Colorectal Cancer Screening and Perceived Disgust:The Importance of the Ick Factor in Faecal Occult Blood Test Uptake

Background: Colorectal cancer is a major cause of cancer deaths worldwide. Screening is key to early detection but uptake of national programmes is poor, especially amongst those from lower socio-economic backgrounds. Decisions not to take up screening may be based more on emotional rather than rational evaluations. We aimed to examine the importance of perceived disgust (the ‘ICK’ factor) in determining colorectal cancer screening uptake, in a large, randomised controlled trial. Methods: This paper reports secondary analysis of a randomised controlled trial of a simple, questionnaire-based Anticipated Regret (AR) intervention, which was delivered alongside existing pre-notification letters. 60,000 adults aged 50- 74 who were participant in the Scottish National Screening programme were randomised to one of 3 treatment arms: 1) no questionnaire (control), 2) Health Locus of Control (HLOC) questionnaire or 3) AR questionnaire. Primary outcome was Faecal Occult Blood Test kit return (FOBT uptake). 13,645 people completed questionnaires of secondary outcomes including intention to return test kit and a new self-report measure of perceived disgust (ICK-C). Results: Intentions, ICK and AR were all predictors of FOBT uptake; however, for people who expressed strong intentions to return their FOBT kit, only ICK differentiated kit returners from non-returners, with non-returners reporting higher disgust (mean difference=0.51; 95% CI for difference (0.37, 0.64), Cohen’s d=0.34). The 4-item ICK-C showed excellent internal reliability and predictive validity with regard to an objective measure i.e., FOBT uptake. Conclusions: The findings show that perceived disgust is an important emotional psychological construct in determining uptake of colorectal cancer screening. We also demonstrated that a simple 4-item scale (the ‘ICK-C), developed to be used in research on colorectal cancer screening, has excellent psychometric properties

Circulating LH/hCG receptor (LHCGR) may identify pre-treatment IVF patients at risk of OHSS and poor implantation

<p>Abstract</p> <p>Background</p> <p>Successful pregnancy via <it>in vitro </it>fertilization (IVF) depends on the recovery of an adequate number of healthy oocytes and on blastocyst implantation following uterine transfer. Two hormones, LH and hCG, utilize a common LH/hCG receptor (LHCGR), variations in which have profound implications in human reproduction. Soluble LHCGR (sLHCGR) is released from experimental cell lines and placental explants and it can be detected in the follicular fluid and serum.</p> <p>Methods</p> <p>To evaluate the impact of circulating soluble LHCGR (sLHCGR) in fertility treatment, we measured sLHCGR and LH-sLHCGR complex in serum from women seeking IVF using specifically developed quantitative enzyme-linked immunosorbent assays (ELISA). Following an IVF cycle of treatment, patients were grouped according to oocyte yield into low (lower than or equal to 7 oocytes), intermediate (8-14 oocytes) and high (greater than or equal to 15 oocytes) responders and pregnancy outcome noted.</p> <p>Results</p> <p>Pre-treatment sLHCGR identified many women at risk of ovarian hyperstimulation. Low levels of sLHCGR were associated with pregnancy in both high and low responders but sLHCGR did not significantly affect the treatment outcome of intermediate responders. Low responders who failed to become pregnant had high levels of circulating sLHCGR bound to LH (LH-sLHCGR).</p> <p>Conclusions</p> <p>Pre-treatment measurement of sLHCGR could be used to tailor individual fertility treatment programs and improve outcomes by avoiding ovarian hyperstimulation and poor embryo implantation.</p

