"Ahead on points": Understanding the long-term impact of colorectal cancer with liver metastases on quality of life and survivorship experiences

The aim of this study was to investigate the impact of colorectal cancer (CRC) with liver metastases on long-term quality of life (QOL) and survivorship experiences, and to explore the relevance of the EORTC QOL questionnaires to this population, using a qualitative approach. Overall 15 participants were interviewed, 5 women and 10 men. Interviews were analysed using inductive theoretical thematic analysis. Three main themes were identified: Cancer and me: establishing a relationship with cancer; Living with cancer; and Aligning the long-term impacts: the person I’ve become. The results illustrate that CRC survivors with liver metastases define QOL in different ways and have a broad and diverse range of experiences. As long-term cancer survivors, the focus on short-term physical symptoms is no longer relevant. Instead, the relationship with cancer, development of coping strategies, and coming to terms with a post-cancer self are of far more importance. As QOL is a subjective experience, there is no ‘one size fits all’ approach to definition and measurement. Health care professionals and policy makers need to understand the variety in meaning and be clear about the purpose of QOL measures. In attempts to promote long-term positive adjustment, cancer survivors may benefit from a wider range of support and expertise. Health Psychologists in particular could offer valuable insight and support in relation to adaptive coping strategies, mental framing, adjustment to physical changes, and the development and adjustment to the ‘post-cancer self’. Future work would benefit from holistic definition of QOL and from using a broad range of assessment techniques

The Importance of Sleep for People With Chronic Pain:Current Insights and Evidence

ABSTRACT We are currently in the midst of a sleep crisis. Our current work and lifestyle environments are normalizing poor sleep with substantial negative impact on our health. Research on sleep has linked sleep deprivation to poorer mental health, obesity, cancer, diabetes, heart disease, and a myriad of other health conditions. Sleep deprivation is an even greater issues for people with musculoskeletal conditions and chronic pain. Between 67% and 88% of individuals with chronic pain experience sleep disruption and insomnia, and at least 50% of people with insomnia report chronic pain. The link between sleep and pain is well documented. Experimental, cohort, and longitudinal studies have all demonstrated that restricted sleep is linked to greater pain. Poor sleep therefore not only affects general health but has a direct impact on inflammation, pain response, and experience. Improving sleep in people living with musculoskeletal conditions and with chronic pain has the potential to deliver great benefit to many. This article describes the evidence base that can underpin such work, including research about the link between pain and sleep as well as theories and approaches to intervention that may help. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research

Development of a novel intervention to improve sleep and pain in patients undergoing total knee replacement

BACKGROUND: Up to 20% of patients experience long-term pain and dissatisfaction after total knee replacement, with a negative impact on their quality of life. New approaches are needed to reduce the proportion of people to go on to experience chronic post-surgical pain. Sleep and pain are bidirectionally linked with poor sleep linked to greater pain. Interventions to improve sleep among people undergoing knee replacement offer a promising avenue. Health beliefs and barriers to engagement were explored using behaviour change theory. This study followed stages 1–4 of the Medical Research Council’s guidance for complex intervention development to develop a novel intervention aimed at improving sleep in pre-operative knee replacement patients. METHODS: Pre-operative focus groups and post-operative telephone interviews were conducted with knee replacement patients. Before surgery, focus groups explored sleep experiences and views about existing sleep interventions (cognitive behavioural therapy for insomnia, exercise, relaxation, mindfulness, sleep hygiene) and barriers to engagement. After surgery, telephone interviews explored any changes in sleep and views about intervention appropriateness. Data were audio-recorded, transcribed, anonymised, and analysed using framework analysis. RESULTS: Overall, 23 patients took part, 17 patients attended pre-operative focus groups, seven took part in a post-operative telephone interview, and one took part in a focus group and interview. Key sleep issues identified were problems getting to sleep, frequent waking during the night, and problems getting back to sleep after night waking. The main reason for these issues was knee pain and discomfort and a busy mind. Participants felt that the sleep interventions were generally acceptable with no general preference for one intervention over the others. Views of delivery mode varied in relation to digital move and group or one-to-one approaches. CONCLUSION: Existing sleep interventions were found to be acceptable to knee replacement patients. Key barriers to engagement related to participants’ health beliefs. Addressing beliefs about the relationship between sleep and pain and enhancing understanding of the bidirectional/cyclical relationship could benefit engagement and motivation. Individuals may also require support to break the fear and avoidance cycle of pain and coping. A future intervention should ensure that patients’ preferences for sleep interventions and delivery mode can be accommodated in a real-world context

