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Rune KT, Cadet TJ, Davis C. Meeting the needs of rural cancer patients in survivorship: Understanding the role of telehealth. Aust J Rural Health 2024; 32:188-192. [PMID: 37927175 DOI: 10.1111/ajr.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE This study explores perceptions about the role of telehealth in providing health and supportive services to Australian rural/regional cancer patients and survivor during COVID-19 and the quality of these services to inform future practice. DESIGN Data were collected as part of a bi-annual survey on client satisfaction at a rural/regional community cancer wellness centre in Australia. SETTINGS AND PARTICIPANTS Rural/regional cancer patients and survivors (n = 66) completed an online survey. MAIN OUTCOME MEASURES The three main outcome measures were: (1) attitudes towards telehealth; (2) preference for future cancer support services; and (3) experiences with video/telehealth. RESULTS Younger participants were more likely to use allied health services via video/telehealth during COVID-19 than their older counterparts. The preferred format for cancer support services in future was face-to-face (59% for younger and 42% for older participants), telehealth (10% for both groups) and mixed (31% for younger and 48% for older participants). CONCLUSIONS Telehealth has benefits for the delivery of health and supportive services to rural/regional cancer patients and survivors. Nurses can play a key role in assessing the support needs of cancer survivors and facilitating strategies to ensure that survivors have the skills necessary to access telehealth support.
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Affiliation(s)
- Karina T Rune
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Tamara J Cadet
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cindy Davis
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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2
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Kerr L, Ilangakoon C, Russo P. "A Different Normal": Living With Cancer During the COVID-19 Pandemic in Australia. Cancer Nurs 2023; 46:E328-E335. [PMID: 37607383 DOI: 10.1097/ncc.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic has seen mass disruptions to healthcare globally. People with cancer are in a vulnerable position, and treatment teams may be anxious in making decisions that try to balance risks associated with malignant disease with those of potential exposure to COVID-19. In addition, palliative care is likely to have experienced significant burdens during the pandemic. As a result of COVID-19 disturbances, people with cancer and their caregivers may have increased stressors and therefore poor outcomes. OBJECTIVE The aim of this study was to explore the experiences of people with cancer and their caregivers during the COVID-19 pandemic, with the aim to inform future oncology practice during infectious crises. METHODS This qualitative study had 2 stages. Stage 1 involved key informant interviews (n = 16) conducted with healthcare professionals working in cancer care. These were used to inform the stage 2 interview guide for participants who had cancer or were caregivers of someone with cancer (n = 19). Data were thematically analyzed using NVivo. RESULTS Five interconnected themes were identified from the interviews: uncertainty and vulnerability, constraints and restrictions, isolation and disconnection, burdens and stressors, and adaptability and resilience. Across themes, complexity and diversity in experience were demonstrated. CONCLUSIONS The findings suggest cancer concerns outweigh those associated with the COVID-19 pandemic. Many difficulties experienced by healthcare professionals and people with cancer during the COVID-19 pandemic were related to social isolation. IMPLICATIONS FOR PRACTICE Provision of psychosocial and spiritual telehealth services should be increased. It is important during times of crisis to pay attention to those who are most vulnerable.
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Affiliation(s)
- Lucille Kerr
- Author Affiliations: Department of Nursing Research, Cabrini Institute (Drs Kerr and Russo); and Monash University (Dr Russo and Ms Ilangakoon), Melbourne, Victoria
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Collins IM, Blum R, Segelov E, Parente P, Underhill C. Workforce challenges across Victorian medical oncology services. Intern Med J 2023; 53:946-950. [PMID: 36571397 DOI: 10.1111/imj.16000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cancer incidence is growing, with increasing treatment options and durations. This has led to an increase workload on the current oncology workforce. The global pandemic has increased this pressure further. AIMS To determine the current medical oncology workforce in Victoria, current shortfalls and future anticipated shortfalls beyond the COVID-19 pandemic. METHODS A self-reported, cross-sectional observational study of all current adult Victorian cancer services in June 2020 examining workforce, workload and early effects of the COVID-19 pandemic. RESULTS The current average workload of 242 new patients per full-time equivalent consultant in medical oncology across Victoria. This is higher than optimal to deliver a safe and efficient cancer service. The significant variation in workforce between sites highlights the areas in need of most urgent resource allocation. Use of safe prescribing practises such as electronic chemotherapy prescribing are not universal but urgently needed. CONCLUSIONS The medical oncology workforce in Victoria is inadequate to meet current and future demands. This needs to be addressed urgently to avoid an adverse impact on cancer measures and quality standards. Better, standardised data collection is needed to allow for ongoing measures of workforce activity. Novel workforce solutions will also need to be implemented in the short and medium term in the face of global workforce shortages.
