Rural Australia Research Articles

Empowering junior doctors: A study on the feasibility and efficacy of ultrasound AAA screening in rural Australia

Purposes Abdominal Aortic Aneurysm (AAA) screening via ultrasound in Caucasian males aged 65 and older has proven cost-effective in metropolitan areas. Evidence suggests that with adequate training, individuals without prior sonography experience can achieve accurate aortic measurements. This study evaluates the capability of junior doctors, after brief training, to conduct reliable AAA ultrasound screenings in a rural hospital setting, addressing the gap in speciality surgical services. Methods Three junior doctors participated in a 2-hour practical ultrasound training, subsequently performing scans on both inpatients and community volunteers at a regional hospital. The analysis focused on measurement discrepancies within a 5 mm clinically acceptable difference, scanning efficiency, and aneurysm detection accuracy. Results A total of 71 participants were included. Among the screenings, 81.7% fell within the clinically acceptable discrepancy range, with 72.7% accuracy in inpatient scans and 95.5% in volunteer scans. Measurement reproducibility improved significantly with the standardisation of ultrasound techniques, and there was excellent agreement among operators in detecting aneurysms. Notably, scanning efficiency improved from the inpatient group to the volunteer group with statistical significance. Conclusions Junior doctors demonstrated the ability to efficiently and reproducibly measure the infrarenal aortic diameter at a level comparable to experienced sonographers after only 2 hours of training. A single day of supervised practice is recommended to ensure standardised ultrasound technique. This approach offers a practical, cost-effective supplement to specialist radiology services in rural areas, enhancing access to critical screening procedures without proposing the replacement of professional sonographers.

Thickened Gallbladder Wall, Abdominal Pain, and Fever: A Rare Presentation of Dengue in Rural Australia

Thickened Gallbladder Wall, Abdominal Pain, and Fever: A Rare Presentation of Dengue in Rural Australia

Community-Driven Health Promotion: Evaluation of a Rural Microgrant Program.

Microgrants for health promotion have the potential to engage communities in designing and implementing place-based interventions to improve health and social outcomes. However, the evidence base around microgrants for health promotion is limited. This study presents the evaluation of a health service-funded microgrant program for health promotion in rural Australia. The evaluation framework was developed through a participatory approach and involved collaborative logic model building and co-prioritized evaluation questions with health service staff and grant recipients. Evaluation questions focused on participation, short-term outcomes, and the perceived value of program activities. Qualitative methods (reflexive thematic analysis) were used to answer the evaluation questions. Data sources included semi-structured interviews with grantees (n = 11) and the health service's health promotion team (n = 4), electronic field notes kept by the health promotion team (n = 50 documents), electronic progress reports completed by grantees (n = 6) and information and feedback forums (n = 2). Since the program's inception in 2019, the health service has received 22 grant applications of which 15 were approved and 14 disbursed. Evaluation results show that grantees were community members with multiple roles, often with previous experience in applying for grants. Expected outcomes have been partially met, especially with regard to the program's aim of community empowerment. The most notable impact was the enhancement of participants' perception of and relationship with the health promotion team, as well as the creation of opportunities for community members such as exposure to art and bridging of social groups. Microgrants represent a feasible way to increase health opportunities and foster community participation in the planning and delivery of health promotion programs. The key program activities identified and suggested improvements can help guide program replication and adaptation by other small organizations. Community members who had previously received a health service grant were invited to participate in collaborative workshops and follow-up surveys to codesign the grant program evaluation framework, co-prioritize evaluation questions and guide the results' dissemination plan.

The experiences of rural generalist occupational therapists in provision of palliative care in rural, regional, and remote Australia: A phenomenological inquiry.

