Experiences and perspectives of colorectal cancer survivors and general practitioners on the delivery of survivorship care in general practice: a mixed methods study.

BACKGROUND: Many colorectal cancer (CRC) survivors experience ongoing sequelae from their cancer treatment. Limited evidence exists regarding how CRC survivors and general practitioners (GPs) manage these sequelae in the community. This study aimed to explore the experiences and perspectives of CRC survivors and GPs on current approaches to monitoring and managing sequelae of CRC treatment. METHODS: We conducted a mixed-methods study using cross-sectional national surveys and qualitative interviews with CRC survivors and GPs to explore: (1) treatment sequelae experienced by CRC survivors, (2) how these were monitored and managed by general practitioners, and (3) suggestions to improve ongoing management of the treatment sequelae. Survey responses were reported descriptively. Qualitative data were thematically analysed using an interpretive descriptive approach. RESULTS: Seventy participants completed surveys: 51 CRC survivors and 19 GPs, and four interviews were conducted with GPs. CRC survivors experienced a range of treatment sequelae, but often did not discuss these with their GPs (experienced vs discussed: 86% vs 47% for fatigue/lack of energy, 78% vs 27% for psychological/emotional concern, 63% vs 22% for impaired sleep, 69% vs 29% for weight loss/gain, 59% vs 16% for sexual and intimacy concerns). GPs reported inadequate information transfer from cancer services and workload as major barriers to optimal care. CONCLUSIONS: System-level changes that facilitate adequate information transfer from cancer services to GPs upon CRC treatment completion, as well as addressing time constraint issues essential for comprehensive monitoring and management of CRC treatment sequelae, could enhance the care of CRC survivors in the community setting.

Multidisciplinary teams and social science: a patient perspective.

Multidisciplinary teams (MDTs) are common in colorectal cancer and have been deemed important when providing care. Yet they take place outside of the patient, often with little consideration of the patient's views, goals and desires. In this paper specific examples from a patient perspective are integrated with the social science literature to provide an overview of areas of disconnect between MDT recommendations and the individual patient. The reasons for these disconnects are explored, including how MDTs relate to dyadic patient-clinician relationships, weak incorporation of patient-oriented outcomes in MDTs, poor integration of nonmedical patient information and the patient perspective and the impact of team dynamics and cognitive decision biases. Consideration of these issues should facilitate higher-quality MDT recommendations that are also more acceptable to patients.

Engineering tumor-colonizing E. coli Nissle 1917 for detection and treatment of colorectal neoplasia.

Bioengineered probiotics enable new opportunities to improve colorectal cancer (CRC) screening, prevention and treatment. Here, first, we demonstrate selective colonization of colorectal adenomas after oral delivery of probiotic E. coli Nissle 1917 (EcN) to a genetically-engineered murine model of CRC predisposition and orthotopic models of CRC. We next undertake an interventional, double-blind, dual-centre, prospective clinical trial, in which CRC patients take either placebo or EcN for two weeks prior to resection of neoplastic and adjacent normal colorectal tissue (ACTRN12619000210178). We detect enrichment of EcN in tumor samples over normal tissue from probiotic-treated patients (primary outcome of the trial). Next, we develop early CRC intervention strategies. To detect lesions, we engineer EcN to produce a small molecule, salicylate. Oral delivery of this strain results in increased levels of salicylate in the urine of adenoma-bearing mice, in comparison to healthy controls. To assess therapeutic potential, we engineer EcN to locally release a cytokine, GM-CSF, and blocking nanobodies against PD-L1 and CTLA-4 at the neoplastic site, and demonstrate that oral delivery of this strain reduces adenoma burden by ~50%. Together, these results support the use of EcN as an orally-deliverable platform to detect disease and treat CRC through the production of screening and therapeutic molecules.

Shared decision-making and social science: A patient perspective.

Shared decision making (SDM) between doctors and patients has been deemed important when providing care. Yet, it can be difficult to achieve. Specific examples from a patient perspective are integrated with the social science literature to provide an overview of components of SDM including the role of fit, trust, information asymmetry, cognitive decision frames and balancing medical and patient outcomes. Consideration of these issues should facilitate higher quality SDM conversations.

Social science and teams: a patient perspective.

