Models of palliative care for under-served populations in high-income countries: a scoping review protocol.

Objective: The objective of this scoping review is to describe models of palliative care for under-served populations in high-income countries, defined as adults of culturally and linguistically diverse communities, low socioeconomic status, and/or residing in rural areas.

Introduction: Models of palliative care are processual, referring to the way palliative care services are delivered as people experience a condition, injury, or event. The aim of these models is to ensure people get the right care, at the right time, by the right team, in the right place.

Establishing a clinical ethics support service: lessons from the first 18 months of a new Australian service - a case study.

Background: Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting.

Methods: HOW THE STUDY WAS PERFORMED AND STATISTICAL TESTS USED: A qualitative case study approach was utilised.

A public health framework for reducing stigma: the example of weight stigma.

We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of obesity, needs to be actively challenged and reduced. Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions.

Older Adults' Perspectives of Smart Technologies to Support Aging at Home: Insights from Five World Café Forums.

Globally, there is an urgent need for solutions that can support our aging populations to live well and reduce the associated economic, social and health burdens. Implementing smart technologies within homes and communities may assist people to live well and 'age in place'. To date, there has been little consultation with older Australians addressing either the perceived benefits, or the potential social and ethical challenges associated with smart technology use.

Demonstrating the importance of cultural considerations at end of life utilizing the perspective of Indian patients with cancer.

Purpose: This study aimed to understand Indian cancer patients' hopes and beliefs about the end of life, particularly focusing on how this informed their preferences regarding end-of-life treatment. In India, individuals' lives are mainly guided by culturally driven practices of doing right by one's family and believing death is predetermined.

Methods: Indian patients (25) diagnosed with advanced incurable cancer and aware of their prognosis participated in semi-structured interviews exploring their hopes as they approached the end of life.

Healthcare professionals' perspectives of patient and family preferences of patient place of death: a qualitative study.

Background: Home death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient's carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients.

Documenting plans for care: advance care directives and the 7-step pathway in the acute care context.

Background: Advance care planning involves the discussion and documentation of an individual's values and preferences to guide their future healthcare should they lose capacity to make or communicate treatment decisions. Advance care planning can involve the individual's completion of an Advance Care Directive (ACD), a legislated and common-law instrument which may include appointment of a substitute decision-maker and binding refusals of treatment. In South Australia, ACDs intersect in the acute-care context with the Resuscitation Plan 7-Step Pathway (7-SP), an integrated care plan written for and by clinicians, designed to organise and improve patients' end-of-life care through the use of structured documentation.

'Alcohol causes cancer': a difficult message for Australians to swallow.

Alcohol is a modifiable risk factor for cancer. Public awareness of the link between alcohol and cancer risk is poor; thus, alcohol consumers may be unknowingly putting themselves at increased risk of cancer. One way to raise awareness of alcohol-related cancer is through placing labels warning of cancer risk on alcoholic beverage containers; however, little is known about the impact of such labels.

Value assessment of antimicrobials and the implications for development, access, and funding of effective treatments: Australian stakeholder perspective.

Background: The frameworks used by Health Technology Assessment (HTA) agencies for value assessment of medicines aim to optimize healthcare resource allocation. However, they may not be effective at capturing the value of antimicrobial drugs.

Objectives: To analyze stakeholder perceptions regarding how antimicrobials are assessed for value for reimbursement purposes and how the Australian HTA framework accommodates the unique attributes of antimicrobials in cost-effectiveness evaluation.

Feasibility of de-linking reimbursement of antimicrobials from sales: the Australian perspective as a qualitative case study.

Background: There is a disparity in the economic return achievable for antimicrobials compared with other drugs because of the need for stewardship. This has led to a decline in pharmaceutical companies' willingness to invest in the development of these drugs and a consequent global interest in funding models where reimbursement is de-linked from sales.

Objectives: To explore the perspective of stakeholders regarding the feasibility of de-linked reimbursement of antimicrobials in Australia.

Alcohol warning labels to reduce alcohol-related harm: a scoping review protocol.

Objective: This scoping review aims to explore international literature relating to alcohol warning labels as a public health approach for reducing alcohol-related harm.

Introduction: Alcohol-related harm is a global public health issue. More than 200 injuries, diseases and conditions are attributable to alcohol, and almost 6% of all global deaths are related to alcohol consumption.

Health-related quality of life, psychosocial functioning, and unmet health needs in patients with sarcoma: A systematic review.

Objective: Health-related quality of life (HRQoL), psychosocial distress, and unmet health needs are important patient-reported outcomes (PROs) for patients with sarcoma treated with curative intent. Syntheses of data on these PROs in patients with sarcoma are limited.

Methods: A systematic review of peer-reviewed literature published between 2007 and 2017 was conducted using five databases, guided by the PRISMA and Cochrane reporting guidelines.

Individuate and separate: Values and identity re-development during rehabilitation and transition in the Australian Army.

Many health behaviours and outcomes in veterans can be attributed to issues of identity. Identity is informed by core values, which are critical to service organisations that demand unity, including the military, but the intersection between values, identity, and adaptation to serious wounds, injuries, and illnesses remains relatively unexplored. This article elucidates the relationship between values, identity, and adaptation during rehabilitation in high-risk military personnel through examination of the experiences of 13 Australian combat soldiers undergoing rehabilitation for serious wounds, injuries, and mental health conditions.

"We Were Totally Supportive, of Course": How People Talk About Supporting a Significant Other to Stop or Reduce Their Drinking.

