Imperial College London

DrAlexKing

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3312 1658alex.king Website

 
 
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Location

 

Department of Clinical Health PsychologyClarence WingSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
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15 results found

Le Boutillier C, Jeyasingh-Jacob J, Jones L, King A, Archer S, Urch Cet al., 2023, Improving personalised care and support planning for people living with treatable-but-not-curable cancer., BMJ Open Qual, Vol: 12

People living with treatable-but-not-curable (TbnC) cancer encounter cancer-related needs. While the NHS long-term plan commits to offering a Holistic Needs Assessment (HNA) and care plan to all people diagnosed with cancer, the content, delivery and timing of this intervention differs across practice. Understanding how people make sense of their cancer experience can support personalised care. A conceptual framework based on personal narratives of living with and beyond cancer (across different cancer types and all stages of the disease trajectory), identified three interlinked themes: Adversity, Restoration and Compatibility, resulting in the ARC framework.Our aim was to use the ARC framework to underpin the HNA to improve the experience of personalised care and support planning for people living with TbnC cancer. We used clinical work experience to operationalise the ARC framework and develop the intervention, called the ARC HNA, and service-level structure, called the ARC clinic. We sought expert input on the proposed content and structure from patients and clinicians through involvement and engagement activities. Delivered alongside standard care, the ARC HNA was piloted with patients on the TbnC cancer (myeloma and metastatic breast, prostate or lung) pathway, who were 6-24 months into their treatment. Iterations were made to the content, delivery and timing of the intervention based on user feedback.Fifty-one patients received the intervention. An average of 12 new concerns were identified per patient, and 96% of patients achieved at least one of their goals. Patients valued the space for reflection and follow-up, and clinicians valued the collaborative approach to meeting patients' supportive care needs. Compared with routine initial HNA and care plan completion rates of 13%, ARC clinic achieved 90% with all care plans shared with general practitioners. The ARC clinic adopts a novel and proactive approach to delivering HNAs and care plans in a meaningful and

Journal article

Wade-Mcbane K, King A, Urch C, Jeyasingh-Jacob J, Milne A, Le Boutillier Cet al., 2023, Prehabilitation in the lung cancer pathway: a scoping review, BMC Cancer, Vol: 23, Pages: 1-35, ISSN: 1471-2407

BackgroundLung cancer is the third most common type of cancer in the UK. Treatment outcomes are poor and UK deaths from lung cancer are higher than any other cancer. Prehabilitation has shown to be an important means of preparing patients both physically and psychologically for cancer treatment. However, little is understood about the context and mechanisms of prehabilitation that can impact physiological and psychological wellbeing.Our aim was to review and summarise primary research on prehabilitation in the lung cancer pathway using a realist approach.MethodsA scoping review of empirical primary research was conducted. Five online medical databases from 2016 – February 2023 were searched. All articles reporting on prehabilitation in lung cancer were included in the review. For this review, prehabilitation was defined as either a uni-modal or multi-modal intervention including exercise, nutrition and/or psychosocial support within a home, community or hospital based setting. A realist framework of context, mechanism and outcome was used to assist with the interpretation of findings.ResultsIn total, 31 studies were included in the review, of which, three were published study protocols. Over 95% of studies featured an exercise component as part of a prehabilitation programme. Twenty-six of the studies had a surgical focus. Only two studies reported using theory to underpin the design of this complex intervention. There was large heterogeneity across all studies as well as a lack of clinical trials to provide definitive evidence on the programme design, setting, type of intervention, patient criteria, delivery, duration and outcome measures used.ConclusionA standardised prehabilitation programme for lung cancer patients does not yet exist. Future lung cancer prehabilitation programmes should take into account patient led values, needs, goals, support structures and beliefs, as these factors can affect the delivery and engagement of interventions. Future researc

Journal article

Stewart S-JF, Slodkowska-Barabasz J, McGeagh L, Moon Z, Brett J, Wells M, Brown MC, Turner M, Horne R, Fenlon D, Rehman F, Cain H, Donnelly P, Harmer V, Turner L, Rose J, Sharp L, Watson E, SWEET Research Teamet al., 2023, Development of the HT&Me intervention to support women with breast cancer to adhere to adjuvant endocrine therapy and improve quality of life., Breast, Vol: 70, Pages: 32-40