Access to specialist palliative care in rural and remote Australia is limited, resulting in a reliance on generalist health professionals to provide these services. Although literature exists concerning the experiences of some health professions in providing rural generalist palliative care, little is known about the experiences of occupational therapists who fill these roles. This paper aims to address this gap in knowledge by exploring the experiences of rural generalist occupational therapists in the provision of palliative care in rural, regional, and remote Australia. An interpretive phenomenological approach guided this research. Data were collected from eight rural generalist occupational therapists across Australia, using semi-structured, in-depth interviews. Data were thematically analysed to develop a nuanced understanding of lived experience in provision of palliative care. Due to the focus of this research on the practice experiences of occupational therapists, consumer and/or community involvement was not undertaken in its design or implementation. Three key themes were identified: 'community connections - a double-edged sword'; 'frustrations with structural and contextual factors limiting quality palliative care service provision'; and 'education and support as enablers of professional preparedness for palliative care service provision.' Taken collectively, these findings shed light on a variety of challenges and opportunities associated with rural generalist palliative care occupational therapy practice, as well as clues to their effective management. Knowledge of rural generalist occupational therapists' experiences can inform workforce development, promote retention of rural occupational therapists, and improve outcomes for dying persons, their families and caregivers. This study offers new insights into challenges and opportunities for rural generalist occupational therapy practice in palliative care and highlights the way in which both, new and existing support structures may be of value in promoting practice capacity and therapist wellbeing. It can be hard to get expert support for dying people in areas outside of cities in Australia. Health workers in these areas should be helped to provide good care. In this study, we spoke with some health workers in rural and remote areas who occasionally work with people who are dying. They told us that people in these areas were often helpful in supporting people who are dying because they felt close to them. But they also said that this made caring sadder for health workers because, sometimes, they were close to the people who were dying too. Having too much work, not enough experience and long distances made providing good care extra difficult. The health workers said that getting expert advice or using online teaching could help them improve their practice, but finding the time to do this is hard.

Prospective evaluation of the store-and-forward teledermatology service (eConsult) delivery at Townsville Hospital: A pilot study.

The shortage of dermatologists in rural and regional Australia is acutely felt in north Queensland where the population experiences a leading burden of skin cancer and tropical dermatoses. Store-and-forward teledermatology (SAFT) is recognised as a potential solution to improve accessibility of dermatology specialist care in rural communities. eConsult (a SAFT service) was piloted for the broader Townsville community in 2022. Evaluation was necessary to ensure wider implementation would meet stakeholder needs and improve patient care. To evaluate clinician perspectives and use of eConsult within the Townsville Hospital and Health service catchment over the pilot period (up to 9 months). Pre-engagement interviews with clinicians assessed their management of dermatoses and service expectations prior to eConsult usage. eConsult referrals identified case characteristics, outcomes and uptake of the service amongst clinicians. Post-engagement interviews assessed clinician perceptions and their suggestions for the service at the conclusion of the pilot period. In total, 24 and 17 clinicians participated in the pre- and post-engagement interviews respectively, and 38 referrals were submitted by clinicians. The service assisted diagnosis and management of non-urgent skin conditions for any age group. Clinicians generally had positive perceptions and appreciated timely access to local specialist advice. This study suggests a SAFT service can improve access to dermatology specialist opinion and increase management of dermatoses in primary care. Establishing sustainable teledermatology services with strong engagement from users is important for accessible care. Future research may investigate similar SAFT models involving more specialists and assess long-term cost-effectiveness.

Representing rural Australia: political representation and rural discontent

ABSTRACT There is a distinct rural flavour to contemporary political discontent. Studies in the United States have found that rural populations feel politically neglected and resentful of city dwellers, resulting in significant partisan cleavages. Rural discontent and difference are enduring features of Australian federal politics, with rural populations often frustrated by their treatment from policy-makers in Canberra. To understand better contemporary rural discontent this article considers the views of those elected to represent rural people, rural MPs. It presents findings of an empirical study into how Australian federal rural MPs understand their role, their constituents, and the issues they face. Interviews reveal that the role of a rural MP is shaped by distance, by diverse people and localities, and by a sense that their constituents are misunderstood by urban Australians and policy-makers. The article considers how these interpretations of rural MPs intersect with sentiments of rural discontent.

‘The Little Things’: The Temporality of Young People’s Strategies for Existential, Grounded, and Expansive Wellbeing in Rural Australia

AbstractThis paper is based on research in rural southeast Australia with young people from recent migrant and refugee backgrounds. While existing research on the wellbeing of this group often emphasises successful settlement through education, employment, and belonging as pathways to future wellbeing, this paper asks what we can learn from young people’s own experiences and understandings of wellbeing. Guided by the words, images, and reflections of young people involved in this research, the paper explores everyday wellbeing as an existential, relational, and situated happening that takes both time and place. Young people in the study highlighted the importance of finding beauty, joy, and connection in ‘the little things’ of daily life to bring a sense of meaning into monotonous temporal rhythms and weekly routines structured by work and study. Drawing from Todres and Galvin’s ‘dwelling-mobility’ wellbeing framework, this paper conceptualises young people’s ability to be well as intricately intertwined with their ability to experience their lives over time as grounded and secure, while also having a sense of greater meaning and possibility. Ultimately, the paper illustrates how young people understand their ability to be well as temporally complex, informed by ongoing, non-linear interactions between past, present, and future experiences as they look forward and back over their lives, seeking to transform the passage of time from meaningless to meaningful.

