Creating person-centred support for people with intellectual disabilities at the end of life: An Australian qualitative study of unmet needs and strategies.

BACKGROUND: People with intellectual disabilities at the end of life are at risk of receiving inadequate and inequitable end-of-life care. This study explores their unmet needs, opportunities for person-centred care and experiences of health service use. METHODS: Qualitative interviews with 26 experienced health professionals and carers were used to explore their patients' and residents' unmet needs and end-of-life care options and to outline strategies to support them. RESULTS: A range of challenges and unmet needs experienced by people with intellectual disabilities are presented in themes: (1) accommodation setting at the end of life: dying 'at home'; (2) personal factors and networks: a circle of support; (3) end-of-life medical care and decision-making. Strategies to facilitate good end-of-life care and a model of care are presented. CONCLUSIONS: Well-prepared and collaborative disability and health service workforces are needed, together with flexible and adequate end-of-life funding to ensure compassionate and person-centred care.

A call to action: The need for improved service coordination during early survivorship for women with breast cancer and partners.

Survivorship is an under-recognized period in the care of women with breast cancer. This paper aimed to determine if supports provided by health services were adequate in meeting the expressed needs of women and partners during survivorship. A mixed-method study consisted of: (1) in-depth interviews with women (n = 18) and partners (n = 8) (completed June 2014-November 2014) and (2) a questionnaire with health providers (n = 34) (completed April 2015) regarding services offered, needs addressed, and barriers to service delivery. Both were completed in Perth, Western Australia. Findings were determined using thematic analysis and descriptive statistics. Many unmet needs were identified by women and partners, including: pain, fatigue, fear of recurrence, employment, leisure, and social and intimacy difficulties. Participants did not receive a formal plan to assist them. Health providers reported a range of supports, including cancer surveillance and management of physical, psychological, emotional, and relationship concerns. However, many barriers concerning service delivery were identified. Despite services reporting that they provided various supports, interview participants did not appear to use and benefit from these. Coordination of service delivery was identified as requiring improvement. The use of survivorship care plans also needs refinement to determine suitability for use during survivorship.

Morbidity burden and community-based palliative care are associated with rates of hospital use by people with schizophrenia in the last year of life: A population-based matched cohort study.

OBJECTIVE: People with schizophrenia face an increased risk of premature death from chronic diseases and injury. This study describes the trajectory of acute care health service use in the last year of life for people with schizophrenia and how this varied with receipt of community-based specialist palliative care and morbidity burden. METHOD: A population-based retrospective matched cohort study of people who died from 01/01/2009 to 31/12/2013 with and without schizophrenia in Western Australia. Hospital inpatient, emergency department, death and community-based care data collections were linked at the person level. Rates of emergency department presentations and hospital admissions over the last year of life were estimated. RESULTS: Of the 63508 decedents, 1196 (1.9%) had a lifetime history of schizophrenia. After adjusting for confounders and averaging over the last year of life there was no difference in the overall rate of ED presentation between decedents with schizophrenia and the matched cohort (HR 1.09; 95%CI 0.99-1.19). However, amongst the subset of decedents with cancer, choking or intentional self-harm recorded on their death certificate, those with schizophrenia presented to ED more often. Males with schizophrenia had the highest rates of emergency department use in the last year of life. Rates of hospital admission for decedents with schizophrenia were on average half (HR 0.53, 95%CI 0.44-0.65) that of the matched cohort although this varied by cause of death. Of all decedents with cancer, 27.5% of people with schizophrenia accessed community-based specialist palliative care compared to 40.4% of the matched cohort (p<0.001). Rates of hospital admissions for decedents with schizophrenia increased 50% (95% CI: 10%-110%) when enrolled in specialist palliative care. CONCLUSION: In the last year of life, people with schizophrenia were less likely to be admitted to hospital and access community-based speciality palliative care, but more likely to attend emergency departments if male. Community-based specialist palliative care was associated with increased rates of hospital admissions.

Palliative care for people with schizophrenia: a qualitative study of an under-serviced group in need.