Teamwork is fundamental for providing high quality care and providing positive experiences for patients. Concepts from organisational behaviour and social science are integrated with a patient perspective to elucidate how various aspects of teams impact on the patient experience. Particular attention is devoted to the team composition, the interaction and communication patterns among team members, how teams are structured, coordination among team members, facilitating a positive team climate, and considering patients as a member of the team.

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention.

Incivility in surgery is prevalent and negatively impacts effectiveness and staff well-being. The purpose of this study was to a) examine relationships between incivility, team dynamics, and well-being outcomes, and b) explore a low-cost intervention of 'eye' signage in operating theater areas to reduce incivility in surgical teams. A mixed methods design was used in an orthopedic hospital. Surveys of incivility, teamwork, and well-being were administered three months apart in a small private hospital. An intervention of signage with eyes was placed in the theater area after administration of the first survey, using a pretest-posttest design. Participants also responded to an open-ended question about suggestions for improvements at the end of the survey which was then thematically analyzed. At the individual level (n = 74), incivility was statistically significantly related to team dynamics which in turn was significantly related to burnout, stress, and job attitudes. At the aggregate level, reported incivility was statistically significantly lower after the 'eye' sign intervention. Thematic analysis identified core issues of management behaviors, employee appreciation, communication, and work practices. Incivility in surgical teams has significant detrimental associations with burnout, stress, and job attitudes, which occurs through its impact on decreased team dynamics and communication. A simple intervention that evokes perceptions of being observed, such as signage of eyes in theater areas, has the potential to decrease incivility at least in the short term, demonstrating that incivility is amenable to being modified. Additional research on targeted interventions to address incivility are needed to improve teamwork and staff well-being.

Colorectal cancer detection and treatment with engineered probiotics.

Bioengineered probiotics enable new opportunities to improve colorectal cancer (CRC) screening, prevention and treatment strategies. Here, we demonstrate the phenomenon of selective, long-term colonization of colorectal adenomas after oral delivery of probiotic E. coli Nissle 1917 (EcN) to a genetically-engineered murine model of CRC predisposition. We show that, after oral administration, adenomas can be monitored over time by recovering EcN from stool. We also demonstrate specific colonization of EcN to solitary neoplastic lesions in an orthotopic murine model of CRC. We then exploit this neoplasia-homing property of EcN to develop early CRC intervention strategies. To detect lesions, we engineer EcN to produce a small molecule, salicylate, and demonstrate that oral delivery of this strain results in significantly increased levels of salicylate in the urine of adenoma-bearing mice, in comparison to healthy controls. We also assess EcN engineered to locally release immunotherapeutics at the neoplastic site. Oral delivery to mice bearing adenomas, reduced adenoma burden by ∻50%, with notable differences in the spatial distribution of T cell populations within diseased and healthy intestinal tissue, suggesting local induction of robust anti-tumor immunity. Together, these results support the use of EcN as an orally-delivered platform to detect disease and treat CRC through its production of screening and therapeutic molecules.

Experiences of colorectal cancer survivors in returning to primary coordinated healthcare following treatment.

BACKGROUND: Advances in screening and treatments for colorectal cancer (CRC) have improved survival rates, leading to a large population of CRC survivors. Treatment for CRC can cause long-term side-effects and functioning impairments. General practitioners (GPs) have a role in meeting survivorship care needs of this group of survivors. We explored CRC survivors' experiences of managing the consequences of treatment in the community and their perspective on the GP's role in post-treatment care. METHODS: This was a qualitative study using an interpretive descriptive approach. Adult participants no longer actively receiving treatment for CRC were asked about: side-effects post-treatment; experiences of GP-coordinated care; perceived care gaps; and perceived GP role in post-treatment care. Thematic analysis was used for data analysis. RESULTS: A total of 19 interviews were conducted. Participants experienced side-effects that significantly impacted their lives; many they felt ill-prepared for. Disappointment and frustration was expressed with the healthcare system when expectations about preparation for post-treatment effects were not met. The GP was considered vital in survivorship care. Participants' unmet needs led to self-management, self-directed information seeking and sourcing referral options, leaving them feeling like their own care coordinator. Disparities in post-treatment care between metropolitan and rural participants were observed. CONCLUSION: There is a need for improved discharge preparation and information for GPs, and earlier recognition of concerns following CRC treatment to ensure timely management and access to services in the community, supported by system-level initiatives and appropriate interventions.

