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

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

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

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

‘Your face freezes and so does your life’: A qualitative exploration of adults’ psychosocial experiences of living with acquired facial palsy

Objectives: Facial palsy (FP) is a highly visible appearance-affecting condition and can have a significant impact on facial function. Qualitative research focussing on adults’ experiences of living with acquired FP is limited. This study aimed to explore the psychosocial impact of acquired FP and to gain a greater understanding of patients’ experiences of treatment and care in the United Kingdom. Design: A qualitative interview study with individuals living with acquired FP. Methods: Ten adults with acquired FP were recruited. Their experiences were explored using semi-structured telephone interviews. Data were analysed using thematic analysis. Results: Five master themes were identified through the thematic analysis: 1) grappling with a new identity, 2) the psychosocial impact of living with facial palsy, 3) isolation: dealing with ‘one hell of a problem on your own’, 4) a life on hold, 5) coping strategies. Findings indicated high levels of distress and significant challenges in managing the functional and psychosocial changes associated with acquiring FP. Participants expressed grief for their former appearance and identity, with photographs and mirrors acting as agonizing reminders. Many reported a sense of abandonment due to uncoordinated care and, as a result, engaged in an endless and often fruitless pursuit to gain control over FP by experimenting with their own treatment. Many reported the negative impact of their altered facial expressions on social interactions and a fear of being negatively evaluated. Conclusions: This study highlights a pressing need to review how FP is managed in the UK. To improve patient well-being, health care professionals could benefit from FP education, and patients from timely access to psychological support and clearer standards of care following diagnosis