Exploring Service User and Practitioner Perspectives of Using Cancer Risk Assessment Tools in Primary Care Consultations

Introduction: Cancer risk assessment tools are novel tools that combine risk factors and symptoms to predict an individual’s risk of developing cancer. Little is known about the views of service users and primary care practitioners on how cancer risk assessment tools should be used in primary care. Following a scoping review of the literature, the qualitative study explored perspectives of service users and primary care practitioners about how best cancer risk information can be communicated to patients during primary care consultations. The study also explored the enablers (facilitators) and barriers to the implementation of cancer risk assessment tools from the perspectives of both service users and practitioners. Methods: The scoping review followed the framework proposed by Arksey and O’Malley for conducting scoping reviews. The scoping review resulted in the statement of two research questions: (i) How best can cancer risk information be communicated to patients? (ii) What do service users and practitioners perceive as enablers and barriers to the implementation of cancer risk assessment tools in primary care? The next phase was the qualitative study, which involved the use of individual and focus group interviews with service users recruited from the public and primary care practitioners (GPs and nurses) recruited from general practices in Lincolnshire, a large rural county in the East of England. The qualitative data were transcribed verbatim and analysed using the framework approach. Results: Thirty-six participants (19 service users and 17 primary care practitioners) were interviewed before practitioners used cancer risk assessment tools in patient consultations. Some of the practitioner participants were interviewed again after they had used the tools in patient consultations. Participants suggested ways to best communicate cancer risk information to patients in primary care consultations. Before using the tools with patients, participants emphasised the importance of: tailoring visual representation of risk; being open and honest; informing and involving patients in use of cancer risk assessment tools; and providing time for listening, explaining and reassuring in the context of a professional approach. After using the tools in patient consultations, primary care practitioners maintained these perceptions. These findings add to our knowledge and understanding of how best to communicate cancer risk information to patients when using cancer risk assessment tools in general practice consultations. Before using the tools with patients, both service users and practitioners agreed on the following as potential enablers to the implementation of cancer risk assessment tools: aiding decision making; improving speed and processes of diagnosis and treatment of cancer; identifying and raising awareness for modifying health risk behaviours; and personalising care. After using the tools, primary care practitioners mentioned ‘ease of use’ in addition to the enablers already cited. Barriers to the uptake of cancer risk assessment tools were also identified by participants, which included: the additional time required; worry and anxiety generated by referral for investigations; the potential for over-referral; practitioner scepticism about using the new tools; and the need for evidence of effectiveness before introducing cancer risk assessment tools in general practice consultations. These barriers were perceived before the use of the tools. After using the tools, practitioners identified the following barriers in addition to those already mentioned: the need to integrate the tools into general practice IT systems; the need to involve secondary care specialists (consultants) in the implementation of the tools; and the need for training of practitioners on how to use cancer risk assessment tools in patient consultations. Conclusion: Ways to best communicate cancer risk information during patient consultations were identified in this study, adding to existing knowledge. Enablers and barriers to the implementation of cancer risk assessment tools were also identified by participants in this study

Reliability and validity of an Ambulance Patient Reported Experience Measure (A-PREM): pilot study

Background There are no prehospital ambulance Patient Reported Experience Measures (A-PREMs) routinely used to support service comparisons and improvement. We developed an A-PREM, generating items through secondary analysis of ambulance patient interview data, and refining the instrument using expert assessment and cognitive interviews of service users. We aimed to pilot the A-PREM (48 experience and 12 attribute items) investigating user acceptability, reliability and construct validity. Methods Ambulance users attended by a UK regional ambulance service within the previous six months, excluding those suffering cardiac arrest, were sent a self-administered A-PREM. Returned questionnaires were entered into Microsoft Excel and imported into SPSS v22 for analysis. Experience items were recoded to range from 0 (don’t know/can’t remember) to 3 (best recorded experience). Descriptive analysis for item frequencies and missing values, reliability analyses for potential scales and tests of correlation and association were conducted. Results In all, 111 A-PREMs (22.2%) were returned. Missing data were highest for call-taking items. There was a significant association with a shorter wait for first response for four items measuring overall experience of call-taking (χ, p=0.05), ambulance staff (p<0.001), ambulance overall (p=0.001) and A&E (p=0.023). Four separate experience scales encompassing call taking (AmbCallScore, α=0.91), care at scene (AmbCareScore, α=0.90), care on leaving the patient (AmbLeaveScore, α=0.69), and care on transport (AmbTranScore α=0.71), showed satisfactory to high internal consistencies and distributions indicating generally positive experiences. AmbCallScore, AmbCareScore and AmbLeaveScore showed significantly higher scores (ANOVA) with shorter wait to first response. There were no significant differences for overall measures or scales by sex or age of participant, whether they were transported to hospital or not and whether it was their first experience of the ambulance service. Conclusion Our findings show that the A-PREM should be tested more widely for evidence of reliability, validity and sensitivity to different care and settings

