Cancer survivorship in urban people living with cancer following primary treatment: A secondary analysis of qualitative interview data

PURPOSE

Urban cancer survivors have been shown to have better opportunities for recovery of health and wellbeing than their rural counterparts. Whilst there is a considerable body of evidence that explores urban people with cancers' experiences and outcomes, there is a dearth of research that explicitly explores 'urban cancer survivorship' in its own right. This study aimed to explore cancer survivorship in urban people living with cancer who have completed primary treatment.

METHODS

Secondary analysis of in-depth interview data (n = 18) with adults living with cancer who resided in urban parts of the UK. Data were drawn from a broader study on self-management of people living with cancer. An adapted version of Foster and Fenlon's recovery of health and wellbeing in cancer survivorship framework was used to inform the analysis of the data.

RESULTS

Recovery of health and wellbeing was impacted by a variety of contributory factors, which had a largely positive impact. Access to amenities, social support, travel, and healthcare factors were opportunities for urban cancer survivors, whilst pollution, traffic and a lack of green spaces acted as challenges for health management.

CONCLUSION

This study demonstrated how urban residency acted as both a barrier and a facilitator to recovery of health and wellbeing in urban cancer survivors following the completion of primary treatment. Area of residence should be taken into account by health providers and policymakers supporting cancer survivorship and the views of those with lived experiences should be included in informing future practice.

Motivation for becoming a paid caregiver for older people: a case study in Phuket Province, Thailand

This study aimed to explore the motivations, attitudes, care management strategies and training needs of paid caregivers. Data were collected through 51 semi-structured interviews with paid caregivers and analyzed using thematic analysis. Their motivations included economic stability, the inability to secure other employment, a desire to secure independence through regularly paid employment and a passion and a love of caring. Their role involved being a key communicator of care between medical personnel and relatives, and participants emphasized the importance of paid caregivers being loving, caring, calm, patient, having the ability and willingness to cope with challenging situations. They outlined some specific challenges of the role of caregiving and expressed the importance of gaining recognition for the role as well as the need for bespoke and tailored training to underpin it. This study adds to the growing international literature around the needs of the paid carer workforce and has the potential to inform policy and training around the provision of a better-equipped workforce to meet the growing needs of the aging population.

Implementing the European code of cancer practice in rural settings

Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or "The Code" is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.

A systematic review on the qualitative experiences of people living with lung cancer in rural areas

PURPOSE

To synthesize the qualitative literature exploring the experiences of people living with lung cancer in rural areas.

METHODS

Searches were performed in MEDLINE, CINAHL, and PsycINFO. Articles were screened independently by two reviewers against pre-determined eligibility criteria. Data were synthesized using Thomas and Harden's framework for the thematic synthesis of qualitative research. The CASP qualitative checklist was used for quality assessment and the review was reported in accordance with the ENTREQ and PRISMA checklists.

RESULTS

Nine articles were included, from which five themes were identified: (1) diagnosis and treatment pathways, (2) travel and financial burden, (3) communication and information, (4) experiences of interacting with healthcare professionals, (5) symptoms and health-seeking behaviors. Lung cancer diagnosis was unexpected for some with several reporting treatment delays and long wait times regarding diagnosis and treatment. Accessing treatment was perceived as challenging and time-consuming due to distance and financial stress. Inadequate communication of information from healthcare professionals was a common concern expressed by rural people living with lung cancer who also conveyed dissatisfaction with their healthcare professionals. Some were reluctant to seek help due to geographical distance and sociocultural factors whilst others found it challenging to identify symptoms due to comorbidities.

CONCLUSIONS

This review provides a deeper understanding of the challenges faced by people with lung cancer in rural settings, through which future researchers can begin to develop tailored support to address the existing disparities that affect this population.

Developing a 'Living with Cancer' programme in a rural and coastal setting: Experiences of collaborative and innovative co-production across an Integrated Health System

INTRODUCTION

With projected increases in cancer prevalence, and demonstrated unmet need, there is an urgency for a collaborative approach to improving the lives of those living with cancer particularly in rural and coastal areas where cancer survivors face unique challenges. We report on an innovative 'Living with Cancer' (LWC) programme in the rural and coastal English county of Lincolnshire.

METHODS

In 2016, the Lincolnshire LWC programme was established to develop person-centred, local support for people living with cancer, their carers and significant others in Lincolnshire. This article reports on the setup of the LWC programme, our innovative approach to delivering cancer care in a rural and coastal setting, as well as our most salient achievements.

