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OBJECTIVE: To conduct a systematic review of the effectiveness of consultation recordings and identify factors contributing to their successful implementation in health-care settings. METHODS: A systematic review was conducted for quantitative studies examining the effectiveness of consultation recordings in health care. Two independent reviewers assessed the relevance and quality of retrieved quantitative studies by using standardized criteria. Study findings were examined to determine consultation recording effectiveness and to identify barriers and facilitators to implementation. A supplementary review of qualitative evidence was performed to further explicate implementation factors. RESULTS: Of the 3373 articles retrieved in the quantitative search, 26 satisfied the standardized inclusion criteria (12 randomized controlled trials, 1 quasi-experiment, and 13 cross-sectional studies). Most patients found consultation recordings beneficial. Statistically significant evidentiary support was found for the beneficial impact of consultation recordings on the following patient reported outcomes: knowledge, perception of being informed, information recall, decision-making factors, anxiety, and depression. Implementation barriers included strength of evidence concerns, patient distress, impact of the recording on consultation quality, clinic procedures, medico-legal issues, and resource costs. Facilitators included comfort with being recorded, clinical champions, legal strategies, efficient recording procedures, and a positive consultation recording experience. CONCLUSIONS: Consultation recordings are valuable to patients and positively associated with patient-reported outcomes. Successful integration of consultation recording use into clinical practice requires an administratively supported, systematic approach to addressing implementation factors.

After completing treatment, most patients follow a pre determined schedule of regular hospital outpatient appointments, which includes clinical examinations, consultations and routine tests. After several years of surveillance, patients are transferred back to primary care. However, there is limited evidence to support the effectiveness and efficiency of this approach. This paper examines the current rationale and evidence base for hospital based follow up after treatment for gynaecological cancer. We investigate what alternative models of care have been formally evaluated and what research is currently in progress in europe, in order to make tentative recommendations for a model of follow up. The evidence base for traditional hospital based follow up is limited. Alternative models have been reported for other cancer types but there are few evaluations of alternative approaches for gynaecological cancers. We identified five ongoing european studies; four were focused on endometrial cancer patients and one feasibility study included all gynaecological cancers. Only one study had reached the reporting stage. Alternative models included nurse led telephone follow up and comparisons of more intensive versus less intensive regimes. Outcomes included survival, quality of life, psychological morbidity, patient satisfaction and cost effectiveness of service. More work is needed on alternative strategies for all gynaecological cancer types. New models will be likely to include risk stratification with early discharge from secondary care for early stage disease with fast track access to specialist services for suspected cancer recurrence or other problems.

Women represent nearly one-quarter of the 71,300 people living with HIV in Canada. Within a context of widespread HIV-related stigma and discrimination and on-going risks to HIV disclosure, little is known about the influence of growing social, legal and public health surveillance of HIV on sexual activity and satisfaction of women living with HIV (WLWH). Methods We analyzed baseline cross-sectional survey data for WLWH (≥16 years, self-identifying as women) enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), a multisite, longitudinal, community-based research study in British Columbia (BC), Ontario (ON) and Quebec (QC). Sexual inactivity was defined as no consensual sex (oral or penetrative) in the prior six months, excluding recently postpartum women (≤6 months). Satisfaction was assessed using an item from the Sexual Satisfaction Scale for Women. Multivariable logistic regression analysis examined independent correlates of sexual inactivity. Results Of 1213 participants (26% BC, 50% ON, 24% QC), median age was 43 years (IQR: 35, 50). 23% identified as Aboriginal, 28% as African, Caribbean and Black, 41% as White and 8% as other ethnicities. Heterosexual orientation was reported by 87% of participants and LGBTQ by 13%. In total, 82% were currently taking antiretroviral therapy (ART), and 77% reported an undetectable viral load (VL<40 copies/mL). Overall, 49% were sexually inactive and 64% reported being satisfied with their current sex lives, including 49% of sexually inactive and 79% of sexually active women (p<0.001). Sexually inactive women had significantly higher odds of being older (AOR=1.06 per year increase; 95% CI=1.05–1.08), not being in a marital or committed relationship (AOR=4.34; 95% CI=3.13–5.88), having an annual household income below $20,000 CAD (AOR: 1.44; 95% CI=1.08–1.92), and reporting high (vs. low) HIV-related stigma (AOR=1.81; 95% CI=1.09–3.03). No independent association was found with ART use or und

