The eating-related behaviours, expectations, and experiences of individuals before and after undergoing bariatric surgery

While a variety of disordered eating behaviours can play significant roles in the development and maintenance of obesity, little is known about their prevalence and implications in individuals who undergo bariatric (weight loss) surgery. Patients’ expectations and experiences of eating behaviour change after surgery, and their reasons for undergoing one particular bariatric procedure rather than another, are also not well-understood. This thesis investigated these topics in two reviews and an original research study, with the results presented in four papers. Paper 1 reviewed the literature on eating-related behaviours, disorders, and expectations in pre-bariatric surgery candidates. A variety of disordered eating behaviours appear more common in bariatric candidates than in non-obese populations, with evidence that 4-45% of candidates have binge eating disorder (BED), 20-60% graze, 2-42% have night eating syndrome (NES), 38-59% emotionally eat, and 17-54% fit the criteria for food addiction. Expectations are high, with candidates believing their procedure will almost guarantee significantly improved eating behaviours. Paper 2 systematically reviewed the literature on pre- to post-surgery changes in eating disorders and disordered eating behaviours after Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), or vertical sleeve gastrectomy (VSG). Short- to medium-term reductions in BED and related behaviours were common after RYGB. Short- to medium-term reductions in emotional eating and short to long-term reductions in bulimic symptoms were reported after RYGB. Reoccurrences and new occurrences of disordered eating, especially BED and binge episodes, were apparent after RYGB and AGB. Limited and low-quality evidence hindered conclusions and comparisons. The literature was unclear on whether any bariatric procedure leads to long-term improvement in disordered eating. Using content analysis and quantitative analyses, paper 3 examined patients’ reasons for undergoing their particular bariatric procedure rather than another procedure. RYGB was most often chosen because of its evidence base and success rate, VSG due to a medical practitioner’s recommendation, preference, or choice, and AGB because of characteristics of the procedure including its reversibility. A desire to avoid post-surgical complications and risks such as leaks or malabsorption was the most commonly cited reason against both RYGB and VSG, while information and evidence from failure rates and others’ unsuccessful experiences was most common against AGB. In Paper 4, content analysis and quantitative analyses were utilised to investigate patients’ expectations and experiences of eating-related behaviour change after bariatric procedures. The most common pre-surgical expectations were of eating less and feeling increased satiety (47.0%) and reduced hunger (30.4%). After surgery, patients more often reported positive (84.9%; most often eating less) than negative eating-related experiences (43.7%; most often continued or new problematic/disordered eating behaviours). Disordered eating behaviours persisted or emerged in 17.1% and improved or resolved in 18.1%. Negative experiences were more frequently reported at ≥ 18 months than ≤ 1 year. Reporting any negative eating-related experience was related to poorer outcomes after VSG and AGB, but not RYGB. Relationships between negative eating-related experiences and poorer outcomes, and positive experiences and improved outcomes, were significant almost exclusively from ≥ 18 months post-surgery. The findings of this thesis show that the prevalence and consequences of disordered eating behaviours, eating disorders, and negative eating-related experiences are substantial for pre- and post-surgical bariatric patients. These issues are not always cured or even improved by bariatric surgery, and can continue, worsen, or begin de novo after surgery. Eating-related difficulties may be especially likely to begin or re-emerge at one to two years post-surgery. Patients are likely to benefit from the incorporation of eating-related education, assessment, and provision of therapeutic strategies by bariatric practices from prior to surgery to well beyond two years post-surgery. It is also recommended that surgeons be aware of the different reasons why patients undergo one bariatric procedure rather than another, and ensure that patients receive accurate, unbiased, and individualised information regarding the different procedures.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School and School of Psychology, 201

Intersecting identities, diverse masculinities, and collaborative development : Considerations in creating online mental health interventions that work for men

Online mental health interventions have received attention for their potential to bypass barriers that stop men from seeking mental health help from a health professional. However, emerging data suggest that men's use of online mental health interventions is low, and when used, early attrition is common. In this commentary, we hypothesise that men's common lack of engagement with online mental health interventions may reflect limited attention being paid to the needs and preferences of potential users during their development. We outline a series of considerations that we believe are important to advance the development of acceptable, effective online mental health interventions for men: (1) men's diverse and intersecting characteristics, circumstances, and needs; (2) centring positive, progressive masculinities; and (3) listening to, learning from, and working in partnership with men to develop interventions. We also examine how existing online mental health interventions targeting men have engaged with these considerations