RESULTS

This work, developed within a policy context of tackling health inequalities and personalised approaches to care, started with stakeholder and community engagement where people described the challenges to living well after cancer and the need to focus on 8 themes further exacerbated by rurality. Recognising the limitations of conventional approaches, led to the development of a strategy underpinned by a shared set of principles and a philosophy of the importance of a transformative, whole-system, place-based, asset-based, and person-centred approaches. The strategy is now being coordinated and delivered across all cancer pathways and Lincolnshire communities. In 2022, permanent funding was secured, and our success was also demonstrated by a national Macmillan Integration Excellence award.

DISCUSSION

The initial success of the LWC programme in Lincolnshire is a result of an explicit focus on 'transformation' rather than 'improvement', and a programme not solely situated in an acute setting, which needed a whole systems approach with a focus on person-centred support and community engagement.

Community efforts to promote vaccine uptake in a rural setting: a qualitative interview study

Vaccine hesitancy has been identified as one of the top 10 threats to global health. The causes of low vaccine uptake are many and vary at micro and macro levels. However, rural and remote coastal areas in the UK experience unique vaccine inequalities due to high levels of deprivation and their unique and complex access-related problems. This study aimed to explore community efforts to promote vaccine uptake during the COVID-19 pandemic and understand how the COVID-19 vaccination campaign was experienced by the public. We conducted an exploratory descriptive qualitative study using semi-structured interviews with decision-makers, health professionals and community members in Lincolnshire, a predominantly rural county with a long coastline, a large population of white minority ethnicities, and those living in caravan and temporary housing. Data were analysed using conventional content analysis. Overcoming the various access barriers to vaccination uptake involved working with local media stations, local communities and local community groups, translation of information, bringing vaccines closer to the people through pop-up and mobile clinics and provision of transport and ensuring confidentiality. There is a need to employ inclusive targeted non-conventional care interventions whilst dealing with complex problems as occur in rural and remote coastal regions.

The Application of Kirkpatrick's Evaluation Model in the Assessment of Interprofessional Simulation Activities Involving Pharmacy Students: A Systematic Review

OBJECTIVES

To our knowledge, this systematic review is the first to assess pharmacy-involved interprofessional education (IPE) simulation activities in establishing current methodological effectiveness using Kirkpatrick's Evaluation Model. This is a training evaluative model that assesses educational training activities according to 4 levels: reaction, learning, behavior, and results.

FINDINGS

From the 3108 studies retrieved, 14 studies met the inclusion criteria. Thirteen studies achieved levels 1 and 2 of Kirkpatrick's Evaluation Model, and 1 achieved level 3. One study only achieved level 1. Single-group, pre- and posttest studies were the most common study designs (n = 9), and 1 study followed a longitudinal approach. IPE duration ranged from 45 min to 5 days, and most of the studies were conducted in the United States (n = 10). Most studies alluded to an underpinning theory behind IPE simulation design and chose surveys as their mode of data collection.

SUMMARY

The most common limitation reported was the uneven representation of professions and a lack of data on the studies' effect in practice. To demonstrate the achievement of outcomes in relation to levels 3 and 4, there is a need for longitudinal studies of IPE simulation activities. Although evaluative studies showed a positive response to IPE simulation at a basic level, there is a lack of effective integration of theory behind IPE design. Future studies need to consider this when setting the infrastructure of IPE design, as well as making efforts to mobilize stakeholders in the workplace to help facilitate transfer of learning.

Perceptions and Intentions around Uptake of the COVID-19 Vaccination among Older People: A Mixed-Methods Study in Phuket Province, Thailand

BACKGROUND

A 70% vaccination rate against COVID-19 in the general population was required for re-opening Phuket tourist industry. However, prior to this research, 39.61% of older people remained unvaccinated. This study aimed to examine perceptions and intentions around COVID-19 vaccination amongst older people and to explore the reasons and factors influencing their decisions to receive or refuse vaccination.

METHODS

This was a mixed-methods approach with a sequential explanatory design. We conducted an online survey and semi-structured qualitative interview with a subsample. Multinomial logistic regression was applied and thematic content analysis was conducted.

RESULTS

92.4% of participants reported intention to receive the vaccine. Multinomial regression analysis revealed that perceived barriers (AdjOR = 0.032; 95% CI: 0.17-0.59), perceived benefit (AdjOR = 2.65; 95% CI: 1.49-4.71), good health (AdjOR = 3.51; 95% CI: 1.01-12.12) and health not good (AdjOR = 0.10; 95% CI: 0.02-0.49) were predictors of vaccine uptake. In the qualitative interviews, four key influences on up-take for the 28 vaccinated participants were: prevention and protection, convenience, fear of death from COVID-19, and trust in the vaccine. Four key influences on refusal of vaccination in the eight unvaccinated participants were: rarely leaving the house, fear of vaccine side-effects, fear of death after getting the vaccine, and not enough information for decision-making.

