Colorectal cancer follow-up: An intervention to support patients following treatment

With an increasing numbers of patients treated for colorectal cancer (CRC), strategies that support existing services are required. This thesis outlines a series of studies including GPs’ approaches to treating CRC problems, plus the development and trial of a self-assessment tool (SATp) to support patients who consult their GPs regarding CRC-related health problems. Overall, using SATp with general practice support is a viable method to support CRC patients with problems following cancer treatment

Getting a grip on Safewards: The cross impact of clinical supervision and Safewards model on clinical practice

The Safewards model is used across various mental health settings to reduce incidents of conflict and containment and its efficacy in reducing the use of seclusion and restraint, improving patients\u27 experiences of care, and enhancing safety within clinical settings is well documented (Bowers, Journal of Psychiatric & Mental Health Nursing, 21, 2014, 499). However, there are barriers to successful implementation, including level of staff buy-in (Baumgardt et al., Frontiers in Psychiatry, 10, 2019, 340; Price et al., Mental Health Practice, 19, 2016, 14). This mixed-method study assessed the impact of adopting a Safewards model within a clinical supervision framework in an approach, named Group Reflective integrated Practice with Safewards (GRiP-S), which integrates Safewards theory within the clinical supervision framework. Both quantitative and qualitative data were collected using the questions derived from the Manchester Clinical Supervision Scale −26© (Winstanley & White, The Wiley International Handbook of Clinical Supervision. John Wiley & Sons Ltd, 2014). A total of 67 surveys and eight interviews were completed by nursing staff. Overall, the results showed that the GRiP-S approach improves the implementation of Safewards and nurses\u27 clinical practice. Nursing staff satisfaction with clinical supervision and Safewards improved post GRiP-S pre-GRIP-S- 69.54 (SD 16.059); post-GRIP-S 71.47 (SD 13.978). The survey also identified nursing staff\u27s perception of GRiP-S in the restorative and formative domains of clinical supervision improved. The restorative mean score pre-GRiP-S was 28.43 (SD 5.988) and post-GRiP-S 29.29 (SD 3.951). The formative mean score pre-GRiP-S was 20.10 (SD 5.617) and post-GRiP-S 20.63 (SD 13.978). The qualitative results further explained the satisfaction levels and the changes seen in perception domains. The GRiP-S approach reported (i) improved therapeutic relationships and patient centred care, (ii) improved staff communication and teamwork, (iii) barriers to GRiP-S engagement, and (iv) assistance with the change process. The results indicate that the GRiP-S approach had a positive impact on Safewards delivery and supports ongoing change of practice

Factors associated with risk of falling among younger inpatients in a mental health setting—A systematic review

Aim: To synthesise evidence related to risk factors of falls among younger mental health inpatients age ≤ 65 years old. Background: Hospitalised patients with mental illness are at increased risk of falling. Specific risk factors for falls for younger inpatients are poorly understood. Design: Systematic review. Methods: Medline, CINAHL, APA PsycINFO, Scopus and Web of Science were searched for studies published in English till December 2022. The review followed the 2020 PRISMA checklist. Odds ratios and P values of significant risk fall factors and the frequency of factors related to circumstances of falls were extracted. Results: Nine studies were included and 95 risk factors, across seven categories were extracted. These categories included socio-demographic, fall-related factors, functional status, health and mental status, psychiatric diagnosis and assessment, medication, and staff related factors. Factors related to medication, health and mental status are most reported. Majority of the patients sustained minor or no injury from the fall and circumstances of fall vary across studies. Conclusion: Factors strongly associated with risk of falls were dizziness, use of psychotropics and antihypertensive drugs. A meta-analysis of risk factors was not possible due to different dependent variables studied, controlled confounding variables and control groups used. Relevance to clinical practice: Fall prevention is relevant to all patients in mental health settings. Approaches to fall risk assessment and management need to be better tailored to younger mental health patients in the psychiatric setting. Patient and public contribution: Patient or public contribution was not possible because of the study design

Integrated clinical pathways for lower limb orthopaedic surgeries: An updated systematic review

