The cancer nursing workforce in Australia: a national survey exploring determinants of job satisfaction.

BACKGROUND: To maintain and improve the quality of the cancer nursing workforce, it is crucial to understand the factors that influence retention and job satisfaction. We aimed to investigate the characteristics of cancer nurses in Australia and identify predictors of job satisfaction. METHODS: We analysed data from an anonymous cross-sectional survey distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The survey was compared to national nursing registration data. Data were analysed with non-parametric tests, and a stepwise, linear regression model was developed to best predict job satisfaction. RESULTS: Responses were received from 930 cancer nurses. Most respondents (85%) described themselves as experienced nurses, and more than half had post-graduate qualifications. We identified individual, organizational, and systemic factors that contribute to job satisfaction and can impact in workforce shortages. The findings include strategies to address and prioritize workforce challenges. There were 89 different titles for advanced practice nursing roles. Managing high workload was a reported challenge by 88%. Intention to stay less than 10 years was reported by nearly 60%; this was significantly correlated with job satisfaction and age. Significantly higher scores for job satisfaction were associated with those who had career progression opportunities, career development opportunities, adequate peer support and a clearly defined scope of role. Conversely, job satisfaction scores decreased the more people agreed there was a lack of leadership and they had insufficient resources to provide quality care. CONCLUSION: Cancer nurses are critical to the delivery of cancer care however, the workforce faces multiple challenges. This study provides an understanding of the Australian cancer nursing workforce characteristics, their roles and activities, and highlights important considerations for retaining nurses in the profession.

A Consensus on Stomal, Parastomal, and Peristomal Complications.

OBJECTIVE: To establish a consensus on terminology used to define stomal, parastomal, and peristomal complications in Australia. METHODS: A list of stomal, parastomal, and peristomal complications was generated through group dialogue, which was informed by clinical and academic knowledge of the researchers. An extensive literature review was undertaken to identify any additional terms and to create a database of definitions/descriptions. A library of images related to the identified conditions was generated. An online Delphi process was conducted among a representative, purposive sample of Australia expert wound, ostomy, and continence nurses and colorectal surgeons. Ten terms were presented to the panel with descriptive photographs of each complication. Up to three Delphi rounds and, if necessary, a priority voting round were conducted. RESULTS: Seven of the 10 terms reached agreement in the first round. One term ( allergic dermatitis ) was refined ( allergic contact dermatitis ) and reached agreement in the second round. Two terms ( mucocutaneous granuloma and mucosal granuloma ) were considered by the panel to be the same condition in different anatomical locations and were combined as one term ( granuloma ). Two terms ( skin stripping and tension blisters ) were combined as one term ( medical adhesive-related skin injury ) and reached agreement in round 2. CONCLUSIONS: A consensus in terminology used to describe stomal or parastomal/peristomal complications will enhance communication among patients and health professionals and advance opportunities for education and benchmarking of stomal, parastomal, and peristomal complications nationally.

Midwifery knowledge of equitable and culturally safe maternity care for Aboriginal women.

BACKGROUND: The Birthing on Noongar Boodjar project (NHMRC Partnership Project #GNT1076873) investigated Australian Aboriginal women and midwives' views of culturally safe care during childbearing. This paper reports on midwifery knowledge of Aboriginal women's cultural needs, their perceptions of health systems issues, and their ability to provide equitable and culturally safe care. METHOD: A qualitative study framed by an Indigenous methodology and methods which supported inductive, multilayered analyses and consensus-driven interpretations for two clinical midwife data groups (n = 61) drawn from a larger project data set (n = 145) comprising Aboriginal women and midwives. FINDINGS: Midwives demonstrated limited knowledge of Aboriginal women's cultural childbearing requirements, reported inadequate access to cultural education, substituted references to women-centered care in the absence of culturally relevant knowledge and consistently expressed racialized assumptions. Factors identified by midwives as likely to influence the midwifery workforce enabling them to provide culturally safe care for Aboriginal women included more professional development focused on improving understandings of cultural birth practices and health system changes which create safer maternal health care environments for Aboriginal women. CONCLUSIONS: Individual, workforce, and health systems issues impact midwives' capability to meet Aboriginal women's cultural needs. An imperative exists for effective cultural education and improved professional accountability regarding Aboriginal women's perinatal requirements and significant changes in health systems to embed culturally safe woman-centered care models as a means of addressing racism in health care.

Reliability and criterion-related validity testing (construct) of the Endotracheal Suction Assessment Tool (ESAT©).