CONCLUSION

Intervention and campaigns addressing COVID-19 vaccination should employ strategies, including the widespread use of social and other popular media to increase older people's perceived benefit of vaccination on their current and future health status, while decreasing perceived barriers to receiving the vaccine.

Health-Promoting Behaviours following Primary Treatment for Cancer: A Rural-Urban Comparison from a Cross-Sectional Study

AIM

To compare health-promoting behaviours among rural and urban residents following primary treatment for cancer.

METHODS

A cross-sectional survey collecting demographic variables and data pertaining to health-promoting behaviours, documented using the 52-item Health Promotion Lifestyle Profile II (HPLP-II) measure, which is categorised into six subscales: (1) health responsibility, (2) spiritual growth, (3) physical activity, (4) interpersonal relations, (5) nutrition, and (6) stress management. Residence was defined using the U.K. Office for National Statistics RUC 2011 Rural Urban Classifications. The Index of Multiple Deprivation (IMD) Decile was used to measure deprivation. Quantitative data were analysed using independent samples t-test and multiple linear regression. Qualitative data from open-ended questions were analysed thematically.

RESULTS

In total, 227 participants with a range of cancer types completed the questionnaire. Fifty-three percent were residents in urban areas and forty-five percent in rural areas. Rural participants scored significantly higher on health responsibility (p = 0.001), nutrition (p = 0.001), spiritual growth (p = 0.004), and interpersonal relationships (p = 0.001), as well as on the overall HPLP-II (p = 0.001). When controlling for deprivation, age, marital status, and education, rural-urban residence was a significant predictor of exhibiting health-promoting behaviours. A central theme from the qualitative data was the concept of "moving on" from cancer following treatment, by making adjustments to physical, social, psychological, spiritual, and emotional wellbeing.

CONCLUSIONS

This research revealed, for the first time, differences in health-promoting behaviours among rural and urban U.K. populations who have completed primary cancer treatment. Rural residence can provide a positive environment for engaging with health-promoting behaviours following a cancer diagnosis and treatment.

Understanding sexual and reproductive health from the perspective of late adolescents in Northern Thailand: a phenomenological study

BACKGROUND

Worldwide, Sexual Reproductive Health (SRH) issues comprise a third of health problems for women aged 15-44. SRH education equips people with knowledge of concepts around sexuality and reproduction, and the skills help to make informed decisions to prevent sexual and reproductive ill-health, including unplanned pregnancy and HIV/AIDS, and other sexually transmitted infections (STIs). The aim of this study was to explore the experiences of late adolescents relating to SRH, examining their attitudes toward sex and contraception, and to identify the gaps in knowledge pertiaing to decision-making around risk-taking behaviour.

METHODS

A qualitative phenomenological study was undertaken with 30 adolescents aged 18-19, purposively and snowball sampled from a university in Northern Thailand. Data collaction took place from July 2020 to January 2021. In-depth individual interviews were conducted until data saturation was reached. Data were recorded, transcribed, and analysed in ATLAS.ti version 9, using Modified Interpretative Phenomenological Analysis to identify pertinent themes.

RESULTS

Participants revealed five key experiences of SRH related to sex and contraception: Keeping a secret; Seeking Freedom and Love; Having SRH education; Self-protection; Parental acceptance. All findings reflected the value and impact of SRH on the experiences of late adolescents.

CONCLUSIONS

This study provides detailed knowledge about adolescents' perspectives of SRH and rights in terms of accessing sexual and reproductive health care and information as well as autonomy in sexual and reproductive decision-making. Gaining SRH education can assist decision-making concerning contraceptive methods for family planning and STI prevention. The study recommends that SRH and rights-based education should be designed responsively and appropriately for female and male adolescents, their families, and society. The content of SRH should be informed and advocated by healthcare providers, educators, policy makers, and systems to empower adolescents in order to achieve effective SRH education.

A Rapid Systematic Review on the Experiences of Cancer Survivors Residing in Rural Areas during the COVID-19 Pandemic

The COVID-19 pandemic has caused considerable disruption to cancer care and may have exacerbated existing challenges already faced by cancer survivors from rural areas. This has created a need for a rapid evidence synthesis to inform the development of tailored interventions that address the specific needs of rural cancer survivors who continue to be affected by the pandemic. The review was conducted following guidance from the Cochrane Rapid Review Methods Group. Database searches were performed via the EBSCOHost interface (includes MEDLINE, CINAHL, PsycINFO) on 25 May 2022 and supplemented with searches on Google Scholar. Peer-reviewed articles published after March 2020 that reported primary data on the experiences of cancer survivors residing in rural and remote settings during the pandemic were included. Findings were tabulated and written up narratively. Fourteen studies were included. The COVID-19 pandemic had a mostly detrimental impact on the experiences of rural cancer survivors. People's individual coping mechanisms were challenging for a range of reasons. Specifically, the pandemic impacted on their ability to access testing, treatment, check-ups and supportive care, their ability to maintain and access social support with close friends and family, as well as negative consequences to their finances and emotional wellbeing with some reporting feelings of psychological distress including depression and anxiety. This review provides important insight into the experiences of rural cancer survivors that may help inform tailored support in line with the needs and challenges faced because of the pandemic.

