Experiences of cohabiting partners of women diagnosed with cancer during pregnancy: a qualitative study.

PURPOSE: When a pregnant woman is diagnosed with cancer, she faces complex and unique challenges while navigating both obstetric and oncological care. Despite often being the primary support for women diagnosed with cancer during pregnancy (CDP), little is known about the experiences of their partners. We undertook an in-depth exploration of the experiences of partners of women diagnosed with CDP in Australia. METHODS: Semi-structured interviews were conducted with partners of women diagnosed with CDP treated in Australia. Interviews explored partners' inclusion in decision making and communication with health professionals and their own coping experiences. Data were analysed thematically. RESULTS: Data from interviews with 12 male partners (N = 12) of women diagnosed with CDP were analysed. Two unique themes relevant to partners were identified: 'Partners require support to adjust to changing roles and additional burdens' and 'Treating the couple as a team facilitates agency and coping, but partners' needs are placed second by all'. CONCLUSION: Partners of women diagnosed with CDP commonly experience unique stressors and a substantial shift in previously established roles across multiple domains including medical advocacy, household coordination and parenting. Partners' coping is interlinked with how the woman diagnosed with CDP is coping. Inclusion of partners in treatment decisions and communications, and considering partners' wellbeing alongside that of the woman with CDP, is likely to be supportive for partners. In turn, this is likely to enhance the quality of support that women diagnosed with CDP receive from their partners.

Is de-escalation of treatment by omission of radiotherapy associated with fear of cancer recurrence in women with early breast cancer? An exploratory study.

PURPOSE: Safe de-intensification of adjuvant radiotherapy (RT) for early breast cancer (BC) is currently under evaluation. Little is known about the patient experience of de-escalation or its association with fear of cancer recurrence (FCR), a key issue in survivorship. We conducted a cross-sectional study to explore this association. METHODS: Psychometrically validated measures including the Fear of Cancer Recurrence Inventory-Short Form were completed by three groups of women with early BC: Women in the PROSPECT clinical trial who underwent pre-surgical MRI and omitted RT (A), women who underwent pre-surgical MRI and received RT (B); and women who received usual care (no MRI, received RT; C). Between group differences were analysed with non-parametric tests. A subset from each group participated in a semi-structured interview. These data (n = 44) were analysed with directed content analysis. RESULTS: Questionnaires from 400 women were analysed. Significantly lower FCR was observed in Group A (n = 125) than in Group B (n = 102; p = .002) or Group C (n = 173; p = .001), and when participants were categorized by RT status (omitted RT vs received RT; p < .001). The proportion of women with normal FCR was significantly (p < .05) larger in Group A (62%) than in Group B (35%) or Group C (40%). Two qualitative themes emerged: 'What I had was best' and 'Coping with FCR'. CONCLUSIONS: Omitting RT in the setting of the PROSPECT trial was not associated with higher FCR than receiving RT. Positive perceptions about tailored care, lower treatment burden, and trust in clinicians appear to be protective against FCR.

Universal genetic testing for women with newly diagnosed breast cancer in the context of multidisciplinary team care.

OBJECTIVE: To determine the feasibility of universal genetic testing of women with newly diagnosed breast cancer, to estimate the incidence of pathogenic gene variants and their impact on patient management, and to evaluate patient and clinician acceptance of universal testing. DESIGN, SETTING, PARTICIPANTS: Prospective study of women with invasive or high grade in situ breast cancer and unknown germline status discussed at the Parkville Breast Service (Melbourne) multidisciplinary team meeting. Women were recruited to the pilot (12 June 2020 - 22 March 2021) and expansion phases (17 October 2021 - 8 November 2022) of the Mutational Assessment of newly diagnosed breast cancer using Germline and tumour genomICs (MAGIC) study. MAIN OUTCOME MEASURES: Germline testing by DNA sequencing, filtered for nineteen hereditary breast and ovarian cancer genes that could be classified as actionable; only pathogenic variants were reported. Surveys before and after genetic testing assessed pilot phase participants' perceptions of genetic testing, and psychological distress and cancer-specific worry. A separate survey assessed clinicians' views on universal testing. RESULTS: Pathogenic germline variants were identified in 31 of 474 expanded study phase participants (6.5%), including 28 of 429 women with invasive breast cancer (6.5%). Eighteen of the 31 did not meet current genetic testing eligibility guidelines (probability of a germline pathogenic variant ≥ 10%, based on CanRisk, or Manchester score ≥ 15). Clinical management was changed for 24 of 31 women after identification of a pathogenic variant. Including 68 further women who underwent genetic testing outside the study, 44 of 542 women carried pathogenic variants (8.1%). Acceptance of universal testing was high among both patients (90 of 103, 87%) and clinicians; no decision regret or adverse impact on psychological distress or cancer-specific worry were reported. CONCLUSION: Universal genetic testing following the diagnosis of breast cancer detects clinically significant germline pathogenic variants that might otherwise be missed because of testing guidelines. Routine testing and reporting of pathogenic variants is feasible and acceptable for both patients and clinicians.

