Purpose Communication between mental health professionals and Aboriginal and Torres Strait Islander peoples is critical for culturally safe care. Although the importance of communication is well recognised, genuinely supporting culturally safe communication necessitates moving beyond challenges to identify solutions. Using a strengths-based approach, this study aimed to identify principles and practices for communicating with Aboriginal and Torres Strait Islander peoples accessing mental health services. Methods This study was conducted at the interface of Indigenous and Western knowledge using theories and tools developed by Aboriginal and Torres Strait Islander scholars and integrating these with systematic review methods. A systematic search for qualitative and quantitative evidence was conducted across databases including peer-reviewed and other (‘grey’) literature. Search results were independently screened by an Aboriginal researcher and a non-Indigenous clinician researcher. Following screening, additional searches were conducted (e.g. of reference lists in systematic reviews). The quality of literature sources meeting inclusion criteria was appraised by the same researchers using Aboriginal and Torres Strait Islander and Western tools. Informed by Indigenous research methodology, thematic synthesis was used to identify principles and practices for communication. Main findings The search strategies identified 2,504 unique literature sources. Following screening, 57 sources were deemed to meet inclusion criteria. Critical appraisal identified that most sources were produced by reputable organisations and authors, who provided accurate information based on evidence, although fewer sources incorporated Aboriginal or Torres Strait Islander leadership, governance and authorship. Thematic synthesis identified three high-level principles for communication that could be understood from the standpoints of Aboriginal and Torres Strait Islander Peoples and other people living in Australia: 1) Knowing Our Stories: Professional requirements of knowledge and understanding to support culturally safe communication; 2) Being With Us: Preparing for culturally safe communication; and 3) Doing Things Our Way: Practices for culturally safe communication. Principal conclusions The sizable body of literature synthesised in this review identifies both high-level and detailed principles and practices that mental health professionals should employ to promote culturally safe communication with Aboriginal and Torres Strait Islander peoples accessing mental health services.

OBJECTIVE:To investigate how the presence of multiple parties during paediatric palliative care encounters influences involvement of child patients. METHODS:This mixed-methods observational study analysed 60 video recorded routine clinical encounters within three paediatric palliative care services in Australia. These were classified using a coding scheme that was iteratively developed using conversation analysis methods. Coded data were analysed statistically, with qualitative conversation analysis methods used to explore statistical findings. RESULTS:Statistical analysis of coded data indicated that child involvement increased when more adults were present during an encounter. The number and role of adults present were associated with child involvement. Clinicians were most involved with child patients when there were at least two clinicians present. Clinician involvement with child patients peaked when multiple clinicians were present and when there was only one adult family member present. When multiple family members were present, the likelihood that children would respond to attempts by adults to involve them increased. CONCLUSIONS:Including multiple clinicians and family members in paediatric palliative care encounters is associated with increased involvement of child patients. PRACTICE IMPLICATIONS:To foster optimal conditions for the involvement of children, multiple clinicians and - where possible - multiple family members should be present during clinical encounters.

The diagnosis of a childhood brain tumor impacts the psychological well-being of parents who experience high levels of post-traumatic stress. To understand the etiology of trauma through this unique healthcare experience, a journey mapping exercise was undertaken with parents of children with brain tumor. Data were collected in an online focus group and by written responses. Framework analysis and research poetry were used to map experiences of traumatization and trauma-informed care across time. Nine mothers mapped their experience of their child's brain tumor care describing their needs and responses. Findings are presented by eight milestones, supported by research poetry composed of participant quotes titled: "I must be wrong," "All the fear, no answers," "Paper Thin," "Happy but Terrified," "The Rest of Him," "Less Than," and "Into Our Destiny." Throughout the trajectory of care, parents reported traumatic events and moments of helplessness attributed to the healthcare received, contributing to unrelieved distress. Increased transparency in communication between clinicians and parents fostered increased trust and psychological safety within healthcare services. Understanding the traumatization that occurs across the trajectory of care can inform service improvements and early linkage to specialized support. This study contributes novel understanding of traumatization for parents of children with brain tumor and depth in understanding of emotional components through the presentation of research poetry.

