Advanced Practice Nursing Titles and Roles in Cancer Care: A Scoping Review.

OBJECTIVES: Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways. METHODS: This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12. RESULTS: Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom. CONCLUSIONS: The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets. IMPLICATIONS FOR NURSING PRACTICE: Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways.

Evaluating the effects of lymphoedema management strategies on functional status and health-related quality of life following treatment for head and neck cancer: Protocol for a systematic review.

INTRODUCTION/BACKGROUND: Patients living with and after head and neck cancer often experience treatment-related consequences. Head and neck lymphoedema can be described as a common chronic side effect of head and neck cancer and recognised as a contributing factor to impairment of functional status, symptom burden and health-related quality of life. The effects of head and neck lymphoedema can limit patients' involvement in daily activities and alter their appearance, increasing symptom burden and negatively affecting health-related quality of life. OBJECTIVE: The protocol outlines the rationale and aims for the systematic review. The main aim of the systematic review is to identify and systematically synthesise the literature on the effectiveness of head and neck lymphoedema management strategies, on both function status and health-related quality of life for head and neck cancer patients. METHODS AND ANALYSIS: This protocol will be conducted according to the PRISMA-P guidelines. Electronic databases will be systematically searched using MEDLINE via Ovid and PubMed, CINAHL, Cochrane Central Register of Controlled Trials and Scopus. Inclusion criteria will involve intervention studies for head and neck lymphoedema management, English language, and adult human participants following head and neck cancer. The software Covidence will be used to export, manage, and screen results. Risk of bias and quality will be assessed in included studies using the Cochrane Handbook of Systematic Reviews of Intervention risk of bias and GRADE tools. A meta-analysis will be performed if there are sufficient homogenous studies. Alternatively, a narrative synthesis will be completed on study findings. ETHICS AND DISSEMINATION: No ethical approval is required as the study does not involve patient and public involvement. The findings of the review will be disseminated in conferences and submitted for approval to be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022378417. (S1 Appendix).

Maximizing Professional-Led Sexual Well-being Support in Cancer Care: Findings From a Qualitative Process Evaluation Following Healthcare Professionals' Engagement With an eLearning Resource.

BACKGROUND: Provision of healthcare professional (HP)-led sexual support in cancer care is lacking, perpetuated by barriers including a lack of HP awareness of sexual concerns and strategies to help patients and partners cope. In response, the Maximizing Sexual Wellbeing|Cancer Care eLearning resource (MSW|CC) was developed and demonstrated efficacy in reducing HPs' attitudinal barriers to the provision of sexual support. However, the mechanisms for such change are not yet known. OBJECTIVE: A qualitative process evaluation was used to explore mechanisms that influence HP engagement with MSW|CC and its adoption into practice. METHODS: Semistructured interviews were conducted with HPs providing cancer care in Northern Ireland upon MSW|CC completion. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. RESULTS: Seventeen participants were interviewed, and 4 key themes were identified: (1) MSW|CC raises HPs' awareness of the need for holistic sexual support as part of routine clinical care; (2) MSW|CC prepares and equips HPs to provide sexual support in cancer care; (3) MSW|CC is coherent, engaging, and acceptable; and (4) MSW|CC: moving forward. CONCLUSION: Participants derived benefits from MSW|CC, deeming it an acceptable resource. Insights into MSW|CC mechanisms of success were identified, including language to address sexual concerns, alongside patient referral resources. Perceived MSW|CC shortcomings from an earlier study were confirmed as a software issue.Implications for Practice:Healthcare professionals require training and resources to enhance sexual support provision in cancer care. Proactive implementation strategies used to maximize HP engagement with MSW|CC could equip HPs with tools to improve patient sexual outcomes after cancer.

A qualitative evaluation of a multi-modal cancer prehabilitation programme for colorectal, head and neck and lung cancers patients.

