Digital Feast: Narrative review

First paragraph: Overweight and obesity is the second leading cause of cancer in the UK after smoking. Overweight and obesity causes 13 different types of cancer and over 22,000 cancer cases each year in the UK. It is estimated that each year, obesity costs the NHS in England £6.1bn and the wider UK economy £27bn

Challenges to access and provision of palliative care for people who are homeless : a systematic review of qualitative research

Background: People who are homeless or vulnerably housed are a marginalized group who often experience high rates of morbidity and die young as a result of complex problems. Access to health care and support can be challenging, with access to palliative care even more so. This review presents a synthesis of published qualitative research exploring from the perspective of homeless people and those working to support them, current challenges to palliative care access and provision, in addition to suggestions for what may improve palliative care for this population. Methods: Systematic review of qualitative research analysed using thematic synthesis. PsycINFO, Medline, Sociological Abstracts, Social Services Abstracts, Science citations index and CINAHL were searched up to September 2016. Thematic synthesis involved a three-step inductive process to develop a deeper understanding of the challenges to and suggestions for the access and provision of palliative care for homeless people. Results: Thirteen qualitative articles, reporting nine studies were identified. The challenges to access and provision to palliative care were drawn from the data covering three broad areas, namely “the chaotic lifestyles sometimes associated with being homeless”, “the delivery of palliative care within a hostel for homeless people” and provision within “mainstream health care systems”. Obstacles were related to homeless persons competing day-to-day priorities, their experience of stigma in mainstream settings, the high burden on hostel staff in supporting residents at the end of life and inflexibility in mainstream health care systems. Suggestions for improving access to palliative care include building trust between homeless persons and health professionals, increasing collaboration between and flexibility within services, and providing more training and support for all professionals. Conclusions: The provision of palliative care can be complicated for all populations, however delivering palliative care for people who are homeless is influenced by a potentially greater and more varied range of factors, on both individual and systemic levels, than providing palliative care for the housed population. Careful consideration and potentially great changes will be needed within health care systems to ensure homeless populations have equitable access to palliative care

Exploring the Impact of Simple Distraction Interventions on Patient Experience and Three Month Outcomes Following Minimally Invasive Surgery.

Background - High levels of anxiety and pain during conscious surgery are associated with poorer post-surgical outcomes. This thesis aimed to compare the effectiveness of intraoperative distraction interventions for anxiety and pain management during minimally invasive surgery under local anaesthetic, the impact on 3 month outcomes and patient's experiences of conscious surgery. Methods - Literature and systematic reviews explored the current literature surrounding conscious surgery. Two randomised controlled trials investigated the impact of intra-operative distraction interventions on pain and anxiety during conscious surgery. Analyses of postoperative outcomes including multiple regression and analyses of covariance explored the relationships between intra-operative and post-operative outcomes at 3 months post-surgery. A qualitative analysis explored patient experience of minimally invasive surgery under local anaesthetic. Results - Intra-operative distractions including touch, audiovisual stimuli and interaction with nurses resulted in significantly lower reports of intra-operative anxiety and pain than treatment as usual. Participants who interacted with nurses during surgery reported significantly greater improvements in quality of life at 3 months post-surgery than those who received treatment as usual. Intra-operative distractions had no impact on the course of post-operative pain, return to work or satisfaction with treatment. The symptoms of varicose veins negatively impacted upon quality of life and participants felt unprepared for the experience of surgery. Relationships improved patient experience during surgery and improvements in physical and psychological wellbeing were reported at 3 months following surgery. Conclusions - The use of simple distraction techniques, particularly interacting with nurses, intra-operative touch or audiovisual stimuli used during surgery significantly improved patient experience. Participant satisfaction with surgery was high but there is scope to improve the provision of pre-operative information patients receive to increase their understanding of surgery. Relationships with others influenced all stages of the operative process

Exploring the Impact of Simple Distraction Interventions on Patient Experience and Three Month Outcomes Following Minimally Invasive Surgery.

Background - High levels of anxiety and pain during conscious surgery are associated with poorer post-surgical outcomes. This thesis aimed to compare the effectiveness of intraoperative distraction interventions for anxiety and pain management during minimally invasive surgery under local anaesthetic, the impact on 3 month outcomes and patient's experiences of conscious surgery. Methods - Literature and systematic reviews explored the current literature surrounding conscious surgery. Two randomised controlled trials investigated the impact of intra-operative distraction interventions on pain and anxiety during conscious surgery. Analyses of postoperative outcomes including multiple regression and analyses of covariance explored the relationships between intra-operative and post-operative outcomes at 3 months post-surgery. A qualitative analysis explored patient experience of minimally invasive surgery under local anaesthetic. Results - Intra-operative distractions including touch, audiovisual stimuli and interaction with nurses resulted in significantly lower reports of intra-operative anxiety and pain than treatment as usual. Participants who interacted with nurses during surgery reported significantly greater improvements in quality of life at 3 months post-surgery than those who received treatment as usual. Intra-operative distractions had no impact on the course of post-operative pain, return to work or satisfaction with treatment. The symptoms of varicose veins negatively impacted upon quality of life and participants felt unprepared for the experience of surgery. Relationships improved patient experience during surgery and improvements in physical and psychological wellbeing were reported at 3 months following surgery. Conclusions - The use of simple distraction techniques, particularly interacting with nurses, intra-operative touch or audiovisual stimuli used during surgery significantly improved patient experience. Participant satisfaction with surgery was high but there is scope to improve the provision of pre-operative information patients receive to increase their understanding of surgery. Relationships with others influenced all stages of the operative process