Maternity Care Sustainability in Rural Australia

Introduction: In recent years there has seen significant closure of small maternity units particularly in rural regions of Australia. Those small maternity units that do continue to care for childbearing women may only provide antenatal and postnatal care with women giving birth in a larger maternity unit often some distance away. There are some small maternity units that continue to provide complete care to childbearing women which is the focus of this research. The issue here is that these small rural maternity units tend to only cater for women who are having a low-risk pregnancy. When the women is deemed ‘high risk’ they will need to transfer to a larger maternity unit for their ongoing antenatal visits and to birth. These larger maternity units are often some distance away requiring women to travel for each antenatal care visit and for birth. This research aims to explore women’s experience of having to transfer their care to a larger maternity unit due to being deemed at risk through interview of 40 women deemed at risk. Methods: Focus of the research was women’s experiences of needing to transfer their maternity care and used a qualitative descriptive phenomenology approach. To date seven women have been interviewed. Results: This paper presents the preliminary findings from the interviews that have been undertaken to date on seven women. The data is presented under emerging themes which will be refined with further interviews. The emerging themes are ‘women had no agency’, ‘the hidden cost’ and ‘the journey continues’. Conclusion: The paper presents the preliminary findings from these interviews. Ultimately the aim is to assess how care can be improved for these women and potential options/models of care and make these small rural maternity units sustainable.

Truth-telling about (Teacher) education as settler-colonial project: ‘The past is always with us’

ABSTRACT One of the Editors’ 2022 Challenges to the Field was: What is the story this government wants us to tell our children? What is education for? Continuing this conversation leads to a related question: What can be learnt from reviewing the history of schooling in Australia in this light? I argue here that the nation’s founding discourse of White Australia produced a purposeful project of schooling and teacher education designed to ‘keep rural Australia white’. This also led to the disassociation of rural education and Aboriginal education that remains problematic for rural schools today. As a form of truth-telling from a non-Indigenous perspective, I offer a basis for reflection on the extent to which 21st Century educational practices continue to (re)produce this discourse. Understanding the past – about how the newly federated Australian states century set out to educate their future citizens – is crucial for teacher education aiming for social and environmental justice and change. An anti-colonialist reading of this history of colonial settler schooling might help us understand why the discourse of White Australia (and the systematic regimes of ‘truth’ about our country, its original inhabitants, and its waves of new settler-citizens) has remained so powerful over time.

A Deep Learning Biomimetic Milky Way Compass.

Moving in straight lines is a behaviour that enables organisms to search for food, move away from threats, and ultimately seek suitable environments in which to survive and reproduce. This study explores a vision-based technique for detecting a change in heading direction using the Milky Way (MW), one of the navigational cues that are known to be used by night-active insects. An algorithm is proposed that combines the YOLOv8m-seg model and normalised second central moments to calculate the MW orientation angle. This method addresses many likely scenarios where segmentation of the MW from the background by image thresholding or edge detection is not applicable, such as when the moon is substantial or when anthropogenic light is present. The proposed YOLOv8m-seg model achieves a segment mAP@0.5 of 84.7% on the validation dataset using our own training dataset of MW images. To explore its potential role in autonomous system applications, we compare night sky imagery and GPS heading data from a field trial in rural South Australia. The comparison results show that for short-term navigation, the segmented MW image can be used as a reliable orientation cue. There is a difference of roughly 5-10° between the proposed method and GT as the path involves left or right 90° turns at certain locations.

Understanding the professional factors that impact the retention of pathology workers in regional, rural and remote Australia.

