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Background: The COVID-19 pandemic resulted in rapid changes to head and neck cancer (HNC) services. Multidisciplinary team (MDT) face-to-face appointments were converted to telehealth appointments (telephone and video-call) to reduce the risk of COVID-19 transmission. The literature exploring HNC patient experience of these appointment types is limited. Aims: To explore patient experience of telehealth appointments at one UK centre during the COVID-19 pandemic, as well as the variables that may influence patient preference for virtual or face-to-face appointments. Methods & Procedures: A survey-based study design was used, with closed questions and open text options to capture the views of the participants. Quantitative data were analysed using descriptive statistics. Open text data was used to add depth to the findings. Outcomes & Results: A total of 23 participant surveys were returned. Six categories were identified: Usability; Information receiving & giving; Satisfaction; Emotions and comfort; Rapport; and Travel time and cost. Overall, participants gave positive responses to each category and indicated that telehealth appointments met their needs. Areas for clinical consideration are highlighted. Variables such as age, travel distance from hospital site, fear of COVID-19 and information technology (IT) access did not appear to influence patient preference for appointment type. Conclusions & Implications: Going forward, telehealth may be considered for use in combination with face-to-face appointments in the HNC pathway. Areas for further development include a 'telehealth screening tool' that may help to identify those patients most appropriate for these appointment types, or who require support to access them.

Understanding the school nurse's experience in human papillomavirus (HPV) vaccine promotion can reduce vaccine disparities. HPV vaccination is critical to cancer prevention. Despite the importance of the school nurse in vaccine promotion, there is a lack of understanding. This article aims to examine the knowledge, attitude, experience, and role of school nurses related to HPV vaccination and promotion in school settings. A systematic search for school nurses and their experiences related to HPV vaccination was conducted. A thematic synthesis was undertaken using the socioecological model. This review highlights the complexity of HPV vaccine promotion in schools over time. Multilevel factors impact nursing practice. Nurses have good vaccine knowledge and positive attitudes. Poor workflow processes, competing demands, and vaccine communication challenge school nurses. The themes that were synthesized informed the LEADS model. With the support of school nurses, reaching the goal of eliminating cervical cancer as a public health problem is possible.

Background: It is widely accepted that family caregivers are central to the future of cancer care and the impetus is to understand how best to support and empower them. Aims: This study explored the role of the relationship between the caregiver and the child, the level of perceived support, and the self-compassion of the caregiver, on distress and wellbeing in mothers who were the primary caregiver for a child with cancer. Methods: A self-report questionnaire survey of 255 mothers assessed perceived support, attachment to the child, self-compassion and a range of demographic variables including age, education, employment and time since diagnosis. Results: A model was proposed and explored using Hierarchical Multiple Regression Analysis (HMRA) and tested more fully using Structural Equation Modelling. The results of both analyses support the model and show it to be an excellent fit for the data. Conclusions: The findings suggest that the quality of the attachment bond with the child along with mother's ability to be self-compassionate, combined with perceived social support may moderate the impact of care burden on perceived distress for mothers caring for a child with cancer.

The Centre for Psychosocial Research in Cancer conducts world-leading research and service evaluations to support well-being and quality of life amongst those affected by cancer. This paper reflects on how we adapted our research management and study methods during the COVID-19 pandemic, and the implications for ongoing research practice. We use four case studies to consider the benefits and challenges of adapting to remote approaches to research and evaluation delivery: maintaining high ethical standards and data security in evaluation projects with remote approvals; recruiting for and running online discussion groups to inform intervention development; designing and delivering an in-person intervention via video conferencing; and adapting a longitudinal qualitative study to focus on newly emerging issues. We reflect on how we can maintain quality and rigour when conducting remote research and evaluation, and how this can affect our experience as researchers. We also consider possible implications of the uncertainty created by the COVID-19 pandemic for the funding and design of future research and evaluations.