BACKGROUND: People with schizophrenia are at risk of receiving poorer end of life care than other patients. They are often undertreated, avoid treatment and are about half as likely to access palliative care. There are limited options for end of life care for this under-serviced group in need. This study aims to address the paucity of research by documenting possible need, experiences of health care service use and factors affecting palliative care use for people with schizophrenia who have advanced life limiting illness. METHODS: Semi-structured interviews were undertaken with 16 experienced health professionals caring for people with schizophrenia in Western Australia. The interviews focussed on their perceptions and experiences of end of life care, their patients' unmet needs, palliative care options, and suggested services to support this vulnerable group and improve health care provision. The research used a qualitative design and thematic analyses. RESULTS: The participants all advocated strongly for their patients and recognised their extreme vulnerability. They identified a range of challenges and unmet needs experienced by people with schizophrenia at the end of life including: illness factors such as the impact of schizophrenia on information processing and communication; social factors such as stigma, isolation and the absence of a carer; and health care factors such as late diagnosis, delayed access to care, and mismanagement in care. Four themes were organised into two domains with the first exploring the individual and social circumstances of people with schizophrenia, including the challenges they experience in the health care system. The second domain covers themes that discuss barriers and facilitators to people with schizophrenia receiving palliative care and key features in palliative care provision, including recognising declining health, communication and planning, and collaboration and capacity building in the broader health, mental health and palliative care sectors. CONCLUSIONS: To ensure people with schizophrenia are well supported at the end of life a model of palliative care is required that offers both specialised services and capacity building within the pre-existing health workforce. Resources are needed to address the stigma and lack of services faced by this vulnerable group.

Use of health services in the last year of life and cause of death in people with intellectual disability: a retrospective matched cohort study.

OBJECTIVE: To describe the cause of death together with emergency department presentations and hospital admissions in the last year of life of people with intellectual disability. METHOD: A retrospective matched cohort study using de-identified linked data of people aged 20 years or over, with and without intellectual disability who died during 2009 to 2013 in Western Australia. Emergency department presentations and hospital admissions in the last year of life of people with intellectual disability are described along with cause of death. RESULTS: Of the 63 508 deaths in Western Australia from 2009 to 2013, there were 591 (0.93%) decedents with a history of intellectual disability. Decedents with intellectual disability tended to be younger, lived in areas of more social disadvantage, did not have a partner and were Australian born compared with all other decedents. A matched comparison cohort of decedents without intellectual disability (n=29 713) was identified from the general population to improve covariate balance.Decedents with intellectual disability attended emergency departments more frequently than the matched cohort (mean visits 3.2 vs 2.5) and on average were admitted to hospital less frequently (mean admissions 4.1 vs 6.1), but once admitted stayed longer (average length of stay 5.2 days vs 4.3 days). People with intellectual disability had increased odds of presentation, admission or death from conditions that have been defined as ambulatory care sensitive and are potentially preventable. These included vaccine-preventable respiratory disease, asthma, cellulitis and convulsions and epilepsy. CONCLUSION: People with intellectual disability were more likely to experience potentially preventable conditions at the end of their lives. This indicates a need for further improvements in access, quality and coordination of healthcare to provide optimal health for this group.

The implications of women's activity limitations and role disruptions during breast cancer survivorship.

Early survivorship is a time of critical transition for women survivors of breast cancer as they attempt to resume functional activities and important life roles. This study aimed to explore the challenges of women and their partners as they attempted to resume activities and roles, identify unmet needs and make recommendations regarding a suitable framework to support women and partners to recommence valued activities and important roles during early survivorship. Qualitative methods utilising in-depth interviews of women (n = 18) and their partners (n = 8), and two focus groups (n = 10) were completed in Perth, Western Australia, between June 2014 and April 2015. These methods were used to facilitate women and partners' views regarding the resumption of previously meaningful activities and important life roles during early survivorship. Questions addressed their individual and shared experiences concerning self-care, leisure, social and productive activities and important roles. Thematic analysis was employed to determine themes. Women and partners reported significant impact on their ability to engage in valued activities, resulting in changes to participation in meaningful roles. Three themes were determined: (1) ambiguity regarding survivorship prevents resumption of activities and previous roles, (2) breast cancer continues to impact a couples' relationship during survivorship, and (3) support is needed to assist women and partners to resume activities and important roles. This research provides evidence suggesting that the ongoing symptoms of breast cancer treatment continue to impact many women and their partners, as they attempt to resume functional activities and important life roles during early survivorship. Disruption to these valued activities and roles may influence women and their partner's health and well-being during early survivorship and extend beyond this period. Rehabilitation following cessation of treatment could be offered as required to facilitate access to multi-disciplinary services and supports for both individuals and couples.

