Vanette McLennan

Relinquishing or taking control? Community perspectives on barriers and opportunities in advance care planning

OBJECTIVE This paper reports on the experiences and perspectives of community members in relation to advance healthcare directives and enduring power of attorney, including the factors that encourage or discourage engagement in advance care planning (ACP). METHODS; A qualitative methodology was used involving 26 in-depth telephone interviews with community members (mean age 66 years). The aims of the interview question were to gain an understanding of: (1) motivations for engaging in ACP; (2) barriers that prevent people from engaging in ACP; and (3) suggestions for promoting ACP. RESULTS The findings suggest that: (1) community members lack knowledge about ACP; (2) forms appear inaccessible and complex; (3) community members avoid ACP due to fear, mistrust and concerns over control; and (4) there are misperceptions regarding the relevance of ACP based on age and health. CONCLUSIONS There is unnecessary fear, avoidance and mistrust around ACP activities, largely resulting from misinformation. There is an undoubted need for greater education and support to be offered to individuals and their families regarding ACP, its benefits and its limitations.

Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries

Introduction:The design was a narrative review. The objective of the study was to investigate the potential for early vocational rehabilitation (VR) interventions for people with spinal cord injury (SCI) in overcoming barriers in returning to work, and to pinpoint factors contributing to effectiveness in early VR intervention for this population. The setting was at Queensland, Australia.Materials and methods:Synthesis of the findings of a literature search of online databases ProQuest and CINAHL, using keywords relating to the employment situation and VR of people with SCI. Themes were identified and analysed in accordance with the research objectives.Results:Despite increasing government commitment to the workforce and social participation of people with disabilities, Australians living with SCI have significantly diminished employment outcomes compared with the general population. Current VR approaches usually do not commence until some months post discharge, potentially missing a window of opportunity to preserve pre-existing employment or assist in vocational decision making. The review found that there are opportunities for enhancing VR service provision following SCI, namely integrating the VR programme within the primary rehabilitation team thus facilitating early VR intervention.Discussion:Emerging evidence shows promising results for early intervention in VR; however, questions remain regarding ideal intervention approaches, and it is clear that further empirical investigation is required to support the use of early intervention models post SCI. The study was sponsored by Motor Accident Insurance Commission (MAIC).

Learning from Mistakes and Moving Forward in Intercultural Research with Aboriginal and Torres Strait Islander Peoples.

ABSTRACT The ongoing challenges in equitable research involving Indigenous peoples and their communities and ways to overcome these are discussed in this article. Central to this article is the narrative reflection of a non-Indigenous researcher following research on Indigenous spirituality, well-being and resilience in the Yaegl community of northern New South Wales, Australia, conducted between 2003 and 2010. Upon reflection several years after the studies, the researcher has identified several inadequacies in the ways in which the research was conceptualised, designed, conducted and supervised. In seeking to critically reflect on and learn from this experience, with the hope of contributing to better understanding and protocols in research with Indigenous peoples, as well as improved models of higher degree research (HDR) supervision in this space, the researcher has collaborated with an Indigenous academic to incorporate theory and Indigenous knowledge in highlighting considerations for better research training and practice.

Investigating employment following spinal cord injury: outcomes, methods, and population demographics

Abstract Purpose: The purpose of this review was to synthesize the literature about spinal cord injury and employment, focusing on sample demographics, indicators of employment outcome, and the methods used. The review included literature from the previous decade; 2006–2017. Methods: A systematic quantitative literature review methodology was utilized, wherein papers’ characteristics were extracted and categorized in a database according to their topics, employment outcome indicators, populations, locations, and methods. Frequency tables were generated and cross-tabulated to yield conclusions about the outcomes of the studies and the methods and samples used to yield these outcomes. Results: The review highlighted three key themes; the emergence of broader employment outcome measures that go beyond employment rate; a lack of consistency in the reporting of sample characteristics such as time since injury or ethnicity; and the relative lack of research focusing on people with newly acquired spinal cord injury. Conclusions: The literature review identified a number of limitations in the existing research including the lack of standardized reporting of employment outcomes and a need for increased consistency in reporting sample characteristics. In addition, there are gaps in the research about people with newly acquired spinal cord injury, particularly regarding the timing of interventions. Implications for Rehabilitation Spinal cord injury has the potential to disrupt a person’s career across their lifespan. Employment rate is the gold standard for evaluating employment outcomes. Broader measures of employment, including job retention and hours worked, have potential in evaluating and improving the quality of employment outcomes for this population. Further research with people with newly acquired spinal cord injuries would better support the provision of vocational rehabilitation services earlier in a person’s rehabilitation, potentially preserving jobs.