The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Professional supervision practice under new public management : a study of the perspectives of probation officers and service managers in the community probation service : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Social Policy and Social Work, Massey University, Palmerston North, New Zealand

This thesis examines professional supervision practice under new public management from the perspectives of probation officers and service managers in the Community Probation Service. In particular, the research explores the participants’ philosophy of professional supervision, their recent supervision experiences, and their aspirations and expectations with regard to professional supervision. In order to provide a background for an informed analysis and discussion of the research findings, the thesis discusses the key themes in the social service supervision and new public management literature. It also examines the Community Probation Service’s context and the history of new public management and professional supervision in this organisation. The thesis is a qualitative study that is informed by social work practice theory and utilises the phenomenological and hermeneutic approaches. The research findings show that amongst the participants there was: (a) an unclear philosophy of supervision; (b) minimal recent experience of supervision and little ownership or support for the agency supervision project; (c) a belief that the context increased their need for supervision, but at the same time reduced their ability to receive or participate in it; (d) an expectation that professional supervision would assist them to work more effectively with clients and staff; (e) an expectation of good committed supervisors who would support and help them develop; and (f) an expectation that the agency would support professional supervision through resourcing, guidelines, accredited supervisors and the establishment of a learning culture. The major implications of these findings are that: (1) there is a need for staff to be socialised into professional social service supervision; (2) that the professional supervision programme within the Community Probation Service, as currently implemented, is unlikely to be successful; and (3) that professional social service supervision needs to be focused upon persons and their environments, rather than upon the agency

Towards the construction of social work supervision in Aotearoa New Zealand : a study of the perspectives of social work practitioners and supervisors : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Work at Massey University, Palmerston North, New Zealand

This thesis presents the construction of social work supervision from the perspectives of social work practitioners and supervisors. In particular, the research explored how social work supervision was constructed, the influence of the Aotearoa New Zealand context upon its construction, and where and how social work supervision can most effectively be improved. In order to provide a background for informed analysis and discussion of the research findings, key themes within the international and Aoteaoroa New Zealand supervision literature were discussed. The thesis was a mixed methods study that was informed by a constructionist conceptual framework with regard to the framing and exploration of the research questions. The methodological approach used was derived from pragmatism and involved a combination of survey research with qualitative individual interviews, with the survey being used to recruit and purposefully select participants for the individual interviews. The key findings from the study were: a) social work supervision was predominantly constructed from a professional standpoint, with the social, organisational and interpersonal context influencing how supervision was produced in any setting at anytime; b) the Aotearoa New Zealand context influenced supervision through the discourses of biculturalism and indigenous development, with multiculturalism being a secondary influence; and c) that improvements were needed in the professional and organisational systems that support supervision as well as in the practice and provision of it. The implications and recommendations arising from these findings focus on social work supervision theory and practice, cultural competence and the further development of professional supervision. From these implications it is suggested that the future research and development agenda for social work supervision both internationally and within Aotearoa New Zealand concerns theory-building, responding to the dynamics of culture and difference within supervision and the professionalisation of supervision. The recommendations related to the professionalisation of supervision concern: formal education and training; the role of supervision within organisations and contribution to organisational development; and the need for a stronger evidence-base regarding supervision’s contribution to client practice and social worker well-being and development