Making community palliative and end-of-life care sustainable; investigating the adaptability of rural Australian service provision.

With the increased attention and demand on community-based palliative and end-of-life (EOL) care services comes the question of how to ensure their sustainability. Sustainability has three key attributes: acceptability, affordability and adaptability. Having established the acceptability and affordability of the community-based service, this paper focussed on adaptability, as the remaining issue affecting long-term sustainability. The aim of this study was to identify components of the palliative and EOL service which require adaptability to ensure long-term sustainability for the service. A mixed methods approach was used for this study. Semi-structured interviews were conducted with family members. Semi-structured focus groups and interviews were held with health professionals. Patient data were included to describe frequency and nature of contacts. The results were analysed using descriptive analysis. The setting was a rural town in Victoria, Australia. Nine family members were interviewed, and 16 health professionals were interviewed or took part in a focus group. Patient data included 121 participants. Four themes were identified: the uniqueness of the patient, workforce issues, collaboration between services and symptom and pain management. All themes indicated that the palliative and EOL service faces challenges which may threaten the sustainability of the service and require adaptability. Families regard palliative and EOL care as special and valued, and appreciate the endeavour, care and support taken to assist their loved one to die with dignity regardless of the location and setting. With sufficient attention paid to the adaptability of the service, community palliative and EOL care service can become more sustainable, thus offering choice and dignity for people approaching the end of life.

Factors influencing the engagement of cancer patients with advance care planning: A scoping review.

INTRODUCTION: Advance care planning (ACP) is increasingly regarded as the best way to optimise end-of-life (EOL) care. Studies have examined a multitude of factors impacting on the lagging uptake of ACP. In the current study, we specifically focused on patient factors related to the uptake of ACP in adult cancer patients. METHODS: A scoping review was conducted, for which we searched the CINAHL, Cochrane, MEDLINE and PsycINFO databases (January 2013-December 2018). Studies exploring patient-related factors influencing the uptake of ACP in cancer patients were eligible for inclusion. RESULTS: Eleven papers and two overarching themes: person-related (e.g. socio-demographic) factors and "comprehension and awareness," were identified. White, well-educated patients with a support network were more likely to be involved in ACP. However, there is limited comprehension and awareness among cancer patients regarding ACP. CONCLUSIONS: The identified themes warrant a tailored approach to ACP. With regard to person-related factors, the existing body of knowledge on health literacy, disparities and shared decision-making should be used when designing strategies to improve ACP uptake. Further, our findings regarding "comprehension and awareness" suggest that ACP should not be limited to a narrow process without acknowledging the complexity surrounding personalised cancer care near the EOL.