AIMS AND OBJECTIVES: To establish criterion-related construct validity and test-retest reliability for the Endotracheal Suction Assessment Tool© (ESAT©). BACKGROUND: Endotracheal tube suction performed in children can significantly affect clinical stability. Previously identified clinical indicators for endotracheal tube suction were used as criteria when designing the ESAT©. Content validity was reported previously. The final stages of psychometric testing are presented. DESIGN: Observational testing was used to measure construct validity and determine whether the ESAT© could guide "inexperienced" paediatric intensive care nurses' decision-making regarding endotracheal tube suction. Test-retest reliability of the ESAT© was performed at two time points. METHODS: The researchers and paediatric intensive care nurse "experts" developed 10 hypothetical clinical scenarios with predetermined endotracheal tube suction outcomes. "Experienced" (n = 12) and "inexperienced" (n = 14) paediatric intensive care nurses were presented with the scenarios and the ESAT© guiding decision-making about whether to perform endotracheal tube suction for each scenario. Outcomes were compared with those predetermined by the "experts" (n = 9). Test-retest reliability of the ESAT© was measured at two consecutive time points (4 weeks apart) with "experienced" and "inexperienced" paediatric intensive care nurses using the same scenarios and tool to guide decision-making. RESULTS: No differences were observed between endotracheal tube suction decisions made by "experts" (n = 9), "inexperienced" (n = 14) and "experienced" (n = 12) nurses confirming the tool's construct validity. No differences were observed between groups for endotracheal tube suction decisions at T1 and T2. CONCLUSION: Criterion-related construct validity and test-retest reliability of the ESAT© were demonstrated. Further testing is recommended to confirm reliability in the clinical setting with the "inexperienced" nurse to guide decision-making related to endotracheal tube suction. RELEVANCE TO CLINICAL PRACTICE: The ESAT© is the first validated tool to systematically guide endotracheal nursing practice for the "inexperienced" nurse.

Content validity testing of the ESAT©: A decision aid tool for performing endotracheal suction in children.

BACKGROUND AND PURPOSE: Endotracheal tube suction performed in children can affect clinical stability. Previous research has identified clinical indicators used to perform endotracheal suction. These were used to develop the Endotracheal Suction Assessment Tool© (ESAT©). This study sought to evaluate the degree to which the ESAT© items as a whole constitute an operational definition of the construct used to determine whether a paediatric intensive care nurse should perform the endotracheal tube suction procedure. METHODS: Lynn's process for calculation of content validity and scale content validity index using a team of expert reviewers was adopted. Experts were drawn from paediatric intensive care units in Australia (n=6), United Kingdom (n=1), Switzerland (n=1) and Canada (n=1). These experts established the content validity index of the Endotracheal Suction Assessment Tool© using a minimum preset a-priori criterion agreement of 0.78 and a scale content validity index of 0.8. Scale content validity index was used to enhance the interpretability of the content validity data. RESULTS: All 15 items achieved the preset a-priori agreement for apparent internal consistency. Minor adjustments were required to improve the clarity of four items. The content validity index ranged from 0.8 to 1.0 and scale content validity index ranged from 0.9 to 1.0 for all items. CONCLUSION: Item and scale content validity indexes of the tool were established. Further psychometric testing for construct validity and stability over time is required to establish clinical utility of the tool and practice of novice paediatric intensive care nurses and other PIC health professionals.

The Women's wellness after cancer program: a multisite, single-blinded, randomised controlled trial protocol.

