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PURPOSE: To date, the research on relocation has been conducted in countries such as Australia where there are vast distances that need to be travelled by regional, rural and remote patients to access specialist metropolitan treatment. This research considers the issue of relocation for specialist treatment in a New Zealand context. METHODS: The exploration of the experience of relocation from the consumers' perspective was conducted through an iterative, qualitative research methodology using open-ended interviews conducted by speaker-phone at the time and location of each participant's choice. RESULTS: The three factors that underpin the phenomenon of 'travel-based' accommodation in New Zealand are the strong desire to return home, the small geographical distances that make this possible for many and the strong determination to endure hardship associated with travel when distances are long. CONCLUSIONS: Any understanding of relocation for specialist treatment needs to be informed by two concepts: 'travel-based' relocation and 'accommodation-based' relocation. RELEVANCE OF MANUSCRIPT TO INFORM RESEARCH, POLICIES AND/OR PROGRAMS: The focus needs to be on providing supportive travel arrangements where possible. In New Zealand, as elsewhere, cancer supportive care organisations are increasingly providing volunteers to assist with travel. Such practical volunteer assistance is important, as is financial support through government subsidies to cover the cost of such travel. The insights from the study affirm the importance of health professionals who are supportive and creative in their efforts to assist people to return home. Supportive clinical care such as addressing issues in relation to nausea and pain management for those travelling must also be considered.
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Acessibilidade aos Serviços de Saúde , Habitação , Especialização/estatística & dados numéricos , Viagem , Adulto , Atitude Frente a Saúde , Demografia , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Neoplasias Hematológicas/terapia , Humanos , Masculino , Melanoma/terapia , Nova Zelândia , População Rural , Neoplasias Cutâneas/terapiaRESUMO
PURPOSE: The use of the word 'survivor' is now widely accepted in academic and clinical oncology culture. However, despite such prevalence, there is limited research exploring the meaning of the term survivor for the very individuals to which the term is applied. The article provides insights on the term survivor from a sub-set of findings taken from a Queensland study exploring the experience of survivorship for individuals diagnosed with a haematological malignancy. METHODS: The qualitative study involved in-depth interviews with 50 individuals diagnosed with a haematological malignancy. The interviews were transcribed verbatim, coded and then analysed thematically. RESULTS: The results indicated that the majority of participants actively disliked the term and did not embrace the notion of survivor in their post-diagnosis identity. Only a small number actively embraced the term. CONCLUSION: The word survivor had a multiplicity of meanings depending on the individual interpretation of the term. RELEVANCE OF MANUSCRIPT TO INFORM RESEARCH, POLICIES AND/OR PROGRAMMES: The clear message from the research is that the term survivor needs to be used with care and sensitivity. The strong recommendation is that caution should be used when applying the term to individuals diagnosed with a haematological malignancy. The naming of support groups and newsletters should be sensitive to the wide range of meanings that individuals bring to this term. Indeed, the findings indicate that many do not identify with the term and require a more appropriate language to respond to their supportive care needs.
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Neoplasias Hematológicas , Autoimagem , Sobreviventes/psicologia , Adulto , Idoso , Atitude Frente a Saúde , Feminino , Neoplasias Hematológicas/psicologia , Neoplasias Hematológicas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Queensland , Identificação SocialRESUMO
PURPOSE: Despite the personal and economic importance of the issue of returning to work after cancer treatment, there are major limitations in the research literature on the topic. Indeed, in relation to the focus of the present article, the experience of return to work for Australian haematology patients, there is little research available. METHODS: The return-to-work findings are a sub-set from a study examining survivorship issues conducted through in-depth, qualitative interviews with a state-wide sample (n = 50) of individuals who were at least 1 year post-treatment for haematological malignancy. RESULTS: There were three groups identified in relation to employment: (1) those who were retired and work was not an issue, (2) those who had successfully re-entered the workforce and (3) those who wanted to work but were finding the process of return-to-work difficult. It is the third group that is the major focus for this paper. CONCLUSIONS: The clear indications are that group 3 requires assistance with return-to-work and were vulnerable to a range of psychosocial distress caused by inability to return to employment. Supportive care strategies to assist return to employment are provided. Relevance of manuscript to inform research, policies and/or programs Current improvements in cancer treatments have not only increased the number of cancer survivors but also peoples' ability to work during and following treatment. Maximising opportunities for cancer patients to return to work is a significant concern not only for individuals and employers but also economically for society. The findings reported in this article explored the individual story of a range of individuals with haematological malignancies in relation to their desire and efforts to return to work. Importantly, the findings not only provide insights on the work re-entry challenges faced by such individuals but also posit supportive care service delivery solutions to assist those who are vulnerable and frustrated in their efforts to find employment.