BACKGROUND: Growing evidence indicates patients' survivorship outcomes can be enhanced through active engagement in a multi-modal cancer prehabilitation programme (MCPP), although this intervention is not uniformly embedded as a standard of care. MCPP aims to optimise patients physiologically and psychologically for cancer treatments, shorten recovery time, reduce complications, promote healthier lifestyles and improve quality of life. South Eastern Health and Social Care Trust (SET) developed and evaluated a system-wide collaborative approach to MMCP across three tumour groups (colorectal, lung, head and neck cancer). Addressing the lack of qualitative evaluation of MCPPs, this novel paper explores mechanisms promoting feasibility and acceptability of MCPP from patients' and interdisciplinary professionals' perspectives. METHODS: Semi-structured virtual one-to-one interviews were conducted with 24 interdisciplinary professionals and nine patients. Transcripts were recorded, transcribed verbatim and themes developed using Framework Analysis. RESULTS: Analysis of findings identified three themes providing an in-depth understanding of key elements required to develop and promote system-wide delivery of a MCPP: 1) Equipping the team: Capability and capacity, 2) Timing of intervention and delivery timeframe and 3) Systems and processes. CONCLUSION: The system-wide collaborative approach to developing a MCPP was deemed both feasible and acceptable. Success was attributed to visionary leadership, alongside a diverse group of interdisciplinary professionals being engaged, motivated and committed to intervention delivery in an effort to improve patient outcomes. Iterative, responsive troubleshooting during initial delivery is required to facilitate successful implementation. Further training is required for greater adherence to provision of prescriptive high intensity exercise within the programme, which may further promote enhanced patient outcomes. To enable sustainability of MCPP, ongoing training for professionals and funding is required.

Compliance with oral hygiene and dietary advice for the prevention of post-radiotherapy dental disease among head and neck cancer patients - a qualitative study.

OBJECTIVES: To elicit head and neck cancer (HANC) patients' views about their oral health and to identify potential issues regarding compliance with clinical oral hygiene and dietary advice for the prevention of post-radiotherapy dental disease. METHODS: A purposive sample of twelve HANC patients between 6- and 12-months post-radiotherapy were recruited to undergo a semi-structured interview with a qualitative researcher. A pre-piloted topic guide was used to frame each interview. Qualitative data were analysed via thematic analysis. RESULTS: Data were categorised into four main themes - 'How HANC patients perceive oral health', 'Cancer diagnosis and cancer care pathway', 'Impact of oncology treatment (radiotherapy, surgery, and chemotherapy)', and 'Post-oncology treatment recovery', with 14 subthemes. Oral health was viewed as an important component of HANC patients' overall physical and mental health post-treatment. Patients' non-compliance with adequate oral hygiene practice was related to oral mucositis, a "burning" sensation associated with high fluoride toothpaste, forgotten or inconsistent clinical advice, and an inadequate supply of preventive oral hygiene products. The potentially highly cariogenic nature of prescribed nutritional supplements for patients at risk of malnutrition did not tend to be communicated to patients in advance of their prescription. CONCLUSIONS: Adequate oral health is essential for the overall physical and mental well-being of post-treatment HANC patients. Non-compliance with preventive clinical advice increases the risk of post-treatment oral health deterioration and was related to miscommunication, inadequate supplies of oral hygiene products, and treatment-related oral discomfort. CLINICAL SIGNIFICANCE: Post-treatment HANC patients are at increased risk of dental disease. Educational and behavioural techniques should be employed to enhance patients' compliance with clinical oral hygiene and dietary advice for the prevention of post-radiotherapy dental disease. Patients should be informed about the potentially highly cariogenic nature of nutritional supplements, and these patients should undergo frequent dental recall. Clinical advice regarding oral hygiene and dietary practices needs to be given consistently to HANC patients by different specialists of the HANC multidisciplinary team.

Evaluating the effects of lymphoedema management strategies on functional status and health-related quality of life following treatment for head and neck cancer: a systematic review.

PURPOSE: Patients living with head and neck lymphoedema (HNL) after completion of head and neck cancer (HNC) often can experience long-term functional challenges and overall poorer health-related quality of life (HRQOL). This systematic review aims to explore components of effective HNL interventions through identification and synthesising literature on existing HNL management interventions. METHODS: Five electronic databases (MEDLINE via Ovid and PubMed, CINAHL, CENTRAL, and Scopus) were systematically searched using Medical Subject Headings and free text, as well as citation tracking and Google Scholar for grey literature. RESULTS: A total of 1910 studies were screened, with 12 studies meeting the inclusion criteria. Findings indicated vast heterogeneity within HNL interventions. Patients' adherence to intervention strategies was reported as low and partially adhered to, particularly at home. This impacted on function domains and overall HRQOL during the post-treatment HNC phase, as well as further increasing the demands placed on healthcare professionals. CONCLUSIONS: Synthesis of the research findings highlighted a need to provide and educate patients with individualised HNL self-management intervention strategies. Promoting adherence was reported as being essential, with self-efficacy and behaviour change techniques being emphasised as a critical element to enhance motivation and therefore effective intervention delivery. Further work is important to address barriers to adherence and promote both motivation and behaviour change, to develop individualised self-management interventions for this cancer population. IMPLICATIONS FOR CANCER SURVIVORS: The findings from this systematic review will provide guidance in the development and delivery of individualised self-management HNL interventions for patients who have completed HNC treatment.

