Using appreciative inquiry to develop, implement and evaluate a multi-organisation ‘Cultivating Compassion’ programme for health professionals and support staff

The ‘Cultivating Compassion’ project was developed in response to a research and innovation call relating to compassion training for National Health Service staff in the South East of England. The project aims included the following: the use of Appreciative Inquiry to develop, implement and evaluate a sustainable and evidence-based programme of compassion awareness training through engaging with a diverse group of health professionals and support staff; an evaluation of a ‘train the trainers’ approach; and an evaluation of ‘compassion lead’ roles and a multi-modal compassion toolkit. The project team included academics from two universities and one medical school, NHS staff from three separate organisations and service users. The participants recruited to the study included doctors, nurses, receptionists, chaplains and others working in close contact with service users from within four NHS organisations in the South East of England. The main findings from the project using thematic analysis from participant focus groups and interviews identified project enablers and inhibitors, the value of project resources, and shifts in perspectives. Project conclusions highlighted the importance of effective senior-level support and organisational leadership in cultivating compassion within a healthcare organisation and the importance of the integration of compassion-promoting resources within existing staff development initiatives

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Engaging families with a premature family history of heart disease : a primary prevention study for coronary heart disease

This thesis focuses upon a preventative approach for people with a familial history of premature coronary heart disease. The research study had two aims; firstly to understand the experience of individuals when their parent or sibling had been diagnosed with heart disease; secondly to develop and evaluate a primary prevention health promotion programme for these people. The thesis provides unique insight into their personal experiences of living with this familial diagnosis and gives details of how this population can be identified and involved successfully in a health promotion programme. The study was conducted in a district general hospital; 28 people were recruited of whom 20 participants completed the two year study. Narrative interviews were conducted at the beginning and end of the study, providing insight into people's personal experience. Salutogenesis is the theoretical framework in which the narratives are discussed; from these health resources are identified which can enhance people's progress and maintenance for a healthy lifestyle. The health promotion programme has established, developed and evaluated a nurse- led and doctor supported primary prevention strategy. Education and support was provided in the programme for individuals and families. The participants' physical and behavioural changes were reviewed six monthly, for two years. People are aware of risk factors associated with heart disease, but still seek professional support and advice in relation to their own lifestyle and behaviour. Individual lifestyle changes were achieved by most participants, which translated into significant findings for blood pressure and alcohol consumption; positive changes were seen in physical activity, smoking, diet and psychosocial stress. There were no improvements in lipid profiles. The need for a preventative approach in health care, which includes primordial and primary prevention for heart disease, is discussed. The issues in this thesis are reflective upon current government focus to develop preventative health services which actively engage with people as integral to this process. The thesis discusses coronary heart disease, the roles of prevention and health promotion, and identifies health resources for people at high-risk of future cardiovascular problems.</p

Family history of premature cardiac heart disease: exploring the experience

Evidence confirms that a family history of coronary heart disease is an independent risk factor for coronary heart disease. Having a close family relative diagnosed with heart disease has lasting implications and repercussions for the family. This qualitative study aimed to explore the issues and challenges that people face when aclose relative is diagnosed with heart disease and their own future risk for developing heart disease subsequently increases. Using narrative enquiry, participants told their stories associated with this event. They spoke about the period leading up to the diagnosis and what happened during this acute phase; they described the processof coming to terms with this diagnosis and how it has affected them and their family. This study shows how awareness of key issues associated with this group of people may have the potential to enhance preventive strategies

Physical activity and cardiovascular disease

This paper will discuss the role of physical activity in the development of cardiovascular disease as well as the general health benefits it can provide for adults who are not known to have coronary hear t disease (CHD). A historical introduction is given and physical inactivity as a risk factor associated with coronary hear t disease is examined. The benefits of physical activity along with consideration of levels of activity and CHD in the current population and government recommendations will be discussed, as is the role of nurses in encouraging enhanced levels of activity. </jats:p

Family history of premature coronary heart disease: Exploring the experience

Evidence confirms that a family history of coronary heart disease is an independent risk factor for coronary heart disease. Having a close family relative diagnosed with heart disease has lasting implications and repercussions for the family. This qualitative study aimed to explore the issues and challenges that people face when a close relative is diagnosed with heart disease and their own future risk for developing heart disease subsequently increases. Using narrative enquiry, participants told their stories associated with this event. They spoke about the period leading up to the diagnosis and what happened during this acute phase; they described the process of coming to terms with this diagnosis and how it has affected them and their family. This study shows how awareness of key issues associated with this group of people may have the potential to enhance preventive strategies. </jats:p

Why nurses need to be engaged with clinical research

Martha J Wrigley and Caroline Humphreys argue the case for a better understanding of what clinical research involves, and the contribution that nurses in practice can make </jats:p