Transcript Development of a Model Of Care for Haematology and

Significant End-of-Life Rural
Issues for Australia
Dr Pam McGrath, B.Soc.Wk., MA, Ph D
Director, International Program of
Psycho-Social Health Research (IPPSHR)
www.ipp-shr.cqu.edu.au
7 million or 32% Australian population live outside metropolitan areas
3% of Australians live in remote or very remote areas
Australian Institute of Health and Welfare 2008. Rural, regional and remote health: indicators of health
system performance. Rural Health Series no. 10. Cat. no. PHE 103. Canberra: AIHW.
Vast distances, economic hardship, higher proportion of
disadvantage groups such as Indigenous peoples, lack of critical
population mass translates into high cost of health service
infrastructure, shortage of health care providers, difficulty retaining
doctors, translate into major health care concerns
Australian Government Department of Health and Ageing. Report on the Audit of Health Workforce in Rural and Regional Australia.
Commonwealth of Australia, Canberra, April 2008.
Rural and remote peoples health outcomes substantially poorer, less
healthy, shorter life expectancy, higher death rates, higher rates of
chronic diseases and injury, more likely to have a disability.
Hegney D., McCarthy A., Rogers-Clark C., & Gorman D., Why nurses are attracted to rural and remote practice. Aust J Rural Health, 2002, 10:
178-186.
Ageing population – 35% aged 65yr and over in rural and remote
areas. Movement of young to cities. Access to aged care, health
care and ancillary services (e.g. transport, respite, aids) limited,
local services less comprehensive, more expensive to run, and less
infrastructure.
National Rural Health Alliance, Ageing in rural, regional and remote Australia, Fact Sheet, May 2009.
One third of Australians with cancer live in r & r areas; higher
mortality rate especially with lung, prostate and colorectal cancers ;
diagnosed later so more advanced; poorer treatment -38%
hospitals administering chemotherapy no oncologist; no trained
oncology nurses; only 7% access to radiation unit; long waiting
lists, lack of allied health
Clinical Oncological Society of Australia (COSA) Mapping rural and regional oncology services in Australia, 2006.
Death rates for men in r & r 5-25% higher; Men significantly higher
rates of cancer diagnosed at a late stage related to avoidance or delay
in visiting doctor; Men in rural areas do not talk about health, visit
doctors as last resort, and have a set of attitude that act against
preventative or health seeking behaviours e.g. ‘big bloke’ sign of
strength rather than over weight, don’t ask for help, more risk taking.
National Rural Health Association, Submission to Senate Select Committee on Men’s Health, Deakin West, Canberra, 2009,
www.ruralhealth.org.au
Indigenous people make up substantial proportion of population in
R&R; die younger, less healthy, and have fewer services than
other rural peoples
Hunter E., Staying tuned to developments in Indigenous health: reflections on a decade of change. Australas Psychiatry, 2003: 11: 41823; Lowenthal R, Grogan P., Kerrins E. Reducing the impact of cancer in Indigenous communities: ways forward. Med J Aust, 2005;
182:105-6; Maddocks I. Palliative care on the margins. Prog Palliat Care 1999; 7:107-8
Mortality rate for Indigenous peoples 3 times higher than average
Indigenous peoples utilise aged care services at a younger age,
consistent with poorer health status and lower life expectancy; Carers
challenged by distance, social isolation, poverty and overcrowding
Palliative Care Australia (PCA) The hardest thing we have ever done: The social impact of caring for terminally ill people in Australia, Canberra,
2004.
IPP-SHR research focus on
two major topic areas
1. Relocation for
specialist care
2. Indigenous endof-life care
Relocation
Specialist care centralized in major metropolitan cities which are long
distances from rural and remote areas – psycho-social impact on all
aspects of the continuum of care
Relocation
• Dealing with challenge of serious illness out of comfort of home,
family/friend network with major impact on family and personal life
(separation; life on hold; loneliness; isolation)
• Importance of carer escort
• Significant financial impact exacerbated by problems with patient
travel and accommodation assistance schemes
• Major difficulties associated with the palliative care stage and the
need to return home to die; lack of local palliative care or hospice
services.
• Few specialist centers have appropriately developed referral
pathways or established support in local communities to facilitate
end-of-life return home; many die in specialist treatment centre in
major metropolitan area away from care of family and friends
Relocation for Indigenous
peoples
• Special connection with land and community
• Fear (leaving home land, travel, out of comfort of
family/community, fear western medicine)
• Different cultural perspective on health and healing
• Importance of local, community based health care services
• For traditional Indigenous peoples understand that the referral to
a major metropolitan hospital for specialist treatment is a
cultural, as much as a clinical, decision and so is to be avoided
whenever possible. Full discussion of the costs/benefits needs
to be conducted with appropriate family members.
• Appropriate kinship escorts and presence of Aboriginal Health
Care Workers essential
Indigenous Australians end-oflife cultural issues
The ‘Living Model’: A
Resource Manual for
Indigenous Palliative Care
Service Delivery
McGrath P & Holewa H
Researchman Publishers
Publications are available by request
from:
www.ipp-shr.cqu.edu.au
© Pam McGrath 2009. No part of this presentation can be used, altered or distributed without the express permission of the author.