"Respecting our patients' choices": making the organizational decision to participate in voluntary assisted dying provision: findings from semi-structured interviews with a rural community hospice board of management.

BACKGROUND: There is limited literature around how palliative care organizations determine the degree to which they will interface with voluntary assisted dying in jurisdictions where it is legal. The aim of this research was to describe the experience of the board of management of an Australian community-based hospice during their decision-making process around whether to support voluntary assisted dying in the facility, prior to the legislation coming into operation. METHODS: The Board considered this decision over ten meetings in 2020, during which time they received information on the legislation, relevant literature, feedback from workshops which included the community, comment from hospice founders, staff survey results and presentations by clinicians able to discuss the impact of voluntary assisted dying on palliative care services. Members were encouraged to make notes of their own experiences during this time. Following this, semi-structured interviews were conducted with seven of the nine board members. Interviews were audio-recorded and transcribed verbatim and analysed using conventional qualitative content analysis method. RESULTS: The board members experienced a sense of journey in reaching an overall decision, which was to allow full participation in voluntary assisted dying provision for inpatients. Themes based on the journey motif included: starting from a personal view; moving to a hospice perspective; exploring if voluntary assisted dying can be part of end-of-life care; awareness and assessment of risks to the Hospice; arriving at a common platform to vote on; factors facilitating a safe decision-making journey; and personal impact of the journey. CONCLUSIONS: The group highlighted several facilitators of a successful outcome including having adequate time, the availability of useful resources, sound board processes and a trusting culture. The study may provide support to other healthcare organisations as they face similar decisions triggered by legislative change.

Being a safe place: a qualitative study exploring perceptions as to how a rural community hospice could respond to enactment of voluntary assisted dying legislation.

BACKGROUND: There is a lack of research to guide the implementation of voluntary assisted dying legislation within a hospice setting. Furthermore, there is limited published information related to the expectations of the community and staff to assist decision making regarding voluntary assisted dying in a community hospice. The aim of this study was to explore the expectations of staff, volunteers and members of the community as how a rural Australian community hospice could respond in relation to imminent enactment of Voluntary Assisted Dying legislation. METHODS: A total of 63 Hospice staff and volunteers and community members participated in 11 workshops. This qualitative study used the interpretive description method to analyse the workshop transcripts. RESULTS: While there was not a consensus view on community expectation, there was agreement among the participants for respect for a patient's individuality and choices. Furthermore, care offered in hospice needs to remain non-judgemental and patient focused regardless of whether voluntary assisted dying policy was implemented or not. Both opportunities and risks associated with implementation were identified by the participants. CONCLUSION: There was common ground around the respect for the dying person and the ideal of a "safe place" despite opposing views on what this may mean in practice. There is a need for clarity in organisational responses around policy, risk management, education, and staff support.

Satisfaction with general practitioner obstetrician-led maternity care in rural Western Australia.

OBJECTIVE: To measure satisfaction with general practitioner obstetrician-led maternity care in Western Australia and to explore perspectives of maternity service users DESIGN: Women were recruited at antenatal visits with their general practitioner obstetrician. Participants completed a validated three-part survey about their satisfaction with antenatal, intrapartum and postpartum care. They were all offered a semi-structured interview. SETTING: Nine general practitioner obstetrician practices located in regional Western Australia. PARTICIPANTS: 155 women receiving general practitioner obstetrician-led maternity care within the South West or Great Southern regions of Western Australia. 13 of these women also participated in an interview. MAIN OUTCOME MEASURES: We quantified satisfaction with aspects of antenatal, intrapartum and postpartum care using a Likert scale. Descriptive variables included demographic information and birth outcomes. Qualitative data described valued aspects of maternity care. RESULTS: 116 women completed all 3 surveys. General practitioner obstetrician-led care resulted in high rates of satisfaction across all 3 stages of care, with 78%-100% agreement with positively worded satisfaction statements. Thematic analysis identified four key aspects of care women valued when receiving maternity care: the woman-centred care experience, the skills of the general practitioner obstetrician, support from the health care team and the health care environment. CONCLUSION: General practitioner obstetrician-led maternity care is a highly regarded model of maternity care, valued by rural women with high rates of satisfaction.

Specialist haematology consultation services in regional Western Australia: evaluating a model combining telehealth and onsite clinics.