Background/Objectives: Parents report unmet information needs relating to childhood brain tumors. Existing research shows that providing information to families supports self-efficacy and well-being. The project therefore aimed to co-design resources tailored to the informational needs of families navigating childhood brain tumors in Australia. Methods: Mixed methods were used across multiple phases. A landscape analysis in Phase 1 confirmed the gap in Australian resources as well as the identification of international resources suitable to inform local solutions. Following the Double Diamond Design Framework, subsequent phases of the project aimed to discover and define the problems faced by families before developing and delivering the solution. Parents of children with brain tumors participated in a journey mapping workshop, content adaptation through feedback, and an online survey to determine the preferred delivery mode of information. Clinicians provided iterative feedback as the resource was developed and refined. Results: Nine mothers participated in journey mapping and iterative adaptation of the resource along with twelve clinicians. There were 46 respondents to the survey, which identified a preference for multi-modal delivery of information, and 23 clinical and consumer reviewers in the final revision phase. The process of adaptation is presented, providing transparency on the development of this national resource. Conclusions: The use of self-efficacy theory and co-design was pivotal in this project. Integration of concepts from self-efficacy moves beyond simply presenting information to empowering the audience to feel capable of the task ahead of them. Co-design ensured the content and tone of the resulting resource are fit-for-purpose from the perspective of both clinicians and consumers. The resource is available as a physical book, digital resource, and audiobook and disseminated through children’s hospitals, professional networks, and brain tumor support groups.

Background: Advances in diagnosis and treatment have significantly increased survival rates for childhood cancer, leading to a growing population of long-term survivors. However, these survivors face substantial physical and psychological sequelae that affect both the child and their family. We developed the RECOVER model of care to support childhood cancer survivors as they transition from the end of their planned treatment to survivorship, addressing the broader health and wellness needs beyond medical surveillance. The primary objectives are to assess the feasibility and acceptability of the RECOVER model of care in routine paediatric oncology practice. Secondary objectives include evaluating preliminary efficacy outcomes and identifying factors that influence the successful adoption and integration of the model. Methods: The study comprises a Type 2 Hybrid Implementation/Effectiveness non-randomised controlled trial to compare historical and prospective data. Quantitative data will assess feasibility, reach, effectiveness, adoption, maintenance, and implementation. The qualitative component will assess end-user acceptability and appropriateness through focus groups, surveys, and interviews. Quantitative and qualitative results will be integrated during the interpretation phase to provide complementary insights into the interconnected contextual factors that facilitate the model uptake. Discussion: The RECOVER model of care aims to offer a robust approach to survivorship care, facilitating the continuous monitoring and management of long-term and late effects in childhood cancer survivors. This model has the potential to significantly improve the quality of life and health outcomes for this vulnerable population by addressing their comprehensive needs in a timely and systematic manner.

Communication is recognised as crucial to culturally safe healthcare, and poor communication remains a major reason that Aboriginal and Torres Strait Islander people do not access healthcare. This pragmatic, pre-post comparison study employed mixed methods to evaluate cultural capability and clinical yarning training delivered to 57 clinicians supporting Aboriginal and Torres Strait Islander people at three persistent pain management services in Queensland, Australia. Observable outcomes of the training were evaluated by video recording clinicians’ training experiences and seven consultations with patients that occurred either pre- or post-training. Reported outcomes were evaluated by using a modified Cultural Safety Survey (CSS), which was completed by 67 patients during a period pre- and post-training delivered to the clinicians. Using conversation analysis methods and focusing on clinicians recorded both pre- and post-training, analysis of video recordings identified observable differences in communication practices that were consistent with learning opportunities in the training. Statistical analysis of the CSS survey focused on subsamples of data from 20 patients who consulted clinicians who attended training. A comparison of pre- and post-training data and found no difference in the overall score of the CSS (p=0.594). The study identified differences in social practices following training but did not find changes to patient experiences of care. These findings demonstrate the feasibility of changing clinical communication in relation to culture, while also highlighting the importance of examining practices used in social interaction to determine whether and how training is applied by learners.

