Exploring health visiting professionals' evaluations of early parent-infant interactions.

Objective: To examine the accuracy of Health Visitors (HVs) evaluations of the quality of parent-infant interactions. Background: HVs have been identified as key professionals in the early identification of difficulties in parent-infant interactions. Method: A sample of 56 HVs, 4 Family Health Nurses (FHNs) and 14 Community Nursery Nurses (CNNs) recruited from two National Health Service (NHS) Trusts, viewed video footage of six early parent-infant interactions which had been categorised as 'sensitive', 'mixed', and 'problematic' using the CARE-Index. Participants evaluated the quality of the parent-infant interactions shown in these videos using the Parent-Infant Interaction Rating Questionnaire (PIIRQ). Results: On average, participants correctly rated the problematic videos as lowest in quality, the mixed as higher in quality than the problematic videos, and the sensitive videos as highest in quality. Interestingly, within the problematic category participants rated the 'unresponsive' pattern of interaction as significantly lower in quality than the 'controlling' interaction. Conclusions: Findings suggest participants were relatively accurate in their evaluations of parent-infant interactions. However, they indicate that participants were more likely to be concerned about unresponsive, as opposed to controlling, interactive behaviours. Recommendations for further research include exploration of potential differences in how health-visiting professionals evaluate particular patterns of parent-infant interactions.

"You don't know what's wrong with you": an exploration of cancer-related experiences in people with an intellectual disability.

OBJECTIVE: Few empirical studies have explored cancer-related experiences of people with an intellectual disability (ID), despite rising cancer incidence in this population. The present research aims to better understand the experiences of this population from multiple perspectives, generating theory and further research questions. METHODS: Six people with ID and cancer, alongside 12 participants from their supportive network (including family and social and health care professionals), were interviewed; transcripts were analyzed using grounded theory. RESULTS: People with ID were often overlooked within cancer consultations and excluded from conversations about their care and treatment-related decisions. Caregivers (family and paid) were relied upon to facilitate communication and understanding and supplement health care professional knowledge. Caregivers' attempts to protect the patient from distress harmed communication further; our interviewees suggest that increased involvement and empowerment mediated cancer-related distress. Where health care professionals possessed good patient-centered skills, and additional support was offered, people with ID were more likely to engage meaningfully in their cancer-related experience. CONCLUSIONS: Interestingly, emergent concepts were consistent with general psycho-oncology literature; however, incidence and severity of difficulty was substantially greater in this sample. This disparity warrants further exploration, with a need for intervention research to develop effective ways of supporting health care professionals in enhancing patient-centered skills with this population. In the clinical setting, patient involvement in health care decisions (despite problems associated with comorbidity) is imperative to optimize engagement.

Psychosocial experiences of chronic illness in individuals with an intellectual disability: A systematic review of the literature.

BACKGROUND: Increased life expectancy has led to an increase in diagnoses of chronic illness in people with an intellectual disability; despite this increase, research about the psychological impact is rare. This review explored the psychosocial experiences of chronic illness in adults with an intellectual disability, revealing potential predictors and moderators of these experiences. METHODS: Online databases were systematically searched to identify relevant literature, using predefined inclusion criteria. Of the 25,058 titles initially identified, 4 were included, that is, those collecting data on people with an intellectual disability and diagnosed with cancer (n = 2), chronic pain (n = 1) and diabetes (n = 1). RESULTS: Narrative synthesis of the data identified six themes, namely, (1) delayed diagnosis, (2) information, communication and understanding, (3) negative psychological consequences, (4) negative physical consequences, (5) social perception and (6) social support. CONCLUSIONS: There are unmet needs within this population, including a lack of assistance in understanding their illness. A substantial gap in the literature should be addressed through further empirical work.

The role of relationship attachment in psychological adjustment to cancer in patients and caregivers: a systematic review of the literature.

OBJECTIVE: The objective of this works is to report the results of a systematic review to evaluate the role of attachment in adjustment to cancer for patients and those close to them. METHODS: A systematic search of electronic databases was undertaken, identifying literature published up to June 2013. PsychINFO, Medline and the Cumulative Index to Nursing & Allied Health Literature were searched using search strings related to cancer, relationships, attachment and commonly assessed self-report psychosocial outcome measures. Extracted papers were assessed for their relevance. Key data were extracted to spreadsheets, and two raters coded the quality of the research. RESULTS: Following inclusion assessment, data were extracted from 15 quantitative studies. Scores from patients or caregivers on attachment questionnaires did not differ greatly from normative data. A more insecure attachment style has poorer outcomes for patients in terms of their psychological adjustment to cancer and their ability to perceive and access social support. A secure attachment style is associated with positive growth and better well-being. A more insecure attachment style in caregivers was associated with depression, higher caregiving stress, less autonomous motivations for caregiving and difficulties with caregiving. CONCLUSIONS: An awareness of attachment theory and the ways in which different forms of insecure attachment impact on patients and caregivers and their well-being may substantially improve the ability of those working with cancer patients and their families to better understand and provide for their support needs. The development and evaluation of support interventions tailored to different attachment styles remains a longer-term goal.

