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Briggs L, Corner J, Blake H. Perceived Value of Holistic Needs Assessment in Supporting the Needs of Women With Breast Cancer. Cancer Nurs 2023:00002820-990000000-00161. [PMID: 37449709 DOI: 10.1097/ncc.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly. OBJECTIVE The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support. METHODS A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions. RESULTS The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture. CONCLUSION Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes. IMPLICATIONS FOR PRACTICE Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.
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Affiliation(s)
- Lydia Briggs
- Author Affiliations: School of Health Sciences, University of Nottingham (Drs Briggs and Blake); Research England, UK Research and Innovation (Prof Corner); and NIHR Nottingham Biomedical Research Centre, Nottingham (Dr Blake), England
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Knight H, Jia R, Ayling K, Blake H, Morling JR, Villalon AM, Corner J, Denning C, Ball J, Bolton K, Figueredo G, Morris D, Tighe P, Vedhara K. The changing vaccine landscape: rates of COVID-19 vaccine acceptance and hesitancy in young adults during vaccine rollout. Perspect Public Health 2023; 143:220-224. [PMID: 35575215 PMCID: PMC10467000 DOI: 10.1177/17579139221094750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Development and rollout of vaccines offers the best opportunity for population protection against the SARS-CoV-2 (COVID-19) virus. However, hesitancy towards the vaccines might impede successful uptake in the United Kingdom, particularly in young adults who demonstrate the highest rates of hesitancy. This prospective study explored COVID-19 vaccine hesitancy in young adults and whether the reasons behind these attitudes changed during the initial stages of the United Kingdom's vaccine rollout. METHOD Data on vaccination intention were collected from a British university student cohort at three time points: October 2020, February 2021, and March 2021. This online survey included items on intention to receive a vaccine and a free-text response for the reasons behind this intention. Cochran's Q tests examined changes in rates of hesitancy and acceptance over time and free-text responses were analysed thematically. RESULTS At baseline, 893 students provided data, with 476 participants completing all three time points. Hesitancy declined over time, with 29.4% of participants expressing hesitancy at baseline, reducing to 9.1% at wave 2 and 5.9% at wave 3. The most commonly endorsed themes for those willing to accept a vaccine were self-protection against COVID-19 and pro-social reasons, including protecting the population or unspecific others, and ending the pandemic/returning to normal life. The most commonly endorsed hesitancy themes related to 'confidence' in the vaccines and potential personal risk, including insufficient testing/scientific evidence, concern about side effects, and long-term effects. These reasons remained the most commonly endorsed at both waves 2 and 3. CONCLUSIONS While a decline in hesitancy was observed over time, the key reasons behind both vaccine acceptance and hesitancy remained consistent. Reasons behind hesitancy aligned with those of the general public, providing support for the use of generalist interventions. Pro-social reasons frequently underpinned vaccine acceptance, so cohort-specific interventions targeting those factors may be of benefit.
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Affiliation(s)
- H Knight
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - R Jia
- School of Medicine, University of Nottingham, Nottingham, UK
| | - K Ayling
- School of Medicine, University of Nottingham, UK
| | - H Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - JR Morling
- School of Medicine, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - AM Villalon
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - J Corner
- University Executive Board, University of Nottingham, Nottingham, UK
| | - C Denning
- Biodiscovery Institute, University Park, University of Nottingham, Nottingham, UK
| | - J Ball
- Biodiscovery Institute, University Park, University of Nottingham, Nottingham, UK
| | - K Bolton
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
| | - G Figueredo
- School of Computer Sciences, University of Nottingham, Nottingham, UK
| | - D Morris
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - P Tighe
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - K Vedhara
- School of Medicine, University of Nottingham, Nottingham, UK
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Blake H, Carlisle S, Fothergill L, Hassard J, Favier A, Corner J, Ball JK, Denning C. Process evaluation of a university residence-based SARS-CoV-2 testing programme in the UK. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Regular testing for SARS-CoV-2 is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel 4-week intervention implemented at two student residences on a UK university campus, aiming to increase asymptomatic testing frequency and normalise university life through relaxed social restrictions onsite.
Methods
Mixed-methods process evaluation determined whether RB-TPP was implemented as planned and identified implementation barriers and facilitators. Data were collected from meeting records, university students (online survey: n = 152; focus groups: n = 30), and staff (interviews, n = 13). Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation-Behaviour’ (COM-B) behaviour change framework.
Results
Uptake was high (n = 464 students opted-in; 98% of those living onsite). Implementation was broadly as planned, with adjustments due to national escalation of the COVID-19 Delta variant. Majority engaged in testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Most felt positively towards relaxed social distancing (97.9%). Implementation was facilitated by convenience and efficiency of testing and reduced negative impacts of isolation through opportunities for students to socialise. Barriers to implementation were mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority.
Conclusions
This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences. Testing participation increased and student mental wellbeing improved. Rapid adaptions to the changing pandemic context generated complexity and challenge. Findings have global relevance for outbreak prevention and management strategies in higher education settings.
Key messages
• Delivery of asymptomatic SARS-CoV-2 testing and relaxation of social distancing within residences led to high rates of testing participation and benefits for student mental wellbeing.
• This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences with global relevance for outbreak prevention in higher education settings.
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Affiliation(s)
- H Blake
- School of Health Sciences, University of Nottingham , Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham , Nottingham, UK
| | - S Carlisle
- School of Health Sciences, University of Nottingham , Nottingham, UK
| | - L Fothergill
- School of Health Sciences, University of Nottingham , Nottingham, UK
| | - J Hassard
- School of Medicine, University of Nottingham , Nottingham, UK
| | - A Favier
- Faculty of Registrars, University of Nottingham , Nottingham, UK
| | - J Corner
- Executive Office, University of Nottingham , Nottingham, UK
| | - JK Ball
- School of Life Sciences, University of Nottingham , Nottingham, UK
- Biodiscovery Institute, University of Nottingham , Nottingham, UK
| | - C Denning
- School of Medicine, University of Nottingham , Nottingham, UK
- Biodiscovery Institute, University of Nottingham , Nottingham, UK
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Blake H, Somerset S, Mahmood I, Mahmood N, Corner J, Ball JK, Denning C. A Qualitative Evaluation of the Barriers and Enablers for Implementation of an Asymptomatic SARS-CoV-2 Testing Service at the University of Nottingham: A Multi-Site Higher Education Setting in England. Int J Environ Res Public Health 2022; 19:13140. [PMID: 36293719 PMCID: PMC9603241 DOI: 10.3390/ijerph192013140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/24/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Asymptomatic testing for SARS-CoV-2 RNA has been used to prevent and manage COVID-19 outbreaks in university settings, but few studies have explored their implementation. The aim of the study was to evaluate how an accredited asymptomatic SARS-CoV-2 testing service (ATS) was implemented at the University of Nottingham, a multi-campus university in England, to identify barriers and enablers of implementation and to draw out lessons for implementing pandemic response initiatives in higher education settings. A qualitative interview study was conducted with 25 ATS personnel between May and July 2022. Interviews were conducted online, audio-recorded, and transcribed. Participants were asked about their experience of the ATS, barriers and enablers of implementation. Transcripts were thematically analysed. There were four overarching themes: (1) social responsibility and innovation, (2) when, how and why people accessed testing, (3) impact of the ATS on the spread of COVID-19, and (4) lessons learned for the future. In establishing the service, the institution was seen to be valuing its community and socially responsible. The service was viewed to be broadly successful as a COVID-19 mitigation approach. Challenges to service implementation were the rapidly changing pandemic situation and government advice, delays in service accreditation and rollout to staff, ambivalence towards testing and isolating in the target population, and an inability to provide follow-up support for positive cases within the service. Facilitators included service visibility, reduction in organisational bureaucracy and red tape, inclusive leadership, collaborative working with regular feedback on service status, flexibility in service delivery approaches and simplicity of saliva testing. The ATS instilled a perception of early 'return to normality' and impacted positively on staff feelings of safety and wellbeing, with wider benefits for healthcare services and local communities. In conclusion, we identified common themes that have facilitated or hindered the implementation of a SARS-CoV-2 testing service at a university in England. Lessons learned from ATS implementation will inform future pandemic response interventions in higher education settings.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
| | - Sarah Somerset
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Ikra Mahmood
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Neelam Mahmood
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
| | - Jessica Corner
- Executive Office, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jonathan K. Ball
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK
| | - Chris Denning
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK
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Blake H, Somerset S, Mahmood I, Mahmood N, Corner J, Ball JK, Denning C. Workforce Experiences of a Rapidly Established SARS-CoV-2 Asymptomatic Testing Service in a Higher Education Setting: A Qualitative Study. Int J Environ Res Public Health 2022; 19:12464. [PMID: 36231764 PMCID: PMC9566715 DOI: 10.3390/ijerph191912464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
The aim of the study was to explore workforce experiences of the rapid implementation of a SARS-CoV-2 asymptomatic testing service (ATS) in a higher education setting during the COVID-19 pandemic. The setting was a multi-campus university in the UK, which hosted a testing service for employees and students over two years. Qualitative semi-structured videoconference interviews were conducted. We contacted 58 participants and 25 were interviewed (43% response rate). Data were analysed thematically. The analysis produced four overarching themes: (1) feelings relating to their involvement in the service, (2) perceptions of teamwork, (3) perceptions of ATS leadership, (4) valuing the opportunity for career development. Agile and inclusive leadership style created psychological safety and team cohesion, which facilitated participants in the implementation of a rapid mitigation service, at pace and scale. Specific features of the ATS (shared vision, collaboration, networking, skills acquisition) instilled self-confidence, value and belonging, meaningfully impacting on professional development and career opportunities. This is the first qualitative study to explore the experiences of university employees engaged in the rapid deployment of a service as part of a pandemic outbreak and mitigation strategy within a higher education setting. Despite pressures and challenges of the task, professional growth and advancement were universal. This has implications for workforce engagement and creating workplaces across the sector that are well-prepared to respond to future pandemics and other disruptive events.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
| | - Sarah Somerset
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Ikra Mahmood
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Neelam Mahmood
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
| | - Jessica Corner
- Executive Office, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jonathan K. Ball
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK
| | - Chris Denning
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK
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Blake H, Carlisle S, Fothergill L, Hassard J, Favier A, Corner J, Ball JK, Denning C. Mixed-methods process evaluation of a residence-based SARS-CoV-2 testing participation pilot on a UK university campus during the COVID-19 pandemic. BMC Public Health 2022; 22:1470. [PMID: 35915479 PMCID: PMC9343222 DOI: 10.1186/s12889-022-13792-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Regular testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation rates can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel intervention implemented at two student residences on a large UK university campus over 4 weeks. The aim of the pilot was to increase the frequency of asymptomatic SARS-CoV-2 saliva testing onsite. This process evaluation aimed to determine whether RB-TPP was implemented as planned and identify implementation barriers and facilitators. METHODS A mixed-methods process evaluation was conducted alongside the RB-TPP. Evaluation participants were students (opting in, or out of RB-TPP) and staff with a role in service provision or student support. Monitoring data were collected from the intervention delivery team and meeting records. Data were collected from students via online survey (n = 152) and seven focus groups (n = 30), and from staff via individual interviews (n = 13). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation-Behaviour' (COM-B) behaviour change framework. RESULTS Four hundred sixty-four students opted to participate in RB-TPP (98% of students living onsite). RB-TPP was implemented broadly as planned but relaxed social distancing was terminated early due to concerns relating to national escalation of the COVID-19 Delta variant, albeit testing continued. Most students (97.9%) perceived the period of relaxed social distancing within residences positively. The majority engaged in asymptomatic testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Implementation was facilitated by convenience and efficiency of testing, and reduction in the negative impacts of isolation through opportunities for students to socialise. Main barriers to implementation were perceived mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority. CONCLUSIONS This process evaluation identifies factors that help or hinder the success of university residence-based outbreak prevention and management strategies. RB-TPP led to increased rates of SARS-CoV-2 testing participation among students in university residences. Perceived normalisation of university life significantly enhanced student mental wellbeing. The complexity and challenge generated by multiple lines of communication and rapid adaptions to a changing pandemic context was evident. TRIAL REGISTRATION NUMBER UKAS 307727-02-01; Pre-results. CLINICALTRIALS gov Identifier: NCT05045989 ; post-results (first posted, 16/09/21). ETHICAL APPROVAL Faculty of Medicine & Health Sciences Research Ethics Committee, University of Nottingham (Ref: FMHS 96-0920).