BACKGROUND: Models of care that increase specialist medical services to regional or remote patients are being explored worldwide. Many of the models include telehealth (also called telemedicine or video-conferencing consultations) alone or in combination with traditional face-to-face clinic visits. AIM: To report the experience of patients using telehealth consultation and costs associated with delivering the service in a Regional Cancer Centre over a 12-month period. METHODS: Patients attending a Great Southern haematology clinic between September 2018 and July 2019 were invited to complete a brief questionnaire about their demographic and diagnosis details. Those attending a telehealth clinic were invited to complete a Tele-Haematology Satisfaction Questionnaire and invited to participate in a face-to-face interview regarding their general experiences and thoughts related to telehealth and face-to-face consultations. Occasions of service costs and direct hospital expenses were provided by the central health service's telehealth office. RESULTS: The use of telehealth alone or as part of a mixed model was acceptable and convenient for most patients. In addition, high levels of satisfaction were reported including improved access to specialist services, reduced travel time and an ease of use of the telehealth system. The total cost saving was A$308 per occasion of service. CONCLUSIONS: The present study demonstrated that the model was effective in providing outpatient services and cost effective to the health service, while being experienced as a satisfactory model by patients.

Transition to adulthood for young people with intellectual disability: the experiences of their families.

Whilst the transition from school to adult roles can be challenging for any adolescent, for those with an intellectual disability it can present as a particularly difficult time both for the individual and their family. The process may involve coordinated planning, collaboration and decision-making among school staff, families and community agencies. This mixed-methods study utilised information from two cohorts: young people with Down syndrome in Western Australia (n = 190) and young people with intellectual disability (of any cause) in Queensland, Australia (n = 150). The parent-report questionnaires administered in both states comprised two parts: part 1 collected information about the individual with intellectual disability including information on health, functioning and service needs, and about specific transition related issues; and part 2 collected information about the health and well-being of their family. The majority (87 %) of parents said that they were involved in decision-making about transition planning but less than two-thirds (59.5 %) of young people were involved in this process. The three most helpful strategies indicated by parents that assisted with transition planning related to the provision of more information about financial assistance, the school transition program and the building of informal community-based supports. A number of themes emerged from the qualitative data which included parents' views and concerns about the capacity of their young adult to adapt and change to life in adulthood, their difficulty navigating services and programs, issues and challenges around their young person building connectedness, strain on family wellbeing and finances and worry about the longer term future.

Health in arts: are arts settings better than sports settings for promoting anti-smoking messages?

AIM: Tobacco smoking is a leading cause of preventable mortality and morbidity. Since 1991, the Western Australian Health Promotion Foundation (Healthway) has sponsored the arts and sport in exchange for cigarette smoke-free events, smoke-free policies and the promotion of anti-smoking messages (e.g. Quit, Smoke Free or Smarter than Smoking). As health promoters often look for innovative and effective settings to advocate health, and as the approach of sponsoring the arts to promote health to the general population is uncommon, the purpose of this study was to evaluate the effectiveness of 'health in arts' by measuring the cognitive impact (message awareness, comprehension, acceptance and intention) of promoting anti-smoking messages at arts events, and comparing findings to sports events, a more traditional health promotion setting. METHOD: A secondary analysis of the 2004-2009 Healthway Sponsorship Monitor data was conducted. A total of 12 arts events (n = 592 respondents) and 9 sports events (n = 420 respondents) sponsored by Healthway to promote an anti-smoking message were evaluated. The study was cross-sectional in design. Participants were residents of Western Australia aged 15 years or above and attended events as part of an audience or as a spectator. Descriptive and regression analyses were conducted. RESULTS: After adjustment for demographic variables, smoking status and clustering, arts events were found to be as effective in promoting anti-smoking message awareness, comprehension and acceptance and twice as effective on intention to act (p = .03) compared with sports events. CONCLUSION: This study provides evidence of the effectiveness of arts sponsorship to promote health to the general population, that is, health in arts. Promoting an anti-smoking message in arts settings was as, or more, effective than in sports settings. Results suggest that the arts should be utilised to communicate and reinforce anti-smoking messages to the general population. The suitability of the arts to promote other types of health messages should be investigated further.

Health conditions and their impact among adolescents and young adults with Down syndrome.

OBJECTIVE: To examine the prevalence of medical conditions and use of health services among young adults with Down syndrome and describe the impact of these conditions upon their lives. METHODS: Using questionnaire data collected in 2011 from parents of young adults with Down syndrome we investigated the medical conditions experienced by their children in the previous 12 months. Univariate, linear and logistic regression analyses were performed. RESULTS: We found that in addition to the conditions commonly experienced by children with Down syndrome, including eye and vision problems (affecting 73%), ear and hearing problems (affecting 45%), cardiac (affecting 25%) and respiratory problems (affecting 36%), conditions also found to be prevalent within our young adult cohort included musculoskeletal conditions (affecting 61%), body weight (affecting 57%), skin (affecting 56%) and mental health (affecting 32%) conditions and among young women menstrual conditions (affecting 58%). Few parents reported that these conditions had no impact, with common impacts related to restrictions in opportunities to participate in employment and community leisure activities for the young people, as well as safety concerns. CONCLUSION: There is the need to monitor, screen and provide appropriate strategies such as through the promotion of healthy lifestyles to prevent the development of comorbidities in young people with Down syndrome and, where present, to reduce their impact.