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Affiliation(s)
- Ian M Collins
- Southwest Oncology, Warrnambool, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Rob Blum
- Bendigo Health, Bendigo, Victoria, Australia
| | - Eva Segelov
- Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Phillip Parente
- Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
| | - Craig Underhill
- Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, New South Wales, Australia
- Rural Clinical School, University New South Wales, Albury, New South Wales, Australia
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Chan RJ, Crawford-Williams F, Crichton M, Joseph R, Hart NH, Milley K, Druce P, Zhang J, Jefford M, Lisy K, Emery J, Nekhlyudov L. Effectiveness and implementation of models of cancer survivorship care: an overview of systematic reviews. J Cancer Surviv 2023; 17:197-221. [PMID: 34786652 PMCID: PMC8594645 DOI: 10.1007/s11764-021-01128-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To critically assess the effectiveness and implementation of different models of post-treatment cancer survivorship care compared to specialist-led models of survivorship care assessed in published systematic reviews. METHODS MEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were searched from January 2005 to May 2021. Systematic reviews that compared at least two models of cancer survivorship care were included. Article selection, data extraction, and critical appraisal were conducted independently by two authors. The models were evaluated according to cancer survivorship care domains, patient and caregiver experience, communication and decision-making, care coordination, quality of life, healthcare utilization, costs, and mortality. Barriers and facilitators to implementation were also synthesized. RESULTS Twelve systematic reviews were included, capturing 53 primary studies. Effectiveness for managing survivors' physical and psychosocial outcomes was found to be no different across models. Nurse-led and primary care provider-led models may produce cost savings to cancer survivors and healthcare systems. Barriers to the implementation of different models of care included limited resources, communication, and care coordination, while facilitators included survivor engagement, planning, and flexible services. CONCLUSIONS Despite evidence regarding the equivalent effectiveness of nurse-led, primary care-led, or shared care models, these models are not widely adopted, and evidence-based recommendations to guide implementation are required. Further research is needed to address effectiveness in understudied domains of care and outcomes and across different population groups. IMPLICATIONS FOR CANCER SURVIVORS Rather than aiming for an optimal "one-size fits all" model of survivorship care, applying the most appropriate model in distinct contexts can improve outcomes and healthcare efficiency.
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Affiliation(s)
- Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South, Australia.
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Megan Crichton
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Science & Medicine, Bond University, Robina, QLD, Australia
| | - Ria Joseph
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Kristi Milley
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Paige Druce
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Jianrong Zhang
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Jefford
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karolina Lisy
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jon Emery
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Larissa Nekhlyudov
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Thomas EE, Kelly JT, Taylor ML, Mendis R, Banbury A, Haydon H, Catto J, Der Vartanian C, Smith AC, Caffery LJ. Telehealth adoption in cancer clinical trials: An Australian perspective. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/08/2022] [Accepted: 10/22/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Emma E. Thomas
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Jaimon T. Kelly
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Monica L. Taylor
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Roshni Mendis
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Annie Banbury
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Helen Haydon
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | | | | | - Anthony C. Smith
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
- Centre for Innovative Medical Technology University of Southern Denmark Odense Denmark
| | - Liam J. Caffery
- Centre for Online Health The University of Queensland Brisbane Queensland Australia
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
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Delany C, Milch V, Keefe D, Wong ZW. COVID-19 recovery: implications for cancer care clinicians. Support Care Cancer 2022; 30:1003-1006. [PMID: 34626251 PMCID: PMC8501333 DOI: 10.1007/s00520-021-06600-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
The wellbeing of clinicians delivering cancer care needs to be considered and included in recovery roadmaps from the COVID-19 pandemic. In this paper, we refer to a report undertaken by Cancer Australia to review and reflect on the impact of COVID-19 in the delivery of cancer care. The report focused on post COVID-19 recovery and asked 3 questions: What changed? What has been the impact of that change? And how can high-value changes be embedded or enhanced? We suggest the same three questions should also be asked of cancer care clinicians. Using the three Cancer Australia questions, we draw from clinicians' insights collected through the Victorian COVID-19 Cancer Network (VCCN) and from the wider health professional literature. We summarise key features of the COVID-19 experience for cancer care clinicians, highlighting moral distress, fatigue and disrupted practice. We then discuss how pandemic-related ethical values might guide health leaders and administrators to balance support for clinician wellbeing with ongoing delivery of cancer care for patients.
