Publications
55 results found
Thibaut B, Dewa L, Ramtale S, et al., 2019, Patient safety in inpatient mental health settings: a systematic review, BMJ Open, Vol: 9, Pages: 1-19, ISSN: 2044-6055
Objectives: Patients in inpatient mental health settings face similar risks to those in other areas of health care (e.g. medication errors). In addition, some unsafe behaviours associated with serious mental health problems (e.g. self-harm), and the measures taken to address these (e.g. restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. Design: Systematic review and meta-synthesis. Embase, CINAHL, HMIC, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to “mental health”, “patient safety”, “inpatient setting” and “research”. Study quality was assessed using the Hawker checklist. Data was extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random effects model.Results: Of the 57,637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150,000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. Conclusions: Patient safety in inpatient mental health settings is under researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety which require investment in research, policy development, and translation into clinical practice.
Reynolds J, Archer S, Pilling M, et al., 2019, Public acceptability of nudging and taxing to reduce consumption of alcohol, tobacco, and food: A population-based survey experiment, Social Science and Medicine, Vol: 236, Pages: 1-10, ISSN: 0277-9536
There is growing evidence for the effectiveness of choice architecture or ‘nudge’ interventions to change a range of behaviours including the consumption of alcohol, tobacco and food. Public acceptability is key to implementing these and other interventions. However, few studies have assessed public acceptability of these interventions, including the extent to which acceptability varies with the type of intervention, the target behaviour and with evidence of intervention effectiveness. These were assessed in an online study using a between-participants full factorial design with three factors: Policy (availability vs size vs labelling vs tax) x Behaviour (alcohol consumption vs tobacco use vs high-calorie snack food consumption) x Evidence communication (no message vs assertion of policy effectiveness vs assertion and quantification of policy effectiveness [e.g., a 10% change in behaviour]). Participants (N = 7058) were randomly allocated to one of the 36 groups. The primary outcome was acceptability of the policy. Acceptability differed across policy, behaviour and evidence communication (all ps < .001). Labelling was the most acceptable policy (supported by 78%) and Availability the least (47%). Tobacco use was the most acceptable behaviour to be targeted by policies (73%) compared with policies targeting Alcohol (55%) and Food (54%). Relative to the control group (60%), asserting evidence of effectiveness increased acceptability (63%); adding a quantification to this assertion did not significantly increase this further (65%). Public acceptability for nudges and taxes to improve population health varies with the behaviour targeted and the type of intervention but is generally favourable. Communicating that these policies are effective can increase support by a small but significant amount, suggesting that highlighting effectiveness could contribute to mobilising public demand for policies. While uncertainty remains about the strength of public supp
Phillips E, Archer S, Montague J, et al., 2019, Experiences of enhanced recovery after surgery in general gynaecology patients: an interpretative phenomenological analysis, Health Psychology Open, ISSN: 2055-1029
Archer SA, Pinto A, Vuik S, et al., 2019, Surgery, complications and quality of life: a longitudinal cohort study exploring the role of psychosocial factors, Annals of Surgery, Vol: 270, Pages: 95-101, ISSN: 0003-4932
Objective:To determine if psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).Summary Background:Patients who experience surgical complications have significantly worse post-operative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear if they impact on QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients post-operatively. Methods:This is a longitudinal cohort study; data were collected at pre-op, 1 month post-op, 4 months post-op and 12 months post-op. A total of 785 patients undergoing major elective gastro-intestinal, vascular or cardio-thoracic surgery were recruited from 28 National Health Service (NHS) sites in England and Scotland took part in the study.Results:Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (p<0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.Conclusion:Surgical complications alongside other socio-demographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies prior to surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow up procedures.
Sabharwal S, Archer S, Cadoux-Hudson D, et al., 2019, Exploring elderly patients' experiences of recovery following complex proximal humerus fracture: A qualitative study., J Health Psychol, Pages: 1359105319850883-1359105319850883
This study explores the experiences and perceptions of recovery in elderly patients who had sustained a proximal humerus fracture. In-depth semi-structured interviews were conducted with 15 patients over the age of 65. Thematic analysis identified aspects of care that impacted upon patient experience and quality of life. Seven main patient-reported themes were identified, including pain, sleep, shoulder function, emotional state, social support, relationship with their professional and experience of healthcare institution. These themes offer insight into the experiences of adults receiving care for proximal humerus fracture and highlight that existing quantitative measures of quality of life do not measure domains that are important to patients.