Impact of different unconditional monetary incentives on survey response rates in men with prostate cancer: A 2-arm randomised trial

Background: Men are often viewed as a difficult group to recruit for psychological research, including in psycho-oncology. Whilst research has demonstrated the effectiveness of small monetary incentives for encouraging research participation, little research has examined different large unconditional incentive amounts. Larger unconditional incentives may result in increased participation of men in psychological research. This randomised study within a case–control trial of men diagnosed with early-stage prostate cancer aimed to investigate whether (a) response rates to a 30-min questionnaire completed via mail, online, or phone would vary with different unconditional incentive amounts, and (b) demographics would vary in those who responded within the different incentive groups. Methods: We conducted this randomised study within a case–control cross-sectional study aiming to identify the social-ecological factors influencing treatment discontinuation in prostate cancer patients. A total of 238 participants from the cross-sectional study were randomised to receive one of two unconditional incentives (n = 121 received AUD $10, n = 117 received AUD$20) with the study materials (consent form and survey). Results: Overall, 113 (47 %) responded; n = 61/121 (50.4 %) in the AUD $10 group, and n = 52/117 (44.4$20 group. No evidence of a difference was found in response rates by incentive group (odds ratio 1.27, 95 % CI = 0.76 – 2.12, p = 0.36). Additionally, there were no evident differences in the demographics of the responders vs. non-responders within each incentive group (all p \u3e 0.05). Conclusions: Unlike previous research, we were unable to show that higher monetary incentives were more effective for increasing response rates. An AUD $20 unconditional incentive may be no more effective than a lesser amount for encouraging prostate cancer survivors to participate in research involving long questionnaires. Future research should consider the cost-benefits of providing large unconditional incentives, as non-responses will result in lost resources perhaps better utilised in other engagement strategies

Why do men with prostate cancer discontinue active surveillance for definitive treatment? A mixed methods investigation

Objectives: To explore the personal and/or medical reasons patients on active surveillance (AS) have, or consider having, further definitive treatment for their prostate cancer. Research suggests up to 50% of patients on AS will discontinue within 5 years, though reasons for discontinuation from the patient\u27s perspective is under-explored. Methods: Prostate cancer patients who were or had been on AS for at least 6 months were recruited. A questionnaire assessed reasons for receiving/considering definitive treatment and the extent to which reasons were personal or medical. Clinical information was extracted from a state-level population registry. A subset of participants were interviewed to further explore questionnaire responses. Results: One-hundred and-three individuals completed the survey; 33 were also interviewed. Fifty-four survey participants (52%) had discontinued AS for definitive treatment. Common reasons for discontinuation were evidence of disease progression, doctor recommendation, desire to act, and fear of progression. Many participants who considered or had treatment reported weighing medical and personal factors equally in their decision. Interview participants described strongly considering any amount of disease progression and personal factors such as fear of progression, family concerns, and adverse vicarious experiences when deciding whether to pursue treatment. Conclusion: Both medical and personal factors are considered when deciding whether to discontinue AS. Identifying predictors of discontinuation is essential for informing supportive care services to improve AS management

Social ecological influences on treatment decision-making in men diagnosed with low risk, localised prostate cancer

Objective: Individuals diagnosed with low risk, localised prostate cancer (PCa) face a difficult decision between active surveillance (AS) and definitive treatment. We aimed to explore perceived influences on treatment decision-making from the patient and partner\u27s perspectives. Methods: Patients (and partners) who met AS criteria and had chosen their treatment were recruited. Semi-structured individual interviews were conducted via telephone to explore experiences of diagnosis, impact on patient lifestyle, experiences with physicians, treatment preferences/choice, treatment information understanding and needs, and overall decision-making process. Interviews were audio recorded, transcribed verbatim, and analysed using Reflexive Thematic Analysis. Results: Twenty-four male patients (18 chose AS) and 12 female partners participated. Five themes relating to social-ecological influences on treatment choice were identified: (1) partner support and direct influence on patient treatment choice, (2) patient and partner vicarious experiences may influence treatment decisions, (3) the influence of the patient\u27s life circumstances, (4) disclosing to wider social networks: friends, family, and co-workers, and (5) the importance of a good relationship and experience with physicians. Additionally, two themes were identified relating to information patients and partners received about the treatment options during their decision-making process. Conclusions: A range of individual and social influences on treatment decision-making were reported. Physicians providing treatment recommendations should consider and discuss the patient and partner\u27s existing beliefs and treatment preferences and encourage shared decision-making. Further research on treatment decision-making of partnered and non-partnered PCa patients is required. We recommend research considers social ecological factors across the personal, interpersonal, community, and policy levels