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Affiliation(s)
- Clare Delany
- Peter MacCallum Cancer Centre, 305 Grattan st Parkville, Melbourne, 3010 Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | | | | | - Zee Wan Wong
- Peninsula Clinical School, Monash University, Clayton, VIC Australia
- Southern Melbourne Integrated Cancer Service, Melbourne, Australia
- Oncology Unit, Peninsula Health, Melbourne, Australia
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Roberts NA, Cubitt A, Lindsay D, Bury K, Dixon J, Gebbie C, Hawkins CA, Major T, Jenkins-Marsh S, Morris-Smith B, Poxton M, Richmond S, Smith D, Stoneley A, Thaker DA, Wilson E, Woollett A, Underhill C, Sabesan S. Teletrials, the new norm? Expert recommendations for teletrials into the future: Findings from the Clinical Oncology Society of Australia Clinical Trial Research Professionals Group Workshop. Asia Pac J Clin Oncol 2022; 18:650-659. [PMID: 35098670 DOI: 10.1111/ajco.13737] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The Australasian Teletrial Model was piloted in co-funded sites across Australia. The purpose was to extend the reach of clinical trials using telemedicine to improve equity and access to this treatment pathway for oncology patients. Experts across Australia gathered to share the learnings of implementation so that future directions can be effective and sustainable. METHODS The 1-day workshop was attended in person and virtually. Attendees were invited to analyze and disseminate the results. Recordings from the presentations were coded independently by three researchers and synthesized. The results were sent to the authorship team for further review to build consensus on the findings in three drafts. RESULTS Four key themes were identified: "Being on the Same Page," "Building Foundations," "Key Roles in Teletrials," and "Incentives." Although there were many successes that were accelerated by the COVID-19 pandemic, there is work still to be done. CONCLUSION The Australasian Teletrial Model has been identified as acceptable and feasible. Future directions need to continue to work on streamlining regulatory processes, implementation and monitoring, and build knowledge to further build networks across Australia.
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Affiliation(s)
- Natasha A Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,University of Queensland Clinical Centre for Research (UQCCR), Herston, Queensland, Australia.,Clinical Oncology Society of Australia Clinical Trials Research Professionals Group, Sydney, New South Wales, Australia
| | - Annette Cubitt
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Clinical Oncology Society of Australia Clinical Trials Research Professionals Group, Sydney, New South Wales, Australia
| | - Dianne Lindsay
- Clinical Oncology Society of Australia Clinical Trials Research Professionals Group, Sydney, New South Wales, Australia
| | - Kimberley Bury
- Townsville Cancer Centre, Townsville University Hospital, Townsville, Queensland, Australia
| | | | - Chantal Gebbie
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Cheryl-Ann Hawkins
- Alfred Health, Melbourne, Victoria, Australia.,Melanoma and Skin Cancer Trials Ltd, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | | | | - Melanie Poxton
- Townsville Cancer Centre, Townsville University Hospital, Townsville, Queensland, Australia
| | - Sue Richmond
- Clinical Research Unit, Cairns Hospital, Cairns, Queensland, Australia
| | - Delaine Smith
- Australasian Leukaemia and Lymphoma Group, Melbourne, Victoria, Australia
| | | | - Darshit A Thaker
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Clinical School, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | | | - Anne Woollett
- TrialHub, Alfred Health, Melbourne, Victoria, Australia
| | - Craig Underhill
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, Albury, New South Wales, Australia.,Albury Campus, Regional Medical School, University of NSW, Albury, New South Wales, Australia
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville University Hospital, Townsville, Queensland, Australia
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8
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Milch V, Wang R, Der Vartanian C, Austen M, Hector D, Anderiesz C, Keefe D. Cancer Australia consensus statement on COVID-19 and cancer care: embedding high value changes in practice. Med J Aust 2021; 215:479-484. [PMID: 34689343 PMCID: PMC8662192 DOI: 10.5694/mja2.51304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022]
