Realist informed mixed-methods evaluation of cancer rehabilitation services in South Wales

Background: Cancer rehabilitation, which can comprise exercise and dietary advice among other interventions depending on people’s needs, has been found to improve quality of life worldwide. However, in Wales, 41.3% of Welsh Cancer Survey respondents reported receiving no or limited support with their rehabilitation needs. The reasons for this insufficient support are uncertain. The broad aim of this study was to investigate what works in two cancer rehabilitation services, for whom, in what circumstances and how. Methods: Realist evaluation (RE) informed the study design, as RE seeks to answer the question of what works, for whom, in what circumstances and how with the development of context-mechanism-outcome (CMO) configurations. Based on RE principles, first four initial cancer rehabilitation theories were developed through literature review and consultation with experts. The initial theories were tested with mixed methods: quantitative secondary analysis of routine cancer rehabilitation data; and qualitative, one-on-one, semi-structured interviews (n=35) with healthcare professionals and people with cancer. Findings: Testing the four initial theories which focused on information provision, healthcare professionals’ training, individualised care, and cancer rehabilitation interventions showed that services did not always work as hypothesised. Numerous contexts inhibited information provision, healthcare professionals’ training and cancer rehabilitation, for example, the medical model, healthcare professionals’ lack of time, accessibility concerns, and insufficient needs assessment, leading to fluctuations in service uptake, staff capacity issues and people’s unmet health needs. Moreover, professional boundaries were identified as mechanisms influencing cancer rehabilitation provision. However, well managed therapeutic relationships, family and “spontaneous” peer support aided the provision of individualised, tailored cancer rehabilitation interventions resulting in people’s improved quality of life and self-management. Conclusion: Cancer rehabilitation services in South Wales have the potential to help people cope with cancer and improve quality of life. However, several contexts hinder service provision, which needs addressing for optimal cancer rehabilitation

An exploration of the relationship of the Modified Total Body Rotation Test with the Functional Reach Test, Lateral Reach Test and Centre of Pressure measures in healthy population

Background: With aging changes occur in the human body, which can lead to postural control alterations and falls; therefore it is important to have appropriate screening tools for physical performance changes. The Modified Total Body Rotation Test (MTBRT), which measures reach distance during rotation in a standing position, was first published as a flexibility test, although it might have abilities to indicate postural control problems. Aims: To explore MTBRT as a physical performance test by correlating it to the Functional reach test (FRT), Lateral reach Test (LRT) and Centre of pressure (COP) total excursion. To further investigate the relationship between measures the effect of height, height normalization and gender was examined. Methods: Correlational design was chosen to investigate MTBRT as a physical performance test. 20 healthy adults participated in the study, who performed MTBRT, FRT, LRT and quiet standing on a force platform. Pearson’s correlation coefficient was calculated from the data. Height normalization was applied to further investigate relationships between measures. Independent t-test and Mann-Whitney U test was used to compare gender groups. The level of significance was given as p˂0.05. Results: MTBRT was significantly correlated to LRT (r=0.609, p˂0.01). However, no significant relationship was found between MTBRT and FRT or MTBRT and COP measures (p˃0.05). MTBRT was significantly related to height (r=0.618, p˂0.01). After height normalization changes were found in the relationship between measures. There was no significant difference in reach distance between female and male participants (p˃0.05). Conclusion: The results indicate that MTBRT might measure the same component of postural control as LRT. Therefore, MTBRT can be a useful addition to clinically available screening tools. The relationship between MTBRT and height and the changes in the results after height normalization might indicate the benefits of height normalization throughout the interpretation of reach tests

Patients' experiences of cancer immunotherapy with immune checkpoint inhibitors: A systematic review and thematic synthesis