Hospital admissions in children with down syndrome: experience of a population-based cohort followed from birth.

OBJECTIVE: Children with Down syndrome, the most common genetic cause of intellectual disability, are prone to multiple and varied health-related problems. This study describes patterns of hospitalisations for children and young people with Down syndrome in Western Australia. METHODS: Birth records were linked to the Western Australian population-based Intellectual Disability database to identify all children born with Down syndrome in Western Australia between 1 January, 1983 and 31 December, 1999. These records were linked to the Hospital Morbidity Data System to provide information on all hospitalisations up to 31 December, 2004. Hospitalisation data, coded using ICD-9CM or ICD-10 (v0.5) were grouped into clinically relevant categories using the primary diagnosis. Rates of hospital admission for all and specific diagnoses were expressed in 1000-person-years at-risk and median age at first admission and length of stay were calculated. RESULTS: Of the 405 children, 395 had one or more hospital admissions, totalling 3786 admissions for all children and an estimated 39.5 person-years in hospital. On average, children were admitted 9.7 times, with an estimated rate of 757.2 admissions per 1000pyr (95% CI: 680, 843). A quarter of all admissions occurred in the first year of life. The average hospital length of stay was 3.8 days (95% CI: 3.7, 4.1). Upper respiratory tract conditions affected the most children (58.5%) and accounted for 12.1% of all admissions. Other disorders which affected a high percentage of children were ear/hearing conditions (50.6%), disorders of the oral cavity (38.0%) and lower respiratory tract conditions (37.5%). Overall, children with Down syndrome were hospitalised at a rate five times (95% CI = 4.3-6.2) that of the general population. CONCLUSION: Children with Down syndrome are at increased risk of morbidity for varied causes underlining the importance of comprehensive and targeted primary care for this group.

The epidemiology of injury among surfers, kite surfers and personal watercraft riders: wind and waves.

The objective of this review was to summarize the epidemiological literature for surfboard riding (surfing), kite surfing and personal watercraft (PWC) riding injuries and describe the incidence and nature of these injuries, common risk factors, and strategies for prevention. The databases searched for relevant publications included Medline, ScienceDirect, ProQuest International, PubMed, Academic Search Premier as well as Google Scholar to identify additional, non-indexed studies. Overall, there was a lack of good quality descriptive studies for these three sports and many of the studies reviewed involved the use of administrative datasets or case-series designs. Among the few studies to provide incidence estimates, there were inconsistencies in how injury was defined, the inclusion criteria, and the reporting of incidence rates, making comparisons within and between the sports difficult. While the reported incidence rates were generally low, head and lower extremity injuries were common across all three sports. Only two studies reported evidence for postulated risk factors. Bigger waves and surfing over rock or reef sea floor increased the risk of injury among competitive surfers, while older age and having more experience increased the risk of significant injuries among recreational surfers. No evaluations of preventative measures were identified. This review demonstrates the need for well-designed epidemiological research, especially studies that focus on the accurate measurement and description of incidence, nature, severity and circumstances of injuries. Once this has occurred, interventions targeted at reducing the incidence of injuries among these sports can be designed, implemented and evaluated.

Rapid ascent and buoyancy problems among Western Australian certified recreational divers.

INTRODUCTION: We investigated risk factors associated with ascending rapidly and/or losing buoyancy control among recreational divers. METHODS: Dive and diver information were collected and depth/time loggers attached to recreational divers. Case dives recording an ascent > 18 m per min were compared with control dives made at the same dive site and time by divers recording ascents ≤ 18 m per min. In a second analysis, case dives with reported buoyancy problems were compared with control dives during which no problems were reported. Conditional logistic regression identified factors significantly associated with ascending faster than 18 m per min or reporting a buoyancy problem. RESULTS: In total, 1,032 dive profiles were collected. Case dives (n = 71) recording an ascent > 18 m per min were compared with 282 control dives. The main risk factor for making a rapid ascent was a loss of buoyancy control. Case dives were also shorter. Dives resulting in reported buoyancy problems (n = 68 cases) were compared with 320 control dives. The three main risk factors for buoyancy problems were an inability to describe how to check for neutral buoyancy, reportedly not being in control during the final ascent and maximum ascent rates that were a mean of 20% faster than during control dives. CONCLUSIONS: Further research is necessary to identify if ascending rapidly is the result of a loss of buoyancy control, a lack of ascent rate reference or a failure to appreciate the potential consequences of ascending rapidly. The inability of many divers to describe how to check for neutral buoyancy also deserves attention.