BACKGROUND: Breast cancer is the most common cancer in women worldwide. Approximately 80% of breast cancers are oestrogen receptor positive (ER+). Patients treated surgically are usually recommended adjuvant endocrine therapy (AET) for 5-10 years. AET significantly reduces recurrence, but up to 50% of women do not take it as prescribed. OBJECTIVE: To co-design and develop an intervention to support AET adherence and improve health-related quality-of-life (QoL) in women with breast cancer. METHODS: Design and development of the HT&Me intervention took a person-based approach and was guided by the Medical Research Council framework for complex interventions, based on evidence and underpinned by theory. Literature reviews, behavioural analysis, and extensive key stakeholder involvement informed 'guiding principles' and the intervention logic model. Using co-design principles, a prototype intervention was developed and refined. RESULTS: The blended tailored HT&Me intervention supports women to self-manage their AET. It comprises initial and follow-up consultations with a trained nurse, supported with an animation video, a web-app and ongoing motivational 'nudge' messages. It addresses perceptual (e.g. doubts about necessity, treatment concerns) and practical (e.g. forgetting) barriers to adherence and provides information, support and behaviour change techniques to improve QoL. Iterative patient feedback maximised feasibility, acceptability, and likelihood of maintaining adherence; health professional feedback maximised likelihood of scalability. CONCLUSIONS: HT&Me has been systematically and rigorously developed to promote AET adherence and improve QoL, and is complemented with a logic model documenting hypothesized mechanisms of action. An ongoing feasibility trial will inform a future randomised control trial of effectiveness and cost-effectiveness.

Journal article

Wade-Mcbane K, King A, Urch C, Johansson L, Wells Met al., 2023, Is personalised prehabilitation feasible to implement for patients undergoing oncological treatment for lung cancer at a London teaching hospital? Protocol of a feasibility trial, BMJ Open, Vol: 13, Pages: 1-9, ISSN: 2044-6055

Introduction:There is significant potential to improve outcomes for patients with lung cancer in terms of quality of life and survival. There is some evidence that prehabilitation can help, but, to date, this has only been tested in surgical populations, despite 70-80% of lung cancer patients in the UK receiving non-surgical treatment. The physiological and psychological benefits of prehabilitation seen in surgical patients could be extrapolated to those receiving non-surgical treatment, particularly in such a poor prognosis group. With patients and healthcare professionals, we have co-designed a personalised and evidence-based prehabilitation programme. This draws on a conceptual framework that aligns with patient values and needs as well as functional goals. We aim to investigate whether this programme is feasible to implement and evaluate in clinical practice.Methods and analysis:An open-label, single-group feasibility study incorporating quantitative assessments, a qualitative free text questionnaire and reflective field notes. Thirty participants will be recruited over an eight-month period from a single London teaching hospital. All recruited participants will receive a personalised prehabilitation programme during their oncological treatment. This includes a one-hour face-to-face appointment prior to, at week three and at week six of their treatment regimen as well as a weekly telephone call. Interventions including nutrition, physical activity and psychological wellbeing are stratified according to a patient’s priorities, level of readiness and expressed needs. The primary outcome will be feasibility of the personalised prehabilitation programme in clinical practice by investigating areas of uncertainty regarding patient recruitment, attrition, treatment fidelity, intervention adherence and acceptability of study outcome measures. Secondary outcomes will include quality of life, functional capacity and grip strength.Ethics and dissemination:Ethical app

Journal article

Cotter P, Holden A, Johnson C, Noakes S, Urch C, King Aet al., 2022, Coping With the Emotional Impact of Working in Cancer Care: The Importance of Team Working and Collective Processing, FRONTIERS IN PSYCHOLOGY, Vol: 13, ISSN: 1664-1078

Journal article

LeBoutillier C, Urch C, King A, Barry C, Mansfield L, Archer Set al., 2022, ‘Still living with it even though it’s gone’: Using Interpretive Phenomenological Analysis to explore shared experiences of living with and beyond breast, prostate, and colorectal cancer, European Journal of Oncology Nursing (EJON), Vol: 56, ISSN: 1462-3889

Purpose:Living with and beyond cancer is an increasingly common experience. While research is uncovering valuable individual experiences of those living with and beyond cancer, it has been argued that this idiographic approach is limited in outlook, reach and impact. This study contributes to the understanding of what it means to live with and beyond cancer by complementing idiographic knowledge with multiple perspectives from a group of participants who are living with and beyond cancer, to explore how individual experiences may be relevant to others.Method:Semi-structured interviews were conducted with people who had received treatment for breast (n = 6), prostate (n = 6) or colorectal cancer (n = 6). Data were analysed using interpretive phenomenological analysis. The early findings were then shared with a wider group of people who had received treatment for breast, prostate or colorectal cancer (n = 26) in six focus groups, to explore whether they had similar experiences.Results:While individual accounts of living with and beyond cancer detail unique features specific to each person's experience, focus group discussions illustrated how participant life worlds interact and overlap. The findings identified thematic similarities within and between individual and group levels and across cancer types. Three super-ordinate themes describe the shared experience of living with and beyond cancer: i) the cancer shock, ii) managing cancer and getting through and iii) getting over cancer.Conclusions:A multiple perspective approach informs our understanding of shared experiences of living with and beyond cancer. This knowledge can be used to direct, design, and deliver relevant supportive cancer care.