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Emprego , Neoplasias Hematológicas/psicologia , Retorno ao Trabalho/psicologia , Adulto , Idoso , Feminino , Grupos Focais , Neoplasias Hematológicas/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Queensland , SobreviventesRESUMO
OBJECTIVE: In Australia, 25% of international medical graduates (IMGs) make up the medical workforce. Concern is expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs' education. Although there is literature alluding to difficulties IMGs face with undertaking the Australian Medical Council (AMC) examination, there is little research detailing this experience. We therefore explored IMGs' reflections on facilitators and barriers in undertaking the AMC examination. METHODS: After ethics approval, in-depth telephone interviews were conducted with 30 IMGs selected from a hospital in Queensland. Data were coded and analysed using thematic analysis principles. Results. Two facilitating themes were identified: ability to sit for the first part of the examination in country of origin; and having access to resources such as bridging courses and study groups. Three themes represented barriers: not understanding procedural steps; financial issues; and lack of information on examination content and standards. CONCLUSION: The themes provide new insights and add depth to existing literature that can be used to improve procedural processes and education for IMGs towards successful outcomes in the AMC examination.
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Avaliação Educacional , Médicos Graduados Estrangeiros/psicologia , Austrália , Competência Clínica , Humanos , Entrevistas como AssuntoRESUMO
INTRODUCTION: There has been no research exploring the financial impact on the live renal donor in terms of testing, hospitalisation and surgery for kidney removal (known as nephrectomy). The only mention of financial issues in relation to live renal transplantation is the recipients' concerns in relation to monetary payment for the gift of a kidney and the recipients' desire to pay for the costs associated with the nephrectomy. The discussion in this article posits a new direction in live renal donor research; that of understanding the financial impact of live renal donation on the donor to inform health policy and supportive care service delivery. The findings have specific relevance for live renal donors living in rural and remote locations of Australia. METHODS: The findings are presented from the first interview (time 1: T1) of a set of four times (time 1 to time 4: T1-T4) from a longitudinal study that explored the experience of live renal donors who were undergoing kidney removal (nephrectomy) at the Renal Transplantation Unit at the Princess Alexandra Hospital, Brisbane, Australia. A qualitative methodological approach was used that involved semi-structured interviews with prospective living kidney donors (n=20). The resulting data were analysed using the qualitative research methods of coding and thematic analysis. RESULTS: The findings indicate that live renal donors in non-metropolitan areas report significant financial concerns in relation to testing, hospitalisation and surgery for nephrectomy. These include the fact that bulk billing (no cost to the patient for practitioner's service) is not always available, that individuals have to pay up-front and that free testing at local public hospitals is not available in some areas. In addition, non-metropolitan donors have to fund the extra cost of travel and accommodation when relocating for the nephrectomy to the specialist metropolitan hospital. CONCLUSION: Live renal transplantation is an important new direction in medical care that has excellent long-term results for individuals diagnosed with end-stage renal disease. An essential element of the transplantation procedure is the voluntary donation of a healthy kidney by the live renal donor. Such an altruistic gift, which has no personal health benefit for the donor, is to be applauded and supported. The present research demonstrates that for some donors, particularly those living outside the metropolitan area, the gift may also include a range of financial costs to the donor. There is no prior research available on the financial impact of live renal donation for individuals living in non-metropolitan areas. Thus, this article is a seminal work in the area. The findings affirm 'rural disadvantage' by demonstrating that it is the live renal donors in non-metropolitan areas who are reporting financial concerns in relation to testing, hospitalisation and surgery for nephrectomy. It is the hope and expectation that the reporting on these costs will encourage further work in this area and the findings will be used for health policy and service delivery considerations.
