Melbourne School of Population and Global Health - Research Publications
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ItemManaging risks associated with environmental water delivery: a case study of the Goulburn River, Australia(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2024-01-01)
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Item'The tabloid test': a qualitative interview study on the function and purpose of termination of pregnancy review committees in Victoria, Australia(BMC, 2023-07-18)BACKGROUND: Termination of pregnancy (TOP) is not an uncommon procedure. Availability varies greatly between jurisdictions; however, additional institutional processes beyond legislation can also impact care and service delivery. This study serves to examine the role institutional processes can play in the delivery of TOP services, in a jurisdiction where TOP is lawful at all gestations (Victoria, Australia). As per the Abortion Law Reform Act 2008, TOPs post-24 weeks require the approval of two medical practitioners. However, in Victoria, hospitals that offer post-24 week TOPs generally require these cases to additionally go before a termination review committee for assessment prior to the service being provided. These committees are not stipulated in legislation. Information about these committees and how they operate is scarce and there is minimal information available to the public. METHODS: To trace the history, function, and decision-making processes of these committees, we conducted a qualitative interview study. We interviewed 27 healthcare professionals involved with these committees. We used purposive sampling to gain perspectives from a range of professions across 10 hospitals. Interviews were transcribed verbatim, identifying details removed and inductive thematic analysis was performed. RESULTS: Here, we report the three main functions of the committees as described by participants. The functions were to protect: (1) outward appearances; (2) inward functionality; and/or, (3) service users. Function (1) could mean protecting the hospital's reputation, with the "Herald Sun test"-whether the TOP would be acceptable to readers of the Herald Sun, a tabloid newspaper-used as a heuristic. Function (2) related to logistics within the hospital and protecting the psychological wellbeing and personal reputation of healthcare professionals. The final function (3) related to ensuring patients received a high standard of care. CONCLUSIONS: The primary functions of these committees appear to be about protecting hospitals and clinicians within a context where these procedures are controversial and stigmatized. The results of this study provide further clarity on the processes involved in the provision of TOPs at later gestations from the perspectives of the healthcare professionals involved. Institutional processes beyond those required by legislation are put in place by hospitals. These findings highlight the additional challenges faced by patients and their providers when seeking TOP at later gestations.
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ItemNo Preview AvailableExploring the role and decision-making behavior of irrigation water supply authorities in Australia(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2023-03-04)
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ItemInstitutional objection to abortion: A mixed-methods narrative review(SAGE PUBLICATIONS LTD, 2023)Institutional objection (IO) occurs when institutions providing health care claim objector status and refuse to provide legally permissible health services such as abortion. IO may be regulated by sources including law, ethical codes and policies (including State and local/institutional policies). We conducted a mixed-methods narrative review of the empirical evidence exploring IO to abortion provision globally, to inform areas for further research. MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Global Health (CAB Abstracts), ScienceDirect and Scopus were searched in August 2021 using keywords including 'conscientious objection', 'faith-based organizations', 'religious hospitals' and 'abortion'. Eligible research focused on clinicians' attitudes and experiences of IO to abortion. The 28 studies included in the review were from nine countries: United States (19), Chile (2), Turkey (1), Argentina (1), Australia (1), Colombia (1), Ghana (1), Poland (1) and South Africa (1). The analysis demonstrated that IO was claimed in a range of countries, despite different legislative and policy frameworks. There was strong evidence from the United States that clinicians in religious healthcare institutions were less likely to provide abortions and abortion referrals, and that training of future abortion providers was negatively affected by IO. Qualitative evidence from other countries showed that IO was claimed by secular as well as religious institutions, and individual conscientious objection could be used as a mechanism for imposing IO. Further research is needed to explore whether IO is morally justified, how decisions are made to claim IO, and on what grounds. Finally, appropriate models for regulating IO are needed to ensure the protection of women's access to abortion. Such models could be informed by those used to regulate IO in other contexts, such as voluntary assisted dying.
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ItemNo Preview AvailableAbortion Law in Australia: Conscientious Objection and Implications for Access(Monash University, 2022)As of 2021, abortion has been decriminalised, at least partially, in every Australian jurisdiction; however, barriers to accessing a lawful abortion remain. This article focuses on one of those barriers, namely conscientious objection to the provision of abortion services. It provides an in-depth legal analysis of the nature and scope of the obligations imposed by each Australian jurisdiction’s conscientious objection provision and considers how the framing of these provisions facilitate (such as through referral requirements), and in some cases compromise, access. It is argued that there is a case for law reform to address some of the inconsistency, legal gaps and uncertainty identified and that other regulatory strategies and tools can supplement the law to ensure compliance with legal obligations and minimize access issues.