The SCRIPT trial: study protocol for a randomised controlled trial of a polygenic risk score to tailor colorectal cancer screening in primary care.

BACKGROUND: Polygenic risk scores (PRSs) can predict the risk of colorectal cancer (CRC) and target screening more precisely than current guidelines using age and family history alone. Primary care, as a far-reaching point of healthcare and routine provider of cancer screening and risk information, may be an ideal location for their widespread implementation. METHODS: This trial aims to determine whether the SCRIPT intervention results in more risk-appropriate CRC screening after 12 months in individuals attending general practice, compared with standard cancer risk reduction information. The SCRIPT intervention consists of a CRC PRS, tailored risk-specific screening recommendations and a risk report for participants and their GP, delivered in general practice. Patients aged between 45 and 70 inclusive, attending their GP, will be approached for participation. For those over 50, only those overdue for CRC screening will be eligible to participate. Two hundred and seventy-four participants will be randomised to the intervention or control arms, stratified by general practice, using a computer-generated allocation sequence. The primary outcome is risk-appropriate CRC screening after 12 months. For those in the intervention arm, risk-appropriate screening is defined using PRS-derived risk; for those in the control arm, it is defined using family history and national screening guidelines. Timing, type and results of the previous screening are considered in both arms. Objective health service data will capture screening behaviour. Secondary outcomes include cancer-specific worry, risk perception, predictors of CRC screening behaviour, screening intentions and health service use at 1, 6 and 12 months post-intervention delivery. DISCUSSION: This trial aims to determine whether a PRS-derived personalised CRC risk estimate delivered in primary care increases risk-appropriate CRC screening. A future population risk-stratified CRC screening programme could incorporate risk assessment within primary care while encouraging adherence to targeted screening recommendations. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry ACTRN12621000092897p. Registered on 1 February 2021.

Profiles of intended responses to requests for assisted dying: A cross-sectional study.

BACKGROUND: Responding to legal medically assisted dying requests may become the most frequent form of nurses' participation in that service. Recent research has explored nurses' discrete responses to requests about or for assisted dying; however, nurses likely hold intentions for multiple responses to these requests. These intentions form patterns shaped by individual factors such as attitude and beliefs. No research has investigated patterns of multiple responses to requests for assisted dying, how these patterns form profiles of nurses and factors that might explain these response profiles. OBJECTIVES: Identify patterns of multiple responses that nurses intend for requests for assisted dying. Explore how these patterns form profiles of nurses' who share similar patterns of intended responses. Finally, investigate how attitude, norms and beliefs distinguish response profiles. DESIGN: Cross-sectional survey SETTINGS: Online survey of Australian nurses PARTICIPANTS: 365 experienced registered nurses (years in nursing mean = 23, SD = 14.21) working primarily with adults across various practice settings. METHODS: Principal components analysis identified five types of intended responses. K-means cluster analysis was then used to develop profiles of nurses' intended responses across these five responses. Multinomial logit regression was utilised to examine psychosocial variables that distinguished different profiles RESULTS: Cluster analysis resulted in five profiles that reflect different patterns of intended responses by nurses - Facilitator, Complier, Expediter, Objector, and Detached. Logit regressions of explanatory variables indicated that nurses' attitude toward assisted dying, ethical beliefs, and social norms predicted nurses' membership in intended response profiles. The overall model was statistically significant, χ2(20) = 106.527, p < .001, and the predictors accounted for 25.3% of the variance in the profiles (Cox and Snell test: Pseudo R2 = 0.253). CONCLUSION: Nurses intended responses have been usefully constructed as five patterns or profiles of multiple responses. These profiles represent different types and levels of engagement with requests. Further, attitude and social expectations distinguish profiles with stronger intentions to engage positively. Using a cluster analysis methodology provides a more holistic understanding of nurses' intended responses to assisted dying requests by focusing on various responses and demonstrating that nurses have distinctive patterns of responses.

Trust in direct leaders and top leaders: A trickle-up model.

