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van Schaik, Katherine

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van Schaik

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Katherine

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van Schaik, Katherine
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    Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives
    (BioMed Central, 2013) Shahid, Shaouli; Bessarab, Dawn; van Schaik, Katherine; Aoun, Samar M; Thompson, Sandra C
    Background: Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers’ experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. Methods: In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the ‘cultural security’ framework. Thematic analysis was carried out that identified patterns within data. Results: Fifteen palliative care providers were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. Conclusion: Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to impinge on Aboriginal people’s willingness and ability to accept care and support from these services. This context needs to be understood and acknowledged at the system level. More cultural safety training was requested by care providers but it was not seen as replacing the need for an Aboriginal worker in the palliative care team.
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    Methodological Comparison in Analysis of Lesion Burden and Aging in Human Remains From Past Populations
    (2018-05-15) van Schaik, Katherine; McNeil, Barbara J.; Podolsky, Scott; Sasson, J. Pierre; Taylor, William
    Background: Study of disease in the past can help illuminate patterns of human health, disease, and aging in the present and can shed light on human physiology. There are many methods to investigate questions of health and disease in the past, including DNA analysis and examination of human skeletal remains through gross inspection and X-ray imaging. Each method has its own possibilities and limitations for the kinds of information it can provide. Inspection and imaging of bones for evidence of disease is particularly important: such studies provide valuable data about chronic disease, as bones preserve information about malnutrition, longstanding infection, and inflammatory disease, among other conditions. There can be discrepancies, however, in assessments made by osteologists, who focus on visual and tactile inspection of the bone, and in those made by radiologists, who can see cortical depth and bone interior but cannot appreciate the bone surface details apprehended by tactile examination. Identification of the areas and extent of these discrepancies is important, as such places of difference affect assertions made about health and disease in the past. Consideration of the relationship between chronic disease and human longevity in the past is of particular importance in a modern context, as average human life expectancy and incidence of chronic disease have increased in the last century, encouraging more investigation of healthy aging. Studies identifying atherosclerosis in mummies from four different populations have emphasized the role that inflammation plays in chronic disease, underscoring that current human lifestyle modifications cannot solely be accountable for the rise of chronic disease. Examination of past populations, therefore, can provide insight into the human physiology that affects how humans age, and the relationship between chronic disease and age-at-death. This investigation had two goals: First, recognizing that variable methods of analysis of human remains yield different results about the presence and severity of disease in the past, we sought to compare two methods of analysis to identify their areas of overlap and difference in the results they yielded. These two methods were osteological analysis (gross visual and tactile inspection of bone by an osteologist) and radiological analysis (evaluation of a plain film radiograph by a radiologist). Second, bearing in mind the difficulties in evaluating age-at-death in bioarchaeological samples in the absence of historically-verifiable information, we sought to use a data set for which this information was available, so that we might identify a quantifiable relationship between age-at-death and the number and type of lesions observed using osteological and radiological analysis. Methods: Using this comparative approach, this investigation examined 212 mostly 19th century adult skeletons from the crypt of St. Bride’s Church in London, in order to investigate the relationships among age-at-death, sex, the number and kinds of lesions observed in bone, and potential differences in lesion identification with respect to the types of bones studied. Historically verifiable age-at-death data were available for every individual in the study. Each skeleton was examined by an osteologist, and lesions noted were recorded and classified into macro-level categories according to the Rapid Method for Recording Human Skeletal Data. A radiologist examined radiographs of the crania, humeri, pelves (including sacra), tibiae, and femora of these individuals; lesions noted were classified into the same categories the osteologist used. When comparisons were made between the two methods of analysis, matched sets that used only data for the crania, humeri, pelvises (with sacra), tibiae, and femora were employed. Results: Three studies were carried out on the data. Study 1 focused on characterization of differences in the number and type of lesions identified using osteological and radiological methods of analysis, and whether any differences, if present, were related to the sex of the individuals. It also focused on determining whether there was a relationship between number of lesions and age-at-death, and how method of analysis might affect this potential relationship. Exclusion criteria applied by the radiologist meant that 189 individuals were included in the matched comparison. Study 2 included all 212 individuals in each data set and incorporated analysis of age groups, instead of treating age-at-death as a discrete number. It focused on the relationship between number of observed lesions and age-group-at-death for groups over the age of 45. Study 2 also attempted to develop a model based on age-at-death and lesion burden. Study 3 investigated differences in methods of analysis through a bone-by-bone comparison. Correlations between age-at-death and the number and type of lesions were compared across both methods of analysis. A greater total number of lesions and a greater number of types of lesions were observed for the osteologically analyzed data, compared to the radiologically analyzed data. Correlations between age-at-death and specific pathology groups were in general weak, though stronger for the osteologically analyzed data. For each method of analysis, there were statistically significant differences between the total number of lesions and age group, with total number of lesions increasing with age, regardless of method of analysis. Joint and metabolic lesions were the most significant predictors of age-at-death. The correlations between total lesions observed and age-at-death were similar for radiologically and osteologically analyzed data, for the same set of bones. Bone-to-bone comparison of methods of analysis showed higher correlations in number of lesions identified for long bones. Conclusions: Taken together, these studies point to two broad conclusions. The first is that the use of different methods of analysis yields areas of convergence and areas of divergence in the identification of lesions. Such variation provides evidence for lesion types and locations that are particularly robust, and for the kinds of lesions that are more or less likely to be identified depending on the ways that we look for them. Osteological analysis identified infectious lesions, in more people, than radiological analysis did. Both modalities identified similar numbers of circulatory and neoplastic lesions. Study 3 showed stronger correlations between the total number of lesions measured by osteological and radiological analysis of long bones. Greater discrepancies in analytical modalities were noted for the cranium and pelvis. These areas of convergence imply that the kinds of lesions that can be identified most securely are circulatory and neoplastic lesions located in the long bones. The second conclusion suggested by this investigation is that the use of different methods of analysis holds the potential to further characterize the relationship between age-at-death and lesion burden, especially for individuals over the age of 45. This investigation contributes to be field of bioarchaeology because it not only provides evidence supporting the need for multimodality study, it also, through its comparative results, offers a framework in which multimodality results may be interpreted. The results of this work are relevant for modern patients because they shed light on the relationship between chronic disease and age-at-death in a treatment-naïve population. The presence of 19th century people who attained greater ages at death, with a potential leveling-off of lesion burden relative to their younger counterparts, encourages re-examination of multimorbidity and advanced age as modern concepts and suggests new ways we might formulate questions about healthy aging.