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Purpose: People with functional movement disorders (FMD) are commonly seen in neurology clinics. Despite a recent increase in research, no standardised treatment pathway across the UK exists. Currently only a few qualitative studies in FMD with a focus on psychological aspects and diagnosis have been published. This study aimed to understand people with FMD perceptions of their physiotherapy treatment. Method: Qualitative web-based interviews were conducted with seven participants and an interpretive phenomenological approach was used to identify themes from the data. Results: Four themes were identified; 1) my brain, mind and body are all me, 2) physiotherapy; what helps and what doesn't, 3) what recovery is to me, and 4) barriers to treatment. Participants desired a combination of psychological and physical approaches, which were holistic, individualised, and delivered by experienced physiotherapists. Limited availability and funding of specialist treatments were barriers to recovery. Conclusion: Holistic management combining psychological and physiological systems seems to be crucial for effective management of FMD. Large variations in physiotherapy treatment exist across the UK. It is hoped that increasing the understanding, amongst healthcare professionals will lead to the development of timely and appropriate pathways for patients that otherwise find themselves lost between medical specialities. IMPLICATIONS FOR REHABILITATION: Patients report more positive experiences when a combined and detailed psychological and physiological explanation to their symptoms is given. An individualised approach working with the patient on activities they find challenging is more preferable than group exercise or impairment based (e.g., strengthening/stretching) treatments. Having a physiotherapist who is experienced in treating functional movement disorders or prepared to learn and understand them helped with adherence to treatment. [ABSTRACT FROM AUTHOR]

Background: Current treatments for people with obesity emphasise the need for person-centred approaches that consider complex biopsychosocial factors and value the lived experience of people when attempting to lose weight. Methods: Narrative interviews (n = 20) were conducted with people living with obesity to explore the causes of their weight gain and their expectations and engagement with treatment at a Weight Management Clinic. A mixed inductive and deductive qualitative analysis identified utterances that represented psychological constructs used to understand self-appraisal and health behaviour. A narrative analysis was used to situate these findings in the context of a participant's life story. Results: Locus of control was a dominant construct evidenced through a person's attributional style and self-efficacy. Transcripts represented a heightened sense of self-understanding and shifts in control, and styles of attribution and efficacy resulted in either stasis or self-actualisation. The Stages of Change model could be applied to narratives to ascertain a patient's motivation to access treatment. Importantly, narrative interviews also allowed for the consideration of how a person's systemic context influenced their weight. Conclusion: Narrative interaction supports both self- and shared understandings of the causes and consequences of obesity for individuals, in a non-blaming or shaming manner. It provides an opportunity to enhance engagement through tailored, person-centred treatments. [ABSTRACT FROM AUTHOR]

Identity loss and (re)construction forms a central debate in sociology of chronic illness. Living with chronic/persistent health conditions may raise questions about how disruptions can touch upon and further threaten the very roots of existence, by which people reflexively perceive a coherent and stable sense of 'being‐in‐the‐world'. Whilst medical sociologists have shown interest in 'existential loss' in chronic illness, this question remains largely underexplored. Adopting a qualitative study on Long COVID (LC) as an example, this article illuminates existential identity loss as a deeply painful experience of losing body as a fundamental medium to retain continuity and consistency of one's narratively constructed identity. Interviews with 80 LC sufferers in the UK revealed that living with persistent and often uncertain symptoms and disruptions can cause the loss of biographical resources and resilience, making it difficult to reflexively understand their own being within the world. Their dynamic responses to LC also highlighted how sufferers' longing for a narratively coherent self can profoundly shape the ongoing construction of their identity in chronic health conditions. These insights into the complicated and often hard‐to‐express existential pain of identity loss can also nurture more holistic understandings of and support for LC and chronic illness more broadly. [ABSTRACT FROM AUTHOR]

Background. Following the dramatic impact of tyrosine kinase inhibitor (TKI) drugs on chronic myeloid leukaemia (CML) survival, research interest has grown into the long-term impact of treatment, identifying difficulties with medication adherence and ongoing side effects. Qualitative studies suggest the disease has a significant physical and psychological impact on patients, and medication management may be complex. However, only one study worldwide has examined healthcare practitioner (HCP) experiences of managing CML treatment and very little UK qualitative research exists exploring the patient experience. Purpose. Our qualitative study aimed to investigate both patient and HCP experiences of managing CML treatment in the UK. Methods. Patients and HCPs were purposively sampled from within the Haematological Malignancy Research Network (HMRN), a UK population-based patient cohort. Qualitative interviews were carried out with seventeen patients and thirteen HCPs, and data were analysed using thematic analysis. Results. Four themes were developed from interview analysis: "Importance of optimal clinical management," "Multiple adherence strategies," "Inconsistent management of adherence," and "Controlling side effects is complex." HCPs tended to focus on sometimes complex, clinical decision-making. Patients described various strategies to support adherence and manage side effects, some of which HCPs seemed to be less aware of. Several patients did not discuss non-adherence or side effects with their HCP, who tended to avoid direct enquiry regarding adherence and could be uncertain about adherence advice, whilst relying on medical strategies to manage side effects. Conclusions. Despite HCPs focusing on the medical management of CML treatment, patients may opt to use self-management techniques to control adherence and side effects and can be reluctant to discuss related difficulties. Increased clinic time and clear adherence advice guidance may support such discussion, in addition to adjusting the context of follow-up care through the introduction of shared care with GP services. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the importance of seeking the views of children about their experiences of healthcare • To enhance your understanding of children's experiences of staying in hospital from the perspective of children and children's nurses • To consider the improvements in nursing practice that could be made to enhance the care of children in hospital Children should have a voice in relation to all aspects of healthcare as respected and credible service users, a belief endorsed by the United Nations Convention on the Rights of the Child. The children's nurse is the healthcare professional who delivers care most frequently to children in hospital and their families, so is in an optimal position to offer valuable insight into children's experiences of being in hospital. Therefore, it is important to listen to the voices of children and children's nurses in relation to this area. This article is informed by a narrative literature review and study, undertaken by the author as part of her doctoral thesis, which explored children's experiences of staying overnight in hospital from the perspective of children and children's nurses. In this article, the author summarises the main findings from the study and considers the implications for children's nursing practice based on her reflection on these findings. [ABSTRACT FROM AUTHOR]

Cognitive Behavioural Therapy for voice hearing (CBTv) has been shown to be effective at reducing distress. However, it is unclear why voice hearers might deteriorate or continue to benefit post-intervention. This study aimed to explore therapeutic change processes following CBTv. A critical realist, grounded theory methodology was utilised. Individual interviews were conducted with 12 participants who had experienced distressing voice hearing and had completed a CBTv intervention in the last 3–12 months. Participants were recruited from a specialist hearing voices service. Three categories were found to be facilitative of positive change within CBTv: "New Ways of Managing", "Overcoming Challenges" and "Gaining New Perspectives". Five categories denoted the maintenance or furthering of positive change following intervention: "Having a Sense of Control", "Standing on My Own Two Feet", "Voices Are Just Part of My Life", "Investing in Sustaining Relationships", and "Rediscovering and Developing Identity". Challenging circumstances faced by participants are also incorporated into a model for maintaining change following CBTv. The model adds to current literature on change processes occurring within and after CBTv. The results support the need for those working with voice hearers post-therapy to focus on rebuilding social relationships, meaning making and identity. [ABSTRACT FROM AUTHOR]

Aim: To understand the health needs, experiences, and views of women with type 2 diabetes in relation to diabetes, reproductive health experiences, and general wellbeing. Method: A qualitative study using semi‐structured interviews. Thirty‐six women with type 2 diabetes (median age 37 years; age ranges 20–45 years; median diabetes duration 4.5 years), recruited through social media and charities in the UK (n = 23) and Turkey (n = 13). Video interviews (n = 28) were audio recorded and transcribed verbatim. Email interviews (n = 8) and transcribed video interviews were analysed using Framework Analysis. Results: Two overarching themes were identified: (1) Perception of self and identity, (2) type 2 diabetes care is not orientated to women's needs. These themes highlight that living with type 2 diabetes was negatively perceived by the women in terms of their self‐identity and reproductive health. Women reported that the diabetes care provided was often not appropriate or relevant to their health needs, and neglected issues of relevance to them. The women voiced ideas for enhancing current care to reflect their health needs, in particular the need for more emotional and peer‐based support. Conclusion: Living with type 2 diabetes may negatively impact how women view themselves and how they relate to the roles they identify with such as, as a partner, mother, colleague. Current healthcare systems are not orientated to the specific needs of younger women with type 2 diabetes with limited opportunities to target their diabetes care around their health and wellbeing concerns and interests. [ABSTRACT FROM AUTHOR]