BACKGROUND: Despite advances in cancer diagnosis and treatment have significantly improved survival rates, patients post-treatment-related health needs are often not adequately addressed by current health services. The aim of the Women's Wellness after Cancer Program (WWACP), which is a digitised multimodal lifestyle intervention, is to enhance health-related quality of life in women previously treated for blood, breast and gynaecological cancers. METHODS: A single-blinded, multi-centre randomized controlled trial recruited a total of 351 women within 24 months of completion of chemotherapy (primary or adjuvant) and/or radiotherapy. Women were randomly assigned to either usual care or intervention using computer-generated permuted-block randomisation. The intervention comprises an evidence-based interactive iBook and journal, web interface, and virtual health consultations by an experienced cancer nurse trained in the delivery of the WWACP. The 12 week intervention focuses on evidence-based health education and health promotion after a cancer diagnosis. Components are drawn from the American Cancer Research Institute and the World Cancer Research Fund Guidelines (2010), incorporating promotion of physical activity, good diet, smoking cessation, reduction of alcohol intake, plus strategies for sleep and stress management. The program is based on Bandura's social cognitive theoretical framework. The primary outcome is health-related quality of life, as measured by the Functional Assessment of Cancer Therapy-General (FACT-G). Secondary outcomes are menopausal symptoms as assessed by Greene Climacteric Scale; physical activity elicited with the Physical Activity Questionnaire Short Form (IPAQ-SF); sleep measured by the Pittsburgh Sleep Quality Index; habitual dietary intake monitored with the Food Frequency Questionnaire (FFQ); alcohol intake and tobacco use measured by the Australian Health Survey and anthropometric measures including height, weight and waist-to-hip ratio. All participants were assessed with these measures at baseline (at the start of the intervention), 12 weeks (at completion of the intervention), and 24 weeks (to determine the level of sustained behaviour change). Further, a simultaneous cost-effectiveness evaluation will consider if the WWACP provides value for money and will be reported separately. DISCUSSION: Women treated for blood, breast and gynaecological cancers demonstrate increasingly good survival rates. However, they experience residual health problems that are potentially modifiable through behavioural lifestyle interventions such as the WWACP. TRIAL REGISTRATION: The protocol for this study was registered with the Australian and New Zealand Clinical Trials Registry, Trial ID: ACTRN12614000800628 , July 28, 2014.

Models of survivorship care provision in adult patients with haematological cancer: an integrative literature review.

PURPOSE: Increasing numbers of haematology cancer survivors warrants identification of the most effective model of survivorship care to survivors from a diverse range of haematological cancers with aggressive treatment regimens. This review aimed to identify models of survivorship care to support the needs of haematology cancer survivors. METHOD: An integrative literature review method utilised a search of electronic databases (CINAHL, Medline, PsycInfo, PubMed, EMBASE, PsycArticles, and Cochrane Library) for eligible articles (up to July 2014). Articles were included if they proposed or reported the use of a model of care for haematology cancer survivors. RESULTS: Fourteen articles were included in this review. Eight articles proposed and described models of care, and six reported the use of a range of survivorship models of care in haematology cancer survivors. No randomised controlled trials or literature reviews were found to have been undertaken specifically with this cohort of cancer survivors. There was variation in the models described and who provided the survivorship care. CONCLUSION: Due to the lack of studies evaluating the effectiveness of models of care, it is difficult to determine the best model of care for haematology cancer survivors. Many different models of care are being put into practice before robust research is conducted. Therefore, well-designed high-quality pragmatic randomised controlled trials are required to inform clinical practice.

Identifying psychosocial risk among mothers in an Australian private maternity setting: A pilot study.

BACKGROUND: Psychosocial assessment and depression screening are recommended for all pregnant and postnatal women in Australia. However, women who give birth in private maternity settings remain less likely to participate in psychosocial assessment programs, making it difficult to comment on the potential resource implications. AIMS: To describe the psychosocial profile of a sample of women who had recently given birth in a private hospital and to examine the acceptability and feasibility of introducing psychosocial assessment as a routine component of maternity care. MATERIALS AND METHODS: Two hundred and twenty participants were recruited in a four-month period from a private tertiary hospital located in Murdoch, Western Australia. All participants completed the Edinburgh Depression Scale (EDS) and a Antenatal Risk Questionnaire (ANRQ) prior to discharge via an iPad. RESULTS: The mean total score for the EDS was 4.77 (SD = 3.93), with 5% of women scoring above the recommended cut-off of 13 or more. The mean total score for the ANRQ was 17.73 (SD = 10.72). 45.0% of all women endorsed no significant risk factors. The proportion of women scoring above the recommended ANRQ cut-off of 23 or more was 32.3%. Approximately 11% of women were referred for additional support or treatment. Acceptability of the ANRQ was high at 97.3%. CONCLUSIONS: This study describes the psychosocial profile of a sample of women who recently gave birth in an Australian private maternity hospital and demonstrates that with additional resources, the implementation of psychosocial assessment as a routine component of maternity care was feasible and highly acceptable in this setting.

Developing a research agenda for nursing and midwifery: a modified Delphi study.