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Affiliation(s)
- H Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK.
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
| | - S Carlisle
- School of Medicine, University of Nottingham, Nottingham, UK
| | - L Fothergill
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - J Hassard
- School of Medicine, University of Nottingham, Nottingham, UK
| | - A Favier
- Faculty of Registrars, University of Nottingham, Nottingham, UK
| | - J Corner
- Faculty of Registrars, University of Nottingham, Nottingham, UK
| | - J K Ball
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - C Denning
- School of Medicine, University of Nottingham, Nottingham, UK
- Biodiscovery Institute, University of Nottingham, Nottingham, UK
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7
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Vedhara K, Ayling K, Jia R, Fairclough L, Morling JR, Ball JK, Knight H, Blake H, Corner J, Denning C, Bolton K, Jackson H, Coupland C, Tighe P. Relationship Between Anxiety, Depression, and Susceptibility to Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Proof of Concept. J Infect Dis 2022; 225:2137-2141. [PMID: 35022740 PMCID: PMC8807218 DOI: 10.1093/infdis/jiac006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/07/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Psychological factors can influence susceptibility to viral infections. We examined whether such influences are evident in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS Participants (n = 102) completed measures of anxiety, depression, positive mood, and loneliness and provided a blood sample for the measurement of antibodies to the SARS-CoV-2 spike and nucleocapsid proteins. RESULTS SARS-CoV-2 was significantly negatively associated with anxiety and depression. The model remained significant after adjustment for age and gender, although anxiety and depression were no longer significant independent predictors. CONCLUSIONS These findings offer early support for the hypothesis that psychological factors may influence susceptibility to SARS-CoV-2 infection.
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Affiliation(s)
- Kavita Vedhara
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kieran Ayling
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Ru Jia
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Lucy Fairclough
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Joanne R Morling
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Jonathan K Ball
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
- Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Holly Knight
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Holly Blake
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Jessica Corner
- University Executive Board, University of Nottingham, Nottingham, United Kingdom
| | - Chris Denning
- Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Kirsty Bolton
- School of Mathematical Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Hannah Jackson
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Carol Coupland
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Patrick Tighe
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
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8
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Birt L, Lane K, Corner J, Sanderson K, Deakins A, Bunn D. 983 LEARNING FROM THE EXPERIENCES OF NURSES IN CARE HOMES DURING COVID-19 (THRIVE STUDY): STEERING THE SHIP THROUGH THE STORM. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Nurses practising in older people’s care homes are often the only trained nurse on shift, undertaking leadership roles while also supporting residents with complex clinical needs. The study aimed to explore Nursing and Midwifery Council (NMC)-registered nurses’ experiences of working in older people’s care homes during the COVID-19 pandemic.
Method
Recruitment used direct contact with care homes, social media and links provided by national partners, then purposive sampling for age, gender, type of care home and location. Data collected through one-to-one on-line interviews using a topic guide developed collaboratively with care home nurses, focusing on how COVID-19 impacted on nurses’ resilience and mental well-being. Data were analysed thematically.
Results
18 nurses interviewed between March–July 2021: female 16, majority aged between 46–55 years; mean time registered with NMC 19 years (range 18 months-45 years); one had not nursed residents with COVID-19. Preliminary findings indicate that nurses developed enhanced clinical skills, which increased their professional standing. Many nurses were in leadership roles responsible for processing and sharing rapidly-changing guidance, making judgements on how to manage infection risk within the home. Nurses reported balancing information-assimilation and reporting with providing direct care due to staff shortages. All nurses provided emotional support to other staff. They sought support from their peers, namely nurses inside and outside their workplace. As leaders, many of the nurses spoke about the emotional impact of having to manage relatives’ expectations and make decisions on whether a relative could be with a dying resident.
Conclusion
Understanding the types of support that might best increase resilience and well-being for nurses in care homes now and in the future is essential to maintain a healthy, stable workforce. Support for nurses will likely benefit other care workers either directly through wider roll-out, or indirectly through improved well-being of the nurse leaders.
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Affiliation(s)
- L Birt
- School of Health Sciences, University of East Anglia Norwich
| | - K Lane
- School of Health Sciences, University of East Anglia Norwich
| | - J Corner
- School of Health Sciences, University of East Anglia Norwich
| | - K Sanderson
- School of Health Sciences, University of East Anglia Norwich
| | | | - D Bunn
- School of Health Sciences, University of East Anglia Norwich
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Knight H, Carlisle S, O’Connor M, Briggs L, Fothergill L, Al-Oraibi A, Yildirim M, Morling JR, Corner J, Ball J, Denning C, Vedhara K, Blake H. Impacts of the COVID-19 Pandemic and Self-Isolation on Students and Staff in Higher Education: A Qualitative Study. Int J Environ Res Public Health 2021; 18:10675. [PMID: 34682418 PMCID: PMC8535702 DOI: 10.3390/ijerph182010675] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/05/2021] [Indexed: 12/21/2022]
Abstract
This qualitative study explored the impact of COVID-19 self-isolation and social restriction measures on university students, through the perspectives of both students and the staff supporting them. The study comprised 11 focus groups (students) and 26 individual interviews (staff) at a higher education institution in England during a period of national lockdown (January-March 2021). Participants were university students (n = 52) with self-isolation experiences and university staff (n = 26) with student-facing support roles. Focus group and interview data were combined and analysed using an inductive thematic approach. Four themes emerged: 'Adaptation during the pandemic', 'Practical, environmental, and emotional challenges of self-isolating', 'Social factors and their impact on COVID-19 testing and self-isolation adherence', and 'Supporting self-isolation'. Students and staff struggled with the imposed restrictions and shift to online education. Students found it difficult to adapt to new expectations for university life and reported missing out on professional and social experiences. Students and staff noted concerns about the impact of online teaching on educational outcomes. Students endorsed varied emotional responses to self-isolation; some felt unaffected whilst others experienced lowered mood and loneliness. Students were motivated by pro-social attitudes; campaigns targeting these factors may encourage continued engagement in protective behaviours. Staff struggled to manage their increased workloads delivering support for self-isolating students. Universities must consider the support needs of students during self-isolation and prepare for the long-term impacts of the pandemic on student wellbeing and educational attainment. Greater support should be provided for staff during transitional periods, with ongoing monitoring of workforce stress levels warranted.
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Affiliation(s)
- Holly Knight
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
| | - Sophie Carlisle
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
| | - Mórna O’Connor
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Lydia Briggs
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Lauren Fothergill
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Amani Al-Oraibi
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Mehmet Yildirim
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
| | - Joanne R. Morling
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
| | - Jessica Corner
- University Executive Board, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Jonathan Ball
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK;
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK
| | - Chris Denning
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
- Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Kavita Vedhara
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (S.C.); (J.R.M.); (C.D.); (K.V.)
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (M.O.); (L.B.); (L.F.); (A.A.-O.); (M.Y.); (H.B.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
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Batehup L, Gage H, Williams P, Richardson A, Porter K, Simmonds P, Lowson E, Dodson L, Davies N, Wagland R, Winter J, Turner A, Corner J. Unmet supportive care needs of breast, colorectal and testicular cancer survivors in the first 8 months post primary treatment: A prospective longitudinal survey. Eur J Cancer Care (Engl) 2021; 30:e13499. [PMID: 34423494 PMCID: PMC9285526 DOI: 10.1111/ecc.13499] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/23/2021] [Accepted: 07/08/2021] [Indexed: 01/26/2023]
Abstract
Objectives To explore the supportive care needs of cancer survivors, the characteristics of patients with high levels of unmet need, changes in unmet need after treatment ends and differences in unmet needs of breast, colorectal and testicular survivors. Methods The method used was a prospective longitudinal mailed survey. Unmet needs, measured by 25‐item modified Cancer Survivors Unmet Needs survey at baseline (immediately post‐treatment) and 8 months later, were analysed descriptively. Results Of 434 breast, 186 colorectal and 75 testicular patients responding at baseline, 56.2%, 65.6% and 50.7%, respectively, had no unmet needs, the top decile having ≥10 (breast) or seven (colorectal and testicular) different needs and seven different unmet needs. The most frequently reported unmet need (all groups) was fear of cancer recurrence. Unmet needs fell significantly at 8 months for breast patients. Some patients reported new needs. Needs were lowest amongst colorectal survivors and differed between the three groups. Higher levels of unmet needs (breast and colorectal) were associated with having had chemotherapy. Conclusion Most survivors reported few unmet needs, but a small proportion have persisting or emerging needs. Routine or regular monitoring of unmet needs is required so that healthcare professionals can deliver personalised care based on individual needs, preferences and circumstances.