Exploring the perceptions and acceptability of an integrated lifestyle database for public health research and service commissioning: a qualitative study

AIM

Public health lifestyle databases at local authority level are currently poorly aligned across the UK. The integration of lifestyle databases at a regional level could provide a rich resource to support research and help inform public health leads and service commissioners in improving service delivery, facilitating decision-making and developing key public health policies. Prior to its implementation, the acceptability of an integrated lifestyle database should be explored. The aim of this study was to consult with public health stakeholders to explore the acceptability of developing and implementing a regional integrated lifestyle database across four key areas of public health: smoking cessation, diet, physical activity and alcohol consumption.

METHOD

Qualitative interviews were conducted with public health stakeholders recruited from across the East Midlands region of England. All interviews were conducted using video conferencing software and recorded, transcribed, and analysed using the Framework approach. Sixteen public health stakeholders were purposively identified and invited to participate in interviews.

RESULTS

Stakeholders viewed the integrated database as having potential to support research, service development and commissioning decisions. Barriers such as providers' reluctance to reveal their business strategies to rival organisations, cost of setting up and running the proposed database, complex information-sharing and governance were identified.

CONCLUSION

An integrated lifestyle database has the potential to support research and service commissioning regionally. However, several barriers were identified that must be addressed prior to the development and implementation of an integrated database.

A rural-urban comparison of self-management in people living with cancer following primary treatment: A mixed methods study

OBJECTIVE

To investigate and compare self-management in people living with cancer following treatment, from rural and urban areas in the United Kingdom where there is a significant evidence gap.

METHODS

A cross-sectional explanatory sequential mixed methods design. This involved a self-completion questionnaire that collected data on demographics, self-management using the PAM-13 and rural-urban residence and 34 in-depth interviews that aimed to explore and compare the barriers and facilitators to self-management in rural and urban settings.

RESULTS

227 participants completed the questionnaire: mean age 66.86 (±11.22). Fifty-two percent (n = 119) were female and 48% (n = 108) were male. Fifty-three percent (n = 120) resided in urban areas and 45 % (n = 103) in rural areas. Participants had a range of different types of cancer but the three most common were breast (n = 73), urological (n = 53), upper and lower gastrointestinal (n = 41). Rural respondents (63.31 ± 13.66) were significantly (p < 0.05) more activated than those in urban areas (59.59 ± 12.75). The barriers and facilitators to self-management identified in the interviews were prevalent in both rural and urban settings but some barriers were more explicit in rural settings. For example, there was a lack of bespoke support in rural areas and participants acknowledged how travelling long distances to urban centres for support groups was problematic. Equally, there were barriers and facilitators that were not necessarily unique to either geographic setting.

CONCLUSION

Whilst the active treatment phase can present considerable challenges for people living with cancer in rural areas the findings suggest that the rural environment has the potential to increase engagement with self-management in the transition to survivorship. The rigorous mixed methods design has led to different and complementary conclusions that would not have been possible had either quantitative or qualitative methods been used in isolation.

Rapid systematic review on developing web-based interventions to support people affected by cancer

OBJECTIVE

To systematically identify and explore the existing evidence to inform the development of web-based interventions to support people affected by cancer (PABC).

DESIGN

A rapid review design was employed in accordance with the guidance produced by the Cochrane Rapid Reviews Methods Group and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. A rapid review was chosen due to the need for a timely evidence synthesis to underpin the subsequent development of a digital resource (Shared Lives: Cancer) as part of an ongoing funded project.

METHODS AND OUTCOMES

Keyword searches were performed in MEDLINE to identify peer-reviewed literature that reported primary data on the development of web-based interventions designed to support PABC. The review included peer-reviewed studies published in English with no limits set on publication date or geography. Key outcomes included any primary data that reported on the design, usability, feasibility, acceptability, functionality and user experience of web-based resource development.

