Jaclyn Bishop

Objective: Appropriate intervals for repeat (surveillance) colonoscopy are important for early colorectal cancer detection and treatment, timely patient access, and minimising patient risks. This study aimed to assess the concordance of endoscopist-recommended surveillance colonoscopy intervals with those recommended by the 2018 Australian Cancer Council surveillance colonoscopy guidelines. Methods: Three metropolitan and three rural public hospitals in Victoria, Australia, each retrospectively audited at least 35 consecutive colonoscopy cases where the outcome recommendation was for future surveillance. The audit covered colonoscopies conducted between April 2020 and June 2021. Nurses at each hospital audited colonoscopy reports, histopathology results and other relevant patient documentation. Audit data were used to calculate the guideline-interval, which was compared with the endoscopist-recommended return interval to determine concordance. Results: Of 465 consecutive colonoscopy cases audited, 248 were recommended for future surveillance colonoscopy and had complete data. A total of 25.4% (63/248) had an endoscopist-recommended interval that was consistent with the guidelines. Among discordant cases, 74.6% (n = 138) of recommendations were early; 20.5% (n = 38) were not indicated and 4.9% (n = 9) were late according to the guidelines. Excluding cases that should not return for surveillance (n = 38), concordance by guideline-recommended interval categories was 66.7% (8/12) for cases with an interval of ≤12 months, 31.0% (13/42) for 3 years, 58.3% (42/72) for 5 years and 0.0% (0/84) for 10 years. Conclusions: Guideline concordance was suboptimal at participating hospitals. Most discordant surveillance interval recommendations made were earlier than the guidelines recommend. An active, tailored approach to implementation is required given the lack of uptake several years after guideline introduction.

Introduction: An Advance Care Directive (ACD) allows a person to document their future health care wishes, guiding health care professionals in times when the person is unable to speak for themselves. In the United States, the Patient Self-Determination Act was passed into federal law in 1990, marking the beginning of the advance care planning movement in the United States. Despite ongoing efforts, ACD completion rates are poor, particularly among those coming into general practice. This narrative review sought to identify and synthesize community-based interventions designed to improve ACD completion rates to inform local approaches. Methods: A narrative review using a systematic approach was conducted. Two databases—Ovid Medline and CINAHL—were searched for original research published in English between 2000 and January 2025. Titles/abstracts and full texts were independently reviewed by two authors for eligibility. Conflicts were resolved by a third author. Data were extracted from included articles and synthesized narratively to describe the interventions and their impact on ACD completion rates. Results: Database searches yielded 1200 articles, of which 40 studies were included. While studies were predominately from the United States, research was conducted in settings of varying size and employed diverse randomized, nonrandomized and quality improvement study designs. The interventions trialled targeted patients and/or primary care providers and commonly comprised a suite of complementary strategies that spanned education/training, resources/decision aids, system improvements/quality improvement activities, support/consults/visits, and reminders/prompts. The outcomes were predominately positive, with most studies showing improvements in ACD completion rates following the intervention. Conclusion: There is increasing research interest and evidence for interventions supporting ACD completion rates among patients in primary care settings. Health care administrators and clinicians should consider and test which interventions or intervention components are most likely to drive higher completion rates in their local contexts. Further research is now needed to evaluate the extent to which interventions can enhance ACD completion rates in diverse countries and settings.

Objective: With a growing older population, there is an increased need for aged care services. Care staff are a critical factor in delivering these services. The aim of this study was to identify the key components of a well‐being program for staff caring for older people with responsive behaviours in rural aged care homes. Methods: A single co‐design session based on the seven integrated principles of World Café was hosted. Facility staff, organisational representatives and consumers were identified through purposive and snowball sampling. Facilitators led scenario‐based discussion on three topics: leadership, peer support and workplace practices. The academic literature synthesis conducted by researchers of the key components generated through co‐design identified those with evidence of benefit and local feasibility. Results: Twelve participants attended the co‐design session. Key components identified were early ‘check‐ins’ by management, ad hoc peer debriefing, regular scheduled whole‐of‐facility debriefing, peer‐based rewards, conveying behaviour expectations, greater information on care recipients, fun workplace activities, team building and staff training. Two meso‐level components considered feasible to implement and evidence‐informed were: a peer supporter program and a structured all‐of‐facility debriefing. Conclusions: A co‐design process involving consumers and staff identified two evidence‐informed and feasible components of a well‐being program for rural aged care staff: peer support and a structured all‐of‐facility debriefing. This process, blending co‐design and evidence, has laid the foundation for a well‐being program that could achieve sustained, positive change.

