Negotiating pace, focus and identities: Patient/public involvement/engagement in a palliative care study.

Patient and public involvement and engagement (PPIE) is an increasingly important component of research conduct to enhance processes and potential for impact, yet is rarely critically interrogated. This paper draws on Foucauldian analysis to highlight the disciplinary powers and tensions arising in PPIE. The paper draws on a nested evaluation interview study with three PPIE members and eight academics, who had been involved in an implementation science study focused on palliative care. PPIE members were involved in the whole study and are co-authors of this article. Through shared values and commitments to the study, a team culture of equality was developed. Yet while power was dispersed and taken-up by all team members, in so doing a self-governance approach within the team was developed. The pace and focus of discussions was at times more subjugating than co-production. Identities and positions were porous; the simplistic division of 'academic' and 'PPIE' did not stand up to scrutiny, with an increasing blurring of boundaries as people's experiences and insights changed over time. Continual, subtle, negotiations of roles, inputs and identities were manifest throughout the project. PPIE in research involves subtle, complex and ongoing disciplinary practices enacted by all members of the team.

"More support, less distress?": Examining the role of social norms in alleviating practitioners' psychological distress in the context of assisted dying services.

This study explores how providing assisted dying services affects the psychological distress of practitioners. It investigates the influence of professional norms that endorse such services within their field. Study 1 included veterinarians (N = 137, 75.2% female, Mage = 43.1 years, SDage = 12.7 years), and Study 2 health practitioner students (N = 386, 71.0% female, Mage = 21.0 years, SDage = 14.4 years). In both studies, participants indicated their degree of psychological distress following exposure to scenarios depicting assisted dying services that were relevant to their respective situations. In Study 1, we found that higher willingness to perform animal euthanasia was associated with lower distress, as were supportive norms. In Study 2, a negative association between a greater willingness to perform euthanasia and lower psychological distress occurred only when the provision of such services was supported by professional norms. In conclusion, psychological distress is buffered by supportive professional norms.

Efficacy of systemic therapy on adults with depressive disorders: A meta-analysis.

OBJECTIVE: This meta-analysis evaluates the efficacy of systemic therapy approaches on adult clients with depressive disorders. METHODS: The illness-specific systematic review updates a previous meta-analysis on the efficacy of systemic therapy on psychiatric disorders in adulthood. It integrates the results of 30 randomized controlled trials (RCTs) comparing systemic psychotherapy for depression with an untreated control group or alternative treatments. Studies were identified through systematic searches in relevant electronic databases and cross-referencing. A random-effects model calculated weighted mean effect sizes for each type of comparison (alternative treatments, control group with no alternative treatment/waiting list) on two outcomes (depressive symptoms change, drop-out rates). RESULTS: On average, systemic interventions show larger improvements in depressive symptoms compared to no-treatment controls at post-test (g = 1.09) and follow-up (g = 1.23). Changes do not significantly differ when comparing systemic interventions with alternative treatments (post-test g = 0.25; follow-up g = 0.09). Results also vary, in part, by participant age, publication year, and active control condition. CONCLUSION: This meta-analysis indicates the potential benefits of systemic interventions for adult patients with depression. Future randomized clinical trials in this area should enhance study quality and include relational and other relevant outcome measures.

A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments.

BACKGROUND: Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES: 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS: Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA: To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS: We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS: We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS: We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.

Using Latent Profile Analysis to Understand Health Practitioners' Attitudes Toward Voluntary Assisted Dying.

Prior work has documented considerable diversity among health practitioners regarding their support for voluntary assisted dying (VAD). We examined whether their attitudes are characterised by different combinations of personal support, normative support by other health practitioners, and whether they are predisposed to vicariously experience others' emotions (i.e., empathy). We also examined whether these profiles experienced different mental health outcomes (i.e., burnout and posttraumatic stress) in relation to VAD. To test this, 104 Australian health practitioners were surveyed after VAD was legalised in Victoria, Australia in 2019. Results indicated that practitioners' attitudes were characterised by three profiles: 1) strong personal and normative support (strong VAD supporters), 2) moderate personal and normative support (moderate VAD supporters), and 3) lower personal and normative support (apprehensive practitioners). However, each profile reported similar mental health outcomes. Findings suggest that the normative environments in which health practitioners operate may explain their diverse attitudes on VAD.

Attitudes Toward and Experience With Assisted-Death Services and Psychological Implications for Health Practitioners: A Narrative Systematic Review.

