The impact of continuous lenalidomide maintenance treatment on people living with multiple myeloma-a single-centre, qualitative service evaluation study.

PURPOSE: Continuous lenalidomide maintenance treatment after autologous stem cell transplantation delivers improvement in progression free and overall survival among newly diagnosed multiple myeloma patients and has been the standard of care in the UK since March 2021. However, there is scant information about its impact on patients' day-to-day lives. This service evaluation aimed to qualitatively assess patients receiving lenalidomide treatment at a cancer centre in London, in order that the service might better align with needs and expectations of patients. METHODS: We conducted 20 semi-structured interviews among myeloma patients who were on continuous lenalidomide maintenance treatment at a specialist cancer centre in London. Members of the clinical team identified potentially eligible participants to take part, and convenience sampling was used to select 10 male and 10 female patients, median age of 58 (range, 45-71). The median treatment duration was 11 months (range, 1-60 months). Participants were qualitatively interviewed following the same semi-structured interview guide, which was designed to explore patient experience and insights of lenalidomide. Reflexive thematic analysis was used for data analysis. RESULTS: Four overarching themes were as follows: (i) lenalidomide: understanding its role and rationale; (ii) reframing the loss of a treatment-free period to a return to normal life; (iii) the reality of being on lenalidomide: balancing hopes with hurdles; (iv) gratitude and grievances: exploring mixed perceptions of care and communication. Results will be used to enhance clinical services by tailoring communication to better meet patients' preferences when making treatment decisions. CONCLUSION: This study highlights that most patients feel gratitude for being offered continuous lenalidomide and perceive it as alleviating some fears concerning relapse. It reveals variations in side effects in different age groups; younger patients reported no/negligible side effects, whilst several older patients with comorbidities described significant symptom burden, occasionally leading to treatment discontinuation which caused distress at the perceived loss of prolonged remission. Future research should prioritise understanding the unique needs of younger patients living with multiple myeloma.

Evaluating the role and effectiveness of co-produced community-based mental health interventions that aim to reduce suicide among adults: A systematic review.

BACKGROUND: Suicide is a major public health risk requiring targeted suicide prevention interventions. The principles of co-production are compatible with tailoring suicide prevention interventions to meet an individual's needs. AIMS: This review aimed to evaluate the role and effectiveness of co-produced community-based suicide prevention interventions among adults. METHODS: Four electronic databases (PsycInfo, CINAHL, MEDLINE and web of science) were systematically searched. A narrative synthesis was conducted. RESULTS: From 590 papers identified through searches, 14 fulfilled the inclusion criteria. Most included studies elicited the views and perspectives of stakeholders in a process of co-design/co-creation of community-based suicide prevention interventions. CONCLUSION: Stakeholder involvement in the creation of community-based suicide prevention interventions may improve engagement and give voice to those experiencing suicidal crisis. However, there is limited evaluation extending beyond the design of these interventions. Further research is needed to evaluate the long-term outcomes of co-produced community-based suicide prevention interventions. PATIENT AND PUBLIC INVOLVEMENT: This paper is a systematic review and did not directly involve patients and/or the public. However, the findings incorporate the views and perspectives of stakeholders as reported within the studies included in this review, and the findings may inform the future involvement of stakeholders in the design, development and delivery of community-based suicide prevention interventions for adults.

Exploring the impact of COVID-19 on the psychological well-being of oncology healthcare professionals.