Opportunities and challenges in involving people with lived experience of inclusion health as co-researchers in palliative and end of life research: a rapid review and thematic synthesis

Abstract Background Co-research is a collaborative approach to research, promoting involvement of individuals with lived experience of a research area as experts by experience. Recently, the importance of co-research within palliative and end of life care (PEoLC) has been highlighted, yet few recommendations exist regarding best practice for involving inclusion health groups (i.e., groups that are socially excluded, typically experiencing multiple disadvantages that contribute to poor health outcomes). Aims To identify and synthesise qualitative literature outlining barriers and facilitators for involving four inclusion health groups (individuals with lived experience of: homelessness, substance use disorder, incarceration or exchanging sex for money) in PEoLC research, from the perspectives of both the researchers and individuals with lived experience. Methods This report is a rapid review with thematic synthesis methodology. Three electronic databases were searched (2012–30th August 2022). Thematic synthesis was used to generate themes across qualitative studies. Results Three qualitative studies were eligible for inclusion. Two involved individuals with lived experience of incarceration, and one lived experience of homelessness. No papers outlined best-practice guidance for co-research; all offered reflections on the co-research process. Challenges for involvement included: facilitating appropriate reimbursement; overcoming stigma; fear of tokenism; pre-conceived views and the emotional burden of research. Successes and benefits included: advanced level of insight, a two-way learning opportunity and relatability of lived experience co-researchers. Conclusions This review did not identify any best-practice guidance for co-production of PEoLC research with inclusion health groups. There are few, good quality, qualitative studies offering insight into challenges and facilitators for lived experience co-researcher involvement. Further research and formal policy development is required to produce formal best-practice guidance to support safe, impactful inclusion in PEoLC research. Plain English Summary It is important that researchers work together with people who have lived experience of the topic they are researching. Palliative care is specialised medical care for people living with a terminal illness. There is some collaboration between researchers and people with lived experience in palliative and end-of-life care research. However, some groups of people have been excluded. This includes people experiencing homelessness, or people with drug or alcohol addictions. This review aimed to understand what works and what doesn’t work when involving four excluded groups in palliative and end-of-life research. These groups were people experiencing homelessness, those who had spent time in prison, people with drug or alcohol disorders, and people who exchanged sex for money. This review used a shortened methodology, which allowed it to be done quickly. Three online academic databases (Medline, PubMed, PsychINFO) were searched for research projects: three papers were included in the review. No clear guidance for working with these groups was found. Analysis identified themes across papers. Challenges for collaboration included: appropriate payment methods; overcoming stigma; fear of being talked down to,; assumptions made before meeting people, and the potential of becoming upset. Successes and benefits included: better understanding of the research topic, the opportunity to learn from one another, and how research participants could relate to lived experience co-researchers. There are few, good quality papers, but more research is needed to produce guidance to support safe, impactful collaboration

Understanding aims, successes and challenges of palliative care and homelessness initiatives across the UK: an exploratory study

Background Due to the recognition that people experiencing homelessness (PEH) often die young and unsupported, a growing number of initiatives focusing on palliative care and homelessness are emerging across the UK. However, there has been no systematic exploration of the nature and landscape of this work.Aims To understand the range, aims, successes and challenges of current initiatives within the field of palliative care and homelessness in the UK, by exploring existing projects and initiatives.Method An online survey was distributed to members of an Extension for Community Healthcare Outcomes network focusing on palliative care and homelessness for a mixed professional audience. The survey collated the aims, successes and challenges of initiatives aiming to improve palliative care for PEH. Responses were summarised using descriptive statistics, and free-text responses were analysed using thematic analysis.Results 162 professionals completed the survey. Of these, 62% reported involvement in at least one palliative care and homelessness initiative. Initiatives focused on service delivery (59%), training (28%) and research (28%). Themes for success included improved service engagement, relationship formation, housing provision, honouring end-of-life wishes, upskilling staff and enabling safe hospital discharge. The main challenges included stigma around substance misuse, securing funding, staff capacity, equipment and facilities, and engaging communities.Conclusion The number and scope of initiatives aiming to support PEH with advanced ill health and palliative care needs across the UK is growing, with a range of professionals engaging in the field. Future research may benefit from exploring initiatives in more detail to understand the specific drivers of impact on PEH and the staff and services supporting them