AIM: We sought to ascertain the nursing and midwifery research priorities at a large private tertiary hospital in Australia. DESIGN: A modified Delphi technique with two rounds of questionnaires. METHODS: The first round survey was distributed to 448 nurses and midwives with a 19.2% (n=86) response rate. Due to a low response rate in some specialties, the second round of the Delphi was only sent to nurses in the Learning and Organisational Development speciality who were asked to rank 10 identified topics specific to Learning and Organisational Development using a five point Likert-type scale. RESULTS: Two hundred and fifty seven topics were identified in Round One and were condensed to 181 topics. Each topic was assigned to one of four categories: clinical audit; existing evidence base; research; or other topics which fell beyond the bounds of nursing or midwifery research. Twenty three research topics were identified with priorities focusing on learning and development and workforce issues. CONCLUSION: Priorities were congruent with the organisation's strategic workforce focus. Topics identified in this study will ensure that the nursing and midwifery research conducted at the study setting is relevant and reflects priorities as determined by clinical nurses and midwives.

Cancer Nurses' Voices and Recommendations to Address Workforce Challenges: A Qualitative Analysis.

OBJECTIVES: Amidst the fulfilment of making a positive impact on patients' lives, cancer nurses also contend with high workloads, limited resources, and barriers to career advancement. Understanding the perceptions of cancer nurses is essential in addressing these challenges and fostering an environment that promotes both professional satisfaction and optimal patient care. Our aim was to explore Australian cancer nurses' experiences and perspectives of workforce challenges and their proposed solutions to address them. METHODS: The Cancer Nurses Society Australia workforce cross-sectional survey was distributed online in 2022 through professional networks and social media. Free text responses to open-ended questions were analyzed using qualitative content analysis and inductive processes. RESULTS: Responses from 601 cancer nurses highlight the intricate interplay between rewards and obstacles experienced by the profession and identify key areas for improvement. Positive and negative quotes highlight the passion of cancer nurses which were summarized into themes and subthemes: 1) Finding fulfilment while struggling against the tide. While feeling undervalued and facing workload pressures, burnout and limited opportunities for career progression, nurses express love for their jobs, finding it rewarding yet emotionally challenging. 2) Grassroots solutions versus organizational inertia. Proposed solutions included addressing nurse-to-patient ratios, proactive succession planning, more specific education, dedicated time for learning, and mentorship and career development programs. Perceived barriers to initiatives included lethargic management and resistance to change. Networking opportunities, appropriate remuneration, and interdisciplinary teamwork with an appreciation of individual expertise are desired. CONCLUSIONS: Our findings give a voice to the cancer nurses of Australia. Nurses identified a range of solutions to address workforce challenges. IMPLICATIONS FOR NURSING PRACTICE: Addressing the systemic issues that contribute to high workload and impede nurses' well-being and their recognition, and promoting policies to support professional growth will increase satisfaction, enhance patient care outcomes, and contribute to a sustainable workforce.

Negative stereotyping of older nurses despite contact and mere exposure: the case of nursing recruiters in Western australia.

Ageist attitudes have been identified across different industries. The nursing profession has a high proportion of older workers. As this facilitates regular contact with, as well as exposure to, older nurses, it may be expected to show less ageism. This study investigated 163 Western Australian nursing recruiters' attitudes toward older nurses. Results showed clear evidence of both negative and positive stereotyping of older nurses. Nursing recruiters indicated that they would be more than likely to hire older nurses and that age was less relevant in making hiring decisions. These findings suggest that enhancing the employability of older workers does not necessarily change ageist attitudes. This is relevant to policy formulation, attitude change interventions, and the well-being of older workers.

Neurological patient and informal caregiver quality of life, and caregiver burden: A cross-sectional study of postdischarge community neurological nursing recipients.

Neurological conditions produce considerable disease burden.To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden.A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview.Most patients and caregivers rated quality of life as 'Good'. The patients' physical, psychological and environment domain scores, and caregivers' physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression.A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity.

Incidence and Associated Risk Factors for Falls in Older Adults After Elective Total Knee Replacement Surgery: A Prospective Cohort Study.

OBJECTIVE: The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 mos after elective, primary total knee replacement surgery. DESIGN: A prospective observational cohort of older adults undergoing total knee replacement were followed. Baseline measurements included risk factors of history of falls, using a gait aid and number of medications. Falls data were recorded after discharge for 12 mos alongside patient reported outcomes (Oxford Knee Score). Analyses used logistic and negative binomial regression modeling. RESULTS: There were 267 participants (mean age = 70 [6.7] yrs) enrolled. Participants who fell (n = 102 [40.6%]) reported 200 falls in the 12 mos after surgery. The incidence of falls was 2.4 falls per 1000 patient days in the 12 mos after surgery, with the highest incidence (2.6 falls per 1000 patient days) in month 1. Risk factors for falling were a history of falls (adjusted odds ratio = 2.41, 95% confidence interval = 1.35-4.31) and number of central nervous system acting medications taken before surgery (adjusted odds ratio = 1.66, 95% confidence interval = 1.25-2.21). Using a walking aid at baseline was associated with falls after discharge (adjusted incident rate ratio = 2.38, 95% confidence interval = 1.57-3.60). CONCLUSIONS: Older adults experience a high incidence of falls after elective total knee replacement. Further research that investigates falls prevention after total knee replacement is required.