RESULTS

Ten studies were identified that met the pre-specified eligibility criteria. All studies employed an iterative, co-design approach underpinned by either quantitative, qualitative or mixed methods. The findings were grouped into the following overarching themes: (1) exploring current evidence, guidelines and theory, (2) identifying user needs and preferences and (3) evaluating the usability, feasibility and acceptability of resources. Resources should be informed by the experiences of a wide range of end-users taking into consideration current guidelines and theory early in the design process. Resource design and content should be developed around the user's needs and preferences and evaluated through usability, feasibility or acceptability testing using quantitative, qualitative or mixed methods.

CONCLUSION

The findings of this rapid review provide novel methodological insights into the approaches used to design web-based interventions to support PABC. Our findings have the potential to inform and guide researchers when considering the development of future digital health resources.

TRIAL REGISTRATION NUMBER

The review protocol was registered on the Open Science Framework (https://osf.io/ucvsz).

Ethnicity and risk for SARS-CoV-2 infection among the healthcare workforce: Results of a retrospective cohort study in rural United Kingdom

BACKGROUND

The reason why Black and South Asian healthcare workers are at a higher risk for SARS-CoV-2 infection remain unclear. We aimed to quantify the risk for SARS-CoV-2 infection among healthcare staff who belong to the ethnic minority and elucidate pathways of infection.

METHODS

A one-year follow-up retrospective cohort study has been conducted among National Health Service employees who were working at 123 facilities in Lincolnshire, UK.

RESULTS

Overall, 13,366 professionals were included. SARS-CoV-2 incidence per person-year was 5.2% (95% CI: 3.6-7.6%) during the first COVID-19 wave (January-August 2020) and 17.2% (13.5-22.0%) during the second wave (September 2020-February 2021). Compared with White staff, Black and South Asian employees were at higher risk for SARS-CoV-2 infection during both the first wave (hazard ratio, HR 1.58 [0.91-2.75] and 1.69 [1.07-2.66], respectively) and the second wave (HR 2.09 [1.57-2.76] and 1.46 [1.24-1.71]). Higher risk for SARS-CoV-2 infection persisted even after controlling for age, sex, pay grade, residence environment, type of work, and time exposure at work. Higher adjusted risk for SARS-CoV-2 infection were also found among lower-paid health professionals.

CONCLUSION

Black and South Asian health workers continue to be at higher risk for SARS-CoV-2 infection than their White counterparts. Urgent interventions are required to reduce SARS-CoV-2 infection in these ethnic groups.

Antimicrobial Resistance and Community Pharmacists’ Perspective in Thailand: A Mixed Methods Survey Using Appreciative Inquiry Theory

Global action plans to tackle antimicrobial resistance (AMR) are the subject of ongoing discussion between experts. Community pharmacists have a professional responsibility to tackle AMR. This study aimed to evaluate the knowledge of antibiotic resistance and attitudes to promoting Antibiotic Smart Use (ASU) amongst part and full-time practicing community pharmacists across Thailand. An online mixed-method survey applying Appreciative Inquiry theory was validated and conducted in 2020. Non-probability sampling was used, with online survey dissemination via social networks. A total of 387 community pharmacists located in 59 out 77 provinces seemed knowledgeable about antimicrobial resistance (mean score = 82.69%) and had acceptable attitudes towards antibiotic prescribing practices and antimicrobial stewardship (mean score = 73.12%). Less than 13% of pharmacists had postgraduate degrees. Postgraduate education, training clerkship, preceptors, and antibiotic stewardship training positively affected their attitudes. The community pharmacists proposed solutions based on the Appreciative Inquiry theory to promote ASU practices. Among these were educational programmes consisting of professional conduct, social responsibility and business administration knowledge, up-to-date legislation, and substitutional strategies to compensate business income losses.

Narratives on Sex and Contraception From Pregnant Adolescent Women in a Northern Province in Thailand: A Phenomenological Study

Gaps in understanding, a lack of awareness of contraceptive use and a lack of control, related to gender dynamics, may influence the demand for contraception among adolescents and their decision-making around pregnancy prevention. This study explored the experiences of pregnant adolescents at the time of pregnancy and prior to becoming pregnant, examining attitudes toward sex and contraception. An interpretive phenomenological study guided by Heideggerian philosophy, analysed data from 30 in-depth interviews conducted with purposively selected consenting pregnant adolescents aged 15–19. Interviews were audio-recorded and transcribed verbatim and were analysed using a modified interpretative phenomenological approach. Participants exposed 5 key findings or experiences associated with sex and contraception: ‘Premarital cohabitation and sex’, ‘Staying in the relationship’, ‘Unforeseen future’, ‘Parental conformity’, and ‘Male command’. These findings can have far-reaching implications for the holistic understanding of the needs of adolescents in Thailand. They can be used to inform the development of appropriate and responsive interventions to support female and male adolescents, their families, and society. This includes interventions around reproductive health rights and sex education from health care providers, educators providing counselling to facilitate adolescents’ decision-making in order to reduce unintended adolescent pregnancy.