Community-based specialist palliative care is associated with reduced hospital costs for people with non-cancer conditions during the last year of life.

BACKGROUND: Community-based palliative care is associated with reduced hospital costs for people dying from cancer. It is unknown if reduced hospital costs are universal across multiple life-limiting conditions amenable to palliative care. The aim of this study was to determine if community-based palliative care provided to people dying from non-cancer conditions was associated with reduced hospital costs in the last year of life and how this compared with people dying from cancer. METHOD: A retrospective population-based cohort study of all decedents in Western Australia who died January 2009 to December 2010 from a life-limiting condition considered amenable to palliative care. Hospital costs were assigned to each day of the last year of life for each decedent with a zero cost applied to days not in hospital. Day-specific hospital costs averaged over all decedents (cohort averaged) and decedents in hospital only (inpatient averaged) were estimated. Two-part models and generalised linear models were used. RESULTS: The cohort comprised 12,764 decedents who, combined, spent 451,236 (9.7%) days of the last year of life in hospital. Overall, periods of time receiving community-based specialist palliative care were associated with a 27% decrease from A$112 (A$110-A$114) per decedent per day to $A82 (A$78-A$85) per decedent per day of CA hospital costs. Community-based specialist palliative care was also associated a reduction of inpatient averaged hospital costs of 9% (7%-10%) to A$1030 per hospitalised decedent per day. Hospital cost reductions were observed for decedents with organ failures, chronic obstructive pulmonary disease, Alzheimer's disease, Parkinson's disease and cancer but not for motor neurone disease. Cost reductions associated with community-based specialist palliative care were evident 4 months before death for decedents with cancer and by one to 2 months before death for decedents dying from other conditions. CONCLUSION: Community-based specialist palliative care was associated with hospital cost reductions across multiple life-limiting conditions.

The impact of community-based palliative care on acute hospital use in the last year of life is modified by time to death, age and underlying cause of death. A population-based retrospective cohort study.

OBJECTIVE: Community-based palliative care is known to be associated with reduced acute care health service use. Our objective was to investigate how reduced acute care hospital use in the last year of life varied temporally and by patient factors. METHODS: A retrospective cohort study of the last year of life of 12,763 Western Australians who died from cancer or one of seven non-cancer conditions. Outcome measures were rates of hospital admissions and mean length of hospital stays. Multivariate analyses involved time-to-event and population averaged log-link gamma models. RESULTS: There were 28,939 acute care overnight hospital admissions recorded in the last year of life, an average of 2.3 (SD 2.2) per decedent and a mean length of stay of 9.2 (SD 10.3) days. Overall, the rate of hospital admissions was reduced 34% (95%CI 1-66) and the mean length of stay reduced 6% (95%CI 2-10) during periods of time decedents received community-based palliative care compared to periods of time not receiving this care. Decedents aged <70 years receiving community-based palliative care showed a reduced rate of hospital admission around five months before death, whereas for older decedents the reduction in hospital admissions was apparent a year before death. All decedents who were receiving community-based palliative care tended towards shorter hospital stays in the last month of life. Decedents with neoplasms had a mean length of stay three weeks prior to death while not receiving community-based palliative care of 9.6 (95%CI 9.3-9.9) days compared to 8.2 (95% CI 7.9-8.7) days when receiving community-based palliative care. CONCLUSION: Rates of hospital admission during periods of receiving community-based palliative care were reduced with benefits evident five months before death and even earlier for older decedents. The mean length of hospital stay was also reduced while receiving community-based palliative care, mostly in the last month of life.

The Association of Community-Based Palliative Care With Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors.

STUDY OBJECTIVE: Palliative care has been shown to reduce end-of-life emergency department (ED) use. Our objective was to determine how the association of community-based palliative care with reduced ED visits in the last year of life varied by patient factors. METHODS: This was a retrospective cohort study of 11,875 decedents who died with neoplasms, heart failure, renal failure, chronic obstructive pulmonary disease, or liver failure in Western Australia in 2009 to 2010. Outcome measures were adjusted hazard ratios (HRs) and daily (hazard) rates of ED visits. RESULTS: The adjusted average rate of ED visits for the cohort was reduced 50% (HR 0.50; 95% confidence interval [CI] 0.47 to 0.53) during periods of receipt of community-based palliative care. This relative reduction in ED visits varied by patient factors, ranging from 43% (HR 0.57; 95% CI 0.45 to 0.74) for decedents aged 60 years and younger up to 71% (HR 0.29; 95% CI 0.18 to 0.46) for people aged 90 years and older. Decedents living in the most disadvantaged areas had a 44% (HR 0.56; 95% CI 0.44 to 0.72) reduction in ED visits when receiving community-based palliative care compared with a 60% (HR 0.40; 95% CI 0.31 to 0.53) reduction for decedents who lived in the least disadvantaged areas and received this care. The ED visit rates while patients were receiving palliative care also varied by ED visit history, partner status, and region of residence. CONCLUSION: Receipt of community-based palliative care in the last year of life was associated with a reduced rate of ED visits. The magnitude of this association was modified by patient health, as well as social and demographic factors.

Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population.

BACKGROUND: Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. AIM: To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data. DESIGN: Retrospective cohort study. SETTING/PARTICIPANTS: The cohort consisted of 23,852 people aged 20 years and over who died in Western Australia between 1 January 2009 and 31 December 2010 after excluding deaths related to pregnancy or trauma. Within this cohort, the number, proportion and characteristics of people who died from one or more of 10 medical conditions considered amenable to palliative care were identified using linked hospital records and death certificate data. RESULTS: Depending on the information source(s) used, between 43% and 73% of the 23,852 people who died had a condition potentially amenable to palliative care identified. The median age at death and the sex distribution of the decedents by condition also varied with the information source. CONCLUSION: Health service planners and researchers need to be aware of the limitations when using hospital records and death certificate data to determine a potential palliative care population. The use of Emergency Department and other administrative data sources could further exacerbate this variation.

The Value of a Gardening Service for the Frail Elderly and People With a Disability Living in the Community.

Little is known about the significance of gardening services for frail elderly people. This study explored the value of a gardening service for frail older people and people with a disability living in the community. Using qualitative and quantitative data collected from pre-gardening (n = 38) and post-gardening service delivery interviews (n = 35) and the Housing Enabler, the value of a gardening service was examined. Findings suggest that the service had a positive impact on the independence and emotional well-being of frail aged people and younger people with a functional disability, with little impact on physical health. Results indicate that gardening services should be fundamental to planning for these populations to remain or return to living in the community.

A dyadic approach to understanding the impact of breast cancer on relationships between partners during early survivorship.

BACKGROUND: The shared impact of breast cancer for women and their male partners is emerging as an important consideration during the experience of a breast cancer diagnosis, particularly during survivorship. This study aimed to explore the experiences of women and their partners during early survivorship and contributes a range of insights into the lives of those intimately affected by breast cancer. METHODS: In-depth interviews were completed with Australian women survivors of breast cancer (n = 8) and their partners (n = 8), between six months and five years following cessation of treatment. Questions included a focus on the women and their partners' daily experiences during early survivorship, including the management of ongoing symptoms, engagement in leisure and social interests, returning to work, communicating with each other, maintenance of the current relationship and other important roles and responsibilities. Thematic analysis was employed to determine key themes arising from the dyadic accounts of women and their partners' experiences during early breast cancer survivorship. RESULTS: Women and their partners experienced many changes to their previous roles, responsibilities and relationships during early breast cancer survivorship. Couples also reported a range of communication, intimacy and sexuality concerns which greatly impacted their interactions with each other, adding further demands on the relationship. Three significant themes were determined: (1) a disconnection within the relationship - this was expressed as the woman survivor of breast cancer needing to prioritise her own needs, sometimes at the expense of her partner and the relationship; (2) reformulating the relationship - this reflects the strategies used by couples to negotiate changes within the relationship; and (3) support is needed to negotiate the future of the relationship - couples emphasised the need for additional support and resources to assist them in maintaining their relationship during early survivorship. CONCLUSION: It can be concluded that the early survivorship period represents a crucial time for both women and their partners and there are currently limited options available to meet their shared needs and preferences for support. Findings indicate that a suitable model of care underpinned by a biopsychosocial framework, access to comprehensive assessment, timely support and the provision of targeted resources are urgently needed to assist women and their partners during this critical time.

Occupational therapy in Australian acute hospitals: A modified practice.