Introduction: Little is known about support needs and patterns of recovery among lung cancer patients following surgical treatment with curative intent. Consequently, there is insufficient evidence to guide the development of services to support patients in the post treatment period and to identify those at risk of protracted recovery. We are conducting an innovative study to test the feasibility of establishing a cohort of patients to investigate the factors that influence recovery after lung cancer surgery. Methods: A prospective, longitudinal cohort study design is employed. We are recruiting eligible patients, due to undergo surgery with curative intent, at nine geographical sites across the UK (recruitment period: August 2013 to early 2014). Participants complete questionnaires before surgery and three months later. Questionnaires include socio-demographic questions and validated Patient Reported Outcome Measures (PROMs) assessing quality of life, recovery and wellbeing. Participants’ clinical details will be collected. Study procedures will be evaluated using semi-structured interviews with patient participants and local site staff. Results: We will assess the feasibility of recruiting a consecutive sample of eligible patients to a cohort study and of retaining these patients for the duration of the study. Feasibility assessment will be informed by qualitative data collection to determine the acceptability of study procedures including questionnaires and methods for gathering patients’ medical details. Conclusion: We believe this is the first study to test the feasibility of recruiting a cohort of lung cancer patients to assess wellbeing and to understand patterns of recovery. This feasibility work will inform a large (n = 1000), UK wide, cohort study of patients undergoing surgery with curative intent. We plan to follow patients for a number of years. This novel approach to understanding lung cancer survival will enhance our ability to offer patients appropri

Introduction and aims Evidence for the management of patients after treatment is limited and particularly so for patients with advanced cancer. There is little empirical evidence to establish best practice in the after care of lung cancer patients. The aim of this study was to develop an understanding of patients' and carers' views of their aftercare and to integrate these into a new intervention. Methods A qualitative approach was taken using the principles of grounded theory. 35 interviews were conducted with patients and carers, participants had a range of histological diagnoses and stage of cancer and all treatment options were included in the sampling strategy. Results The period after treatment was highlighted as a difficult time for participants with anxiety and uncertainty after the ‘treadmill’ of treatment. Follow-up appointments provided significant reassurance about the patients' condition, which participants felt was best assessed by x-ray. Despite often poor prognosis the focus was to ‘get back to normal’ and live life to the full. Participants highlighted a lack of appropriate information after treatment, specific information about long term effects of treatment, symptoms and disease progression/recurrence. Transitions between teams were important concerns which led to worries about rapid access back to treatment/specialists. Conclusion Patient and carer preferences should be incorporated into the development of interventions; they have revealed important issues that impact on the day-to-day lives of people living with lung cancer, specifically, targeted information focusing on aftercare issues, care planning and identification of key contacts to manage care and transitions.

Background: This paper will report on the findings from an economic evaluation of traditional hospital follow-up versus telephone follow-up by specialist breast care nurses for patients treated for breast cancer in the United Kingdom (UK). Materials and Methods: We conducted a cost minimisation analysis from a National Health Service (NHS) perspective using data from a randomised controlled trial that demonstrated equivalence between hospital and telephone follow-up in terms of psychological morbidity; 374 participants at low-moderate risk of recurrence were recruited to the study. The study was carried out at two hospitals in the North West of Engalnd. In a primary analysis we compared NHS resource use for routine follow-up (i.e. consultations, investigations and referrals) during a mean follow-up period of 24 months. Secondary analyses included patient and carer travel and productivity costs incurred and the NHS and personal social services costs of care in the minority of patients who developed a recurrence of their breast cancer. Results: Participants in the telephone follow-up group had approximately 20% extra consultations (634 versus 524). Telephone consultations were of longer duration and conducted by senior nurses whereas hospital clinic appointments were of shorter duration and often conducted by junior medical staff; this resulted in higher routine follow-up costs in the telephone follow-up group (mean difference £55, 95% bCI £29-£77). There were no significant differences in the costs of treating recurrence between groups. Participants receiving hospital follow-up had significantly higher travel and productivity costs (mean difference £47; 95% bCI £40-£55). Conclusions: Telephone follow-up by specialist nurses may be a useful strategy for reducing the burden on busy hospital clinics and providing a quality service. Although patients and carers will have fewer costs with telephone follow-up, this approach will not necessarily lead to cost or salary savin