Risk factors for running low on gas in recreational divers in Western Australia.

INTRODUCTION: The aim of this study was to investigate risk factors associated with running low on gas among certified recreational divers. METHODS: Dive and diver information were collected from divers joining organised recreational dives in Western Australia and depth/time loggers were attached to each diver. Case dives ending with < 50 bar in the cylinder were compared with control dives made at the same dive site and time by divers with > or = 50 bar remaining. A conditional logistic regression model identified factors significantly associated with running low on gas. RESULTS: In total, 1,032 dive profiles were collected. Case dives (n = 183) returning with < 50 bar were compared with 510 control dives ending with > or = 50 bar. Perceived workload was associated with rate of consumption of gas. Factors associated with a dive ending low on gas included: younger age; males; lower number of lifetime dives; a longer period since last dive; deeper maximum depth and breathing at a heavier rate. Eleven per cent of case divers, compared with 1% of control dives, reported surprise at the low remaining level of gas. CONCLUSIONS: Dive organisers are recommended to select dive sites based on the recent experience of the group and to encourage divers to monitor their remaining gas frequently, relative to the depth of the site. Divers are reminded that, if they perceive a strenuous workload, they should pay even closer attention to monitoring their gas reserves. That 89% of low-on-gas dives were reported to be no surprise to the divers making them warrants further investigation.

School site and the potential to walk to school: the impact of street connectivity and traffic exposure in school neighborhoods.

The impact of neighborhood walkability (based on street connectivity and traffic exposure) within 2 km of public primary schools on children regularly walking to school was examined. The most (n=13) and least walkable (n=12) schools were selected using a school-specific 'walkability' index and a cross sectional study undertaken of Year 5, 6 and 7 children (n=1480) and consenting parents (n=1332). After adjustment, regularly walking to school was higher in children attending schools in high walkable neighborhoods (i.e, high street connectivity and low traffic volume) (Odds ratio (OR) 3.63; 95% Confidence Interval (CI) 2.01-6.56), and less likely in neighborhoods with high connectivity but high traffic volume (OR 0.32; 95% CI 0.22-0.47). Connected street networks provide direct routes to school but when designed for heavy traffic, the potential for children to walk to school is reduced. This highlights the importance of carefully considering school siting and, particularly, street design in school neighborhoods.

Developing a tool to measure safe recreational boating practice.

To reduce the number of recreational boating injuries and incidents, appropriate educational measures are important to improve boat operator safety practice. A tool (the boating safety scale (BSS)) to measure safe practice was developed and tested among Western Australian recreational boaters. The BSS allowed the identification of factors influencing safety behaviour among recreational boaters. Using a database of registered recreational vessels, a telephone survey was conducted in 2008 among a sample of 1002 boat owners and a response fraction of 47.5% was achieved. The majority of boaters displayed a moderate level of safe boating behaviour based on BSS scores. Not being a member of a boating association and going boating less often in protected waters was associated with a higher level of boating safety behaviour. With further development, the BSS can provide information to assist is designing effective intervention strategies to reduce the number of boating-related fatalities, injuries and incidents.

Associations between intrapersonal and neighborhood environmental characteristics and cycling for transport and recreation in adults: baseline results from the RESIDE study.

BACKGROUND: This study investigated the relationship between individual and neighborhood environmental factors and cycling for transport and for recreation among adults living in Perth, Western Australia. METHODS: Baseline cross-sectional data from 1813 participants (40.5% male; age range 18 to 78 years) in the RESIDential Environment (RESIDE) project were analyzed. The questionnaire included information on cycling behavior and on cycling-specific individual, social environmental, and neighborhood environmental attributes. Cycling for transport and recreation were dichotomized as whether or not individuals cycled in a usual week. RESULTS: Among the individual factors, positive attitudes toward cycling and perceived behavioral control increased the odds of cycling for transport and for recreation. Among the neighborhood environmental attributes, leafy and attractive neighborhoods, access to bicycle/walking paths, the presence of traffic slowing devices and having many 4-way street intersections were positively associated with cycling for transport. Many alternative routes in the local area increased the odds of cycling for recreation. CONCLUSIONS: Effective strategies for increasing cycling (particularly cycling for transport) may include incorporating supportive environments such as creating leafy and attractive neighborhood surroundings, low traffic speed, and increased street connectivity, in addition to campaigns aimed at strengthening positive attitudes and confidence to cycle.