Telehealth in the context of COVID-19

Introduction: The rise in telehealth adoption due to the emergence of COVID-19 may have had implications for men who experience barriers to accessing traditional forms of healthcare. This study sought to explore how a sample of older men interacted with telehealth during the pandemic. Method: Data sourced from a cross-sectional, population-based questionnaire (completed from October 2020 to March 2021) were used to analyze the characteristics of older men’s (a) use of telehealth services, and (b) perceptions of telehealth in comparison to in-person healthcare using Andersen’s Behavioral Model of Health Services Use. Results: Of the 731 participants (mean age = 69 years; SD = 9.6), 241 (32.9%) had used telehealth services during pandemic restrictions. Most of them who had used telehealth (63.1%; 152/241) thought it was “just as good” as in-person, 4.1% (10/241) believed it was “better,” and 25.7% (62/241) thought it was “worse.” Men with more chronic conditions were more likely to (a) have used telehealth (odds ratio [OR], 1.44 [95% CI, 1.21–1.71]) and (b) perceived telehealth as “better” or “just as good” as in-person healthcare (OR, 1.63 [95% CI, 1.17–2.29]). Men with clinically significant depressive symptoms were more likely to view telehealth as worse than in-person care (OR, 0.32 [95% CI, 0.12–0.88]). Conclusion: While telehealth is acceptable to the majority of middle-aged and older men who have used it during the pandemic, attitudes may vary according to their current health issues. Men with more chronic conditions are more likely to feel positive about telehealth, while those with clinically significant depression symptoms are more likely to view it negatively. Healthcare providers should consider men’s needs and preferences when offering telehealth services

A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer

Objective Understanding the unmet supportive care needs of men on active surveillance for prostate cancer may enable researchers and health professionals to better support men and prevent discontinuation when there is no evidence of disease progression. This review aimed to identify the specific unmet supportive care needs of men on active surveillance. Methods A systematic review following PRISMA guidelines was conducted. Databases (Pubmed, Embase, PsycINFO, and CINAHL) were searched to identify qualitative and/or quantitative studies that reported unmet needs specific to men on active surveillance. Quality appraisals were conducted before results were narratively synthesised. Results Of the 3613 unique records identified, only eight articles were eligible (five qualitative and three cross-sectional studies). Unmet Informational, Emotional/Psychological, Social, and “Other” needs were identified. Only three studies had a primary aim of investigating unmet supportive care needs. Small active surveillance samples, use of nonvalidated measures, and minimal reporting of author reflexivity in qualitative studies were the main quality issues identified. Conclusions The unmet needs of men on active surveillance is an underresearched area. Preliminary evidence suggests the information available and provided to men during active surveillance is perceived as inadequate and inconsistent. Men may also be experiencing unmet psychological/emotional, social, and other needs; however, further representative, high-quality research is required to understand the magnitude of this issue. Reporting results specific to treatment type and utilising relevant theories/models (such as the social ecological model [SEM]) is recommended to ensure factors that may facilitate unmet needs are appropriately considered and reported

Men’s sexual help-seeking and care needs after radical prostatectomy or other non-hormonal, active prostate cancer treatments