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Affiliation(s)
- Lynn Batehup
- Health Sciences, University of Southampton, Tremona Road, Southampton, UK
| | - Heather Gage
- Surrey Health Economics Centre, School of Bioscience & Medicine, University of Surrey, Guildford, UK
| | - Peter Williams
- School of Mathematics, University of Surrey, Guildford, UK
| | - Alison Richardson
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Katerina Porter
- Health Sciences, University of Southampton, Tremona Road, Southampton, UK
| | - Peter Simmonds
- Cancer Research UK, Clinical Research Unit, University of Southampton, Southampton, UK
| | - Elizabeth Lowson
- Health Sciences, University of Southampton, Tremona Road, Southampton, UK
| | - Lynne Dodson
- Health Sciences, University of Southampton, Tremona Road, Southampton, UK
| | - Nicola Davies
- Health Psychology Consultancy Ltd., 12 Hitchin Lane, Clifton, Shefford, UK
| | - Richard Wagland
- Health Sciences, University of Southampton, Tremona Road, Southampton, UK
| | - Jane Winter
- University of Southampton NHS Trust, Tremona Road, Southampton, Hampshire, UK.,Wessex Cancer Alliance, Oakley Road, Southampton, Hampshire, UK
| | - Andrew Turner
- Centre For Intelligent Healthcare, Coventry University, The Hub, Jordan Well, Coventry CV1 5T, UK
| | - Jessica Corner
- The University of Nottingham, University Park, Nottingham, UK
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11
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Blake H, Knight H, Jia R, Corner J, Morling JR, Denning C, Ball JK, Bolton K, Figueredo G, Morris DE, Tighe P, Villalon AM, Ayling K, Vedhara K. Students' Views towards Sars-Cov-2 Mass Asymptomatic Testing, Social Distancing and Self-Isolation in a University Setting during the COVID-19 Pandemic: A Qualitative Study. Int J Environ Res Public Health 2021; 18:4182. [PMID: 33920908 PMCID: PMC8071290 DOI: 10.3390/ijerph18084182] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/27/2022]
Abstract
We aimed to explore university students' perceptions and experiences of SARS-CoV-2 mass asymptomatic testing, social distancing and self-isolation, during the COVID-19 pandemic. This qualitative study comprised of four rapid online focus groups conducted at a higher education institution in England, during high alert (tier 2) national COVID-19 restrictions. Participants were purposively sampled university students (n = 25) representing a range of gender, age, living circumstances (on/off campus), and SARS-CoV-2 testing/self-isolation experiences. Data were analysed using an inductive thematic approach. Six themes with 16 sub-themes emerged from the analysis of the qualitative data: 'Term-time Experiences', 'Risk Perception and Worry', 'Engagement in Protective Behaviours', 'Openness to Testing', 'Barriers to Testing' and 'General Wellbeing'. Students described feeling safe on campus, believed most of their peers are adherent to protective behaviours and were positive towards asymptomatic testing in university settings. University communications about COVID-19 testing and social behaviours need to be timely and presented in a more inclusive way to reach groups of students who currently feel marginalised. Barriers to engagement with SARS-CoV-2 testing, social distancing and self-isolation were primarily associated with fear of the mental health impacts of self-isolation, including worry about how they will cope, high anxiety, low mood, guilt relating to impact on others and loneliness. Loneliness in students could be mitigated through increased intra-university communications and a focus on establishment of low COVID-risk social activities to help students build and enhance their social support networks. These findings are particularly pertinent in the context of mass asymptomatic testing programmes being implemented in educational settings and high numbers of students being required to self-isolate. Universities need to determine the support needs of students during self-isolation and prepare for the long-term impacts of the pandemic on student mental health and welfare support services.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK;
| | - Holly Knight
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (H.K.); (R.J.); (K.A.); (K.V.)
| | - Ru Jia
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (H.K.); (R.J.); (K.A.); (K.V.)
| | - Jessica Corner
- University Executive Board, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Joanne R. Morling
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK;
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (H.K.); (R.J.); (K.A.); (K.V.)
| | - Chris Denning
- Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (C.D.); (J.K.B.)
| | - Jonathan K. Ball
- Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (C.D.); (J.K.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Kirsty Bolton
- School of Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Grazziela Figueredo
- School of Computer Sciences, University of Nottingham, Nottingham NG8 1BB, UK;
| | - David E. Morris
- Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (D.E.M.); (A.M.V.)
| | - Patrick Tighe
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Armando Mendez Villalon
- Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (D.E.M.); (A.M.V.)
| | - Kieran Ayling
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (H.K.); (R.J.); (K.A.); (K.V.)
| | - Kavita Vedhara
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (H.K.); (R.J.); (K.A.); (K.V.)
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12
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Blake H, Corner J, Cirelli C, Hassard J, Briggs L, Daly JM, Bennett M, Chappell JG, Fairclough L, McClure CP, Tarr A, Tighe P, Favier A, Irving W, Ball J. Perceptions and Experiences of the University of Nottingham Pilot SARS-CoV-2 Asymptomatic Testing Service: A Mixed-Methods Study. Int J Environ Res Public Health 2020; 18:E188. [PMID: 33383781 PMCID: PMC7796111 DOI: 10.3390/ijerph18010188] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 01/01/2023]
Abstract
We aimed to explore student and staff perceptions and experiences of a pilot SARS-CoV-2 asymptomatic testing service (P-ATS) in a UK university campus setting. This was a mixed-method study comprised of an online survey, and thematic analysis of qualitative data from interviews and focus groups conducted at the mid-point and end of the 12-week P-ATS programme. Ninety-nine students (84.8% female, 70% first year; 93.9% P-ATS participants) completed an online survey, 41 individuals attended interviews or focus groups, including 31 students (21 first year; 10 final year) and 10 staff. All types of testing and logistics were highly acceptable (virus: swab, saliva; antibody: finger prick) and 94.9% would participate again. Reported adherence to weekly virus testing was high (92.4% completed ≥6 tests; 70.8% submitted all 10 swabs; 89.2% completed ≥1 saliva sample) and 76.9% submitted ≥3 blood samples. Students tested to "keep campus safe", "contribute to national efforts to control COVID-19", and "protect others". In total, 31.3% had high anxiety as measured by the Generalized Anxiety Disorder scale (GAD-7) (27.1% of first year). Students with lower levels of anxiety and greater satisfaction with university communications around P-ATS were more likely to adhere to virus and antibody tests. Increased adherence to testing was associated with higher perceived risk of COVID-19 to self and others. Qualitative findings revealed 5 themes and 13 sub-themes: "emotional responses to COVID-19", "university life during COVID-19", "influences on testing participation", "testing physical and logistical factors" and "testing effects on mental wellbeing". Asymptomatic COVID-19 testing (SARS-CoV-2 virus/antibodies) is highly acceptable to students and staff in a university campus setting. Clear communications and strategies to reduce anxiety are likely to be important for testing uptake and adherence. Strategies are needed to facilitate social connections and mitigate the mental health impacts of COVID-19 and self-isolation.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK;
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
| | - Jessica Corner
- University Executive Board, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Cecilia Cirelli
- School of Medicine, University of Nottingham, Nottingham NG7 2UH/NG7 2TU, UK; (C.C.); (J.H.)
| | - Juliet Hassard
- School of Medicine, University of Nottingham, Nottingham NG7 2UH/NG7 2TU, UK; (C.C.); (J.H.)
| | - Lydia Briggs
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK;
| | - Janet M. Daly
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough LE12 5RD, UK; (J.M.D.); (M.B.)
| | - Malcolm Bennett
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough LE12 5RD, UK; (J.M.D.); (M.B.)
| | - Joseph G. Chappell
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Lucy Fairclough
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - C. Patrick McClure
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Alexander Tarr
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Patrick Tighe
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Alex Favier
- Faculty of Registrars, University of Nottingham, Nottingham NG7 2RD, UK;
| | - William Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
| | - Jonathan Ball
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK; (J.G.C.); (C.P.M.); (A.T.); (P.T.); (W.I.); (J.B.)
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 2UH, UK;
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13
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Sodergren SC, Wheelwright SJ, Permyakova NV, Patel M, Calman L, Smith PWF, Din A, Richardson A, Fenlon D, Winter J, Corner J, Foster C. Supportive care needs of patients following treatment for colorectal cancer: risk factors for unmet needs and the association between unmet needs and health-related quality of life-results from the ColoREctal Wellbeing (CREW) study. J Cancer Surviv 2019; 13:899-909. [PMID: 31512164 PMCID: PMC6881415 DOI: 10.1007/s11764-019-00805-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022]
Abstract
Purpose To investigate unmet needs of patients with colorectal cancer (CRC) at the end of treatment and whether unmet needs improve over time. Identify predictors of need following treatment and whether unmet need is associated with worse health-related quality of life (HRQoL). Methods As part of the UK ColoREctal Wellbeing (CREW) cohort study, patients treated for CRC completed the Supportive Care Needs Survey Short Form-34 (SCNS SF-34) 15 and 24 months following surgery, along with questionnaires measuring HRQoL, wellbeing, life events, social support, and confidence to manage their cancer before surgery, 3, 9, 15, and 24 months post-surgery. Results The SCNS SF-34 was completed by 526 patients at 15 months and 510 patients at 24 months. About one-quarter of patients had at least one moderate or severe unmet need at both time points. Psychological and physical unmet needs were the most common and did not improve over time. Over 60% of patients who reported 5 or more moderate or severe unmet needs at 15 months experienced the same level of unmet need at 24 months. HRQoL at the beginning of treatment predicted unmet needs at the end of treatment. Unmet needs, specifically physical, psychological, and health system and information needs, were associated with poorer health and HRQoL at the end of treatment. Conclusions Unmet needs persist over time and are associated with HRQoL. Evaluation of HRQoL at the start of treatment would help inform the identification of vulnerable patients. Assessment and care planning in response to unmet needs should be integrated into person-centred care. Implications for Cancer Survivors Early identification of CRC patients at risk of unmet needs will help infrom personalised survivorship care plans. The implementation of personalised and tailored services are likely to confer HRQoL gains. Electronic supplementary material The online version of this article (10.1007/s11764-019-00805-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S C Sodergren
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - S J Wheelwright
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - N V Permyakova
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - M Patel
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - L Calman
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - P W F Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - A Din
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - A Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - J Winter
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Corner
- Executive Office, University of Nottingham, Nottingham, UK
| | - C Foster
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK.