Improving hen welfare on cage-free egg farms in Asia: Egg producers' perspectives.

There is a trend towards the adoption of cage-free housing systems in the egg industry across Asia. While cage-free housing systems can hold significant animal welfare advantages over cages, there can also be challenges in managing these systems. This exploratory study aimed to investigate the perspectives of egg producers on the main challenges and proposed solutions associated with cage-free systems in China, Indonesia, Thailand, Japan, Malaysia, and the Philippines. Cage-free producers found disease prevention and maintaining a healthy profit margin more difficult than producers from cage farms, while it was less difficult to provide environmental enrichment in cage-free systems compared to cage farms. The top challenges for cage-free producers were the cost of production, system management, disease, sales, and egg production, and the top proposed solution was to improve on-farm practices and efficiencies. Eighty-one percent of egg producers believed that more support is needed to maintain their farms than is currently available, and support was most needed in helping to improve sales, improve farm operations, lower farm costs, and provide information for producers in the form of education and training. Most responses identified the government as the stakeholder that should offer support. These results may help direct further studies in this field as well as supplying information to develop relevant initiatives with an emphasis on education and training, thereby improving animal welfare on cage-free farms and increasing the uptake of high welfare cage-free farms across the region.

Isolation experienced by women with gestational cancer: could peer support and tailored information be the answer?

Women diagnosed with cancer during pregnancy (gestational cancer) are a small but vulnerable population, with experts suggesting they require greater psycho-social support than either other women with cancer or other pregnant women. However, information on their psychological needs remains sparse. This commentary describes our work exploring the psychological needs of women diagnosed with gestational cancer, areas of unmet need we identified, and our recommendations for future programs and research. We conducted in-depth, semi-structured interviews with 23 Australian women diagnosed with gestational cancer in the preceding 5 years. Our findings depicted a group of women for whom cancer diagnosis and treatment had resulted in a sense of isolation and loneliness. Women reported seeking tailored information about their condition and treatments as well as one-on-one peer support with other gestational cancer survivors, which was challenging for them to access and which existing services struggled to provide. To address these unmet needs, innovative solutions may be necessary. Technology has the potential to connect and match women with one-to-one peer support, and research exploring the efficacy and acceptability of such interventions is required. Creative solutions, such as virtual resource hubs monitored or moderated by experts, would potentially meet the information needs of this group. However, as gestational cancer is relatively rare, the development and evaluation of such interventions would require a collaborative effort across multiple sites, as well as international collaboration and data pooling.

Cancer during pregnancy: A qualitative study of healthcare experiences of Australian women.

OBJECTIVES: To identify features enhancing the quality of healthcare experiences for women with gestational cancer, and explore the impact of the heterogeneous Australian healthcare system on those experiences. METHODS: Semi-structured, qualitative interviews were conducted with women diagnosed with any cancer during pregnancy in the last five years. Recruitment occurred during 2018-2019 via social media and professional, clinical and community networks. Questions related to women's experiences of their healthcare, wellbeing and psychosocial needs. Interviews were analysed thematically. RESULTS: Study participants (n = 23) received treatment in the private sector (n = 10), public sector (n = 8), or both (n = 5). Five interview themes were found: Control over healthcare; Trust in clinicians, hospitals and systems; Coordination of care; An uncommon diagnosis; Holistic, future-oriented care. Women were most likely to have had a positive healthcare experience when (a)care was well-coordinated and adjusted to meet their unique needs/challenges, and (b)women perceived their care went beyond their immediate medical needs and encompassed future psychosocial wellbeing, including preparation for postpartum challenges. CONCLUSION: Existing 'usual care' in the public and/or private sector for both the pregnancy and the cancer is insufficient to meet these women's needs. Prioritising psychological wellbeing including psychosocial needs, and communication and planning around fertility and postnatal challenges are essential for this population.