Objective To examine prostate cancer (PCa) survivors’ sexual help-seeking intentions, behaviours, and unmet needs. Methods In this prospective cohort study, men who underwent active, non-hormonal treatment completed baseline (N = 558) and 6-month follow-up (N = 387) questionnaires. Theory of planned behaviour (TPB) constructs (sexual help-seeking intention, perceived behavioural control (PBC), subjective norm, attitude), masculine values (e.g., sexual importance/priority, emotional self-reliance), sex life and functioning, sexual supportive care needs, distress (anxiety, depression), and sexual help-seeking behaviour were assessed. Results Most men (M age = 64.6 years; M years post-diagnosis = 4.0) received prostatectomy (93%), reported severe erectile dysfunction (52%), ≥ 1 unmet sexual care need (66%), and sought help from a doctor (baseline 52%, follow-up 42%). Sexual care needs were significantly associated with poorer erectile function, reduced satisfaction with sex-life, valuing sex as important/integral to identity (masculine values), and increased depression (p ≤ 0.001). Sexual help-seeking intentions were significantly associated with valuing sex as important/integral to identity, recent help-seeking, greater confidence/control, perceiving support from important others, and positive attitudes, for sexual help-seeking (p < 0.001). Significant predictors of sexual help-seeking (follow-up) were baseline intentions, recent help-seeking (p < 0.001), and increased anxiety (p < 0.05). Conclusions Men’s unmet sexual care needs, sexual help-seeking intentions, and behaviour appear driven by the importance/value attributed to sex, distress, positive feelings, support from others, and confidence for help-seeking. Psychosocial providers are well-placed to address men’s concerns, yet few sought their assistance. Interventions to improve men’s access to effective sexual care are needed, particularly focused on reframing masculine values about the importance of sex and leveraging TPB-based predictors of help-seeking

Men’s sexual help-seeking and care needs after radical prostatectomy or other non-hormonal, active prostate cancer treatments

ObjectiveTo examine prostate cancer (PCa) survivors’ sexual help-seeking intentions, behaviours, and unmet needs.MethodsIn this prospective cohort study, men who underwent active, non-hormonal treatment completed baseline (N\ua0= 558) and 6-month follow-up (N\ua0= 387) questionnaires. Theory of planned behaviour (TPB) constructs (sexual help-seeking intention, perceived behavioural control (PBC), subjective norm, attitude), masculine values (e.g., sexual importance/priority, emotional self-reliance), sex life and functioning, sexual supportive care needs, distress (anxiety, depression), and sexual help-seeking behaviour were assessed.ResultsMost men (M age\ua0= 64.6 years;\ua0M years post-diagnosis\ua0= 4.0) received prostatectomy (93%), reported severe erectile dysfunction (52%), ≥ 1 unmet sexual care need (66%), and sought help from a doctor (baseline 52%, follow-up 42%). Sexual care needs were significantly associated with poorer erectile function, reduced satisfaction with sex-life, valuing sex as important/integral to identity (masculine values), and increased depression (p\ua0≤ 0.001). Sexual help-seeking intentions were significantly associated with valuing sex as important/integral to identity, recent help-seeking, greater confidence/control, perceiving support from important others, and positive attitudes, for sexual help-seeking (p\ua0< 0.001). Significant predictors of sexual help-seeking (follow-up) were baseline intentions, recent help-seeking (p\ua0< 0.001), and increased anxiety (p\ua0< 0.05).ConclusionsMen’s unmet sexual care needs, sexual help-seeking intentions, and behaviour appear driven by the importance/value attributed to sex, distress, positive feelings, support from others, and confidence for help-seeking. Psychosocial providers are well-placed to address men’s concerns, yet few sought their assistance. Interventions to improve men’s access to effective sexual care are needed, particularly focused on reframing masculine values about the importance of sex and leveraging TPB-based predictors of help-seeking

Anticipatory anxiety and participation in cancer screening. A systematic review

ObjectivesTo synthesize current evidence on the association between anticipatory anxiety, defined as apprehension-specific negative affect that may be experienced when exposed to potential threat or uncertainty, and cancer screening to better inform strategies to maximize participation rates.MethodsSearches related to cancer screening and anxiety were conducted in seven electronic databases (APA PsycINFO, Scopus, Web of Science, Embase, Cochrane Library, PubMed, CINAHL), with potentially eligible papers screened in Covidence. Data extraction was conducted independently by multiple authors. Barriers to cancer screening for any type of cancer and relationships tested between anticipatory anxiety and cancer screening and intention were categorized and compared according to the form and target of anxiety and cancer types.ResultsA total of 74 articles (nparticipants = 119,990) were included, reporting 103 relationships tested between anticipatory anxiety and cancer screening and 13 instances where anticipatory anxiety was reported as a barrier to screening. Anticipatory anxiety related to a possible cancer diagnosis was often associated with increased screening, while general anxiety showed no consistent relationship. Negative relationships were often found between anxiety about the screening procedure and cancer screening.ConclusionAnticipatory anxiety about a cancer diagnosis may promote screening participation, whereas a fear of the screening procedure could be a barrier. Public health messaging and primary prevention practitioners should acknowledge the appropriate risk of cancer, while engendering screening confidence and highlighting the safety and comfort of screening tests