Objective The objective of the study was to comprehensively synthesise the components of integrated clinical pathways (ICPs) and post-operative outcomes of patients undergone total hip and knee arthroplasty (THA & TKA) and hip fracture surgeries. Background Previous systematic reviews examined components and effectiveness of ICPs for lower limb joint replacement and hip fracture surgeries. Design and Methods An updated systematic review guided by the Whittemore and Knafl (2005) framework. Electronic databases, Ovid MEDLINE, EBSCOhost-CINAHL, the Cochrane Reviews and Trails, EMBASE and PubMed, were searched from 2007 to 31 January 2021. Due to the heterogeneity of the methods and data collection tools of included studies, pooling of the quantitative data was not possible. Therefore, the included studies were synthesised and presented narratively under subthemes of arthroplasty and hip fracture surgeries. The PRISMA checklist for systematic reviews was used. Results Twenty-four studies met selection criteria with 11 examined ICPs for hip fracture and 13 for the THA and TKA. Twenty-one ICPs were reviewed, and 33 components were extracted. The most frequently included components for hip fracture subgroup were ‘discharge disposition arrangement’ and ‘dedicated personnel and resources’. ‘Exercise plan’ and ‘pain management’ were for the arthroplasty subgroup. A significant reduction in the length of stay and post-operative complications were associated with the ICPs. Results were mixed for the effectiveness of ICPs in reducing unplanned hospital admissions, mortality rates, post-operative complications and hospital costs. Conclusion The number of ICP components varied across studies. This review could not recommend a one size-fits-all ICP that could be adapted for use for patients undergoing hip fracture and joint replacement surgeries. Relevance for clinical practice This review identified research evidence-based components considered as essential for the inclusion in ICP’s for hip fracture and arthroplasty surgeries. Further research is suggested to determine the patient experience and healthcare providers’ acceptance of ICPs

Family-centered care for hospitalized children aged 0-12 years: a systematic review of qualitative studies

The foundation for a family-centered approach to pediatric health care is the belief that a child'semotional and developmental needs, and overall family wellbeing are best achieved when the service system supports the ability of the family to meet the needs of their child by involving families in their child’s care. There are a range of potential benefits and difficulties associated with the provision of family centred care, e.g. role negotiation, parental expectations in regard to participation in their child’s care, and issues relating to power and control. Currently, however, there is limited systematic information on how the principles of family-centered care are implemented in the delivery of care to the hospitalized child and their family, and the impact on the family and the health care providers

Developing nurse-sensitive outcomes in acute inpatient mental health settings—A systematic review

Background: While nurse-sensitive outcomes (NSOs) are well established in numerous health settings, to date there is no indicator suite of NSOs for inpatient mental health settings. Aim: To assess the relationship between nursing variables and patient outcomes in acute inpatient mental health settings to determine which outcomes can be used as indicators of the quality of nursing care. Methods: Databases accessed were CINAHL, MEDLINE, PsycINFO and EMBASE, last searched in May 2022. The review followed the 2020 PRISMA checklist for systematic reviews. Papers published between 1995 and 2022, conducted in acute mental health care units were included. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis was not possible because of the large number of variables and measurement inconsistencies. Results: A total of 57 studies were reviewed. Studies were categorised according to whether they found a significant or non-significant relationship between nurse variables and patient outcomes. Seven outcomes—aggression, seclusion, restraint, absconding, pro-re-nata medications, special observations and self-harm—were identified. For each outcome, there were significant findings for several nurse variables indicating that all included outcomes could be used as NSOs. However, evidence for aggression, seclusion and restraint use as suitable NSOs was more robust than the evidence for self-harm, absconding, pro-re-nata medications and special observations. Conclusion: All the seven outcomes can all be used to develop an NSO indicator suite in mental health inpatient settings. More work is needed to establish high-quality studies to clearly demonstrate the relationship between these outcome measures and changes in nurse variables such as nurse staffing, skill mix, work environment, nurse education and nurse experience. Patient and Public Contribution: Patient or public contribution was not possible because of the type of the variables being explored

Development of a patient-administered self-assessment tool (SATp) for follow-up of colorectal cancer patients in general practice