Maternal breast cancer and communicating with children: A qualitative exploration of what resources mothers want and what health professionals provide.

OBJECTIVE: To explore the communication and resource needs of mothers diagnosed with breast cancer treated with curative intent in communicating with their young children and to identify gaps in the resources and support provided to these women. METHODS: Data were collected via semi-structured telephone interviews from 13 mothers who were diagnosed with breast cancer while parenting a young child (age 3-12 years), and 10 health professionals in Victoria, Australia. Data were analysed qualitatively using the Framework Method. RESULTS AND CONCLUSION: Mothers and health professionals prioritised communication with children about the cancer diagnosis; however, health professionals and mothers differed in their views of parents' communication needs both in terms of the nature of the support/information needed and the delivery of this support/information. Mothers wanted easily accessible resources that were both instructive and practical. Mothers also emphasised quality over quantity of support. Health professionals were mostly aware of mothers' needs, however, emphasised less instructive support and information. This study highlights the need for improved coordination and tailoring of psychosocial resources and supports for these parents and families communicating about a cancer diagnosis with their young children.

Recruiting Research Higher Degree Students into Veterinary Science.

Research at veterinary schools is usually driven by post-graduate students, yet there has been little or no study of how these students are selected. We undertook a review of the challenges faced in enlisting research higher degree (RHD) students at a long-established veterinary school, the School of Veterinary Science at the University of Queensland. Our aim was to identify the best methods of developing a strategic recruitment program that would enhance veterinary research in the school. A total of 21 academic research supervisors completed a quantitative survey assessing the associated importance placed on a variety of selection criteria and the level of potential challenges presented in recruiting suitable RHD students. Thirteen of these respondents completed a semi-structured qualitative interview to obtain further information. Respondents rated the motivation levels of potential students as the most important area of concern with regard to the assessment of student suitability, followed by their academic strength and English competency levels. The biggest challenge reported was that of obtaining sufficient funding for research projects and matching that funding to suitable students, followed by the geographical and student culture challenges of a rural campus. During the interviews, interviewees drew attention to the importance of developing a strong research culture in veterinary schools, and there was some concern centered on taking students with diverse cultural backgrounds. These constraints are discussed in light of the development of a broad-ranging strategy for developing an active and effective RHD program within veterinary schools.

Distress and psychological morbidity do not reduce over time in carers of patients with high-grade glioma.

PURPOSE: This study aimed to determine how carer distress and psychological morbidity change over time following a patient's diagnosis of high-grade glioma (HGG) and identify factors associated with changes in carers' psychological status. METHODS: Carers of patients with HGG planned for chemoradiotherapy were recruited to this longitudinal cohort study. Carers completed questionnaires during patients' chemoradiotherapy and 3 and 6 months later including the following: the Distress Thermometer (DT); General Health Questionnaire-12 (GHQ-12); and three single-item questions about understanding of information presented by health professionals, confidence to care and preparedness to care for their relative/friend. Linear latent growth models were applied. RESULTS: The time 1 questionnaire was completed by 118 carers, of these 70 carers provided responses to the third time point. Carer distress and psychological morbidity were most prominent proximal to diagnosis, but remained high over time. Sixty-two percent of participants had moderate or high distress on the DT at time 1, 61% at time 2 and 58% at time 3. Scores on the DT and the GHQ-12 correlated significantly at all time points as did changes in scores over time (p < .001). However, for individual carers, the DT or GHQ-12 scores at one time point did not strongly predict scores at subsequent time points. CONCLUSION: In carers of patients with HGG, distress levels are consistently high and cannot be predicted at any time point. Carers should be monitored over time to identify evolving psychological morbidity. The single-item DT correlates highly with GHQ-12 scores and is a suitable tool for rapid repeated screening.

Varied manifestations of persistent hyperplastic primary vitreous with graded somatic mosaic deletion of a single gene.