Shah N, Martin G, Archer S, et al., 2019, Exploring mobile working in healthcare: Clinical perspectives on transitioning to a mobile first culture of work, International Journal of Medical Informatics, Vol: 125, Pages: 96-101, ISSN: 1386-5056
ObjectivesThis study investigated the views of healthcare professionals (HCPs) as end-users of mobile technologies to inform the requirements for a successful move towards a mobile first culture of work within secondary care. Many HCPs already used mobile devices to support their day-to-day practice and so transitioning to an organisational led mobile way of working is both needed and timely.Materials and methodsIn-depth focus groups and interviews at a UK academic hospital were conducted with HCPs (nurses, doctors, and allied health professionals). The interviews elicited views from HCPs about the use of mobile technologies in their clinical work and discussed their experiences of previous technology deployments.ResultsThirty-four HCPs participated. Three themes were identified: integrating mobile working in hospital care; addressing data governance and accountability for mobile working; and handling the pace of change. The acceptance of mobile working is determined by whether it enhances, rather than hinders clinical practice whilst holding end-user’s confidence; measuring the impact of the administrative burden on workload, changes to professional accountability and safeguarding patient data are serious issues that need consideration; and the pace of change needs to work for all stakeholders.Discussion and conclusionsThe benefits of adopting mobile technologies are well recognised, however, technical and policy related factors identified by professional end-users require answers in order to successfully integrate mobile working into current practice. Adopting a mobile first approach to work is timely and achievable, but can only be delivered on a foundation of positive end-user engagement and strong organisational leadership.
Le Boutillier C, Archer S, Barry C, et 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 person‐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.
Pannick S, Archer S, Long S, et al., 2019, What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards, BMJ Open, Vol: 9, ISSN: 2044-6055
Objectives To compare the quality metrics selected for public display on medical wards to patients’ and carers’ expressed quality priorities.Methods Multimodal qualitative evaluation of general medical wards and semi-structured interviews.Setting UK tertiary National Health Service (public) hospital.Participants Fourteen patients and carers on acute medical wards and geriatric wards.Results Quality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients’ trust in their medical teams. More philosophically, patients’ and carers’ ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients’ and carers’ lack of control in this inpatient setting.Conclusions There is a gap between general medical inpatients’ care priorities and the aspects of care that are publicly reported. Patients and carers do not act as ‘informed choosers’ of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.
Pucher P, Johnston M, Archer S, et al., 2019, Informing the consent process for surgeons: A survey study of patient preferences, perceptions and risk tolerance, Journal of Surgical Research, Vol: 235, Pages: 298-302, ISSN: 0022-4804
BackgroundDespite the ethical and statutory requirement to obtain consent for surgical procedures, the actual process itself is less well defined. The degree of disclosure and detail expected may vary greatly. A recent shift toward a more patient-centered approach in both clinical and medico-legal practice has significant implications for ensuring appropriate and legal practice in obtaining informed consent before surgery.MethodsTwo hundred patients undergoing elective surgery across two hospitals returned a survey of attitudes toward consent, perceived important elements in the consent process, and risk tolerance, as well as demographic details.ResultsNo significant associations between patient demographics and survey responses were found. Patients were least concerned with the environment in which consent was taken and the disclosure of uncommon complications. The most important factors related to communication and rapport between clinician and patients, as opposed to procedure- or complication-specific items. A majority of patients preferred risks to be described using proportional descriptors, rather than percentage or non-numeric descriptors.ConclusionsRisk tolerance and desired level of disclosure varies for each patient and should not be presumed to be covered by standardized proformas. We suggest an individualized approach, taking into account each patient's background, understanding, and needs, is crucial for consent. Communications skills must be prioritized to ensure patient satisfaction and reduced risk of litigation.
Archer SA, Holland FG, Montague J, 2018, ‘Do you mean I’m not whole?’: Exploring the role of support in women’s experiences of mastectomy without reconstruction, Journal of Health Psychology, Vol: 23, Pages: 1598-1609, ISSN: 1461-7277
This study explores the role of others in supporting younger women who opt not to reconstruct their breast post-mastectomy. Semi-structured interviews were conducted with six women, diagnosed with breast cancer in their 30s/40s. The women lived in England, had been diagnosed a minimum of 5 years previously and had undergone unilateral mastectomy. An interpretative phenomenological analysis revealed three themes; Assuring the self: “I’ll love you whatever”, Challenging the self: ‘Do you mean I’m not whole?’, and Accepting the self: ‘I’ve come out the other side’. The women’s experiences of positive support and challenges to their sense of self are discussed.