Bowel management post major joint arthroplasty: A randomised controlled trial to test two pre-admission bowel regimens.

BACKGROUND: The length of stay for patients undergoing joint arthroplasty has reduced but there is a paucity of knowledge relating to bowel management within this enhanced recovery framework. AIM: The study's primary aim was to determine which of two dosage regimens of macrogol (Movicol®) commenced pre-operatively is most effective in facilitating a return to normal bowel function. PROCEDURE: Ninety-one eligible patients were randomised to one of three groups: 1) commence macrogol one sachet in the morning for two days prior to surgery; 2) commence macrogol one sachet, morning and evening of the day prior to surgery; or 3) control group. RESULTS: Seventy-seven percent of patients in group one, and 83% of group two had returned to normal bowel function by one-week post discharge compared to 70% of control patients (p = .470). Participants in group one required less aperients in the week following discharge compared with the other two groups although the result was not statistically significant (p = .060). CONCLUSION: Despite not reaching statistical significance, the results are considered clinically significant. The authors recommend patients commence macrogol one sachet in the morning for the two days prior to admission for major joint arthroplasty and the Murdoch Bowel Protocol® continue to be followed for inpatients.

Symptom Burden and Unmet Needs in Malignant Pleural Mesothelioma: Exploratory Analyses From the RESPECT-Meso Study.

OBJECTIVE: Malignant Pleural Mesothelioma (MPM) has a poor prognosis and high symptom burden. RESPECT-Meso was a multicenter randomized study examining the role of early specialist palliative care (SPC) on quality of life (QoL) with MPM. This is a post-hoc exploratory analysis of the symptom burden and unmet needs identified from RESPECT-Meso participants. METHODS: Exploratory analysis from 174 participants using the General Health Status (GHS) measure (from the EORTC QLQ-C30 QoL questionnaire) and 87 participants using validated assessment questionnaires in those randomized to SPC. Eligibility for the study included confirmed MPM with diagnosis <6 weeks prior, performance score (PS) 0 or 1, no significant physical or psychological comorbidity. Cox proportional hazards models were derived to examine for relationships with survival. Free text was assessed using content analysis, looking for common themes and words. RESULTS: Participants were predominantly male (79.9%), mean age 72.8 years, PS was 0 in 38%, 78% of MPM was epithelioid. At least 3 symptoms were reported in 69.8% of participants, including fatigue (81%), dyspnea (73.3%), pain (61.2%), weight loss (59.3%). Anxiety was reported by 54.7% of participants, 52.3% low mood and 48.8% anhedonia symptoms. After multivariable adjustment, only pain remained statistically significant with a hazard ratio (HR) 2.9 (95% CI 1.3-6.7; p = 0.01). For each 1 unit increase in GHS score, the HR for death was 0.987 (0.978-0.996; p = 0.006), indicating a worse reported QoL is related to shorter survival. Unmet needs were common: 25.9% wanted more information about their condition, 24.7% about their care and 21.2% about their treatment. 79.1% were concerned about the effect of their illness on family. CONCLUSION: There is a high symptom burden in mesothelioma despite good baseline performance status. A worse QoL is associated with a worse survival. Unmet needs are common, perhaps highlighting a need for improved communication and information sharing.

Incidence and Associated Risk Factors for Falls in Older Adults Postdischarge Who Undergo Elective Total Hip Replacement Surgery-A Prospective Cohort Study.