Background: When people with chronic kidney disease reach kidney failure, renal replacement therapy is usually required to improve symptoms and maintain life. Although in‐centre haemodialysis is most commonly used for this purpose, other forms of dialysis are available, including home haemodialysis and peritoneal dialysis. Objectives: We aimed to explore the experiences of adults living with chronic kidney disease who were either approaching the need for dialysis or had reached kidney failure and were receiving a form of dialysis. In particular, we explored how different forms of dialysis affect their quality of life, wellbeing, and physical activity. Methods: Individual semistructured interviews were conducted with 40 adults with kidney failure, comprising four groups (n = 10 each): those receiving in‐centre haemodialysis, home haemodialysis or peritoneal dialysis, or predialysis. Interviews were transcribed verbatim, thematically analysed, and then composite vignettes were subsequently developed to present a rich narrative of the collective experiences of each group. Findings: Compared with adults who were predialysis, quality of life and wellbeing improved upon initiation of their home haemodialysis or peritoneal dialysis. Conversely, minimal improvement was perceived by those receiving in‐centre haemodialysis. Low physical activity was reported across all four groups, although those receiving home haemodialysis and peritoneal dialysis reported a greater desire and ability to be physically active than those in‐centre. Conclusion: These findings highlight that dialysis modalities not requiring regular hospital attendance (i.e., home haemodialysis and peritoneal dialysis) improve independence, quality of life, wellbeing, and can facilitate a more physically active lifestyle. [ABSTRACT FROM AUTHOR]

Objective: The objective of this work was to explore head and neck cancer (HNC) patients' and their family members' views on acceptability and feasibility of patient‐initiated follow‐up (PIFU), including concerns and anticipated benefits. Methods: Patients were recruited from UK HNC clinics, support groups and advocacy groups. They completed a survey (n = 144) and/or qualitative interview (n = 30), three with a family member. Qualitative data were analysed thematically, quantitative data using descriptive statistics. Results: Preference for follow‐up care in HNC was complex and individual. Many patients thought PIFU could beneficially reallocate health care resources and encourage self‐management. Patients' main concerns with PIFU were losing the reassurance of regular clinic appointments and addressing mental well‐being needs within PIFU, possibly using peer support. Patients were concerned about their ability to detect recurrence due to lack of expertise and information. They emphasised the importance of a reliable, direct and easy urgent appointment service and of feeling supported and heard by clinicians. Patients believed family and friends need support. Conclusion: PIFU may be feasible and acceptable for certain HNC patients, providing it addresses support for mental well‐being, provides quick, reliable and direct clinician access and information on "red flag" symptoms, and ensures patients and their caregivers feel supported. [ABSTRACT FROM AUTHOR]

Background: Self‐management strategies improve asthma outcomes, although interventions for South Asian populations have been less effective than in White populations. Both self‐management and culture are dynamic, and factors such as acculturation and generation have not always been adequately reflected in existing cultural interventions. We aimed to explore the perspectives of Bangladeshi and Pakistani people in the United Kingdom, across multiple generations (first, second and third/fourth), on how they self‐manage their asthma, with a view to suggesting recommendations for cultural interventions. Methods: We purposively recruited Bangladeshi and Pakistani participants, with an active diagnosis of asthma from healthcare settings. Semi‐structured interviews in the participants' choice of language (English, Sylheti, Standard Bengali or Urdu) were conducted, and data were analysed thematically. Results: Twenty‐seven participants (13 Bangladeshi and 14 Pakistani) were interviewed. There were generational differences in self‐management, influenced by complex cultural processes experienced by South Asians as part of being an ethnic minority group. Individuals from the first generation used self‐management strategies congruent to traditional beliefs such as 'sweating' and often chose to travel to South Asian countries. Generations born and raised in the United Kingdom learnt and experimented with self‐management based on their fused identities and modified their approach depending on whether they were in familial or peer settings. Acculturative stress, which was typically higher in first generations who had migration‐related stressors, influenced the priority given to asthma self‐management throughout generations. The amount and type of available asthma information as well as social discussions within the community and with healthcare professionals also shaped asthma self‐management. Conclusions: Recognizing cultural diversity and its influence of asthma self‐management can help develop effective interventions tailored to the lives of South Asian people. Patient or Public Contribution: Patient and Public Involvement colleagues were consulted throughout to ensure that the study and its materials were fit for purpose. [ABSTRACT FROM AUTHOR]

The aim of the current study was to examine adolescents' goals when coping with pain and map these goals to the cognitive and emotional profiles of both adolescent and their parent. 17 adolescents (11‐16 years) and their parents participated in a cohort study of Juvenile Idiopathic Arthritis (JIA); the adolescents, took part in a two‐part interview (about their pain perceptions and about a recent pain experience) and the parents completed an open‐ended qualitative survey. The three datasets were analysed following a qualitative framework approach. A coping framework was developed and cognitive and emotional profiles for both adolescent and parent were mapped back to the framework. The overall goal of adolescents was to preserve social identity, by either focusing on maintaining a "normal" lifestyle (sub‐coping goal one) or managing the pain (sub‐coping goal two). Across these two sub‐coping goals, the adolescents held similar cognitive profiles (beliefs about timeline, consequences, control) but different emotional profiles such as feeling fine/happy compared with feeling angry and frustrated. Conversely, the parents' cognitive and emotional profiles were mapped back to the two groups and found that their beliefs were different across the two sub‐coping goals but had similar emotional profiles across the two groups such as worry. Both the adolescents' emotional representations and parental cognitive profiles seem to be related to how the adolescent perceives a pain event, deals with the pain, and the overall coping goal of the adolescent. Findings are suggestive that parental pain beliefs influence the adolescents' pain representations and their coping goals but are also driven by adolescents' emotions. Further work on these potential pathways is needed. Family interventions should be designed, targeting coping goals taking into consideration the importance of emotions for adolescents and parental pain beliefs. [ABSTRACT FROM AUTHOR]

Hip precautions are routinely provided in the UK, despite evidence suggesting that they are no longer needed. A change in practice was introduced into an orthopaedic service whereby the provision of routine hip precautions was discontinued for selected individuals receiving a primary total hip replacement. The change involved implementing a new regime of "no precautions" which was facilitated using a number of key strategies. The aim of this study was to explore the experiences of clinicians associated with the change in practice. Individual semi-structured interviews were conducted with clinicians who had experience of delivering both hip precautions and no hip precaution regimes. Data were analysed thematically. Ten orthopaedic staff (two senior occupational therapists, one occupational therapy support worker, three senior physiotherapists, two surgeons, and two senior nurses) were interviewed. Three main themes were identified: changes experienced, perceptions of the new regime, and challenges experienced. Several barriers and facilitators to the successful changeover were identified. Successful strategies in changing practice included assigning "Hip Champions", staff education and targeted training. It is proposed that holding multidisciplinary education and training would be the ideal model. Key strategies for changing practice were educating staff and providing targeted training. Multidisciplinary training might prevent discrepancies in the advice given to patients. Appointing "Hip Champions" provided clear role models and enabled new clinical behaviours to be enforced. [ABSTRACT FROM AUTHOR]