AIMS: To explore how psychological well-being is maintained by healthcare professionals (HCPs) employed in a cancer setting during the COVID-19 pandemic. DESIGN: A qualitative design using diaries and interviews to collect data was used to gain insights into how HCPs managed their well-being during the pandemic. METHODS: Interpretative Phenomenological Analysis (IPA) was used to analyse diaries and interviews completed by 66 HCPs during the second pandemic lockdown period (December 2020-April 2021). A total of 102 HCPs were recruited, drawn from five groups: nursing staff, radiographers, medical staff, allied health professionals (AHPs) (non-radiographers) and support staff. RESULTS: The majority of participants adjusted to the challenges of the pandemic using positive coping strategies, although difficult days required the mobilization of additional resources. Emotion management was regulated through peer relationships, professional roles and the workplace, sustained through communities of practice involving knowledge exchange, shared goals and social interactions. Maintaining high-quality patient care was a source of job satisfaction, providing a route through which positive emotions could be channelled; however, it was juxtaposed with threats to well-being from busy workloads and variable organizational responsiveness. Work routines provided a platform for well-being, underpinned by the sharing of problems and solutions within peer networks. CONCLUSION: This study has highlighted the dynamic nature of well-being amongst HCPs during the pandemic. Well-being interventions should build on the preferred coping strategies of HCPs, focusing on the way individuals coalesce in groups to learn from and support one another. IMPACT: HCPs may experience different psychological responses when exposed to a pandemic situation. This study identifies the strategies used by HCPs to maintain positive psychological well-being within professional roles, whilst adjusting to emerging well-being threats. Key components of HCP's well-being are addressed, which are relevant to clinical practice and the broader healthcare workforce. PATIENT OR PUBLIC CONTRIBUTION: Research team members included public representatives who contributed to the development, methods, data collection and analysis of the study. They supported the development of the Research Assistant by providing mock interview skills training.

The effect of pain on reference memory for duration.

Previous research has consistently reported that pain related stimuli are perceived as lasting longer than non-pain related ones, suggesting that pain lengthens subjective time. However, to date, the investigation has been limited to the immediate effects of pain on time perception. The current study aims to investigate whether pain affects how a duration is recalled after a period of delay. In two experiments, participants were asked to complete four temporal generalisation tasks, where they were required first to remember the duration of a standard tone (learning phase) and then to compare the standard duration to a series of comparison durations (testing phase). Using a 2 × 2 design, the four tasks differed in terms of whether participants were exposed to a painful or non-painful stimulus during the learning phase, and whether the testing phase started immediately or 15 min after the learning phase. Participants were exposed to low pain in Experiment 1 and high pain in Experiment 2. Two possible results were expected: pain could decrease temporal accuracy, because pain disrupts cognitive processes required for accurate timing, or pain could increase temporal accuracy, because pain facilitates memory consolidation. Contrary to expectations, results from both Experiments indicated that participants' temporal performances were similar in the pain and no-pain conditions when testing occurred 15 min after the learning phase. Findings, therefore, suggest that pain neither disrupts nor enhances long-term memory representations of duration.

Evaluating Postvention Services and the Acceptability of Models of Postvention: A Systematic Review.

BACKGROUND: Suicide is a major public health issue that increases the risk of suicide for those bereaved by suicide themselves. There is a lack of evaluation of the effectiveness and acceptability of suicide postvention services supporting those bereaved by suicide. AIMS: This review aimed to assess evaluations of postvention services supporting those bereaved by suicide and the acceptability of methods of postvention. METHODS: Searches of peer-reviewed literature identified 36 studies for inclusion. 22 studies evaluated specific postvention services, 14 evaluated models of postvention. RESULTS: Using the Mixed Methods Appraisal Tool, mixed-methods and qualitative postvention evaluation and acceptability research produce high-quality studies. Studies rated as low quality reflect poor reporting, rather than ineffective services. CONCLUSION: Further evaluation of community-based postvention services within the UK is needed. This would evidence that services in the UK are effective in supporting those bereaved by suicide. Evaluation would benefit services in accessing funding, improve service development and provide holistic support.

Construction of meanings during life-limiting illnesses and its impacts on palliative care: Ethnographic study in an African context.