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14
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Downing A, Glaser AW, Finan PJ, Wright P, Thomas JD, Gilbert A, Corner J, Richards M, Morris EJA, Sebag-Montefiore D. Functional Outcomes and Health-Related Quality of Life After Curative Treatment for Rectal Cancer: A Population-Level Study in England. Int J Radiat Oncol Biol Phys 2018; 103:1132-1142. [PMID: 30553942 DOI: 10.1016/j.ijrobp.2018.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/18/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE There is a growing population of cancer survivors at risk of treatment-related morbidity. This study investigated how potentially curative rectal cancer treatment influences subsequent function and health-related quality of life using data from a large-scale survey of patient-reported outcomes. METHODS AND MATERIALS All individuals 12 to 36 months after receiving a diagnosis of colorectal cancer in England were sent a survey in January 2013. The survey responses were linked with cancer registration, hospital admissions, and radiation therapy data through the National Cancer Registration and Analysis Service. Outcome measures were cancer specific (Functional Assessment of Cancer Therapy and Social Difficulties Inventory items related to fecal incontinence, urinary incontinence, and sexual difficulties) and generic (EuroQol EQ-5D). RESULTS Surveys were returned by 6713 (64.2%) of 10,452 patients with rectal cancer. Of these, 3998 patients were in remission after a major resection and formed the final analysis sample. Compared with those who had surgery alone, patients who received preoperative radiation therapy had higher odds of reporting poor bowel control (43.6% vs 33.0%; odds ratio [OR] = 1.55; 95% confidence interval [CI], 1.26-1.91), severe urinary leakage (7.2% vs 3.5%; OR = 1.69; 95% CI, 1.18-2.43), and severe sexual difficulties (34.4% vs 18.3%; OR = 1.73; 95% CI, 1.43-2.11). Patients who received long-course chemoradiotherapy reported significantly better bowel control than those who had short-course radiation therapy, with no difference for other outcomes. Respondents with a stoma present reported significantly higher levels of severe sexual difficulties and worse health-related quality of life than those who had never had a stoma or had undergone stoma reversal. CONCLUSIONS This study demonstrated the feasibility of a large-scale assessment of patient-reported outcomes and provided "real-world" data regarding the effect of rectal cancer treatment. The results show that patients who receive preoperative radiation therapy reported poorer outcomes, particularly for bowel and sexual function, and highlighted the negative impact of a stoma. We hope that our experience will encourage researchers to perform similar studies in other healthcare systems.
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Affiliation(s)
- Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK.
| | - Adam W Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Paul J Finan
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | | | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jessica Corner
- Faculty of Executive Office, University of Nottingham, Nottingham, UK
| | | | - Eva J A Morris
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
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15
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Cummings A, Grimmett C, Calman L, Patel M, Permyakova NV, Winter J, Corner J, Din A, Fenlon D, Richardson A, Smith PW, Foster C. Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: Results from the ColoREctal Well-being (CREW) cohort study. Psychooncology 2018; 27:2427-2435. [PMID: 30070052 PMCID: PMC6221152 DOI: 10.1002/pon.4845] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 12/13/2022]
Abstract
Objective More people are living with the consequences of cancer and comorbidity. We describe frequencies of comorbidities in a colorectal cancer cohort and associations with health and well‐being outcomes up to 5 years following surgery. Methods Prospective cohort study of 872 colorectal cancer patients recruited 2010 to 2012 from 29 UK centres, awaiting curative intent surgery. Questionnaires administered at baseline (pre‐surgery), 3, 9, 15, 24 months, and annually up to 5 years. Comorbidities (and whether they limit activities) were self‐reported by participants from 3 months. The EORTC QLQ‐C30 and QLQ‐CR29 assessed global health/quality of life (QoL), symptoms, and functioning. Longitudinal analyses investigated associations between comorbidities and health and well‐being outcomes. Results At baseline, the mean age of participants was 68 years, with 60% male and 65% colon cancer. Thirty‐two per cent had 1 and 40% had ≥2 comorbidities. The most common comorbidities were high blood pressure (43%), arthritis/rheumatism (32%), and anxiety/depression (18%). Of those with comorbidities, 37% reported at least 1 that limited their daily activities. Reporting any limiting comorbidities was associated with poorer global health/QoL, worse symptoms, and poorer functioning on all domains over 5‐year follow‐up. Controlling for the most common individual comorbidities, depression/anxiety had the greatest deleterious effect on outcomes. Conclusions Clinical assessment should prioritise patient‐reported comorbidities and whether these comorbidities limit daily activities, as important determinants of recovery of QoL, symptoms, and functioning following colorectal cancer. Targeted interventions and support services, including multiprofessional management and tailored assessment and follow‐up, may aid recovery of health and well‐being in these individuals.
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Affiliation(s)
- Amanda Cummings
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Chloe Grimmett
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Mubarak Patel
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Natalia Vadimovna Permyakova
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK.,Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - Jane Winter
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jessica Corner
- Executive Office, University of Nottingham, Nottingham, UK
| | - Amy Din
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
| | - Deborah Fenlon
- College of Health and Human Sciences, Swansea University, Swansea, UK
| | - Alison Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Health Sciences, University of Southampton, Southampton, UK
| | - Peter W Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | | | - Claire Foster
- Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Southampton, UK
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16
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Mason SJ, Downing A, Wright P, Hounsome L, Bottomley SE, Corner J, Richards M, Catto JW, Glaser AW. Health-related quality of life after treatment for bladder cancer in England. Br J Cancer 2018; 118:1518-1528. [PMID: 29755116 PMCID: PMC5988662 DOI: 10.1038/s41416-018-0084-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Little is known about quality of life after bladder cancer treatment. This common cancer is managed using treatments that can affect urinary, sexual and bowel function. METHODS To understand quality of life and inform future care, the Department of Health (England) surveyed adults surviving bladder cancer 1-5 years after diagnosis. Questions related to disease status, co-existing conditions, generic health (EQ-5D), cancer-generic (Social Difficulties Inventory) and cancer-specific outcomes (Functional Assessment of Cancer Therapy-Bladder). RESULTS In total, 673 (54%) patients responded; including 500 (74%) men and 539 (80%) with co-existing conditions. Most respondents received endoscopic treatment (60%), while 92 (14%) and 99 (15%) received radical cystectomy or radiotherapy, respectively. Questionnaire completion rates varied (51-97%). Treatment groups reported ≥1 problem using EQ-5D generic domains (59-74%). Usual activities was the most common concern. Urinary frequency was common after endoscopy (34-37%) and radiotherapy (44-50%). Certain populations were more likely to report generic, cancer-generic and cancer-specific problems; notably those with co-existing long-term conditions and those treated with radiotherapy. CONCLUSION The study demonstrates the importance of assessing patient-reported outcomes in this population. There is a need for larger, more in-depth studies to fully understand the challenges patients with bladder cancer face.
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Affiliation(s)
- Samantha J Mason
- Leeds Institute of Cancer and Pathology, University of Leeds, Level 11, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK. .,Leeds Institute for Data Analytics, University of Leeds, Level 11, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.
| | - Amy Downing
- Leeds Institute of Cancer and Pathology, University of Leeds, Level 11, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.,Leeds Institute for Data Analytics, University of Leeds, Level 11, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology, University of Leeds, Level 11, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Luke Hounsome
- Public Health England, 2 Rivergate, Temple Quay, Bristol, BS1 6EH, UK
| | - Sarah E Bottomley
- Academic Urology Unit, University of Sheffield, The Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Jessica Corner
- Executive Office, University of Nottingham, Trent Building, University Park, Nottingham, NG7 2RD, UK
| | | | - James W Catto
- Academic Urology Unit, University of Sheffield, The Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Adam W Glaser
- Leeds Institute of Cancer and Pathology, University of Leeds, Level 11, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.,Leeds Institute for Data Analytics, University of Leeds, Level 11, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
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Haviland J, Sodergren S, Calman L, Corner J, Din A, Fenlon D, Grimmett C, Richardson A, Smith PW, Winter J, Foster C. Social support following diagnosis and treatment for colorectal cancer and associations with health-related quality of life: Results from the UK ColoREctal Wellbeing (CREW) cohort study. Psychooncology 2017; 26:2276-2284. [PMID: 29094430 PMCID: PMC6220760 DOI: 10.1002/pon.4556] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/11/2017] [Accepted: 09/09/2017] [Indexed: 01/09/2023]
Abstract
Objective Social support is acknowledged as important in cancer survivorship, but little is known about change in support after cancer diagnosis and factors associated with this, particularly in colorectal cancer. The CREW cohort study investigated social support up to 2 years following curative intent surgery for colorectal cancer. Methods A total of 871 adults recruited pre‐treatment from 29 UK centres 2010 to 2012 consented to follow‐up. Questionnaires at baseline, 3, 9, 15, and 24 months post‐surgery included assessments of social support (Medical Outcomes Study‐Social Support Survey, MOS‐SSS) and health‐related quality of life (HRQoL). Socio‐demographic, clinical and treatment details were collected. Longitudinal analyses assessed social support over follow‐up, associations with participant characteristics, and HRQoL. Results Around 20% were living alone and 30% without a partner. Perceived social support declined in around 29% of participants, with 8% of these reporting very low levels overall from baseline to 2 years (mean MOS‐SSS overall score < 40 on a scale from 0 to 100). Older age, female gender, greater neighbourhood deprivation, presence of co‐morbidities, and rectal cancer site were significantly associated with reductions in perceived support. Poorer HRQoL outcomes (generic health/QoL, reduced wellbeing, anxiety, and depression) were significantly associated with lower levels of social support. Conclusions Levels of social support decline following colorectal cancer diagnosis and treatment in nearly a third of patients and are an important risk factor for recovery of HRQoL. Assessment of support early on and throughout follow‐up would enable targeted interventions to improve recovery, particularly in the more vulnerable patient groups at risk of poorer social support.
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Affiliation(s)
- Joanne Haviland
- Institute of Cancer Research Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Samantha Sodergren
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jessica Corner
- Executive Office, University of Nottingham, Nottingham, UK
| | - Amy Din
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Deborah Fenlon
- College of Health and Human Sciences, Swansea University, Swansea, Wales, UK
| | - Chloe Grimmett
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Peter W Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - Jane Winter
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Claire Foster
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
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Wagland R, Brindle L, James E, Moore M, Esqueda AI, Corner J. Facilitating early diagnosis of lung cancer amongst primary care patients: The views of GPs. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28497588 PMCID: PMC5949863 DOI: 10.1111/ecc.12704] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/21/2022]
Abstract
Early diagnosis of lung cancer (LC) is a policy priority. However, symptoms are vague, associated with other morbidities, and frequently unrecognised by both patients and general practitioners (GPs). This qualitative study, part of a larger mixed methods study, explored GP views regarding the potential for early diagnosis of LC within primary care. Five focus group discussions (FGDs) were conducted with GPs (n = 16) at primary care practices (n = 5) across four counties in south England. FGDs were audio‐recorded, transcribed verbatim and analysed using a framework approach. Four broad themes emerged: patients’ reporting of symptoms; GP response to symptoms; investigating LC, and; potential initiatives for early diagnosis. GPs reported they often required high levels of suspicion to refer patients on to specialist respiratory consultations, and concerns of ‘system overload’ were prevalent. Greater access to more sensitive diagnostic investigations such as computed tomography, was argued for by some, particularly for symptomatic patients with negative chest X‐rays. GPs challenged current approaches to promoting earlier diagnosis through national symptom awareness campaigns, arguing instead that interventions targeted at high‐risk individuals might be more effective without burdening services already under pressure. Further work is needed to identify primary care patients who might most benefit from such targeted interventions.