Background: After total laryngectomy, surgical voice restoration is used to establish communication via tracheoesophageal voice prosthesis. Once voice is established, there is a paucity of information on what speech and language therapists (SLTs) should do to improve tracheoesophageal voice quality to ensure functional communication. No existing surveys or studies investigate this specific question. There is also a disconnect between guidelines, knowledge and clinical practice, whereby clinical guidelines stipulate the requirement for SLT intervention, but do not detail what this entails in the rehabilitation context. Aims: (1) To advance understanding of current clinical practice beyond voice prosthesis management and care. (2) To explore what approaches are implemented in clinical practice across the UK and Republic of Ireland to rehabilitate tracheoesophageal voice. (3) To investigate the barriers and facilitators to provision of tracheoesophageal voice therapy. Methods & Procedures: A self-administered 10-min online survey was developed using Qualtrics software and piloted before dissemination. Survey development was informed by the Behaviour Change Wheel to identify barriers, facilitators and additional factors contributing to SLTs' provision of voice therapy to tracheoesophageal speakers. The survey was disseminated via social media and professional networks. Eligibility criteria included SLTs with at least one year post-registration experience and with experience of working with laryngectomy in the past 5 years. Descriptive statistics were used to analyse closed answer questions. Open question responses were analysed using content analysis. Outcomes & Results: The survey received 147 responses. Participants were representative of the head and neck cancer SLT workforce. SLTs believe that tracheoesophageal voice therapy is an important aspect of laryngectomy rehabilitation; however, there was a lack of knowledge about therapy approaches and insufficient resources for implementing therapy. SLTs expressed a desire for more training, specific guidelines and a stronger evidence base to inform clinical practice. Some SLTs expressed feelings of frustration and lack of acknowledgement for the specialist skills required to undertake laryngectomy rehabilitation and tracheoesophageal work in general. Conclusions & Implications: The survey identifies the need for a robust training approach and detailed clinical guidelines to promote consistent practice across the profession. The evidence base within this clinical area is emergent, hence there is a need for increased research and clinical audit to inform practice. Under-resourcing was highlighted, which should be considered in service planning to ensure that adequate staff, access to expert practitioners or time ring-fenced for therapy are available for tracheoesophageal speakers to receive the support they require.

For people with symptoms that could indicate cancer, prompt presentation to a health care practitioner facilitates early diagnosis, improves survival, and is encouraged by public health agencies and cancer charities. Nevertheless, time to presentation from symptom onset (the patient interval) is known to vary widely. We report findings from a mixed-methods study examining help-seeking among people with symptoms of lung or colorectal cancer. Patients referred for urgent investigation were invited to complete a questionnaire about their symptoms and help-seeking experiences; 26 of these participants then took part in a semi-structured interview. Discrepant accounts of help-seeking were reported through the different research methods, with longer 'patient intervals' reported in interviews. We use the concept of 'public and private accounts' to reflect upon why socially conforming accounts of early presentation were presented in the questionnaires, whilst accounts of longer 'patient intervals' tended to be presented within an interview encounter.

Autistic individuals may be at risk of premature mortality, and physical health comorbidity increases this risk; however, most studies fail to include older autistic adults or consider lifestyle-related factors that affect health. We developed an anonymous, online physical health survey. The final sample included n = 2368 individuals (mean age = 41.42), and of these, n = 1156 were autistic individuals (mean age = 40.98). We utilized three sex-stratified statistical models to determine the prevalence of cancer, cardiovascular conditions, respiratory conditions, and diabetes. All three models indicate that autistic females are more likely to have cardiovascular conditions, respiratory conditions, asthma, low blood pressure, arrhythmias, and prediabetes than non-autistic females, and autistic males are more likely to have arrhythmias than non-autistic males; these results suggest that autistic individuals carry increased risks for these conditions when compared to the general population, even after controlling for age, ethnicity, education level, body mass index, smoking, and alcohol use. Further, these risks may differ depending on biological sex for autistic individuals. Autistic adults, and particularly autistic females, have greater and wider-ranging risks than previously thought, even after controlling for demographic and lifestyle-related factors. Although this is a large sample of autistic adults across the lifespan, future research should employ larger, population-based samples to confirm these findings.

In this paper, we examine the use of creative methods for understanding the experience of young adults aged between 16 and 30 years over a year following a cancer diagnosis. Exploring the renegotiation of identity, the narrative, longitudinal research design of the study demonstrated the unfolding process of the narrative work between participants and researcher. We used a combination of visual, spoken and reflexive psychosocial approaches to understand emergent narratives, many of which do not always find symbolisation in language. Our methodological approach focused on the difficult and sometimes 'unspeakable' nature of the young adults' narratives, demonstrating the importance of different modes of communication in articulating complicated relations with uncertain futures. In this respect the links between narrative, social action and the imagining of possible futures are precarious. In this paper, we explore how untellable issues were explored, and the challenges of doing so.

