval: 0.18, 0.37; t₂₈₂ = 5.8, P < 0.01) were found. Although statistically significant improvements were evident in all subscales measured, clinicians' work stress related to EOLC and support for staff, patients, and their families were identified as needing further improvement.

Conclusions: The development and implementation of a multicomponent interdisciplinary intervention successfully improved EOLC quality, as measured by chart audit and family and clinician perceptions. Continuing interdisciplinary collaboration is needed to drive further change to continue to support high-quality EOLC for patients, families, and clinicians in the ICU.

White D, Barham D, McEniery J, Mherekumombe M, Bridge D.

Background: Spiritual pain and distress are commonly unrecognised among patients receiving palliative care, yet engaging with a person's spirituality can allow healing to occur even amid suffering. Palliative care clinicians lack training in assessing and managing spiritual distress among patients.

Objectives: Development of a virtually delivered spirituality workshop to improve clinicians' understanding of their own spirituality and confidence in addressing the spiritual dimension of patients' experience.

Method: 32 palliative care clinicians across Australia and New Zealand attended four 1.5-hour sessions across consecutive weeks, with additional pre-session and post-session written and audiovisual content. Participants completed a pre-post evaluation survey, rating their confidence in knowledge and skills relating to the provision of spiritual care.

Results: All participants completed at least three of the four workshop sessions, and 19 responded to the pre-post evaluation survey. Confidence ratings across all skills significantly improved following the workshop. Most participants reported improved confidence in taking a spiritual history, assessing patients for spiritual issues and managing patients experiencing spiritual pain. All reported that they would recommend the workshop to a colleague, and most (11/19) felt virtual delivery of the workshop was appropriate for the content and activities.

Conclusions: Spirituality training can be safely and effectively delivered through a virtual workshop for palliative care clinicians. The training was highly valued and deepened participants' understanding of their own spirituality. Further exploration of how virtual and face-to-face learning can be combined may identify a flexible and engaging experience for learners.

Bindley K, Lewis J, DiGiacomo M.

Abstract: Caring for someone with a life-limiting illness is associated with complex psychosocial sequelae; amplified for carers experiencing structural vulnerability. Workers across sectors of health and social care provide support for vulnerably positioned carers, yet exploration of the impacts of this work has predominantly focused on health professionals directly engaged with death and dying. This qualitative study explored ways in which palliative care and welfare workers experience work with current and bereaved carers of people with life-limiting illness, in a region associated with socioeconomic disadvantage. Work in this landscape involved: (1) navigation of evocative content, (2) encountering limits of grief literacy, (3) negotiating effects of policy constraints, (4) meaning-making for system survival, and (5) varied utilization of resources and strategies. Findings indicate the need for cross-sectoral recognition of consequences of this work, reflected through initiatives to cultivate grief literacy, acknowledgement of harmful consequences of policy, and structural approaches to workforce well-being.

Meyer C, Golenko X, Sinclair R, Lowthian J.

Abstract: Respite and permanent transition to residential aged care are processes that are designed to support preferences and needs of people living with dementia and their carers as the disease progresses. These services are highly variable in acceptability, accessibility, and availability for the caregiving dyad, often not reflecting a person-centred, co-ordinated and cohesive approach. This study aimed to use a two-phase realist synthesis to explore how respite and permanent transition models of care work in different contexts, through different mechanisms to produce varying outcomes.Phase 1 explored preliminary theories and assumptions of the respite care journey, including (a) identification of systematic reviews and innovative programs, and (b) semi-structured interviews sessions with key stakeholders. Phase 2 involved an iterative scoping review to identify and map the available evidence, with a synthesis designed to unpack underlying program theories of why, for whom and in what circumstances respite/transition models of care works.Phase 1(a) identified ten citations from 126 systematic review abstracts. Fourteen residential care managers participated in a contextual scan - Phase 1(b). Phase 2 expanded this knowledge, identifying a further 13 studies. Three program theories, at the macro, meso and micro level, were elucidated: (1) system-level evidence-based integration, through collaboration and co-ordination; (2) inclusive, quality care, with supportive environmental design; and (3) trust, autonomy, and meaning-making.A novel realist synthesis approach was used to explore respite and permanent transition models of care beyond 'what works'. Importantly, findings at the macro, meso and micro level context, suggest nuance, with a shared decision-making approach, is needed to optimise the ever-changing dementia care journey.