Beatriz Cuesta-Briand

Background Junior doctor training is stressful and associated with significant challenges, including poor mental health and burnout. Mindfulness-based interventions (MBI) are increasingly being offered within junior doctor education programs to support junior doctor wellbeing, with online platforms for delivery attracting interest. Methods This mixed-method randomised waitlist control trial was conducted with junior doctors across two hospitals in Western Australia. The intervention was an 8-week online mindfulness training program, with usual training as control. Outcome measures were changes from baseline to program completion (8 weeks) and then 1-month follow-up for self-reported surveys of trait mindfulness, perceived stress, self-compassion, occupational stress, and work engagement. Intervention and control participants completed surveys at all three time points. Semi-structured interviews and focus groups were conducted with participants at program completion. Results Seventy-two (35 intervention, 37 control) junior doctors were randomised. Seventeen did not complete the baseline measures. Data for the remaining 55 participants (28 Intervention, 27 Control) were retained for analysis. Most intervention participants formally practiced mindfulness 2 to 3 times per week for 5–7 minutes. For the intervention group, perceived stress increased at program completion (-1.4, 95% CI − 2.6, -0.3, p = 0.0151) while work engagement was decreased (-2.9, CI − 5.6, -0.2, p = 0.0355) at final follow-up. There were no significant changes in any of the outcomes for the control group at any follow-up point. Thirteen intervention and 8 control participants undertook semi-structured interviews about their experience. Despite lack of positive quantitative findings, benefits reported regarding the program during interview included: improved self-awareness, emotion regulation, self-compassion and work productivity, as well as professional and personal relationships. Barriers to participation in the program included limited time, work stress, and challenges with elements of the intervention. Conclusion This novel online mindfulness training program was not associated with improvements in measured outcomes including trait mindfulness, perceived stress, self-compassion, occupational stress or work engagement for participating junior doctors. This contrasts with our qualitative findings suggesting that junior doctors experience wellbeing benefits from participating, and with the results of our similar trial in medical students. Organisational factors such as stressful workplaces and time limitations likely minimised the impact of the mindfulness intervention in this group.

Background: Mental illness is a public health challenge disproportionately affecting rural Australians. GPs provide most of the mental health care, and they report increasing levels of burnout and unsustainable workload in the context of increased patient complexity. This may be more salient in rural settings characterised by resource constraints. In this paper, we use evaluation data from a GP psychiatry phone line established in Western Australia’s Great Southern region in 2021 to describe GPs’ perspectives on the service and reflect on how it may help alleviate rural GP workload. Methods: The sample was recruited among GPs practicing in the region. Data were collected through an online survey and semistructured interviews. Descriptive statistics were used to analyse the survey data. Interview data were subjected to thematic analysis; qualitative survey data were used for triangulation. Results: A total of 45 GPs completed the survey and 14 were interviewed. Interview data yielded three themes: the criticality of timeliness; the building blocks of confidence; and trust. GPs were highly satisfied with the service, and timeliness and trust were the characteristics underpinning its effectiveness. The service built GPs’ confidence in managing mental health and alcohol and other drug use issues through strengthening knowledge and providing reassurance. Conclusions: Our results suggest that a telephone line operated by trusted, local psychiatrists with knowledge of the local mental health ecosystem of support can reduce rural GP workload through building confidence and strengthening personal agency, helping GPs navigate the ethical and clinical labyrinth of managing patient complexity in rural settings.