Background: Awake craniotomy with electrical stimulation has become the gold standard for tumour resection in eloquent areas of the brain. Patients' speech during the procedure can inform the intervention and evidence for language experts to support the procedure is building. Within the UK a burgeoning speech and language therapist awake craniotomy network has emerged to support this practice. Further evidence is needed to underpin the specific contribution of speech and language therapists working within the awake craniotomy service. Aims: To investigate and analyse the current practices of speech and language therapists: their role, pre-, intra- and postoperative assessment, and management practice patterns and skill set within awake craniotomy. Methods & Procedures: Speech and language therapists in the UK, who work in awake craniotomy, were invited to complete an online questionnaire. Participants were recruited via several networks supported by a social media campaign. Data were analysed using a mixed methodology approach including descriptive statistics, summative and conventional content analysis. Outcomes & Results: A total of 24 speech and language therapists completed the survey, an unknown proportion of the available population. All four UK countries were represented. The majority were highly specialist clinicians 58% (n = 14) with the remainder clinical leads 25% (n = 6) or specialist clinicians 17% (n = 14). Only 29% (n = 7) had funding for awake craniotomy or had awake craniotomy in their job description. Median experience with awake craniotomy was 3 years. Median estimated contact time per case was 10.3 h. Current intraoperative practice is characterized by a sustained period of real-time, dynamic, informal assessment of speech, language, oromotor and cognitive functions. Respondents described a range of intraoperative clinical deficits that, once detected, are immediately communicated to surgeons. There was evidence of variable and diverse language mapping practices and barriers to the translation of information at multidisciplinary team level. Barriers to participation in awake craniotomy included lack of: standardized validated language mapping methods, funding, standardized training methods and guidance to direct practice. Conclusions & Implications: The evidence suggests areas of consistent practice patterns in preoperative preparation and intraoperative assessment. However, considerable variability exists within language testing and mapping that would benefit from validation. These speech and language therapists support improved outcomes of awake craniotomy by real-time intraoperative speech, language, oromotor and cognitive assessment, rapid detection of clinical deterioration and immediate communication to surgeons. Further research exploring intraoperative language testing, consistent use of language mapping terminology, and selection of test methods is recommended.

This study describes the quantitative aspects of metaphor in academic publications. In particular, we analyze the frequency of metaphor types and source domains in medical papers written by native and non-native speakers of English. The data have been collected from selected published articles on cancer and tissue engineering. The method combines a manual procedure with a semantic tagger and keyness statistics in Wmatrix software for metaphor identification. The results show that while the distribution of metaphor is relatively stable across tissue engineering and cancer articles written by native and non-native speakers, indirect metaphor is more often used than other types of metaphor. Moreover, the findings indicate that some metaphorical source domains are specifically used for a particular topic and that some are more frequently exploited by native speakers of English than by non-native speakers. This study has implications for English for Academic Purposes (EAP) pedagogy and the development of metaphorical awareness activities as it may set the ground for future corpus studies that analyze metaphor properties in academic registers.

Objectives: This qualitative study aimed to understand the experiences, information and support needs of family members of cancer patients and their satisfaction with the services provided to them as a family member. Design: Inductive qualitative and critical realist approach to data collection and analysis. Methods: Purposive sampling was used to identify family members of cancer patients. We conducted semi-structured interviews with 10 participants by means of email, enabling us to explore sensitive topics at a pace appropriate for each participant and gain rich sources of information. We analysed the data using an inductive thematic approach. Results: Three superordinate themes were identified: information acquisition, seeking support and family members' experiences of cancer. Needs were high, and a complex relationship between information and support was apparent. Many participants felt dissatisfied with the support and information received as it was sometimes inconsistent, incorrect or vague, and some reported deterioration in their own health as a consequence. Online communities were reported as being informative and supportive as the participants felt they could relate to the firsthand experience of the other members. Conclusion: Improving healthcare professionals' awareness of the type of information and support the family members need is vital for both family members and patients. There is a need for the development of educational and psychological interventions to assist family members in coping when a loved one is diagnosed with cancer, is undergoing or recovering from treatment, or is receiving palliative care.