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Affiliation(s)
- R Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - L Brindle
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - E James
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - M Moore
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - A I Esqueda
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Corner
- Executive Office, The Nottingham University, University Park, Nottingham, UK
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19
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Downing A, Wright P, Wagland R, Watson E, Kearney T, Mottram R, Allen M, Cairnduff V, McSorley O, Butcher H, Hounsome L, Donnelly C, Selby P, Kind P, Cross W, Catto JWH, Huws D, Brewster DH, McNair E, Matheson L, Rivas C, Nayoan J, Horton M, Corner J, Verne J, Gavin A, Glaser AW. Life after prostate cancer diagnosis: protocol for a UK-wide patient-reported outcomes study. BMJ Open 2016; 6:e013555. [PMID: 27927667 PMCID: PMC5168696 DOI: 10.1136/bmjopen-2016-013555] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prostate cancer and its treatment may impact physically, psychologically and socially; affecting the health-related quality of life of men and their partners/spouses. The Life After Prostate Cancer Diagnosis (LAPCD) study is a UK-wide patient-reported outcomes study which will generate information to improve the health and well-being of men with prostate cancer. METHODS AND ANALYSIS Postal surveys will be sent to prostate cancer survivors (18-42 months postdiagnosis) in all 4 UK countries (n=∼70 000). Eligible men will be identified and/or verified through cancer registration systems. Men will be surveyed twice, 12 months apart, to explore changes in outcomes over time. Second, separate cohorts will be surveyed once and the design will include evaluation of the acceptability of online survey tools. A comprehensive patient-reported outcome measure has been developed using generic and specific instruments with proven psychometric properties and relevance in national and international studies. The outcome data will be linked with administrative health data (eg, treatment information from hospital data). To ensure detailed understanding of issues of importance, qualitative interviews will be undertaken with a sample of men who complete the survey across the UK (n=∼150) along with a small number of partners/spouses (n=∼30). ETHICS AND DISSEMINATION The study has received the following approvals: Newcastle and North Tyneside 1 Research Ethics Committee (15/NE/0036), Health Research Authority Confidentiality Advisory Group (15/CAG/0110), NHS Scotland Public Benefit and Privacy Panel (0516-0364), Office of Research Ethics Northern Ireland (16/NI/0073) and NHS R&D approval from Wales, Scotland and Northern Ireland. Using traditional and innovative methods, the results will be made available to men and their partners/spouses, the funders, the NHS, social care, voluntary sector organisations and other researchers.
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Affiliation(s)
- Amy Downing
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Rebecca Mottram
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Majorie Allen
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Victoria Cairnduff
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Oonagh McSorley
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Hugh Butcher
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
- Yorkshire Cancer Patient Forum, c/o Strategic Clinical Network and Senate, Yorkshire and The Humber, Harrogate, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Conan Donnelly
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Peter Selby
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Paul Kind
- Academic Unit of Health Economics, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Cross
- Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - James W H Catto
- Academic Urology Unit, University of Sheffield, Medical School, Sheffield, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK
| | - David H Brewster
- Public Health and Intelligence (NHS National Services Scotland), Edinburgh, UK
| | - Emma McNair
- Public Health and Intelligence (NHS National Services Scotland), Edinburgh, UK
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mike Horton
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Jessica Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Julia Verne
- Knowledge and Intelligence Directorate, Public Health England, Bristol, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Adam W Glaser
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
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20
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Wagland R, Brindle L, Ewings S, James E, Moore M, Rivas C, Esqueda AI, Corner J. Promoting Help-Seeking in Response to Symptoms amongst Primary Care Patients at High Risk of Lung Cancer: A Mixed Method Study. PLoS One 2016; 11:e0165677. [PMID: 27814375 PMCID: PMC5096702 DOI: 10.1371/journal.pone.0165677] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/14/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Lung cancer symptoms are vague and difficult to detect. Interventions are needed to promote early diagnosis, however health services are already pressurised. This study explored symptomology and help-seeking behaviours of primary care patients at 'high-risk' of lung cancer (≥50 years old, recent smoking history), to inform targeted interventions. METHODS Mixed method study with patients at eight general practitioner (GP) practices across south England. Study incorporated: postal symptom questionnaire; clinical records review of participant consultation behaviour 12 months pre- and post-questionnaire; qualitative participant interviews (n = 38) with a purposive sample. RESULTS A small, clinically relevant group (n = 61/908, 6.7%) of primary care patients was identified who, despite reporting potential symptoms of lung cancer in questionnaires, had not consulted a GP ≥12 months. Of nine symptoms associated with lung cancer, 53.4% (629/1172) of total respondents reported ≥1, and 35% (411/1172) reported ≥2. Most participants (77.3%, n = 686/908) had comorbid conditions; 47.8%, (n = 414/908) associated with chest and respiratory symptoms. Participant consulting behaviour significantly increased in the 3-month period following questionnaire completion compared with the previous 3-month period (p = .002), indicating questionnaires impacted upon consulting behaviour. Symptomatic non-consulters were predominantly younger, employed, with higher multiple deprivation scores than their GP practice mean. Of symptomatic non-consulters, 30% (18/61) consulted ≤1 month post-questionnaire, with comorbidities subsequently diagnosed for five participants. Interviews (n = 39) indicated three overarching differences between the views of consulting and non-consulting participants: concern over wasting their own as well as GP time; high tolerance threshold for symptoms; a greater tendency to self-manage symptoms. CONCLUSIONS This first study to examine symptoms and consulting behaviour amongst a primary care population at 'high- risk' of lung cancer, found symptomatic patients who rarely consult GPs, might respond to a targeted symptom elicitation intervention. Such GP-based interventions may promote early diagnosis of lung cancer or other comorbidities, without burdening already pressurised services.
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Affiliation(s)
- Richard Wagland
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom
| | - Lucy Brindle
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom
| | - Sean Ewings
- Southampton Statistical Sciences Research Institute, Faculty of Social, Human and Mathematical Sciences, Highfield, University of Southampton, Southampton, United Kingdom
| | - Elizabeth James
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom
| | - Mike Moore
- Faculty of Medicine, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom
| | - Ana Ibanez Esqueda
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom
| | - Jessica Corner
- Executive Office, The Nottingham University, University Park, Nottingham, NG7 2RD, United Kingdom
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21
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Haviland J, Cummings A, Winter J, Grimmett C, Calman L, Corner J, Din A, Fenlon D, May CM, Richardson A, Smith PW, Foster C. The impact of co-morbidities on recovery from colorectal cancer within first 2 years after surgery: Results from the UK Colorectal Wellbeing (CREW) cohort study. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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Downing A, Finan PJ, Sebag-Montefiore D, Wright P, Thomas JD, Gilbert A, Corner J, Richards M, Morris EJA, Glaser AW. P77 Health-related quality of life and functional outcomes following curative treatments for rectal cancer: A population-level study in England. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Complementary and alternative medicine are widely used by people with cancer, yet little information exists as to how such therapies are used or people's motivations for using them, and few studies have been conducted to assess the efficacy and safety of these in the context of cancer and its treatment. Therapies may be used in parallel to conventional cancer treatment in the belief that they may help cure the cancer, prevent its recurring, help manage the symptoms or simply enhance well-being. Little data exist for patients to help guide choices over whether or not to use complementary medicine. There is also a lack of information available to inform patients as to how to use therapies for their best effect; many patients manage complementary treatments themselves as there is little else to guide them. Pressure is increasing to fill in the large evidence gaps surrounding the efficacy and safety of complementary medicine through conducting large-scale clinical trials. This paper argues against launching, at this stage, a major initiative to conduct clinical trials to test the effectiveness of various therapies; instead, an approach using qualitative methods and drawing on biographical narrative research is advocated. We are in the process of collecting information about how people with cancer use complementary therapies in a longitudinal study of cancer patients who have declared that they are users or non-users of complementary medicine, funded by the NHS R&D Programme. Using a biographic narrative method, detailed maps of the ways in which patients' use complementary medicine and the intersection of this with individual cancer journeys and personal biographies are being acquired. Arguments for this novel methodological approach are presented.
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Affiliation(s)
- Jessica Corner
- School of Nursing and Midwifery University of Southampton
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24
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Abstract
The relationship between research and practice development has not always been a close one. Researchers focus upon the production of new knowledge to create the evidence base upon which the development of practice is taken forward, usually by other people within the clinical area. Work being undertaken at the Macmillan Practice Development Unit (MPDU) in London about the dissemination and utilisation of evidence concerning the management of breathlessness has raised a number of issues. These concern the confidence of practitioners to take on new approaches within the practice sphere, their desire for accredited education, and questions about responsibility for, and ownership of, the dissemination process. Different values about the nature of learning are explored here, which may explain the dissonance between practitioner and researcher expectations about the dissemination and utilisation process.
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Affiliation(s)
- Katherine Froggatt
- Macmillan Practice Development Unit, The Centre for Cancer and Palliative Care Studies, The Institute o f Caner Research, Royal Marsden Hospital, London
| | - Jessica Corner
- School of Nursing and Midwifery, University of Southampton
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Abstract
This paper describes the first two phases of an NHS R&D-funded study to develop and evaluate an alternative model of nurse-led follow-up care in the management of patients with lung cancer. Phase I of the study identified the needs of lung cancer patients during their follow-up period of care. This was achieved through observation of outpatient consultations and an audit of patients' medical records. Phase two of the study developed and piloted a nurse specialist-led model of follow-up care. This model moved away from the existing medical one focusing on disease surveillance towards a more patient-centred model responsive to the specific needs of lung cancer patients that were identified during Phase 1. The paper concludes that nurse-led follow-up care of lung cancer patients was demonstrated to be safe, acceptable and appropriately managed. Patients in the study reported positive benefits from a model of care responsive to the experience of, and needs arising from, living with lung cancer.
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Affiliation(s)
- Sally Moore
- Centre for Cancer and Palliative Care Studies, at the Institute of Cancer Research, London
| | - Jessica Corner
- Centre for Cancer and Palliative Care Studies, at the Institute of Cancer Research, London
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26
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Abstract
Nurses, it is argued, should participate in interdisciplinary research, yet there is little written about working in an interdisciplinary environment in research. This paper sets out some reflections on the experience of a nurse and a health economist working together on a series of studies. A number of difficulties are identified as themes running through the experience of interdisciplinary research: evaluating complex interventions, disruption of normal academic and scientific life, competition between disciplines and teams, finding a common language and learning to work together, finding the common ground and mutual self-interest, and learning to respect other perspectives and disciplines. Rosenfield's (1992) taxonomy of cross-disciplinary research is presented as a model to explain the development of our own approach. A commitment to the goal of transdisciplinarity in research is suggested.
