Clinicians' accounts of communication with patients in end-of-life care contexts: A systematic review.

OBJECTIVE: Communication between patients and end-of-life care providers requires sensitivity given the context and complexity involved. This systematic review uses a narrative approach to synthesise clinicians' understandings of communication in end-of-life care. METHODS: A systematic, narrative synthesis approach was adopted given the heterogeneity across the 83 included studies. The review was registered prospectively on PROSPERO (ID: CRD42019125155). Medline was searched for all articles catalogued with the MeSH terms "palliative care," "terminal care" or "end-of-life care," and "communication". Articles were assessed for quality using a modified JQI-QARI tool. RESULTS: The findings highlight the centrality and complexity of communication in end-of-life care. The challenges identified by clinicians in relation to such communication include the development of skills necessary, complexity of interpersonal interactions, and ways in which organisational factors impact upon communication. Clinicians are also aware of the need to develop strategies for interdisciplinary teams to improve communication. CONCLUSION: Training needs for effective communication in end-of-life contexts are not currently being met. PRACTICE IMPLICATIONS: Clinicians need more training to address the lack of skills to overcome interactional difficulties. Attention is also needed to address issues in the organisational contexts in which such communication occurs.

'Not in the room, but the doctors were': an Australian story-completion study about consumer representation.

Current mental health policy requires consumer involvement in all levels of health service management (i.e. planning, implementation, delivery and evaluation). However, current models often limit consumers to 'representation' roles that are criticized for silencing consumer views. This study compares understandings of consumer representatives' and health professionals' participation in decision-making processes in the mental health sector in Australia. Story completion methods were employed, with 34 participants (21 consumers, 8 health professionals and 5 people identifying both as consumer and health professional) completing a story stem about either a consumer representative or a health professional changing a committee meeting agenda. Using a thematic approach, three overarching themes were developed: how consumer representative roles remain unvalued, how such lack of value translates to not achieving co-production and how consumer representative roles can be better supported through allyship or subversion against organizational cultural norms. Findings suggest that organizational cultural norms in health settings need to be more inclusive of consumers to maximize the benefits of partnerships and fulfil policy expectations. Two methods for greater empowerment of consumers working in mental health are through allyship with non-consumer health professionals who support the goals of the consumer movement, and subversion of current practices.

Social shedding: Identification and health of men's sheds users.

OBJECTIVE: Extant research has previously found several benefits of community Men's Sheds. Drawing on social identity theory, we examine the extent to which membership in Men's Sheds can influence the quality of life of Men's Sheds users. METHOD: We surveyed 322 Men's Sheds users in Australia on 4 quality of life domains and their willingness to take health advice offered at the sheds. RESULTS: Social identity was found to be a significant predictor of physical health, psychological, social relationships, and environmental domains of quality of life, as well as willingness to accept health advice. CONCLUSIONS: Our exploratory findings enrich the existing knowledge on the benefits of community men's groups. We highlight the potential importance of social identity (particularly ingroup ties) among Men's Sheds members. These initial insights may be beneficial for future research and the promotion of men's engagement with health information and practice.