The Effect of Rural Residence on Cancer-Related Self-Efficacy With UK Cancer Survivors Following Treatment

PURPOSE

To examine rural and urban differences in cancer-related self-efficacy with UK cancer survivors following treatment.

METHODS

A cross-sectional postal survey with posttreatment cancer survivors in the East Midlands of England. The survey collected data on demographics and cancer-related self-efficacy using the Cancer Survivors Self-Efficacy Scale. Rural-urban residence was determined using Office for National Statistics classifications. Linear Regression models were developed using a Directed Acyclic Graph that determined confounding variables. When the model deviated from normal the outcome variable was transformed using the Box-Cox transformation.

FINDINGS

Of those surveyed, 227 responded, of whom 58% were female and 45% lived in a rural area. A linear regression model showed a significant increase in cancer-related self-efficacy in cancer survivors living in rural areas compared to urban residents (0.76, 95% CI: 0.25-1.27), although the residual plot deviated from a normal distribution. A model of the effect of rural living on a Box-Cox transformed outcome variable confirmed an increased cancer-related self-efficacy score in rural regions (9.06, 95% CI: 2.97-15.14). Rural living remained significant (7.98, 95% CI: 1.78-14.19) after adjustment for the respondents' income. Similarly adjusting for deprivation led to a significant increase in cancer-related self-efficacy in rural regions (8.64, 95% CI: 2.48-14.79).

CONCLUSION

This study has important implications when considering the impact of location of residence on cancer-related self-efficacy in cancer survivorship. The role of deprivation had some impact for sample respondents in both the urban and rural environment and merits further analysis.

What is known about the role of rural-urban residency in relation to self-management in people affected by cancer who have completed primary treatment? A scoping review

Purpose

Despite wide acknowledgement of differences in levels of support and health outcomes between urban and rural areas, there is a lack of research that explicitly examines these differences in relation to self-management in people affected by cancer following treatment. This scoping review aimed to map the existing literature that examines self-management in people affected by cancer who were post-treatment from rural and urban areas.

Methods

Arksey and O’Malley’s framework for conducting a scoping review was utilised. Keyword searches were performed in the following: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science. Supplementary searching activities were also conducted.

Results

A total of 438 articles were initially retrieved and 249 duplicates removed leaving 192 articles that were screened by title, abstract and full text. Nine met the eligibility criteria and were included in the review. They were published from 2011 to 2018 and conducted in the USA (n = 6), Australia (n = 2) and Canada (n = 1). None of the studies offered insight into self-managing cancer within a rural-urban context in the UK. Studies used qualitative (n = 4), mixed methods (n = 4) and quantitative designs (n = 1).

Conclusion

If rural and urban populations define their health in different ways as some of the extant literature suggests, then efforts to support self-management in both populations will need to be better informed by robust evidence given the increasing focus on patient-centred care. It is important to consider if residency can be a predictor of as well as a barrier or facilitator to self-management.

Conscientious object in nursing: Regulations and practice in two European countries

BACKGROUND

The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery.

AIM

To present (a) the arguments for and against conscientious objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice.

DESIGN

Discussion paper.

ETHICAL CONSIDERATIONS

Ethical guidelines has been followed at each stage of this study.

FINDINGS

Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient's rights.

DISCUSSION AND CONCLUSION

Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice.

An Evaluation of Rural Health Care Research

This article reviews the state of the art of rural health research and evaluation with par ticular emphasis on the questions of access, health personnel, and financing. The current state of knowledge both in the published and in the unpublished literature in each area is summarized and a series of unresolved issues is proposed. A strategy for further research to include the various types of rural health care programs is described. Major findings suggest that, although rural populations do have somewhat less access to care than do urban populations, our ability to quantify precisely the extent and importance of this discrepancy is underdeveloped. Despite a substantial investment in a variety of rural health care programs there is inadequate information as to their effectiveness. Programs designed to increase the supply of health personnel to rural areas have met with mixed success. Sites staffed by National Health Service Corps personnel show consistently lower productivity than do sites under other sponsorship. Nonphysician personnel (physician assistants and nurse practitioners) offer apromising source of primary carefor rural areas; recent legislation that reimburses such care should increase their utilization. A persistent problem is the expectation (often a mandate) incorporated into many rural health care demonstration efforts that the programs become financially self-sufficient in a finite period of time. Self-sufficiency is a function of utilization, productivity, and the ability to recover charges for services. In many instances stringent enforcement of the self-suf ficiency requirement may mean those those who need the services most will be least likely to receive them.

