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CONTENT WARNING: This article refers to sexual abuse.

More than half of Australians aged over 45 who have experienced sexual violence have never told another person what happened to them. Some carry that secret for 40, 50 or even 60 years. For a small but significant number, it is only after being diagnosed with a life-limiting illness that they finally find the courage to speak.

That little-known reality has prompted what is believed to be Australia’s first specialised training program designed to prepare palliative care workers for one of the most profound conversations they may ever have. Next month, Palliative Care ACT and the Canberra Rape Crisis Centre will begin training staff and volunteers across Canberra’s palliative care services, equipping them with the skills to respond safely and compassionately when patients disclose sexual violence during end-of-life care.

The initiative was born from a simple but confronting question: What happens when someone chooses the final chapter of their life to reveal its darkest one? Palliative Care ACT chief executive officer Paul Arztenhofer said receiving a terminal diagnosis often changed how people looked back on their lives.

“Life-limiting illness diagnosis or end-of-life care often prompts reflection, and many people naturally spend time looking back over their lives,” he said.

“For some, that can include conversations they have wanted to have for years, or experiences they have never previously felt able to share. It can become a time of truth-telling and addressing things that have remained unspoken.”

Serious illness can also bring buried trauma back to the surface. Personal care, medical examinations and physical touch may trigger memories of past abuse, while the trusting relationships built with palliative care workers often create the first space where someone finally feels safe enough to speak. Sometimes, that moment comes not in a hospital ward, but over a cup of coffee.

At Leo’s Place, Palliative Care ACT’s respite home, guests often spend time talking with staff in a setting deliberately designed to feel more like a home than a healthcare facility. Mr Arztenhofer recalls one woman whose story has stayed with him.

The 28-year-old, originally from Africa, had survived years of sexual violence in an arranged marriage before coming to Australia. She is now undergoing treatment for an aggressive cancer and has been told she will never be able to have children. It was only while spending time at Leo’s Place that she felt able to tell someone what had happened.

Being able to finally speak about the abuse, Mr Arztenhofer said, gave her a sense of peace after years of carrying the trauma alone.

“Going through a diagnosis that means your life is going to change makes people reflect on everything that’s happened to them,” he said, “For a lot of people, being able to share or release that trauma means they’re able to take their next steps feeling more comfortable and at peace. And sometimes, if the perpetrator was someone known to the family, simply being able to tell another person without judgment is a huge step.”

Quite often, he said, palliative care workers are the first people survivors choose to tell. The numbers suggest many Australians may be carrying that burden in silence. Nearly three in 10 Australians experienced child sexual abuse, while more than half of Australians aged over 45 who experienced sexual violence have never disclosed it to anyone. That means many people entering palliative care may be carrying experiences their partners, children and even closest friends know nothing about. Yet there has been very little Australian research into how often those disclosures occur during end-of-life care.

International evidence is increasingly showing that serious illness, particularly cancer treatment and palliative care, can reactivate memories of childhood sexual abuse and other trauma. The immediate response to Canberra’s new training also highlights the need, with 26 staff and volunteers already registered before the first session has even been delivered.

Mr Arztenhofer said the training was not about turning palliative care workers into counsellors. It was about making sure the first response to a disclosure did not cause further harm.

“The training is not about giving staff and volunteers a script,” he said, “It’s about helping them listen well, respond in a trauma-informed way, understand the boundaries of their role, and know what support pathways are available.”

He said the training also recognised that hearing such deeply personal stories could affect staff and volunteers themselves.

“We want to make sure the person disclosing feels heard and acknowledged and doesn’t experience additional trauma because of the conversation. But we also have a responsibility to make sure our staff and volunteers understand how to process what they’ve heard and know what supports are available for them as well.”

The partnership itself began with a conversation. The chief executives of Palliative Care ACT and the Canberra Rape Crisis Centre met at a community event and realised both organisations were supporting people through some of the most difficult moments of their lives. What started as an informal discussion quickly became a plan to develop specialist training and stronger referral pathways for palliative care staff.

Canberra Rape Crisis Centre chief executive officer Tiffany Karlsson said disclosures of sexual violence could happen at any stage of life, including many decades after the abuse occurred.

“For victim-survivors, the response they receive in that moment can shape whether they feel believed, respected and safe or whether they feel silenced all over again.”

The organisations believe the program is the first Australian initiative developed specifically for palliative care settings, highlighting how little attention has been paid to an issue that sits at the intersection of trauma, ageing and end-of-life care.

This story written by Naziya Alvi Rahman was first published by the Region Canberra on 22 August 2026. It has been republished with permission. 

If this story has raised any concerns for you, 1800RESPECT, the national 24-hour sexual assault, family and domestic violence counselling line, can be contacted on 1800 737 732.

The NSW Sexual Violence Helpline is available 24-hours on 1800 424 017. The Rainbow Sexual, Domestic, and Family Violence Helpline available 24-hours, free and confidential, can be reached on 1800 497 212.

For Lifeline call 13 11 14. In an emergency, call triple zero.

If you have been affected by sexual violence, or someone you know has, you can report it to police. Read about the reporting options on the NSW Police Community Portal here.