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.

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.