The psychological and social impact of hair loss and its ongoing treatment can be considerable. Medical treatments are not always successful, and alternative treatments, such as medical tattooing, are growing in popularity. The aims of this study were to explore adults' motivations, experiences, and self-perceived outcomes in relation to medical tattooing. Individual telephone interviews were conducted with 22 women from the United Kingdom aged 26–67 years who had undergone medical tattooing in the past 5 years related to hair loss. Interviews were transcribed and inductive thematic analysis was performed. Appearance concerns, loss of self-confidence/identity, and the practicalities of daily upkeep were cited as reasons for seeking a semi-permanent solution. Trust in the practitioner and the ongoing costs of tattoo maintenance were important considerations in participants' decision-making process and their overall satisfaction with treatment outcomes. Participants felt the emotional impact of hair loss and the subsequent need for appearance-restoring treatment remains unrecognised. This study provides insight into participants' perceptions of an under-researched and unregulated but widely accessible treatment. Implications for the decision-making process are discussed, and suggestions for health professionals are offered. [ABSTRACT FROM AUTHOR]

Objectives: To quantify patient eligibility for cochlear implantation following National Institute for Health and Care Excellence 2019 guidelines (TA566) over five years at our institution, and identify factors influencing patients' decisions surrounding cochlear implantation referral. Methods: A multi-perspective service evaluation was conducted at a district general hospital, comprising cochlear implantation eligible patients. The main outcome measures were: eligibility numbers for 2014–2019, comparing application of TA566 versus 2009 (TA166) guidelines; and patient interview transcripts and questionnaires. Results: There was a 259 per cent average increase in cochlear implantation eligibility from 2014 to 2019. Most patients' thresholds were 80 dB HL or more at 3 kHz and 4 kHz. There are several cochlear implantation barriers, including patient-centred issues (e.g. health-related anxieties, implantation misperceptions) and external barriers (difficulty getting to regional implant centres). Motivating factors for cochlear implantation include improved quality of life and access to local cochlear implantation services. Conclusion: The TA566 guidelines have increased cochlear implantation eligibility, putting pressure on cochlear implantation centres and referring hospitals. Current referral systems have external and patient-centred implantation barriers. British cochlear implantation delivery may need rethinking to meet increasing populational demands and improve accessibility for those most vulnerable to these barriers. [ABSTRACT FROM AUTHOR]

Aim: To understand patients' perceptions and experiences of directly observed therapy (DOT) for tuberculosis treatment in the UK. Method: Patients receiving DOT as part of their TB treatment participated in semi-structured and audio-recorded interviews. Data were analysed using a framework approach. Results: Non-adherence was driven by socio-cultural, mental health, employment and discrimination factors. Patients valued DOT for its support and social connection but those in employment feared it could lead to disclosure and social discredit. Conclusion: TB patients experience social isolation and fear discrimination. DOT offers a degree of social connection and support for marginalised patients but fails to tackle fundamental barriers to adherence such as mental health issues, addictions, housing and discrimination. Practice implications: Flexible patient-centred methods of DOT should be offered throughout patients' treatment. Research into multi-agency responsibility for promoting adherence needs to be commissioned, implemented and evaluated. Telemedicine and nurse-led clinics may improve access to care and improve patient experience. [ABSTRACT FROM AUTHOR]

We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18‐month period. Heterosexual, non‐donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well‐developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic‐patient interactions. Our findings develop understanding of the process of 'mazing' (Image ‐ The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore service-user perspectives of sensory approaches introduced and promoted by the trauma and self-injury service within the National High Secure Healthcare Service for Women (NHSHSW) at Rampton Hospital. Design/methodology/approach: This cross-sectional descriptive study used a semi-structured questionnaire, which was devised for this evaluation and included both open and closed questions. The data collected were then analysed using descriptive statistics and thematic analysis. Findings: The paper evaluates the current use of sensory approaches within the NHSHSW. Sensory approaches were widely used across the service, with essential oils being the most commonly used sensory approach. The use of sensory approaches can be understood according to the following three themes: independence, accessibility and self-regulation. The self-regulation theme contained three sub-themes as follows: safety-seeking, relaxation and reducing distress. The evaluation also highlighted barriers to using sensory approaches and sought service-user feedback as to how these may be overcome. Practical implications: Participants' feedback informed changes to practice, such as introducing sensory approaches to service-users earlier in their care pathway and increasing the accessibility of sensory items. These approaches may be of relevance to service provision in other forensic or inpatient settings. Originality/value: This paper offers a unique contribution to the current literature with its focus on using sensory approaches to ameliorate trauma symptoms, in the context of a forensic setting. [ABSTRACT FROM AUTHOR]

Mental health in Black Asian and Minority Ethnic (BAME) communities is a rising public health concern in the UK, with key challenges around accessing mental health services. Our understanding of mental health issues in the growing Nepali and Iranian communities in the UK is very limited. Therefore, this study aims to explore the major factors affecting access to, and engagement with NHS mental health services. This study used a qualitative approach comprising in‐depth interviews with seven Nepali, eight Iranians and six community mental health workers in the south of England. The data were analysed using a thematic approach. Six themes were identified: (1) stigma and fear; (2) gender; (3) language; (4) tradition and culture; (5) family involvement; and (6) lack of cultural awareness in health workers, all appearing to be major issues. This study contributes to a shared understanding of mental illness within two given cultural contexts to promote early interventions in UK mental health services. Developing cross‐cultural perspectives in health care should be a priority in practice. [ABSTRACT FROM AUTHOR]

Background: Given the much greater COVID‐19 mortality risk experienced by people with intellectual disabilities (ID), understanding the willingness of people with ID to take a COVID‐19 vaccine is a major public health issue. Method: In December 2020 to February 2021, across the United Kingdom, 621 adults with ID were interviewed remotely and 348 family carers or support workers of adults with ID with greater needs completed an online survey, including a question on willingness to take a COVID‐19 vaccine if offered. Results: Eighty‐seven per cent of interviewees with ID were willing to take a COVID‐19 vaccine, with willingness associated with white ethnicity, having already had a flu vaccine, gaining information about COVID‐19 from television but not from social media, and knowing COVID‐19 social restrictions rules. A percentage of 81.7% of surveyed carers of adults with ID with greater needs reported that the person would be willing to take a COVID‐19 vaccine, with willingness associated with white ethnicity, having a health condition of concern in the context of COVID‐19, having had a flu vaccine, being close to someone who had died due to COVID‐19, and having shielded at some point during the pandemic. Conclusions: Reported willingness to take the COVID‐19 vaccine is high among adults with ID in the United Kingdom, with factors associated with willingness having clear implications for public health policy and practice. [ABSTRACT FROM AUTHOR]

There is a substantial amount of literature that suggests that animals, and specifically animals kept as pets, can have a positive effect on wellbeing. Research exploring the impact of animals on wellbeing in care homes mainly concerns visiting animals as well as shared communal pets. In light of the lack of research regarding personal pets in care homes, the aim of this study was to explore what the experience of keeping a personal pet in a care home means for residents' sense of wellbeing. Semi-structured interviews were conducted with seven care home residents who were currently living with their pet in a care home. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Analysis revealed four master themes deemed to be relevant to participants' wellbeing. these were: 'sense of self and identity', 'responsibility and ownership', 'motivation and desire to live' and 'feeling content in the care home'. The analysis indicated that living with a personal pet in a care home has the potential to enhance residents' wellbeing. At the same time, it also found that the benefits of keeping a personal pet may be dependent on specific circumstances, such as the attitudes of staff and fellow residents at the care home. This study indicates that it may be advisable for more care homes to accept personal pets. [ABSTRACT FROM AUTHOR]

Background and Objectives Important decisions about the future care of people living with dementia are routinely made in hospitals. Very little is known about how the care needs of hospitalized people with dementia are understood, or how the perspectives of the person, families, and staff intersect to inform decision-making. This study explores how the care needs of people with dementia are understood by the person, their family, and hospital staff (the care triad), and how these perspectives shape decision-making. Research Design and Methods Ethnographic data were collected from 2 care-of-older-people general hospital wards via observations, conversations, and interviews with people with dementia, families, and staff. In total, 400 hr of observation and 46 interviews were conducted across two 7- to 9-month periods. Results The person's care needs were often understood differently between and within arms of the care triad. A lack of consistent engagement with families and people with dementia reduced opportunities to recognize and integrate this range of views, leading to delays or difficulties in decision-making. People with dementia, particularly those lacking capacity, were most likely to have their perspectives overlooked. Discussion and Implications Early engagement with people with dementia and their families is required to ensure that all perspectives on the person's current and future care needs are understood and represented during decision-making. Particular attention should be paid to involving people living with dementia in discussions and decisions about their care, and to the assessment and involvement of people who may lack capacity. [ABSTRACT FROM AUTHOR]

