Social Work - Theses
Permanent URI for this collection
Search Results
1 - 2 of 2
-
ItemAn exploratory study into the experience of healthcare professionals caring for adolescent and young adults (AYA) with cancer when cure is no longer the goal of care.( 2015)Adolescents and young adults (AYA) with cancer are a unique subgroup within oncology due to specific medical and psychosocial needs. Palliative care in AYA oncology is largely an under researched area. Much of the research to date in palliative care has focussed on the paediatric and older adult populations. However, recent research illustrates that clinicians caring for young people with incurable disease identify this work to be challenging, although the reasons for this, and whether there are differences across professional disciplines, remains unknown. This study aimed to provide an understanding of the experience, degree of knowledge, attitudes and practices of healthcare professionals caring for AYA patients with incurable cancer. The study was based at Peter MacCallum Cancer Centre, a specialist cancer centre in Melbourne. A practice based, qualitative research methodology was employed comprising two phases. Phase I involved focus groups. Phase II involved semi structured in-depth interviews. Results are described by professional discipline. They highlight the challenges and enablers to practice, reported by professionals. The main challenges faced were: a lack of age-appropriate knowledge, experience and communication skills and insufficient organisational prioritisation of appropriate care for AYAs. The main enablers of good clinical care for AYAs were: a multidisciplinary approach to practice; age-appropriate education and skills and; support for staff. Recommendations arising from this research include a multipronged approach to improving service delivery comprising three areas. First, targeted professional development, education and training in age-appropriate care and communication. Second, greater organisational commitment to clinician skill development, increasing multidisciplinary forums for care planning, formalising staff support and improving hospital wide age-appropriate resources. Third, the development of policies, procedures and guidelines for these key areas.
-
ItemSliding doors: how we can effectively manage the transition from palliative hospice care to residential care( 2011)The increasing survival of patients with advanced-stage cancer, coupled with the increased presence of end-stage chronic illness in an ageing population, is leading to an increase in demand for patients requiring palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few of these are able to offer any long-stay admission for those whose symptoms have been stabilised. Transfer from an inpatient palliative care facility may then be necessary, when a patient is considered to be no longer requiring specialist palliative care services. A core component of the role of palliative-care social workers involves working with patients and their families/carers1 when the care pathway shifts and the option of residential care (in this context, nursing homes) needs to be considered. As a social work clinician, I have observed that, when this process has been considered or contemplated, the patient and their families often display anxiety, anger and distress. This practice research study has explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary healthcare team treating the patient. This study has analysed this phenomenon in two ways. In the first part of the study, a data-mining process was utilised. A sample of 30 consecutive patients who were assessed as being eligible for high-level care (or nursing-home level care) was included. Medical files/histories were reviewed using an audit tool that was developed based on the literature review. The salient or pertinent characteristics of the population group were documented. In the second part of the study, an investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to residential care and highlight the opportunities to improve clinical practice in this area. This investigation analysed the literature and clinical practice, and interviewed the key stakeholders involved in this process. A tripartite approach was adopted by conducting face-to-face interviews with patients, their carers and members of the interdisciplinary healthcare team. As social work clinicians have a substantive role in this area of transition, telephone interviews were also conducted with 10 social workers working in similar inpatient palliative-care facilities in the area of Victoria to gauge their experiences. A thematic analysis discerned a number of common themes highlighting the impact and difficulties of this transition on the key stakeholders. The results suggested recommendations to improve or best manage this process and service delivery. The research study has highlighted the difficulties that patients/families encounter in the transition from palliative care in a hospice to nursing home care and emphasises the importance of protecting the integrity of the patient and family by holding open and continuous dialogue, particularly through family meetings, and working in collaboration with the patient, the family and the team. Understanding the experience of this transition is crucial to the knowledge required to provide psychosocial care to this population. This practice-based research study incorporates the ‘voices’ of terminally ill patients, families and members of the healthcare team on matters directly affecting them. Their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a residential-care facility has been documented with the hope of enabling their input to have some real impetus on clinical practice and service delivery. The importance of this work is that it highlights issues that can arise in the terminal phase of illness and illustrates the benefits of practice based, qualitative research.