A Systematic Review of Educational Interventions to Equip Health and Social Care Professionals to Promote End-of-Life Supportive Care when a Parent with Dependent Children is Dying with Cancer.

OBJECTIVES: This systematic review aimed to determine the content, mode of delivery, assessment, and outcomes of educational interventions to equip health and social care professionals when delivering end of life supportive care for parents dying with cancer who have dependent children. DATA SOURCES: A mixed-methods systematic review was undertaken. Six electronic database were searched from their inception until September 2023 (Medline OVID, CINAHL, EMBASE, PsycINFO, Web of Science, and ERIC), supplemented by citation chaining, grey literature searches using Google Advanced Search and relevant professional bodies. Quality assessment was conducted independently by two researchers on the included studies. A convergent integrated approach was utilised for data synthesis. CONCLUSION: The review identified two educational interventions; highlighting a dearth of training opportunities to equip health and social care professionals to provide supportive care to families when a parent is at end of life with cancer. Despite health and social care professionals reported need and desire for upskilling in this area of clinical practice, there is a severe lack of evidence-based educational interventions. It is imperative that effective educational interventions are made accessible to professionals. IMPLICATIONS FOR NURSING PRACTICE: There is an imminent need for robust educational interventions to be developed, as health and social care professionals often lack the knowledge, skills and confidence on how best to support families when a parent of dependent children is at end of life. Health and social care professionals engagement with high-quality, evidence-based and theory-driven educational interventions has the potential to impact professionals' provision of family-centred cancer care at end of life. This could lead to better mental and physical outcomes for the whole family at end of life and in bereavement.

Experiences of cancer patients in receiving dietary advice from healthcare professionals and of healthcare professionals in providing this advice-a systematic review.

PURPOSE: This systematic review investigated qualitative and quantitative studies exploring patients and healthcare professionals' (HCP) experience of nutrition care throughout the cancer journey. METHODS: Five databases were systematically searched for studies reporting on patient and healthcare professionals' experience of nutrition advice. RESULTS: Fifteen studies including 374 patients and 471 healthcare professionals were included. Findings indicate that patients desire more specific nutrition advice supported by members of the multidisciplinary team and delivered in appropriate and understandable language. Healthcare professionals have highlighted a lack of time, funding, dietetic roles, and knowledge as barriers to integrating nutrition as a standard part of cancer care. Five themes were identified (current provision of nutrition advice, optimal provision of nutrition advice, tension between patient values and nutritional or HCP priorities, providing evidence-based nutrition care, and practical barriers to nutrition advice provision). CONCLUSIONS: Further work is essential to better understand and address identified barriers and improve the provision of nutrition advice to this population. IMPLICATIONS FOR CANCER SURVIVORS: Findings from this review will guide the delivery of nutrition advice for cancer survivors.

An Overview of the Fundamentals of Data Management, Analysis, and Interpretation in Quantitative Research.

OBJECTIVES: To provide an overview of three consecutive stages involved in the processing of quantitative research data (ie, data management, analysis, and interpretation) with the aid of practical examples to foster enhanced understanding. DATA SOURCES: Published scientific articles, research textbooks, and expert advice were used. CONCLUSION: Typically, a considerable amount of numerical research data is collected that require analysis. On entry into a data set, data must be carefully checked for errors and missing values, and then variables must be defined and coded as part of data management. Quantitative data analysis involves the use of statistics. Descriptive statistics help summarize the variables in a data set to show what is typical for a sample. Measures of central tendency (ie, mean, median, mode), measures of spread (standard deviation), and parameter estimation measures (confidence intervals) may be calculated. Inferential statistics aid in testing hypotheses about whether or not a hypothesized effect, relationship, or difference is likely true. Inferential statistical tests produce a value for probability, the P value. The P value informs about whether an effect, relationship, or difference might exist in reality. Crucially, it must be accompanied by a measure of magnitude (effect size) to help interpret how small or large this effect, relationship, or difference is. Effect sizes provide key information for clinical decision-making in health care. IMPLICATIONS FOR NURSING PRACTICE: Developing capacity in the management, analysis, and interpretation of quantitative research data can have a multifaceted impact in enhancing nurses' confidence in understanding, evaluating, and applying quantitative evidence in cancer nursing practice.