A narrative systematic review was conducted to review studies that examine mental health implications of involvement in assisted-death services among health practitioners. Qualitative and quantitative studies were included to understand health practitioners' attitudes and experiences with assisted dying services, as well as to identify the mental health consequences. We identified 18 articles from 1591 articles drawn from seven major scientific databases (i.e., PubMed, MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, and Scopus). Two raters independently evaluated the exclusion and inclusion decisions of the articles and examined methodological flaws in the selected articles. We found that engagement in assisted death services were not reliably associated with mental health outcomes such as anxiety and moral distress. Both positive and negative outcomes were reported, and psychological outcomes for practitioners were shown to vary based on factors including social support for health practitioners' views; their perceived capacity to care for the patients; and legislation.

Context and mechanisms that enable implementation of specialist palliative care Needs Rounds in care homes: results from a qualitative interview study.

BACKGROUND: Improving quality of palliative and end of life care in older people's care homes is essential. Increasing numbers of people die in these settings, yet access to high quality palliative care is not routinely provided. While evidence for models of care are growing, there remains little insight regarding how to translate evidence-based models into practice. Palliative Care Needs Rounds (hereafter Needs Rounds) have a robust evidence base, for providing palliative care in care homes, reducing resident hospitalisations, improving residents' quality of death, and increasing staff confidence in caring for dying residents. This study aimed to identify and describe the context and mechanisms of change that facilitate implementation of Needs Rounds in care homes, and enable other services to reap the benefits of the Needs Rounds approach to care provision. METHODS: Qualitative interviews, embedded within a large randomised control trial, were conducted with a purposive sample of 21 staff from 11 care homes using Needs Rounds. The sample included managers, nurses, and care assistants. Staff participated in individual or dyadic semi-structured interviews. Implementation science frameworks and thematic analysis were used to interpret and analyse the data. RESULTS: Contextual factors affecting implementation included facility preparedness for change, leadership, staff knowledge and skills, and organisational policies. Mechanisms of change that facilitated implementation included staff as facilitators, identifying and triaging residents, strategizing knowledge exchange, and changing clinical approaches to care. Care home staff also identified planning and documentation, and shifts in communication. The outcomes reported by staff suggest reductions in hospitalisations and problematic symptoms for residents, improved staff skills and confidence in caring for residents in their last months, weeks and days of life. CONCLUSIONS: The significance of this paper is in offering care homes detailed insights into service contexts and mechanisms of change that will enable them to reap the benefits of Needs Rounds in their own services. The paper thus will support the implementation of an approach to care that has a robust evidence base, for a population under-served by specialist palliative care. TRIAL REGISTRATION: ACTRN12617000080325 .

How is Systemic and Constructionist Therapy Change Process Narrated in Retrospective Accounts of Therapy? A Systematic Meta-synthesis Review.

Despite the considerable potential of qualitative approaches for studying the systemic and constructionist therapy process due to shared theoretical and epistemological premises, to date there is lack of a comprehensive qualitative synthesis of how change process is experienced and conceptualized by clients and therapists. To address this evidence gap, we performed a systematic meta-synthesis review of 30 studies reporting clients' and therapists' retrospective narratives of change process across systemic and constructionist models and across a range of client configurations, including individuals, couples, families, and groups. The studies were identified following a systematic search in PsycINFO and MEDLINE resulting in 2,977 articles, which were screened against eligibility criteria. Thematic analysis led to the identification of four main themes: (1) navigating through differences, (2) toward nonpathologizing construction of problems, (3) navigating through power imbalances, and (4) toward new and trusting ways of relating. Findings illustrate the multifaceted aspects of systemic and constructionist change process, the importance for their reflexive appraisal, and the need for further research contributing to the understanding of the challenges inherent in the systemic and constructionist therapeutic context.

A pesar del potencial considerable de los enfoques cualitativos para estudiar el proceso de la terapia sistémica y construccionista debido a premisas teóricas y epistemológicas compartidas, hasta la fecha hay una escasez de síntesis cualitativas completas de cómo los pacientes y los terapeutas viven y conceptualizan el proceso de cambio. Para abordar esta falta de datos, realizamos una revisión sistemática de la metasíntesis de 30 estudios que informan historias retrospectivas de los pacientes y los terapeutas del proceso de cambio entre modelos sistémicos y construccionistas y entre una variedad de configuraciones de pacientes, entre ellas, individuos, parejas, familias y grupos. Los estudios se identificaron después de una búsqueda sistemática en PsycINFO y MEDLINE, de donde se obtuvieron 2,977 artículos, que se analizaron según los criterios de elegibilidad. El análisis temático condujo a la identificación de cuatro temas principales: 1) orientarse entre las diferencias, 2) hacia una construcción no patologizante de los problemas, 3) orientarse entre los desequilibrios de poder, 4) hacia formas nuevas y confiables de relacionarse. Los resultados ilustran los aspectos multifacéticos del proceso de cambio sistémico y construccionista, la importancia para su valoración reflexiva y la necesidad de más investigaciones que contribuyan a la comprensión de los desafíos inherentes en el contexto terapéutico sistémico y construccionista.