Informing use of QCancer in the primary care consultation - perspectives of service users and practitioners

Introduction: Earlier detection of cancer may help reduce the current high level of cancer mortality in the UK. Cancer risk assessment tools such as QCancer, which predict the absolute risk of cancer in symptomatic individuals, may help identify those at high risk needing investigation for possible cancer. Little is known about the views of service users and primary care practitioners on the use of QCancer in primary care consultations. The aim of this study was to explore the perspectives of service users and primary care practitioners on use of QCancer and how communication with patients might be enhanced when using QCancer in primary care consultations. Methods: The study was conducted in Lincolnshire, a large rural county in the East Midlands, using a qualitative research design. This involved individual interviews with service users recruited from the general public, and both individual and focus group interviews with primary care practitioners including general practitioners and practice nurses. Data were recorded, transcribed verbatim and analysed using the framework approach. Ethics approval was granted by the University of Lincoln School of Health and Social Care Ethics Committee. Results: We interviewed 36 participants (19 service users and 17 practitioners) until data saturation was achieved. Four main themes emerged: the implications of quantifying cancer risk; usefulness of QCancer; communicating cancer risk and barriers to implementation in primary care consultations. Participants expressed a range of views about the implications of quantifying cancer risk using QCancer. These included: potential conflict with current cancer risk guidelines and the need to refer patients with symptoms suggestive of cancer whatever their quantified risk. Participants agreed that QCancer would help to: quantify cancer risk; support clinical decision making; inform efforts to modify health behaviours; improve processes and speed of assessments, diagnosis and treatment; and, enable practitioners to personalise patient care. To enhance patient-practitioner communication of cancer risk, both service users and primary care practitioners suggested the following: tailoring a visual representation of risk; being honest and open with patients; involving patients in the use of QCancer; and allowing time for listening, explaining, informing and reassuring patients. Potential challenges to the uptake of QCancer were also identified including: the additional time required for its use and communication; unnecessary worry caused by investigation of false positives; potential for over-referral; and practitioner scepticism with the need to establish the effectiveness of QCancer against current practice before introducing it more widely. Conclusion: Participants perceived the potential usefulness of QCancer but felt that communication needs of users and potential barriers should be considered when planning to implement QCancer. Before rolling out the tool, further research is needed to pilot and evaluate the impact of QCancer on outcomes such as rates of investigations, referrals, diagnoses as well as patient and practitioner experiences of using the tool

Should journalism curriculae include trauma resilience training? An evaluation of the evidence from a scoping literature review and findings from a pilot study

We investigated the claim in literature that exposure to work related traumatic events affects the wellbeing of journalists. We did this through a scoping review of studies on practising journalists; studies on journalism curriculae and reflections on findings of a questionnaire pilot study of journalism students’ experiences of exposure to traumatic events through teaching materials. We found evidence to suggest that practising journalists who are regularly exposed to traumatic events are susceptible to a range of adverse psychological reactions including post-traumatic stress disorder (PTSD); and that the teaching of resilience is not widely included in journalism curriculae. The pilot study indicates that teaching materials did not evoke adverse psychological reactions with damaging effect to students’ wellbeing. Nevertheless, we recommend the inclusion of resilience training in journalism curriculae to be taught by an interdisciplinary team of scholars in order to build resilience among journalism students and equip them to cope with the increasing risk of journalism practice in the twenty first century

A systematic scoping review of the use of cancer risk assessment tools for early detection of cancer risk in primary care