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Affiliation(s)
- Jessica Corner
- Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, London
| | - Charles Normand
- Health Services Research Unit, London School of Hygiene and Tropical Medicine
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27
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Plant H, Bredin M, Krishnasamy M, Corner J. Working with resistance, tension and objectivity: Conducting a randomised controlled trial of a nursing intervention for breathlessness. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/136140960000500606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is vital that nurses wishing to recommend or introduce new strategies are able to provide supporting evidence that is acceptable to their colleagues. The methodology from which to derive such evidence remains to be clearly defined, as the research process is complex, demanding and, to a certain extent, uncharted. This paper examines the experience of nurses collaborating in a multi-centre randomised controlled trial which evaluated a nursing intervention for the management of breathlessness in patients with lung cancer. The study raised several important methodological issues: resistance among colleagues to innovative nursing practice; the difficulty of measuring well-being in patients whose physical condition is deteriorating; maintaining uniformity of practice within a diverse group of collaborating nurse researchers; and the tension between the nursing role and the necessity of an ethically demanding research design. Analysis of the process of conducting a randomised controlled trial produced valuable insights which indicated the kind of support required to undertake research and successfully implement a new intervention into clinical practice. The study also highlighted the problems associated with asking ill people to complete standard measurement tools, particularly when such instruments might not be sensitive to the reality of the patient(s) problem, in this case, the experience of breathlessness.
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Affiliation(s)
- Hilary Plant
- Centre of Cancer and Palliative Care studies, Institute of Cancer Research, Royal Marsden NHS Trust, London
| | - Mary Bredin
- Centre of Cancer and Palliative Care studies, Macmillan practice Development unit, Institute of Cancer Research, Royal Marsden NHS Trust, London
| | - Meinir Krishnasamy
- Centre of Cancer and Palliative Care studies, Macmillan practice Development unit, Institute of Cancer Research, Royal Marsden NHS Trust, London
| | - Jessica Corner
- Centre of Cancer and Palliative Care studies, Institute of Cancer Research, Royal Marsden NHS Trust, London
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28
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Foster C, Haviland J, Winter J, Grimmett C, Chivers Seymour K, Batehup L, Calman L, Corner J, Din A, Fenlon D, May CM, Richardson A, Smith PW. Pre-Surgery Depression and Confidence to Manage Problems Predict Recovery Trajectories of Health and Wellbeing in the First Two Years following Colorectal Cancer: Results from the CREW Cohort Study. PLoS One 2016; 11:e0155434. [PMID: 27171174 PMCID: PMC4865190 DOI: 10.1371/journal.pone.0155434] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/28/2016] [Indexed: 12/05/2022] Open
Abstract
Purpose This paper identifies predictors of recovery trajectories of quality of life (QoL), health status and personal wellbeing in the two years following colorectal cancer surgery. Methods 872 adults receiving curative intent surgery during November 2010 to March 2012. Questionnaires at baseline, 3, 9, 15, 24 months post-surgery assessed QoL, health status, wellbeing, confidence to manage illness-related problems (self-efficacy), social support, co-morbidities, socio-demographic, clinical and treatment characteristics. Group-based trajectory analyses identified distinct trajectories and predictors for QoL, health status and wellbeing. Results Four recovery trajectories were identified for each outcome. Groups 1 and 2 fared consistently well (scores above/within normal range); 70.5% of participants for QoL, 33.3% health status, 77.6% wellbeing. Group 3 had some problems (24.2% QoL, 59.3% health, 18.2% wellbeing); Group 4 fared consistently poorly (5.3% QoL, 7.4% health, 4.2% wellbeing). Higher pre-surgery depression and lower self-efficacy were significantly associated with poorer trajectories for all three outcomes after adjusting for other important predictors including disease characteristics, stoma, anxiety and social support. Conclusions Psychosocial factors including self-efficacy and depression before surgery predict recovery trajectories in QoL, health status and wellbeing following colorectal cancer treatment independent of treatment or disease characteristics. This has significant implications for colorectal cancer management as appropriate support may be improved by early intervention resulting in more positive recovery experiences.
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Affiliation(s)
- Claire Foster
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
- * E-mail:
| | - Joanne Haviland
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Jane Winter
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, United Kingdom
| | - Chloe Grimmett
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Kim Chivers Seymour
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Lynn Batehup
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Lynn Calman
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Jessica Corner
- Executive Office, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - Amy Din
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Deborah Fenlon
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Christine M. May
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, United Kingdom
| | - Peter W. Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
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Abstract
BACKGROUND With significant developments in the management of metastatic breast cancer, the trajectory of progressive breast cancer is becoming increasingly complex with little understanding of the illness course experienced by women, or their ongoing problems and needs. AIM This study set out to systematically explore the illness trajectory of metastatic breast cancer using models from chronic illness as a framework. DESIGN Longitudinal mixed methods studies detailing each woman's illness trajectory were developed by triangulating of narrative interviews, medical and nursing documentation and an assessment of functional ability using the Karnofsky Scale. The Corbin and Strauss Chronic Illness Trajectory Framework was used as a theoretical framework for the study. PARTICIPANTS Ten women aged between 40 and 78 years, with metastatic breast cancer. RESULTS Women's illness trajectories from diagnosis of metastatic disease ranged from 13 months to 5 years and 9 months. Eight of the 10 women died during the study. Chronic illness trajectory phases identified by Corbin and Strauss (pretrajectory, trajectory onset, living with progressive disease, downward phase and dying phase) were experienced by women with metastatic breast cancer. Three typical trajectories of different duration and intensity were identified. Women's lives were dominated by the physical burden of disease and treatment with little evidence of symptom control or support. CONCLUSIONS This is the first study to systematically explore the experience of women over time to define the metastatic breast cancer illness trajectory and provides evidence that current care provision is inadequate. Alternative models of care which address women's increasingly complex problems are needed.
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Affiliation(s)
- Elizabeth Reed
- Research and Evaluation Department, Breast Cancer Care, London, UK
| | - Jessica Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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30
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Wagland R, Recio-Saucedo A, Simon M, Bracher M, Hunt K, Foster C, Downing A, Glaser A, Corner J. Development and testing of a text-mining approach to analyse patients' comments on their experiences of colorectal cancer care. BMJ Qual Saf 2015; 25:604-14. [PMID: 26512131 DOI: 10.1136/bmjqs-2015-004063] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/26/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Quality of cancer care may greatly impact on patients' health-related quality of life (HRQoL). Free-text responses to patient-reported outcome measures (PROMs) provide rich data but analysis is time and resource-intensive. This study developed and tested a learning-based text-mining approach to facilitate analysis of patients' experiences of care and develop an explanatory model illustrating impact on HRQoL. METHODS Respondents to a population-based survey of colorectal cancer survivors provided free-text comments regarding their experience of living with and beyond cancer. An existing coding framework was tested and adapted, which informed learning-based text mining of the data. Machine-learning algorithms were trained to identify comments relating to patients' specific experiences of service quality, which were verified by manual qualitative analysis. Comparisons between coded retrieved comments and a HRQoL measure (EQ5D) were explored. RESULTS The survey response rate was 63.3% (21 802/34 467), of which 25.8% (n=5634) participants provided free-text comments. Of retrieved comments on experiences of care (n=1688), over half (n=1045, 62%) described positive care experiences. Most negative experiences concerned a lack of post-treatment care (n=191, 11% of retrieved comments) and insufficient information concerning self-management strategies (n=135, 8%) or treatment side effects (n=160, 9%). Associations existed between HRQoL scores and coded algorithm-retrieved comments. Analysis indicated that the mechanism by which service quality impacted on HRQoL was the extent to which services prevented or alleviated challenges associated with disease and treatment burdens. CONCLUSIONS Learning-based text mining techniques were found useful and practical tools to identify specific free-text comments within a large dataset, facilitating resource-efficient qualitative analysis. This method should be considered for future PROM analysis to inform policy and practice. Study findings indicated that perceived care quality directly impacts on HRQoL.
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Affiliation(s)
- Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Michael Simon
- Institute of Nursing Science, University of Basel, Basel, Switzerland Directorate of Nursing/AHP, Inselspital Bern University Hospital, Bern, Switzerland
| | - Michael Bracher
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Claire Foster
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Amy Downing
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
| | - Adam Glaser
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
| | - Jessica Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Jarrett N, Porter K, Davis C, Lathlean J, Duke S, Corner J, Addington-Hall J. Palliative care patients' perceptions of the work involved in understanding and managing the network of care provision surrounding them. BMJ Support Palliat Care 2015; 7:133-139. [PMID: 25829381 DOI: 10.1136/bmjspcare-2014-000781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/17/2015] [Accepted: 03/11/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the work carried out for cancer palliative care patients in understanding and dealing with the often large network of care provision surrounding them. METHOD Qualitative thematic analysis of interviews with 24 patients (aged 48-85 years) with 15 different types/sites of cancer and palliative care needs. RESULTS The main theme of 'patient work-their strategies and project management' is presented. Subthemes included: being organised and keeping records; planning ahead and coordinating care; information gathering; understanding the hierarchy and knowing who the key people are; strategies to remember names and roles; understanding and 'working the system'. Insights are given into the work carried out on patients' behalf by family, although it was unclear who would do this work if no family was available. Some of the challenges faced by patients and families are identified. These included limited information; uncertainty when care is transferred between different teams or locations; deciding who to contact and how; and negotiating through gatekeepers. CONCLUSIONS The number and variety of people contributing to the care of a cancer palliative care patient can be difficult for patients and family to comprehend. Work is required by patients or family on their behalf to achieve the level of understanding required to become accomplished at navigating the system and project managing their care organisation, and is probably influenced by role expectations and previous experience. Much of this additional, often hidden, workload for patients and family could probably be reduced with clear, timely information provision by health professionals.