OBJECTIVE: Knowledge about how people make meaning in cancer, palliative, and end-of-life care is particularly lacking in Africa, yet it can provide insights into strategies for improving palliative care (PC). This study explored ways in which cancer patients, their families, and health care professionals (HCPs) construct meaning of their life-limiting illnesses and how this impact on provision and use of PC in a Nigerian hospital. METHODS: This ethnographic study utilised participant observation, informal conversations during observation, and interviews to gather data from 39 participants, comprising service users and HCPs in a Nigerian hospital. Data were analysed using Spradley's framework for ethnographic data analysis. RESULTS: Meaning-making in life-limiting illness was predominantly rooted in belief systems. Most patients and their families, including some HCPs, perceived that cancer was caused by the devil, mystical, or supernatural beings. They professed that these agents manifested in the form of either spiritual attacks or that wicked people in society used either poison or acted as witches/wizards to inflict cancer on someone. These beliefs contributed to either nonacceptance of, or late presentation for, PC by most of patients and their families, while some professionals depended on supernatural powers for divine intervention and tacitly supporting religious practices to achieve healing/cure. CONCLUSIONS: Findings revealed that cultural and religious world views about life-limiting illnesses were used in decision-making process for PC. This, therefore, provided evidence that could improve the clinicians' cultural competence when providing PC to individuals of African descent, especially Nigerians, both in Nigerian societies and in foreign countries.

Understanding the Organization of Hospital-Based Palliative Care in a Nigerian Hospital: An Ethnographic Study.

CONTEXT: Organization and delivery of palliative care (PC) services vary from one country to another. In Nigeria, PC has continued to develop, yet the organization and scope of PC is not widely known by most clinicians and the public. OBJECTIVES: The aim of the study is to identify PC services available in a Nigerian Hospital and how they are organized. METHODS: This ethnographic study, utilized documentary analysis, participant observation, and ethnographic interviews (causal chat during observation and individual interviews) to gather data from members of PC team comprising doctors (n = 10), nurses (n = 4), medical social workers (n = 2), a physiotherapist, and a pharmacist, as well nurses from the oncology department (n = 3). Data were analyzed using Spradley's framework for ethnographic data analysis. RESULTS: PC was found to be largely adult patient-centered. A hospital-based care delivery model, in the forms of family meetings, in- and out-patients' consultation services, and a home-based delivery model which is primarily home visits conducted once in a week, were the two models of care available in the studied hospital. The members of the PC team operated two shift patterns from 7:00 am to 2.00 pm and a late shift from 2:00 pm to 7:00 pm instead of 24 h service provision. CONCLUSIONS: Although PC in this hospital has made significant developmental progress, the organization and scope of services are suggestive of the need for more development, especially in manpower and collaborative care. This study provided knowledge that could be used to improve the clinical practice of PC in various cross-cultural Nigerian societies and other African context, as well as revealing areas for PC development.

Being in safe hands: Patients' perceptions of how cancer services may support psychological well-being.

AIMS: To explore how cancer services may positively promote and support patients' well-being throughout treatment. Specifically to identify components of care that are important to patients and meet their needs. BACKGROUND: Patients commonly experience stress and uncertainty during their cancer journey which can have a negative impact on their psychological health and quality of life. Comparatively, little is known about how patients may experience positive well-being during their treatment experience. DESIGN: Qualitative study using semi-structured interviews. METHODS: Interviews were conducted between 2014 - 2015 with a purposive sample of 30 individuals who were at the beginning, middle or end of treatment for lung, colorectal and head and neck cancer. The majority were outpatients and receiving radiotherapy, chemotherapy or a combination of these. The recordings were analysed using thematic analysis. RESULTS: Patients may obtain a range of positive health benefits derived from contact with staff, patients and public. Positive emotional gains were based on "being in safe hands" and part of the collective effort to eradicate cancer. This appeared to assist patients achieve favourable treatment responses, however, a range of factors encouraged and hindered them to express concerns. CONCLUSION: Interactions with staff, patients and the hospital environment supported well-being in those receiving cancer treatment. Findings demonstrate additional areas for research including the development of interventions to facilitate peer support and the implementation of communication strategies that promote well-being.

The sharing of ballistics data across Europe and neighbouring territories.

The current study explored the use of ballistic examinations and cross-border information sharing across 14 European countries. The presented data were collected using a mixed methods technique consisting of semi-structured interviews and questionnaires that were completed by participants. The results painted a very heterogeneous picture of the use of automated ballistic systems across these countries, as well as how ballistic analyses are integrated in the fight against gun-enabled crime. Three super-ordinates themes emerged from the thematic analysis: use of automated ballistic systems; Ballistic evidence recovery and analysis; knowledge exchange and best practices. The ability to draw firm conclusions regarding the value of ballistics comparison systems, either on a national or cross-border basis, is hampered by inconsistencies regarding data recording practices and definitions. Therefore, key recommendations are suggested to establish better cross border cooperation between member states and develop a better understanding of data sharing procedures.