The Discursive Performance of Change Process in Systemic and Constructionist Therapies: A Systematic Meta-Synthesis Review of In-Session Therapy Discourse.

Despite the emphasis of systemic and constructionist approaches on discourse and interaction, to date there has been no comprehensive overview of how change process is performed within in-session therapeutic dialogue. In this paper, we present a qualitative meta-synthesis of 35 articles reporting systemic and constructionist therapy process data from naturally occurring therapeutic dialogue. The studies were selected following the screening against eligibility criteria of a total sample of 2,977 studies identified through a systematic search of PsycINFO and MEDLINE databases. Thematic analysis of the 35 studies' findings identified four main themes depicting change process performance: (a) shifting to a relational perspective, (b) shifting to non-pathologizing therapeutic dialogue, (c) moving-forward dialogue, and (d) the dialogic interplay of power. Findings highlight the interactional and discursive matrix within which systemic and constructionist change process occurs. Findings illuminate the value of qualitative research studies sampling naturally occurring therapeutic discourse in bringing this matrix forth, particularly when utilizing discursive methodologies like conversation or discourse analysis.

A pesar del énfasis de los enfoques sistémicos y construccionistas sobre el discurso y la interacción, hasta ahora no se ha hecho una descripción general completa de cómo se lleva a cabo el proceso de cambio dentro del diálogo terapéutico en la sesión. En este artículo presentamos una metasíntesis cualitativa de 35 artículos que informan datos del proceso de terapia sistémica y construccionista obtenidos del diálogo terapéutico que se produce naturalmente. Los estudios se eligieron siguiendo los criterios de evaluación por elegibilidad de una muestra total de 2977 estudios detectados mediante una búsqueda sistemática en las bases de datos PsycINFO y MEDLINE. El análisis temático de los resultados de los 35 estudios identificó cuatro temas principales que describen la representación del proceso de cambio; (a) el cambio a una perspectiva relacional, (b) el cambio a un diálogo terapéutico no patologizante, (c) el diálogo de avance, y (d) la interacción dialógica del poder. Los resultados destacan la matriz interactiva y discursiva dentro de la cual se produce el proceso de cambio sistémico y construccionista. Los resultados ilustran el valor de los estudios de investigación cualitativa que muestrean el discurso terapéutico producido naturalmente a la hora de presentar esta matriz, particularmente cuando se utilizan metodologías discursivas, como el análisis de la conversación o el discurso.

Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes.

BACKGROUND: Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. AIM: To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. DESIGN: Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. SETTING/PARTICIPANTS: 1700 residents in 12 Australian care homes for older people. RESULTS: Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: -0.44, -0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). CONCLUSION: The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.

The Healthcare Conflict Scale: development, validation and reliability testing of a tool for use across clinical settings.

Despite the widespread incidence of conflict and its detrimental impact across a range of health-care settings, there is no validated tool with which to measure it. This paper describes the international innovation of a tool to measure staff-family conflict in pediatrics, intensive care, emergency, palliative care, and nursing homes. Sixty-two health-care workers contributed to focus group discussions to refine a draft tool developed from the literature. Subsequently, 101 health-care workers applied the tool to fictionalized vignettes. The psychometric properties (construct validity, internal consistency, repeatability, and reliability) were explored using principal component analysis, Cronbach's alpha, and intra-class correlation (ICC) tests. The initial 17-item tool was reduced to seven items within three factors that explained 70.2% of the total variance in overarching construct. The internal consistency of the final overall scale was good (Cronbach's alpha: 0.750); test-retest reliability of each item was excellent with ICCs ≥0.9. This new tool can be used to identify and score conflict, making it a key reference point in healthcare conflict work across clinical specialties. It's development and testing across specialities and across countries means it can be used in a variety of contexts. The tool provides health-care professionals with a new way to identify and measure conflict, and consequently has the potential to transform health-care relationships across disciplines and settings.