Aims: Diabetes is two to three times more prevalent in people with severe mental illness, yet little is known about the challenges of managing both conditions from the perspectives of people living with the co‐morbidity, their family members or healthcare staff. Our aim was to understand these challenges and to explore the circumstances that influence access to and receipt of diabetes care for people with severe mental illness. Methods: Framework analysis of qualitative semi‐structured interviews with people with severe mental illness and diabetes, family members, and staff from UK primary care, mental health and diabetes services, selected using a maximum variation sampling strategy between April and December 2018. Results: In all, 39 adults with severe mental illness and diabetes (3 with type 1 diabetes and 36 with type 2 diabetes), nine family members and 30 healthcare staff participated. Five themes were identified: (a) Severe mental illness governs everyday life including diabetes management; (b) mood influences capacity and motivation for diabetes self‐management; (c) cumulative burden of managing multiple physical conditions; (d) interacting conditions and overlapping symptoms and (e) support for everyday challenges. People living with the co‐morbidity and their family members emphasised the importance of receiving support for the everyday challenges that impact diabetes management, and identified barriers to accessing this from healthcare providers. Conclusions: More intensive support for diabetes management is needed when people's severe mental illness (including symptoms of depression) or physical health deteriorates. Interventions that help people, including healthcare staff, distinguish between symptoms of diabetes and severe mental illness are also needed. [ABSTRACT FROM AUTHOR]

Evidence suggests that physical activity (PA) programmes promoted via healthcare settings worldwide may not currently meet the needs of many patients and healthcare professionals (HCPs). This paper describes the outcomes of a qualitative enquiry into the perspectives of patients and professionals from multiple healthcare services regarding the role of PA. 19 patients and 22 HCPs were purposively recruited from physiotherapy, podiatry, chronic pain, diabetes and continence services at a community-based healthcare clinic in the United Kingdom. Participants' views were explored using semi-structured interviews and analysed using thematic analysis. Results identified five themes: differences between the social and medical rationales underpinning PA promotion; the impact of the patient-professional relationship on patient activation, self-management and PA; a risk culture surrounding PA; challenges to meet variation in patients' needs and preferences; and lack of formal role for PA as a core part of routine healthcare. The study highlights tensions between needs and aspirations, and the reality of delivering advice and support for PA. Challenges resonated with patients and HCPs across different care groups and were not condition-specific. This highlights a need for sharing good practice across healthcare services and system-level interventions to address organisational barriers to the promotion of PA. [ABSTRACT FROM AUTHOR]

Research suggests that bullying is one of the most common presenting issues for young people accessing counselling. In this study, we explored helpful aspects of counselling for young people who have experienced bullying. Semi-structured interviews were conducted with 10 participantsand analysed using thematic analysis. Participants identified five helpful counsellor activities: (a) counsellors' way of relating, (b) creating safety, (c) incorporating creative media, (d) teaching strategies, and (e) offering advice. They also identified four helpful client activities: (f) trusting, (g) talking, (h) expressing emotions, and (i) remembering and applying techniques. Findings suggest that a range of techniques and practices, aligned to different therapeutic orientations, can be of value to these young people. This supports a pluralistic perspective on therapeutic change. [ABSTRACT FROM AUTHOR]

Psychological problems are common among people with inflammatory bowel disease (IBD) following stoma surgery. However, the ways in which stoma-related psychological needs are identified and addressed in health care settings remain unexplored. In this study, we investigated the perspectives of young people with a stoma and health care professionals about access to psychological support. Semi-structured interviews were conducted with young people with an IBD stoma (18–29 years, n = 13) and health care professionals (n = 15), including colorectal surgeons, gastroenterologists, specialist nurses in IBD and stoma care, and general practitioners in England. Data collection and analysis were informed by constructivist grounded theory. Three analytic categories were developed: "initiating support-seeking," "affirming psychological needs," and "mobilizing psychological support," which capture young peoples' trajectory to access psychological support. Based on the findings, we highlight the need for both patients and health care professionals to assign greater priority to the identification of psychological symptoms post-stoma surgery. More effective care pathways, which include responsive psychological services, would enhance access to psychological support for young people with a stoma. [ABSTRACT FROM AUTHOR]

Background: Pelargonium sidoides DC (Geraniaceae) root extract, EPs®7630 or "Kaloba®", is a widely used herbal remedy for respiratory infections, with some evidence of effectiveness for acute bronchitis. However, it is not yet widely recommended by medical professionals in the UK. There is a need to undertake appropriately designed randomised trials to test its use as an alternative to antibiotics. The aim was to assess the feasibility of conducting a double-blind randomised controlled trial of Pelargonium sidoides root extract for treatment of acute bronchitis in UK primary care, investigating intervention compliance, patient preference for dosage form and acceptability of patient diaries. Study design: Feasibility double-blind randomised placebo-controlled clinical trial. Methods: We aimed to recruit 160 patients with cough (≤ 21 days) caused by acute bronchitis from UK general practices. Practices were cluster-randomised to liquid or tablet preparations and patients were individually randomised to Kaloba® or placebo. We followed participants up for 28 days through self-reported patient diaries with telephone support and reviewed medical records at one month. Outcomes included recruitment, withdrawal, safety, reconsultation and symptom diary completion rates. We also assessed treatment adherence, antibiotic prescribing and consumption, mean symptom severity (at days 2–4 after randomisation) and time to symptom resolution. We interviewed 29 patients and 11 health professionals to identify barriers and facilitators to running such a randomised trial. Results: Of 543 patients screened, 261 were eligible, of whom 134 (51%) were recruited and 103 (77%) returned a completed diary. Overall, 41% (41/100) of patients took antibiotics (Kaloba® liquid group: 48% [15/31]; placebo liquid group: 23% [6/26]; Kaloba® tablet group: 48% [9/21]; placebo tablet group: 50% [11/22]). Most patients adhered to the study medication (median 19 out of 21 doses taken in week 1, IQR 18–21 - all arms combined). There were no serious adverse events relating to treatment. Most patients interviewed found study recruitment to be straightforward, but some found the diary too complex. Conclusions: It was feasible and acceptable to recruit patients from UK primary care to a double-blind placebo-controlled trial of herbal medicine (Kaloba®) for the treatment of acute bronchitis, with good retention and low data attrition. Trial registration: HATRIC was registered on the ISRCTN registry (ISRCTN17672884) on 16 August 2018, retrospectively registered. The record can be found at http://www.isrctn.com/ISRCTN17672884. [ABSTRACT FROM AUTHOR]

Formerly heterosexually partnered gay fathers raised with religion are an under-researched group of LGBTQ parents. This group have potentially complex coming out journeys, which can result in them seeking counselling. This research qualitatively explores the counselling experiences of 12 such men and offers suggestions for working therapeutically with them. The key finding of the qualitative analysis of the participants' interviews was that they wanted therapists to not assume a "best" outcome for them as either gay or "straight". Instead, they wanted therapists to respect and assist them to explore their own individual sense-making around their identities and to reject fixed notions from both ex-gay and gay affirmative therapy of what it means to be a "well-adjusted" gay father. [ABSTRACT FROM AUTHOR]