Despite the strong influence our significant others have on health behaviors such as alcohol consumption, little is known about when they are willing to provide support for changing such behaviors. We conducted interviews with 13 Australian adults who had a partner, friend, or family member who stopped or significantly reduced their alcohol consumption within the past 2 years, to understand how these significant others accounted for providing support for this behavior change as reasonable. Through thematic discourse analysis, we identified three types of accounts: (a) deontological, referring to duty or obligation to support others; (b) consequentialist, where costs for providing support were minimized or balanced; and (c) relational, attending to the importance of maintaining relationships.

Constructions of alcohol consumption by non-problematised middle-aged drinkers: a qualitative systematic review.

Background: Current research into alcohol consumption focuses predominantly on problematic drinkers and populations considered likely to engage in risky behaviours. Middle-aged drinkers are an under-researched group, despite emerging evidence that their regular drinking patterns may carry some risk.

Methods: We searched Scopus, Ovid Medline, and Ovid PsycInfo for peer-reviewed, English-language publications appearing prior to 31 December 2015 and relating to the construction of alcohol consumption by middle-aged non-problematised drinkers.

Heroic journeys through sobriety: How temporary alcohol abstinence campaigns portray participant experiences.

Background: In Australia, recent years have seen a rise in the popularity of temporary abstinence campaigns, in which people pledge to abstain from alcohol for a month while raising funds for charity. In addition to their fundraising aims, such initiatives have been viewed as tools for broader behavioural and cultural change around alcohol, encouraging participants to reflect on their drinking and make longer-term changes to their behaviour. The extent to which these initiatives promote enduring change may depend on how they portray the experience of temporarily abstaining from alcohol, and how they position participants.

'Sussing that doctor out.' Experiences and perspectives of people affected by hepatitis C regarding engagement with private general practitioners in South Australia: a qualitative study.

Background: Australians with chronic hepatitis C (HCV) can access affordable Direct Acting Antiviral (DAA) treatments with high cure rates (>90%), via General Practitioners (GPs). Benefits from this treatment will be maximised if people with HCV readily disclose and engage with private GPs regarding HCV-related issues. Investigating the perceptions and experiences of people affected by HCV with GPs can allow for this pathway to care for HCV to be improved.

An examination of Australian newspaper coverage of the link between alcohol and cancer 2005 to 2013.

Background: Alcohol is a Class-1 carcinogen but public awareness of the link between alcohol and cancer is low. The news media is a popular, readily-accessible source of health information and plays a key role in shaping public opinion and influencing policy-makers. Examination of how the link between alcohol and cancer is presented in Australian print media could inform public health advocacy efforts to raise awareness of this modifiable cancer risk factor.

How have people who have stopped or reduced their alcohol consumption incorporated this into their social rituals?

Objective: Limiting alcohol consumption is beneficial for health, but can be challenging given the role alcohol plays in the rituals of many social occasions. We examined how people who stopped or reduced their alcohol consumption incorporated this change within their social rituals.

Design: We conducted 16 semi-structured one-on-one interviews with adults aged 25-65 years, who lived in Australia and had stopped or significantly reduced their alcohol consumption in the previous year.

Translating into Practice Cancer Patients' Views on Do-Not-Resuscitate Decision-Making.

Do-not-resuscitate (DNR) orders are necessary if resuscitation, the default option in hospitals, should be avoided because a patient is known to be dying and attempted resuscitation would be inappropriate. To avoid inappropriate resuscitation at night, if no DNR order has been recorded, after-hours medical staff are often asked to have a DNR discussion with patients whose condition is deteriorating, but with whom they are unfamiliar. Participants in two qualitative studies of cancer patients' views on how to present DNR discussions recognized that such patients are at different stages of understanding of their situation and may not be ready for a DNR discussion; therefore, a one-policy-fits-all approach was thought to be inappropriate.

'Why can't I just not drink?' A qualitative study of adults' social experiences of stopping or reducing alcohol consumption.

Introduction And Aims: Alcohol is ingrained in Australian culture, playing an important role in many social occasions. This can make reducing or stopping alcohol consumption challenging, as one risks rejecting, not just a drink but also the valued social norms that drink represents. This study aimed to investigate the social experiences of adults who stop or reduce their alcohol consumption.

Age determination in refugee children: A narrative history tool for use in holistic age assessment.

Aim: To present the rationale for using a narrative history tool as part of a holistic age assessment of accompanied refugee children with age uncertainty by exploring cultural narratives of age.

Methods: Seven small group, semi-structured interviews with 24 humanitarian entrants (10 male, 14 female) recruited from Afghan, Bhutanese and Burundian communities in Adelaide, Australia were conducted. Interviews were performed with interpreters present, audio-recorded, transcribed verbatim and thematically analysed.

Why is Pain Still Under-Treated in the Emergency Department? Two New Hypotheses.

Across the world, pain is under-treated in emergency departments (EDs). We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain's under-treatment in the ED is due partly to (1) an epistemic preference for signs over symptoms on the part of some practitioners, and (2) some ED practices that themselves worsen pain by increasing patients' anxiety and fear.

Mandatory cancer risk warnings on alcoholic beverages: what are the ethical issues?

The link between alcohol consumption and cancer is well established, but public awareness of the risk remains low. Mandated warning labels have been suggested as a way of ensuring "informed choice" about alcohol consumption. In this article we explore various ethical issues that may arise in connection with cancer warning labels on alcoholic beverages; in particular we highlight the potentially questionable autonomy of alcohol consumption decisions (either with or without labels) and consider the implications if the autonomy of drinking behavior is substantially compromised.