“Are you still on that stupid diet?” Women’s experiences of societal pressure and support regarding weight loss, and attitudes towards health policy intervention

This study investigated how people’s attitudes and motivations towards losing weight are influenced by societal pressures surrounding weight loss, their interaction with the obesogenic environment and individuals’ attitudes and motivations towards weight. Semi-structured qualitative interviews were conducted with 10 women currently attending commercial weight-loss programmes. Participants experienced conflicting messages regarding weight norms, with the media portraying powerful social norms relating to thinness and beauty, and changes to the food environment and interactions with family and friends commonly undermining weight-loss activities and promoting increased consumption. Providing social and environmental support for the behaviours needed to produce weight loss may need to be a primary focus for obesity policy. </jats:p

Value, transparency, and inclusion:A values-based study of patient involvement in musculoskeletal research

BACKGROUND: Patient and public involvement work (PPI) is essential to good research practice. Existing research indicates that PPI offers benefits to research design, conduct, communication, and implementation of findings. Understanding how PPI works and its value helps to provide information about best practice and highlight areas for further development. This study used a values-based approach to reporting PPI at a Research Unit focused on musculoskeletal conditions within a UK medical school. METHODS: The study was conducted between October 2019 and January 2020 using Gradinger’s value system framework as a theoretical basis. The framework comprises three value systems each containing five clusters. All PPI members and researchers who had attended PPI groups were invited to participate. Participants completed a structured questionnaire based on the value system framework; PPI members also provided further information through telephone interviews. Data were deductively analysed using a framework approach with data mapped onto value systems. RESULTS: Twelve PPI members and 17 researchers took part. Views about PPI activity mapped onto all three value systems. PPI members felt empowered to provide their views, and that their opinions were valued by researchers. It was important to PPI members that they were able to ‘give back’ and to do something positive with their experiences. Researchers would have liked the groups to be more representative of the wider population, patients highlighted that groups could include more younger members. Researchers recognised the value of PPI, and the study highlighted areas where researchers members might benefit from further awareness. CONCLUSIONS: Three areas for development were identified: (i) facilitating researcher engagement in training about the value and importance of PPI in research; (ii) support for researchers to reflect on the role that PPI plays in transparency of healthcare research; (iii) work to further explore and address aspects of diversity and inclusion in PPI

Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement:a systematic review

Objectives: To assess the effectiveness and reporting standards of psychological interventions for improving outcomes after total knee replacement (TKR).Design: The systematic review protocol was registered on the International Prospective Register of Systematic reviews (CRD42018095100). MEDLINE, EMBASE, and PsycINFO were searched from inception to up to 9th May 2019 with no language restrictions applied. Randomised controlled trials (RCTs) assessing the effectiveness of psychological interventions for short and long-term post-operative pain after TKR were included. Screening, data extraction and assessment of methodological quality was performed in duplicate by two reviewers. The primary effectiveness outcome was post-operative pain severity and the primary harm outcome was serious adverse events. Secondary outcomes included function, quality of life, and psychological wellbeing. Reporting standards were assessed using the TIDieR checklist for intervention reporting. Results: 12 RCTs were included, with a total of 1299 participants. Psychological interventions comprised music therapy (five studies), guided imagery and music (one study), hypnosis (one study) progressive muscle relaxation with biofeedback (one study), pain coping skills programme (one study), cognitive behavioural therapy (two studies), and a post-operative management programme (one study). Due to the high heterogeneity of interventions and poor reporting of harms data, it was not possible to make any definitive statements about the overall effectiveness or safety of psychology interventions for pain outcomes after TKR. Conclusion: Further evidence about the effectiveness of psychological interventions for improving pain outcomes after TKR is needed. The reporting of harm outcomes and intervention fidelity is currently poor and could be improved. Future work exploring the impact of intervention timing on effectiveness and whether different psychological approaches are needed to address acute post-operative pain and chronic post-operative pain would be of benefit