Health service staff have been criticised for implementing practices (e.g. a new procedure, new checklist) into care because they seem like ‘good ideas’ yet may not have the evidence to support them. The Just Cos Initiative (Just Cos) was developed based on a Learning Health System approach to address this problem. It encourages staff to think critically about their work practices and provides a pathway for staff to submit queries about potentially low-value or non-evidence based/informed (low-value) practice. Just Cos then integrates internal audit data and external research evidence with stakeholder consensus and puts that knowledge into practice using quality improvement methods. The aim of this study is to evaluate whether this integrated quality improvement and research approach can identify low-value practices and where identified, whether these practices can be minimised. It is important to adopt and evaluate systematic approaches to identifying low value practices in health so that the patient care is delivered optimally and risks are minimised. This study was a multi-method evaluation utilising the RE-AIM framework. Submissions received over 14 months were collated from a Just Cos submission log. Implementation of Just Cos was explored through 9 semi-structured interviews with staff who either submitted a Just Cos request or otherwise participated in at least one element of the Just Cos process. Twelve unique Just Cos submissions were received from nursing (7), allied health (3), executive (1) and management (1). Two submissions identified a low value practice that required practice change. Policy changes (e.g. clarification of a process or approach) occurred in four submissions. No change to practice or policy was required in three, and three submissions did not complete the Just Cos process. Participants described Just Cos as giving staff a ‘voice’ and that they valued being able to update practices. The use of centralised resources to review submissions saved time for busy staff, and protected individuals from any criticism for raising the concern. An integrated model using research evidence combined with quality improvement identified two low value practices that required practice change. It provided a psychologically safe mechanism through which staff could be curious about their practice. There is the opportunity to scale this approach to further improve the uptake of evidence based or informed practices within the healthcare setting.

Problem: Programs that identify people with a low‐risk allergy who can be safely delabeled by a direct oral challenge have emerged but are mostly reported in tertiary centres. There is limited information in the rural setting where resources are more constrained. Setting: A medium‐sized rural health service in Victoria (Australia). Key Measures for Improvement: The outcome measure was the number of patients with a low‐risk penicillin allergy who completed a penicillin oral challenge. Strategies for Change: The penicillin oral challenge program developed considered four critical workflows: choice of allergy assessment tool, identifying those with a low‐risk penicillin allergy who were interested in an oral challenge, oral challenge supervision and communication of the outcome. These were tested through Plan, Do, Study, Act (PDSA) cycles. Effects of Change: Of 23 allergy assessment tools completed, fifteen revealed a low‐risk allergy (PEN‐FAST score 0, 1 or 2). Six people were not interested in the oral challenge and three did not have their interest recorded. Of the remaining six, four had an oral challenge (27%). Lessons Learnt: Utilizing teamwork and the broad skill set of generalist rural staff, this rural health service was able to complete a penicillin oral challenge for over 25% of inpatients with a low‐risk penicillin allergy.

Introduction: With Australiaʼs ageing population, especially in rural regions, promoting physical activity among older adults is crucial.Objective: To identify factors influencing participation of older adults (60 years or over) from a rural community in a modified sport program and assess satisfaction with a pilot modified sport program informed by these findings.Design: Insights and ideas from two focus groups exploring community perspectives on a modified sport program informed the development of a six‐week pilot modified sport program delivered with the local fitness centre. Post‐program surveys assessed participant satisfaction, willingness to continue, and likelihood of recommending the program to others.Findings: Nine participants attended the focus groups, highlighting increased social connection, health management, and healthy ageing as key motivators. Joint and health concerns, cost, and time constraints emerged as main barriers. Preferences for the program included weekly sessions, alternating sports, indoor venues, and supporting modifications, but maintaining traditional rules.Thirteen participants participated in the pilot modified sport program. There was strong program attendance (86%). All participants (13/13) rated their satisfaction as very satisfied. They were highly likely to recommend the program to others (8.5/10) and were interested in continuing modified sport after the pilot (7.7/10).Discussion: This study demonstrates for the first time that modified sport is of interest to older people in the rural setting, and that delivering such a program is feasible in a small community. Rural communities implementing modified sport should consider the availability of suitable facilities and equipment, access to an engaging facilitator and participant cost.Conclusion: Through a strong connection between the health service and community fitness centre, a modified sport program was developed and implemented, well‐attended and enjoyed by participants in a rural community.