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Affiliation(s)
- N Jarrett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - K Porter
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - C Davis
- Countess Mountbatten House, Moorgreen Hospital and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Lathlean
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - S Duke
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Addington-Hall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Jarrett N, Porter K, Davis C, Addington-Hall J, Duke S, Corner J, Lathlean J. The networks of care surrounding cancer palliative care patients. BMJ Support Palliat Care 2015; 5:435-42. [PMID: 25812576 DOI: 10.1136/bmjspcare-2014-000782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 03/11/2015] [Indexed: 11/04/2022]
Affiliation(s)
- N Jarrett
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - K Porter
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - C Davis
- Countess Mountbatten House, Moorgreen Hospital and University Hospital Southampton NHS Foundation Trust, Southampton, Hants, UK
| | - J Addington-Hall
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - S Duke
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - J Corner
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
| | - J Lathlean
- Faculty of Health Sciences, Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, Hants, UK
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Foster C, Breckons M, Cotterell P, Barbosa D, Calman L, Corner J, Fenlon D, Foster R, Grimmett C, Richardson A, Smith PW. Cancer survivors' self-efficacy to self-manage in the year following primary treatment. J Cancer Surviv 2015; 9:11-9. [PMID: 25028218 PMCID: PMC4341005 DOI: 10.1007/s11764-014-0384-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/01/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Cancer survivors are increasingly expected to manage the consequences of cancer and its treatment for themselves. There is evidence that self-efficacy is important for successful self-management and that this can be enhanced with support. The purpose of this study was to assess self-efficacy to manage problems in the year following primary treatment. METHODS This cross-sectional online survey included cancer survivors who had completed their treatment within the past 12 months. Self-efficacy was assessed and variables expected to be associated with self-efficacy were measured using validated scales including quality of life, well-being, illness perceptions, depression and social support. RESULTS One hundred eighty-two respondents (mean age 50; 81% female) completed the survey. They had been treated for a range of cancers; most commonly breast (45%). Self-efficacy scores varied between individuals and according to the illness-related task to be managed. Respondents were least confident in managing fatigue and most confident in accessing information about their cancer. Individuals most likely to report low self-efficacy were women, those experiencing higher levels of pain and/or depression, lower well-being scores, lower socio-economic status, low levels of social support, or a more negative perception of cancer. CONCLUSIONS Self-efficacy to self-manage problems faced as a consequence of cancer and its treatment can vary widely in the year following treatment. Fatigue may be particularly difficult to manage. IMPLICATIONS FOR CANCER SURVIVORS Variations in self-efficacy highlight the importance of assessing specific problems faced and people's confidence to manage them in order to tailor appropriate self-management support.
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Affiliation(s)
- C Foster
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK,
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Foster C, Calman L, Grimmett C, Breckons M, Cotterell P, Yardley L, Joseph J, Hughes S, Jones R, Leonidou C, Armes J, Batehup L, Corner J, Fenlon D, Lennan E, Morris C, Neylon A, Ream E, Turner L, Richardson A. Managing fatigue after cancer treatment: development of RESTORE, a web-based resource to support self-management. Psychooncology 2015; 24:940-9. [DOI: 10.1002/pon.3747] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 12/03/2014] [Accepted: 12/16/2014] [Indexed: 11/10/2022]
Affiliation(s)
- C. Foster
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - L. Calman
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - C. Grimmett
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - M. Breckons
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - P. Cotterell
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - L. Yardley
- School of Psychology; University of Southampton; Southampton SO17 1BJ UK
| | - J. Joseph
- School of Psychology; University of Southampton; Southampton SO17 1BJ UK
| | - S. Hughes
- School of Psychology; University of Southampton; Southampton SO17 1BJ UK
| | - R. Jones
- School of Psychology; University of Southampton; Southampton SO17 1BJ UK
| | - C. Leonidou
- School of Psychology; University of Southampton; Southampton SO17 1BJ UK
| | - J. Armes
- Florence Nightingale School of Nursing and Midwifery; Kings College London; London SW1 8WA UK
| | - L. Batehup
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - J. Corner
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - D. Fenlon
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - E. Lennan
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - C. Morris
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - A. Neylon
- Macmillan Cancer Support; London SE1 7UQ UK
| | - E. Ream
- School of Health Sciences; University of Surrey; Guildford GU2 7TE UK
| | - L. Turner
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
| | - A. Richardson
- Faculty of Health Sciences; University of Southampton; Southampton SO17 1BJ UK
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Downing A, Morris EJA, Richards M, Corner J, Wright P, Sebag-Montefiore D, Finan P, Kind P, Wood C, Lawton S, Feltbower R, Wagland R, Vernon S, Thomas J, Glaser AW. Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis. J Clin Oncol 2015; 33:616-24. [PMID: 25559806 DOI: 10.1200/jco.2014.56.6539] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This population-level study was conducted to define the health-related quality of life (HRQL) of individuals living with and beyond colorectal cancer (CRC) and to identify factors associated with poor health outcomes. PATIENTS AND METHODS All individuals diagnosed with CRC in England in 2010 and 2011 who were alive 12 to 36 months after diagnosis were sent a questionnaire. This included questions related to treatment, disease status, other long-term conditions (LTCs), generic HRQL (EuroQol-5D), and cancer-specific outcomes (Functional Assessment of Cancer Therapy and Social Difficulties Inventory items). RESULTS The response rate was 63.3% (21,802 of 34,467 patients). One or more generic health problems were reported by 65% of respondents, with 10% of patients reporting problems in all five domains. The reporting of problems was higher than in the general population and was most marked in those age less than 55 years. Certain subgroups reported a higher number of problems, notably those with one or more other LTCs, those with active or recurrent disease, those with a stoma, and those at the extremes of the age range (< 55 and > 85 years). Of respondents without a stoma, 16.3% reported no bowel control. Reversal of a stoma resulted in fewer severe bowel problems but more moderate problems than those who had never had a stoma. A quarter of rectal cancer respondents (25.1%) reported difficulties with sexual matters (compared with 11.2% of colon cancer respondents). CONCLUSION This study demonstrates the success of a national patient-reported outcomes survey. The results have the potential to support system-wide improvement in health outcomes through the identification of particular challenges faced by individuals after treatment for CRC.
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Affiliation(s)
- Amy Downing
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Eva J A Morris
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Mike Richards
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Jessica Corner
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Penny Wright
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - David Sebag-Montefiore
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Paul Finan
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Paul Kind
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Charlotte Wood
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Sarah Lawton
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Richard Feltbower
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Richard Wagland
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Sally Vernon
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - James Thomas
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom
| | - Adam W Glaser
- Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom.
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Corner J. "Are we right to concentrate on prospective students' values?". Nurs Times 2014; 110:7. [PMID: 26021048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Moore S, Brindle L, Corner J. 117 Representing lung cancer: an examination of UK media stories. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grimmett C, Armes J, Breckons M, Calman L, Corner J, Fenlon D, Hulme C, May CM, May CR, Ream E, Richardson A, Smith PWF, Yardley L, Foster C. RESTORE: an exploratory trial of an online intervention to enhance self-efficacy to manage problems associated with cancer-related fatigue following primary cancer treatment: study protocol for a randomized controlled trial. Trials 2013; 14:184. [PMID: 23786716 PMCID: PMC3698162 DOI: 10.1186/1745-6215-14-184] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/04/2013] [Indexed: 11/10/2022] Open
Abstract
Background There are over 25 million people worldwide living with or beyond cancer and this number is increasing. Cancer survivors face a range of problems following primary treatment. One of the most frequently reported and distressing symptoms experienced by cancer survivors is fatigue. There is growing support for survivors who are experiencing problems after cancer treatment to engage in supported self-management. To date there is some evidence of effective interventions to manage fatigue in this population; however, to our knowledge there are no online resources that draw on this information to support self-management of fatigue. This paper describes the protocol for an exploratory randomized controlled trial of an online intervention to support self-management of cancer-related fatigue after primary cancer treatment. Methods/design This is a parallel-group two-armed (1:1) exploratory randomized controlled trial including 125 cancer survivors experiencing fatigue (scoring ≥4 on a unidimensional 11-point numeric rating scale for fatigue intensity) within five years of primary treatment completion with curative intent. Participants will be recruited from 13 NHS Trusts across the UK and randomized to either the online intervention (RESTORE), or a leaflet comparator (Macmillan Cancer Backup, Coping with Fatigue). The primary outcome is a change in Perceived Self-Efficacy for Fatigue Self-Management (as measured by the Perceived Self-Efficacy for Fatigue Self-Management Instrument). Secondary outcomes include impact on perception and experience of fatigue (measured by the Brief Fatigue Inventory), and quality of life (measured by the Functional Assessment of Cancer Therapy - General and the Personal Wellbeing Index). Outcome measures will be collected at baseline, 6 weeks (completion of intervention), and 3 months. Process evaluation (including telephone interviews with recruiting staff and participants) will determine acceptability of the intervention and trial processes. Discussion Data from this trial will be used to refine the intervention and contribute to the design of an effectiveness trial. This intervention will be expanded to address other cancer-related problems important to cancer survivors following primary cancer treatment. Trial registration ISRCTN67521059
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Affiliation(s)
- Chloe Grimmett
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK
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Griffiths P, Simon M, Richardson A, Corner J. Is a larger specialist nurse workforce in cancer care associated with better patient experience? Cross-sectional study. J Health Serv Res Policy 2013; 18:39-46. [DOI: 10.1177/1355819612473451] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives: To assess whether variation in the provision of cancer specialist nurses is associated with the experiences of care for patients undergoing treatment for cancer. Methods: This is a cross-sectional study using routinely collected national survey data in 158 acute hospital National Health Service (NHS) Trusts in England. Patients with a primary diagnosis of cancer who attended hospital as inpatients or day cases in the first three months of 2010 responded to a national survey ( n = 67,713, response rate 67%). Patient perceptions of coordination of care, quality of information provision, emotional support and support for symptom management were studied. Results: Patients in Trusts that had the fewest patients per specialist nurse were more likely to report that people treating and caring for them worked well together (adjusted odds ratio 1.08, 95% confidence interval 1.01–1.15; p = 0.02) and provided enough emotional support during ambulatory treatment (1.15, 1.01–1.32; p = 0.04), but were no more likely to report being given the right amount of information (0.96, 0.88–1.05; p = 0.38) when compared to patients in Trusts with the most patients per specialist nurse. Breast cancer patients undergoing chemotherapy in the Trusts with fewer patients per specialist nurse were more likely to report good support for the control of side effects from chemotherapy (1.34, 1.02–1.75; p = 0.03). Conclusions: Cancer patients’ experience of care coordination and emotional support was better in Trusts with more specialist nurses. The absolute differences were small, and it was unclear whether particular roles or service configurations are associated with better experience.