Wahl J, Sheffield D, Maratos F, et al., 2018, Development of a Compassion for Cancer curriculum for female breast cancer patients in stages I-III and cancer survivors. Origins, rationale and initial observations, Mindfulness and Compassion
Dewa LH, Murray K, Thibaut B, et al., 2018, Identifying research priorities for patient safety in mental health: an international expert Delphi study, BMJ Open, Vol: 8, ISSN: 2044-6055
Objective Physical healthcare has dominated the patient safety field; research in mental healthcare is not as extensive but findings from physical healthcare cannot be applied to mental healthcare because it delivers specialised care that faces unique challenges. Therefore, a clearer focus and recognition of patient safety in mental health as a distinct research area is still needed. The study aim is to identify future research priorities in the field of patient safety in mental health.Design Semistructured interviews were conducted with the experts to ascertain their views on research priorities in patient safety in mental health. A three-round online Delphi study was used to ascertain consensus on 117 research priority statements.Setting and participants Academic and service user experts from the USA, UK, Switzerland, Netherlands, Ireland, Denmark, Finland, Germany, Sweden, Australia, New Zealand and Singapore were included.Main outcome measures Agreement in research priorities on a five-point scale.Results Seventy-nine statements achieved consensus (>70%). Three out of the top six research priorities were patient driven; experts agreed that understanding the patient perspective on safety planning, on self-harm and on medication was important.Conclusions This is the first international Delphi study to identify research priorities in safety in the mental field as determined by expert academic and service user perspectives. A reasonable consensus was obtained from international perspectives on future research priorities in patient safety in mental health; however, the patient perspective on their mental healthcare is a priority. The research agenda for patient safety in mental health identified here should be informed by patient safety science more broadly and used to further establish this area as a priority in its own right. The safety of mental health patients must have parity with that of physical health patients to achieve this.
Holland FG, Petersen K, Archer SA, 2018, Thresholds of size: An interpretative phenomenological analysis of childhood messages around body, health and weight, Journal of Critical Dietetics, Vol: 4, Pages: 25-36, ISSN: 1923-1237
This study explores the lived experiences of non-dieting, middle-aged Western women classified as ‘overweight’ or ‘obese’ onBMI charts. Qualitative research that has focused on non-weight loss experiences with this population has been rare. Thisstudy aims to allow their experiences to be heard within the mainstream health literature. Four women from aged 40-55years were interviewed about their early messages and experiences around food, body, health and weight. An interpretativephenomenological analysis was conducted. Three themes were identified: 1) family culture and body norms 2) thresholds ofsize and 3) action and outcome. Participants identified a range of influences upon their early body appraisal, with parents,extended family, peers and community members contributing to their understanding of what constituted as an acceptablesize. The impact upon their sense of identity and emotional wellbeing is discussed. This study contributes to the role of themodelling and messages around size and value given by important others and the psychological ramifications these can haveover time.
Archer SA, Hull L, Soukup T, et al., 2017, Development of a Theoretical Framework of Factors Affecting Patient Safety Incident Reporting: A Theoretical Review of the Literature, BMJ Open, Vol: 7, ISSN: 2044-6055
Objectives The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting.Design To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers.Results The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators).Conclusion A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement.
Phillips E, Montague J, Archer SA, 2017, "A peculiar time in my life": Making sense of illness and recovery with gynaecological cancer, International Journal of Qualitative Studies on Health & Well-Being, Vol: 12, ISSN: 1748-2623
Worldwide there are nearly 1.1 million new cases of gynaecological cancer annually. In England, uterine, ovarian and cervical cancers comprize the third most common type of new cancer in women. Research with gynaecological cancer patients within 6 months of diagnosis is rare, as is data collection that is roughly contemporaneous with treatment. Our aim was to explore the experiences of women who were, at study entry, within 6 weeks of surgery or were undergoing chemotherapy or radiotherapy. Methods: An interpretative phenomenological analysis (IPA) of data from 16 women in five focus groups was conducted in the UK, exploring women’s experiences of being diagnosed with and treated for gynaecological cancer. Results: Participants conceptualized their experiences temporally, from the shock of diagnosis, through their cancer treatment, to thinking about recovery. They tried to make sense of diagnosis, even with treatment being complete. In the context of the Self-Regulation Model, these women were struggling to interpret a changing and multi-faceted illness identity, and attempting to return to pre-illness levels of health. Conclusions: This study adds to this under-studied time period in cancer survivorship. The results suggest that survivors’ goals may change from returning to pre-illness status to reformulating goals as survival time increases.