Repetitive transcranial magnetic stimulation over primary motor vs non-motor cortical targets; effects on experimental hyperalgesia in healthy subjects.

BACKGROUND: High frequency repetitive transcranial magnetic stimulation (rTMS) targetted to different cortical regions (primary motor/sensory, prefrontal) are known to alter somatosensory responses. The mechanism(s) for these effects are unclear. We compared the analgesic effects of rTMS at different cortical sites on hyperalgesia induced using topical capsaicin cream. METHODS: Fourteen healthy subjects had capsaicin cream applied to a 16 cm2 area of the medial aspect of the right wrist (60 min) on 4 separate occasions over 6 weeks. rTMS (10Hz for 10s/min = 2000 stimuli @ 90% resting motor threshold of first dorsal interosseus muscle) was applied to the optimum site for right hand (M1), left dorsolateral prefrontal (DLFPC) and occipital midline (OCC) in a pseudo-randomised order. Thermal and mechanical perception and pain thresholds were determined using standardised quantitative sensory testing (QST) methods at the capsaicin site. Subjective responses to thermal stimuli (pain score on a numerical rating scale) from -2.5°C to +2.5°C of the individualised heat pain threshold (HPT) resulted in a hyperalgesia curve. Sensory testing took place prior to capsaicin application (PRE-CAP), after 30 min of capsaicin (POST-CAP) and following rTMS (30 min = POST-TMS). RESULTS: Capsaicin application resulted in substantial changes in thermal (but not mechanical) sensitivity to both heat and cold (eg. HPT PRE-CAP = 43.6°C to POST-CAP = 36.7°C (p < 0.001)) with no differences between groups pre-rTMS. POST-TMS HPT showed no changes for any of the treatment groups, however the pain scores for the hyperalgesia curve were significantly lower for M1 vs OCC (-24.7%, p < 0.001) and for M1 vs DLFPC (-18.3%, p < 0.02). CONCLUSION: rTMS over the primary motor cortex results in a significant analgesic effect compared to other cortical areas.

Distortions to the passage of time during chronic pain: A mixed method study.

BACKGROUND: A core aspect of the clinical assessment of pain is establishing how long pain has been present for. The reported length of pain can therefore influence diagnosis and treatment. Despite this, little is known about how chronic pain affects the passage of time. METHODS: A mixed-methods cross-sectional study examined experiences of the passage of time in people identifying as living with chronic pain (n = 398). RESULTS: Experiencing chronic pain slows the passage of time for most people. Greater pain intensity, rumination about pain, helplessness and identifying as disabled were associated with a greater slowing of the passage of time. Thematic analysis of responses to open-ended questions suggested that a slowing of time during pain was associated with (1) pain intrusion preventing activities which would otherwise enable time to pass quickly, (2) increased attention to time and (3) as sense that in retrospect, time throughout life was 'lost' to chronic pain. CONCLUSION: Chronic pain causes widespread distortion to the passage of time. The slowing of time during pain means that periods of pain feel subjectively longer than periods without, exacerbating patient distress. SIGNIFICANCE: This study examined how chronic pain impacts on the experience of time. Chronic pain substantially slowed the passage of time for most people, subjectively lengthening the period of time that pain lasted for, exacerbating distress. Given the importance of time processing in clinical assessments of pain, medication adherence and therapeutic interventions, these findings underscore the importance of raising awareness about altered temporal processing in patients and clinicians.

Factors influencing midwives' conversations about smoking and referral to specialist support: a qualitative study informed by the Theoretical Domains Framework.