BACKGROUND/AIM: Ongoing changes to health-care funding Australia wide continue to influence how occupational therapists practise in acute hospitals. This study describes the practice challenges experienced by Western Australian acute care occupational therapists. Then, it explores if and how acute care occupational therapists are modifying their practice in response to these practice changes. METHODOLOGY: This study used a qualitative grounded theory approach. Semi-structured interviews were completed with 13 purposively selected acute care occupational therapists from four Western Australian metropolitan hospitals. Data were analysed using a constant comparative method to provide detailed descriptions of acute care occupational therapy practice and to generate theory. FINDINGS: Five conceptual categories were developed. The first two addressed practice challenges: pragmatic organisational influences on client care and establishing a professional identity within the multidisciplinary team. Three categories related to therapist responses are as follows: becoming the client advocate, being the facilitator and applying clinical reasoning. Finally, modified practice was identified as the core category which explains the process whereby acute care occupational therapists are ensuring they remain relevant and authentic in the acute care context. CONCLUSION: Western Australian acute care occupational therapists are practising in a highly complex health context that presents many challenges. They are responding by using a modified form of practice that ensures occupational therapy skills remain relevant within the narrow confines of this health setting.

A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?

BACKGROUND: Historically, specialist palliative care has been accessed by a greater proportion of people dying with cancer compared to people with other life-limiting conditions. More recently, a variety of measures to improve access to palliative care for people dying from non-cancer conditions have been implemented. There are few rigorous population-based studies that document changes in palliative care service delivery relative to the number of patients who could benefit from such services. METHOD: A retrospective cohort study of the last year of life of persons with an underlying cause of death in 2009-10 from cancer, heart failure, renal failure, liver failure, chronic obstructive pulmonary disease, Alzheimer's disease, motor neurone disease, Parkinson's disease, Huntington's disease and/or HIV/AIDS. The proportion of decedents receiving specialist palliative care was compared to a 2000-02 cohort. Logistic regression models were used identify social and demographic factors associated with accessing specialist palliative care. RESULTS: There were 12,817 deaths included into the cohort; 7166 (56 %) from cancer, 527 (4 %) from both cancer and non-cancer conditions and 5124 (40 %) from non-cancer conditions. Overall, 46.3 % of decedents received community and/or hospital based specialist palliative care; a 3.5 % (95 % CI 2.3-4.7) increase on specialist palliative care access reported ten years earlier. The majority (69 %; n = 4928) of decedents with cancer accessed palliative care during the last year of life. Only 14 % (n = 729) of decedents with non-cancer conditions accessed specialist palliative care, however, this represented a 6.1 % (95 % CI 4.9-7.3) increase on the specialist palliative care access reported for the same decedent group ten years earlier. Compared to decedents with heart failure, increased odds of palliative care access was observed for decedents with cancer (OR 10.5; 95 % CI 9.1-12.2), renal failure (OR 1.5; 95 % CI 1.3-1.9), liver failure (OR 2.3; 95 % CI 1.7-3.3) or motor neurone disease (OR 4.5; 95 % CI 3.1-6.6). Living in major cities, being female, having a partner and living in a private residence was associated with increased odds of access to specialist palliative care. CONCLUSION: There is small but significant increase in access to specialist palliative care services in Western Australia, specifically in patients dying with non-cancer conditions.

Evaluation of a healthy ageing intervention for frail older people living in the community.

AIM: To evaluate a healthy ageing intervention in the form of a program of physical and social activity for frail older people living in the community. METHODS: New members of an activity program were surveyed before and after attending the program and interviewed face-to-face prior to the program, immediately after the program and through a telephone interview two months following the program. RESULTS: Program participants reported better health, social function and mental well-being; greater engagement in household and leisure activities; and increased enjoyment and confidence through participating in the program. Some participants could not attend the whole program due to poor health or difficulties securing transport. CONCLUSION: The results suggest the program was successful in enhancing the health and well-being of those community-dwelling older adults who stayed in the program. However, the high drop-out rate suggests that flexibility is required in community-based healthy ageing programs.

Occupational therapy practice in acute physical hospital settings: Evidence from a scoping review.