The objective of this study was to determine what professional factors impact the retention of pathology workers in regional, rural and remote Australia. A cross-sectional survey was used to collect data regarding the professional factors that impact the retention of regional, rural and remote pathology workers in Australia (n = 95). The survey focused on pathology workers' satisfaction with specific professional factors and how long they intended to stay in their current position. Regional, rural and remote (MM2-7) pathology laboratories in Australia. There were a total of 95 participants, including 24 phlebotomists/laboratory assistants, 34 medical laboratory scientists and 29 supervisors/managers, with the majority of participants being from New South Wales, Queensland and Western Australia. Significant positive associations were found between satisfaction with career advancement opportunities, workplace culture and maintaining professional skills with the retention of regional, rural and remote pathology workers. Open-ended responses indicated that personal factors also played an important role in pathology worker retention in regional, rural and remote communities. This study provides important insights into the professional factors that impact the retention of pathology workers in regional, rural and remote Australia. Personal factors were also found to play an important role in retention. These findings have highlighted the need for further research to be conducted to explore the relationship between professional and personal factors and how this impacts the retention of pathology workers in regional, rural and remote Australia.

Integrating health and child protection systems: towards collaboratively improving health outcomes for children in kinship care in rural Australia

PurposeThere is a growing recognition that the integration of health systems will benefit children in out-of-home care (OOHC), especially those who have experienced trauma. This paper examines the adaptation of existing health systems and the persistent barriers between rural health and child protection programs. It focuses on health systems integration for children aged 0–6 years in kinship care and their siblings.Design/methodology/approachThe study applied a multi-methods qualitative approach involving individual interviews and focus groups with project members from operational or strategic reference groups, child protection personnel and the kinship carer program. We also reviewed documentary evidence.FindingsWe found evidence that health clinicians and child protection practitioners adapted and adjusted services as they collaboratively worked together to improve care delivery to children in kinship care. Yet, despite successful adaptations to systems and the appointment of a health navigator, systemic barriers remain. These include service and staff shortages in rural Australia, complications around information sharing, authority and power dynamics and siloed operations. Such barriers prevent better-integrated health systems and ultimately impair health outcomes for children in kinship care.Originality/valueThis paper contributes to knowledge and practice to improve the integration of child protection and healthcare services in Australian OOHC. It provides valuable insights into the challenges and successes of health systems integration, highlighting the need for continued collaborative effort to create effective, place-based models of care that benefit these children and their carers.

Evaluation of nurse practitioners' extended scope of practice in a regional hospital emergency department in tropical Australia.

There is very little literature examining the workload and impact of nurse practitioners (NPs) working in emergency departments (ED) in regional and rural Australia. The aim of this paper was to review the ED NPs scope of practice in the ED discharge stream and patient outcomes at Cairns Hospital over a 7-month period. This retrospective study examined the ED electronic medical record between 14 May 2019 and 31 December 2019. Cases managed by ED NPs, referrals, procedures performed, representations and disposition data were collected. Adverse events were sought from the Qld Health adverse events register (Riskman), the department complaints register and the ED M&M meeting minutes. A total of 1443 patients were treated by NPs, with ages ranging from 0 to 98 years (median 40 years). Australasian Triage Score (ATS) 3 cases made up 30% of the workload. Other than ATS 3 cases, time to being seen was better than the general department. There were very few unexpected representations, complaints or adverse events. This study supports the view that NPs working in a regional emergency department can safely manage a variety of patients outside a fast-track model, with a wide age range and a variety of triage categories and diagnoses. We believe this has important implications for the provision of emergency care, especially in regional and rural Australia.

Regenerative agriculture in Australia: the changing face of farming

The agricultural and social landscape of rural Australia is changing, with many farmers interested in, and some actively moving towards, regenerative agriculture—but what do we understand of the farmers undertaking these transitions? Regenerative agriculture is a holistic way of managing landscapes that aims to move beyond sustainability to regenerate natural systems, while supporting farming system viability. While several authors have discussed the higher-level philosophical underpinnings of regenerative agriculture, there are few empirical studies exploring the motivators for farmers to implement a suite of practices within the regenerative agriculture tool-kit. By undertaking an online survey targeting regenerative farmers, this study identifies common attributes of regenerative farmers, as well as key motivators for, and barriers to change, including perceived benefits arising from the approach. An online survey was promoted through the social media pages of three farming groups, resulting in 96 self-identifying Australian regenerative farmers included in this analysis. Results demonstrate that a clear and recent shift has taken place for this group, who may feel ostracized within their local community, hence often rely on information from online and international sources of agricultural information. This article builds a core understanding of the goals, attributes, aspirations and challenges of regenerative farmers and offers a definition of regenerative agriculture that is derived from farmer responses.