Aim and objective: To explore older people's initial experience of household isolation, social distancing and shielding, and the plans they constructed to support them through the COVID‐19 pandemic. Background: Public health guidance for those aged 70 or older was predominantly to undertake stringent social distancing within their household. Little is known about older people's experience of these measures. This paper explores changes experienced by those over the age of 70 during the first two weeks of household isolation, social distancing and shielding in the UK and the Republic of Ireland, and their early perceptions and plans to support them through the pandemic. Methods: An inductive phenomenological study. University staff posted the study invitation flyer on social media, such as WhatsApp neighbourhood groups, the Nextdoor App and Twitter. Qualitative semi‐structured interviews were undertaken with 19 participants and repeated at 2‐week intervals for 10 weeks; further data collection is still in progress. This paper presents the findings from the baseline interviews, which showed older peoples' early responses. The COREQ (COnsolidated criteria for REporting Qualitative research) checklist was adhered to in the reporting of this study. Results: Three themes emerged from older people's early experiences of social distancing: protective measures; current and future plans; and acceptance of a good life, but still a life to live. Conclusion: People over 70 adapted to household isolation, social distancing and shielding, by using social media and neighbourhood resources. Nurses and other professionals can develop holistic care for older people by listening to their experiences of what works for them, helping them link to local and distant supports. Understanding the holistic life view of older people, including death anxiety, is an important element of care planning; to help older people access the protective resources, they need to reduce the serious risks associated with coronavirus. Relevance to clinical practice: Older people engage with social media, and during the current pandemic and beyond nurses can engage with this medium to communicate with older people. The importance of nurses to understand some older people consider quality of life to be more important than longevity, which may impact on their adherence to health advice. [ABSTRACT FROM AUTHOR]

Aims: To compare the emotional distress experienced by people with Type 2 diabetes with the perceptions of their partners, and to explore the perceptions of healthcare providers and how these differ from the perceptions and experiences of couples living with Type 2 diabetes regarding their support needs. Methods: A purposive sample of people with Type 2 diabetes and their partners was recruited through Diabetes UK media outlets and support groups, while healthcare providers were recruited through hospital and diabetes education teams. Inductive thematic analysis was conducted. Results: Seven people with Type 2 diabetes and six partners took part in separate semi‐structured interviews and seven healthcare providers took part in focus groups. Themes emerged regarding unique psychological struggles for people with Type 2 diabetes: 'sense of restriction'; 'disempowerment'; and 'acceptance of diabetes'. For partners the themes of 'feeling responsible' and 'need for greater involvement' emerged. Common themes arising from people with Type 2 diabetes, partners and healthcare providers highlighted diabetes‐related stresses: 'self‐care struggles' and 'perceived need for appropriate psychological support'. A key theme drawn from healthcare providers was 'perceived professional barriers to psychological support', which captures concerns related to providing emotional support in clinical practice. Conclusions: People with Type 2 diabetes, partners, and healthcare providers share a common understanding of the emotional stresses of living with Type 2 diabetes, but also experience diabetes differently depending on their role and responsibilities. All face barriers that need to be considered to ensure that emotional support in diabetes is meaningful and feasible in routine practice. What's new?: This study is the first to examine the emotional experiences reported by people living with Type 2 diabetes compared with the perceptions of their partners.The study also explores how the experiences and perceptions of couples living with Type 2 diabetes align with the perceptions of diabetes healthcare providers about support needs.This study conveys different perspectives of the emotional stresses of diabetes and affirms the importance of considering diverse personal and professional challenges when developing strategies to enhance emotional well‐being. [ABSTRACT FROM AUTHOR]

Background: Constipation is a major problem for many older adults, more so for those who are receiving specialist palliative care. However, limited research reports the subjective experiences of constipation, despite evidenced differences between the healthcare professional and patient/carer perspective. Aim: The main aim of this study is to explore the experience of how constipation is assessed and managed within specialist palliative care from the patient, carer and healthcare professional perspective. Design: Exploratory, qualitative design, utilising focus groups and interviews, and analysed using thematic analysis. Setting/participants: Six focus groups with 27 healthcare professionals and semi-structured interviews with 13 patients and 5 family caregivers in specialist palliative care units across three regions of the United Kingdom. Results: Constipation impacted physically, psychologically and socially on patients and families; however, they felt staff relegated it on the list of importance. Lifestyle modifications implemented at home were not incorporated into their specialist palliative care plan within the hospice. Comparatively, healthcare professionals saw constipation solely as a physical symptom. Assessment focused on the physical elements of constipation, and management was pharmacologically driven. Healthcare professionals reported patient embarrassment as a barrier to communicating about bowel care, whereas patients wanted staff to initiate communication and discuss constipation openly. Conclusion: Assessment and management of constipation may not yet reflect the holistic palliative care model. A focus on the pharmacological management may result in lifestyle modifications being underutilised. Healthcare professionals also need to be open to initiate communication on bowel care and consider non-pharmacological approaches. It is important that patients and families are supported in self-care management, alongside standardised guidelines for practice and for healthcare professionals to facilitate this. [ABSTRACT FROM AUTHOR]

Health risk behaviours (HRBs) are prevalent within the cystic fibrosis (CF) population, and there is a lack of research around what influences their engagement. This research explored beliefs associated with HRBs within an adult CF population using qualitative semi-structured interviews. Participants' beliefs towards their CF and its life impact were investigated to explore reasons for engaging in HRB. A desire for normalcy was evident, often accompanied by engagement in everyday HRB as a method of minimising the illness identity. Evidence of a life-orientated illness perspective was also prevalent, with participants engaging in some risky behaviours for fun. Overall, there was a lack of knowledge on the consequences of HRB, with many participants reporting not being informed of these by clinicians. This research highlights a dilemma between clinical recommendations and personal life strategies undertaken by individuals with CF to support their identity. [ABSTRACT FROM AUTHOR]

Background Patients often carry medication lists to mitigate information loss across healthcare settings. We aimed to identify mechanisms by which these lists could be used to support safety, key supporting features, and barriers and facilitators to their use. Methods We used a mixed-methods design comprising two focus groups with patients and carers, 16 semistructured interviews with healthcare professionals, 60 semistructured interviews with people carrying medication lists, a quantitative features analysis of tools available for patients to record their medicines and usability testing of four tools. Findings were triangulated using thematic analysis. Distributed cognition for teamwork models were used as sensitising concepts. Results We identified a wide range of mechanisms through which carrying medication lists can improve medication safety. These included improving the accuracy of medicines reconciliation, allowing identification of potential drug interactions, facilitating communication about medicines, acting as an aide-mémoire to patients during appointments, allowing patients to check their medicines for errors and reminding patients to take and reorder their medicines. Different tools for recording medicines met different needs. Of 103 tools examined, none met the core needs of all users. A key barrier to use was lack of awareness by patients and carers that healthcare information systems can be fragmented, a key facilitator was encouragement from healthcare professionals. Conclusion Our findings suggest that patients and healthcare professionals perceive patient-held medication lists to have a wide variety of benefits. Interventions are needed to raise awareness of the potential role of these lists in enhancing patient safety. Such interventions should empower patients and carers to identify a method that suits them best from a range of options and avoid a 'one size fits all' approach [ABSTRACT FROM AUTHOR]

Objectives: While the presence of publication bias in clinical research is well documented, little is known about its role in the reporting of health services research. This paper explores stakeholder perceptions and experiences with regard to the role of publication and related biases in quantitative research relating to the quality, accessibility and organization of health services. Methods: We present findings from semi-structured interviews with those responsible for the funding, publishing and/or conduct of quantitative health services research, primarily in the UK. Additional data collection includes interviews with health care decision makers as 'end users' of health services research, and a focus group with patient and service user representatives. The final sample comprised 24 interviews and eight focus group participants. Results: Many study participants felt unable to say with any degree of certainty whether publication bias represents a significant problem in quantitative health services research. Participants drew broad contrasts between externally funded and peer reviewed research on the one hand, and end user funded quality improvement projects on the other, with the latter perceived as more vulnerable to selective publication and author over-claiming. Multiple study objectives, and a general acceptance of 'mess and noise' in the data and its interpretation was seen to reduce the importance attached to replicable estimates of effect sizes in health services research. The relative absence of external scrutiny, either from manufacturers of interventions or health system decision makers, added to this general sense of 'low stakes' of health services research. As a result, while many participants advocated study pre-registration and using protocols to pre-identify outcomes, others saw this as an unwarranted imposition. Conclusions: This study finds that incentives towards publication and related bias are likely to be present, but not to the same degree as in clinical research. In health services research, these were seen as being offset by other forms of 'novelty' bias in the reporting and publishing of research findings. [ABSTRACT FROM AUTHOR]