This paper presents qualitative research completed in two groups of hospitals in the United Kingdom, as part of a larger mixed methods study. It involved eight qualified nurses caring for patients with gastro-intestinal cancer in general surgical wards. It explored the nurses' experiences of using an online programme and their perceptions of the impact of learning on patient care delivery. The nurses volunteered to complete an online open source package www.cancernursing.org. and meet for focus group discussions and interviews following a lapse of six weeks. Two of the participants experienced difficulties completing the package and following changes to the previously attained ethical approval, a focus group was conducted with these staff. Analysis of the transcripts identified a number of issues for those considering the adoption of such modes of delivery within healthcare. Nurses referred to a lack of information technology skills and competence in computer use, access issues, organizational barriers and lack of protected study time. In spite of difficulties they gave examples of how their learning had impacted on patient care.

The UK has the highest rate of cannabis use among young people worldwide. Dr. Alan Leshner, Director of the National Institute of Drug Abuse reports, "Every year more than 100,000 people, most of them adolescents, seek treatment for their inability to control their marijuana use." According to the Scottish Drug Misuse Statistics in Scotland 2002, 51% of individuals under 20 years have used cannabis. Cannabis use is not limited to youth; it is also the single-most used illicit drug among adults. Because of their widespread negative impact, illicit drugs have become a focus of the agenda of the English Parliament and there is ongoing debate on how to combat this problem. As the research assistant of Michael Matheson (MSP), the author compiled this report to gather information on cannabis and to assess approaches that would form the most effective cannabis policy. This research explores whether or not the recent change toward decriminalization is adequate, or if it needs further revising.

Background: Despite breast screening in Britain being free to all women within the allotted age range, uptake of this service is often poor in women with intellectual disabilities. Reasons put forward are numerous, including poor knowledge, pain and difficulty travelling to the centre. However, what influences the decision to attend is rarely discussed. Background: Despite breast screening in Britain being free to all women within the allotted age range, uptake of this service is often poor in women with intellectual disabilities. Reasons put forward are numerous, including poor knowledge, pain and difficulty travelling to the centre. However, what influences the decision to attend is rarely discussed. Results: Despite the experience of mammography being negative, high uptake of breast screening services was reported in this study. Pain and previous poor treatment in hospital were reasons for nonparticipation in breast screening. Although awareness about breast screening varied, those who had previous breast problems were more knowledgeable; however, there was poor awareness of the risks of hereditary breast cancer. Overall, paid-carers were found to play a key role, as means of support, information and a potential influence in determining participation in breast screening. Conclusions: There was general equality of access but an inequality in the preparation and delivery of the service which was dependent on a complex range of issues and relationships. Key to participation was preparation with the paid-carer facilitating discussions about breast screening were key to participating in mammography. This has implications on the future direction of funding and policy making. Risks associated with hereditary breast cancer and earlier presentation of breast tumours also needs highlighting.

Much of the evidence translation literature focuses narrowly on the use of evidence in the initial policy formulation stages, and downplays the crucial role of institutions and the inherently political nature of policy making. More recent approaches acknowledge the importance of institutional and political factors, but make no attempt to incorporate their influence into new models of evidence translation. To address this issue, this article uses data from a comparative case study of bowel cancer screening policy in Australia, the United Kingdom and New Zealand, to propose alternative models of evidence incorporation which apply to all stages of the policy process.

Research suggests that the uptake of cervical screening by women with intellectual disabilities (commonly known as learning disabilities within UK policy frameworks, practice areas and health services) is poor compared to women without intellectual disabilities. The present study explored learning disability nurses' experiences of supporting women with intellectual disabilities to access cervical screening in order to examine their role in promoting attendance and elucidate potential barriers and facilitators to uptake. Ten participants recruited from a specialist learning disability service completed a semi-structured interview and data were analysed using experiential thematic analysis. Identified individual barriers included limited health literacy, negative attitudes and beliefs and competing demands; barriers attributed to primary care professionals included time pressures, limited exposure to people with intellectual disabilities and lack of appropriate knowledge, attitudes and skills. Attendance at cervical screening was facilitated by prolonged preparation work undertaken by learning disability nurses, helpful clinical behaviours in the primary care context and effective joint working.