Distance education methods are useful for delivering education to palliative caregivers: A single-arm trial of an education package (PalliativE Caregivers Education Package).

BACKGROUND: Face-to-face/group education for palliative caregivers is successful, but relies on caregivers travelling, being absent from the patient, and rigid timings. This presents inequities for those in rural locations. AIM: To design and test an innovative distance-learning educational package (PrECEPt: PalliativE Caregivers Education Package). DESIGN: Single-arm mixed-method feasibility proof-of-concept trial (ACTRN12616000601437). The primary outcome was carer self-efficacy, with secondary outcomes focused on caregiver preparedness and carer tasks/needs. Analysis focused on three outcome measures (taken at baseline and 6 weeks) and feasibility/acceptability qualitative data. SETTING AND PARTICIPANTS: A single specialist palliative care service. Eligible informal caregivers were those of patients registered with the outpatient or community service, where the patient had a prognosis of ⩾12 weeks, supporting someone with nutrition/hydration and/or pain management needs, proficient in English and no major mental health diagnosis. RESULTS: Two modules were developed and tested (nutrition/hydration and pain management) with 18 caregivers. The materials did not have a statistically significant impact on carer self-efficacy. However, statistically significant improvements were observed on the two subsidiary measures of (1) caregiving tasks, consequences and needs ( p = 0.03, confidence interval: 0.72, 9.4) and (2) caregiver preparedness ( p = 0.001, confidence interval: -1.22, -0.46). The study determined that distance learning is acceptable and feasible for both caregivers and healthcare professionals. CONCLUSION: Distance education improves caregiver preparedness and is a feasible and acceptable approach. A two-arm trial would determine whether the materials benefitted caregivers and patients compared to a control group not receiving the materials. Additional modules could be fruitfully developed and offered.

How and why are subcutaneous fluids administered in an advanced illness population: a systematic review.

AIMS AND OBJECTIVES: To identify the mechanisms of subcutaneous fluid administration in advanced illness. BACKGROUND: Hydration at end of life is a fundamental issue in quality care internationally. Decision-making regarding the provision of artificial hydration in advanced illness is complicated by a paucity of evidence-based guidance. Despite considerable attention given to the topic including two recent Cochrane reviews, there has been no focus in systematically identifying papers that report the mechanisms for delivering hydration subcutaneously. Consequently, there is a need to produce guidance on the site, mode, volume and rate of infusion, based on empirical evidence. DESIGN: Systematic review of papers reporting empirical research data. METHODS: Key databases (CENTRAL, Medline, EMBASE, Web of Science, CINAHL) were searched in September 2015, with no date limitations. Inclusion criteria focused on hypodermoclysis in adults within an advanced illness population. Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. RESULTS: Fourteen papers were included in the analysis; most (n = 8) were conducted in hospices with others (n = 6) in long-stay units with a population affected by chronic conditions associated with ageing. Studies were of moderate or high quality. The site and mode of infusion were not well described in these papers, and rates of infusion varied widely allowing for little clear consensus to guide clinical practice in the administration of subcutaneous fluids. CONCLUSIONS: Studies under-report the mechanisms by which artificial hydration is provided, creating a paucity of evidence-based guidance by which to practice. There is a need for evidence generated from nonmalignant populations to ensure applicability to the large number of people with other advanced illness. RELEVANCE TO CLINICAL PRACTICE: In the absence of sufficiently powered robust evidence, the mode of delivery of artificial hydration at end of life remains in the gloaming between evidence and unfounded habit.

Couple-Based Psychosexual Support Following Prostate Cancer Surgery: Results of a Feasibility Pilot Randomized Control Trial.

INTRODUCTION: Surgery for prostate cancer can result in distressing side effects such as sexual difficulties, which are associated with lower levels of dyadic functioning. The study developed and tested an intervention to address sexual, relational, and emotional aspects of the relationship after prostate cancer by incorporating elements of family systems theory and sex therapy. AIMS: To develop and test the feasibility and acceptability of relational psychosexual treatment for couples with prostate cancer, determine whether a relational-psychosexual intervention is feasible and acceptable for couples affected by prostate cancer, and determine the parameters for a full-scale trial. METHODS: Forty-three couples were recruited for this pilot randomized controlled trial and received a six-session manual-based psychosexual intervention or usual care. Outcomes were measured before, after, and 6 months after the intervention. Acceptability and feasibility were established from recruitment and retention rates and adherence to the manual. MAIN OUTCOME MEASURES: The primary outcome measurement was the sexual bother subdomain of the Expanded Prostate Cancer Index Composite. The Hospital Anxiety and Depression Scale and the 15-item Systemic Clinical Outcome and Routine Evaluation (SCORE-15) were used to measure emotional and relational functioning, respectively. RESULTS: The intervention was feasible and acceptable. The trial achieved adequate recruitment (38%) and retention (74%) rates. The intervention had a clinically and statistically significant effect on sexual bother immediately after the intervention. Small decreases in anxiety and depression were observed for the intervention couples, although these were not statistically significant. Practitioners reported high levels of adherence to the manual. CONCLUSION: The clinically significant impact on sexual bother and positive feedback on the study's feasibility and acceptability indicate that the intervention should be tested in a multicenter trial. The SCORE-15 lacked specificity for this intervention, and future trials would benefit from a couple-focused measurement.