Callender T, Riley J, Droney J, et al., 2017, The determinants of dying where we choose: an analysis of coordinate my care, Annals of Internal Medicine, Vol: 167, Pages: 519-521, ISSN: 1539-3704
Pannick SAJ, Archer S, Johnston MJ, et al., 2017, Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards, BMJ Open, Vol: 7, ISSN: 2044-6055
ObjectivesTo understand how frontline reports of day-to-day care failings might be better translated into improvement.DesignQualitative evaluation of an interdisciplinary team intervention to capitalise on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS.ResultsPCTS fostered psychological safety – a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and the relative comfort afforded by the avoidance of accountability. At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described.ConclusionsProspective safety strategies relying on staff-volunteered data do approximate the realities of frontline care, but still produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, they give managers access to these accounts, and support frontline staff to make incremental changes in their daily work. These are
D'Lima D, Crawford M, Darzi A, et al., 2017, Patient safety and quality of care in mental health: a world of its own?, BJPsych Bulletin, Vol: 41, Pages: 241-243, ISSN: 2056-4694
Quality and safety in healthcare, as an academic discipline, has made significant progress over recent decades, and there is now an active and established community of researchers and practitioners. However, work has predominantly focused on physical health, despite broader controversy regarding the attention paid to, and significance attributed to, mental health. Work from both communities is required in order to ensure that quality and safety is actively embedded within mental health research and practice and that the academic discipline of quality and safety accurately represents the scientific knowledge that has been accumulated within the mental health community.
D'Lima D, Archer SA, Thibaut B, et al., 2016, A systematic review of Patient Safety in Mental Health: a protocol based on the Inpatient Setting, Systematic Reviews, Vol: 5, ISSN: 2046-4053
Background Despite the growing international interest in patient safety as a discipline, there has been a lack of exploration of its application to mental health. It cannot be assumed that findings based upon physical health in acute care hospitals can be applied to mental health patients, disorders and settings. To the authors’ knowledge, there has only been one review of the literature that focuses on patient safety research in mental health settings, conducted in Canada in 2008. We have identified a need to update this review and develop the methodology in order to strengthen the findings and disseminate internationally for advancement in the field. This systematic review will explore the existing research base on patient safety in mental health within the inpatient setting. Methods To conduct this systematic review, a thorough search across multiple databases will be undertaken, based upon four search facets (“mental health”, “patient safety”, “research” and “inpatient setting”). The search strategy has been developed based upon the Canadian review accompanied with input from the National Reporting and Learning System (NRLS) taxonomy of patient safety incidents and the Diagnostic and Statistical Manual of Mental Disorders (5th edition). The screening process will involve perspectives from at least two researchers at all stages with a third researcher invited to review when discrepancies require resolution. Initial inclusion and exclusion criteria have been developed and will be refined iteratively throughout the process. Quality assessment and data extraction of included articles will be conducted by at least two researchers. A data extraction form will be developed, piloted and iterated as necessary in accordance with the research question. Extracted information will be analysed thematically. Discussion We believe that this systematic review will make a significant contribution to the advancement of p
Phillips E, Montague J, Archer SA, 2016, Worlds within worlds: a strategy for using interpretative phenomenological analysis with focus groups, Qualitative Research in Psychology, Vol: 13, Pages: 289-302, ISSN: 1478-0895
There is increasing interest in applying Interpretative Phenomenological Analysis (IPA) to focus group data, and in developing appropriate strategies for doing so. These strategies should exploit the unique features of focus groups, which provide a rich canvas of experiences not seen in individual interviews, while remaining true to the personal, phenomenological perspective of IPA. We present a four-stage approach with specific group focused analytical strategies: looking for ‘groupness’, clustering reoccurring group interactions, identifying interactional relationships, and incorporating group elements into an analysis. These stages are illustrated with worked examples developed while working with data from focus groups of women with gynaecological cancer discussing a yoga intervention, and explain how these can enrich our understanding of participants’ lived experiences. This approach demonstrates a suggested framework for developing IPA themes from focus group data by analysing and interpreting the group setting. We discuss links to psychological concepts, potential applications and limitations. This empirically based methodology is presented as a practical guide for other researchers grappling with this type of data.