Introduction: Providing balanced information that emphasizes clinical equipoise (i.e., uncertainty regarding the relative merits of trial interventions) and exploring patient treatment preferences can improve informed consent and trial recruitment. Within a trial comparing adjuvant radiotherapy versus active monitoring following surgical resection for an atypical meningioma (ROAM/EORTC‐1308), we explored patterns in communication and reasons why health practitioners may find it challenging to convey equipoise and explore treatment preferences. Materials and Methods: Qualitative study embedded within ROAM/EORTC‐1308. Data were collected on 40 patients and 18 practitioners from 13 U.K. sites, including audio recordings of 39 patients' trial consultations, 23 patient interviews, and 18 practitioner interviews. Qualitative analysis drew on argumentation theory. Results: Practitioners acknowledged the importance of the research question that the trial aimed to answer. However, they often demonstrated a lack of equipoise in consultations, particularly with eligible patients who practitioners believed to be susceptible to side effects (e.g., cognitive impairment) or inconvenienced by radiotherapy. Practitioners elicited but rarely explored patient treatment preferences, especially if a patient expressed an initial preference for active monitoring. Concerns about coercing patients, loss of practitioner agency, and time constraints influenced communication in ways that were loaded against trial participation. Conclusions: We identified several challenges that practitioners face in conveying equipoise and exploring patient treatment preferences in oncology, and particularly neuro‐oncology, trials with distinct management pathways. The findings informed communication about ROAM/EORTC‐1308 and will be relevant to enhancing trial communication in future oncology trials. Qualitative studies embedded within trials can address difficulties with communication, thus improving informed consent and recruitment. ROAM/EORTC‐1308 RCT: ISRCTN71502099. Implications for Practice: Oncology trials can be challenging to recruit to, especially those that compare treatment versus monitoring. Conveying clinical equipoise and exploring patient treatment preferences can enhance recruitment and patient understanding. This study focused on the challenges that practitioners encounter in trying to use such communication strategies and how practitioners may inadvertently impede patient recruitment and informed decision making. This article provides recommendations to support practitioners in balancing the content and presentation of trial management pathways. The results can inform training to optimize communication, especially for neuro‐oncology trials and trials comparing markedly different management pathways. Recruitment of enough eligible patients to randomized controlled clinical trials can be challenging. Within the context of an active clinical trial, this study explored communication strategies, especially how practitioners conveyed equipoise, explored and responded to patient treatment preferences, and the challenges encountered. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to identify the barriers and facilitators to the implementation of a high fidelity individual placement and support service in a community forensic mental health setting. Method: In-depth interviews were conducted with clinical staff (n = 11), patients (n = 3), and employers (n = 5) to examine barriers and facilitators to implementation of a high fidelity individual placement and support service. Data was analysed using thematic analysis, and themes were mapped onto individual placement and support fidelity criteria. Results: Barriers cited included competing interests between employment support and psychological therapies, perceptions of patients' readiness for work, and concerns about the impact of returning to work on welfare benefits. Facilitators of implementation included clear communication of the benefits of individual placement and support, inter-disciplinary collaboration, and positive attitudes towards the support offered by the individual placement and support programme among stakeholders. Offences, rather than mental health history, were seen as a key issue from employers' perspectives. Employers regarded disclosure of offending or mental health history as important to developing trust and to gauging their own capacity to offer support. Conclusions: Implementation of individual placement and support in a community mental health forensic setting is complex and requires robust planning. Future studies should address the barriers identified, and adaptations to the individual placement and support model are needed to address difficulties encountered in forensic settings. [ABSTRACT FROM AUTHOR]

Purpose: This study explored patient experiences of Guided graded Exercise Self-help (GES) delivered as part of a randomised controlled trial for people with chronic fatigue syndrome/myalgic encephalomyelitis. The trial found that GES was better than specialist medical care at reducing fatigue and improving physical functioning. Methods: Semi-structured interviews were conducted with patients reporting improvement (n = 9) and deterioration (n = 10), and analysis involved thematic "constant comparison." Results: The improved group described more facilitators to doing GES, and were more likely to describe high levels of self-motivation, whereas the deteriorated group described more barriers to GES (including worse exacerbation of symptoms after GES, greater interference from comorbid conditions, and obstacles to GES in their lives), and had been ill for longer. Having the capacity to do GES was important; of note, those with relatively lower levels of functioning sometimes had more time and space in their lives to support their GES engagement. We identified an important "indeterminate phase" early on, in which participants did not initially improve. Conclusions: GES may be improved by targeting those most likely to improve, and teaching about the indeterminate phase. Using the Guided Exercise Self-help booklet alone is unlikely to be sufficient to support patients through Guided Exercise Self-help successfully. Additional guidance from skilled physiotherapists/health professionals who demonstrate an understanding of what it is like to cope with chronic fatigue syndrome/myalgic encephalomyelitis is also important. Those using Guided Exercise Self-help may need additional support through a commonly experienced "indeterminate phase" – an initial phase in the programme where few benefits, along with various challenges associated with increasing activity, are experienced. Individuals who have been ill with chronic fatigue syndrome/myalgic encephalomyelitis for a relatively longer period of time and/or have additional comorbid conditions may benefit from more bespoke therapies with greater health professionals input, delivered by appropriate therapists. [ABSTRACT FROM AUTHOR]

There is limited provision of inpatient detoxification relative to other treatments for alcohol and other drug (AOD) use. This means people often need to wait prior to detoxifying. However, waiting for healthcare is generally perceived as negative and stressful. This paper aims to understand patients' experiences of waiting for inpatient AOD detoxification to ascertain whether and how service-level policies and practices might be improved. Semi-structured telephone interviews were conducted with 32 people (20 males, 12 females; aged 25–67 years) who were waiting for inpatient detoxification. Data collection was part of a wider evaluation of a policy initiative started in 2021 to increase detoxification service capacity in England, UK. Interviews were professionally transcribed and data on waiting experiences were coded using qualitative software. Analyses were informed by new materialist thinking and undertaken via Iterative Categorisation. We found that waiting was constituted through five dimensions: i. duration; ii. support; iii. information; iv. preparations; and v. emotions. These five dimensions were multi-faceted and operated in and through wider interacting social, material, and affective forces (e.g., professional judgements, formal and informal relationships, the availability of beds and funding, bureaucratic procedures, the utility and relevance of information, and participants' diverse feelings, including desperation for treatment). Not all accounts of waiting were negative. The experience was complex, non-uniform and variable over time. Moreover, it affected how people felt and how they behaved. Changes to service-level policies and practices can potentially minimise the stress of waiting for inpatient AOD detoxification. The negative impact of waiting may be reduced if professionals more consistently engage patients in a wider range of constructive pre-treatment activities, offer regular 'check-ins' to mitigate any anxiety, explain changes in wait duration to help with planning and demonstrate fairness, and facilitate contact between those waiting to lessen feelings of isolation. [ABSTRACT FROM AUTHOR]

Background: The use of quality-adjusted life years rests on the assertion that the objective of the health care system is to improve health. Aim: To elicit the views of expert stakeholders on the purpose and evaluation of supportive end of life care, and explore how different purposes of end of life care imply the need for different evaluative frameworks. Design: Semi-structured qualitative interviews, analysed through an economic lens using a constant comparative approach. Participants: Twenty professionals working in or visiting the United Kingdom or Republic of Ireland, with clinical experience and/or working as academics in health-related disciplines. Results: Four purposes of end of life care were identified from and are critiqued with the aid of the qualitative data: to improve health, to enable patients to die in their preferred place, to enable the patient to experience a good death, and to enable the patient to experience a good death, and those who are close to the patient to have an experience which is as free as possible from fear, stress and distress. Conclusion: Managing symptoms and reducing anxiety were considered to be core objectives of end of life care and fit with the wider health service objective of improving/maximising health. A single objective across the entire health system ensures consistency in the way that resource allocation is informed across that entire system. However, the purpose of care at the end of life is more complex, encompassing diverse and patient-centred objectives which we have interpreted as enabling the patient to experience a good death. [ABSTRACT FROM AUTHOR]