Factors that affect quality of life for older people with head and neck cancer: A systematic review.

PURPOSE: Quality of life is a critical aspect in the management of older head and neck cancer patients. It needs to be considered alongside survival benefit, treatment burden, and longer-term outcomes. The purpose was to undertake a systematic review of empirical peer-reviewed studies with a primary focus on factors impacting quality of life for older head and neck cancer patients. METHODS: A systematic review, searching 5 electronic databases (PsychoINFO, MEDLINE, CINHAL, Embase, and Scopus) using PRISMA methodology was conducted. Data was appraised using the Newcastle-Ottawa scale and a narrative synthesis performed. RESULTS: Only 10 papers fulfilled the inclusion criteria. Two main themes emerged: 1) Impact of head and neck cancer on quality of life domains and 2) quality of life in treatment decision-making. CONCLUSIONS: In an era of progressive personalised care, there is an evident need for more qualitative and quantitative studies focusing on quality of life for older head and neck cancer patients. However, older head and neck cancer patients experience notable differences, especially with poorer physical functioning and greater eating and drinking challenges. Quality of life impacts older patients decision-making, treatment planning and intensifies post-treatment support.

Cancer nursing research priorities: A rapid review.

PURPOSE: Identifying cancer nursing research priorities is central to influencing the direction of cancer care research. The aim of this rapid review was to explore research priorities identified by oncology nurses for cancer care delivery between 2019 and 2022. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis informed the design of the rapid review. MEDLINE, CINAHL, PUBMED, Web of Science, and Cochrane databases were searched for studies published between December 1st, 2018, and September 30th, 2022. This timeframe was chosen to account for the latest relevant evidence synthesis, as well as changes in cancer care necessitated by the COVID-19 pandemic. The Quality Assessment of Diverse Studies tool was used to appraise quality. RESULTS: Four studies met the inclusion criteria. Many of the research priorities identified were influenced by the COVID-19 pandemic. The top cancer nursing research priority identified was the role of technology in improving patient and caregiver symptoms and health outcomes. Other most prevalent research priorities were focused on symptom management, culturally sensitive palliative and psychosocial care, early/integrated palliative care, financial toxicity, modifiable risk factors related to social determinants of health, public and patient involvement in research, and oncology nurses' well-being and scope of practice. CONCLUSION: The findings indicate a need to steer a strategic programme of cancer nursing research towards digitalisation in cancer care to meet the current needs of people living with cancer and their caregivers. However, cancer nurses' burnout, staff shortages and disparities in specialist education will hinder the implementation of certain models of care.

Availability and use of web-based interventions for patients with head and neck cancer: a scoping review.

PURPOSE: To identify and review the nature, scope and use of web-based interventions for patients with head and neck cancer (HNC). METHOD: A scoping review guided by the methodological framework described by the Joanna Briggs Institute was performed to review empirical studies and websites. Seven electronic databases (CINAHL, Medline, Scopus, Embase, Cochrane, PubMed and PsycInfo) were searched from 2010 to 2020, data extracted and synthesised using thematic analysis. The Google search engine was employed, identifying the first 100 websites, using the search term head and neck cancer. Websites meeting eligibility criteria were assessed using the QUEST analysis tool, and descriptively summarised. RESULTS: Thirteen empirical studies and 32 websites were included. As identified by empirical studies, web-based interventions were developed to provide (1) patient information on HNC and related treatments, (2) advice and support during treatment and (3) management strategies promoting adjustment to life with and beyond HNC. The reviewed websites provided minimal information to aid shared decision-making and facilitate preparedness for treatment, with few utilising patient narratives. Web-based interventions for HNC patients were mainly text based and focused on survivorship. CONCLUSIONS: There is a paucity of theory-based, co-designed web-based interventions using patient narratives. IMPLICATIONS FOR CANCER SURVIVORS: As patients increasingly look to the internet for advice and support, healthcare professionals are in a position to provide high-quality web-based interventions. There is an opportunity to rigorously develop a web-based intervention, containing narratives of peoples' lives before and after HNC treatment, aiding decision-making, preparedness for treatment and self-management.