Examining the impact of an online educational video on the contraceptive knowledge, awareness and choices of young women living in rural and remote Australia

ObjectiveTo assess whether an online educational video, tailored to young women living in rural and remote areas, increases their contraceptive knowledge, preference for and uptake of long-acting reversible contraception (LARC). Study DesignA single group pre-post survey design, in which participants completed the pre-video survey (S1), watched the 13-min video, then completed a survey immediately after (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression. ResultsA total of 153 participants watched the video and completed S1 and S2; 56 % of these completed S3. Prevideo (S1) 33 % of participants were unaware of LARC methods. Only 3 % rated their knowledge about every method as high. Knowledge improved immediately post video (S2) for all methods (aOR 12.5, 95 % CI 5.2 to 29.8) and LARC methods (aOR 7.9, 95 % CI 4.3 to 11.8). Overall method preference for LARC increased from 23.5 % (n = 36) at S1 to 48 % (n = 74) at S2. Likelihood of using a LARC increased at S2 (aOR 2.1, 95 % CI 1.5 to 2.9). The overall proportion of participants using a LARC increased from 18 % at S1 to 21 % at S3, however, this increase was not significant (p = 0.3). ConclusionOur findings underscore the effectiveness of tailored online educational videos in enhancing contraceptive knowledge and preference for LARCs amongst young women living in rural and remote areas. However preference did not translate into uptake, suggesting that structural and other barriers may be prominent. ImplicationsThis study emphasises the need for a multifaceted approach to facilitating young womens’ access to effective methods of contraception, including LARC. Efforts to promote knowledge should be coordinated with place-based initiatives and policies that directly address the structural barriers to accessing critical sexual and reproductive health services unique to women in rural and remote areas.

It's all about relationships: Developing nurse-led primary health care in rural communities.

The role of nurses in leading the design and delivery of primary health care services to address health inequities is growing in prominence, specifically in rural Australia. However, limited evidence exists to inform nurse-led primary health care in this context. Based on a focus group with nursing executives and semi-structured interviews with registered nurses we describe nurse experiences of leading the design of a primary health care service in rural Australia and nurse transition to and practice in this service. Nurse experiences were analysed using reflexive thematic analysis. The study reveals the centrality of relational integration in service design and nurse acquisition of relational practice as it relates to nurse to care recipient and nurse to nurse relationships. Tensions between primary health care nurses and their peers, and resultant de-valuing of primary health care practice, are described. The acquisition of nurse professional agency draws attention to investments required to position nurses to lead and sustain care innovations external to hospital settings. The authors propose that relational approaches may provide nurses with the opportunity to reframe their leadership and service contributions towards community literate primary health care provision and provide a pathway to professional emancipation from constrained practice expectations.

The implications of COVID-19 on regional journalism in far north Queensland: Measuring the heart rate of local communities

In 2020, COVID-19 thrust newsrooms into lockdown, affecting how journalists source, gather and report news. According to media giant News Corp, the pandemic fast-tracked its axing of more than 112 community newspapers, already vulnerable following a decade of gradual decline exacerbated by the arrival of digital technology. Consequently, hundreds of jobs were slashed and ‘news deserts’ were created across vast swathes of rural Australia, including far north Queensland. This article looks closely at the mediascape in far north Queensland from a journalism industry perspective during COVID-19, a time which saw a raft of differing and, sometimes, conflicting pressures exerted on journalists – from complying with health and safety regulations to fulfilling the community’s insatiable hunger for information. Through an online survey and long-form interviews with journalists, the study informing this article focuses on what happens when newsrooms are centralized, diminished in resources and the most senior journalists are made redundant and, as such, no longer available to mentor or control journalistic quality. It also observes the arrival of a new and independent press or ‘green shoots’ while casting an eye on the future of local news.