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ItemUnearthing the Learning of Genomic Medicine in the Workplace: a Qualitative Study(SPRINGER, 2022-10)Abstract Workplace learning is fundamental in contextualizing theoretical concepts into practice, making it opportune for professionals to learn emerging concepts. With genomic testing transitioning from the research space into healthcare, there are more opportunities to engage with workplace learning related to genomic medicine. We therefore aimed to unearth how genomics was being learnt in the workplace and the opportunities and factors that influenced these learning experiences. Qualitative secondary analysis was applied to a purposive sample of interviews with non-genetic physicians who had reflected on their genomic medicine practice and education. Thematic analysis, guided by Billett’s co-participation at work theory, was conducted to identify workplace learning opportunities related to genomic medicine and any influencing factors. A coding framework was developed and iteratively refined until consensus was reached. Various workplace learning opportunities related to genomic medicine were identified from interviews with 29 physicians. Engagement occurred through established clinical work practice, contextual affordances, and agentic pursuits. Barriers and facilitators influenced participants’ experiences and access with opportunities. Some participants recognized these learning opportunities as “informal”; however, most did not. Opportunities to engage with workplace learning beyond formal training are essential to ensure the medical workforce has the knowledge and confidence to engage with practice-related developments. However, ‘work’ activities were not often recognized as ‘learning’ opportunities. With continued efforts to integrate genomics and other innovations into routine healthcare and help reduce the theory–practice gap, this study adds to our understanding of how workplace learning occurs and offers a platform on which to build a robust model for continuing education.
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ItemHealth professionals' views and experiences of the Australian moratorium on genetic testing and life insurance: A qualitative study(SPRINGERNATURE, 2022-11)Australian life insurance companies can legally use genetic test results in underwriting, which can lead to genetic discrimination. In 2019, the Financial Services Council (Australian life insurance industry governing body) introduced a partial moratorium restricting the use of genetic testing in underwriting policies ≤ $500,000 (active 2019-2024). Health professionals (HPs), especially clinical geneticists and genetic counsellors, often discuss the implications of genetic testing with patients, and provide critical insights into the effectiveness of the moratorium. Using a sequential explanatory mixed methods design, we interviewed 23 Australian HPs, who regularly discuss genetic testing with patients and had previously completed an online survey about genetic testing and life insurance. Interviews explored views and experiences about the moratorium, and regulation, in greater depth. Interview transcripts were analysed using thematic analysis. Two key themes emerged from views expressed by HPs during interviews (about matters reported to or observed by them): 1) benefits of the moratorium, and 2) concerns about the moratorium. While HPs reported that the moratorium reassures some consumers, concerns include industry self-regulation, uncertainty created by the temporary time period, and the inadequacy of the moratorium's financial limits for patients' financial needs. Although a minority of HPs felt the current industry self-regulated moratorium is an adequate solution to genetic discrimination, the vast majority (19/23) expressed concern with industry self-regulation and most felt government regulation is required to adequately protect consumers. HPs in Australia are concerned about the adequacy of the FSC moratorium with regards to consumer protections, and suggest government regulation is required.
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ItemUnderstanding the barriers to, and facilitators of, ovarian toxicity assessment in breast cancer clinical trials(CHURCHILL LIVINGSTONE, 2022-08)BACKGROUND: Detailed toxicity data are routinely collected in breast cancer (BC) clinical trials. However, ovarian toxicity is infrequently assessed, despite the adverse impacts on fertility and long-term health from treatment-induced ovarian insufficiency. OBJECTIVES: To determine the barriers to and facilitators of ovarian toxicity assessment in BC trials of anti-cancer drugs. METHODS: Semi-structured interviews were conducted with purposively selected stakeholders from multiple countries involved in BC clinical trials (clinicians, consumers, pharmaceutical company representatives, members of drug-regulatory agencies). Participants were asked to describe the perceived benefits and barriers to evaluating ovarian toxicity. Interviews were transcribed verbatim, coded in NVivo software and analysed using inductive thematic analysis. RESULTS: Saturation of the main themes was reached and the final sample size included 25 participants from 14 countries (9 clinicians, 7 consumers, 5 members of regulatory agencies, 4 pharmaceutical company representatives); half were female. The main reported barrier to ovarian toxicity assessment was that the issue was rarely considered. Reasons included that these data are less important than survival data and are not required for regulatory approval. Overall, most participants believed evaluating the impact of BC treatments on ovarian function is valuable. Suggested strategies to increase ovarian toxicity assessment were to include it in clinical trial design guidelines and stakeholder advocacy. CONCLUSION: Lack of consideration about measuring ovarian toxicity in BC clinical trials that include premenopausal women suggest that guidelines and stronger advocacy from stakeholders, including regulators, would facilitate its more frequent inclusion in future trials, allowing women to make better informed treatment decisions.
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ItemThe Unethical Texas Heartbeat Law(WILEY, 2022-05)What is already known? The Texas Heartbeat Act, which has been in effect since September 2021, prohibits abortions once a ‘fetal heartbeat’ is detected, except in emergency situations. The law significantly limits access to abortion services in Texas, by essentially prohibiting abortions post 6 weeks' gestation. The law has been subjected to several legal challenges, none of which have been successful to date. What does this article add? This article provides an overview of some of the ethical concerns the law raises and identifies some of the problems the law creates for women, the health profession and society. The article ultimately argues that the law ought to be quashed.
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ItemScientific research in news media: a case study of misrepresentation, sensationalism and harmful recommendations(SCUOLA INT SUPERIORE STUDI AVANZATI-S I S S A-INT SCH ADVANCED STUDIES, 2022)Accurate news media reporting of scientific research is important as most people receive their health information from the media and inaccuracies in media reporting can have adverse health outcomes. We completed a quantitative and qualitative analysis of a journal article, the corresponding press release and the online news reporting of a scientific study. Four themes were identified in the press release that were directly translated to the news reports that contributed to inaccuracies: sensationalism, misrepresentation, clinical recommendations and subjectivity. The pressures on journalists, scientists and their institutions has led to a mutually beneficial relationship between these actors that can prioritise newsworthiness ahead of scientific integrity to the detriment of public health.