"It's part of our life now": a qualitative exploration of the social eating experiences of family members of patients living with head and neck cancer.

PURPOSE: Family members (FMs) of patients with head and neck cancer (HNC) report a change in their social eating experience. They miss out on the opportunities and benefits that eating with others provides. However, few studies investigate FM's social eating experiences, with existing research primarily focusing on the patient experience. Therefore, the aim of this study was to explore the social eating experiences of FMs of patients who have had treatment for HNC. METHODS: A qualitative research design using semi-structured interviews was used to understand FM's social eating experiences. Key themes were inductively developed from the data using reflexive thematic analysis. RESULTS: Twelve interviews were conducted with FMs, and three key themes were identified: (1) changes and challenges experienced by FMs due to HNC patients' social eating difficulties, (2) living with social eating changes is a balancing act, and (3) FMs' efforts to promote social eating for a patient with HNC. FMs expressed significant changes to their social eating habits within and outside the home, indicating the need for support to meet their own emotional, psychological and social needs. CONCLUSION: FMs experience many demands and tensions, having to balance the psychological impact they experience, which are often minimised, whilst attempting to find the best ways to support, protect and encourage their loved ones to adjust and adapt to social eating changes. Therefore, interventions need to support FMs' challenges and equip them to know how to best support patients living with HNC and themselves.

'I didn't know what was in front of me'-Bereaved parents' experience of adapting to life when a co-parent of dependent children has died with cancer.

OBJECTIVE: It is not clear how the bereaved parent navigates life with the children after a co-parent has died. The objective of this study is to explore bereaved parents' experience of managing life when a co-parent of dependent children has died with cancer. METHODS: Twenty-one in-depth interviews were conducted with bereaved parents when a co-parent died with cancer. Data were analysed thematically. RESULTS: Bereaved parents highlighted how their children was their key focus after the death of a co-parent with cancer, as they effortfully strived to be a 'perfect parent'. While some bereaved parents struggled to adapt to the role as a sole parent, others described the importance of maximising social networks to help with the practical aspects of parenting. However, most bereaved parents described intense feelings of loneliness as they navigated parenting alone. To help navigate this post-bereavement period, parents considered it important for their children to openly talk about the deceased parent. Also, meeting others who have experienced similar situations was helpful for the bereaved parent and children, providing hope for the future. Results are discussed under two themes: (1) adapting to life without the parent, and (2) a desire to keep the memory alive of the parent that died with cancer. CONCLUSIONS: Bereaved parents should be encouraged to practice self-care when a co-parent has died from cancer so they can appropriately meet the needs of their children. Bereaved parents should be reassured that showing emotion in front of the children is helpful and could facilitate better grief experiences for the whole family.

Enhancing healthcare professional-led sexual support in cancer care: Acceptability and usability of an eLearning resource and its impact on attitudes towards providing sexual support.

OBJECTIVE: Barriers to healthcare professional (HP) (HP)-led sexual support in cancer care include lack of knowledge, skills and evidence-based educational interventions, to equip HPs to address sexual challenges faced by patients and partners. Consequently, sexual support is often avoided. This study examined HPs' acceptability and usability of the Maximising Sexual Wellbeing: Cancer Care (MSW|CC) eLearning resource for HPs and evaluated its impact on HPs' sexual attitudes and beliefs to providing sexual support in cancer care. METHODS: HPs (n = 87) completed pre and post-test surveys using the modified 12-item Sexual Attitudes and Beliefs Scale (SABS). Post-test, participants rated acceptability and usability of the MSW|CC, with optional free-text comments. A repeated measures t-test assessed changes in HPs' scores on the SABS. Descriptive statistics and reporting of free text comments were used to explore HPs' perspectives of the MSW|CC. RESULTS: SABS scores increased significantly from Time 1 (M = 35.1, SD = 4.8) to Time 2 (M = 40.1, SD = 4.3), t (86) = -10.2, p < 0.001 (two-tailed) with a medium effect size (d = 0.55); indicating a decrease in HPs' attitudinal barriers to providing sexual support. The MSW|CC was deemed acceptable, user-friendly and easy to navigate. Healthcare professionals would recommend the use of this eLearning resource to others (3.78/4, SD = 0.5), considered it a good informational resource (3.78/4, SD = 0.5) and straightforward to use (3.8/4, SD 0.42). DISCUSSION/CONCLUSION: The MSW|CC reduced HPs' attitudinal barriers towards the provision of HP-led sexual support in cancer care, whilst being acceptable and useable. The MSW|CC could support implementation of global clinical guidelines advocating for HP-led sexual support across the treatment trajectory.