Objectives The aim of this study was to explore the intention of health professionals to use evidence generated through an integrated knowledge translation (iKT) activity undertaken during the COVID-19 pandemic to answer a time-critical research question about the delivery of community-based group programmes to rural clients via virtual technology, and describe the participating health professionals and researchers’ perceptions of the iKT partnership. Design Multimethod study incorporating qualitative and quantitative approaches. Setting Two regional health services in Victoria (Australia). Participants 26 allied health professionals (knowledge-partners) from eight disciplines across two regional health services and eight researchers from five Victorian universities. Intervention An iKT approach was used to facilitate problem identification, evidence synthesis and adaption of evidence to the local context. Data collection and analysis Participants were invited to complete a survey (knowledge-partners) and undertake a semistructured interview (knowledge-partners and researchers) on their experiences. A process log of collaborative activities tracked the type of engagement activities, who attended and the outcomes. The survey and process log results were analysed descriptively, the interviews using thematic analysis and a comparison of results approach applied to evaluate similarities and differences in the perception of the partnership from separate data collection and analysis processes. Results The survey indicated strong positive attitudes towards using research evidence in practice as well as strong intentions to use it in the future by knowledge-partners. Knowledge-partners indicated that their expertise was used in the research process, although there was greater collaboration in some steps of iKT. The context of COVID-19 facilitated collaboration between knowledge-partners and researchers through a sense of urgency and shared purpose. Rapid team development was a key mechanism that enabled iKT. Team participation was necessarily pragmatic and flexible in nature to facilitate knowledge-partner involvement. Participants suggested the iKT process was likely to result in greater end-user buy in and a powerful example of how to upskill health professionals without a significant impact on their day-to-day workload. This project was considered by knowledge-partners to be more likely to have an impact compared with other projects without a research partner. Conclusions This study highlights how researchers and knowledge-partners can work effectively and rapidly to address a time-sensitive problem of mutual interest. Establishing and nurturing rural-based researcher and knowledge-partner networks is key to enabling agile and timely responses to the changing evidence needs of the health system.

Increasing evidence of the effects of the COVID-19 pandemic on healthcare workers’ mental health and wellbeing has prompted concerns about the longer-term impacts on healthcare delivery and health workforce sustainability. For rural health services and communities, the pandemic has compounded existing challenges including workforce shortages, potentially leading to further health inequalities. This qualitative interview study aimed to explore factors within and external to the health service environment that influenced health service staff mental health and wellbeing in rural and regional Victoria, Australia, during the first two years of the COVID-19 pandemic (2020-2021). Participants were recruited from nine publicly funded rural and regional health services. Semistructured interviews were conducted via videoconference, audio-recorded, and transcribed. Data were analysed using a five-stage framework approach. Eighteen health service staff from four rural areas participated in the study. A range of factors that were perceived by participants to influence their wellbeing were identified. These were coded to four main themes: (1) rural community relations, (2) the nature of the health workplace, (3) self-care and supportive networks, and (4) public health measures and the unpredictable nature of the pandemic. Factors coded to these themes were described as both positive and negative influences on health staff mental health and wellbeing. Optimising the mental health and wellbeing of rural health staff is imperative to the sustainability of this workforce during and beyond the COVID-19 pandemic. Rural health services must consider the community and health service (meso-level), individual (microlevel), and broader pandemic context (macrolevel) when developing and implementing strategies to promote staff wellbeing. Strategies must encompass the development of senior leadership capabilities, mechanisms to support effective leadership, and optimal communication processes within health services. Given the potential for community support to positively influence rural health staff wellbeing, community engagement should be a feature of health service wellbeing strategies.

Background: The primary aim of this study was to describe if there was a change in physical functioning of rural clients with chronic diseases who were unable to attend their structured exercise groups during the COVID-19 pandemic. The secondary aim was to describe their physical activity during lockdown and their wellbeing upon return to their structured exercise groups. Method: Physical functioning measures collected in January to March 2020 (prior to suspension of structured exercise groups due to the lockdown) were repeated in July 2020 (when face-to-face activity resumed) and compared. A survey collected information about the client’s level of physical activity during lockdown and wellbeing measures at the end of the lockdown. Results: Forty-seven clients consented to provide physical functioning tests and 52 completed the survey. Only the modified 2-min step-up test displayed a statistically (but not clinically) significant change (n = 29, 51.7 vs 54.1 rep, P = 0.01). Physical activity undertaken during lockdown was less in 48% (n = 24), the same in 44% (n = 22) and increased in 8% (n = 4) of clients. Despite the lockdown, clients had high global satisfaction, high subjective wellbeing and normal resilience. Conclusions: Clinically significant changes in physical functioning when clients were unable to attend structured exercise groups for three months during the COVID-19 pandemic were not observed in this exploratory study. Further research is required to confirm the impact of isolation on physical functioning in those participating in group exercise to improve their chronic disease management.

RRH: Rural and Remote Health. Published article number: 7347 - The Pharmacy Community Apgar Questionnaire: a modified Delphi technique to develop a rural pharmacist recruitment and retention tool