Stacey Ann Rich

Fear of cancer recurrence is a common experience in cancer survivorship and can impact both physical and mental well-being. Some evidence exists on the manifestation of fear of cancer recurrence and its treatment. The purpose of this qualitative study was to fill a gap in the understanding of rural older women’s lived experience of fear of cancer recurrence. A sample of ten women aged ≥ 65 years living in rural Australia who were in remission from gynaecological cancers participated in semi-structured interviews about their lived experience of fear of cancer recurrence. Inductive thematic analysis generated four overarching themes that were subsequently mapped onto the Lee-Jones Model of fear of cancer recurrence, which provided a largely congruent interpretative framework for the affective, behavioural and cognitive aspects of older women’s experiences in this sample. However, themes relating to coping mechanisms and help-seeking behaviour extended beyond the model’s constructs, particularly around participants' strong self-reliance values and aversion to seeking support. Across interviews, a prominent concern was the fearof being a burden to family if cancer were to return, or concern for family members if they were to die. Further, they expressed an aversion to seeking professional help when worries about recurrence emerged, preferring to distract themselves or avoid thoughts of fear. The aversion to help-seeking highlighted in this sample suggested that traditional forms of support offered for fear of cancer recurrence may not be appropriate for older women. Further work is needed to establish targeted support for this cohort.

Objective: To describe an evidence‐informed, experience‐based co‐design process used to adapt metropolitan early palliative care referral models for implementation in a regional Australian health service. Methods: A scoping review of palliative care delivery and early referral models to inform evidence‐informed, experience‐based co‐design workshops involving consumers, clinicians, and health service staff. Design: Sequential mixed‐methods development study comprising evidence synthesis to identify model components, followed by two iterative workshops to construct and refine a context‐appropriate outpatient early referral model. Setting: A regional public health service in Victoria, Australia, seeking to establish an outpatient early referral palliative care clinic for people with advanced cancer. Participants: Purposefully sampled stakeholders (patients/carers, oncologists, palliative care clinicians, cancer care coordinators, Aboriginal health worker, managers, and researchers) took part in two online workshops. Main Outcome Measures: Co‐designed model structure and components, perceived feasibility in a resource‐constrained regional context, and agreed service scope and patient eligibility. Results: The process generated a regionally tailored early referral pathway incorporating needs‐based screening, prioritisation to manage limited capacity, and staged roll‐out initially focused on selected cancer groups. These adaptations, while pragmatic, highlight the resourcing disparities faced by rural and regional services and the equity implications of resource‐driven variation in care delivery. Conclusions: Evidence‐informed co‐design enabled pragmatic adaptation of metropolitan palliative care models to a regional setting and offers a transferable approach for other rural and regional services.

The Australian Royal Commission into Aged Care Quality and Safety has highlighted the chronic shortages of labour to provide care for those aged 65 and over in rural and remote areas of Australia. This descriptive cross-sectional study compares the availability of care provision in metropolitan regions with that in rural and remote regions. We analysed the 2021 Australian Census, grouped according to Aged-Care-Planning Region (ACPR), and investigated the numbers of people aged 65 years and over with different levels of care need, both in residential care and in-home. The available workforce in each ACPR was also examined in detail, using occupational classifications reported in the Census, and shortages of doctors, nurses, allied health and other care workers were identified. Overall, an additional 492,416 care hours were needed per week (or 12,958 full-time equivalent (FTE) care workers) in order to bring remote community ACPRs to parity with provision in metropolitan ACPRs. A further 95,342 FTE workers were needed in rural ACPRs to bring these areas to parity with metropolitan ACPRs. Our findings underscore the ongoing disparities in aged care workforce availability between metropolitan, rural, and remote regions of Australia. Addressing these workforce shortages is crucial to ensuring equitable access to care for older Australians, regardless of their geographical location. The implementation of targeted strategies to enhance workforce recruitment, retention, and training in these underserved areas is essential to bridge the gap and improve the quality of care provided to older adults in rural and remote communities. Such strategies could include targeted recruitment campaigns and incentives for professionals to relocate; further capacity for clinical placements and supervision in rural areas; tailoring funding and employment models for rural needs; and strengthening vocational education in regional areas.