Introduction Cancer risk assessment tools are designed to predict cancer risk using risk factors and symptoms of individuals. These tools could prompt investigations and referral for specialist attention, leading to early diagnosis and treatment and a potential reduction in the high mortality of cancer in the UK. While cancer risk assessment tools are thought to accurately predict the risk of specific cancers, this is based on statistical testing of data from databases rather than using the tools on actual patients. More needs to be known about the use and implementation in practice of cancer risk assessment tools to aid primary care detection of cancer. We aimed to scope the evidence relating to the use of cancer risk assessment tools for early detection of cancer in primary care. Methods Using the framework proposed by Arksey and O’Malley, we conducted a systematic scoping review of the literature published in the English language from 2004 to 2015 to ensure relevance to current practice. Our search strategy included specific search terms which were used to search six electronic databases: Medline; CINAHL; Scopus; Cochrane; Science Direct and Psych INFO. A narrative synthesis was used to analyse the papers identified. Results We retrieved 481 papers from the initial database search. After sifting titles and abstracts, 72 full text papers remained, of which 48 studies were excluded because these did not meet the inclusion criteria. The remaining 24 studies were included in the review. These included: randomised controlled trials (2); cohorts (11), survey (2); case control (3); qualitative (3), critical reviews (1) and other unspecific designs (2). This review found limited evidence on: novel cancer risk assessment tools being used; perceptions of users and outcomes of using the tools. While there was also some evidence pointing to the usefulness of cancer risk assessment tools, there was limited evidence on how best to communicate cancer risk to patients when using a cancer risk assessment tool. Conclusion The evidence available on the use of cancer risk assessment tools in primary care was limited. Further research is needed to explore how best cancer risk can be communicated to patients when using a cancer risk assessment tool in primary care consultations

EAST MIDLANDS INTEGRATED LIFESTYLE (ILS) DATABASE: FEASIBILITY STUDY - FINAL REPORT

EXECUTIVE SUMMARY Background: A regional integrated database could serve as a rich data source for in-depth analysis in research studies across key Public Health lifestyle areas in the East Midlands. This could inform Public Health policy, service delivery and commissioning decisions. Unfortunately, existing datasets are poorly aligned across the four key Public Health lifestyle areas examined in this study: physical activity, smoking cessation, reduction in alcohol consumption, and diet and weight management. This feasibility study was therefore commissioned by the East Midlands Directors of Public Health Group chaired by Professor Derek Ward, Director of Public Health in Lincolnshire, with funding from the NIHR East Midlands Clinical Research Network and the College of Social Science, University of Lincoln. Public Health researchers in the Mental Health, Health and Social Care Research Group (MH2aSC) at the University of Lincoln were invited to carry out the study to explore the feasibility of developing and implementing an integrated lifestyle database across the East Midlands Region. Methods: A scoping review for available evidence was conducted to inform decisions about feasibility of the proposed integrated lifestyle database. This was followed by a consultation exercise with 18 stakeholders, predominantly in the East Midlands, from September 2020 to February 2021. The consultation exercise sought to gather the views of stakeholders, purposively invited to take part due to their role in public health, about the potential feasibility of an integrated database. Stakeholders were identified and invited by email to participate in the consultation meetings which took place via Microsoft Teams. A topic guide, designed specifically for this study, was used to guide the discussion. The meetings were recorded, transcribed, and analysed thematically. Results: The scoping literature review revealed potential benefits but also barriers to the development of an integrated lifestyle dataset, and highlighted the need to consider local factors which need to be better understood prior to implementation. These findings from the literature were supported by rustults from the subsequent consultation exercise. Stakeholders for the most part, welcomed the idea of an integrated East Midlands lifestyle database because of its potential benefits for research and to produce evidence to inform service development and commissioning decisions. However, concerns were expressed by some providers including anxieties around revealing their business strategies to rival organisations also involved in the provision of lifestyles services, the cost of setting up and running the proposed integrated database, and the complexities involved in information sharing and governance arrangements which would need to be established. Conclusion: In view of the findings the following options should be explored while taking into consideration the barriers and facilitators expressed by stakeholders: 1. A fully integrated individual level lifestyle dataset across the whole East Midlands covering all four lifestyle areas, with governance and access controlled by one institution (possibly a Local Authority or a university) that will house and maintain the database. 2. A fully integrated individual level dataset for all four lifestyle areas, within just one geographical area to start with, which is owned by the service provider. There is a need to consider how to make this available more widely, as the providers only report collated data back to the commissioners. 3. A fully integrated individual level dataset initially starting with one health area (possibly smoking which already has a standardised Key Performance Indicators (KPI) across the whole region, (to be rolled out later subject to success), with governance and access controlled by the institution (either a Local Authority or a local university) that will house the database. 4. An integrated aggregated level dataset covering all four lifestyle areas (reporting similar KPIs as is done currently by service providers who report back to their commissioners), across the whole East Midlands, with governance and access controlled by one institution (possibly a Local Authority or a university) that will house and maintain the database. 5. A fully integrated aggregated level dataset for all four lifestyle areas, within just one geographical area to start with, as we have in Lincolnshire, which is owned by the service provider. There is a need to consider how to make this more widely available, as the providers only report collated data back to the commissioners. This is the model already used in Lincolnshire. 6. An integrated aggregated level dataset initially starting with one health area (possibly smoking which already has a standardised KPI) across the whole region, (to be rolled out later subject to success), with governance and access controlled by the institution (either a Local Authority or a local university) that will house the database