Journal article

Marcus D, King A, Yazbek J, Hughes C, Ghaem-Maghami Set al., 2021, Anxiety and stress in women with suspected endometrial cancer: Survey and paired observational study, Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer, Vol: 30, Pages: 1939-1400, ISSN: 1057-9249

ObjectiveTo determine the anxiety and stress levels of women with suspected endometrial cancer and factors affecting this.MethodsProspective survey and paired observational study of consecutive women with suspected endometrial cancer in a rapid access gynaecology clinic. Structured questionnaire including a GAD-7 anxiety test and a modified stress thermometer were used. Patients ranked their perception of a cancer diagnosis on 0-5 Likert scale (0 = confident not cancer and 5 = cancer). Patients requiring an endometrial tissue biopsy were asked to rank their pain on a visual analogue scale (VAS), this was paired with the survey results.Results250 patients completed the study and 23 of which underwent an endometrial tissue biopsy. The median age was 50-59 years old and 59% of women spoke English as their first language. 32% of patients had significant levels of anxiety with GAD-7 score ≥10. The median stress score was three out of five on Likert scale. GAD-7 anxiety scores were higher in women who perceived that they received insufficient information prior to clinic (sufficient information 5 vs. insufficient information 9.5, P = 0.00036) or had a disability (disability 9 vs. no disability 5.5, P = 0.00374). The median VAS score from the biopsies was seven out of 10 (range 1-10). Patients with higher anxiety levels (GAD-7 scores) were more likely to believe they had cancer P <0.00001.ConclusionsThese findings confirm high levels of anxiety and stress in women with suspected endometrial cancer. Adequate pre-clinic information is essential, particularly for minority groups.

Journal article

Le Boutillier C, Archer S, Barry C, King A, Mansfield L, Urch Cet al., 2019, Conceptual framework for living with and beyond cancer: A systematic review and narrative synthesis, Psycho-Oncology, Vol: 28, Pages: 948-959, ISSN: 1057-9249

ObjectiveThe concept of living with and beyond cancer is now emerging in policy and literature. Rather than viewing this notion simply as a linear timeline, developing an agreed understanding of the lived experience of people affected by cancer will aid the development of personā€centred models of care.MethodsA systematic review was conducted. The review question was “What does the term ‘living with and beyond cancer’ mean to people affected by cancer?” The protocol for the review was preregistered in the PROSPERO database (PROSPERO CRD42017059860). All included studies were qualitative, so narrative synthesis was used to integrate descriptions and definitions of living with and beyond cancer into an empirically based conceptual framework.ResultsOut of 2345 papers that were identified and 180 that were reviewed, a total of 73 papers were included. The synthesis yielded three interlinked themes: Adversity (realising cancer), Restoration (readjusting life with cancer), and Compatibility (reconciling cancer), resulting in the ARC framework.ConclusionsThree themes describe the experience of living with and beyond cancer: adversity, restoration, and compatibility. The ARC framework provides an empirically informed grounding for future research and practice in supportive cancer care for this population.

Journal article

Halliday L, Wynter-Blyth V, Osborn H, King A, Moorthy Ket al., 2017, Adherence to prehabilitation in oesophago-gastric cancer patients, Clinical Nutrition ESPEN, Vol: 19, Pages: 90-90, ISSN: 2405-4577

Journal article

Wynter-Blyth V, Halliday L, King A, Osborn H, Moorthy Ket al., 2017, The role of self-efficacy in prehabilitation and its impact on post-operative recovery, Clinical Nutrition ESPEN, Vol: 19, Pages: 89-89, ISSN: 2405-4577

Journal article

King A, 2017, Behind the bright headlines, mind the long shadows, PSYCHO-ONCOLOGY, Vol: 26, Pages: 588-592, ISSN: 1057-9249

Journal article

King A, 2016, The next challenge for psycho-oncology in the UK: targeting service quality and outcomes, FUTURE ONCOLOGY, Vol: 12, Pages: 2811-2816, ISSN: 1479-6694

Journal article

King A, 2016, Making connections for a biopsychosocial future in cancer care, FUTURE ONCOLOGY, Vol: 12, Pages: 2767-2769, ISSN: 1479-6694

Journal article

Munro H, Scott SE, King A, Grunfeld EAet al., 2015, Patterns and predictors of disclosure of a diagnosis of cancer, PSYCHO-ONCOLOGY, Vol: 24, Pages: 508-514, ISSN: 1057-9249

Journal article

King A, Hulbert-Williams N, Flynn S, 2015, Psychological Care and Support for People affected by Cancer, Cancer and Cancer Care, Publisher: SAGE Publications Ltd, Pages: 327-342

Book chapter

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