Aileen Collier

Aim: To explore nurses' perspectives on decision‐making processes and influencing factors when caring for unresponsive dying patients in the last days of life. Design: A qualitative interpretive study. Methods: Using purposive recruitment and informal peer referral, twenty‐one nurses from a specialist palliative care service in a metropolitan city in Australia were interviewed between July 2024 and January 2025. Data were analysed using reflexive thematic analysis. Decision‐making theory was used as an interpretive lens. Findings: Two themes were generated: ‘The patient as an absent presence’ and ‘Enacting agency through embodied cognition and relational attunement’, together with five interconnected subthemes. The analysis highlighted the importance of knowing the patient's cues and wishes. The data linked nurses' decision‐making to both relational and communication processes, particularly in the context of family engagement and the care needs of the unresponsive dying patient. Other influences included uncertainty and the nurse's own professional practice. Conclusion: Nurses' decision‐making when caring for the unresponsive dying patient is complex. Decision‐making evolves through the nurse's intentionality in assessment, communication skills, accommodation of uncertainty, and through implicit ethical and moral agency. Recognising the vulnerability of unresponsive dying patients is essential to supporting person‐centred care. Implications for the Profession and/or Patient Care: This research contributes valuable new insights into decision‐making by nurses caring for a largely under‐researched vulnerable population. Strengthening nurses' decision‐making may support more timely recognition of care needs, improve assessment and management of distress or discomfort, promote person‐centred care, and enhance communication with families when patients are in the final days of life. Impact: This study explored nurse decision‐making among a vulnerable population of unresponsive dying patients. Creating relationships with the patient and their family through effective communication, informed and influenced nurses' decision‐making. Patients die in many different health care settings. This research foregrounds the need for enhanced nurse decision‐making when caring for unresponsive dying patients and their families. Reporting Method: The research team adhered to the Standards for Reporting Qualitative Research (SRQR). Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct, or reporting.

ObjectiveTo explore women’s perspectives on their supportive care needs during the first three years following a diagnosis of ovarian cancer. MethodsA qualitative study informed by Appreciative Inquiry was conducted with 11 women diagnosed with ovarian cancer in South Australia. Data were collected through semi-structured interviews and analysed using reflexive thematic analysis. Consumer representatives contributed to the study design. Rigour was ensured through reflexivity, team-based analysis, and adherence to RTAR guidelines. FindingsFour themes were identified: 1) Limited awareness of signs and symptoms of ovarian cancer among community and healthcare professional; 2) Healthcare system strength and gaps in supporting people with ovarian cancer; 3) Lack of supportive care needs that extend beyond the hospital environment; 4) The many burdens and challenges that comes with and ovarian cancer diagnosis. Participants described delays in diagnosis, communication challenges, fragmented care, and unmet psychosocial and supportive care needs. Access to allied health, survivorship support, and education on menopause and sexual health was limited. Participants emphasised the importance of person-centred communication, coordinated care, and access to integrated support services. ConclusionWomen with ovarian cancer experience significant unmet supportive care needs across the care continuum. Improving awareness, communication, and access to integrated, person-centred supportive care services is essential to enhance survivorship outcomes and quality of life.

Purpose: To critically synthesise qualitative research to understand the experiences of supportive care needs in people affected by ovarian cancer and their informal caregivers. Method: A qualitative systematic review has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The Joanna Briggs meta-aggregation methodology was utilised. Electronic databases were searched for all qualitative studies irrespective of research design by an expert systematic review librarian. Data extraction and methodological quality assessment were performed. Results: A total of 26 studies were included which represented a total sample of 962 participants inclusive of 842 patients and 120 informal caregivers. There were a total of 133 individual findings included in this review, which were synthesised into four main findings that emerged: (1) awareness around ovarian cancer, (2) communication in the healthcare sector, (3) everything that comes with the disease, (4) what the future holds. Conclusion: This review identified that while some women living with ovarian cancer experienced suffering and distress, others reported emotional wellbeing and comfort needs met. There were gaps in service from both the informal caregiver and women ranging from before diagnosis even to post-treatment and beyond. Service redesign needs to occur with a focus on (1) improved awareness around ovarian cancer signs and symptoms, (2) effective communication strategies within and across healthcare providers, (3) increased information and support for both women and their informal caregiver throughout the cancer trajectory, and (4) developing survivorship care plans to promote wellness.

The importance of music in enhancing the well-being of individuals in residential aged care is well-documented. However, the efficacy and prevalence of music-based activities for culturally and linguistically diverse (CALD) individuals are poorly understood, and self-report data limit the rigour of studies in this domain. This narrative review examined published literature regarding the provision of music-based activities for CALD groups in residential aged care settings. From ten databases, 1093 papers were screened. Ten studies, including more than 500 participants, were included for analysis. Common findings were synthesised into four categories: a) Professional Perspectives of Multicultural Practice and Training, b) Specific Methods and Repertoire: Activities in cross-cultural contexts, c) The Therapeutic Relationship and d) Challenges and Barriers. Therapists displayed general support for multiculturalism in their work and some knowledge of strategies for improving engagement and rapport with CALD clients. Nevertheless, a pressing need for improved training and expert guidelines to promote culturally appropriate care for residents with a CALD background is indicated. Such training should be informed by a rigorous evidence base of existing and future research. Specifically, we recommend that upcoming studies seek insights from residents, families, and other key stakeholders in residential aged care to explore strategies for effectively implementing music-based activities across cultural groups.