AIM:This study aimed to identify diverse ways nonspeaking and speaking children are involved in clinical encounters. METHODS:The study analysed video recordings of paediatric palliative care encounters in Australia. Conversation analytic coding methods were used to identify embodied (e.g., gesture) and vocal (e.g., grunting) modes of interaction used by all children and lexical verbalisations (i.e., words) used by speaking children. Analysis focused on interactions between children and adults (both family members and clinicians). RESULTS:A total of 38 child patients (seven speaking, 31 nonspeaking), 56 family members and 50 clinicians participated across 60 video-recorded encounters with the child patient present. Analysis identified 1737 spates (i.e., periods) of interaction with child patients. Nonspeaking children were involved in a median of 38.0 spates of involvement per hour and speaking children in a median of 58.7 spates per hour. Observed practices of nonspeaking and speaking children included adult clinicians and family members doing something with a child without speaking, identifying the child as a recipient of some action, assessing the child, telling the child something, and physically tending to the child with verbal commentary. Clinicians and adult family members more often initiated spates of involvement (62.9%) than children themselves and were more responsive to spates initiated by nonspeaking children (89.6%) than speaking children (79.3%). CONCLUSIONS:This study demonstrates how children-including nonspeaking children-are regularly involved in clinical encounters. The study findings indicate a need to avoid exclusively focusing on verbal communication, to appreciate the diverse ways that children can be involved in clinical encounters about them.

BACKGROUND:Increases in survival for childhood brain tumour are evidence of improved care; however, survival is not the only outcome that matters. There has been little scholarly investigation into the psychosocial wellbeing of the diagnosed child and their parents/carers (caregivers) in the early years after diagnosis-fewer still have considered indicators for increased early support. The aim of the present study was to explore whether child and caregiver quality of life (QoL), and family functioning, change over the first 24 months post-diagnosis, and whether this varies by clinical and sociodemographic factors. PROCEDURE:Ninety-six caregivers were recruited less than 3 months after their child was diagnosed to complete surveys at five time points. Outcome measures were child QoL (caregiver-proxy), caregiver QoL, and family functioning; linear mixed models with random intercepts were used to assess predictors for each. RESULTS:Child and caregiver QoL did not improve with time, nor did family functioning. Those with a child who had a low-grade tumour at baseline who received chemotherapy and/or radiation consistently reported the worst QoL for themselves and their child. Household income was a predictor of all outcomes-those with a lower income (<AU$70,000) reported worse experiences. CONCLUSIONS:Time alone may not improve QoL and family functioning. Psychosocial support must be provided to all children with a brain tumour and their families, regardless of tumour grade. Families who have a child diagnosed with any brain tumour and who have a lower household income would likely benefit from intensive psychosocial support from diagnosis and beyond.

Purpose Cancer-related fatigue (CRF) is a prevalent and distressing symptom experienced by people affected by cancer. A breakdown of the clinician-patient partnership and suboptimal clinician communication has been identified as a significant barrier to implementing into clinical practice effective self-management strategies for CRF. This study examined the use and impact of communication practices employed by trained cancer nurse counsellors when providing CRF self-management support to cancer survivors. Methods Interactions from 41 telehealth consultations between three nurse counsellors and 23 cancer survivors in a CRF self-management support clinic in Queensland, Australia were recorded and analysed using conversation analysis methods. Results Analysis found that in instances where nurses established the agenda of a consultation from the outset of a session (e.g., focusing on fatigue self-management support), cancer survivors displayed clearer understandings of their self-management role, the tasks, and goals of a session; and displayed less difficulty engaging in supportive care discussions. Furthermore, clinicians used formulation practices, such as summarising dialogue, to sustain focus on fatigue during consultations, and to close discussion matters not ostensibly pertinent to fatigue self-management planning supporting the goals of the CRF SMS clinic consultations. Conclusion For supportive care sessions targeting fatigue management, clinicians should ideally focus discussion on CRF support early, by clearly introducing the agenda at the outset of the consultation while also asking for client agreement. Periodically summarising patient's talk allows clinicians to maintain a focus on matters relevant for self-management fatigue planning and provide support within the typically constrained timeframes allocated for addressing CRF.

Background: The wellbeing of a child with brain tumour is affected by several factors. We present the first investigation of quality of life and family functioning in a parent and child across the first 12 months after diagnosis, examining potential factors to guide the provision of psychosocial resources to families who most need them. Procedure: Data were collected from parents/carers in Queensland, Australia, from 2020 to 2023. Child (parent/carer-proxy reported) and carer quality of life was assessed across three timepoints (repeated measures analysis of variance [ANOVA]) and by five potential co-variates (mixed between-within ANOVA). Family functioning was assessed across two timepoints (repeated-measures t-test), and by potential co-variates (repeated measures ANOVA). Univariate relationships were explored with Pearson's correlation coefficient; significant relationships were entered into multiple regression models. Results: Ninety-six diverse families were represented. Quality of life (child, carer) and family functioning did not change across time. Children from households with lower income reported worse cognitive difficulties (p = .023) and pain and hurt (p = .013) than those from a higher income. Caregiver quality of life was poorer for those whose child had received chemotherapy and/or radiation, was aged less than 4 years at diagnosis, and had a lower household income. At 12 months, caregiver quality of life was correlated with family functioning (r = -.45, p < .001), with positive adaptation being a significant key predictor (beta = -.66, p < .005). Conclusions: The following factors indicate a need for increased early psychosocial support: cognitive difficulties, aged <4 years at diagnosis, receiving chemotherapy and/or radiation, and low household income.