Barriers and facilitators to implementing a cancer risk assessment tool (QCancer) in primary care: a qualitative study

Aim We aimed to explore service users’ and primary care practitioners’ perspectives on the barriers and facilitators to implementing a cancer risk assessment tool, QCancer, in general practice consultations. Background Cancer risk assessment tools, including QCancer, are designed to estimate the chances of previously undiagnosed cancer in symptomatic individuals. Little is known about the barriers and facilitators to implementing cancer risk assessment tools in primary care consultations. Methods We used a qualitative design, conducting semi-structured individual interviews and focus groups with a convenience sample of service users and primary care practitioners. Findings In all, 36 participants (19 service users, 17 practitioners) living in Lincolnshire, were included in the interviews and focus groups. Before asking for their views, participants were introduced to QCancer and shown an example of how it estimated cancer risk. Participants identified barriers to implementing the tool namely: additional consultation time; unnecessary worry; potential for over-referral; practitioner scepticism; need for training on use of the tool; need for evidence of effectiveness; and need to integrate the tool in general practice systems. Participants also identified facilitators to implementing the tool as: supporting decision making; modifying health behaviours; improving speed of referral; and personalising care. Conclusion The barriers and facilitators identified should be considered when seeking to implement QCancer in primary care. In addition, further evidence is needed that the use of this tool improves diagnosis rates without an unacceptable increase in harm from unnecessary investigation

Patient, carer, and staff perceptions of robotics in motor rehabilitation: a systematic review and qualitative meta‑synthesis.

Background: In recent years, robotic rehabilitation devices have often been used for motor training. However, to date, no systematic reviews of qualitative studies exploring the end-user experiences of robotic devices in motor rehabilitation have been published. The aim of this study was to review end-users’ (patients, carers and healthcare professionals) experiences with robotic devices in motor rehabilitation, by conducting a systematic review and thematic meta-synthesis of qualitative studies concerning the users’ experiences with such robotic devices. Methods: Qualitative studies and mixed-methods studies with a qualitative element were eligible for inclusion. Nine electronic databases were searched from inception to August 2020, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review. Results: The search strategy identified a total of 13,556 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 30 studies were included. All studies were considered of acceptable quality. We developed six analytical themes: logistic barriers; technological challenges; appeal and engagement; supportive interactions and relationships; benefits for physical, psychological, and social function(ing); and expanding and sustaining therapeutic options. Conclusions: Despite experiencing technological and logistic challenges, participants found robotic devices acceptable, useful and beneficial (physically, psychologically, and socially), as well as fun and interesting. Having supportive relationships with significant others and positive therapeutic relationships with healthcare staff were considered the foundation for successful rehabilitation and recovery

Hand hygiene compliance among healthcare workers in Ghana’s health care institutions: An observational study

Objective: To assess hand hygiene compliance in selected primary hospitals in Ghana. Design: A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures: The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results: The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion: Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients