Needs assessment in mental health care in general practice

Current practices in mental health care among general practitioners (GPs) servicing part of the rural South West region of Western Australia were ascertained in a survey on psychosocial morbidity in rural general practice (Aoun et al 1995a,b). The survey identified the patient and illness profiles and the patterns of treatment and referral to mental health services..

What palliative care can do for motor neurone disease patients and their families

Appropriate palliative care is essential for people with motor neurone disease, a progressive and irreversible neurological condition that can have distressing symptoms in its later stages. David Oliver and Samar Aoun detail how and when the specialist palliative care team should get involved

The assessment of the health care needs of the community from a consumer and provider perspective

This project aimed at identifying the health care needs of a community from a consumer and a provider perspective using a combination of quantitative and qualitative research methodologies. As stated in the objectives, this needs analysis has provided information on: -the characteristics of the community served the local Division of General Practice (Chapter 2). -the health status of the community, in terms of disease patterns, healthy lifestyles ... (Chapter 3). -the extent to which services exhibit qualities of convenient location, availability, equity of access, integrated care and providing education (Chapters 4 and 5). -the various aspects concerning general practice interests, hours worked, training and education needs (Chapter 6). -the gaps in services provided by GPs, specialists, community and allied health services and hospital services from the GP and the community perspectives (Chapters 5,6 and 8). -the areas of health needs which should be specifically targeted by local Division of General Practice (Chapters 3, 7, 8 and 9)

Improving the Evidence Base in Palliative Care to Inform Practice and Policy: Thinking Outside the Box

The adoption of evidence-based hierarchies and research methods from other disciplines may not completely translate to complex palliative care settings. The heterogeneity of the palliative care population, complexity of clinical presentations, and fluctuating health states present significant research challenges. The aim of this narrative review was to explore the debate about the use of current evidence-based approaches for conducting research, such as randomized controlled trials and other study designs, in palliative care, and more specifically to 1) describe key myths about palliative care research; 2) highlight substantive challenges of conducting palliative care research, using case illustrations; and 3) propose specific strategies to address some of these challenges. Myths about research in palliative care revolve around evidence hierarchies, sample heterogeneity, random assignment, participant burden, and measurement issues. Challenges arise because of the complex physical, psychological, existential, and spiritual problems faced by patients, families, and service providers. These challenges can be organized according to six general domains: patient, system/organization, context/setting, study design, research team, and ethics. A number of approaches for dealing with challenges in conducting research fall into five separate domains: study design, sampling, conceptual, statistical, and measures and outcomes. Although randomized controlled trials have their place whenever possible, alternative designs may offer more feasible research protocols that can be successfully implemented in palliative care. Therefore, this article highlights “outside the box” approaches that would benefit both clinicians and researchers in the palliative care field. Ultimately, the selection of research designs is dependent on a clearly articulated research question, which drives the research process

Evaluation of the Bunbury chronic pain management program

The objective of this study was to evaluate the effectiveness of a six-week program in pain management for patients with chronic pain referred by GPs in Bunbury, Australind, Harvey, Collie, and Donnybrook. The evaluation consisted of a retrospective analysis of patient data from the first 3 courses of the program (November 1996 to March 1997), and satisfaction surveys for 26 clients, 26 GPs and the 7 staff in the multidisciplinary team. A comparison of pre-program and post-program pain inventory psychometric measures revealed a significant decrease in the amount pain interfered with general activity, social activities, normal work, sleep and mood. There was a trend towards an increase in sense of control or coping, but no change is recorded in the severity of pain or the relief obtained from medication or analgesics. It is important to note that nearly all the variables changed favourably despite the reported pain levels remaining high and the same pre- and post-program. This is consistent with outcomes of other pain management programs which conclude that improvements resulted from implementing strategies for coping with pain rather than reducing pain. Similarly the changes in the Physical Fitness Measures, before and at completion of the program, reflected a significant improvement in fitness and endurance

How religious and spiritual beliefs explain prolonged grief disorder symptoms

This study investigated the importance of religious and spiritual beliefs in daily life in explaining prolonged grief disorder (PGD) symptomatology. Participants were 588 bereaved adults who completed a questionnaire. The importance of spiritual beliefs in daily life explained a small to medium, significant 3% of variance in PGD symptoms, but religious beliefs in daily life did not. Individuals who placed moderate importance on spiritual beliefs in their daily life may experience more intense grief

Using the Carers’ Alert Thermometer tool to identify needs and support family caregivers of people with Motor Neurone Disease: Moving beyond needs assessments