Risk factors for negative experiences during psychotherapy

Background: It is estimated that between 3% and 15% of patients have a negative experience of psychotherapy, but little is understood about this. Aims: The aim of this study was to investigate the factors associated with patients’ negative therapy experiences. Method: The data comprised 185 patient and 304 therapist questionnaires, 20 patient and 20 therapist interviews. Patients reported on an unhelpful or harmful experience of therapy, and therapists on a therapy where they thought the patient they were working with had a poor or harmful experience. These were transcribed and analysed using thematic analysis. Results: There was a Lack of fit between Patient needs, Therapist skills, and Service structures. This could result in Fault Lines, a tension between Safety and containment and Power and control. This tension led to Strain and Poor Engagement, which led to Consequences following the negative therapy experience. Conclusions: Patients require clear information, choice, involvement in decision-making, explicit contracting and clarity about sessions and progress. Opportunities for patient feedback should be the norm, where the therapist and service are vigilant for signs of deterioration and solutions considered.Clinical and methodological significance of this article: Estimates of “unwanted effects,” including long-lasting effects, of psychotherapy have ranged from 3% to 15%. Few empirical studies have been conducted in this area. This study aimed to address this gap and provide clinicians with a model of risk factors for negative therapy effects. The findings of this study indicate the importance of providing patients with a supportive service structure that offers clear information, choice and involvement in decision-making. Explicit contracting at the beginning of therapy and clarity about sessions and progress are also important in managing patient expectations throughout. Opportunities for patient feedback should be provided

Anticipated regret to increase uptake of colorectal cancer screening (ARTICS):a randomised controlled trial

Objective. Screening is key to early detection of colorectal cancer. Our aim was to determine whether a simple anticipated regret (AR) intervention could increase colorectal cancer screening uptake. Methods. We conducted a randomised controlled trial of a simple, questionnaire-based AR intervention, delivered alongside existing pre-notification letters. 60,000 adults aged 50-74 from the Scottish National Screening programme were randomised to: 1) no questionnaire (control), 2) Health Locus of Control questionnaire (HLOC) or 3) HLOC plus anticipated regret questionnaire (AR). Primary outcome was guaiac Faecal Occult Blood Test (FOBT) return. Secondary outcomes included intention to return test kit and perceived disgust (ICK). Results. 59,366 people were analysed as allocated (Intentionto- treat (ITT)); there were no overall differences between treatment groups on FOBT uptake (control: 57.3%, HLOC: 56.9%, AR: 57.4%). 13,645 (34.2%) people returned questionnaires. Analysis of the secondary questionnaire measures showed that AR had an indirect effect on FOBT uptake via intention, whilst ICK had a direct effect on FOBT uptake over and above intention. The effect of AR on FOBT uptake was also moderated by intention strength: for less than strong intenders only, uptake was 4.2% higher in the AR (84.6%) versus the HLOC group (80.4%) (95% CI for difference (2.0, 6.5)). Conclusion. The findings show that psychological concepts including anticipated regret and perceived disgust (ICK) are important factors in determining FOBT uptake. However, there was no simple effect of the AR intervention in the ITT. We conclude that exposure to AR in those with low intentions may be required to increase FOBT uptake. Current controlled trials: www.controlledtrials. com number: ISRCTN74986452

Evidence to support delivery of effective health services : a responsive programme of rapid evidence synthesis

Background Two UK academic centres were commissioned to provide a responsive rapid evidence synthesis service. The service covered topics identified by the National Institute for Health Research Health Services & Delivery Research (NIHR HSDR) programme as priorities for the National Health Service or to inform research commissioning. Aims and objectives To describe and evaluate the review teams’ interactions with the evidence users the programme aimed to serve, primarily NHS clinicians, commissioners and managers. We particularly aim to highlight the barriers and facilitators to the impact that this type of programme may have on the uptake and use of research evidence by decision makers. Methods Narrative review of stakeholder interactions at different stages of the review process: prioritisation and defining scope; dealing with unexpected results; dissemination of findings; and measuring impact, illustrated by examples from the first three years of the service (2014–17). Conclusions Timely production of high-quality outputs was facilitated by: initial mapping and scoping of the available published evidence; early engagement with stakeholders to optimise their involvement within limited time and resources; and willingness to consider creative solutions and different ways of working to overcome problems encountered in specific projects

Is overexpression of HER-2 a predictor of prognosis in colorectal cancer?