An Economic Evaluation Supported by Qualitative Data About the Patient Concerns Inventory (PCI) versus Standard Treatment Pathway in the Management of Patients with Head and Neck Cancer.

BACKGROUND: The head and neck cancer (HNC) Patient Concerns Inventory (PCI) is a condition-specific prompt list that allows patients to raise concerns to cancer consultants that otherwise might be overlooked. OBJECTIVE: This is the first economic evaluation of the PCI in patients with HNC investigating the costs and effects to the health service of not prioritising certain treatment pathways in addition to the primary cancer pathway. Additional costs can be accrued due to delayed referral to other appropriate services, e.g. hospital dentist. Economic evidence could influence future policy direction in this area globally. METHODS: Alongside a 3-year clustered randomised controlled trial, an economic evaluation was undertaken with Client Service Receipt Inventory data collected at three different time points (baseline and 6 and 12 months post-baseline). Patients were identified by a multidisciplinary team at the trial clinics. This economic analysis compared the PCI intervention versus the non-PCI treatment pathway. A deterministic and probabilistic sensitivity analysis was conducted to investigate the cost per quality-adjusted life-year (QALY) gain of the PCI versus non-PCI intervention treatment pathways. Qualitative data were also collected from seven consultants to triangulate findings from the economic evaluation. RESULTS: The analysis used data from 191 patients (66% of the full trial sample). The PCI inventory was low cost, at just over £13 per participant. The PCI intervention was cost effective and also cost saving, with an incremental cost difference of £295.91 over the 12-month follow-up period. The QALY values were higher in the PCI intervention strategy, with a value of 0.79, whereas the non-PCI group had a value of 0.76, thus the PCI intervention was dominant. The sensitivity analysis showed that, at a willingness-to-pay threshold of £20,000 per QALY gained, the probability of being cost effective was 0.85 (95% confidence interval [CI] 0.80-0.83). Qualitative results showed that consultants using the PCI reported an enhanced awareness of patients' overall post-treatment needs. DISCUSSION: The PCI provided an effective means to conduct clinical consultations by avoiding unnecessary healthcare costs and focussing on aspects of care most important to patients. The cost per QALY gain was within the National Institute for Health and Care Excellence guideline threshold. The economic evaluation showed that the PCI intervention strategy was dominant and therefore cost saving to the national health service (NHS) and was more effective in terms of treatment. CONCLUSION: The PCI appears to be a low-cost intervention that generates a cost-effective benefit to patients from a NHS perspective if rolled out as part of routine care. Qualitative evidence has shown that the use of the PCI is supported by consultants in routine practice. TRIAL REGISTRATION: Clinical Trials Identifier: NCT03086629.

Experiences and perceptions of social eating for patients living with and beyond head and neck cancer: a qualitative study.

PURPOSE: Patients with head and neck cancer (HNC) describe eating as more than a physical activity for nutrition and calories. After treatment for HNC, patients report a changed social experience around food, with eating and drinking in front of family and friends depicted as a challenge. However, there is limited research exploring how patients with HNC adapt and cope with social eating difficulties. This study aims to explore patients' experiences and perceptions of social eating and drinking following treatment for HNC. METHODS: A qualitative research design using semi-structured interviews was employed to understand the experiences of social eating of patients living with and beyond HNC. Reflexive thematic analysis was used to inductively develop key themes from the data. RESULTS: Fourteen interviews were conducted with patients, and two key themes were identified: (1) "Social eating became a conscious process" and (2) "Strategies to maximise social eating participation". To maximise social eating enjoyment, patients attempted to minimise the attention on their eating function and the fuss created around food. Patients with HNC established psychological and cognitive adaptations to manage expectations and promote positive participation in social eating. CONCLUSION: This paper identifies key barriers limiting or diminishing social eating for patients with HNC; including being self-conscious, lack of understanding from others and functional issues with eating and drinking. This research highlights the need to raise awareness of social eating challenges and for the social dimensions of eating to be addressed through family-centred, supportive holistic interventions implemented early in the patient's cancer journey.