Bowel cancer is a serious health problem in developed countries. Australia, the United Kingdom (UK) and New Zealand (NZ) reviewed the same randomised controlled trial evidence on the benefits and harms of population-based bowel cancer screening. Yet only NZ, with the highest age standardised rate of bowel cancer mortality, decided against introducing a bowel cancer screening programme. This case study of policy making explores the unique resource, ethical, institutional and political environments in which the evidence was considered. It highlights the centrality of context in assessing the relative worth of evidence in policy making and raises questions about the suitability of knowledge utilisation strategies.

Background: As people with intellectual disabilities (ID) are living longer, their chances of developing cancer also increases. However, recognising the early signs and symptoms of cancer in a population with cognitive impairment and communication difficulties poses difficulties for both family carers and professional care staff. Engagement in health promotion and cancer prevention activities is also a challenge; yet, people with ID have an equal right to these important public services as other members of the population. Aims: The aim of this study was to examine how care staff engaged in cancer prevention and health promotion activities on behalf of people with ID. Methods: This was an exploratory descriptive study using a postal survey design employing a questionnaire. Fifteen residential facilities for adults with ID were targeted within one geographic region of the UK. In total, 40 residential staff completed a questionnaire about their knowledge of the risk and protective factors of stomach, breast, cervical and testicular cancer. Staff then completed questionnaires regarding 90 adults with ID, recording details about body mass index (BMI), lifestyle choices (i.e. smoking, dietary intake), "Helicobacter pylori" testing, family history of cancer and staff's health promotion and cancer prevention activities with these individuals. Findings: The women with ID were reported to have significantly higher BMIs than the men with ID and only two people with ID had been tested for the "H. pylori" infection: potential risk factors for developing breast and stomach cancer, respectively. The majority of the staff reported that they did not receive training in cancer prevention. Likewise, the majority of the staff reported that they were unaware of the family histories of the people with ID in their care. Reports varied with how staff engaged with people with ID regarding stomach, breast, cervical and testicular cancer health promotion activities and cancer screening opportunities. Discussion: Findings of this study show that health promotion and cancer prevention activities for people with ID may be less than optimal. The importance of staff training in order to raise knowledge and awareness is highlighted. Educating both staff and people with ID about the early signs and symptoms of cancer and the importance of a healthy lifestyle as a protective factor may help lead to more informed healthier lifestyle choices and lower cancer risk and morbidity.

Purpose: The aim of this small-scale focus group study is to explore the impact the Human Papilloma Virus (HPV) vaccine has on attitudes towards HPV, cervical cancer and sexual risk taking amongst university students in the UK. Design/methodology/approach: Participants were recruited through advertisements placed on notice boards throughout the campus of the University of Leeds. The study sampled purposively to obtain two groups of ten men and two groups of ten women. A total of 34 people attended the sessions. The missing participants gave no reason for the absence. Those who agreed to take part were aged 19-24 and were from a range of academic courses. Ethical approval was sought and approved by the Medical School Ethics Committee at the University of Leeds. Findings: Participants saw HPV as being distinct from genital warts. This led to a duality in their view of the vaccine, which they saw as a cancer vaccine for schoolgirls and as an STI vaccine in relation to people of their own age, and thus believed it would cause sexual complacency among young adults. There was a fear that the HPV vaccine would reinforce gender bias, reinforcing the idea that females are responsible for sexual health. They maintained that mass media campaigns were more effective than sex education for improving sexual health knowledge and practices. Originality/value: With the exception of chlamydia screening, this age group tends to be ignored in sexual health promotion campaigns. This small-scale study provides insights that can inform larger studies and help tailor future health education campaigns on HPV for this audience. (Contains 1 figure.)