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Disparidades em Assistência à Saúde , Transplante de Rim/economia , Transplante de Rim/psicologia , Doadores Vivos , Nefrectomia/economia , População Rural , Adulto , Austrália , Análise Custo-Benefício , Feminino , Gastos em Saúde , Disparidades em Assistência à Saúde/economia , Teste de Histocompatibilidade/economia , Hospitalização/economia , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Período Pós-Operatório , Pesquisa Qualitativa , Autocuidado/economia , Viagem/economiaRESUMO
CONTEXT: The increasing global mobility of physicians and severe physician shortages of many countries has led to an increasing reliance on International Medical Graduates (IMGs) by countries including Australia and Canada. OBJECTIVES: A web-based comparison of licensing policies for IMGs in Australia and Canada to inform and improve policies in each country. METHODS: The research involved identification of relevant government and medical regulatory bodies' official websites documenting information on the licensing process for IMGs from each respective country; in-depth examination and comparison of the licensing processes outlined on these sites; and compilation of a comprehensive list of similarities and differences. FINDINGS: While difficult entry requirements are imposed in Canada, once full registration is achieved IMGs have the same membership rights as Canadian medical graduates and their separate status (nominally) ends. In Australia, IMGs are allowed relatively easy access to temporary or conditional licenses, especially in designated underserviced areas or areas of need in order to fulfil resource demands. However IMGs are predominantly restricted to practise in limited and less prestigious positions within the medical hierarchy. DISCUSSION: The Canadian process for recertifying IMGs can be characterized as being based on the integration/assimilation of IMGs with domestically trained doctors. In contrast, Australia has pursued a different strategy of parallelism of its IMGs. CONCLUSIONS: The findings provide insights into how each country balances national licensing requirements with physician shortages in a globalized environment in order to provide healthcare for its citizens.
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Médicos Graduados Estrangeiros/normas , Internet , Licenciamento/legislação & jurisprudência , Formulação de Políticas , Austrália , Canadá , HumanosRESUMO
OBJECTIVE: This paper presents the findings of research which explored how International Medical Graduates (IMGs) understand and integrate with the allied health system in relation to multidisciplinary care. METHODS: An open-ended, exploratory qualitative design comprised of thirty (n=30) open-ended, in-depth interviews with IMGs employed in a public hospital in Queensland, Australia. RESULTS; Many IMGs have no experience with allied health support in their country of origin. Multidisciplinary collaboration is a new concept for IMGs integrating into the Australia healthcare system. Learning about the allied health system, including how to work effectively within the context of the multidisciplinary team, is an important topic that needs to be addressed as a matter of priority. CONCLUSIONS; There is a strong need to focus on improving strategies for integrating IMGs into the allied health system. In particular, IMGs require information to help them understand the roles and referral processes associated with interfacing with the allied health system.
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Pessoal Técnico de Saúde , Atitude do Pessoal de Saúde , Médicos Graduados Estrangeiros , Comunicação Interdisciplinar , Hospitais Gerais , Humanos , Entrevistas como Assunto , Programas Nacionais de Saúde , QueenslandRESUMO
This article presents the findings from a pilot study conducted as a first step in understanding the myriad psychological and psychiatric sequelae stemming from the use of steroids for hematology patients. Descriptions of the side effects experienced by 10 hematology patients undergoing steroid treatment are documented and discussed. Steroid usage can have a range of physical and emotional side effects on patients, including hematology patients. The insights are a serious reminder to all who care for hematology patients that the psychological and psychiatric side effects of steroids need to be taken seriously.
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Corticosteroides/efeitos adversos , Mieloma Múltiplo/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Idoso , Acatisia Induzida por Medicamentos , Ansiedade/induzido quimicamente , Transtornos Cognitivos/induzido quimicamente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Agitação Psicomotora , Transtornos do Sono-Vigília/induzido quimicamente , Aumento de PesoRESUMO
BACKGROUND: Spousal bereavement is documented as a highly stressful event. This article presents findings from research that explored bereavement survivors' perspectives on what support factors were most helpful to them. METHODS: A qualitative telephone survey was conducted with caregiver spouses of Cittamani Hospice Service clients who died during 2005 and 2006. RESULTS: Partner loss results in significant grief; the initial period is most intense but the grieving continues over a long period. Factors identified as assisting bereaved spouses include: hospice bereavement assistance provided before, during and following the bereavement; having a support network, including both informal support networks and formal support from general practitioners; and keeping active and busy. DISCUSSION: General practitioners play an important role in bereavement care. Key factors assisting bereavement survivors include appropriate referral to palliative care, maintaining a supportive informal network and keeping busy.