PURPOSE: Persistent hyperplastic primary vitreous (PHPV) represents a developmental eye disease known to have diverse manifestations ranging from a trivial remnant of hyaloid vessels to a dense fibrovascular mass causing lens opacity and retinal detachment. PHPV can be modeled in mice lacking individual genes, but certain features of such models differ from the clinical realm. For example, mice lacking the Arf gene have uniformly severe disease with consistent autosomal recessive disease penetrance. We tested whether the graded somatic loss of Arf in a subset of cells in chimeric mice mimics the range of disease in a non-heritable manner. METHODS: Wild type ↔ Arf(-/-) mouse chimeras were generated by morulae fusion, and when the mice were 10 weeks old, fundoscopic, slit-lamp, and histological evaluations were performed. The relative fraction of cells of the Arf(-/-) lineage was assessed with visual, molecular genetic, and histological analysis. Objective quantification of various aspects of the phenotype was correlated with the genotype. RESULTS: Sixteen chimeras were generated and shown to have low, medium, and high contributions of Arf(-/-) cells to tail DNA, the cornea, and the retinal pigment epithelium (RPE), with excellent correlation between chimerism in the tail DNA and the RPE. Phenotypic differences (coat color and severity of eye disease) were evident, objectively quantified, and found to correlate with the contribution of Arf(-/-) cells to the RPE and tail-derived DNA, but not the cornea. CONCLUSIONS: Generating animals composed of different numbers of Arf(-/-) cells mimicked the range of disease severity observed in patients with PHPV. This establishes the potential for full manifestations of PHPV to be caused by somatic mutations of a single gene during development.

Quality of Life Outcomes Associated With Optimization of Treatment by Omitting Radiotherapy in Early Breast Cancer.

PURPOSE: Improved prognosis of early breast cancer (EBC) has created opportunities for treatment optimization but reducing morbidity should not inadvertently compromise quality of life (QoL). PROSPECT1 used pre-operative MRI and pathology findings to identify women suitable for radiotherapy (RT) omission following breast conserving surgery. We retrospectively explored the association between de-escalation by omission of RT and QoL in women with EBC. MATERIALS AND METHODS: Three groups were recruited: PROSPECT participants who omitted RT following preoperative MRI (A); participants who received RT following preoperative MRI (B); and women who received usual care - No MRI, received RT (C). Measures included the EORTC QLQ-C30 and BR23, BCTOS, DASS-21 and a measure of decision regret. Between group differences were assessed using ANOVA or nonparametric equivalents. Semi-structured interviews were analyzed with qualitative description (n = 44). RESULTS: Data from 400 women were analyzed (125A, 102B, 173C). Group A had fewer symptoms and better body image (breast symptoms: A-B P = .003, A-C P = <.001; arm symptoms: A-B P = .004, A-C P = .011; body image: A-C P = .041) and fewer differences between the treated and untreated breasts (cosmetic: A-B P < .001, A-C P < .001; functional: A-C P = .011; breast specific pain: A-B P < .001, A-C P < .001). Two qualitative themes were found: Treatment with the biggest impact on QoL, and Specific impact of RT on QoL. CONCLUSIONS: Omission of RT was associated with better QoL and functional and cosmetic outcomes. It was highly acceptable to patients. Clinicians should consider the potential for preserved QoL associated with treatment optimization via omission of RT in treatment planning for patients with EBC.

Experiences of health professionals treating women diagnosed with cancer during pregnancy and proposals for service improvement.

OBJECTIVE: To examine the experiences, needs, and perceptions of health professionals(HPs) treating women diagnosed with cancer during pregnancy(gestational cancer, GC). METHODS: Interviews were undertaken with Australian HPs who had treated women diagnosed with GC over the previous five years. HPs were recruited via social media, and professional and community networks. Questions focussed upon HPs' confidence caring for these women, whether current guidelines/training met their needs, psychological impacts of care provision, and service gaps. Interview data were analysed thematically. RESULTS: Twenty-seven HPs were interviewed; most were oncology HPs(22/27) with experience caring for women with gestational breast cancer and 13 had a breast-specific clinical focus (e.g. breast surgeon). Many were currently treating women with GC(48%) or had in the last 6-12 months(29.6%). Four themes were identified: A clinically complex case, Managing multi-disciplinary care, Centralised resources for health professionals, and Liaison, information and shared experiences for women. HPs found this population personally challenging to treat. They reported initial uncertainty regarding treatment due to infrequent exposure to GC, limited resources/information, and the need to collaborate with services with which they did not usually engage. Solutions offered include centralised resources, clinical liaison/care coordinators, and connecting women with GC with peer support. CONCLUSIONS: HPs perceived women with GC as a vulnerable, complex population and experienced challenges providing comprehensive care; particularly when treatment was delivered at geographically separated hospitals. Systemic changes are needed to optimise comprehensive care for these women. Their insights can guide the development of more integrated cancer and obstetric care, and better HP support.

