Understanding the factors and mechanisms that influence colorectal cancer screening uptake among socially deprived and non-deprived populations.

Colorectal cancer (CRC) is the second most common cause of cancer death in the UK. Since the introduction of the NHS Bowel Cancer Screening Programme CRC incidence and mortality rates have reduced, however, screening uptake in the overall population remains suboptimal and is disproportionately low among populations with low socioeconomic status (SES) and Black and Minority Ethnic populations. This thesis aimed to critically assess the available evidence of public health interventions to improve CRC screening and to examine the possible mechanisms of socioeconomic inequalities in CRC screening uptake within a UK setting. A systematic review and meta-analysis (Study 1) of randomised controlled trials (RCTs) to increase CRC screening uptake was conducted. Data from 102 RCTs including 1.94 million participants were analysed and intervention effectiveness was examined by level of SES. Interventions significantly improved screening uptake, especially among low SES populations, and helped reduce - but not eliminate - SES disparities. Specific intervention strategies were highlighted as effective among low SES groups. Study 2 used qualitative interviews (N = 27) to explore the views of different socioeconomic and sociodemographic population subgroups and identify the barriers and facilitators to CRC screening. Results highlighted both practical and emotional factors that influenced screening decisions and revealed both similarities and differences in the views of different subgroups. Study 3 used cross-sectional, observational, survey data (N = 206) to explore key sociodemographic and psychosocial variables as potential moderators and mediators of screening intention. Results indicated that psychosocial variables mediated the effects of past behaviour on screening intention and identified some differences by educational attainment and area-level deprivation. This thesis argues the importance of considering both sociodemographic and psychosocial factors in relation to improving CRC screening uptake and reducing inequalities. Results highlighted key determinants of CRC screening participation and identified specific pathways via which sociodemographic and psychosocial variables interact to affect screening intention. This thesis provides an evidentiary basis that can be used to inform future public health initiatives and/or interventions that aim to reduce the CRC inequality gap

Suicide and dementia: A systematic review and meta-analysis of prevalence and risk factors.

Dementia is a global health concern with increasing numbers of people living long enough to develop dementia. People with dementia (PwD) may be particularly vulnerable to suicidality. However, suicide in PwD has not been thoroughly explored. The objective of this review was to determine the prevalence and risk factors of suicide in PwD. Five databases were searched from inception to July 2023. Peer-reviewed publications reporting prevalence, risk factors or quantitative summary data for suicide outcomes in PwD were included. Random effects models were used to calculate the pooled prevalence and effect sizes. 54 studies met inclusion criteria. In PwD, the point prevalence of suicidal ideation was 10 % (95 %CI=6 %;16 %), 2-year period prevalence of suicide attempts was 0.8 % (95 %CI=0.3 %;2 %), 10-year period prevalence of suicide attempts was 8.7 % (95 %CI=6.0 %%;12.7 %) and the incidence of death by suicide 0.1 % (95 %CI=0.1 %;0.2 %). Compared to not having dementia, a diagnosis of dementia increased risk of suicidal ideation (OR=1.62[95 %CI=1.17;2.24]) but not risk of suicide attempt (OR=1.77 [95 %CI=0.85;3.69]) or death by suicide (OR=1.30 [95 %CI=0.81;2.10]). People with moderate dementia had significantly increased risk of suicidal ideation than those with mild dementia (OR=1.59[95 %CI=1.11;2.28]), younger PwD were at increased risk of dying by suicide (OR=2.82[95 %CI=2.16;3.68]) and men with dementia were more likely to attempt (OR=1.28[95 %CI=1.25;1.31]) and die by suicide (OR=2.88[95 %CI=1.54;5.39]) than women with dementia. This review emphasises the need for mental health support and suicide prevention in dementia care, emphasising tailored approaches based on age, symptoms, and being male

Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review

Objective To determine whether there is an association between healthcare professionals’ wellbeing and burnout, with patient safety. Design Systematic research review. Data Sources PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles. Eligibility Criteria for Selecting Studies Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations. Results Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety. Conclusions Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed. Implications This review illustrates the need for healthcare organisations to consider improving employees’ mental health as well as creating safer work environments when planning interventions to improve patient safety

Healthcare Professionals' Experiences of Endings in Paediatric Cancer Treatment: An Interpretative Phenomenological Analysis

Completing cancer treatment is a time of high stress and overwhelming concerns for childhood cancer survivors and their families. Empirical data suggests that during the end-of-treatment period, families are in need of specialist follow-up care and clearer direction around navigating the complexities of the post-treatment period. Healthcare professionals (HCPs) play a crucial role in patients’ wellbeing and clinical outcomes across all stages of the cancer pathway - including the end-of-treatment stage - and yet, research documenting HCPs’ perspectives around endings in active treatment is almost non-existent, resulting in the experiences and needs of staff remaining poorly understood. The primary aim of this research is to qualitatively explore the end-of-treatment experience from the perspective of HCPs caring for paediatric cancer patients. Part One is a qualitative meta-synthesis of findings from 12 qualitative studies exploring HCPs’ experiences of providing care to paediatric cancer patients in the UK. Part Two is an empirical paper reporting the findings from a qualitative study, underpinned by the methodological principles of Interpretative Phenomenological Analysis (IPA). The present study was part of a joint project exploring endings in paediatric cancer treatment from the perspective of paediatric cancer patients, their parents/carers and HCPs providing care to this population. This research was separate from the studies exploring patients and parents’/carers’ views and specifically explored the experiences and perspectives of HCPs working in a paediatric hematology and oncology tertiary care centre in the UK. Semi-structured interviews were conducted with seven HCPs from a range of professional groups. Findings are discussed in relation to previous literature, whilst the unique contributions of the present research are also highlighted. Implications and suggestions for further research are noted. Part Three represents a critical reflection on the project. This part considers the potential impact of the author’s previous academic and professional experiences on the present thesis and outlines the steps that were taken towards maintaining reflexivity throughout the research process. The author further discusses some contextual challenges that were encountered during the research process and how these were experienced and managed

Endings and the end of treatment bell in paediatric cancer treatment for acute lymphoblastic leukaemia: An interpretative phenomenological analysis of children’s perspectives

Advancements in paediatric oncology have made quality of life after cancer increasingly clinically important. Little is currently known about children's experiences of treatment completion and its management. Aim. The current study explores children's experience of ending treatment for Acute Lymphoblastic Leukaemia (ALL), and the meaning it is given, particularly how endings are signified and marked. Method. Semi-structured interviews were conducted with seven children who had completed cancer treatment for ALL with good prognoses. Interviews were analysed using Interpretative Phenomenological Analysis. Results. Five superordinate themes were generated: 'the end is always there', 'the punctuation of endings', 'that which is remembered, that which is forgotten', 'the voiced and the unvoiced', and 'freedom from cancer.' Conclusion. Children highlighted the importance of punctuating and celebrating the end of their treatment, and the need for doing this in ways that helped them process the complexity of ending active treatment and provides space for their voices

Electronic databases searched and number of results.

<p>Electronic databases searched and number of results.</p

Flow chart documenting the screening process.

<p>Flow chart documenting the screening process.</p

Risk of bias graph displaying the overall study quality for all 46 studies.

<p>Risk of bias graph displaying the overall study quality for all 46 studies.</p