Search

Background: A robust evidence base is required to assist healthcare commissioners and providers in selecting effective and sustainable approaches to improve cancer diagnosis and treatment. Such evidence can be difficult to build, given the fast-paced and highly pressured nature of healthcare delivery, the absence of incentives, and the presence of barriers in conducting pragmatic yet robust research evaluations. Cancer Research UK (CRUK) has played an active part in building the evidence base through its funding of programmes to identify, evaluate and scale-up innovative approaches across the UK. The aim of this paper is to describe and explain the research design and intended approach and activities for two cancer services improvement projects in Scotland funded by CRUK. Methods: A hybrid effectiveness-implementation study design will assess both the efficiency of the new pathways and their implementation strategies, with the aim of generating knowledge for scale-up. A range of implementation, service and clinical outcomes will be assessed as determined by the projects' Theories of Change (ToCs). A naturalistic case study approach will enable in-depth exploration of context and process, and the collection and synthesis of data from multiple sources including routine datasets, patient and staff surveys, in-depth interviews and observational and other data. The evaluations are informed throughout by a patient/public representatives' group, and by small group discussions with volunteer cancer patients. Discussion: Our approach has been designed to provide a holistic understanding of how (well) the improvement projects work (in relation to their anticipated outcomes), and how they interact with their wider contexts. The evaluations will help identify barriers, facilitators, and unanticipated consequences that can impact scalability, sustainability and spread. By opting for a pragmatic, participatory evaluation research design, we hope to inform strategies for scaling up successful innovations while addressing challenges in a targeted manner. [ABSTRACT FROM AUTHOR]

Suicide among children and young people (CYP) is a leading cause of death. In the UK children identified as suicidal are referred to Child and Adolescent Mental Health Services (CAMHS) for assessment and treatment. However, the number of children referred for suicidality, and their care journey is unknown. This retrospective cohort study conducted in two distinct CAMHS teams, in Scotland, UK, aimed to quantify the numbers of children referred for suicidality, describing this population and the outcomes of these referrals. All CAMHS referrals (n = 1159) over a 6-month period (Jan-June 2019) were screened to identify those referred primarily for suicidality. Data extracted included: age, gender, source of referral, reason for referral including underlying issues, whether offered an assessment, and referral outcome. Area based deprivation scores were attached to each referral. Associations between the referred CYP's characteristics (including source of referral and underlying issues) and referral outcomes were explored using Chi Square, Fishers Exact test, and one-way ANOVA. Referrals for 284 children were identified as being for suicidality across the two sites (Site A n = 104; Site B n = 180). These represented 25% of all referrals to these CAMHS over a six-month period. One third of these concerned children under 12. The underlying issues, referrals sources, and demographic indicators were similar in both sites. In site A 31% were offered an assessment, whilst in Site B which had a dedicated team for suicidal CYP, 82% were offered an assessment. Similarly, more children in Site B were offered treatment (47.8%), than Site A (7.7%). Referrals fromA&E were prioritized in both areas, and those who had attempted suicide offered an assessmentmore often. Older children were more likely to be offered treatment, although they were more likely to present with a history of self-harming behavior and/or previous suicide attempt. There are high numbers of children being referred to CAMHS for suicidality, and many are young children (<12). There is variation within and between services in terms of assessment, referral outcomes and care pathways for these children. Having a dedicated team to respond to referrals for suicidality appears to support access to assessment and treatment. [ABSTRACT FROM AUTHOR]

Study aim: Rates of out of hospital cardiac arrest are higher in deprived communities. Bystander Cardiopulmonary Resuscitation (BCPR) can double the chance of survival but occurs less often in these communities in comparison to more affluent communities. People living in deprived communities are, therefore, doubly disadvantaged and there is limited evidence to explain why BCPR rates are lower. The aim of this paper is to examine the barriers to administering BCPR in deprived communities. Method: Mixed method qualitative study with ten single sex focus groups (n = 61) conducted in deprived communities across central Scotland and 18 semi-structured interviews with stakeholders from the UK, Europe and the USA. Results: Two key themes related to confidence and environmental factors were identified to summarise the perceived barriers to administering BCPR in deprived communities. Barriers related to confidence included: self-efficacy; knowledge and awareness of how, and when, to administer CPR; accessing CPR training; having previous experience of administering BCPR; who required CPR; and whether the bystander was physically fit to give CPR. Environmental barriers focused on the safety of the physical environment in which people lived, and fear of reprisal from gangs or the police. Conclusions: Barriers to administering BCPR identified in the general population are relevant to people living in deprived communities but are exacerbated by a range of contextual, individual and environmental factors. A one-size-fits-all approach is not sufficient to promote 'CPR readiness' in deprived communities. Future approaches to working with disadvantaged communities should be tailored to the local community. [ABSTRACT FROM AUTHOR]