Cage egg producers' perspectives on the adoption of cage-free systems in China, Japan, Indonesia, Malaysia, Philippines, and Thailand.

Asia is responsible for ~60% of global egg production. As in most of the world, nearly all of the egg-laying hens are housed in cages. While there is growing demand for cage-free eggs in many regions of the world, challenges have been reported when transitioning to these systems, which may affect the willingness of producers to transition. The aim of this research was to investigate the views of Asian egg producers on the feasibility of cage-free systems and what they perceive to be the main challenges and proposed solutions in adopting cage-free systems. A total of 224 egg producers (165 cage egg producers) completed questionnaires containing a mix of free-form, Likert scale and demographic items. Data were analyzed using thematic qualitative analysis and descriptive quantitative statistics. Responses indicated that cages are primarily used for their efficiency and ease of management. The most common reasons to consider adopting cage-free systems included improved animal welfare, increased market access, and increased product quality. A majority of producers (65%) responded "yes" or "maybe" when asked if they consider cage-free systems to be feasible in their country. Perceived challenges in adopting cage-free systems included reduced profitability, higher costs, and biosecurity and disease. Potential solutions included the development of the cage-free industry and market development. Most producers (72%) said more support is needed to establish cage-free farms, mostly pertaining to technical advice, training and resources. The findings of this study provide an enhanced understanding of the egg industry in these countries and potential areas for producer support in transitioning to cage-free systems.

Farm Animal Welfare Science in China-A Bibliometric Review of Chinese Literature.

Farm animal welfare in the People's Republic of China (henceforth, China) is not well represented in the international scientific literature. This may lead researchers, advocates and those with agricultural partnerships in China to assume that animal welfare is not a field of interest there. This study reports a literature review of published pig and poultry welfare research in China using Chinese scientific databases. We aimed to determine which areas of welfare research have recently received academic attention in China. From an understanding of areas being studied, current and emerging priority areas for research could be determined. This study identified 854 academic publications citing pig or chicken welfare in China published between 2008 and 2018. Within these publications, two broader areas of significant attention were addressed in the context of animal welfare; yield and product quality, such as feeding, biosecurity and antimicrobial resistance, including immunity and second, the relationship of animal welfare with the Chinese philosophy of 'ecological agriculture.' Holistic systems were advocated to maximize sustainability and maintain a healthy environment, such as the creation of fermented bedding for pigs. Environmental enrichment was also a focus of attention, demonstrating an interest in animals' mental welfare, which was usually conjectured from their behavior. Few of the articles were translated into English or other languages and therefore most were largely unavailable to the English-speaking global scientific community. This presents an opportunity to provide relevant animal welfare knowledge, which could improve animal welfare globally. China is a global animal trade leader and the home of the largest agricultural industries in the world. An increase in collaboration on animal welfare research and understanding of the advancements that have been made in China, as reviewed in this manuscript, could advance farm animal welfare from a global perspective.

Asian Livestock Industry Leaders' Perceptions of the Importance of, and Solutions for, Animal Welfare Issues.

The welfare of farm animals has been the focus of increasing international interest, however, the movement has had little engagement with livestock leaders who are, arguably, the stakeholders in the position most able to make decisions that impact on animal welfare at critical times. Previous studies have drawn attention to the need to engage in constructive collaborations with the livestock industry for the betterment of animal welfare, and to uncover mutual benefits for both stakeholders and proponents of animal welfare with which collaborations can be motivated. This study aimed to continue this need to understand leaders in livestock management, by consulting their opinions as to what constitutes the most critical animal welfare issues during farming and slaughter, and what they see as some of the solutions to begin addressing livestock welfare issues in their country. Seventeen focus group sessions were held with 139 leaders in livestock industries in six diverse countries in Asia, including China, India, Malaysia, Vietnam, Thailand, and Bangladesh. Leaders included government representatives, key academics in agriculture, and business managers and leaders within the domestic animal agriculture industries, as relevant to each country. After conducting thematic analysis and applying basic statistical measures, the findings suggest that solutions within the themes of education, training, and awareness are most valued. However, how each of these could be best addressed varied by country. The need for local research and local solutions also contributed to the most frequent opportunities, as did the requirement for prescriptive and consistent standards and expectations. A ranking of animal welfare issues is presented, as is a selection of suggested animal welfare initiatives resulting from the findings of this study.