Experiences of young people in a 16-18 Mental Health Service.

BACKGROUND: 16-18-year-old young people experience a relatively high incidence of mental health problems but there is a paucity of research on their experience of mental health services (MHS). METHOD: To gain understanding of young people's experiences of 16-18 MHS, we used qualitative Interpretative Phenomenological Analysis. Ten young people in two 16-18 MHS were interviewed about experiences of using MHS. RESULTS: Five superordinate themes emerged from the data analysis, 'Power Differentials', 'Parental Involvement', 'Developmentally Attuned Services', 'Developing Self-Expression', 'Continuity and Loss of Relationships'. CONCLUSIONS: Respondents valued developmentally appropriate MHS and emphasised the value of continuity in therapeutic relationships.

Depression in chronic pain patients: prevalence and measurement.

This study aimed to: (1) determine prevalence of depression in patients referred to specialist pain services using the Structured Clinical Interview (SCID) diagnostic interview, (2) compare results on the Beck Depression Inventory II (BDI-II) with the SCID to determine the utility of the BDI-II as a screening tool in this population. Thirty-six participants were recruited, mainly women, with a mean age = 47.83 years (standard deviation = 12.85 years), who were heterogeneous with regard to their pain. All completed the BDI-II and SCID. The SCID diagnosed 26 (72%) cases of depression. BDI-II scores showed 31 (86%) that reported at least mild depression. Agreement between BDI-II scores over threshold for mild depression and SCID diagnosis were assessed by Cohen's kappa (= 0.6). ROC analysis for BDI-II scores against SCID diagnosis gave a large area under the curve (0.97, 95% confidence interval 0.93 to 1.02), suggesting BDI-II is an excellent screen for this population, although the curve was unusual in that sensitivity was high even when the false positive rate was zero. ROC analysis suggested 22 or above as an optimum cut-off score for depression on the BDI-II-higher than for a general population sample. It has been suggested that the BDI overestimates incidence of depression in pain patients, but this study confirmed through diagnostic interview the very high incidence of depression in this population. It is therefore questionable whether there is value in screening referrals for depression. When using BDI-II for screening, audit or evaluation purposes with a pain clinic population, we suggest a cut-off of 22 or above.

'Haematological cancers, they're a funny bunch': A qualitative study of non-Hodgkin's lymphoma patient experiences of unmet supportive care needs.

Despite high levels of psychological distress, there is a scarcity of research on unmet supportive care needs in haematological cancer patients. This qualitative study used an in-depth interpretative phenomenological approach to investigate the needs reported by six non-Hodgkin's lymphoma patients and explored how these needs consequently shaped the patient experience. Emergent themes included the following: concerns for family, information needs and the need for psychological support. Participants reported feeling different to other cancer patients. Lack of understanding of their diagnosis by friends and family and lack of access to relevant support services are notable unmet needs that differ from previous findings.

Factor Structure of the Beck Depression Inventory-II in patients With chronic pain.

OBJECTIVES: To examine the factor structure of the Beck Depression Inventory version II (BDI-II) in patients seeking treatment for chronic pain, using exploratory and confirmatory factor analysis and provide comparative data for use with similar patient populations. In addition, to consider the utility of using BDI-II subscale scores to further inform the management of patients with chronic pain. METHODS: Phase I involved analysis of responses to the BDI-II by 1227 patients assessed for a pain management program. The sample data was split into 2 halves. A series of exploratory factor analyses on the first half suggested 2 factors. Confirmatory factor analysis was then used on the second half to confirm goodness-of-fit for this 2-factor solution and compare with a 1-factor solution and factor models presented in the BDI-II handbook derived on student and psychiatric outpatient populations. Comparison was also made of derived factor scores between this pain clinic sample and the normative psychiatric outpatient and student samples. In the second phase, longitudinal data on a further 269 patients who had completed the pain management program was used to examine the amount of variance in pain and disability outcomes accounted for by total BDI-II and 2-factor subscale scores at assessment. RESULTS: Two correlated factors incorporating 18 items from the BDI-II gave good goodness-of-fit (0.916). Factor 1 loaded heavily onto negative cognitions about the self plus mood symptoms, factor 2 onto changes in behavior and activity plus low mood. Summed scores on factor 1 from pain clinic patients were very significantly lower than for psychiatric outpatients, indicating less negative cognitions about the self, and very significantly higher than for a student sample. Pain clinic patient scores on factor 2 were very significantly higher than those for both psychiatric outpatients and students, indicating more reporting of behavior change and affective symptoms. Subscale scores accounted for a small but significant amount of variance in both pain and disability at follow-up, with each scale predicting in opposite directions. Total BDI-II scores predicted similar amounts of variance in disability at follow-up, but were not significantly associated with pain at follow-up. DISCUSSION: Results are consistent with studies using previous versions of the BDI in suggesting that 2-factor scores may be more clinically useful in the assessment of patients referred with chronic pain.