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Luto , Clínicos Gerais , Cônjuges , Humanos , Entrevistas como Assunto , Queensland , Apoio SocialRESUMO
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Synthesizing trait observations and knowledge across the Tree of Life remains a grand challenge for biodiversity science. Species traits are widely used in ecological and evolutionary science, and new data and methods have proliferated rapidly. Yet accessing and integrating disparate data sources remains a considerable challenge, slowing progress toward a global synthesis to integrate trait data across organisms. Trait science needs a vision for achieving global integration across all organisms. Here, we outline how the adoption of key Open Science principles-open data, open source and open methods-is transforming trait science, increasing transparency, democratizing access and accelerating global synthesis. To enhance widespread adoption of these principles, we introduce the Open Traits Network (OTN), a global, decentralized community welcoming all researchers and institutions pursuing the collaborative goal of standardizing and integrating trait data across organisms. We demonstrate how adherence to Open Science principles is key to the OTN community and outline five activities that can accelerate the synthesis of trait data across the Tree of Life, thereby facilitating rapid advances to address scientific inquiries and environmental issues. Lessons learned along the path to a global synthesis of trait data will provide a framework for addressing similarly complex data science and informatics challenges.
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Biodiversidade , Ecologia , Evolução Biológica , Fenótipo , PesquisaRESUMO
This article presents the findings of a cross-cultural research project that explored similarities and differences between palliative care service provision in Kerala, India and South-East Queensland, Australia, to inform a process of mutual learning for service development. Three major points of difference that can inform this process of mutual learning were identified: 1) an understanding of the significance of honesty in information-giving to the patient, 2) recognition of the importance of palliative care specialists providing education to mainstream health professionals, and 3) appreciation of the need for palliative care to be cognizant of the socio-economic impact of dying-especially for families experiencing poverty-by embracing strategies for financial and material support. The findings highlight the effectiveness of a cross-cultural collaboration between health professionals and researchers in South-East Queensland, Australia and Kerala, India.
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Atitude do Pessoal de Saúde/etnologia , Atitude Frente a Saúde/etnologia , Cuidados Paliativos , Adulto , Idoso , Atitude Frente a Morte/etnologia , Neoplasias da Mama/etnologia , Comparação Transcultural , Diversidade Cultural , Feminino , Neoplasias de Cabeça e Pescoço/etnologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Pesquisa Metodológica em Enfermagem , Cuidados Paliativos/organização & administração , Cuidados Paliativos/psicologia , Pesquisa Qualitativa , Queensland , Apoio Social , Fatores Socioeconômicos , Revelação da VerdadeRESUMO
Although Aboriginal Australians experience morbidity and mortality rates far greater than that of the wider Australian population, to date, their access to culturally appropriate palliative care services has remained unexplored. This article provides findings from an Australian National Health and Medical Research funded study that documents the availability of palliative care services to Aboriginal peoples of the Northern Territory, Australia. The data were collected through a series of open-ended, qualitative interviews with a cross section of Aboriginal peoples and health professionals conducted during a 2-year period. The findings provide an overview of the palliative care services that are presently available and reflect a serious lack of local, culturally appropriate palliative care services. This research shows the similarities in the struggles and difficulties faced by Australian Aboriginals and Indigenous peoples worldwide. The hope is that the suggestions put forward for improvement will one day be useful for the world's Indigenous peoples.
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Acessibilidade aos Serviços de Saúde , Serviços de Saúde do Indígena/provisão & distribuição , Área Carente de Assistência Médica , Havaiano Nativo ou Outro Ilhéu do Pacífico , Cuidados Paliativos/organização & administração , Serviços de Saúde Rural/provisão & distribuição , Continuidade da Assistência ao Paciente , Estudos Transversais , Diversidade Cultural , Humanos , Entrevistas como Assunto , Northern Territory , Pesquisa QualitativaRESUMO
OBJECTIVES: The findings are drawn from a 2-year research project, funded by the National Health and Medical Research Council (NHMRC), which aimed to develop an innovative model for Indigenous palliative care. The findings presented in this article explore one important strategy for putting Aboriginal families and their communities at the centre of the model: that is, the employment of Aboriginal Health Workers (AHWs) in relation to the provision of palliative care in the Northern Territory. METHODS: The data were collected from 72 qualitative interviews conducted throughout the regional, rural and remote areas of the Northern Territory with Indigenous patients and carers in the Northern Territory and the health professionals who care for them. RESULTS: While highlighting the valuable role of AHWs, the findings emphasise that the current lack of availability of such workers for palliative care provision for Indigenous peoples needs serious consideration.
