Perspectives of health professionals on the psychosocial impact of an altered appearance among adolescents treated for cancer and how to improve appearance-related care

© 2017 Taylor & Francis Group, LLC. An altered appearance can impact the psychosocial well-being of adolescent cancer patients, yet patient reports imply a dearth of appearance-related support. Using a two-phase qualitatively driven mixed method design, 62 health professionals from a range of UK oncology care settings provided data relating to their views on the impact of appearance changes on adolescent patients (aged 12–18 years), of delivering appearance-related care, and their training needs. Integrated findings were divided into two main outcomes. The first comprises health professionals' perceptions of the psychosocial and behavioral impacts of appearance-related distress in their patients and their experiences of interventions that prevent or ameliorate appearance concern. The second illustrates personal barriers (among health professionals, adolescents, and parents) and organizational barriers that inhibit the delivery of appearance-related support, together with suggestions about how these may be overcome. The needs of patients are extensive and varied, but due to the barriers identified can be poorly addressed. Nonetheless, some practitioners are utilizing a variety of interventions supported by theory and/or evidence of their success in other clinical areas. Recommendations are made for the content, design, and coordination of interventions for adolescents and for the content of education programs to meet the training needs identified by participants

Skin scarring: new insights may make adjustment easier

Skin scarring is a clinical problem that can cause many psychological and social difficulties—some as a result of the cause of the scarring (for example, trauma), some related to the effects (for example, itching), and many to the appearance of the scar itself. In the review by Bayat et al their argument that a decision to treat will depend on site, symptoms, severity of functional impairment, and stigma would be enhanced by the inclusion of two crucial insights from recent psychological literature, insights that can make it much easier for patients to adjust to these problems.Firstly, much research has now confirmed that the seriousness of psychosocial sequelae is not positively correlated with the severity, size, or location of scarring. It is therefore important in the clinical examination and assessment process that doctors do not make assumptions about the psychosocial impact of scarring—it is important to ask patients about how self conscious they feel, for example, and how noticeable they feel the scar is to others because these factors are likely to be more predictive of distress.Secondly, recognising that even with the skills of surgeons and others, scars cannot yet be made to disappear has prompted new psychosocial interventions to be developed for patients distressed by disfigurements of any kind, including scarring, to their face, hands, and body. These have focused on the strengthening of self esteem and communication skills (so as to manage the reactions of other people) and are available in various formats including in self-help guides produced by a charity, Changing Faces (for example, Everybody's Staring at Me! How to Communicate When You Have an Unusual Face). These new interventions are becoming known to psychologists across the NHS and can be delivered by individual psychologists or through a centralised referral unit such as the outlook unit at Frenchay Hospital, Bristol

The routine psychological screening of cosmetic surgery patients

In order to improve outcomes, the process of patient selection within the cosmetic industry has received considerable attention from surgeons, psychologists and policy makers. Indeed, as increasing numbers of people are seeking cosmetic procedures it is crucial to ensure that patients are appropriately assessed for their suitability for surgery. Pre-operative screening to identify patients at risk of poor post-operative outcomes is now considered a crucial part of the surgeon’s role in providing appropriate care and treatment. In recognition of the importance of patient selection, we have developed a brief, user-friendly screening tool designed for routine use with cosmetic surgery patients. The tool has been designed to identify psychological factors which are likely to increase the risk of a poor psychological outcome. The tool should be used in addition to a thorough pre-operative consultation and as part of a pathway which includes onward referral where necessary

CLAPA Scotland regional coordinators project: End of year two interim report

During Year Two, the SRC has continued to act as a key contact for people affected by CL/P and their families in the Scotland region.A large number of events aimed at families and young people have been held, in addition to a number of awareness-raising activities and training sessions.Recommendations have been made for an increase in services for adults born with CL/P.There have also been recommendation for more activities aimed more specifically at increasing individuals’ knowledge of CL/P and their ability to cope with any related challenges (e.g. with teachers, health professionals and school children)

The psychosocial impact of breast cancer diagnosis and treatment amongst Black, South Asian and White women: Do differences exist between ethnic groups?