Archer S, Forshaw MJ, 2015, Using a randomised controlled trial (RCT) methodology in CAM research with gynaecological cancer patients: A commentary on the perks and pitfalls, COMPLEMENTARY THERAPIES IN CLINICAL PRACTICE, Vol: 21, Pages: 11-18, ISSN: 1744-3881
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Archer SA, Phillips E, Montague J, et al., 2014, ‘‘I’m 100% for it! I’m a convert!’’: Women’s experiences of a yoga programme during treatment for gynaecological cancer; an interpretative phenomenological analysis., Complementary Therapies in Medicine, ISSN: 1873-6963
SummaryObjectives: To explore patients’ experiences of taking part in a yoga intervention while under-going treatment for gynaecological cancer. Design: Sixteen women (age range 31—79 years; mean age 60) participated in focus groups based on a semi-structured question schedule. Resulting discussions were audio-recorded, transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Setting: Royal Derby Hospital, UK. Interventions: Patients took part in a 10-week course of Hatha yoga, where they participated in a one hour long class per week. Results: Three themes emerged from the data: applying breathing techniques, engaging in the physicality of yoga and finding a community. The first theme was particularly important to the patients as they noted the breadth and applicability of the techniques in their day-to-day lives. The latter two themes reflect physical and social perspectives, which are established topics in the cancer and yoga literature and are contextualised here within the women’s experiences of cancer treatment. Conclusions: The women’s perceptions of the programme were generally positive, providing a previously unseen view of the patient experience of participating in a yoga intervention. The difference between the women’s prior expectations and lived experiences is discussed.
Holland FG, Archer SA, Montague J, 2014, Younger women’s experiences of deciding against delayed breast reconstruction post-mastectomy following breast cancer: An interpretative phenomenological analysis, Journal of Health Psychology, ISSN: 1461-7277
Archer SA, Buxton S, Sheffield D, 2014, The effect of creative psychological interventions on psychological outcomes for adult cancer patients: a systematic review of randomised controlled trials, Psycho-Oncology
Objective: This systematic review examined the effectiveness of creative psychological interventions (CPIs) for adult cancer patients. In particular, the findings of randomised controlled trials of art, drama, dance/movement and music therapies on psychological outcomes were examined. Methods: The review yielded 10 original studies analysing data from a total of 488 patients. Data extraction and quality assessment were conducted by two independent reviewers.Results: Four of the papers focused on the use of art therapy, three studies used music therapy, one paper utilised dance therapy, one study used dance/movement therapy and the remaining paper used creative arts therapies, which was a combination of different art-based therapy approaches. Eight papers focused solely on breast cancer patients, and the remaining studies included mixed cancer sites/stages. The studies reported improvements in anxiety and depression, quality of life, coping,stress, anger and mood. However, few physical benefits of CPIs were reported; there was no significant impact of a CPI on physical aspects of quality of life, vigour-activity or fatigue-inertia or physical functioning. One study was assessed as high quality, seven studies were assessed as satisfactory and two studies were assessed to be of poorer quality.Conclusions: There is initial evidence that CPIs benefit adult cancer patients with respect to anxiety and depression, quality of life, coping, stress, anger and mood; there was no evidence to suggest that any one type of CPI was especially beneficial. However, more and better quality research needs to be conducted, particularly in the areas of drama and dance/movement therapies.
Archer SA, Montague J, Bali A, 2014, Exploring the experience of an enhanced recovery programme for gynaecological cancer patients: a qualitative study, Perioperative Medicine, Vol: 3
BackgroundPerioperative enhanced recovery programmes (ERPs), identified as initiatives that improve care and save money, have been adopted by NHS Improvement and are currently being rolled out across many surgical departments within the NHS. To date, five papers have specifically explored patients’ experiences of ERPs; none, however, has explored the gynaecological cancer patient experience. MethodsIn total, 14 women (mean age, 66 years) participated in an audio-recorded face-to-face or telephone interview in which they discussed their experience of taking part in an ERP. The resulting data were transcribed verbatim and analysed using interpretative phenomenological analysis. ResultsTwo main themes emerged from the analysis. The first, ‘Taking part in the programme’, highlights two important aspects of the ERP: being given an opportunity to receive information and, following this, to build knowledge about the programme. The theme also explores the challenges associated with the programme, particularly around getting mobile and complying with its demands - the women report experiencing a constant battle between intuition and instruction. The second theme, ‘Home’, focuses on the role home plays in motivating the patients to aim for an early discharge from hospital. Patients describe their need to return to a suitable home and the need for support from others. They also discuss the importance of the follow-up phone call. ConclusionOverall, the patients in this study positively assessed the individual aspects of the ERP, in particular, information resources, the availability of the physiotherapist and the delivery of follow-up phone calls. These findings highlight the importance of developing and maintaining individual aspects of ERPs over time, to ensure their sensitivity and responsiveness to patient needs.
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