Sexuality education in different contexts: limitations and possibilities

Purpose

– Sexuality education is a controversial and contested issue that has evoked wide debate on the question of its aims, contents, methods, pedagogy and desired outcomes. This editorial aims to provide a brief commentary, positioning the contributions to this Special Issue of Health Education within the research landscape concerning sexuality education in schools internationally.

Design/methodology/approach

– The idea for this Special Issue was born in Odense, Denmark, in October 2012, during the 4th European Conference of Health Promoting Schools. The Conference Programme and the debates during the sessions demonstrated the need for a wider discussion of sexuality education, particularly within the framework of the health-promoting school. There was recognition of the need to endorse positive and wide socio-ecological views of health, including sexual health and a critical educational approach to sexuality education. The conference delegates and the members of the Schools for Health in Europe Research Network were invited to submit a paper for the Special Issue, and the invitation was also sent through other networks and research communities globally. The invitation resulted in papers being submitted beyond Europe and the Special Issue took an interesting global turn. This networking process also resulted in the identification of a number of key international subject-specific experts who took on the role of independent reviewers.

Findings

– Following the review and editorial process six papers were accepted for the Special Issue. The papers highlight contrasts, tensions, potentials and barriers embedded in the ways sexuality education is delivered to children and young people internationally. Examples are drawn from Russia, Wales, China and the USA; they identify historical and structural issues related to the implementation of comprehensive progressive approaches. Topics discussed include the importance of appropriate content, theoretical/conceptual frameworks, modes of delivery, timing, attitudes from key stakeholders and the need for comprehensive evaluation of innovative approaches to the delivery of sexual education.

Originality/value

– The Special Issue provides a unique blend of evaluations of practical examples of pioneering programmes, research using qualitative, quantitative and mixed method designs, and critical conceptual discussions related to sexuality education and factors that influence it. The Special Issue addresses sexuality education from a life course perspective; some of the individual papers focus on young children and some on lifelong learning. All the papers point to the importance of understanding structural, socio-historical, political and cultural factors influencing sexuality education.

Clinical practice models in nursing education: implication for students' mobility

BACKGROUND

In accordance with the process of nursing globalization, issues related to the increasing national and international mobility of student and qualified nurses are currently being debated. Identifying international differences and comparing similarities for mutual understanding, development and better harmonization of clinical training of undergraduate nursing students is recommended.

AIMS

The aim of the study was to describe and compare the nature of the nursing clinical practice education models adopted in different countries.

METHODS

A qualitative approach involving an expert panel of nurses was adopted. The Nominal Group Technique was employed to develop the initial research instrument for data collection. Eleven members of the UDINE-C network, representing institutions engaged in the process of professional nursing education and research (universities, high schools and clinical institutes), participated. Three data collection rounds were implemented. An analysis of the findings was performed, assuring rigour.

RESULTS

Differences and homogeneity are reported and discussed regarding: (a) the clinical learning requirements across countries; (b) the prerequisites and clinical learning process patterns; and (c) the progress and final evaluation of the competencies achieved.

CONCLUSIONS

A wider discussion is needed regarding nursing student exchange and internalization of clinical education in placements across European and non-European countries. A clear strategy for nursing education accreditation and harmonization of patterns of organization of clinical training at placements, as well as strategies of student assessment during this training, are recommended. There is also a need to develop international ethical guidelines for undergraduate nursing students gaining international experience.

A rare cause of hypoactive delirium

A 90-year-old man was transferred to a geriatric evaluation and management (GEM) unit for management of hypoactive delirium following a pneumonia and acute myocardial infarction complicated by septic shock. He was found to have central hypothyroidism and hypoadrenalism leading to the diagnosis of hypopituitarism. Cerebral imaging confirmed this was secondary to a pituitary haemorrhage. This case illustrates the complexity of assessment of delirium and its aetiologies. Hypoactive forms of delirium in particular can be difficult to detect and therefore remain undiagnosed. While this patient's delirium was likely multifactorial, his hypopituitary state explained much of his hypoactivity. His drowsiness, bradycardia, hypotension and electrolyte imbalance provided clinical clues to the diagnosis.

Prise en charge du priapisme à Dakar

Objectif

Évaluer la prise en charge des patients présentant un priapisme.

Patients et méthodes

Il s’agit d’une étude rétrospective sur quatre ans, du 1er août 2002 au 31 juillet 2006, portant sur 35 patients. Les cadres d’étude ont été les trois grands services d’urologie du Sénégal qui sont tous à Dakar. Les paramètres suivants ont été étudiés: l’âge, le temps d’évolution du priapisme, les données anamnestiques, le type hémodynamique du priapisme, les résultats du bilan paraclinique, le traitement chirurgical (la technique chirurgicale, la technique d’anesthésie), la durée d’hospitalisation, le traitement associé, les complications per- et postopératoires, les résultats immédiats et à long terme.