Caring for cancer patients with an intellectual disability: Attitudes and care perceptions of UK oncology nurses.

PURPOSE: Caring for people with cancer or an intellectual disability (ID) is stressful: little is known about the combined impact of caring for cancer patients with an ID, though this is expected to be especially challenging. METHOD: Eighty-three nurses, working in oncology or a related field (i.e. palliative care) were recruited. Perceptions of caring for patients with and without an ID were measured, alongside potentially confounding information about participant demographic characteristics and perceived stress. RESULTS: Participants felt less comfortable communicating with patients with an ID about their illness (F(1,82) = 59.52, p < 0.001), more reliant on a caregiver for communication (F(1,82) = 26.29, p < 0.001), and less confident that the patient's needs would be identified (F(1,82) = 42.03, p < 0.001) and met (F(1,81) = 62.90, p < 0.001). Participants also believed that caring for this patient group would induce more stress, compared with patients without an ID (F(1,81) = 31.592, p < 0.001). Previous experience working with ID patient groups appears to mitigate some perceptions about providing care to this population. CONCLUSIONS: Caring for cancer patients with an ID may intensify this, already difficult, role. Through training and knowledge exchange, oncology nurse's confidence in communication, providing appropriate care, and positivity towards this patient group may be improved.

Psychological adjustment to gynaecological cancer: patients' illness representations, coping strategies and mood disturbance.

This study examined associations between illness representation dimensions specified by the self-regulation model, coping and mood in recently diagnosed gynaecological cancer patients. Participants were 61 patients recruited from a specialist outpatient gynaecology clinic. Patients completed a survey measuring their cognitive illness representations (IPQ-R), coping strategies (COPE) and mood (POMS-SF). Consistent with research into other illnesses, the study found theoretically congruent cross-sectional associations between illness representations and mood disturbance. Support was found for a possible path whereby higher denial and avoidant coping might mediate the relationships between cyclical timeline and illness coherence representations and more negative mood. There were no mediational relationships for other coping strategies. Mediation of the relationship between illness representations and mood by avoidant coping has important theoretical and practical implications. These are discussed, as are direct relationships between illness representations and mood.

The utility of the Beck Depression Inventory Fast Screen (BDI-FS) in a pain clinic population.

This study compared the BDI-FS to the BDI-II in a sample of patients with chronic pain. The objectives were to: look at agreement between measures, determine BDI-FS cut-off scores, develop a conversion formula, consider the usefulness of the suicide ideation item and compare ability to detect clinical change. Phase I: Archival data from 1227 patients assessed for a pain management programme was analysed. The BDI-FS displayed good internal consistency (alpha=.839). ROC curve analysis showed good agreement between the BDI-II and FS and suggested a BDI-FS cut-off of four corresponded to the 19 cut-off recommended in the BDI-II manual. We recommend a cut-off of five to correspond to a BDI-II cut-off of 22 for pain clinic patients recommended by previous research. Regression suggested BDI-II score=(2.77 x BDI-FS score)+9.14. Our data support the clinical usefulness of the suicide ideation item in this population. Phase II: Archival data from 584 patients collected at baseline, following a 16 day pain management programme and at 6 months follow-up, was analysed. Effect sizes indicated equivalent sensitivity to clinical change. The BDI-FS showed good psychometric properties, strong agreement with the BDI-II and equal ability to detect clinical change in a pain clinic population. The BDI-FS has the practical advantages of faster administration and reduced patient burden.

Health professionals' and service users' interpretation of screening test results: experimental study.

OBJECTIVE: To investigate the accuracy of interpretation of probabilistic screening information by different stakeholder groups and whether presentation as frequencies improves accuracy. DESIGN: Between participants experimental design; participants responded to screening information embedded in a scenario. SETTING: Regional maternity service and national conferences and training days. PARTICIPANTS: 43 pregnant women attending their first antenatal appointment in a regional maternity service; 40 companions accompanying the women to their appointments; 42 midwives; 41 obstetricians. Participation rates were 56%, 48%, 89%, and 71% respectively. MEASURES: Participants estimated the probability that a positive screening test result meant that a baby actually had Down's syndrome on the basis of all the relevant information, which was presented in a scenario. They were randomly assigned to scenarios that presented the information in percentage (n = 86) or frequency (n = 83) format. They also gave basic demographic information and rated their confidence in their estimate. RESULTS: Most responses (86%) were incorrect. Obstetricians gave significantly more correct answers (although still only 34% [corrected]) than either midwives (0%) or pregnant women (9%). Overall, the proportion of correct answers was higher for presentation as frequencies (24%) than for presentation as percentages (6%), but further analysis showed that this difference occurred only in responses from obstetricians. Many health professionals were confident in their incorrect responses. CONCLUSIONS: Most stakeholders in pregnancy screening draw incorrect inferences from probabilistic information, and health professionals need to be aware of the difficulties that both they and their patients have with such information. Moreover, they should be aware that different people make different mistakes and that ways of conveying information that help some people will not help others.