Breast cancer is the most commonly diagnosed cancer in females, affecting women of all ethnic groups. Until now, very little research has captured the psychosocial impact of the disease amongst Black and Minority Ethnic (BME) women, and that which has been conducted has been restricted to English-speaking participants. The aim of this qualitative study was to explore the experiences of five Gujarati-speaking Indian women with regard to their breast cancer diagnosis and treatment; all five had Limited English Proficiency (LEP) and lived in the UK. Individual semi-structured interviews were conducted in Gujarati, with the assistance of an interpreter. Interpretative Phenomenological Analysis (IPA) of the data revealed 3 key themes: making sense of the cancer, importance of support and body image concerns. The findings show that these women’s experiences were influenced by culturally specific concerns, especially in relation to knowledge of breast cancer and language barriers. This study has implications for healthcare professionals in terms of providing culturally competent care and support to BME women with LEP

An evaluation of the impact of a burn camp on children and young people’s concerns about social situations, satisfaction with appearance and behaviour

Introduction: This evaluation aimed to assess the impact of a burn camp on children and young people’s concerns about social situations, satisfaction with appearance and behaviour.Methods: Young people completed the Perceived Stigmatisation Questionnaire (PSQ), Social Comfort Questionnaire (SCQ) and Satisfaction with Appearance Scale (SWAP) one month before camp (n=23), on the last day of camp (n=21) and at a three-month follow-up (n=13). Parents completed the Strengths and Difficulties Questionnaire (SDQ) one month before camp (n = 22) and at follow-up (n=12). Parents and young people also completed open-ended questions before camp and at the follow-up.Results: Results in this evaluation were mixed. While parents’ reported scores on the SDQ were poorer after camp, young people’s reported outcomes on all three measures improved at the end of camp. PSQ and SWAP scores were maintained and improved, respectively, at the follow-up. Qualitative responses were generally consistent with these scores. Significant improvements were found between the scores before camp and at the three-month follow-up for both the SWAP and PSQ. These results indicate that the burncamp may help to improve young people’s satisfaction with their appearance and concerns about social situations. However, there was no comparison group and there was a significant loss of participants atfollow-up.Conclusion: Burn camps may therefore offer a range of psychosocial benefits to young people with burn injuries. This was the first evaluation to demonstrate a positive impact of a burn camp on satisfaction with appearance and concerns about social situations using outcome measures validated with the burns population

Experiences of living with visible difference: Individual and social reflections

Many health conditions impact upon an individual’s appearance and result in an altered appearance (“visible difference”). The presence of visible difference is associated with a variety of psychosocial difficulties and challenges, yet calls for an integrated theory of adjustment remain largely unanswered. This qualitative research, conducted in the United Kingdom, drew upon 22 interviews conducted with participants who had a variety of visible differences. It examined their experiences and reflections related to their difference and the impact that their visible difference had upon their lives. A thematic analysis produced two themes. The first of which was predominantly concerned with the impact of visible difference upon the individual whilst the second captured the inherently social nature of appearance and appearance based judgements. The analysis is considered in light of the contention that an integrated theory of adjustment to visible difference is required and participants’ experiences with healthcare professionals and the implications for those providing care are introduced

Young people’s perceptions of visible difference

Visible facial differences (VFDs) can pose a number of psychosocial challenges for those affected by them. In particular, the experience of being stigmatised may have a harmful effect on the psychological adjustment of the individual concerned. This is especially pertinent for young people, who are at an age where appearance becomes increasingly central to social interaction and self-esteem. Suitable and effective interventions are needed to reduce stigma in general, but in the case of appearance-relateddiscrimination the prevalence and the processes involved are poorly understood. The aim of this research was therefore to explore young people’s perceptions of visible difference.A mixed-methods online questionnaire was administered to a cross-sectional sample of 412 pupils aged 12–14 years, recruited from three UK schools. Participants were asked to look at five photographs of people with VFDs and to indicate their level of agreement with 30 statements using a 5-point Likert scale. They were also asked to answer the open-ended question ‘What do you think when you see people with facial differences?’ Although quantitative responses were overwhelmingly neutral, inductive content analysis revealed a number of insights. Four main themes were identified: them and us, initial reactions, common assumptions and behavioural intentions. Participants reported a wide range of complex responses. Although negative reactions and judgements were described, these were often due to seeing something unusual, or to a lack of understanding, rather than to the intention to cause harm. Conflicting emotions led to uncertainty and lack of confidence about how best to behave around peoplewith VFDs. The findings suggest the need for a two tieredapproach to intervention: first, to raise awareness of VFDs and to facilitate the development of appropriate social skills within the general population, and secondly, to provide support to enable those with VFDs to cope with any negative reactions they may encounter