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Pessoal Técnico de Saúde/provisão & distribuição , Serviços de Saúde Comunitária , Serviços de Saúde do Indígena , Havaiano Nativo ou Outro Ilhéu do Pacífico , Cuidados Paliativos , Emprego , Humanos , Entrevistas como Assunto , Área Carente de Assistência Médica , Northern Territory , Inovação Organizacional , Seleção de Pessoal , Recursos HumanosRESUMO
With regards to end-of-life care, there is scant published research that looks specifically at the provision of palliative care services for Indigenous people. In addition, for Indigenous people in the rural and remote areas there is only limited literature that focuses on the problems associated with geography. To address the hiatus in the literature on Aboriginal, rural and remote palliative care, the following article provides findings from a two-year research project, funded by Australia's National Health and Medical Research Council (NH&MRC), which developed an innovative model for Indigenous palliative care. The data was collected through a qualitative methodology (descriptive phenomenology) which involved open-ended in-depth interviews, audio-recorded, transcribed verbatim and thematically analysed. The sub-set of findings from the study presented in this paper examine issues in relation to the many practical obstacles in relation to palliative care service provision to Indigenous people in the rural and remote areas. The findings are a testament to the ingenuity and dedication of those who provide end-of-life care for Aboriginal peoples in rural and remote locations. The information about the many obstacles associated with equipment, power, transport, distance and telephone access provide important insights to inform the development of health policy planning and funding. The topic is specifically relevant to nurses as further findings from the study indicate that clinic and community nurses are key health professionals providing care to Indigenous people in the rural and remote areas.
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Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Havaiano Nativo ou Outro Ilhéu do Pacífico , Avaliação das Necessidades , Cuidados Paliativos/organização & administração , Serviços de Saúde Rural/organização & administração , Estudos Transversais , Fontes de Energia Elétrica/economia , Equipamentos e Provisões/economia , Humanos , Queensland , Meios de TransporteRESUMO
Whilst access to respite care has been found to represent an important source of support for terminally ill patients and their families, the availability of these services to Indigenous Australians has to date remained undocumented. This potential need for respite in Indigenous communities was explored as part of a National Health and Medical Research Council (NH&MRC) funded study designed to develop an innovative model for Indigenous palliative care. The data needed for model development were collected through a series of open-ended, qualitative interviews conducted with a cross-section of consumers and health professionals within the Northern Territory, Australia. The findings reflected a serious need for Indigenous respite services, coupled with a severe deficiency in the present availability of these services, especially within rural and regional areas. This lack of local respite services was documented to be negatively impacting upon the ability of carers to fulfil their caring duties and was found placing undue physical, emotional and economic stress upon carers, patients and their families. Furthermore, the lack of access to local respite services documented was found to be forcing rural and regional patients to relocate to metropolitan areas away from the family, community and land to which strong ties are held. The lack of Indigenous respite services was also found to obstruct patients' and carers' wishes for death to occur in the local community, rather than in far away cities. Significant obstacles were found to be hindering the provision of respite care to Indigenous Australians, namely beliefs about families looking after their own, resource restrictions, limited staff availability in local areas, as well as problems associated with hostel use in metropolitan areas. The conclusions drawn from this study suggest the importance of tackling the obstacles preventing local respite services being established in areas close to where patients and carers live.