Background: Women with intellectual disability (ID) are surviving to the age group at greatest risk of developing breast cancer (50-69 years). These women are more likely to experience a greater number of risk factors placing them at an advanced threat of developing breast cancer. However, as a result of cognitive deficits and communication difficulties these women are dependent upon staff to support them to attend the breast screening clinics. Aim: The aim of this paper was to examine how community nurses and residential staff support women with ID to access breast screening services. Methodology: Six focus groups were held with community nurses and residential staff who work in the field of ID in one region of the UK. The focus groups were tape recorded and the transcriptions were subjected to a thematic content analysis. Findings: Although many of the participants recognised the risk factors and signs/symptoms of breast cancer, there was still a deficit of knowledge. Both positive and negative experiences of women with ID attending for breast screening were reported; however, greater discussion focused on the latter. The participants identified "a lack of health educational material" and also negative "emotions, attitudes and physical barriers" as inhibiting factors for attendance. Discussion: This paper highlights the need for developing a health promotion programme for women with ID focusing on breast awareness and information on screening, and also healthier lifestyles. Breast awareness via visual checks was identified for women with ID who refused to attend the breast clinics; however, issues of informed "consent" and "vulnerability" were raised for staff and also family carers having to undertake these checks. Development of user-friendly health educational literature using "pictures, symbols, signs" and simplified words should be accessible to all ID staff, healthcare staff, and also women with ID. (Contains 2 boxes.)

Skin cancer is an increasing problem in Europe, America and Australasia, although largely preventable by avoiding excessive ultraviolet (UV) exposure. This paper presents the findings of a systematic review of qualitative research about the prevention of skin cancer attributable to UV exposure. The aim is to understand elements that may contribute to the successful or unsuccessful conveyance of skin cancer prevention messages and their uptake by the public. A systematic review was undertaken using evidence identified through searching electronic bibliographic databases and Web sites and reference list checks. Predefined inclusion and exclusion criteria were used. Sixteen study reports (relating to 15 separate studies) were included from the United Kingdom, United States, Australia, Canada and New Zealand. Each included study was quality appraised, and the findings were extracted into an evidence table. A coding scheme, framed by the Health Belief Model, was developed by the reviewers and informed analysis and synthesis. This showed that most people perceived their susceptibility to skin cancer, and its severity, as low. While benefits of adopting changed behaviour were acknowledged, there were substantial barriers to this, including positive perceptions of a tan as healthy and attractive and the hassle of covering up or using sunscreen. Peers, parents and media may offer "cues to action" that encourage adoption of preventative behaviour and finally self-efficacy or the perceived ability to make such changes. Effective health education messages will need to address the barriers to adopting protective behaviours identified through this review.

Background: The impact of a total laryngectomy on an individual's life has primarily been measured from a male viewpoint reflecting the demographics of a diagnosis of laryngeal cancer. A small number of studies have looked specifically at females, but very few are comparison studies. Consequently, there is little consistent research regarding any potential gender differences. Aims: To investigate whether there are gender differences in perceptions of health-related quality of life and functional abilities following total laryngectomy. Methods & Procedures: A total of 43 participants (22 males, 21 females), who had undergone a total laryngectomy procedure at least one year previously, took part in the study. They completed The European Organisation for Research and Treatment of Cancer Core Questionnaire Version 3.0 (EORTC QLQ-C30) in conjunction with the disease-specific Head & Neck Cancer Module (QLQ-H&N35). Outcomes & Results: There were no significant differences between males and females on demographic and disease-related variables, except for the following: significantly more females lived alone and changed their employment status following surgery. Males had a significantly higher global health status/quality of life than females (p less than 0.05) and significantly higher levels of physical (p = 0.01), emotional (p less than 0.01), cognitive (p less than 0.05) and social functioning (p less than 0.05). After adjusting for differences in living arrangements and change in employment status, differences in emotional and social functioning remained significant. There was a general trend for females to have higher symptom/impairment levels and to report more treatment-related problems, but the majority of these differences were not significant. Conclusions & Implications: Following total laryngectomy, females appear to be worsely affected in aspects of quality of life than males. Emotional and social functioning are particularly vulnerable. The findings imply that rehabilitation programmes after total laryngectomy need to evaluate quality of life and address these specific areas in order to improve patient-reported long-term outcomes. (Contains 4 tables and 1 figure.)