Communication is central to pediatric care. Conversation analytic (CA) studies of recorded naturally occurring pediatric interactions contribute distinctive understandings; however, to date there has been no detailed review of CA's unique contributions. We searched Medline, PsychINFO, Sciencedirect, Google Scholar, and the EM/CA Wiki database, identifying 74 empirical articles across diverse areas of pediatrics. Our state-of-the-art review highlights CA of clinician and caregiver conversations about a child patient, in addition to those involving the child. The findings have the potential to enhance clinical practice by illuminating how healthcare tasks are practically accomplished and enrich our knowledge of children's participation in consultations by revealing the mechanisms that constrain and enable their involvement. We call for better synthesis of findings with broader CA literature (e.g., nonclinical child interactions, adult triadic clinical encounters, and fundamental knowledge of social interaction). We appeal for increased support for scholarly work in non-Western settings, and emphasize scope for applied initiatives. The data reported are in multiple languages.

Abstract Background Evidence suggests that public, and some professional, understandings of palliative care are limited to care provided immediately before death, which contrasts palliative care's scope as care provided across a range of illness stages. Objective To examine how clinicians manage patients' understandings of palliative care during initial consultations. Design Initial palliative care consultations were video‐recorded and analysed using conversation analytic methods. Setting/Participants Consultations were recorded in a specialist palliative care outpatient unit within an Australian public hospital. Participants included 20 newly referred patients and their families, and three palliative care clinicians. Results During initial consultations, it was observed that specialist palliative care clinicians frequently managed the possibility that patients may understand palliative care as limited to care provided immediately before death. Clinicians used recurrent practices that seemed designed to pre‐empt and contradict patients' possible narrow understandings. When discussing the palliative care inpatient unit, clinicians recurrently explained inpatient care could include active treatment and referred to the possibility of being discharged. These practices contradict possible understandings that future admission to the inpatient unit would be solely for care immediately before death. Discussion The findings demonstrate that palliative care clinicians are aware of possible narrow understandings of their discipline among members of the public. The practices identified show how clinicians pre‐emptively manage these understandings to patients newly referred to palliative care. Conclusions These findings highlight scope for greater partnership with teams referring patients to palliative care, to assist patients in understanding the range of reasons for their referral. Patient or Public Contribution The observational method of conversation analysis provides direct insight into matters that are relevant for patients, as raised in their consultations with clinicians. This direct evidence enables analysis of their lived experience, as it occurs, and grounds analysis in observable details of participants' conduct, rather than interpretations of subjective experiences. The patients' contributions, therefore, were to allow observation into their initial palliative care consultations.

PurposeTo generate direct observational evidence for understanding how diet, nutrition, and weight-related topics are discussed during follow-up after treatment for gynecological cancer, as recommended by survivorship care guidelines.MethodsConversation analysis of 30 audio-recorded outpatient consultations, involving 4 gyne-oncologists, 30 women who had completed treatment for ovarian or endometrial cancer, and 11 family members/friends.ResultsFrom 21 instances in 18 consultations, diet, nutrition, or weight-related talk continued beyond initiation if the issue raised was ostensibly relevant to the clinical activity being undertaken at the time. These instances led to care-related outcomes (i.e., general dietary recommendations, referral to support, behavior change counseling) only when the patient identified needing further support. Diet, nutrition, or weight-related talk was not continued by the clinician if it was not apparently related to the current clinical activity.ConclusionsThe continuation of diet, nutrition, or weight-related talk during outpatient consultations after treatment for gynecological cancer, and the subsequent delivery of care-related outcomes, depends on its immediate clinical relevance and the patient indicating needing further support. The contingent nature of these discussions means there can be missed opportunities for the provision of dietary information and support post-treatment.Implications for Cancer SurvivorsIf seeking information or support for diet, nutrition, or weight-related issues post-treatment, cancer survivors may need to be explicit regarding their need for this during outpatient follow-up. Additional avenues for dietary needs assessment and referral should be considered to optimize the consistent delivery of diet, nutrition, and weight-related information and support after treatment for gynecological cancer.