Knowledge of Stakeholders in the Livestock Industries of East and Southeast Asia about Welfare during Transport and Slaughter and Its Relation to Their Attitudes to Improving Animal Welfare.

The World Organisation for Animal Health (OIE) sets standards and guidelines for international animal welfare for the international livestock trade. The growing economic advancement in the East and Southeast Asian region suggested the potential benefit of a research study to examine stakeholders' understanding of animal welfare during the transport and slaughter of livestock. A survey of stakeholders' knowledge of livestock welfare in the transport and slaughter industries was conducted in four Southeast Asian countries, Malaysia, China, Vietnam and Thailand, in association with trainer and stakeholder workshops conducted in each country. The attitudes of participants towards animal welfare during slaughter and transport were also identified. Knowledge scores were in accordance with the respondents' assessment of their own knowledge level. The biggest knowledge improvement was among Thai respondents, who tended to be younger and less experienced than in other countries. The respondents with the biggest improvement in knowledge scores were most likely to be involved in the dairy industry and least likely to be involved in the sheep and goat industries, with meat processors and those involved in pig or poultry production intermediate. The respondents who obtained their knowledge from multiple sources had most knowledge, but it increased the least after training. Connections between attitudes to improving animal welfare and knowledge were limited, being mainly confined to ambivalent responses about their attitudes. The study suggests that knowledge can be improved in animal welfare training programs focused on livestock welfare around transport and slaughter, but that local cultural backgrounds must be considered in designing the program.

Attitudes of Pig and Poultry Industry Stakeholders in Guandong Province, China, to Animal Welfare and Farming Systems.

Although the People's Republic of China produces more animals for consumption than any other country, very little is known about the attitudes of stakeholders in the livestock industries to animal welfare in farming systems. This study investigated the attitudes of stakeholders in pig and poultry farming in south China towards animal welfare in different farming systems, pig and poultry behaviour, and the inherent value of the animals themselves. Respondents thought welfare was important, particularly if they had worked in the industry a long time, and that they intended to make improvements, even though they also believed it to be generally satisfactory. Outdoor systems were perceived to be better for welfare but indoor systems better for food safety, particularly among respondents that had gained their knowledge from multiple sources. Respondents believed pigs and chickens to have equally important needs, despite the fact that pigs were considered more intelligent than chickens. Pig farmers with outdoor systems had a more positive attitude to making welfare improvements compared with those operating intensive indoor systems. However an absence of enrichment in chicken farms increased respondents' intentions to make improvements, and these were more likely to occur on small chicken farms. Veterinarians and government officials were more likely to perceive welfare as unsatisfactory or to want change it than those working directly with animals. City residents were more likely to support and express confidence that they could improve animal welfare, compared to rural residents. It is concluded that stakeholders in China's pig and poultry production industries recognised a need to improve welfare, although they saw a conflict with production of safe food. However, farmers involved in intensive production systems were less likely to perceive a need or capacity to improve welfare than those operating more extensive systems, suggesting a dichotomisation of the people in the industry into those in small and outdoor farms that could and were improving welfare and those in indoor intensive farms who did not envisage this happening.

Turning Intentions into Animal Welfare Improvement in the Asian Livestock Sector.

Intentions form the basis of behavioral action to improve animal welfare; however an intention-behavior gap has been previously identified. Livestock stakeholders in China, Malaysia, Vietnam and Thailand (n = 1041) involved in slaughter and transport completed a survey in which they were asked their level of intention to improve animal welfare, and their level of confidence in their ability to do this. Chinese respondents had the most confidence in their ability to improve animal welfare, and veterinarians showed more confidence than livestock team leaders. Those with high or low intentions, and either high or low confidences were compared for key influencing factors to identify the circumstances that may be most conducive to behavior change. Respondents with high intentions and low confidence in their ability to improve animal welfare identified extrinsic factors associated with their immediate workplace and different company priorities, and the intrinsic factor of lack of personal knowledge. It is concluded that targeting these areas to improve confidence in stakeholders in livestock transport and slaughter could bring the most improvements in animal welfare initiatives.