It has been highlighted that health and social care staff need a greater awareness of the needs and problems of those people with young onset dementia in the UK. Symptoms of Alzheimer's disease are relatively well known (memory loss, disorientation, language difficulties and behavioural problems). However, there is less awareness of dementia‐related visual processing impairments in Alzheimer's disease, Dementia with Lewy Bodies or rarer dementia syndromes such as posterior cortical atrophy (PCA), leading to delayed assessment, diagnosis and management. This qualitative study explored health and social care practitioners' opinions of the needs of people with dementia‐related visual processing impairment (such as individuals with PCA) and identify any training that these practitioners might need. Social workers, occupational therapists, care home staff, rehabilitation workers (visual impairment), optometrists and admiral nurses participated in focus groups or one‐to‐one semi‐structured interviews. All participants were shown video clips of people with dementia‐related visual impairment to facilitate discussion. Sixty‐one participants took part in focus groups or interviews between November 2014 and December 2015. Participants' experiences and understanding of dementia were explored and thematic analysis of the data identified two major themes. Theme 1 explores participants' understanding of dementia‐related visual impairments. Theme 2 recounts how participants address and support people with dementia‐related visual impairment and their families. Participants discussed, reflected and critically analysed the video clips during data collection. Most considered new perspectives of their own clients' difficulties and those participants working with people with rarer dementias consolidated their experiences. However, some participants seemed hesitant to accept the existence of visual processing impairment arising due to dementia, rationalising novel information to existing understanding of memory loss or behavioural problems. This study highlights that health and social care practitioners want more training and better understanding of less well‐recognised symptoms of dementia and rarer syndromes (including PCA) to ensure appropriate, evidence‐based assessment and intervention. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is recognized as one of the greatest global public health challenges. There is increasing consensus that optimal disease modification using pharmaceuticals may best be achieved earlier in the disease continuum before symptoms occur. However, more needs to be understood about what outcomes are meaningful to potential participants in clinical trials within this preventative paradigm and how people make trade‐offs between risks and benefits. The Electronic Person‐Specific Outcome Measure (ePSOM) programme is developing an app to capture person‐specific outcomes and preferences in clinical trials. Objective: As one phase in the ePSOM programme, this study explored what matters when developing new treatments to prevent AD and how trade‐offs are made between risks and benefits, from three perspectives. Design: Focus groups were conducted with people living with memory problems (n = 21) and healthy volunteers (n = 10), and telephone interviews with health and social care professionals (n = 10). Differences and overlap between the three groups were explored. Results: Outcomes that matter lie in five key domains in relation to what matters in everyday life: Everyday Functioning; Relationships and Social Connections; Enjoying Life; Sense of Identity; and Alleviating  Symptoms. Insights were gained into the significance of reducing the risk of developing dementia with drugs and the processes of weighing up risks versus benefits. Discussion and conclusions: The key domains identified are being used to inform the next stage of the ePSOM programme which is to develop a survey to be distributed nationally in the UK to explore these issues further. [ABSTRACT FROM AUTHOR]

Aims Treatment of patients with comorbidity of mental health problems and alcohol use disorder (AUD) constitutes a challenge in many countries. The article aimed at exploration of personal experiences of clinicians and patients with the comorbidity regarding its assessment, treatment and organization of care in Poland and the UK. Methods Data were collected via in-depth, semi-structured interviews with clinicians (N = 28) and patients (N = 81) in both countries, according to a unified study protocol. Maximum variation sampling was applied to both study groups. All interviews' transcripts were coded (CAQDA) and the consistency of coding across centres was assessed. Data analysis was performed according to the principles of thematic analysis. Results Our data show that most patients with AUD admitted at the psychiatric wards—apart from assessment which is a standard procedure during admission—receive only minimal support during their hospital stay. This is the consequence of two factors: lack of trained staff prepared to help those patients and a priority given to self-referrals by AUD units. At the same time, it is recognized by clinicians and patients that more support is needed to encourage the utilization of AUD services and to prevent the drop-out. Conclusions In order to improve the system response, the use of screening instruments in the process of the assessment of AUD and establishment of special procedures supporting motivation and adherence to treatment and preventing drop-out merits consideration. Moreover, the psychiatric wards and the AUD services could possibly profit from formalization of the collaboration between services. [ABSTRACT FROM AUTHOR]

Aim: To explore assessment on a hospital ward for older people from the perspectives of patients and healthcare professionals. Design: A qualitative study drawing on grounded theory was undertaken between February 2015 ‐ January 2016. Methods: Interviews with 15 patients and 22 healthcare professionals, a focus group with six healthcare professionals, 45 hr of observation and review of 18 sets of patient notes. Analysis was conducted using initial and focused coding, continuously comparing data, emerging codes and themes. Findings: The core category was navigating, constructed through three themes: containing complexity, networking, and situating the process. Navigating assessment was a complex, flexible, context dependent, and social process where healthcare professionals used a combination of formal, informal, visible, and invisible ways of working. Registered nurses were at the centre of networking and focused on gathering and sharing information in the multi‐disciplinary team, whilst patients had a passive role despite a variety of preferences about their involvement. Conclusions: Navigating the assessment of older people is contextually situated, includes networking and a professional focus on containing complexity. This process may be enhanced by: (a) making informal assessment visible to others; (b) developing the nurses' role beyond chasing information towards coordinating care; and (c) asking patients and acting on how they would like to be involved in decision‐making. Impact: Acknowledging that navigating assessment is a social, flexible and complex process, including different ways of working to meet patient needs, may enhance the usability of current assessment guidelines and their development. [ABSTRACT FROM AUTHOR]

Background: Antifibrotics are recommended for the treatment of individuals with idiopathic pulmonary fibrosis (IPF), but treatment use remains at ∼60%. Objective: To investigate the views of individuals with IPF and pulmonologists on the diagnosis and management of IPF to understand treatment patterns. Methods: Interviews and/or online surveys were completed by patients and pulmonologists from Canada, France, Germany, Italy, Spain, and the UK. Responses from physicians were analyzed by time between diagnosis and treatment initiation in the majority of patients with IPF (group A, > 4 months; group B, ≤4 months). Statistical comparisons between physicians were undertaken using z tests, with p < 0.05 considered statistically significant. Results: The physicians in group A saw fewer patients, were less comfortable discussing the IPF prognosis with patients, and had less belief in the benefits of antifibrotic treatments than the physicians in group B. These physicians' attitudes contrasted with those of the patients, who wanted more information about the IPF prognosis and pharmacological treatment options at diagnosis and were more concerned about preventing disease progression than avoiding medication side effects. Differences between countries were found regarding physicians' comfort in discussing the prognosis at diagnosis and access to care. Conclusions: Several barriers to antifibrotic treatment, principally reflecting the differing views and values of patients and physicians, were identified in this study, suggesting a need for better patient-physician communication about pharmacological therapy for IPF. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: One‐to‐one observation uses continuous staff observation to safeguard patients judged likely to harm themselves or others.Policies increasingly mandate that staff engage therapeutically with patients during one‐to‐one observation. Yet not enough is known about factors facilitating or impeding such therapeutic engagement. What does this paper add to existing knowledge?: This study enriches existing literature on one‐to‐one observation through integrating the perspectives of staff of different levels of qualification, and patients of different diagnostic and risk profiles.Whilst previous research has highlighted the occurrence of counter‐therapeutic staff‐patient interactions, integration of patient and staff perspectives in the current study has demonstrated that patient and staff often attribute the causes differently, with each apportioning blame to the other, leading both parties to feel misunderstood, and staff lack confidence to overcome these challenges.A novel finding was that rapport‐building via simple demonstrations of compassion and conversations about everyday things, was viewed as an essential prerequisite to encouraging patients to open up about their experiences of emotional distress, whilst implementation of techniques drawn from psychological interventions was viewed as less important than staff's core relational skills. What are the implications for practice?: Therapeutic engagement during observation can enhance its risk management aims, providing thought is given to understanding and negotiating complex dynamics between staff and patients. Supervision for staff conducting observations should focus on building rapport in preference to emphasizing psychological intervention (e.g. DBT), and should enable staff to reflect on better understanding and managing their own emotions towards "hard‐to‐engage" patients. Introduction: Policies increasingly focus on staff‐patient interactions during one‐to‐one psychiatric nursing observations as an opportunity for therapeutic engagement – yet if and how this is feasible is unknown. Aim: This study aimed to integrate staff and patient perspectives to determine what factors facilitate or impede therapeutic engagement during one‐to‐one observation. Method: Thematic analysis of qualitative interviews with 31 psychiatric inpatient staff at different levels of seniority and 28 inpatients spanning a range of diagnoses and risk profiles. Results: Negative experiences of observation were characterized by a reciprocal dynamic where both patients and staff withdrew from interactions, having felt the other did not want to engage with them. Staff and patients agreed that these difficulties could be overcome when staff showed patients that they cared, gradually building trust through simple demonstrations of compassion and 'normalizing' conversation about everyday things. This approach helped patients to feel safe enough to open up about their distress, which in turn helped staff to better understand their experiences and work with them to find solutions. Implications for practice: Engagement during observation could be facilitated if staff receive more supervision in understanding difficult dynamics that impede rapport‐building and in managing their emotions towards patients they experience as "hard‐to‐engage". [ABSTRACT FROM AUTHOR]