Involving people with lived experience of homelessness in palliative and end of life care research: key considerations from experts in the field

Abstract Background Co-production of research aims to include people with lived experience of a phenomena throughout the research process. People experiencing homelessness often experience advance ill-health at a young age, yet access palliative care services at a disparately low rate to the level of palliative care need. The voices of people experiencing homelessness are infrequently heard throughout palliative care research, despite the complexities and intricacies of the area. Aim To explore the experiences of experts in the field to identify key context considerations for involving people with lived experience of homelessness in palliative and end of life care research. Methods Qualitative study comprising two data collection streams: interviews with professionals with experience of involving people experiencing homelessness in their work, and focus groups with people with lived experience (PWLE) of homelessness. Data were analysed using iterative, reflexive thematic analysis. Patient and Public Involvement contributors gave feedback on themes. Results A total of 27 participants took part in semi-structured interviews (N = 16; professionals) or focus groups (N = 11; PWLE homelessness). Key considerations of involving people experiencing homelessness in palliative and end of life care research were developed into four key themes: complexity of lived experience of homelessness; representation of homelessness within experts by experience; professionalising lived experience; and methods for involvement. Conclusions Involvement of people with lived experience of homelessness is important in developing palliative care research. This paper begins to outline some contextual considerations for promoting involvement in a complex and intricate field of research

Palliative care, homelessness, and restricted or uncertain immigration status.

BACKGROUND: People experiencing homelessness have limited access to palliative care support despite high levels of ill health and premature mortality. Most research exploring these challenges in the United Kingdom has focused on people living in hostels or temporary accommodation. People with uncertain or restricted immigration status are often unable to access this accommodation due to lack of entitlement to benefits. There is little research about the experiences of those in the United Kingdom who cannot access hostels or temporary accommodation due to restricted or uncertain immigration status with regards to palliative and end-of-life care access. AIM: To explore the barriers to palliative and end-of-life care access for people with uncertain or restricted immigration status, who are experiencing homelessness and have advanced ill health, and the experiences of UK hospices of supporting people in this situation. DESIGN: A multi-method cross-sectional study. SETTING/PARTICIPANTS: An online survey for hospice staff followed by online focus groups with staff from inclusion health, homelessness and palliative care services, charities and interviews with people experiencing homelessness. RESULTS: Fifty hospice staff responded to the online survey and 17 people participated in focus groups and interviews (focus groups: n = 10; interviews: n = 7). The survey demonstrated how hospices are not currently supporting many people with restricted or uncertain immigration status who are homeless and that hospice staff have received limited training around eligibility for entitlements or National Health Service (NHS) care. Interview and focus group data demonstrated high levels of unmet need. Reasons for this included a lack of consistency around eligibility for support from local authorities, issues relating to NHS charging, and mistrust and limited knowledge of the UK health and social care system. These barriers leave many people unable to access care toward the end of their lives. CONCLUSION: To advocate for and provide compassionate palliative and end-of-life care for people with uncertain immigration status, there is need for more legal literacy, with training around peoples entitlement to care and support, as well as easier access to specialist legal advice

Palliative care, homelessness, and restricted or uncertain immigration status

Background: People experiencing homelessness have limited access to palliative care support despite high levels of ill health and premature mortality. Most research exploring these challenges in the United Kingdom has focused on people living in hostels or temporary accommodation. People with uncertain or restricted immigration status are often unable to access this accommodation due to lack of entitlement to benefits. There is little research about the experiences of those in the United Kingdom who cannot access hostels or temporary accommodation due to restricted or uncertain immigration status with regards to palliative and end-of-life care access. Aim: To explore the barriers to palliative and end-of-life care access for people with uncertain or restricted immigration status, who are experiencing homelessness and have advanced ill health, and the experiences of UK hospices of supporting people in this situation. Design: A multi-method cross-sectional study. Setting/participants: An online survey for hospice staff followed by online focus groups with staff from inclusion health, homelessness and palliative care services, charities and interviews with people experiencing homelessness. Results: Fifty hospice staff responded to the online survey and 17 people participated in focus groups and interviews (focus groups: n  = 10; interviews: n  = 7). The survey demonstrated how hospices are not currently supporting many people with restricted or uncertain immigration status who are homeless and that hospice staff have received limited training around eligibility for entitlements or National Health Service (NHS) care. Interview and focus group data demonstrated high levels of unmet need. Reasons for this included a lack of consistency around eligibility for support from local authorities, issues relating to NHS charging, and mistrust and limited knowledge of the UK health and social care system. These barriers leave many people unable to access care toward the end of their lives. Conclusion: To advocate for and provide compassionate palliative and end-of-life care for people with uncertain immigration status, there is need for more legal literacy, with training around people’s entitlement to care and support, as well as easier access to specialist legal advice