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Introduction Advance care planning (ACP) is increasingly regarded as the best way to optimise end‐of‐life (EOL) care. Studies have examined a multitude of factors impacting on the lagging uptake of ACP. In the current study, we specifically focused on patient factors related to the uptake of ACP in adult cancer patients. Methods A scoping review was conducted, for which we searched the CINAHL, Cochrane, MEDLINE and PsycINFO databases (January 2013–December 2018). Studies exploring patient‐related factors influencing the uptake of ACP in cancer patients were eligible for inclusion. Results Eleven papers and two overarching themes: person‐related (e.g. socio‐demographic) factors and “comprehension and awareness,” were identified. White, well‐educated patients with a support network were more likely to be involved in ACP. However, there is limited comprehension and awareness among cancer patients regarding ACP. Conclusions The identified themes warrant a tailored approach to ACP. With regard to person‐related factors, the existing body of knowledge on health literacy, disparities and shared decision‐making should be used when designing strategies to improve ACP uptake. Further, our findings regarding “comprehension and awareness” suggest that ACP should not be limited to a narrow process without acknowledging the complexity surrounding personalised cancer care near the EOL.

Background Healthcare systems are overloaded and changing. In response to growing demands on the healthcare systems, new models of healthcare delivery are emerging. Community paramedicine is a novel approach in which paramedics use their knowledge and skills beyond emergency health response to contribute to preventative and rehabilitative health. In our systematic review, we aimed to identify evidence of the community paramedicine role in care delivery for elderly patients, with an additional focus on palliative care, and the possible impact of this role on the wider healthcare system. Methods A systematic review of peer-reviewed literature from MEDLINE, Embase, CINAHL, and Web of Sciences was undertaken to identify relevant full-text articles in English published until October 3, 2019. Additional inclusion criteria were studies focussing on extended care paramedics or community paramedics caring for elderly patients. Case studies were excluded. All papers were screened by at least two authors and underwent a quality assessment, using the Joanna Briggs Institute appraisal checklists for cross sectional, qualitative, cohort, and randomised controlled trial studies to assess the methodological quality of the articles. A process of narrative synthesis was used to summarise the data. Results Ten studies, across 13 articles, provided clear evidence that Community Paramedic programs had a positive impact on the health of patients and on the wider healthcare system. The role of a Community Paramedic was often a combination of four aspects: assessment, referral, education and communication. Limited evidence was available on the involvement of Community Paramedics in palliative and end-of-life care and in care delivery in residential aged care facilities. Observed challenges were a lack of additional training, and the need for proper integration and understanding of their role in the healthcare system. Conclusions The use of community paramedics in care delivery could be beneficial to both patients’ health and the wider healthcare system. They already play a promising role in improving the care of our elderly population. With consistent adherence to the training curriculum and effective integration within the wider healthcare system, community paramedics have the potential to take on specialised roles in residential aged care facilities and palliative and end-of-life care.

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Background: Using pork or ethylene-vinyl acetate (EVA) pads to teach suturing and excision skills to medical students can be expensive and lack a degree of realism. This project aimed to ascertain if a symbiotic culture of bacteria and yeast (SCOBY) represented a viable alternative. Methods: Part 1 of this study was designed to identify the descriptors against which SCOBY, pork and EVA pads could be evaluated. Participants in part 1 were asked to identify elements of fidelity that best represented skin when comparing the three models. Part 2 of the study required a second cohort of participants to rank the three models against the descriptors identified. Results: The overall results indicate that, with the exception of odour, respondents rated SCOBY superior to EVA pads and equivalent to pork. There were no significant differences between pork and SCOBY for skin likeness, cutting likeness, and suturing likeness, although both were deemed superior to EVA pads. Qualitative feedback indicated that SCOBY was not as robust as pork and lacked the layers of skin that pork better represents. Cultural and religious impediments to using pork models were also highlighted. Conclusion: SCOBY offers a viable, low-cost alternative to pork to teach suturing and excision with comparable fidelity to pork and a superior fidelity to EVA pads. The smell of SCOBY is mildly vinegary due to the secondary fermentation of alcohol to acetic acid. Ten percent of the participants in part 2 of the study identified cultural or religious barriers to using pork.