Hope and meaning-making in phase-one oncology trials: A systematic review and thematic synthesis of qualitative evidence on patient-participant experiences

Background Phase 1 drug trials are popular treatment options for patients with advanced disease, despite the greater levels of uncertainty associated with them. However, their meaning and consequences for patient-participants remains under-explored. This review synthesises the qualitative evidence of patients’ experiences of participating in phase 1 oncology trials, exploring their decisions to take part and the impacts of these trials on patient wellbeing. Methods A comprehensive literature search involving medical subject headings (MeSH) and keywords was undertaken in the following databases: MEDLINE, EMBASE, PsycINFO, Scopus, CINAHL, and Cochrane CENTRAL, with supplementary searches also conducted. Studies were independently screened for inclusion by two researchers. Included studies were critically appraised and data extracted using standardised forms. Qualitative results were analysed using thematic synthesis. Results Three main themes were identified across 13 studies: decision-making and joining the trial; experiences of taking part in the trial and hope and coping. Patients primarily joined trials hoping for therapeutic benefits, sentiments which prevailed and shaped their experiences across their trial journey. Rather than indicate therapeutic misconception based on poor understanding, patient perspectives more commonly pointed to differences between hope and expectation and cultural narratives of staying positive, trying everything and trusting in experts. Conclusions These findings challenge information-based models of consent, favouring coping frameworks which account for the role of hope and meaning-making during serious illness. Personalised consideration of existential and quality-of-life matters before and during trials is recommended, including palliative and supportive care alternatives to active treatmen

The potential of small unmanned aircraft systems and structure-from-motion for topographic surveys: a test of emerging integrated approaches at Cwm Idwal, North Wales

This paper was accepted for publication in the journal Geomorphology and the definitive published version is available at http://dx.doi.org/10.1016/j.geomorph.2014.07.021Novel topographic survey methods that integrate both structure-from-motion (SfM) photogrammetry and small unmanned aircraft systems (sUAS) are a rapidly evolving investigative technique. Due to the diverse range of survey configurations available and the infancy of these new methods, further research is required. Here, the accuracy, precision and potential applications of this approach are investigated. A total of 543 images of the Cwm Idwal moraine–mound complex were captured from a light (b5 kg) semi-autonomous multi-rotor unmanned aircraft system using a consumer-grade 18 MP compact digital camera. The imageswere used to produce a DSM(digital surfacemodel) of themoraines. The DSMis in good agreement with 7761 total station survey points providing a total verticalRMSE value of 0.517mand verticalRMSE values as lowas 0.200mfor less densely vegetated areas of the DSM. High-precision topographic data can be acquired rapidly using this technique with the resulting DSMs and orthorectified aerial imagery at sub-decimetre resolutions. Positional errors on the total station dataset, vegetation and steep terrain are identified as the causes of vertical disagreement. Whilst this aerial survey approach is advocated for use in a range of geomorphological settings, care must be taken to ensure that adequate ground control is applied to give a high degree of accuracy