AIMS: The aim of this study was to identify factors influencing midwives' conversations about smoking, and referral to specialist smoking cessation services, using an evidence-based theoretical framework. METHODS: Semi-structured, qualitative interviews were undertaken with community midwives employed within one health board region of Wales. Deductive framework analysis was employed by coding data to the domains of the Theoretical Domains Framework (TDF) and then identifying themes within domains and across participants. RESULTS: Seven midwives took part in the study. 13, out of a possible 14 domains, were mapped from the TDF. Key enablers to conversations and referrals include knowledge of the risks of smoking in pregnancy, congruence with the professional identity of a midwife, and the use of carbon monoxide monitors in initiating conversations and referrals. Limited knowledge of the specialist service, confusion about the opt-out pathway, varied skills in communicating and engaging with women, low confidence in ability to influence women's decisions, limited appointment times, and competing priorities were identified as barriers. CONCLUSION: Midwives recognise the importance of their role within the provision of smoking cessation advice and referral to specialist services. While there are continued time pressures and competing priorities for midwives, enhancing skills and confidence in collaborative, empowering approaches to addressing smoking would further support in optimising the uptake of maternity smoking cessation support. This could also enhance conversations about other public health issues such diet, physical activity, and alcohol use.

Identifying the key components of social support for patients living with type 2 diabetes: A protocol for a systematic review and meta-analysis of type 2 diabetes social support interventions.

Type 2 diabetes (T2D) is a disease that impacts a huge portion of the world's population. The number of T2D cases is expected to keep rising during the next decade. Committing to the treatment to manage this condition makes participants feel a burden of emotions making them require emotional support from caregivers or close ones. Support from family or caregivers can help improve glycaemia control, medication adherence, and T2D self-management. However, little is known about what aspects of social support effectively improve patients' T2D self-management outcomes. The aim of this systematic review and meta-analysis is to identify the effective components of social support that can help participants improve their T2D self-management. Methods: The protocol of this review was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The PRISMA recommendations were applied to develop a search strategy in collaboration with a team of academics to identify relevant T2D social support interventions via healthcare and psychology databases, Medline, Web of Science, ProQuest, CINHAL. Discussion: This review will provide an overview of what intervention social support components have a significant impact on T2D glycaemia control. These findings will inform future T2D interventions on what social support components could be used to encourage better diabetes self-management and glycemic control.

Psychological risk factors predictive of suicidal distress in men receiving a community-based brief psychological intervention.

INTRODUCTION: Adaptable community-based approaches for assessment and delivery of suicide prevention interventions for men experiencing suicidal crisis are needed. The lay your cards on the table (LYCT) component of the James' Place Model is a novel therapeutic approach comprised of four sets of card variables that correspond with suicidal risk factors. This study investigated the LYCT in predicting suicidal distress among men. METHODS: Cross-sectional data of 511 men aged 18-69 years (M = 34.59 years; SD = 12.30) collected between 1st August 2018 and 29th July 2021 were assessed to predict suicidal distress measured using the CORE Clinical Outcome Measures (CORE-OM). RESULTS: From four categories comprising the LYCT, correlational analyses demonstrated that 20 associations emerged as statistically significant (r's = 0.12-0.19). When these were included in regression analyses, effect sizes explained 2%-5% variance in CORE-OM outcomes (R2). CONCLUSION: Use of LYCT is supported for engaging men in the assessment of suicide risk factors and to inform tailoring of intervention delivery to suit the individual needs of men experiencing suicidal crisis.

Health professionals interface with cultural conflict in the delivery of type 2 diabetes care.

OBJECTIVE: This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN: Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES: Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS: A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS: The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.

A mixed-methods evaluation of the acceptability and fidelity of the James' Place model for men experiencing suicidal crisis.