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Havaiano Nativo ou Outro Ilhéu do Pacífico , Cuidados Intermitentes/provisão & distribuição , Assistência Terminal , Estudos Transversais , Humanos , Entrevistas como Assunto , Northern Territory , Cuidados Paliativos , População RuralRESUMO
Although the incidence of cancer in Indigenous peoples is similar to its incidence in the overall Australian population, Indigenous peoples are less likely to access early detection and medical interventions resulting in higher mortality and morbidity rates. To explore and address this discrepancy, the National Health and Medical Research Council funded a research study to examine Indigenous peoples' views of cancer and cancer treatments with an end goal of developing an innovative model of Indigenous Palliative Care. Seventy-two participants were interviewed from four geographical areas within the Northern Territory (Australia) including patients, caregivers, Indigenous and non-Indigenous health care workers, and interpreters. Indigenous peoples' views of cancer have to be examined within a historical, socio-political, and cultural context. There is no Indigenous word for cancer and the Western biomedical language that semantically constructs the notion of cancer is not widely understood. Additionally, for many Indigenous people, the aetiology of cancer is embedded in beliefs about the spiritual world of curses and payback from perceived misdeeds. The paper advocates for cross-cultural education initiatives, stressing the importance of a two way education strategy incorporating a process whereby medical and nursing personnel would improve their understanding of Indigenous peoples' view of cancer and Indigenous peoples would learn more about prevention and treatment of cancer from a biomedical perspective.
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Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , Neoplasias/psicologia , Austrália , Cuidadores , Coleta de Dados , Ética Médica , Humanos , Neoplasias/enfermagem , Cuidados PaliativosRESUMO
OBJECTIVES: To explore communication issues faced by health care workers and Indigenous patients and their families in a palliative care setting. Effective communication with Aborigines is especially important because Aboriginal beliefs of health and sickness are so different from Western views. METHOD: Data were collected from 72 qualitative interviews conducted throughout the regional, rural and remote areas of the Northern Territory with Indigenous patients and carers and the health professionals who care for them. RESULTS: Participants highlighted the struggle associated with effective communication when working in a cross-cultural setting at the interface of Indigenous and Western health care. The findings record the wisdom and insight from practitioners who have extensive experience dealing with communication difficulties.
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Comunicação , Havaiano Nativo ou Outro Ilhéu do Pacífico , Assistência Terminal/organização & administração , Doente Terminal/psicologia , Austrália , Humanos , Relações Profissional-PacienteRESUMO
AIMS: This study set out to explore the attitudes toward a "Patient Stories" DVD as a psychosocial support initiative for patients diagnosed with a hematological malignancy. DESIGN: A qualitative research design was employed through a series of open-ended interviews and one focus group. PARTICIPANTS: Participants were purposively sampled from a database of patients maintained by the Leukaemia Foundation of Queensland. In total, there were 50 participants (n=26 male, n=24 female), which represented the following major hematological diagnostic groups: multiple myeloma (n=15), lymphoma (n=14), leukemia (n=17), and other (n=4). Of the overall cohort, 11 participants had undergone a bone marrow transplant, and 15 had undergone a stem cell transplant (allogeneic and autologous transplants). RESULTS AND CONCLUSION: Most participants believed that a "Patient Stories" DVD would be a beneficial and effective way for nurses delivering psychosocial support to hematology patients. Such benefits included a sense of normalization from hearing similar stories and providing convenient support that did not require travel or potentially uncomfortable social situations. However, some participants did not show interest in the idea for reasons such as already having a local support system and not wanting to watch potentially frightening stories.
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Neoplasias Hematológicas/psicologia , Disseminação de Informação/métodos , População Rural , Apoio Social , Adulto , Idoso , Feminino , Neoplasias Hematológicas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Queensland , Adulto JovemRESUMO
Issues associated with speech and language have been noted in the international literature as an important aspect of the process of integration for Australian International Medical Graduates (IMGs). This paper makes a contribution through the presentation of a sub-set of findings on the factors associated with speech and language practices for IMGs, taken from a qualitative study which examined the IMGs' experience of integration into the Australian healthcare system. A purposive sample of 30 IMGs were interviewed via telephone. Participants were asked to share their experience with communicating in English with patients and other health professionals in the context of the Australian healthcare system. The taped interviews were transcribed verbatim and then coded and thematically analysed. The findings indicate that the months following the point of entry into a medical position are a critical time for the majority of IMGs in terms of difficulties with communicating in English. A range of suggestions to improve speech and language skills for IMGs is provided. The findings emphasize the importance of speech and language skills and the serious implications of this issue for the clinical practice of IMGs.