Aim To obtain a deeper understanding of peoples' experiences of cancer treatments with immune checkpoint inhibitors (ICIs). Background ICIs are transforming survival outcomes for many with certain advanced cancers. Given the possibility of unique immune-related adverse events (irAEs), understanding treatment experiences is crucial to identify support needs and provide safe and effective person-centred care. Design A systematic review of qualitative research and thematic synthesis. To report this review, the Preferred Reporting Items for Systematic Analysis and Meta Analysis (PRISMA) checklist and Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidance have been used. Data Sources MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science databases were searched in January 2022 for eligible studies published in English from database inception. Review Methods Two reviewers independently screened records, identified papers for inclusion and appraised methodological quality using the Critical Appraisal Skills Programme checklist. Themes were developed using thematic synthesis. Results Eighteen papers were included and three analytical themes developed: immune checkpoint inhibitor treatment decision-making; the experience and impact of immune checkpoint inhibitor treatments; and appraising and responding to irAEs. Conclusion The synthesis renders visible individuals' unmet information, psychological and practical support needs. It identifies shortcomings in immune checkpoint inhibitor treatment decision-making processes and highlights the need for healthcare professionals to recognise and sensitively handle individuals' treatment expectations. Individuals' understandings of and responses to irAEs are also illustrated, and attention drawn to patients' concerns about healthcare professionals' checkpoint inhibitor and irAEs knowledge

Implementing midwifery twinning partnerships: challenges and facilitators. A rapid evidence summary

Twinning is a partnership method that focuses on mutual transfer of knowledge and skills between two parties, including organisations, clinical practices, universities, or individual health professionals. In midwifery, twinning is a particularly important tool that can help countries with high maternal and infant morbidity and mortality rates to make connections with countries where sickness and death rates related to birth are lower and the role of midwives is better developed. The aim of this rapid evidence summary is to explore the literature for midwifery twinning initiatives and the facilitators and challenges of twinning partnerships. Sixteen research reports and textual evidence were identified. Facilitators of successful implementation of twinning initiatives include having a clear vision and mission statement along with investing time and promoting a co-creational approach. Reciprocity along with the building of personal relationships. Strong leadership, commitment, values, mutual respect and personal rapport between the projects. Clear communication plans, workshops, peer exchange visits alongside regular virtual contact. Building on existing relationships, previous experience of international and cross-cultural work and being prepared to overcome cultural differences. Having a local project team and careful; matching and selection of twins and having an adaptable personality. Having funding available. Challenges include communication issues, cultural differences in communication, technological issues and economic considerations. Additionally misplaced expectations, such as difference in social expectations, or one twin partner expecting opportunities that are not agreed upon by the other poses challenges to the successful implementation of twinning initiative

Understanding how two cancer rehabilitation services work for people in South Wales, UK: findings from a mixed methods study

Background: Two cancer rehabilitation (CR) services provide in- and outpatient support, such as a 12-week exercise programme, fatigue management groups etc., in two oncology centres in South Wales, UK. However, some cancer patients still report unmet rehabilitation needs. The aim of this study was to investigate how the two CR services work, for whom, and in what circumstances. Methods: A realist informed mixed-methods study was conducted. Quantitative secondary analysis of a CR database containing pre and post rehabilitation outcome measure data (e.g.: FACIT-F, etc.) was performed using paired t-test or Wilcoxon signed rank test. Qualitative, semi-structured interviews with rehabilitation professionals (n=20) and cancer patients (n=15) were conducted and reflexive thematic analysis was used to develop themes. Results: The quantitative data showed that the 12-week exercise programme potentially led to improved fatigue and mobility (p<0.05), which was supported by some qualitative accounts. However, several factors hindered adequate CR provision. Insufficient needs assessment and care coordination could have led to unmet needs, whilst unmanaged therapeutic relationships might have resulted in cancer patients’ dependency on CR services and a lack of self-management behaviour. Conclusion: Improved coordination of patient support and boundary setting for CR services is needed. However, some of these issues cannot be resolved until CR is fully embedded in the cancer pathway