Abstract
Introduction Driven by the need to reduce risk of SARS‐CoV‐2 infection and optimise use of health system resources, while maximising patient outcomes, the COVID‐19 pandemic has prompted unprecedented changes in cancer care. Some new or modified health care practices adopted during the pandemic will be of long term value in improving the quality and resilience of cancer care in Australia and internationally. The Cancer Australia consensus statement is intended to guide and enhance the delivery of cancer care during the pandemic and in a post‐pandemic environment. This article summarises the full statement, which is available at https://www.canceraustralia.gov.au/covid‐19/covid‐19‐recovery‐implications‐cancer‐care. Main recommendations The statement is informed by a desktop literature review and input from cancer experts and consumers at a virtual roundtable, held in July 2020, on key elements of cancer care that changed during the pandemic. It describes targeted strategies (at system, service, practitioner and patient levels) to retain, enhance and embed high value changes in practice. Principal strategies include:
implementing innovative models of care that are digitally enabled and underpinned by clear governance, policies and procedures to guide best practice cancer care; enabling health professionals to deliver evidence‐based best practice and coordinated, person‐centred cancer care; and empowering patients to improve health literacy and enhancing their ability to engage in informed, shared decision making.
Changes in management as a result of this statement Widespread adoption of high value health care practices across all levels of the cancer control sector will be of considerable benefit to the delivery of optimal cancer care into the future.
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Affiliation(s)
| | | | | | | | | | - Cleola Anderiesz
- Cancer Australia, Sydney, NSW.,Centre for Health Policy, University of Melbourne, Melbourne, VIC
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Delany C, Benhamu J, McDougall R, Ko D, Jones H, Mileshkin L, Largey G, Clinch A, Heynemann S. Supporting cancer care clinicians to 'hold' their patients during and beyond the COVID-19 pandemic: a role for reflective ethics discussions. Intern Med J 2021; 51:1143-1145. [PMID: 34278682 PMCID: PMC8447295 DOI: 10.1111/imj.15375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/14/2021] [Accepted: 05/12/2021] [Indexed: 01/19/2023]
Abstract
The COVID-19 pandemic has placed an overwhelming burden on healthcare delivery globally. This paper examines how COVID-19 has affected cancer care clinicians' capacity to deliver cancer care in the Australian context. We use the lens of 'holding patients' (drawing from attachment theory, psychology and from Australian Indigenous knowledge) to conceptualise cancer clinicians' processes of care and therapeutic relationships with patients. These notions of 'holding' resonate with the deep responsibility cancer care clinicians feel towards their patients. They enrich ethical language beyond duties to benefit, avoid harm, respect patients' autonomy and provide just treatment. We consider the disruptive effects of COVID-19 on care delivery and on clinicians themselves. We then show how models of clinical ethics and other similar reflective discussion approaches are a relevant support mechanism to assist clinicians to process and make sense of COVID-19's disruptions to their professional ethical role of holding patients during and beyond the pandemic.
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Affiliation(s)
- Clare Delany
- Department of Medical Education, Melbourne Medical SchoolThe University of MelbourneMelbourneVictoriaAustralia
| | - Joanne Benhamu
- Cancer Clinical Trials UnitPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Rosalind McDougall
- Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Danielle Ko
- Palliative CareAustin HealthMelbourneVictoriaAustralia
| | - Hayley Jones
- McCabe Centre for Law & CancerMelbourneVictoriaAustralia
| | - Linda Mileshkin
- Cancer Clinical Trials UnitPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Geraldine Largey
- Southern Health Integrated Cancer ServicesMonash HealthMelbourneVictoriaAustralia
| | - Alex Clinch
- Cancer Clinical Trials UnitPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
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