Cancer is a leading cause of premature death and disability in Samoa. Recognizing the importance of symptom awareness and early detection, the Samoa Cancer Society (SCS) developed the ‘Vave’ (quickly) campaign as the first multi-media cancer awareness campaign in Samoa. The campaign adopted a three-pronged community engagement approach including mass media; printed resources; and community outreach at culturally appropriate locations including churches, villages and schools. The campaign promoted three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To measure impact, data were collected using several methods around the outreach education sessions (pre- and post-surveys), campaign recall (survey) and Vave-related enquiries received by SCS. The findings revealed the campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. However, it is of note that almost 30% of campaign recall respondents stated they were unsure or would not see a doctor if concerned about a sign of cancer. The reasons given being a lack of knowledge, lack of trust in hospitals and preference for traditional healing. This suggests more targeted culturally sensitive strategies are needed including partnering with traditional healers. Further, advocacy efforts are needed to address the structural barriers to cancer detection and treatment together with continuing education around causes and symptoms of cancer targeting the hard-to-reach communities in Samoa. Cancer is a number one killer and cause of disability in Samoa. Identifying cancer early can lead to better health outcomes. Ability to understand signs and symptoms of cancer among community members is crucial in facilitating early detection. Recognizing this, the Samoa Cancer Society (SCS) developed the first ever multi-media cancer awareness campaign in Samoa—the ‘Vave’ which means ‘quickly’. The campaign used mass media; printed resources; and community outreach to spread three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To understand how effective the campaign was, data were collected through surveys and statistics on Vave-related calls to SCS. The campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. Efforts are needed to address the structural barriers to cancer early detection and continuing education targeting the hard-to-reach communities in Samoa.

Cancer is a leading cause of death in Samoa, with cancer patients presenting late and experiencing poor outcomes. Barriers to early diagnosis are complex, and cultural factors play an important part. This qualitative study explored the barriers to cancer diagnosis in Samoa through semistructured interviews conducted with 19 Samoan patients. Thematic data analysis was informed by socioecological theory and yielded 4 themes: knowledge and beliefs about cancer; pain as a trigger for health care–seeking behavior; follow-up issues; and communication and trust. Cancer knowledge and attitudes toward pain were strongly influenced by culture and community beliefs. Lack of follow-up resulted in significant delays, and ineffective patient-doctor communication triggered feelings of uncertainty and mistrust in the health care system. Efforts to address knowledge gaps will not be effective unless they are accompanied by broader strategies addressing local health care capacity issues. Adopting a socioecological framework lens within a regional collaborative approach provides a way forward.

RRH: Rural and Remote Health. Published article number: 6118 - Beliefs about cancer causation in Samoa: results from an awareness campaign recall survey

This study uses data from a Rural Clinical School of Western Australia (RCSWA) and WA Country Health (WACHS) study on rural work intentions among junior doctors to explore their internal decision-making processes and gain a better understanding of how junior doctors make decisions along their career pathway. This was a qualitative study involving junior doctor participants in postgraduate years (PGY) 1 to 5 undergoing training in Western Australia (WA). Data was collected through semi-structured telephone interviews. Two main themes were identified: career decision-making as an on-going process; and early career doctors’ internal decision-making process, which fell broadly into two groups (‘explorers’ and ‘planners’). Both groups of junior doctors require ongoing personalised career advice, training pathways, and career development opportunities that best “fit” their internal decision-making processes for the purposes of enhancing rural workforce outcomes.

Medical graduates’ early career is known to be disorienting, and career decision-making is influenced by a complex set of factors. There is a strong association between rural background and rural undergraduate training and rural practice, and personal and family factors have been shown to influence workplace location, but the interaction between interest, training availability, and other work-relevant factors has not yet been fully explored. A qualitative study conducted by the Rural Clinical School of Western Australia (RCSWA) and WA Country Health Service (WACHS) explored factors influencing the decision to pursue rural work among junior doctors. Data collection and analysis was iterative. In total, 21 junior doctors were recruited to participate in semi-structured telephone interviews. Two main themes relating to the systems of influence on career decision-making emerged: (1) The importance of place and people, and (2) the broader context. We found that career decision-making among junior doctors is influenced by a complex web of factors operating at different levels. As Australia faces the challenge of developing a sustainable rural health workforce, developing innovative, flexible strategies that are responsive to the individual aspirations of its workforce whilst still meeting its healthcare service delivery needs will provide a way forward.