Influences and experiences of a UK independent cancer support service

Background: This study investigated influences and experiences of use of a UK Independent Cancer Support Services (ICSS), with a focus on how its use corresponds with the attempts of cancer patients and their families to manage the psychosocial impact of cancer. Method: A case study approach was used to investigate use of an ICSS providing counselling, complementary and creative therapies to cancer patients, families and carers. ICSS clients (17), non-clients (7) and therapists (6) took part in semi- structured interviews discussing influences on and experiences of use of the service. Interviews were analysed using thematic and narrative analytic approaches. Findings: Clients' experiences of the ICSS appeared to centre around a sense of sanctuary and emotional support, arising from a 'safe' opportunity to talk in a way that is under clients' control and through an ethos and atmosphere which conveys a sense of value and personal control over therapy. These experiences often did not reflect clients' initial reasons for coming to the service, which suggested more varied approaches, with many clients initially reporting problem-solving reasons for coming. Barriers to use of the service included concerns about legitimacy of use of the service, especially from family/carers, and discomfort with the emotional support-based ethos of the service. Discussion and Conclusion: Although the predominant experience of the ICSS was one of emotional support, many clients seemed initially reluctant I unable to identify a need for such support. I suggest that the ICSS provides an environment and relationships which enable clients to feel more comfortable with this kind of support. The use of an ICSS is a nuanced and dynamic process reflecting the shifting and multi-faceted nature of the psychosocial impact of cancer and the complex discourses regarding how to manage it.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

What does "disability" mean for medical students?:An exploration of the words medical students associate with the term "disability"

CONTEXT: Disability teaching is a core theme in undergraduate medical education. Medical students bring a range of experiences of disability to their medical training. AIM: The principal aim of this study was to explore the words that medical students associate with the term "disability" and to consider how the resulting information could inform teaching. A secondary aim was to see if a short disability course changed the word associations. METHODS: Students were asked to write down 2 words that came to mind when they heard the word "disability", before and after a 4-day course in disability. Words from 4 cohorts were analysed by frequency and the following word dichotomies: visual icons/personal attributes; loss/enabling, and medical model/social model. A random sample of students took part in focus groups at the beginning and end of the course. RESULTS: A total of 381 students provided 667 before-course words and 189 students provided 336 after-course words. Before the course, words denoting visual icons of disability, and loss were prominent, accounting for 85% of the words, and 74% of the words describing personal attributes were negative. Focus group responses at this stage reflected an eagerness to help but patronising terms were prominent, along with concern about political correctness. Students also expressed nervousness about encountering disabled people. In response, teaching was adapted to make it more learner-focused, to offer a safe environment in which students can test out their language, to build on the positive associations and to develop a range of pre-course creative activities with disabled people. After the course a considerable and significant shift in emphasis was observed, with a reduction in the use of visual icon words, an increase in words denoting enablement, and an increase in words relating to the social model of disability and to positive personal attributes (P < 0.001). Focus group participants at this stage reported greater confidence in approaching disabled people but continued to question political correctness. CONCLUSIONS: Medical students associate disability predominantly with depersonalised or negative words. A short disability course appears to change these associations. Reasons for this and implications for teaching are discussed

‘In the shower crying…but we came back in the following day and did it all again’ : Distress and resilience in care home staff during the COVID-19 pandemic– A qualitative interview study

Background: Care homes (long-term care facilities) were profoundly impacted early in the COVID-19 pandemic, both in terms of resident mortality and restrictions for infection control. This study investigated the impact on the emotional well-being of care home staff of challenges faced at this time, and the strategies used to manage them. Methods: Semi-structured interviews conducted October 2020-June 2021 with care home staff and health service staff working with them explored the impact of the early waves of the COVID-19 pandemic (March 2020-June 2021). Interview data were analysed using reflexive thematic analysis. Results: Interview participants were 16 care home staff and 10 health service staff. Analysis generated four key themes: 1)Anxiety and distress, 2)Overwhelming workload, 3)Pulling through; and 4)Resilience in a time of crisis. Care home staff experienced Anxiety and distress due to uncertainty of what to expect; witnessing illness and deaths of residents; concerns regarding their own health, and sometimes feeling their work was under-recognised. They also experienced an Overwhelming workload due to infection control measures, caring for sick residents and reduction in external healthcare support. Our theme of Pulling through reflects the peer support and problem-solving strategies with which care home staff managed the impact of the pandemic, along with a sense of responsibility and meaning towards their work. An overarching theme of Resilience in a time of crisis drew on the other three themes and describes how many staff managed, maintained, and often increased their work despite the challenges of the pandemic. Participants also described increasing emotional fatigue as the pandemic continued. Conclusions: This paper builds on literature on the emotional impact of the pandemic on care home staff, also exploring ways that staff responded to this impact. These findings can help inform planning for future crises including disease outbreaks, and raise important questions for further work to develop pandemic preparedness in care homes and beyond. They also raise wider questions about the current cultural status of care work, which may have exposed care home staff to greater risk of distress, and which contrasts with the professionalism and responsibility shown by staff in response to pandemic challenges