Advance care planning in rural New South Wales from the perspective of general practice registrars and recently fellowed general practitioners

Littlewood, Jean; Hinchcliff, Reece; Lo, Winston; Rhee, Joel

doi:10.1111/ajr.12525

Cited by 6 publications

(19 citation statements)

References 11 publications

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“…Although inappropriate payment models discourage the involvement of GPs in certain end-of-life care aspects, such as case conferences and home visits, rural communities often indicate closer relationships between GPs and patients and better care integration and collaboration [ 34 ]. This points out the importance of providing GPs and rural/remote communities with support, education, incentives, better administrative tools, and options for advanced care planning [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review

2022

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Objectives: This scoping review identifies and details the scope of practice of health professionals who provide palliative care within the primary health setting in Australia.Methods: A scoping review approach was conducted on the Cinahl (Ebsco), Scopus, Medline (Ovid) and PubMed databases to extract articles from 1 December 2015 to 1 December 2020. Broad text words and MeSH headings were used with relevance to palliative care, general practice, primary health, and community setting. Extracted journal articles were limited to those based on the Australian population or Australian health system.Results: Eighty-four papers met the inclusion criteria and were included in the review. The review identified the following health professional roles within the Primary Health Care setting undertaking palliative care: General Practitioner, Nurse, Pharmacist, Paramedics, Carers, and Allied Health professionals.Conclusion: This review offers a first understanding of the individual health professional roles and multidisciplinary team approach to actively providing palliative care within the Primary Health Care setting in Australia.

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Section: Resultsmentioning

confidence: 99%

Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review

2022

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“…Provision of structured care delivery has been reported to be impeded by workforce challenges 12,15 with many primary and community care practices rarely being fully staffed. 19 Staff shortages are exacerbated by high and rapid staff turnover [17][18][19][20]24,25,27,28,30,31,34,[40][41][42]44 part-time 27 and fly-in-fly-out workers 41 as well as the changing workforce, which is characterised by temporary and rotational staff such as registrars. 34 The presence of internationally trained GPs has also been identified as a barrier to structured care delivery 34 as well as the lack of specialist support and access to specialists.…”

Section: Workforcementioning

confidence: 99%

“…19 Staff shortages are exacerbated by high and rapid staff turnover [17][18][19][20]24,25,27,28,30,31,34,[40][41][42]44 part-time 27 and fly-in-fly-out workers 41 as well as the changing workforce, which is characterised by temporary and rotational staff such as registrars. 34 The presence of internationally trained GPs has also been identified as a barrier to structured care delivery 34 as well as the lack of specialist support and access to specialists. 17,20,21,30,34,40,42,44 Jones et al 30 in their study involving 688 GPs, whereby geographic variation and its relationship to osteoporosis knowledge, management and barriers to care was investigated, identified a lack of available specialists and difficulty in accessing specialists to be key barriers to care delivery in remote areas.…”

Section: Workforcementioning

confidence: 99%

Barriers and enablers to structured care delivery in Australian rural primary care

Mullan

Armstrong²,

Job

2023

Australian J Rural Health

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Objective The primary aim of this study was to explore the barriers and enablers to structured care delivery in rural primary care, reflecting on Australian research findings. Design CINAHL and Scopus databases were searched in August 2021. Inclusion criteria included English language, full‐text studies, published since 2011, reporting on the barriers and enablers to the delivery of structured care within rural and remote primary care. Structured care was conceptualised as care that was organised, integrative and planned. Findings A total of 435 studies were screened. Thirty‐four met the inclusion criteria. Barriers to the provision of structured care related to workforce shortages, limited health care services and health care professional capacity, cultural safety and competency, limited resourcing, insufficient knowledge and education, geographical isolation, inadequate care coordination, unclear roles and responsibilities and poor health professional–patient relationships. Discussion Health care system and geographical barriers and enablers encountered in rural areas are complex and multidimensional. Identification of the specific challenges to structured care delivery highlights the need for a focussed review of workforce supply and distribution challenges as well as the investigation of system integration, leadership, governance and funding reform that would be required to support rural primary care.

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“…3 Compared to urban settings, the uptake in rural areas is thought to be lower due to limited resources and training. 11,12 In residential aged care settings, advance care planning faces additional challenges. An estimated 50% to 80% of residents are living with some degree of dementia 6 and associated impairment or loss of decision-making capacity.…”

Section: Introductionmentioning

confidence: 99%

“…3 Compared to urban settings, the uptake in rural areas is thought to be lower due to limited resources and training. 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

‘Traversing difficult terrain’. Advance care planning in residential aged care through multidisciplinary case conferences: A qualitative interview study exploring the experiences of families, staff and health professionals

et al. 2021

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Background: Advance care planning improves the quality of end-of-life care for older persons in residential aged care; however, its uptake is low. Case conferencing facilitates advance care planning. Aim: To explore the experience of participating in advance care planning discussions facilitated through multidisciplinary case conferences from the perspectives of families, staff and health professionals. Design: A qualitative study (February–July 2019) using semi-structured interviews. Setting: Two residential aged care facilities in one Australian rural town. Participants: Fifteen informants [family ( n = 4), staff ( n = 5), health professionals ( n = 6)] who had participated in advance care planning discussions facilitated through multidisciplinary case conferences. Results: Advance care planning was like navigating an emotional landscape while facing the looming loss of a loved one. This emotional burden was exacerbated for substitute decision-makers, but made easier if the resident had capacity to be involved or had previously made their wishes clearly known. The ‘conversation’ was not a simple task, and required preparation time. Multidisciplinary case conferences facilitated informed decision-making and shared responsibility. Opportunity to consider all care options provided families with clarity, control and a sense of comfort. This enabled multiple stakeholders to bond and connect around the resident. Conclusion: While advance care planning is an important element of high quality care it involves significant emotional labour and burden for families, care staff and health professionals. It is not a simple administrative task to be completed, but a process that requires time and space for reflection and consensus-building to support well-considered decisions. Multidisciplinary case conferences support this process.

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Advance care planning in rural New South Wales from the perspective of general practice registrars and recently fellowed general practitioners

Cited by 6 publications

References 11 publications

Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review

Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review

Barriers and enablers to structured care delivery in Australian rural primary care

‘Traversing difficult terrain’. Advance care planning in residential aged care through multidisciplinary case conferences: A qualitative interview study exploring the experiences of families, staff and health professionals

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