BACKGROUND: Hip replacement surgery improves health-related quality of life; however, it has been suggested that falls rates increase after hospital discharge. The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 months after undergoing elective total hip replacement surgery. METHODS: A prospective observational cohort study was conducted. Participants were adults aged 60 years or older who underwent primary elective total hip replacement surgery in a private tertiary hospital in Perth, Australia. Baseline data collected immediately prior to discharge included use of walking aids, medications, and functional level of independence (using Katz and Lawton scales). Falls data were collected for 12 months using calendars and monthly phone calls. Data were analyzed using logistic and negative binomial regression modeling. RESULTS: Participants' ([n = 167], 54.4% female) mean age was 71.2 (±6.9) years. There were 51 (31%) participants who used a walking aid prior to surgery. There were 140 falls reported over 12 months by 67 (42%) participants, of which 90 (64.3%) were injurious (n = 9 fractures). The fall rate was 2.6 per 1000 patient-days. Age (adjusted odds ratio 1.10, 95% confidence interval 1.01-1.20) and hospital length of stay (adjusted odds ratio 1.24, 95% confidence interval 1.00-1.54).were significantly associated with sustaining multiple falls. CONCLUSIONS: More than 40% of older adults fell in the 12 months after elective hip replacement surgery although the cohort had low fall risk prior to surgery. Rehabilitation after hip replacement surgery should consider fall prevention.

An exploration of factors influencing adherence to highly active anti-retroviral therapy (HAART) among people living with HIV/AIDS in Northern Thailand.

This paper presents the first of a three-phase study exploring the experiences of people living with HIV/AIDS (PLWHA) in Northern Thailand. The principal aim of the study was to gain an in-depth understanding of the factors contributing to adherence in patients taking highly active anti-retroviral therapy (HAART). These insights were used in phase two to inform a number of interventions aimed at improving medication adherence in patients commencing HAART for the first time. The study comprised a cohort of 32 PLWHA over the age of 18 years who had taken HAART for at least three months. Both qualitative and quantitative methods were used. The qualitative component used a multiple case study approach to explore and describe the experiences of patients receiving HAART. The quantitative component comprised the Morisky Medication Adherence Scale and a demographic survey of the respondents. This demographic data were used to provide descriptive statistics of the research population and assist with the interpretation of the qualitative data. The findings identified a number of social, clinical, and economic factors influencing adherence to HAART. These findings led to a number of recommendations that health care providers and policy-makers can implement to improve medication adherence rates in patients taking HAART. The findings demonstrated that improved adherence not only led to improved clinical outcomes, but also the overall quality of life of PLWHA.

Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review.

BACKGROUND: General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. To enhance primary EoLC, the facilitators and barriers to their provision need to be understood. OBJECTIVE: To provide a comprehensive description of the facilitators and barriers to GP and GPN provision of PC or EoLC. METHOD: Systematic literature review. Data included papers (2000 to 2017) sought from Medline, PsycInfo, Embase, Joanna Briggs Institute and Cochrane databases. RESULTS: From 6209 journal articles, 62 reviewed papers reported the GP's and GPN's role in EoLC or PC practice. Six themes emerged: patient factors; personal GP factors; general practice factors; relational factors; co-ordination of care; availability of services. Four specific settings were identified: aged care facilities, out-of-hours care and resource-constrained settings (rural, and low-income and middle-income countries). Most GPs provide EoLC to some extent, with greater professional experience leading to increased comfort in performing this form of care. The organisation of primary care at practice, local and national level impose numerous structural barriers that impede more significant involvement. There are potential gaps in service provision where GPNs may provide significant input, but there is a paucity of studies describing GPN routine involvement in EoLC. CONCLUSIONS: While primary care practitioners have a natural role to play in EoLC, significant barriers exist to improved GP and GPN involvement in PC. More work is required on the role of GPNs.

General practice nurses and physicians and end of life: a systematic review of models of care.

BACKGROUND: General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. In order to maximise the impact of GPs and GPNs, the impact of different models of care that have been developed to support their practice of EoLC needs to be understood. OBJECTIVE: To examine published models of EoLC that incorporate or support GP and GPN practice, and their impact on patients, families and the health system. METHOD: Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. RESULTS: From 6209 journal articles, 13 papers reported models of care supporting the GP and GPN's role in EoLC or PC practice. Services and guidelines for clinical issues have mixed impact on improving symptoms, but improved adherence to clinical guidelines. National Frameworks facilitated patients being able to die in their preferred place. A single specialist PC-GP case conference reduced hospitalisations, better maintained functional capacity and improved quality of life parameters in both patients with cancer and without cancer. No studies examined models of care aimed at supporting GPNs. CONCLUSIONS: Primary care practitioners have a natural role to play in EoLC, and most patient and health system outcomes are substantially improved with their involvement. Successful integrative models need to be tested, particularly in non-malignant diseases. Such models need to be explored further. More work is required on the role of GPNs and how to support them in this role.