Psychosocial outcomes of enhanced external counterpulsation treatment : illness perceptions and psychological wellbeing

The portfolio has three parts: Part 1 is a systematic literature review, in which the theoretical, conceptual and empirical literature relating to the relationship between illness perceptions, mood and quality of life in coronary heart disease populations is reviewed. The results of this study provide support that illness perceptions are related to outcomes across CHD populations and disease progression, however the results do not selectively support one particular model. Recommendations are consistent with cardiac rehabilitation guidelines. Further research should focus on the systemic impact of illness perceptions. Part 2 is divided into two empirical papers: Paper 1 utilises a qualitative methodology to explore refractory angina patients' experiences of undergoing EECP, and their lives before and after the treatment. The study adds to existing literature by proposing that the process of undergoing EECP treatment not only leads to physiological improvement, but also effects psychological pathways, through providing hope, establishing a therapeutic relationship and increasing confidence and self-efficacy to confront positive and challenging health-behaviour changes. Paper 2 utilises a quantitative methodology to explore the relationship between illness perceptions, mood and quality of life in chronic refractory angina patients that have undergone EECP treatment. The current study supports constructs from relevant models; the self-regulatory model, theory of planned behaviour and an adapted version of the fear-avoidance model. A possible model demonstrating the process between illness perceptions and outcomes specific for chronic refractory angina patients is proposed. Future research could focus on concomitant interventions to improve physical and psychological outcomes, for example the Angina Plan could be delivered in conjunction with EECP to establish an integrated, multidisciplinary model of care and service delivery. Part 3 comprises the appendices. This includes a reflective statement and supplementary information relevant to all three papers.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Post-traumatic growth following life-threatening illness

The experience of a heart attack (MI) can be an event that causes distress severe enough to satisfy DSM-IV criteria for trauma in some individuals. However, research has shown that positive outcomes can also follow traumatic events; this has been defined as Posttraumatic Growth (PTG). This cross-sectional study compared the level and pattern of PTG reported by a post-MI sample (n = 97) with that of a healthy control sample (n = 86); and examined demographic, disease-related, social and psychological correlates and predictors of growth. Post-MI patients reported greater PTG than healthy controls in the areas of 'relating to others' and 'appreciation for life'. Post-MI patients' growth was associated with greater support from family, and was unrelated to distress. Perceived severity of the event had a significant effect on PTG, but objective severity largely did not. Although less overall growth was reported than that following other life-threatening illnesses such as cancer, practitioners should be aware of the possibility for growth. Additionally, the meaning that patients ascribe to their MI has been shown to be more important for psychological adjustment than biological markers because perceived severity of MI had more impact on PTG than objective severity.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Why do health professionals refer individual patients to specialist day hospice care?

Background: There are no nationally agreed criteria for admission to specialist palliative day care (SPDC). Previous work has called for future research to qualitatively examine why health and social professionals make referrals to day care. Therefore the current study aims to address this question using semistructured interviews to gain first hand accounts of referrers' reasons for making referrals to SPDC. Design and method: The reasons for referral to SPDC of eight professionals were explored using semistructured interviews. An exploratory methodology (interpretative phenomenological analysis [IPA]) was used to analyze the data to allow for an in-depth investigation. Results: Six main themes were apparent with regard to referring a patient to SPDC: physical, social and psychological well-being, continuity of care, introduction to the hospice environment, and caregiver respite. Conclusions: This study provides an insight into reasons for referral to SPDC. Referrers value the multiprofessional team, the holistic approach to care as useful to managing difficult, complex, and persistent problems in patients wishing to be cared for in the community. Additional benefits include a helpful introduction to hospice services and much needed regular respite for caregivers. Future research into patient and professional perceptions of the process of referral to SPDC could be useful. Expansion of the current study could contribute to the development of a standardized referral tool to be used in conjunction with referrers' clinical judgment

Coping with terminal illness: The experience of attending specialist palliative day care

Background: The provision of supportive and palliative care for people with life-shortening illness has been emphasized throughout Department of Health and National Institute of Clinical Excellence (NICE) cancer guidance. However, the question of whether services are achieving this aim has been sparsely researched to date particularly in relation to Specialist Palliative Day Care (SPDC) services. The current study aims to explore the experiences of patients attending SPDC with regard to coping with a terminal illness. Design and method: The views of 11 patients attending SPDC were explored using semistructured interviews. An exploratory methodology (Interpretative Phenomenological Analysis [IPA]) was used to analyze the data to allow for an in-depth investigation. Results: Emerging themes suggest that SPDC provides an environment in which patients are helped to cope with stressors through a sense of self, belonging, acceptance of the reality of death, and a focus on life. Conclusions: This work provides a piece of the puzzle in the exploration of the processes underpinning attendance at SPDC from a patient's perspective. It suggests that SPDC provides an environment in which patients receive help in coping with terminal illness. In such an under researched area it provides an insight regarding SPDC attendance which can be built upon or challenged by future research. © Copyright 2010, Mary Ann Liebert, Inc. 2010

Patients' psychosocial experiences of attending specialist palliative day care: a systematic review

Recent reviews conclude that the benefits of attending Specialist Palliative Day Care (SPDC) are likely to be in social, psychological and spiritual domains. However, these areas are not easily identified, leaving researchers and practitioners unclear as to what aspects of these domains patients most need and desire. The objective of this review was to systematically evaluate literature on patient-perceived psychosocial experiences of attendance at SPDC. Twelve studies were included. Evidence showed that patients value a person-centred approach that reduces isolation, increases social support, encourages communication and provides activities. Future research could focus on investigating why patients value the psychosocial experiences reported and how these experiences can be defined in a way that would be meaningful to clinical service commissioners. Once this has been done, clinicians can start to measure more effectively clinical effectiveness and devise justifiable interventions to help this patient group

Assessing children’s understanding of complex syntax: a comparison of two methods

We examined the effect of two methods of assessment, multiple-choice sentence-picture matching and an animated truth-value judgement task, on typically developing children’s understanding of relative clauses

Anxiety, illness, beliefs and management of child type 1 diabetes

This portfolio thesis is comprised of three parts; a systematic literature review, an empirical study and a set of appendices.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Growth in syntactic complexity between 4 years and adulthood: evidence from a narrative task

Studies examining productive syntax have used varying elicitation methods and have tended to focus on either young children or adolescents/adults, so we lack an account of syntactic development throughout middle childhood. We describe here the results of an analysis of clause complexity in narratives produced by 354 speakers aged from 4 years to adulthood using the Expressive, Receptive and Recall of Narrative Instrument (ERRNI). We show that the number of clauses per utterance increased steadily through this age range. However the distribution of clause types depended on which of two stories was narrated, even though both stories were designed to have a similar story structure. In addition, clausal complexity was remarkably similar regardless of whether the speaker described a narrative from pictures, or whether the same narrative was recalled from memory. Finally, our findings with the youngest children showed that the task of generating a narrative from pictures may underestimate syntactic competence in those aged below 5 years