Background and Objectives: Older people with cognitive impairment are unrepresented in clinical research. Our objective was to review evidence for strategies to support their research inclusion and participation. Research Design and Methods: Systematic review of published reports of inclusion and participation strategies for older people with cognitive impairment in clinical research (PROSPERO CRD42020212092). 5 databases were searched in September 2020, March 2023, and April 2024. Screening, full-text review, and data extraction were independently performed. The risk of bias was assessed using Scottish Intercollegiate Guidelines Network Methodology Checklists. Outcomes were participant characteristics, recruitment and consent processes, retention, experience, involvement of others, adverse events, and other reported outcomes. Results: Of 4,564 identified sources, 12 studies were included. 9 compared recruitment strategies; 3 examined consent processes. Of 4,208 participants (mean age 78.3 years), 61% were female. Median (interquartile range) monthly recruitment rate was 10.3 (5.6–14.8). Participants had mild cognitive impairment, dementia, and/or delirium, and two-thirds of the studies involved proxies or study partners. Community outreach or population screening had higher recruitment compared with primary care referral and/or screening. Formal capacity and consent methods achieved lower rates of consent compared with informal. A memory and organizational aid increased participants’ ability to provide informed consent compared with standard assessment. Few studies reported participants’ or recruiters’ subjective experience, and no studies reported participant retention or adverse events. Discussion and Implications: Targeted, tailored, and multi-pronged recruitment and consent strategies to support the inclusion of older people with cognitive impairment appear promising. Higher-quality studies are needed to confirm this finding.

To investigate the palliative care experiences of Samoan patients with cancer and the impact these experiences have on their quality of life. Methods: This qualitative interview study was part of a larger study that interviewed19 participants recruited among patients with cancer registered with Samoa Cancer Society, or patients recently discharged from the main tertiary hospital in Samoa. Interview transcripts were reviewed, and the research team identified the key palliative-care-related themes. Results: Analysis led to the generation of the following key themes: living with pain; resource constraints; support from family and faith; and interactions with healthcare professionals. Most participants were experiencing unresolved pain as a result of poor health knowledge, lack of access to medications and practical issues, such as financial limitations and lack of transport. Participants also reported a lack of resources, including financial constraints, as a significant barrier to effective healthcare. Sources of support for patients with cancer were most commonly strong family relationships and religious faith. Although it was difficult for the participants to access care from healthcare professionals, they found that honest communication about their condition was comforting. However, they were frustrated if they felt communication was unsatisfactory. Conclusion: This study provides much needed evidence on the issues that affect the quality of life patients with cancer receiving palliative care and their families in Samoa. It also highlights the intersectionality of these issues and how this compounds the patient experience. Practical recommendations for improving palliative care lie in a few key areas, including a need for improved access to opioids and support for family caregivers. However, from a systemic perspective, the way forward should lie in harnessing the strengths of Samoan culture, including the strong sense of family and the role of religion, to provide support and care for palliative patients.

Purpose of review: The notion of a ‘good death’ is central to hospice and palliative care philosophy. This review interrogates social imaginaries of the ‘good death’ in the context of current global, health and sociopolitical challenges. Recent findings: Research literature and policy documents across fields continue to place emphasis on the ‘good death’. As part of the equity turn in palliative care, there is a growing body of work highlighting the diverse perspectives of people whose voices were heretofore not understood. Inequities are evident not only in terms of who has access to a ‘good death’ but also related to the effects of the dominant ‘good death’ script itself. Summary: There is increasing evidence that pursuit of the ‘good death’ narrative may be counter to supporting people as they are living and dying. The authors instead argue for a research, policy and practice shift to ‘matters of care’.

Introduction: To redress the scholarly preoccupation with gaps, issues, and problems in palliative care, this article extends previous findings on what constitutes brilliant palliative care to ask what brilliant nursing practices are supported and promoted.Methods: This study involved the methodology of POSH‐VRE, which combines positive organisational scholarship in healthcare (POSH) with video‐reflexive ethnography (VRE). From August 2015 to May 2017, inclusive, nurses affiliated with a community health service who delivered palliative care, contributed to this study as co‐researchers (n = 4) or participants (n = 20). Patients who received palliative care (n = 30) and carers (n = 16) contributed as secondary participants, as they were part of observed instances of palliative care. With a particular focus on the practices and experiences that exceeded expectations and brought joy and delight, the study involved capturing video‐recordings of community‐based palliative care in situ; reflexively analysing the recordings with the nurses; as well as ethnography to witness, experience, and understand practices and experiences. Data were analysed, teleologically, to clarify what brilliant practices were supported and promoted.Results: Brilliant community‐based palliative care nursing largely involved maintaining normality in patients’ and carers’ lives. The nurses demonstrated this by masking the clinical aspects of their role, normalising these aspects, and appreciating alternative ‘normals’.Conclusion: Redressing the scholarly preoccupation with gaps, issues, and problems in palliative care, this article demonstrates how what is ordinary is extraordinary. Specifically, given the intrusiveness and abnormalising effects of technical clinical interventions, brilliant community‐based palliative care can be realised when nurses enact practices that serve to promote a patient or carer to normality.Patient or Public Contribution: Patients and carers contributed to this study as participants, while nurses contributed to this study as co‐researchers in the conduct of the study, the analysis and interpretation of the data, and the preparation of the article.