Background: Research supports development of informal, community-based suicide prevention interventions that can be tailored to suit men's unmet needs. The James' Place model (JPM) is a community-based, clinical suicide prevention intervention for men experiencing suicidal crisis. Evidence supports the efficacy of the JPM and there are plans to expand to additional sites across the UK. This study evaluates therapists perceived acceptability of the JPM, and if fidelity to the planned delivery of the model is maintained within therapeutic practice. Method: A mixed-methods design was used. Descriptive analyses of 30 completed intervention cases were examined to review fidelity of the model against the intervention delivery plan. Eight therapists took part in semi-structured interviews between November 2021 and March 2022 exploring the perceived acceptability, and barriers and facilitators to delivering the JPM. Results: Descriptive analyses of James' Place audit notes revealed high levels of adherence to the JPM amongst therapists, but highlighted components of the model needed to be tailored according to individual men's needs. Thematic analysis led to the development of five themes. The first theme, therapeutic environment highlighted importance of the therapy setting. The second theme identified was specialised suicide prevention training in the JPM that facilitated therapists understanding and expertise. The third theme identified was therapy engagement which discusses men's engagement in therapy. The fourth theme, person-centred care related to adaptation of delivery of JPM components. The final theme, adapting the JPM to individual needs describes tailoring of the JPM by therapists to be responsive to individual men's needs. Conclusion: The findings evidence therapist's acceptability and their moderate adherence to the JPM. Flexibility in delivery of the JPM enables adaptation of the model and co-production of therapy to meet men's needs. Implications for clinical practice are discussed.

Opioid prescribing and social deprivation: A retrospective analysis of prescribing for CNCP in Liverpool CCG.

BACKGROUND: Treating Chronic Non-Cancer Pain (CNCP) with long-term, high dose and more potent opioids puts patients at increased risk of harm, whilst providing limited pain relief. Socially deprived areas mapped from Index of Multiple Deprivation (IMD) scores show higher rates of high dose, strong opioid prescribing compared to more affluent areas. OBJECTIVE: To explore if opioid prescribing is higher in more deprived areas of Liverpool (UK) and assess the incidence of high dose prescribing to improve clinical pathways for opioid weaning. DESIGN AND SETTING: This retrospective observational study used primary care practice and patient level opioid prescribing data for N = 30,474 CNCP patients across Liverpool Clinical Commissioning Group (LCCG) between August 2016 and August 2018. METHOD: A Defined Daily Dose (DDD) was calculated for each patient prescribed opioids. DDD was converted into a Morphine Equivalent Dose (MED) and patients stratified according to high (≥120mg) MED cut off. The association between prescribing and deprivation was analysed by linking GP practice codes and IMD scores across LCCG. RESULTS: 3.5% of patients were prescribed an average dose above 120mg MED/day. Patients prescribed long-term, high dose, strong opioids were more likely to be female, aged 60+, prescribed three opioids and reside in the North of Liverpool where there is a higher density of areas in the IMD most deprived deciles. CONCLUSION: A small but significant proportion of CNCP patients across Liverpool are currently prescribed opioids above the recommended dose threshold of 120mg MED. Identification of fentanyl as a contributor to high dose prescribing resulted in changes to prescribing practice, and reports from NHS pain clinics that fewer patients require tapering from fentanyl. In conclusion, higher rates of high dose opioid prescribing continue to be evident in more socially deprived areas further increasing health inequalities.

Feasibility study of a Behavioural Intervention for Opioid Reduction (BIOR) for patients with chronic non-cancer pain in primary care: a protocol.

INTRODUCTION: Around 30%-50% of adults suffer moderate to severe chronic pain not caused by cancer. Significant numbers are treated with opioids which over time may cease to be effective and produce side effects (eg, nausea, drowsiness and constipation). Stopping taking opioids abruptly can cause unpleasant withdrawal effects. Tapering in small steps is recommended, though some patients might struggle and need support, particularly if they have limited access to pain management alternatives. Awareness of the potential risks as well as benefits of tapering should be explored with patients. METHODS AND ANALYSIS: A randomised controlled pilot feasibility study to investigate the effectiveness and feasibility of reducing high doses of opioids through a tapering protocol, education and support in primary care. Working with NHS Knowsley Place, we will identify patients taking 50 mg or above morphine equivalent dose of opioids per day to be randomly allocated to either the tapering group or tapering with support group. At an initial joint appointment with a pain consultant and General Practitioner (GP) GP tapering will be discussed and negotiated. Both groups will have their opioid reduced by 10% per week. The taper with support group will have access to additional support, including motivational counselling, realistic goal setting and a toolkit of resources to promote self-management. Some patients will successfully reduce their dose each week. For others, this may be more difficult, and the tapering reduction will be adjusted to 10% per fortnight. We assess opioid use, pain and quality of life in both groups at the start and end of the study to determine which intervention works best to support people with chronic pain who wish to stop taking opioids. ETHICS AND DISSEMINATION: The Behavioural Intervention for Opioid Reduction feasibility study has been granted full approval by Liverpool Central Research Ethics Committee on 7 April 2022 (22/NW/0047). The current protocol version is V.1.1, date 6 July 2022. Results will be published in peer-reviewed journals and disseminated to patient stakeholders in a lay summary report available on the project website and in participating GP surgeries. TRIAL REGISTRATION NUMBER: ISRCTN 30201337.