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Affiliation(s)
- Peter Griffiths
- Professor of Health Services Research, Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK
| | - Michael Simon
- Senior Research Fellow, Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK
| | - Alison Richardson
- Clinical Professor of Cancer Nursing, Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK, and Clinical Professor of Cancer Nursing, University Hospital Southampton NHS Foundation Trust, UK
| | - Jessica Corner
- Professor of Cancer and Palliative Care, Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK, and Chief Clinician, Macmillan Cancer Support, UK
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Glaser AW, Fraser LK, Corner J, Feltbower R, Morris EJA, Hartwell G, Richards M, Wagland R. Patient-reported outcomes of cancer survivors in England 1-5 years after diagnosis: a cross-sectional survey. BMJ Open 2013; 3:bmjopen-2012-002317. [PMID: 23578682 PMCID: PMC3641492 DOI: 10.1136/bmjopen-2012-002317] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To determine the feasibility of collecting population-based patient-reported outcome measures (PROMs) in assessing quality of life (QoL) to inform the development of a national PROMs programme for cancer and to begin to describe outcomes in a UK cohort of survivors. DESIGN Cross-sectional postal survey of cancer survivors using a population-based sampling approach. SETTING English National Health Service. PARTICIPANTS 4992 breast, colorectal, prostate and non-Hodgkin's lymphoma (NHL) survivors 1-5 years from diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES Implementation issues, response rates, cancer-specific morbidities utilising items including the EQ5D, tumour-specific subscales of the Functional Assessment of Cancer Therapy and Social Difficulties Inventory. RESULTS 3300 (66%) survivors returned completed questionnaires. The majority aged 85+ years did not respond and the response rates were lower for those from more deprived area. Response rates did not differ by gender, time since diagnosis or cancer type. The presence of one or more long-term conditions was associated with significantly lower QoL scores. Individuals from most deprived areas reported lower QoL scores and poorer outcomes on other measures, as did those self-reporting recurrent disease or uncertainty about disease status. QoL scores were comparable at all time points for all cancers except NHL. QoL scores were lower than those from the general population in Health Survey for England (2008) and General Practice Patient Survey (2012). 47% of patients reported fear of recurrence, while 20% reported moderate or severe difficulties with mobility or usual activities. Bowel and urinary problems were common among colorectal and prostate patients. Poor bowel and bladder control were significantly associated with lower QoL. CONCLUSIONS This method of assessing QoL of cancer survivors is feasible and acceptable to most survivors. Routine collection of national population-based PROMs will enable the identification of, and the support for, the specific needs of survivors while allowing for comparison of outcome by service provider.
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Affiliation(s)
- Adam W Glaser
- Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Abstract
OBJECTIVE This study examined how free-text comments from cancer survivors could complement formal patient-reported outcome measures (PROMs), as part of the England PROMs survey programme for cancer. DESIGN A qualitative content analysis was conducted of responses to a single open-ended free-text question placed at the end of the cross-sectional population-based postal questionnaire. SETTING Individuals were identified through three UK Cancer Registries and questionnaires were posted to their home addresses. PARTICIPANTS A random sample of individuals (n=4992) diagnosed with breast, colorectal, non-Hodgkins lymphoma or prostate cancer at 1, 2, 3 and 5 years earlier. RESULTS 3300 participants completed the survey (68% response rate). Of these 1056 (32%) completed the free-text comments box, indicating a high level of commitment to provide written feedback on patient experience. Almost a fifth (19%) related experiences of excellent care during the treatment phase, with only 8% reporting negative experiences. This contrasted with experiences of care after primary cancer treatment where the majority were negative. Factors impacting negatively upon patient-reported outcomes included the emotional impact of cancer; poor experiences of treatment and care; comorbidities, treatment side effects, social difficulties and inadequate preparation for a wide range of sometimes long-lasting on-going physical and psychological problems. Mediating factors assisting recovery incorporated both professional-led factors, such as quality of preparation for anticipated problems and aftercare services, and participant-led factors, such as learning from other cancer survivors and self-learning through trial and error. The support of friends and family was also a factor in participants' outcomes. CONCLUSIONS This analysis of free-text comments complements quantitative analysis of PROMs measure's by illuminating relationships between factors that impact on quality of life (QoL) and indicate why cancer patients may experience significantly worse QoL than the general population. The data suggest more systematic preparation and aftercare for individuals to self-manage post-treatment problems might improve QoL outcomes among cancer survivors.
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Affiliation(s)
- Jessica Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Adam Glaser
- Department of Paediatric Oncology, Leeds General Infirmary, Leeds, UK
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Brindle L, Pope C, Corner J, Leydon G, Banerjee A. Eliciting symptoms interpreted as normal by patients with early-stage lung cancer: could GP elicitation of normalised symptoms reduce delay in diagnosis? Cross-sectional interview study. BMJ Open 2012; 2:e001977. [PMID: 23166137 PMCID: PMC3533064 DOI: 10.1136/bmjopen-2012-001977] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 10/11/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate why symptoms indicative of early-stage lung cancer (LC) were not presented to general practitioners (GPs) and how early symptoms might be better elicited within primary care. DESIGN, SETTING AND PARTICIPANTS A qualitative cross-sectional interview study about symptoms and help-seeking in 20 patients from three south England counties, awaiting resection of LC (suspected or histologically confirmed). Analysis drew on principles of discourse analysis and constant comparison to identify processes involved in interpretation and communication about symptoms, and explain non-presentation. RESULTS Most participants experienced health changes possibly indicative of LC which had not been presented during GP consultations. Symptoms that were episodic, or potentially caused by ageing or lifestyle, were frequently not presented to GPs. In interviews, open questions about health changes/symptoms in general did not elicit these symptoms; they only emerged in response to closed questions detailing specific changes in health. Questions using disease-related labels, for example, pain or breathlessness, were less likely to elicit symptoms than questions that used non-disease terminology, such as aches, discomfort or 'getting out of breath'. Most participants described themselves as feeling well and were reluctant to associate potentially explained, non-specific or episodic symptoms with LC, even after diagnosis. CONCLUSIONS Patients with early LC are unlikely to present symptoms possibly indicative of LC that they associate with normal processes, when attending primary care before diagnosis. Faced with patients at high LC risk, GPs will need to actively elicit potential LC symptoms not presented by the patient. Closed questions using non-disease terminology might better elicit normalised symptoms.
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Affiliation(s)
- Lucy Brindle
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jessica Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Department of Primary Medical Care, University of Southampton, Southampton, UK
| | - Anindo Banerjee
- Department of Respiratory Medicine, Southampton General Hospital, Southampton, UK
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Walsh B, Addington-Hall J, Roberts HC, Nicholls PG, Corner J. Outcomes After Unplanned Admission to Hospital in Older People: Ill-Defined Conditions as Potential Indicators of the Frailty Trajectory. J Am Geriatr Soc 2012; 60:2104-9. [DOI: 10.1111/j.1532-5415.2012.04198.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Bronagh Walsh
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | | | | | - Peter G. Nicholls
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Jessica Corner
- Faculty of Health Sciences; University of Southampton; Southampton UK
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Fenlon D, Richardson A, Addington-Hall J, Smith P, Corner J, Winter J, Foster C. A cohort study of the recovery of health and wellbeing following colorectal cancer (CREW study): protocol paper. BMC Health Serv Res 2012; 12:90. [PMID: 22475242 PMCID: PMC3382420 DOI: 10.1186/1472-6963-12-90] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/04/2012] [Indexed: 11/28/2022] Open
Abstract
Background The number of people surviving colorectal cancer has doubled in recent years. While much of the literature suggests that most people return to near pre-diagnosis status following surgery for colorectal cancer, this literature has largely focused on physical side effects. Longitudinal studies in colorectal cancer have either been small scale or taken a narrow focus on recovery after surgery. There is a need for a comprehensive, long-term study exploring all aspects of health and wellbeing in colorectal cancer patients. The aim of this study is to establish the natural history of health and wellbeing in people who have been treated for colorectal cancer. People have different dispositions, supports and resources, likely resulting in individual differences in restoration of health and wellbeing. The protocol described in this paper is of a study which will identify who is most at risk of problems, assess how quickly people return to a state of subjective health and wellbeing, and will measure factors which influence the course of recovery. Methods/design This is a prospective, longitudinal cohort study following 1000 people with colorectal cancer over a period of two years, recruiting from 30 NHS cancer treatment centres across the UK. Questionnaires will be administered prior to surgery, and 3, 9, 15 and 24 months after surgery, with the potential to return to this cohort to explore on-going issues related to recovery after cancer. Discussion Outcomes will help inform health care providers about what helps or hinders rapid and effective recovery from cancer, and identify areas for intervention development to aid this process. Once established the cohort can be followed up for longer periods and be approached to participate in related projects as appropriate and subject to funding.
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Affiliation(s)
- Deborah Fenlon
- University of Southampton, Macmillan Survivorship Research Group, Southampton, UK.
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Reed E, Simmonds P, Haviland J, Corner J. Quality of life and experience of care in women with metastatic breast cancer: a cross-sectional survey. J Pain Symptom Manage 2012; 43:747-58. [PMID: 22088804 DOI: 10.1016/j.jpainsymman.2011.05.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 05/03/2011] [Accepted: 05/12/2011] [Indexed: 11/29/2022]
Abstract
CONTEXT Despite developments in the medical management of metastatic breast cancer, little is known about the quality of life (QoL) and experience of care in women with it. OBJECTIVES To explore QoL, experience of care, and support needs of women living with metastatic breast cancer in the U.K. METHODS Questionnaire-based, cross-sectional study, undertaken in two U.K. cancer centers and online via the Breast Cancer Care website, assessing QoL and experience of care in 235 women with metastatic breast cancer. RESULTS QoL was assessed using the Functional Assessment of Cancer Therapy--Breast QoL measure. Overall, QoL was low (mean 89.0, standard deviation 21.8) for total score. Low scores were seen uniformly in physical, social, emotional, and functional well-being domains. Symptom burden was a significant problem, with over one-third of women (34%) reporting high levels of pain and other uncontrolled symptoms. In multiple regression analysis, social well-being was significantly better for older women (P<0.001) but was lower in those with bone metastases only (P=0.002). Functional well-being was significantly higher in women without children (P=0.004). Satisfaction with experience of care was low and appeared to be predominantly in the hospital setting, with little evidence of involvement of general practitioners and palliative care services. CONCLUSION Despite improvements in treatment and survival of women with metastatic breast cancer, this group reports high symptom burden and dissatisfaction with elements of their care, indicating that alternative models of service delivery should be explored.
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Jarrett N, Porter K, Addington-Hall J, Corner J, Davis C, Duke S, Lathlean J. How do people with cancer and palliative care needs understand and contribute to the management of communication surrounding their care? BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Porter K, Jarrett N, Addington-Hall J, Corner J, Davis C, Duke S, Lathlean J. ‘Many hands make light work’ or ‘too many cooks spoil the broth’? Achieving the tricky balance of appropriate involvement in palliative care for cancer. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Armes J, Griffiths P, Richardson A, Wagland R, Finnegan-John J, Corner J. 4157 ORAL Developing and Feasibility Testing of Nurse Sensitive Outcome Measures for Ambulatory Cancer Chemotherapy. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71323-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Corner J. Degrees will build in values to underpin and ensure good care. Nurs Times 2011; 107:7. [PMID: 21661483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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