Background Providing cultural education to health professionals is essential in improving the quality of care and outcomes for Aboriginal and Torres Strait Islander patients. This study reports the evaluation of a novel training workshop used as an intervention to improve communication with Aboriginal and Torres Strait Islander patients of persistent pain services. Methods In this single-arm intervention study, health professionals undertook a one-day workshop, which included cultural capability and communication skills training based on a clinical yarning framework. The workshop was delivered across three adult persistent pain clinics in Queensland. At the end of the training, participants completed a retrospective pre/post evaluation questionnaire (5 points Likert scale , 1 = very low to 5 = very high), to rate their perceived importance of communication training, their knowledge, ability and confidence to communicate effectively. Participants also rated their satisfaction with the training and suggested improvements for future trainings. Results Fifty-seven health professionals were trained ( N = 57/111; 51% participation rate), 51 completed an evaluation questionnaire ( n = 51/57; 90% response rate). Significant improvements in the perceived importance of communication training, knowledge, ability and confidence to effectively communicate with Aboriginal and Torres Strait Islander patients were identified ( p < 0.001). The greatest increase was in the perceived confidence pre-training mean of 2.96 (SE = 0.11) to the post-training mean of 4.02 (SE = 0.09). Conclusion This patient-centred communication training, delivered through a novel model that combines cultural capability and the clinical yarning framework applied to the pain management setting, was highly acceptable and significantly improved participants’ perceived competence. This method is transferrable to other health system sectors seeking to train their clinical workforce with culturally sensitive communication skills.

This chapter provides an overview of qualitative, language-based approaches to studying emotion in psychotherapeutic interaction. Particular attention is given to conversation analysis, which has made substantial contributions in this area. A hallmark of conversation analytic inquiry is fine-grained analysis of naturally occurring social interaction. Conversation analytic research investigating language and emotion in psychotherapy is underpinned by a broad conceptualisation of emotion as a socially situated stance. This approach has facilitated description of a range of practices for displaying emotion in psychotherapy. Clients can display emotional stances that are more or less explicit, for example, and therapists use a range of practices in attempts to engage clients in discussion about emotion. Conversation analytic research identifies two key challenges for therapists in this regard. First, therapists do not typically have direct access to clients' emotional experience, and must therefore find ways to display knowledge about experiences that are not their own. Second, therapists need to maintain collaborative working relationships with clients, and this objective can conflict with attempts to discuss emotional experience in ways that do not align with clients' perspectives. Therapists must find ways to manage these challenges in order to promote successful therapeutic outcomes. By highlighting the diverse ways in which emotional stances are displayed in psychotherapy, and the challenges associated with discussion of emotion, conversation analytic research provides key insights into ways language and emotion are central to the psychotherapeutic process.

ObjectiveFrom diagnosis and beyond, a paediatric brain tumour and its treatment impact the child and their family in a myriad of ways. While it is considered best practice to offer ongoing psychosocial support for all family members, there is little scholarly investigation of both families' experiences and the practical implications of offering such care. We aimed to explore families' experiences of paediatric brain tumour and their associated psychosocial health service needs. MethodsFamilies receiving care at the Queensland Children's Hospital in Brisbane, Australia, for a child (0-18 years) who had been diagnosed with a brain tumour between 2019 and 2022 were invited to be interviewed about their experiences. Using qualitative description, we analysed these interviews to identify families' unmet psychosocial health service needs and their suggestions for improvement. ResultsTwenty-three clinically and socially diverse families were represented. While parents/carers expressed gratitude for the care their child had received, most also described unmet needs for the broader family. We identified three primary needs to be addressed: (1) parents want accessible psychological/emotional support for themselves; (2) parents/carers want additional guidance to navigate the hospital setting to reduce uncertainty and loss of control; and (3) parents want support to minimise treatment-associated trauma for their child. ConclusionsOur findings evidence the need for improved family-centred psychosocial care within paediatric brain tumour care in Queensland, Australia. We propose a counselling and care coordination intervention to support parents/carers to care for themselves, their child, and their family through an extremely challenging experience.