Facilitating healthcare practitioners to deliver self-management support in adult cancer survivors: A realist review.

BACKGROUND: Supporting cancer survivors in self-management can empower them to take an active role in managing the long-term physical and psychosocial consequences of cancer treatment. Healthcare practitioners are key to supporting patients to self-manage, however, they do not routinely engage in these discussions. This review aimed to establish what works for whom and in what circumstances in relation to facilitating healthcare practitioners to provide self-management support in people living with long-term consequences of cancer treatment. METHODS: The review follows five steps: define the review's scope, develop initial programme theories, evidence search, selection and appraisal, and data extraction and synthesis. Database searches of Medline, EMBASE, CINAHL, Scopus, PsycINFO, ERIC and AMED databases, to September 2019 were supplemented with practitioner surveys. Insights into the mechanisms that operate in particular contexts to produce successful outcomes were illustrated using realist programme theories, developed using the Theoretical Domains Framework. Data selection was based on relevance and rigour. Data were extracted and synthesised iteratively to illuminate causal links between contexts, mechanisms and outcomes. RESULTS: Five programme theories were identified from 20 included articles and seven practitioner surveys: practitioners will engage patients in discussions about self-management if they have appropriate (1) knowledge and (2) consultations skills, (3) a clear understanding of their self-management support role and responsibilities, and if (4) organisational strategies and (5) health system configuration enable integration into routine care. The mechanisms facilitating practitioners to support self-management were practitioner confidence, mutual trust and shared responsibility between practitioners and cancer survivors, organisational prioritisation and ease of delivery of self-management support. CONCLUSION: The findings articulate the necessary components for embedding self-management support into routine cancer care. Operationalisation of these components into effective self-management support interventions will require reconfiguration of pathways and adaptation for local context, using strategies such as quality improvement and co-design to guide intervention development, implementation and evaluation.

A review of trial and real-world data applying elements of a realist approach to identify behavioural mechanisms supporting practitioners to taper opioids.

This evidence synthesis applying realist concepts and behavioural science aimed to identify behavioural mechanisms and contexts that facilitate prescribers tapering opioids. We identified relevant opioid-tapering interventions and services from a 2018 international systematic review and a 2019 England-wide survey, respectively. Interventions and services were eligible if they provided information about contexts and/or behavioural mechanisms influencing opioid-tapering success. A stakeholder group (n = 23) generated draft programme theories based around the 14 domains of the Theoretical Domains Framework. We refined these using the trial and service data. From 71 articles and 21 survey responses, 56 and 16 respectively were included, representing primary care, hospital, specialist pain facilities and prison services. We identified 6 programme theories comprising 5 behavioural mechanisms: prescribers' knowledge about how to taper; build prescribers' beliefs about capabilities to initiate tapering discussions and manage psychological consequences of tapering; perceived professional role in tapering; the environmental context enabling referral to specialists; and facilitating positive social influence by aligning patient: prescriber expectations of tapering. No interventions are addressing all 6 mechanisms supportive of tapering. Work is required to operationalise programme theories according to organisational structures and resources. An example operationalisation is combining tapering guidelines with information about local excess opioid problems and endorsing these with organisational branding. Prescribers being given the skills and confidence to initiate tapering discussions by training them in cognitive-based interventions and incorporating access to psychological and physical support in the patient pathway. Patients being provided with leaflets about the tapering process and informed about the patient pathway.

Structured block placements of hospital pre-registration trainee pharmacists in primary care medical practices across the United Kingdom: Lessons from a pilot scheme.

BACKGROUND AND PURPOSE: There is increasing demand for suitably trained pharmacists to undertake clinical roles in primary care general practices across the United Kingdom. This necessitates development of sustainable training opportunities to both better prepare future registrants for such roles and raise awareness of the new career pathway. Educational activity and setting: Hospital pre-registration trainee pharmacists undertook four or eight-week placements in general practice as part of their training year. Trainees attended an introductory session and received educational support tools six weeks prior to their placements. Each trainee had an allocated clinical supervisor in general practice and maintained communication with their hospital tutor. On completion of all placements, trainees and general practice staff were asked to share perceptions and outcomes via online questionnaires. FINDINGS: Most trainees reported that the clinical supervision arrangements were satisfactory and found the placement workbook useful for guiding daily activities. Key benefits from the placements included enhanced understanding of the patient journey across healthcare sectors, increased confidence, and raised awareness of general practice as a career option. Main limitations included restricted opportunities to engage in patient-centred activities and lack of integration with general practice teams. All trainees stated that the presence of a general practice pharmacist was essential for learning support. SUMMARY: This model demonstrated the feasibility of structured block placements of trainee pharmacists in general practice with identified benefits for trainees and pharmacy workforce requirements. Future research:Identified key limitations to this model need further investigation, to improve the design of future placements.

Realist review protocol for understanding the real-world barriers and enablers to practitioners implementing self-management support to people living with and beyond cancer.

INTRODUCTION: Self-management support can enable and empower people living with and beyond cancer to take an active role in managing long-term consequences of cancer treatment. Healthcare professionals are key to promoting patients to self-manage, however, they do not routinely engage in these discussions. This review aims to understand what works for whom and in what circumstances in relation to practitioners engaging with supporting people living with and beyond cancer to self-manage long-term consequences of systemic anticancer treatment. METHODS AND ANALYSIS: We will follow five steps for undertaking the realist review: (1) define the review scope, (2) develop initial programme theories, (3) evidence search, (4) selection and appraisal and (5) data extraction and synthesis. We will combine an informal literature search with a theory-based approach, using the theoretical domains framework, and stakeholder feedback to develop initial programme theories. We will search Medline, EMBASE, CINAHL, Scopus, PsycINFO, ERIC and AMED databases to September 2019, and supplement this with citation tracking, grey literature and practitioner surveys. Data selection will be based on relevance and rigour. Data will be extracted and synthesised iteratively, and causal links between contexts, mechanism and outcomes illuminated in the process. The results will be reported according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and publication standards. ETHICS AND DISSEMINATION: We have received ethical approval through the Research Ethics Committee, Faculty of Medicine and Health Sciences, University of East Anglia (ref 2 01 819-124). We will disseminate to the research community through conference presentations and a peer-reviewed journal article. We will work with healthcare organisations, cancer charities and patients to agree a strategy for disseminating to these groups. PROSPERO REGISTRATION NUMBER: CRD42019120910.

What do patients need to know? A study to assess patients' satisfaction with information about medicines.

OBJECTIVES: This study aimed to determine the information needs and reported adherence of patients prescribed medicines for chronic conditions in those who have received a community pharmacy advanced service and those who have not. METHODS: A questionnaire was constructed using validated tools to measure medication information satisfaction and adherence together with questions eliciting information regarding the use of pharmacy services and demographic characteristics. This questionnaire was distributed from four community pharmacies to a convenience sample of 400 patients as they collected their medicines. Patients were eligible if prescribed more than one regular medicine and attending the pharmacy for longer than 3 months. The questionnaire was returned directly to the university. KEY FINDINGS: Two hundred and thirty-two (58%) questionnaires were returned. All respondents desired further information about their prescribed medicines, particularly about potential medication problems. Dissatisfaction centred on side effects, interactions and certain medicine characteristics such as how long it will take to act. Satisfaction with information about medicines and adherence were significantly greater in a subgroup reporting that they had received an advanced pharmacy service, e.g. medicine use review (MUR). CONCLUSION: Patients who had received an advanced service reported greater adherence and satisfaction with medicine-related information. This was a small, observational study, using a convenience sample of four pharmacies; in order to draw definitive conclusions, a larger study with participants randomised to receive an advanced service is required.