Background: Palliative care aims to support people to live actively until death. A rehabilitative approach which includes goal setting could be an important way of achieving this. Goal setting is well established in best practice guidelines for palliative care. However little is known about how the process of goal setting actually happens in practice, especially from patients' points of view. We aimed to investigate patients' expectations, experience and perceptions of goal setting in one hospice. Methods: We conducted 15 semi-structured interviews with a sample of patients who had been admitted to a Scottish hospice for symptom control. Interviews were digitally recorded, transcribed verbatim and analysed using Framework Analysis. Results: Participants understood and valued goal setting but did not always share their goals with hospice staff. These were often participants' own personal activity-based goals that they worked on in parallel, but not always in partnership with hospice professionals. Participants were able to adapt their goals as their situation changed. Conclusions: Our findings revealed a gap between the goals that participants identified and worked towards compared with those that participants perceived the professionals focussed on. As a result, opportunities were missed for patients and professionals to work together to achieve goals. [ABSTRACT FROM AUTHOR]

Background: Goal setting is recognised as an important way of supporting people to live as actively as possible until death. However, there is little agreement about how goal setting should be handled or delivered by health professionals in everyday practice. Aim: To investigate health-care practitioners' understanding and practice of patient-centred goal setting in a hospice. Methods: A comparative case study of 10 healthcare practitioners in one hospice. Non-participant observations (n=28), semi-structured interviews (n=10) and case-note analysis (n=67) were undertaken. Data were analysed using framework analysis. Results: Participants viewed goal setting as part of routine practice. However, goal setting focused around what was seen as important from the health practitioner's perspective, rather than being patient-centred. Participants' goal-setting practice was implicit and opportunities to support patients to pursue goals were missed. Participants emphasised problem solving and alleviating symptoms rather than focusing on patient priorities and establishing patient-centred goals. Conclusion: While goal setting is valued, it is practiced in an implicit, practitioner-centred and inconsistent manner. A more explicit, person-centred goal setting process may support practitioners more consistently in helping patients to identify their priorities and enhance their quality of life. [ABSTRACT FROM AUTHOR]

Background: Hypoglycaemia is a common and potentially life threatening consequence of insulin and sulphonylurea treated Diabetes. Some severe hypoglycaemic events result in emergency ambulance attendance. Many of these patients are treated at home and do not require immediate transportation to an Emergency Department. However only 27-37 % of patients then follow up their care with a diabetes specialist. Consequently repeat severe hypoglycaemic events occur.Methods: The intervention was implemented for 8 months, using a prospective cohort design with a historic control, in one Scottish Health Board in 2012. Data was collected using postal survey questionnaires to patients and ambulance clinicians, telephone survey follow-up questions to patients. Scottish Ambulance Service electronic records were linked with the SCI-Diabetes database of patient records to enable objective measurement of follow-up behaviour.Results: Ambulance clinicians' (n = 92) awareness of the intervention was high and both the prompt card and telephone call components of the intervention were delivered to most eligible patients. The intervention was perceived as highly acceptable to patients (n = 37), and very useful by both patients and ambulance clinicians. However, comparison of patient follow-up behaviours using linked-data (n = 205), suggest that the intervention was unsuccessful in improving rates of patients' following up their care.Conclusions: This study shows that the intervention is implementable, highly acceptable to patients, and considered very useful by both patients and ambulance clinicians. However, preliminary evidence of effectiveness is not encouraging. The study's novel use of linking existing clinical data for outcome measurement exposed challenges in the feasibility of using this data for intervention development and evaluation. Future research should examine challenges to the successful testing and effectiveness of the intervention. Revisions are likely to be required, both to study design and the optimisation of the intervention's content and components. [ABSTRACT FROM AUTHOR]

Purpose: Clinicians' actions impact the patient care process and pathway. This study identified clinicians' actions associated with successful care processes in one community healthcare setting, children's occupational therapy. Method: A secondary analysis in a form of a quantitative content analysis was conducted of 47 interview transcripts, describing outcomes and therapists' (n = 25) self-reported actions in 25 'successful' and 22 'unsuccessful' care processes. The successful processes were those with positive outcomes (clear and coherent process with easy discharge; achieved patient goals and positive patient-clinician relationships). The transcripts were coded for presence of therapists' actions and non-actions using content analysis; and actions associated with success of the process were identified by Pearson Chi-square test. Results: In total 207 actions were identified. These clustered around six areas: assessment, setting goals and planning actions, treatment, review, discharging, and managing processes and relationships. The key actions associated with successful processes were: gather perspectives from others at assessment (χ2 = 6.65, p < 0.01); identify therapy goals (13.16, p < 0.01); agree/communicate plans, roles and responsibilities (9.10, p < 0.01); involve the child and parents in treatment (6.36, p = 0.01); adapt physical environment (6.01, p = 0.01) and make comparisons between the baseline, current and target levels when reviewing progress (6.36, p = 0.01). Conclusions: The actions identified are congruent with literatures about patient involvement and goal achievement. Specific hypotheses about the mechanisms by which the identified actions may relate to care process are presented. [ABSTRACT FROM AUTHOR]