Neuropathic pain intensity, unpleasantness, coping strategies, and psychosocial factors after spinal cord injury: an exploratory longitudinal study during the first year.

OBJECTIVE: To determine the temporal relationship between pain-related coping strategies and psychosocial factors with non-evoked neuropathic pain (NP) intensity and unpleasantness in patients during the subacute phase of spinal cord injury (SCI). DESIGN: Exploratory longitudinal study of NP from 2 to 12 months. SETTING: Hospital Nacional de Parapléjicos, Toledo, Spain. SUBJECTS: A maximum of 26 patients with early symptoms of NP after SCI with a neurological level above the Th10 spinal level. OUTCOME MEASURES: Multidimensional Pain Inventory-Spinal Cord Injury Version, Coping Strategies Questionnaire, General 7-day pain intensity and unpleasantness rated with a visual analog scale, Spearman correlation analysis. RESULTS: PAIN-related coping strategies and psychosocial factors remained stable from 2 to 12 months after SCI. Initially pain intensity and unpleasantness were rated independently, but at 6 months were intercorrelated along with "pain severity,""life interference," and "catastrophizing.""Coping self-statements" and "solicitous responses from others" were frequently adopted, compared with "ignoring pain sensations" and "catastrophising." Perception of "pain severity" correlated with "support,""solicitous responses from others,""distracting responses from others," and "life control" at 6 months, while pain intensity and unpleasantness were related to "coping self-statements,""catastrophizing,""distancing from pain," and "praying." CONCLUSIONS: Pilot longitudinal data suggest that pain-related coping strategies are adopted early after subacute SCI, and correlate with both pain intensity and unpleasantness. Future longitudinal studies of SCI with sufficient sample size will be instrumental to determine the causal relationship between psychosocial factors and coping strategies on pain.

Experiences prior to diagnosis of non-Hodgkin lymphoma: a phenomenological study.

AIM: This paper is a report of a study identifying and describing the essences of patients' experience during the period leading up to the diagnosis of non-Hodgkin lymphoma. BACKGROUND: Patient and doctor delays occur during diagnosis of non-Hodgkin lymphoma, and families can affect patients' help-seeking behaviours. Current guidelines state the need for immediate referral of patients with suspected non-Hodgkin lymphoma symptoms. METHODS: A phenomenological approach was used. A purposive sample of 31 patients diagnosed with non-Hodgkin lymphoma was recruited through a hospital and a support group in the United Kingdom. In-depth interviews were tape-recorded, transcribed and then analysed using Colaizzi's method. Data collection took place over an 18-month period during 2003-2005 and data analysis was completed in 2006. FINDINGS: The overriding theme was: Creating a pathway towards hearing the diagnosis of non-Hodgkin lymphoma. The three themes were as follows: Perceiving individual health and onward movement; Penetrating communication processes and investigations; Advancing towards focusing on the non-Hodgkin lymphoma diagnosis. Patients with non-Hodgkin lymphoma can have a diverse symptom presentation over long periods of time. Their help-seeking behaviours are an interplay of essences, including symptom type, attributions and emotional responses. Patients need tailored information to deal with the uncertainty of their situation at key points during their prediagnosis journey. CONCLUSION: Nurses should help patients identify and acquire the appropriate information at key points during the diagnosis period as this is a period of great uncertainty. Further research should be conducted into the quality of prediagnosis consultations and the extent to which patients think that their agendums have been met at this time.