Aims and objectives To report the findings from interviews conducted as part of a wider study on interventions to support dignified care in older people in acute hospital care. The data in this study present the interview data. Background Dignity is a complex concept. Despite a plethora of recommendations on how to achieve dignified care, it remains unclear how to attain this in practice and what the priorities of patients and staff are in relation to dignity. Design A purposive sample of older patients and staff took part in semi-structured interviews and gave their insight on the meaning of dignity and examples of what sustains and breaches a patient's dignity in acute hospital care. Method Thirteen patients and 38 healthcare professionals in a single metropolitan hospital in the UK interviewed. Interviews were transcribed verbatim and underwent a thematic analysis. Results The meaning of dignity was broadly agreed on by patients and staff. Three broad themes were identified: the meaning of dignity, staffing level and its impact on dignity, and organisational culture and dignity. Registered staff of all healthcare discipline and student nurses report very little training on dignity or care of the older person. Conclusion There remain inconsistencies in the application of dignified care. Staff behaviour, a lack of training and the organisational processes continue to result in breaches to dignity of older people. Clinical nurses have a major role in ensuring dignified care for older people in hospital. Relevance to clinical practice There needs to be systematic dignity-related training with regular refreshers. This education coupled with measures to change the cultural attitudes in an organisation towards older peoples' care should result in long-term improvements in the level of dignified care. Hospital managers have an important role in changing system to ensure that staff deliver the levels of care they aspire to. [ABSTRACT FROM AUTHOR]

AimTo examine how the introduction of intensive community support (ICS) affected admissions to community hospital (CH) and to explore the views of patients, carers and health professionals on this transition.BackgroundICS was introduced to provide an alternative to CH provision for patients (mostly very elderly) requiring general rehabilitation.MethodRoutine data from both services were analysed to identify the number of admissions and length of stay between September 2012 and September 2014. In total, 10 patients took part in qualitative interviews. Qualitative interviews and focus groups were undertaken with 19 staff members, including managers and clinicians.FindingsThere were 5653 admissions to CH and 1710 to ICS between September 2012 and September 2014. In the five months before the introduction of ICS, admission rates to CH were on average 217/month; in the final five months of the study, when both services were fully operational, average numbers of patients admitted were: CH 162 (a 25% reduction), ICS 97, total 259 (a 19% increase). Patients and carers rated both ICS and CH favourably compared with acute hospital care. Those who had experienced both services felt each to be appropriate at the time; they appreciated the 24 h availability of staff in CH when they were more dependent, and the convenience of being at home after they had improved. In general, staff welcomed the introduction of ICS and appreciated the advantages of home-based rehabilitation. Managers had a clearer vision of ICS than staff on the ground, some of whom felt underprepared to work in the community. There was a consensus that ICS was managing less complex and dependent patients than had been envisaged.ConclusionICS can provide a feasible adjunct to CH that is acceptable to patients. More work is needed to promote the vision of ICS amongst staff in both community and acute sectors. [ABSTRACT FROM PUBLISHER]

Objectives Shared decision-making is the pinnacle of patient-centred care; mental health stakeholders value shared decision-making but find it difficult to enact. The objective was to compare and synthesise mental health stakeholder views on antipsychotic prescribing in one NHS Trust, to understand potential reasons for the difficult enactment of shared decision-making in practice. Methods We conducted 12 interviews and 5 focus groups with 33 mental health stakeholders, after obtaining their informed consent. They shared their experiences in and perceptions of antipsychotic prescribing and were recruited from Manchester Mental Health and Social Care Trust. Results Stakeholders agreed that successful shared decision-making demands a collaborative approach. We elucidated a striking divergence in views of the decision-making process and understanding of collaboration. Nurses, consultants and the pharmacist seemed most satisfied with the amount of collaboration but most pessimistic about the scope for it. Carers and most service users did not feel that there was any collaboration. Discussion Comparison of perspectives demonstrated the complexity of shared decision-making which is not addressed in current operational definitions or policy or nursing practice initiatives. The findings have the potential to progress initiatives in the mental health field from those that emphasise the need for shared decision-making to those that develop tools to promote shared decision-making. [ABSTRACT FROM AUTHOR]

Restraint in mental health care has negative consequences, and guidelines/policies calling for its reduction have emerged internationally. However, there is tension between reducing restraint and maintaining safety. In order to reduce restraint, it is important to gain an understanding of the experience for all involved. The aim of the present study was to improve understanding of the experience of restraint for patients and staff with direct experience and witnesses. Interviews were conducted with 13 patients and 22 staff members from one UK National Health Service trust. The overarching theme, 'is restraint a necessary evil?', contained subthemes fitting into two ideas represented in the quote: 'it never is very nice but...it's a necessary evil'. It 'never is very nice' was demonstrated by the predominantly negative emotional and relational outcomes reported (distress, fear, dehumanizing, negative impact on staff/patient relationships, decreased job satisfaction). However, a common theme from both staff and patients was that, while restraint is 'never very nice', it is a 'necessary evil' when used as a last resort due to safety concerns. Mental health-care providers are under political pressure from national governments to reduce restraint, which is important in terms of reducing its negative outcomes for patients and staff; however, more research is needed into alternatives to restraint, while addressing the safety concerns of all parties. We need to ensure that by reducing or eliminating restraint, mental health wards neither become, nor feel, unsafe to patients or staff. [ABSTRACT FROM AUTHOR]

Aims To explore the organized stroke unit experience from the multiple perspectives of stroke survivor, family carer and the multi-disciplinary team. Background Organized stroke unit care reduces morbidity, mortality and institutionalization and is promoted globally as the most effective form of acute and postacute provision. Little research has focused on how care is experienced in this setting from the perspectives of those who receive and provide care. Design This study used a qualitative approach, employing Framework Analysis. This methodology allows for a flexible approach to data collection and a comprehensive and systematic method of analysis. Method Semi-structured interviews were undertaken during 2011 and 2012 with former stroke unit stroke survivors, family carers and senior stroke physicians. In addition, eight focus groups were conducted with members of the multi-disciplinary team. Results One hundred and twenty-five participants were recruited. Three key themes were identified across all data sets. First, two important processes are described: responses to the impact of stroke and seeking information and stroke-specific knowledge. These are underpinned by a third theme: the challenge in building relationships in organized stroke unit care. Conclusions Stroke unit care provides satisfaction for stroke survivors, particularly in relation to highly specialized medical and nursing care and therapy. It is proposed that moves towards organized stroke unit care, particularly with the emphasis on reduction of length of stay and a focus on hyper-acute models, have implications for interpersonal care practices and the sharing of stroke-specific knowledge. [ABSTRACT FROM AUTHOR]