<p>Abstract</p> <p>Background</p> <p>The development of novel chemotherapeutic agents in colorectal cancer has improved survival. Following initial response to chemotherapeutic strategies many patients develop refractory disease. This poses a significant challenge common to many cancer subtypes. Newer agents such as Bevacizumab have successfully targeted the tyrosine kinase receptor epidermal growth factor receptor in metastatic colorectal cancer. Human epidermal growth factor receptor-2 is another member of the tyrosine kinase receptor family which has been successfully targeted in breast cancer. This may play a role in colorectal cancer. We conducted a clinicopathological study to determine if overexpression of human epidermal growth factor receptor-2 is a predictor of outcome in a cohort of patients with colorectal cancer.</p> <p>Methods</p> <p>Clinicopathological data and paraffin-embedded specimens were collected on 132 consecutive patients who underwent colorectal resections over a 24-month period at Mayo General Hospital. Twenty-six contained non-malignant disease. Her-2/neu protein overexpression was detected using immunohistochemistry (IHC). The HER-2 4B5 Ventana monoclonal antibody was used. Fluorescent insitu hybridisation (FISH) was performed using INFORM HER-2/Neu Plus. Results were correlated with established clinical and pathological predictors of outcome including TNM stage. Statistical analysis was performed using SPSS version 11.5.</p> <p>Results</p> <p>114 were HER-2/Neu negative using IHC, 7 showed barely perceptible positivity (1+), 9 showed moderate staining (2+) and 2 were strongly positive (3+). There was no correlation with gender, age, grade, Dukes' stage, TNM stage, time to recurrence and 5-year survival (p > 0.05). FISH was applied to all 2+ and 3+ cases as well as some negative cases selected at random. Three were amplified (2 were 3+ and 1 was 2+). Similarly, HER-2 gene overexpression did not correlate with established prognostic indicators.</p> <p>Conclusion</p> <p>HER-2 protein is over expressed in 11% of colorectal cancer patients. The gene encoding HER-2 is amplified in 3% of cases. Overexpression of HER-2 is not a predictor of outcome. However, patients who over express HER-2 may respond to Herceptin therapy.</p

Anticipated regret to increase uptake of colorectal cancer screening in Scotland (ARTICS): Study protocol for a randomised controlled trial

Background: Colorectal cancer is the second leading cause of cancer deaths in the UK. Screening is key to early detection. The Scottish programme of colorectal cancer screening is running successfully, and involves all adults aged between 50 and 74 years being invited to post back a faecal sample for testing every 2 years. However, screening uptake is sub-optimal: for example rates for the period November 2009 to October 2011 ranged from just 39% for males living in the most deprived areas to 67% for least deprived females. Recent research has shown that asking people to consider the emotional consequences of not participating in screening (anticipated regret) can lead to a significant increase in screening uptake. Methods/Design: We will test a simple anticipated regret manipulation, in a large randomised controlled trial with 60,000 members of the general public. They will be randomly allocated to one of 3 arms, no questionnaire, control questionnaire or anticipated regret questionnaire. The primary outcome will be screening test kit return. Results will also be examined by demographic variables (age, gender, deprivation) as these are currently related to screening kit return. Discussion: If this anticipated regret intervention leads to a significant increase in colorectal cancer screening kit returns, this would represent a rare example of a theoretically-driven, simple intervention that could result in earlier detection of colorectal cancer and many more lives saved. Trial registration: Current Controlled trials: ISRCTN7498645

An evaluation of a new service model: Improving Access to Psychological Therapies demonstration sites 2006-2009, Final Report.

The Government would like to support people to move off benefits and into work. Mental health problems such as depression and anxiety are among the commonest reasons why people cannot work. These are relatively easily treated by psychological therapy, but this is hard to find in the NHS. The NHS has funded two Demonstration Sites which will make psychological therapy more widely available in sites close to peoples homes. We will look at what happens to patients in these sites, and compare it to what happens elsewhere. We will compare three kinds of places (1) The two National Demonstration Sites; (2) Places implementing their own innovations with a smaller amount of money than the Demonstration Sites and (3) Places who have not made any changes to their services, and will act as a kind of benchmark for the other two. We will compare these locations in three ways: (a) how satisfied are people with the services they receive; (b) how many people recover, and to what extent; (c) what is the financial cost of any improvement (balancing any extra costs of services against reductions in benefits claimed.) All participants will fill out some questionnaires to help us assess how their mental health has changed. We will invite a smaller number of people to have an interview, so we can hear in more detail what they liked (or did not like) about the services