Date of Award

2005

Degree Type

Thesis

Degree Name

Doctor of Philosophy

Faculty

Faculty of Computing, Health and Science

First Advisor

Professor Linda Kristjanson

Second Advisor

Associate Professor Suzanne Nikoletti

Third Advisor

Dr Moira O'Connor

Abstract

Palliative care commenced in Australia in the early 1980s. Although the value of palliative care has become more widely recognised by the public and other health care professionals, there is still a lack of understanding about what palliative care is and the depth and scope of this specialty area of health care. The research that I present in this thesis is based on examination of palliative care practice in a selection of Australian services, undertaken with the aim of enhancing understanding of Palliative Care. The significance of the research arises from the notion that members of the Australian community should be well informed about health care options available to them. Understanding palliative care and the ability to differentiate palliative care from other end-of-life care is important if people are to make informed decisions about supporting, accessing, and using services appropriate to their needs. An interpretive ethnographic study from a symbolic interactionist perspective was undertaken in three palliative care services, one in each of the major Australian cities of Sydney. Melbourne, and Perth. Each palliative care service had been established for at least ten years, and was part of a larger health care facility. A fourth service, a purpose-built three-year-old unit, was added during the course of the research to provide contrast to the emerging analyses. As an experienced palliative care nurse, I assumed the role of marginal native as the primary research instrument. Data collection was by means of participant observation, formal and informal interviews, and examination of supplementary data sources, with two months spent in each of the three study sites. Interpretations made from ethnographic observation of these Australian palliative care services showed a diversity of practice, best understood within the context of the particular service. The major findings are presented under the headings of Politics, Place, People, and Practice of Palliative Care. Common approaches to provision of care were found in creating an appropriate physical environment for patients, with an underlying mission to "make the best of things." Patients cared for in the settings were a similar cohort of middle aged to elderly cancer patients. In general, staff shared expectations of appropriate types of patients and showed discomfort or lack of understanding in caring for non-cancer patients, or patients from non-Australian, non-Christian, and non-English speaking backgrounds. Practice diversity was highlighted by the range of technology used and variations in the availability of social activities for patients in the services. These two: areas in particular warrant further research to examine the outcomes associated with these variations, in terms of survival time, quality of life, and service costs.

These findings are particularly relevant at this time when the Australian Government is attempting to enhance access to palliative care. The diversity of practice uncovered in this study suggests that discussions and decisions about allocation of resources and development of services must take into consideration the various interpretations of palliative care services that may exist. The findings also reinforce the need for sound evidence-based studies to examine the impact of variations and the types of populations that might be best served by different types of palliative care support.

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