Barriers and facilitators to self-management in people living with and beyond cancer (PLWABC): a systematic review of qualitative evidence (PROTOCOL)

Review question The review objectives are: To identify, evaluate and synthesise qualitative evidence that has explored the perspectives of people living with and beyond cancer regarding self-management. To utilise this data to identify, explore and explain the potential barriers and facilitators to self-management in people living with and beyond cancer. Condition or domain being studied: Engagement (or lack of) in self-management practices/behaviours, support and resources in adults (≥18) with any diagnosis of cancer who have completed treatment for cancer. Whilst there is no universal definition of self-management, in cancer survivorship, it has been defined as “awareness and active participation by the person in their recovery, recuperation, rehabilitation, to minimise the consequences of treatment, promote survival, health and wellbeing” (DH, Macmillan Cancer Support, NHS Improvement, 2013). This definition will be used for the purposes of this review

Effects of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus: A systematic review and meta-analysis

Introduction: Previous evidence has shown significant effects of exercise, cognitive and dual-task training for improving cognition in healthy cohorts. The effects of these types of interventions in type 2 diabetes mellitus is unclear. The aim of this research was to systematically review evidence, and estimate the effect, of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus. Method: Electronic databases including PubMed, EMBASE, CINAHL, PsycINFO, SPORTDiscus, and MEDLINE were searched for ongoing and completed interventional trials investigating the effect of either an exercise, cognitive or dual-task intervention on cognition in type 2 diabetes mellitus. Results: Nine trials met the inclusion criteria – one dual-task, two cognitive, and six exercise. Meta-analyses of exercise trials showed no significant effects of exercise on measures of executive function (Stroop task, SMD= -0.31, 95% CI -0.71–0.09, P=0.13, trail making test part A SMD= 0.28, 95% CI -0.20–0.77 P=0.25, trail making test part B SMD= -0.15, 95% CI -0.64–0.34 P=0.54, digit symbol SMD= 0.09, 95% CI -0.39–0.57 P=0.72), and memory (immediate memory SMD= 0.20, 95% CI -0.28–0.69, P=0.41 and delayed memory SMD= -0.06, 95% CI -0.55–0.42, P=0.80). A meta-analysis could not be conducted using cognitive or dual-task data, but individual trials did report a favourable effect of interventions on cognition. Risk of bias was considered moderate to high for the majority of included trials. Conclusions: Meta-analyses of exercise trials identified a small effect size (0.31), which whilst not significant warrants further investigation. Larger and more robust trials are needed that report evidence using appropriate reporting guidelines (e.g. CONSORT) to increase confidence in the validity of results. Trial Registration: Protocol was registered (CRD42017058526) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO)

Evaluating follow- up and complexity in cancer clinical trials (EFACCT): an eDelphi study of research professionals’ perspectives.

Objectives: To evaluate patient follow-up and complexity in cancer clinical trial delivery, using consensus methods to: (1) identify research professionals’ priorities, (2) understand localised challenges, (3) define study complexity and workloads supporting the development of a trial rating and complexity assessment tool (TRACAT). Design: A classic eDelphi completed in three rounds, conducted as the launch study to a multiphase national project (evaluating follow-up and complexity in cancer clinical trials). Setting: Multicentre online survey involving professionals at National Health Service secondary care hospital sites in Scotland and England varied in scale, geographical location and patient populations. Participants: Principal investigators at 13 hospitals across nine clinical research networks recruited 33 participants using pre-defined eligibility criteria to form a multidisciplinary panel. Main outcome measures: Statements achieving a consensus level of 70% on a 7-point Likert-type scale and ranked trial rating indicators (TRIs) developed by research professionals. Results: The panel developed 75 consensus statements illustrating factors contributing to complexity, follow-up intensity and operational performance in trial delivery, and specified 14 ranked TRIs. Seven open questions in the first qualitative round generated 531 individual statements. Iterative survey rounds returned rates of 82%, 82% and 93%. Conclusions: Clinical trials operate within a dynamic, complex healthcare and innovation system where rapid scientific advances present opportunities and challenges for delivery organisations and professionals. Panellists highlighted cultural and organisational factors limiting the profession’s potential to support growing trial complexity and patient follow-up. Enhanced communication, interoperability, funding and capacity have emerged as key priorities. Future operational models should test dialectic Singerian-based approaches respecting open dialogue and shared values. Research capacity building should prioritise innovative, collaborative approaches embedding validated review and evaluation models to understand changing operational needs and challenges. TRACAT provides a mechanism for continual knowledge assimilation to improve decision-making

Development of an information leaflet and diagnostic flow chart to improve the management of urinary tract infections in older adults: a qualitative study using the Theoretical Domains Framework

Background: Urinary tract infections (UTIs), older age, lack of access to health care, and recent antibiotic use are risk factors for Escherichia coli (E. coli) bloodstream infections. Aim: To explore the diagnosis and management of UTIs in primary care to inform the development of an information leaflet, a diagnostic flow chart, and recommendations for other resources. Design & setting: The study had a qualitative design and was undertaken in primary care settings and care homes. Method: Interviews and focus groups were informed by the Theoretical Domains Framework (TDF) with 31 care home staff, three residents, six relatives, 57 GP staff, and 19 members of the public. An inductive thematic analysis was used and themes were placed in the Behaviour Change Wheel (BCW) to recommend interventions. Results: Care home staff were pivotal for identifying suspected UTI, alerted clinicians to symptoms that influenced prescribing decisions, and reported confusion or behavioural changes as the most common diagnostic sign. Care home staff lacked knowledge about asymptomatic bacteriuria (ASB) and sepsis, and incorrectly diagnosed UTI using urine dipsticks. GP staff used urine dipsticks to rule out UTI and reported that stopping dipsticks would require a culture change, clear protocols, and education about ASB. Many prescribers believed that stopping urine dipstick use should help to reduce antibiotic use. Conclusion: A consistent message about ASB and UTI diagnosis and management in older adults should be communicated across the care pathway. Resource development should increase capability, motivation, and opportunity to improve management of suspected UTIs. An educational leaflet for older adults and a diagnostic flow chart for clinicians have been developed, and recommendations for interventions are discussed