BACKGROUND/AIM: Increased accountability and growing fiscal limitations in global health care continue to challenge how occupational therapy practices are undertaken. Little is known about how these changes affect current practice in acute hospital settings. This article reviews the relevant literature to further understanding of occupational therapy practice in acute physical hospital settings. METHOD: A scoping review of five electronic databases was completed using the keywords Occupational therapy, acute hospital settings/acute physical hospital settings, acute care setting/acute care hospital setting, general medicine/general medical wards, occupational therapy service provision/teaching hospitals/tertiary care hospitals. Criteria were applied to determine suitability for inclusion and the articles were analysed to uncover key themes. RESULTS: In total 34 publications were included in the review. Analysis of the publications revealed four themes: (1) Comparisons between the practice of novice and experienced occupational therapists in acute care (2) Occupational therapists and the discharge planning process (3) Role of occupation in the acute care setting and (4) Personal skills needed and organisation factors affecting acute care practice. CONCLUSION: The current literature has highlighted the challenges occupational therapists face in practicing within an acute setting. Findings from this review enhance understanding of how occupational therapy department managers and educators can best support staff that practise in acute hospital settings.

Community-based palliative care is associated with reduced emergency department use by people with dementia in their last year of life: A retrospective cohort study.

OBJECTIVE: To describe patterns in the use of hospital emergency departments in the last year of life by people who died with dementia and whether this was modified by use of community-based palliative care. DESIGN: Retrospective population-based cohort study of people in their last year of life. Time-to-event analyses were performed using cumulative hazard functions and flexible parametric proportional hazards regression models. SETTING/PARTICIPANTS: All people living in Western Australia who died with dementia in the 2-year period 1 January 2009 to 31 December 2010 (dementia cohort; N = 5261). A comparative cohort of decedents without dementia who died from other conditions amenable to palliative care (N = 2685). RESULTS: More than 70% of both the dementia and comparative cohorts attended hospital emergency departments in the last year of life. Only 6% of the dementia cohort used community-based palliative care compared to 26% of the comparative cohort. Decedents with dementia who were not receiving community-based palliative care attended hospital emergency departments more frequently than people receiving community-based palliative care. The magnitude of the increased rate of emergency department visits varied over the last year of life from 1.4 (95% confidence interval: 1.1-1.9) times more often in the first 3 months of follow-up to 6.7 (95% confidence interval: 4.7-9.6) times more frequently in the weeks immediately preceding death. CONCLUSIONS: Community-based palliative care of people who die with or of dementia is relatively infrequent but associated with significant reductions in hospital emergency department use in the last year of life.

Cancer survivors' experiences of using survivorship care plans: a systematic review of qualitative studies.

PURPOSE: Cancer survivorship care plans (SCPs) are currently used in care settings to assist survivors during the transition from treatment to survivorship. In this paper, the experiences of cancer survivors are examined to provide their perspective of how survivorship care plans are used in practice. METHODS: A systematic review and critical review of the qualitative literature regarding the experiences of cancer survivors using survivorship care plans was completed. Databases reviewed included CINAHL, AMED, Embase, MEDLINE, Informit, ProQuest, PsycINFO, ScienceDirect, Wiley Online Library, Scopus and Web of Science from 2000 to 2014. RESULTS: Eleven qualitative studies were appraised for methodological quality and content. They revealed four key themes: stakeholders agreed that SCPs should be used as a key strategy for cancer survivors; there was a lack of consensus on the format, content and who should develop the SCP; cancer survivors do not consistently receive SCPs; and there was a lack of evidence to support the use of SCPs in practice. CONCLUSIONS: There is great potential for SCPs to assist cancer survivors and this is supported by the range of qualitative literature examined in this study. Further research is required to examine the many practical issues relating to the delivery of SCPs and how they may be used across a variety of care contexts as well as providing further evidence to support their use. IMPLICATIONS FOR CANCER SURVIVORS: With further research, refinement and contributions made by survivors, health researchers and health care professionals, the survivorship care plan is proposed to be a useful and practical tool aimed at supporting the survivorship continuum of care.

Evaluating the potential of group singing to enhance the well-being of older people.

AIM: To evaluate the effect of a singing program developed specifically for older community-dwelling people on measures of health and well-being. METHOD: An eight-week singing program was developed and evaluated using standardised measures of health and well-being, measures designed to examine specific singing program outcomes, and semi-structured interviews. Participants aged 70 years and older were recruited through a home care service provider (n = 17) and an advertisement in a community newspaper (n = 19). RESULTS: Standard outcome measures indicated that the program had little effect on health and well-being. However, study-specific measures indicated that many participants had positive gains. Those in the home care group required more assistance to attend and continue in the program than those in the general community. Participants reported that the community-based singing facilitator was essential to the program's success. CONCLUSION: Well-structured community-based singing programs have the potential to impact positively upon the well-being of older people, but program viability depends on support with recruitment, transport and funding.