Latest Australian research

Freak-Poli R, Htun HL, Teshale AB, Kung C.

Background: Widowhood negatively affects trajectories of social isolation and loneliness. Given the inevitability of spousal bereavement for many, further investigation into potential modifiers of bereavement-related loneliness is warranted.

Aim: To examine the moderating effects of social isolation, social support, sociodemographic, self-efficacy, health, and quality of life factors on changes in loneliness before and after widowhood.

Methods: We analysed 19 waves of data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, comprising 749 widowed and 8,418 married individuals (comparison). Coarsened exact matching weights were applied, controlling for age and time trends. Local polynomial smoothed plots illustrated social health trajectories from three years before to three years after spousal death. All analyses were gender-stratified.

Results: Low social isolation and higher social support did not prevent increased loneliness following widowhood. Men in major cities were less likely to experience reductions in social isolation during bereavement, despite being less socially-isolated at baseline than men in regional/remote areas. The bereavement-loneliness relationship was consistent across all subgroups. For men, this relationship was weakened by older age and being born in a non-English-speaking country, but strengthened by poverty and living in a regional/remote areas. For women, it was weakened by older age, and strengthened by factors such as being born in a non-English-speaking country, poverty, employment or volunteering, and having a long-term mental health condition.

Conclusions: Loneliness is a common and potentially unavoidable experience during widowhood, highlighting the importance of screening by healthcare workers to improve wellbeing and prevent future mental health issues.

Maslen S.

Abstract: People living with life-limiting illnesses often talk about their ideal experience of 'care' as one where the care itself is hidden. Situated in the sociological literature on places and materialities of palliative care, in this paper I examine the hiding of care in a small, non-clinical respite house in an Australian city. Care is hidden by the at-homeness that staff, guests and volunteers alike all do. Working with Oldenburg's notion of 'third places,' I show how in this illness context the separation between home, work and other places in the community can blur, with respite services 'standing in' for the family home, or acting as a 'homely' extension of the hospital. Such places meet diverse needs beyond pure sociability as in Oldenburg's original conceptualisation.

Maslen S, Olson RE, Collier A.

Abstract: Palliative care, according to the definition offered by the World Health Organisation, should improve the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. Palliative and end-of-life care aims to prevent and relieve suffering through the early identification, correct assessment and treatment of pain and other challenges. Scholarship and practice in this context has long acknowledged the need to consider care as holistic. Dame Cicely Saunders – an English physician, nurse and social worker broadly acknowledged as the founder of the modern hospice movement and the discipline of palliative care – famously outlined the concept of ‘total pain’ in the mid-twentieth century. The term suggests that a person’s suffering extends beyond the physical to the psychological, social, and spiritual. Saunders argued for each individual’s freedom to make their own journey towards their ultimate goals. This conceptual advancement was important for its time, recognising that pain is not contained to the individual, nor is it only physiological. While use of this concept continues, moving beyond these ideas to advance our understanding and theorisation of palliative care is warranted.

Nelson C, Forbes R, Mandrusiak A.

Background: Understanding the experiences of Aboriginal and Torres Strait Islander peoples as healthcare recipients is essential for delivering culturally safe physiotherapy care; however, the literature inadequately explores these experiences. This study aimed to explore the experiences of Aboriginal and Torres Strait Islander peoples who have engaged with physiotherapists and understand their perspectives on how physiotherapists can provide culturally safe care in the community.

Methods: Semi-structured interviews were conducted with adult (aged >18years) self-identified Aboriginal and Torres Strait Islander peoples (n =12) who had received physiotherapy care within a community setting within the previous 3months. A First Nations methodology approach alongside reflexive thematic analysis was used to interpret the data.

Results: Four themes were generated: (1) building trust through yarning; (2) acknowledging and respecting culture; (3) creating a culturally safe environment; and (4) the importance of professional training. 

Conclusions: Aboriginal and Torres Strait Islander peoples have expressed that physiotherapists can establish trust with their patients by dedicating time to develop a therapeutic relationship and by demonstrating respect for their culture. It is essential for physiotherapists to carefully consider the physical environment in which they deliver care to ensure it is welcoming and culturally safe for Aboriginal and Torres Strait Islander peoples. Physiotherapists should undertake professional development to immerse themselves in First Nations culture and history through connecting with community. This study offers insights into the lived experiences of Aboriginal and Torres Strait Islander peoples receiving care in the community and provides recommendations that may assist physiotherapists, alongside other community-based health professionals, to provide culturally safe care.

Nelson KE, Adams K, Kahn-John M, Davidson PM, Ferrell B, Meah M, et al.

Aim: To explore (1) perspectives and attitudes of Native Americans regarding transitions from serious illness to death, and (2) awareness about hospice and palliative care service models in a Great Plains reservation-based community.

Design: Qualitative descriptive study.

Methods: Community members and clinicians were invited to participate in a semi-structured focus group or interview by Tribal Advisory Board members. Analysis involved three phases: (1) qualitative descriptive analysis of preliminary themes using the Addressing Palliative Care Disparities conceptual model; (2) a cultural review of the data; and (3) reflexive thematic analysis to synthesize findings.

Results: Twenty-six participants engaged in two focus groups (n = 5-6 participants in each) and interviews (n = 15). Four themes were derived from their stories: (1) family connectedness is always priority; (2) end-of-life support is a community-wide effort; (3) everyone must grieve in their own way to heal; and (4) support needs from outside the community.

Conclusion: Findings highlight cultural considerations spanning the life course. Clinicians, researchers and traditional wisdom keepers and practitioners, particularly those working in rural and/or reservation-based settings, must provide culturally safe care. This must include acknowledging and prioritizing the needs and preferences of Native American patients and the impact on their families and communities.

Impact and implications for the profession: Leveraging community assets, such as family and social networks, is key for supporting Native American patients with serious illnesses. Additionally, facilitating greater family and caregiver involvement along a patient's care trajectory may be a pathway for easing health care workers' caseloads in reservation-based areas, where resources are limited.