BackgroundFamily caregivers of people with Motor Neurone Disease (MND)experience adverse health outcomes as a result of their caregivingexperience. This may be alleviated if their support needs are identifiedand addressed in a systematic and timely manner.The objective of this pilot study was to assess the feasibility andrelevance of the Carers’ Alert Thermometer (CAT) in home-based care,from the perspective of MND family caregivers. The tool provides aformal structure to facilitate discussions with caregivers to enable needsto be addressed.MethodsThis mixed-method study was conducted in Western Australia (2020-21).Forty-one caregivers and five MND Advisors participated in trialling theCAT intervention which consisted of two encounters with Advisors (6-8weeks apart) to identify and address support needs through action plans.Caregivers’ feedback was obtained via telephone interviews and athematic analysis was undertaken.ResultsThirty caregivers completed two CAT assessments. Caregivers identifiedsupport priorities of managing their feelings and worries, providingemotional or spiritual care, information about the person’s condition andhow their care needs might change. Seventeen caregivers wereinterviewed and found that this assessment process adequatelyaddressed their needs and it should be continued, it brought the focusonto them to clarify problems and work through solutions. Theimprovements that were suggested by them, including betterinformation/education in palliative care, led to the development of anonline support/information toolkit, which served to empower caregiversand staff by accessing relevant information and resources

The effect of caregiving on bereavement outcome: Study protocol for a longitudinal, prospective study

Background: The aim of the current study is to determine the effects of caregiving on bereavement outcome. The study will address two important gaps in the research literature: (1) the relationship between pre-death distress and post-death outcomes and (2) family caregivers' anticipation and preparation of the death of the person for whom they care. Methods/Design: We will conduct a longitudinal, prospective study of adult family caregivers of adult patients receiving palliative care. All participants will complete a questionnaire administered at four points - approximately 4-8 weeks prior to bereavement, and 3-4, 6-7, and 9-10 months post-bereavement. The questionnaire includes measures of multidimensional caregiving experiences (strain, distress, positive appraisals, and family wellbeing), caregiver prolonged grief, multidimensional grief responses (despair, panic behaviour, blame and anger, detachment, disorganisation, and personal growth), prolonged grief, quality of life, general health (psychological and physical) and demographics. These caregivers' data will be compared to a comparison group matched for age, sex, and postcode, allowing the caregivers' general health and quality of life to be compared to a normative group. The caregivers will also be invited to participate in a semi-structured interview about preparing for impending bereavement. Discussion: This is the first study to address the methodological limitations in the current literature and will likely make a significant contribution to both our understanding of caregiving on bereavement outcome and to bereavement care offered in palliative and hospice settings. © 2015 Breen et al.; licensee BioMed Central

Identifying and addressing the support needs of family caregivers of people with motor neurone disease using the Carer Support Needs Assessment Tool

Family caregivers of people with motor neurone disease (MND) experience adverse health outcomes as a result of their caregiving experience. This may be alleviated if their support needs are identified and addressed in a systematic and timely manner. The objective of the present study was to assess the feasibility and relevance of the Carer Support Needs Assessment Tool (CSNAT) in home-based care during the period of caregiving from the perspectives of the family caregivers of people with MND and their service providers. The study was conducted during 2014 in Western Australia. Some 30 family caregivers and 4 care advisors participated in trialling the CSNAT intervention, which involved two visits from care advisors (6–8 weeks apart) to identify and address support needs. The feedback from family caregivers was obtained via telephone interviews and that of care advisors via a self-administered questionnaire. A total of 24 caregivers completed the study (80% completion rate) and identified the highest support priorities as “knowing what to expect in the future,” “knowing who to contact if concerned,” and “equipment to help care.” The majority found that this assessment process adequately addressed their needs and gave them a sense of validation, reassurance, and empowerment. Care advisors advocated the CSNAT approach as an improvement over standard practice, allowing them to more clearly assess needs, to offer a more structured follow-up, and to focus on the caregiver and family. The CSNAT approach for identifying and addressing family caregivers' support needs was found to be relevant and feasible by MND family caregivers and care advisors. The tool provided a formal structure to facilitate discussions with family caregivers and thus enable needs to be addressed. Such discussions can also inform an evidence base for the ongoing development of services, ensuring that new and improved services are designed to meet the explicit needs of the family caregivers of people with a motor neurone disease

The impact of bereavement support on wellbeing: a comparative study between Australia and Ireland

Background: There is a dearth of national and international data on the impact of social support on physical, mental, and financial outcomes following bereavement. Methods: We draw from two large, population-based studies of bereaved people in Australia and Ireland to compare bereaved people’s experience of support. The Australian study used a postal survey targeting clients of six funeral providers and the Irish study used telephone interviews with a random sample of the population. Results: Across both studies, the vast majority of bereaved people reported relying on informal supporters, particularly family and friends. While sources of professional help were the least used, they had the highest proportions of perceived unhelpfulness. A substantial proportion, 20% to 30% of bereaved people, reported worsening of their physical and mental health and about 30% did not feel their needs were met. Those who did not receive enough support reported the highest deterioration in wellbeing. Discussion: The compassionate communities approach, which harnesses the informal resources inherent in communities, needs to be strengthened by identifying a range of useful practice models that will address the support gaps. Ireland has taken the lead in developing a policy framework providing guidance on level of service provision, associated staff competencies, and training needs