Résultats

L’âge moyen des patients était de 21,2 ans. Le groupe d’âge le plus représenté était celui de 20 à 30 ans. La majorité des patients (43 %) avaient une notion de drépanocytose connue. La plupart des patients (65 %) ont été pris en charge avant 24 heures d’évolution. Chez tous nos patients, le priapisme était de bas débit. Dans 50 % des cas, les patients drépanocytaires avaient une forme SS. Dans près de la moitié des cas (62 %), la technique d’anesthésie choisie a été le bloc pénien. La ponction des corps caverneux a été le moyen thérapeutique le plus utilisé (63 %). Aucune complication postopératoire majeure n’a été déplorée dans la prise en charge des patients dans notre série. Chez presque tous les patients (95 %), la détumescence durable a été notée le jour même du début du traitement ou le lendemain. Conclusion: Le priapisme, bien que rare en Afrique, est caractérisé par la prédominance de la drépanocytose comme étiologie et le délai particulièrement long de la prise en charge.

A qualitative study exploring the emotional responses of female patients learning to perform clean intermittent self-catheterisation

AIM

This paper is a report of a study exploring the lived experiences and emotional responses of female patients learning to perform clean intermittent self-catheterisation (CISC).

BACKGROUND

There is general consensus that CISC should be considered in preference to in-dwelling catheterisation wherever feasible. Published literature has tended to focus on quality of life issues and technical and physical aspects. There has been less investigation into patients' initial perceptions of CISC and into their subsequent experiences of learning the technique.

DESIGN

This qualitative study used a phenomenological research design.

METHOD

A series of semi-structured, in-depth interviews were held with a purposive sample of adult female patients performing CISC aged 34-64 years. Interviews were tape recorded and transcribed verbatim. Data were analysed using the 'Framework' method.

RESULTS

This study identified six recurrent themes: grief and loss, lack of knowledge (regarding female anatomy, bladder dysfunction and catheters), negative associations and stigma, psychological aversion and embarrassment, nursing approaches and coping mechanisms.

CONCLUSION

Loss of normal bladder function may represent a devastating event and trigger emotional responses associated with grief and loss. Patients may experience a range of reactions whilst learning CISC, including embarrassment and aversion, which may not dissipate over time. However, psychological distress is not inevitable and varies enormously between individuals. The nursing approach is vital, as individualised, empathic care is recognised and valued.

RELEVANCE TO CLINICAL PRACTICE

This study adds to an emerging body of knowledge providing an enhanced understanding of the lived experiences of patients learning CISC. Nurses need to be alert to a range of potential emotional responses. This will facilitate the adoption of individualised teaching and learning strategies, designed to optimise the patient's assimilation of CISC into their lifestyle, promoting physical health, psychological wellbeing and independent living.

Longitudinal health surveillance in a cohort of Gulf War veterans 18 years after first exposure to depleted uranium

As part of a longitudinal surveillance program, 35 members of a larger dynamic cohort of 79 Gulf War I veterans exposed to depleted uranium (DU) during combat underwent clinical evaluation at the Baltimore Veterans Administration Medical Center. Health outcomes and biomonitoring results were obtained to assess effects of DU exposure and determine the need for additional medical intervention. Clinical evaluation included medical and exposure histories, physical examination, and laboratory studies including biomarkers of uranium (U) exposure. Urine collections were obtained for U analysis and to measure renal function parameters. Other laboratory measures included basic hematology and chemistry parameters, blood and plasma U concentrations, and markers of bone metabolism. Urine U (uU) excretion remained above normal in participants with embedded DU fragments, with urine U concentrations ranging from 0.006 to 1.88 μg U/g creatinine. Biomarkers of renal effects showed no apparent evidence of renal functional changes or cellular toxicity related to U body burden. No marked differences in markers of bone formation or bone resorption were observed; however, a statistically significant decrease in levels of serum intact parathyroid hormone and significant increases in urinary calcium and sodium excretion were seen in the high versus the low uU groups. Eighteen years after first exposure, members of this cohort with DU fragments continue to excrete elevated concentrations of uU. No significant evidence of clinically important changes was observed in kidney or bone, the two principal target organs of U. Continued surveillance is prudent, however, due to the ongoing mobilization of uranium from fragment depots.

[Urinary incontinence in woman: epidemiologic profile in Sub Saharian countries]

The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries.

MATERIAL AND METHODS

A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence.

RESULTS

Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases.

CONCLUSION

Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.