Background: The burden of illness is high for lung cancer patients, carers and society. Follow-up interventions may be able to support patients living with lung cancer and improve survival. The aim of this review was to examine the evidence for the effectiveness of intensive follow-up of patients with lung cancer. This review is the first step in the development of a new model of service delivery for lung cancer patients utilising the Medical Research Council (UK) guidance for the development of complex interventions. Material and Methods: Data sources: English language observational studies and randomised clinical trials (RCTs) were retrieved from electronic databases (Ovid Medline, Embase, PsychINFO, CINAHL, British Nursing Index, Cochrane Library and National Research Register). If there was more than one study with like populations, interventions and outcomes, the relevant data were statistically synthesised. Time to event data were synthesised using hazard ratios (HR) and 95% confidence intervals. Results: Nine studies that examined the role of intensive follow-up for lung cancer patients were included in the review (eight observational studies and one RCT). This meta-analysis shows that there is a trend for intensive follow-up to improve survival in patients with lung cancer, although this result is not statistically significant for the curative treatment intent group (HR 0.82, CI 0.64−1.05) or the palliative treatment group (HR 0.69, CI 0.46−1.04). There is a statistically significant difference in survival for patients with potentially resectable NSCLC with asymptomatic recurrence (HR 0.59, CI 0.48−0.72), although this is complicated by lead time bias. Conclusion: There is no evidence that intensive follow-up of lung cancer patients improves survival compared to standard or less intensive follow-up. However, because this finding is based on observational studies with potential for bias, further evidence, ideally from RCTs, is needed. The review identified li

Background: Current oncology policy and literature promotes the importance of providing information that meets the needs of patients and their partners/carers However, there is little evidence to guide health care professionals on the type of information required, and how best to deliver it, when cancer comes back. The aim of this study was to describe the information needs and experiences of receiving information from the perspectives of patients and their partners/carers at cancer recurrence. Method: This was an exploratory study that used a qualitative design informed by principles of symbolic interactionism and grounded theory. Interviews were chosen as the method of data collection. Eighteen patients diagnosed with a first metastatic recurrence of breast or colo-rectal cancers were recruited from out-patient clinics at a cancer centre in England. Permission was sought to interview separately each patients' partner or person most significant to them (carer), of which sixteen partners/carers consented (total 34 interviews). Participants were asked to describe their experience of the recent metastatic diagnosis and the information they had required and actually received was explored. All interviews were tape-recorded, fully transcribed, and analyzed drawing on techniques of grounded theory. Results: Cancer recurrence was a devastating experience for the majority of patients and their partners/carers. A number of patients presenting with cancer recurrence perceived delays in terms of gaining access to specialist opinion, information and support. Patients and their partners/carers had individual concerns, and sometimes different information needs in relation to the recurrence diagnosis, treatment and care. Partners/carers appeared to be at greater risk than patients of not having their information needs addressed. Conclusion: Optimum information provision at cancer recurrence is a complex and ongoing process of balancing recipients' individual hopes and expectations

Background: Having appropriate information is important for parents of children with asthma, but evidence about the information parents would find most useful is lacking. Identifying the topics that are a priority for parents would help in tailoring asthma education. Methods: A survey was undertaken of parents of children with established asthma attending an outpatient clinic at a district general hospital in the Northwest of England. Data were collected using a structured asthma specific information needs questionnaire, which employed a Thurstonian paired comparisons approach. This consisted of all possible pairings of nine ‘‘core information needs’’, previously identified in adults with asthma (Caress, et al. Patient Educ Couns 2002;47:319–27), adapted for use with parents of children with asthma. Results: Parents of 29 children (child’s median age 8.0 years, IQ range 5.1–12.3; median time since asthma diagnosis 3.7 years) completed the survey. Information needs were prioritised as shown in the table (information needs with Thurstone scale values). Six (20%) respondents were satisfied/very satisfied with their level of information about their current top priority area, while six (20%) were dissatisfied/very dissatisfied. The majority of parents (25/29) were unable to identify additional information needs, while three parents highlighted the need for information on action to take when their child was unwell (that is, an asthma action plan). The majority of parents stated that they would most prefer to receive information from their child’s doctor (22/29) and/or asthma nurse (12/29). Main reasons for this choice were ‘‘confidence in their knowledge’’ and ‘‘familiarity with their child’s asthma’’. Conclusion: Further work is required to better understand why parents value specific items. Some parents identified the need for an asthma action plan. A larger study is now required to validate these findings, in particular to establish whether information about self-manag