Exceeding the limits - estimated tissue pressures among Western Australian recreational divers.

INTRODUCTION: In Western Australia (WA), approximately 40 divers suffer decompression sickness per year, many after exceeding accepted safe time and depth limits. METHODS: Divers on organised recreational scuba dives wore depth/time loggers. Dives ('case' dives) exceeding the Diving Science and Technology gas-content limits (M-values) were matched to control dives made at the same dive site at the same time during which no M-values were exceeded. Potential risk factors for decompression sickness were evaluated using a conditional logistic regression model. RESULTS: A total of 1,032 organised recreational dives were recorded. Case dives (n = 38) were more likely made by females, deeper than other divers in the water at the same time. They were also made by divers less likely to have previously dived as deep. CONCLUSIONS: One in 27 recreational dives studied exceeded an M-value during the dive, but none on surfacing. We recommend that dive organisers in WA continue to encourage recreational dive groups to watch their displayed remaining no-stop time and to dive within the limits of their training and experience. This study successfully utilised periodic depth/time dive profile analysis using freely available software.

Western Australian recreational scuba diving fatalities, 1992 to 2005.

OBJECTIVE: To investigate recreational scuba diving fatalities within Western Australia (WA) between 1992 and 2005. METHODS: Coroners reports for 24 diving fatalities were reviewed to determine anthropometry, certification status and breaches of safe practices for each. RESULTS: Certification status was known for 20 divers and of these six (30%) were uncertified. Certified divers breached significantly fewer safe diving practices than uncertified divers (p<0.01). Existing regulatory mechanisms require training certification only for dives made from commercial dive boats, yet the number of deaths involving shore dives or private craft (n=15) were triple the number diving from commercial boats (n=5). CONCLUSION: Uncertified divers are less regulated and breach more safe practices than certified divers. IMPLICATIONS: We recommend changes to existing regulations governing dives made from shore and private craft in WA, requiring that all divers be certified.

Using a Delphi technique to rank potential causes of scuba diving incidents.

Scuba diving experts suggested and ranked potential causes of three known risk factors for scuba diving incidents: running out of air, losing buoyancy control and making rapid ascents. Three types of scuba diving expert participated: medical experts, divemasters and expert divers. In three rounds, consensus was reached for 28 (58%) of 48 suggested causes. Inexperience was ranked highly for all three risk factors, as was anxiety/stress and diver failure (to monitor contents gauge or release air on ascent). Poor skill levels and inadequate training were also often suggested. Overall, the expert panel suggested potential causes that were more often human or equipment related, than environmental.

Physical activity behavior of dog owners: development and reliability of the Dogs and Physical Activity (DAPA) tool.

BACKGROUND: This study aimed to develop a reliable instrument, the Dogs and Physical Activity (DAPA) tool, for measuring important attributes and scales relating to the dog-walking behavior of dog owners. METHODS: Items measuring dog-specific individual, social environmental, physical environmental, and policy-related factors that affect dog owners' walking with their dogs were assessed for test-retest reliability. Factor analysis was undertaken to demonstrate that the collection of test items had underlying constructs consistent with the theoretical framework. RESULTS: DAPA-tool items had test-retest reliability scores >.7, indicating a high level of stability. Distinct general and dog-specific constructs of subscales measuring dog-supportive features of parks, barriers to dog walking, and behavioral beliefs about the outcomes of regular dog walking were demonstrated through factor analysis. CONCLUSIONS: The DAPA tool is the first comprehensive, reliable tool for measuring important attributes and scales relating to dog owners' physical activity and the context-specific factors that affect owners' walking with their dogs.

Post-training dive inactivity in Western Australia.

INTRODUCTION: A lack of recent diving experience is often cited as relevant in analyses of diving fatalities. The purpose of this study was to measure diving inactivity amongst trained scuba divers within Western Australia and to identify reasons for extended diving inactivity. METHODS: In March 2005, self-administered surveys were mailed through 22 diving training centres to Western Australians who had completed a scuba diving course within the previous five years (n = 2,077). RESULTS: Three-hundred-and-five of 505 returned questionnaires were suitable for analysis. Within two years of completing scuba training, one in five divers had not dived for at least one year, with one half of these making only one post-course dive. Compared with active divers, inactive divers were younger, more likely female, owned less dive gear, were less likely to own a boat and completed fewer additional dive courses. Reasons cited for not diving were a lack of time, diving equipment, someone to dive with and/or money. CONCLUSION: Divers likely to spend extended periods between dives, without intending to permanently give up diving, may benefit from additional support during their first post-course year.