Low levels of employee trust in top leaders pose challenges to organizations with respect to retention, performance, and profits. This research examines how trust in top leaders can be fostered through the relationships individuals have with their direct leaders. We propose a trickle-up model whereby trust in direct leaders exerts an upward influence on trust in top leaders. Drawing on the group value model, we predict that direct leaders' procedural justice serves as the key mechanism in facilitating the trickle-up process. Further, this process should be particularly strong for employees high on vertical collectivism, and the trickled-up trust in top leaders should exert a stronger impact on employees' overall performance in the organization than trust in direct leaders. Multiphase and multisource data from 336 individuals support these hypotheses. The findings advance our understanding of trust and leadership by highlighting that trust in leaders at different levels does not form independently and that trust in leaders trickles up across hierarchical levels. (PsycINFO Database Record

Organizational climate and culture: Reflections on the history of the constructs in the Journal of Applied Psychology.

We review the literature on organizational climate and culture paying specific attention to articles published in the Journal of Applied Psychology (JAP) since its first volume in 1917. The article traces the history of the 2 constructs though JAP has been far more important for climate than culture research. We distinguish 4 main periods: the pre-1971 era, with pioneering work on exploring conceptualization and operationalizations of the climate construct; the 1971-1985 era, with foundational work on aggregation issues, outcome-focused climates (on safety and service) and early writings on culture; the 1986-1999 era, characterized by solidification of a focused climate approach to understanding organizational processes (justice, discrimination) and outcomes (safety, service) and the beginnings of survey approaches to culture; and the 2000-2014 era, characterized by multilevel work on climate, climate strength, demonstrated validity for a climate approach to outcomes and processes, and the relationship between leadership and climate and culture. We summarize and comment on the major theory and research achievements in each period, showing trends observed in the literature and how JAP has contributed greatly to moving research on these constructs, especially climate, forward. We also recommend directions for future research given the current state of knowledge. (PsycINFO Database Record

Organizational climate configurations: relationships to collective attitudes, customer satisfaction, and financial performance.

Research on organizational climate has tended to focus on independent dimensions of climate rather than studying the total social context as configurations of multiple climate dimensions. The authors examined relationships between configurations of unit-level climate dimensions and organizational outcomes. Three profile characteristics represented climate configurations: (1) elevation, or the mean score across climate dimensions; (2) variability, or the extent to which scores across dimensions vary; and (3) shape, or the pattern of the dimensions. Across 2 studies (1,120 employees in 120 bank branches and 4,317 employees in 86 food distribution stores), results indicated that elevation was related to collective employee attitudes and service perceptions, while shape was related to customer satisfaction and financial performance. With respect to profile variability, results were mixed. The discussion focuses on future directions for taking a configural approach to organizational climate.

Does whom you work with matter? Effects of referent group gender and age composition on managers' compensation.

Much research has examined gender and age effects on compensation, concluding that a wage gap exists favoring men and negative stereotypes against older workers persist. Although the effect of an employee's gender or age has been widely studied, little work has examined the impact of the demographic characteristics of a focal employee's immediate referent groups (e.g., subordinates, peers, or supervisors) on pay. The effect of the gender and age composition of a focal manager's subordinates, peers, and supervisor on the manager's compensation levels was investigated in a sample of 2,178 managers across a wide range of organizations and functional areas. After controlling for a number of human capital variables, results indicated that not only does a wage gap favoring men exist, but also managerial pay is lower when managers' referent groups are largely female, when subordinates are outside the prime age group, and when peers and supervisors are younger.

Substantive and operational issues of response bias across levels of analysis: an example of climate-satisfaction relationships.

Two studies tested whether method variance is present at multiple levels of analysis and whether methodological procedures can minimize its impact. In Study 1, 8,052 employees from 71 hotels completed measures of climate, work environment characteristics, and satisfaction. A comparison of correlations at the individual level, cross-level, cross-level split, aggregate level, and aggregate-split level of analysis revealed that response bias was present across multiple levels. Results suggest that samples should be split in half when cross-level and aggregate correlations are computed to ameliorate response bias problems that arise from individual-level method variance. In Study 2, results indicated that the temporal spacing of measures of climate and satisfaction influenced response bias. Implications and recommendations for future research are discussed.