School-based brief psycho-educational intervention to raise adolescent cancer awareness and address barriers to medical help-seeking about cancer: a cluster randomised controlled trial.

OBJECTIVES: Raising cancer awareness and addressing barriers to help-seeking may improve early diagnosis. The aim was to assess whether a psycho-educational intervention increased adolescents' cancer awareness and addressed help-seeking barriers. METHODS: This was a cluster randomised controlled trial involving 2173 adolescents in 20 schools. The intervention was a 50-min presentation delivered by a member of Teenage Cancer Trust's (UK charity) education team. Schools were stratified by deprivation and roll size and randomly allocated to intervention/control conditions within these strata. Outcome measures were the number of cancer warning signs and cancer risk factors recognised, help-seeking barriers endorsed and cancer communication. Communication self-efficacy and intervention fidelity were also assessed. RESULTS: Regression models showed significant differences in the number of cancer warning signs and risk factors recognised between intervention and control groups. In intervention schools, the greatest increases in recognition of cancer warning signs at 6-month follow-up were for unexplained weight loss (from 44.2% to 62.0%) and change in the appearance of a mole (from 46.3% to 70.7%), up by 17.8% and 24.4%, respectively. Greatest increases in recognition of cancer risk factors were for getting sunburnt more than once as a child (from 41.0% to 57.6%) and being overweight (from 42.7% to 55.5%), up by 16.6% and 12.8%, respectively. Regression models showed that adolescents in intervention schools were 2.7 times more likely to discuss cancer at 2-week follow-up compared with the control group. No differences in endorsement of barriers to help-seeking were observed. CONCLUSIONS: School-based brief psycho-educational interventions are easy to deliver, require little resource and improve cancer awareness. © 2015 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

A systematic review and narrative summary of family-based smoking cessation interventions to help adults quit smoking.

BACKGROUND: Smoking is the most significant preventable cause of morbidity and early mortality in the world. The family is an influential context in which smoking behaviour occurs. METHODS: A systematic review and narrative summary of family-based interventions to help adults quit smoking was conducted. RESULTS: Eight controlled trials were included. Risk of bias was high. The smoking-related outcome of the intervention was self-reported smoking status/abstinence, validated by objective measures (including saliva thiocynate or breath carbon monoxide). Follow-up ranged from 6 weeks to 5 years. The main target groups were: pregnant women (1), pregnant women who smoked (2), men at risk of cardiovascular disease (2), adult smokers (1), parents who smoked (1) and couples who both smoked (1). Interventions included family members but most did not go further by drawing on family, systemic or relational theories to harness the influence of family on smoking behaviour. Only three studies directly compared the effects on smoking behaviour of a family-based (i.e., interventions that involve a member of the family) versus an individual-based (i.e., interventions that use behaviour change techniques that focus on the individual) intervention. None of these studies found significant differences between groups on the smoking behaviour of the main target group. CONCLUSIONS: We have yet to develop family-based smoking cessation interventions that harness or re-direct the influence of family members on smoking behaviour in a positive way. Thus, it is likely that individualised-approaches to smoking cessation will prevail.

Service user involvement in research may lead to contrary rather than collaborative accounts: findings from a qualitative palliative care study.

AIM: The aim of this study was to explore what data emerge when former carergivers (co-researchers) are trained to interview current care-givers about their experiences. BACKGROUND: Despite a trend of involving service users in conducting research interviews, there have been few examinations of how and whether a common service user identity has an impact on the data generated. DESIGN: Four co-researchers were recruited, trained and supported to conduct qualitative interviews with 11 current carers of people receiving palliative services. Conversation analysis was used to examine the conversational characteristics of the research interviews. Data were collected in 2010-2011. RESULTS: Conversation analysis identified that interactional difficulties were evident across the data. When co-researchers talked about their own experiences as carers, interviewees frequently changed the topic of conversation, thereby closing-down opportunities for further disclosure or elaboration from the interviewee about the original topic. CONCLUSION: Conversation analysis identifies how caregiving identities are co-constructed and points where there is agreement and disagreement in the co-construction.