BACKGROUND: Treatment for colorectal cancer (CRC) may result in physical, social, and psychological needs that affect patients' quality of life post-treatment. A comprehensive assessment should be conducted to identify these needs in CRC patients post treatment, however, there is a lack of tools and processes available in general practice. AIMS: This study aimed to develop a patient-completed needs screening tool that identifies potentially unmet physical, psychological, and social needs in CRC and facilitates consultation with a general practitioner (GP) to address these needs. METHODS: The development of the self-assessment tool for patients (SATp) included a review of the literature; face and content validity with reference to an expert panel; psychometric testing including readability, internal consistency, and test-retest reliability; and usability in clinical practice. RESULTS: The SATp contains 25 questions. The tool had internal consistency (Cronbach's alpha 0.70-0.97), readability (reading ease 82.5%), and test-retest reliability (kappa 0.689-1.000). A total of 66 patients piloted the SATp. Participants were on average 69.2 (SD 9.9) years old and had a median follow-up period of 26.7 months. The SATp identified a total of 547 needs (median 7 needs/per patient; IQR [3-12.25]). Needs were categorised into social (175[32%]), psychological (175[32%]), and physical (197[36%]) domains. CONCLUSION: SATp is a reliable self-assessment tool useful for identifying CRC patient needs. Further testing of this tool for validity and usability is underway

Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa

Background: Cervical cancer is the second most common female reproductive cancer after breast cancer with 84% of the cases in developing countries. A high uptake of human papilloma virus (HPV) vaccination and screening, and early diagnosis leads to a reduction of incidence and mortality rates. Yet uptake of screening is low in Sub-Saharan Africa and there is an increasing number of women presenting for treatment with advanced disease. Nine women in their twenties die from cervical cancer in Kenya every day. This paper presents the biopsychosocial risk factors that impact on cervical cancer knowledge among Kenyan women aged 15 to 24 years. The findings will highlight opportunities for early interventions to prevent the worrying prediction of an exponential increase by 50% of cervical cancer incidences in the younger age group by 2034. Methods: Data from the 2014 Kenya Demographic and Health Survey (KDHS) was analysed using complex sample logistic regression to assess biopsychosocial risk factors of knowledge of cervical cancer among young women aged 15 to 24 years (n = 5398). Findings: Close to one third of the participants were unaware of cervical cancer with no difference between participants aged 15–19 years (n = 2716) and those aged 20–24 years (n = 2691) (OR = 1; CI = 0.69–1.45). Social predisposing factors, such as lack of education; poverty; living further from a health facility; or never having taken a human immunodeficiency virus (HIV) test, were significantly associated with lack of awareness of cervical cancer (p<0.001). Young women who did not know where to obtain condoms had an OR of 2.12 (CI 1.72–2.61) for being unaware of cervical cancer. Psychological risk factors, such as low self-efficacy about seeking medical help, and an inability to refuse unsafe sex with husband or partner, perpetuated the low level of awareness about cervical cancer (p<0.001). Conclusions: A considerable proportion of young women in Kenya are unaware of cervical cancer which is associated with a variety of social and psychological factors. We argue that the high prevalence of cervical cancer and poor screening rates will continue to prevail among older women if issues that affect young women’s awareness of cervical cancer are not addressed. Given that the Kenyan youth are exposed to HPV due to early sexual encounters and a high prevalence of HIV, targeted interventions are urgently needed to increase the uptake of HPV vaccination and screening

Patient recruitment in primary care research

Introduction: Patient recruitment in primary health research is often a protracted and frustrating process yet research guiding patient recruitment strategies in primary setting is limited. This paper addresses this void through a systematic review and how the systematic review informs the Wheatbelt Chronic Disease Management research projects. Method: Articles were sourced from five academic databases and snowball referencing. Inclusion criteria were papers published in English, reported empirical research, focused on interventions designed to increase patient recruitment in primary health care setting, and reported patient recruitment in primary setting. Results: 66 articles met the inclusion criteria. Effective recruitment strategies included the involvement of a discipline champion, simple patient eligibility criteria, patient incentives, and organisational strategies that reduce practitioner workload. Conclusion: The most effective recruitment in primary care research requires practitioner involvement

Do older people perceive cancer prevention and early detection to be worthwhile? Implications for prevention

Despite evidence that suggests modifying risk factors at any age can reduce the risk of cancer, many older people fail to take relevant preventive actions. The objectives of the project were to assess whether older people perceived taking actions to prevent cancers as worthwhile after the age of 60 years. Fifty men (19) and women (31) 60 years and older (mean age 68 years) participated in seven focus groups to assess their perceptions of preventive health actions and barriers and motivators in relation to cancer prevention. Most participants reported not adhering to preventive actions for cancer. Many did not perceive the benefits if the actions are initiated after the age of 60 years, and some risk factors were not perceived to be related to cancer. There was strong agreement that screening for cancer was worthwhile after the age of 60 years. It appears that awareness programs specifically tailored to seniors may be desirable to promote cancer prevention within a context of chronic disease prevention in general