Evaluating the tailored implementation of a multisite care navigation service for mental health in rural and remote Australia (The Bridging Study): protocol for a community-engaged hybrid effectiveness-implementation study

BackgroundA dramatic decline in mental health of people worldwide in the early COVID-19 pandemic years has not recovered. In rural and remote Australia, access to appropriate and timely mental health services has been identified as a major barrier to people seeking help for mental ill-health. From 2020 to 2021 a care navigation model, Navicare, was co-designed with rural and remote communities in the Greater Whitsunday Region of Central Queensland in Australia. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to design and guide multiple aspects of a multisite study, The Bridging Study, to evaluate the implementation of Navicare in Australia.MethodsA community-engaged hybrid effectiveness-implementation study design will focus on the tailored implementation of Navicare at three new sites as well as monitoring implementation at an existing site established since 2021. Study outcomes assessed will include sustained access as the co-primary outcome (measured using access to Navicare mental health referral services) and Proctor’s Implementation Outcomes of feasibility, acceptability, appropriateness, adoption, fidelity, implementation cost, and sustainability. Data collection for the implementation evaluation will include service usage data, community consultations, interviews, and workshops; analysed using mixed methods and guided by EPIS and other implementation frameworks. Pre-post effectiveness and cost-consequence study components are embedded in the implementation and sustainment phases, with comparison to pre-implementation data and value assessed for each EPIS phase using hospital, service, and resource allocation data. A scaling up strategy will be co-developed using a national roundtable forum in the final year of the study. Qualitative exploration of other aspects of the study (e.g., mechanisms of action and stakeholder engagement) will be conducted.DiscussionOur study will use tailoring to local sites and a community-engaged approach to drive implementation of a mental health care navigation service in rural and remote Australia, with expected benefits to mental healthcare access. This approach is consistent with policy recommendations nationally and internationally as building blocks for rural health including the World Health Organization Framework for Action on Strengthening Health Systems to Improve Health Outcomes.Trial registrationProspectively registered on April 2, 2024, on the Australian New Zealand Clinical Trials Registry, no. ACTRN12624000382572. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386665&isReview=true.

“Everyone has a weight complex”: Experiences of participation in physical activity in regional, rural and remote Australia

ABSTRACT There are many complex and interrelated personal and structural benefits and constraints to being physically active. In this research, we invited people living in regional, rural and remote (RRR) environments of Australia to share their experiences of being active both currently and historically via an in-depth open-ended online survey. This study focuses on the perspectives of 139 participants, 92 of whom identified as female, 43 identified as male and 2 identified as gender fluid. Our participants were aged 18–76 years. By using an interpretivist lens and applying the feminist, weight inclusive Well Now approach (Aphramor, 2018) as a framework to understand these experiences, we identified that this group of people enjoyed the benefits of being active that included physical, mental, and emotional health benefits, as well as social benefits. Participants also shared stories about exclusion, discrimination, and reluctance to participate in various forms of physical activity. Our findings may help inform the work of practitioners who seek to use a weight inclusive approach in RRR areas and highlight the need to support individuals to find safe spaces and meaningful opportunities to be active.

Outcomes of rectal cancer treatment in rural Australia and New Zealand: analysis of the bowel cancer outcomes registry.

The demographics and geography of Australia and New Zealand (ANZ), with few metropolitan centres and vast, sparsely populated rural areas, represent a challenge to providing equal care to all patients. This study aimed to compare rectal cancer care at rural and urban hospitals in ANZ. From the Bowel Cancer Outcomes Registry (BCOR, formerly known as the Bi-National Colorectal Cancer Audit; BCCA), rectal cancer patients treated between 2007 and 2020 were compared based on hospital location (urban versus rural). Propensity-score matching was performed to correct for differences in baseline characteristics between groups. A total of 9385 rectal cancer patients were identified from the BCOR: 1329 (14.2%) were treated at rural hospitals and 8056 (85.8%) at urban hospitals. Propensity-score matching resulted in 889 patients in each group, matched for age, ASA score, hospital type (public/private), tumour height from the anal verge, and pre-treatment cT- and cAJCC-stage. Rural patients had fewer pre-treatment MRIs (67.9% versus 74.7%; P = 0.002), and underwent less neoadjuvant therapy (44.7% versus 50.9%; P = 0.01). Rural patients underwent fewer ULARs (39.4% versus 45.6%; P = 0.03), and fewer anastomoses were formed (67.9% versus 74.4%; P = 0.05). CRM rates and postoperative AJCC stages (P = 0.19) were similar between groups (P = 0.87). Fewer rural patients received adjuvant chemotherapy (37.8% versus 43.3%; P = 0.02). There are significant differences in pre-treatment MRI rates, (neo)adjuvant treatment rates and surgical procedures performed between rectal cancer patients treated at rural and urban hospitals in ANZ, while CRM rates and postoperative AJCC stages are similar.