Developing the DESCARTE Model: The Design of Case Study Research in Health Care.

Case study is a long-established research tradition which predates the recent surge in mixed-methods research. Although a myriad of nuanced definitions of case study exist, seminal case study authors agree that the use of multiple data sources typify this research approach. The expansive case study literature demonstrates a lack of clarity and guidance in designing and reporting this approach to research. Informed by two reviews of the current health care literature, we posit that methodological description in case studies principally focuses on description of case study typology, which impedes the construction of methodologically clear and rigorous case studies. We draw from the case study and mixed-methods literature to develop the DESCARTE model as an innovative approach to the design, conduct, and reporting of case studies in health care. We examine how case study fits within the overall enterprise of qualitatively driven mixed-methods research, and the potential strengths of the model are considered.

Conceptualising psychological distress in families in palliative care: Findings from a systematic review.

BACKGROUND: Adult palliative care patients and their family members experience significant psychological distress and morbidity. Psychosocial interventions adopting a systemic approach may provide a cogent model to improve the psychosocial care of families in palliative care. To facilitate design of these interventions, the construct of psychological distress in families in palliative care should be empirically derived. AIM: To ascertain how psychological distress is conceptualised in families receiving palliative care. DESIGN: A systematic review of the literature; this was followed by a thematic analysis and narrative synthesis. DATA SOURCES: Using pre-defined search terms, four electronic databases (MEDLINE, CINAHL, PsycINFO and Behavioural Sciences collections) were searched with no date restrictions imposed. Pre-determined inclusion and exclusion criteria were then applied. RESULTS: A total of 32 papers were included in the review. Two findings emerged from data synthesis. First, distress is conceptualised as a multi-dimensional construct but little consensus exists as to how to capture and measure distress. Second, distress in the families within these studies can be conceptualised using a tiered approach, moving from individual non-interactive depictions of distress through gradations of interaction to convey a systemic account of distress within the family system. Thus, distress shifts from a unitary to a systemic construct. CONCLUSION: Currently, there is a paucity of research examining distress informed by family systems theories. This review proposes that distress in families in palliative care can be conceptualised and illustrated within a tiered model of distress. Further research is merited to advance current explanatory frameworks and theoretical models of distress.

Nurses respond to patients' psychosocial needs by dealing, ducking, diverting and deferring: an observational study of a hospice ward.

BACKGROUND: Psychosocial support is considered a central component of nursing care but it remains unclear as to exactly how this is implemented in practice. The aim of this study was to provide a descriptive exploration of how psychosocial needs (PNs) of patients in a hospice ward are expressed and met, in order to develop an understanding of the provision of psychosocial support in practice. METHODS: An embedded mixed-methods study was conducted in one hospice ward. Data collection included observations of patients' expressions of PNs and nurses' responses to those expressed PNs, shift hand-overs and multi-disciplinary meetings. Interviews about the observed care were conducted with the patients and nurses and nursing documentation pertaining to psychosocial care was collated. Descriptive statistical techniques were applied to quantitative data in order to explore and support the qualitative observational, interview and documentary data. RESULTS: During the 8-month period of observation, 227 encounters within 38 episodes of care were observed among 38 nurses and 47 patients. Within these encounters, 330 PNs were expressed. Nurses were observed immediately responding to expressed PNs in one of four ways: dealing (44.2 %), deferring (14.8 %), diverting (10.3 %) and ducking (30.7 %). However, it is rare that one type of PN was clearly expressed on its own: many were expressed at the same time and usually while the patient was interacting with the nurse for another reason, thus making the provision of psychosocial support challenging. The nurses' response patterns varied little according to type of need. CONCLUSIONS: The provision of psychosocial support is very complex and PNs are not always easily recognised. This study has allowed an exploration of the actual PNs of patients in a hospice setting, the way in which they were expressed, and how nurses responded to them. The nurses faced the challenge of responding to PNs whilst carrying out the other duties of their shift, and the fact that nurses can provide psychosocial support as an inherent component of practice was verified. The data included in this paper, and the discussions around the observed care, provides nurses everywhere with an example against which to compare their own practice.