Experienced teachers have long asserted that children blind from retinoblastoma (Rb), a rare cancer of the eye, are of above average intelligence. To test this hypothesis, standardized verbal intelligence tests were administered to a sample of 85 children and adults, all diagnosed with the early infancy form of this condition. For 42 of the Rb participants, a control group was assembled of other blind individuals, each matched one-to-one on age, age of onset of the blindness, duration of the condition, sex, and educational history/background. The IQ scores of 200 visually impaired children are also presented for general comparison purposes in view of a common belief that verbal ability may be enhanced when sight is impaired. The mean verbal IQ of the 85 Rb participants was significantly above that of the sighted population upon which the IQ tests had been standardized. Also, the mean IQ of the sub-group of 42 Rb participants was statistically significantly superior to that of their 42 matched control group peers. (Contains 2 tables and 2 figures.)

There is growing evidence that childhood IQ is inversely associated with mortality in later life. However, the specificity of this association in terms of causes of death, whether it is continuous over the whole range of IQ scores and whether it is the same according to age and sex is not clear. In a large cohort (N = 11,603) of a complete population of children born in one city in the UK in the early 1950s, IQ measured at age 7 years (using a routinely administered picture test) was found to be inversely associated with mortality between the ages of 15 and 57 years. For every 1 SD increase in IQ at 7, the all cause mortality hazard ratio was 0.79 (95% CI 0.73, 0.85). On adjustment for a range of perinatal factors, father's social class at birth, number of sibs in the household and childhood height and weight, this was attenuated slightly to 0.81 (0.74, 0.88). Almost identical associations of IQ with mortality were seen for men and women as well as at younger (15-39) and older (40+) ages. These associations were across the entire IQ range, although some of the high mortality in the lowest category of IQ (less than 70) was accounted for by causes associated with congenital disorders. Overall, external causes of death showed the strongest association, with weaker associations being seen for cancer. Further work is required to understand the mechanisms whereby childhood IQ has such a robust association with mortality in later life. (Contains 6 tables.)

Aims: To compare voice quality as defined by formant analysis using a sustained vowel in patients who have undergone a partial glossectomy with a group of normal subjects. Methods & Procedures: The design consisted of a single centre, cross-sectional cohort study. The setting was an Adult Tertiary Referral Unit. A total of 26 patients (19 males) who underwent partial glossectomy and 31 normal volunteers (18 males) participated in the study. Group comparisons using the first three formant frequencies (F1, F2 and F3) using linear predictive coding (Laryngograph Ltd, London, UK) were performed. The existence of any significant difference of F1, F2 and F3 between the two groups using the sustained vowel /i/ and the effects of other factors, namely age, first presentation versus recurrence, site (oral cavity, oropharynx), subsite (anterior two-thirds of the tongue, tongue base), stage, radiation, complication, and neck dissection, were analysed. Outcomes & Results: Formant frequencies F1, F2 and F3 were normally distributed. F1 and F2 were significantly different in normal males versus females. F1, F2 and F3 were not different statistically between male and female glossectomees. Comparison of only women showed significant differences between normal subjects and patients in F2 and F3, but none in F1. This was the opposite in men where F1 was significantly different. Age, tumour presentation, site, subsite, radiation and neck dissection showed no significant difference. Postoperative complications significantly affected the F1 formant frequency. Conclusions: The study found that the formant values in patients following a partial glossectomy were altered significantly as compared with the normal control subjects. Only gender and complications and not the age, site, subsite, radiation and neck dissection were seen to influence the formant scores. (Contains 6 figures and 3 tables.)

This paper describes the development and evaluation of a blended learning resource in the biosciences, created by combining online learning with formal face-face lectures and supported by formative assessments. In order to improve the effectiveness and efficiency of teaching large classes with mixed student cohorts, teaching was delivered through a variety of media which included three main components: (1) an interactive online tutorial, based on the cellular processes of DNA replication, damage and repair in relation to oncogenesis (2) formative assessment in the form of multiple choice questions to allow self evaluation and (3) small group follow-up workshops, to encourage deeper learning. The online tutorial was designed using Flash[C] software to help conceptualise complex cellular processes in time and space. It was supported by formative quizzes, references and printer-ready notes. Introduction of these resources in 2005 led to significant improvements in summative assessments across all student cohorts compared to scores from 2004. Students highly valued the usefulness of self-paced learning combined with supportive formative assessments which helped enhance the learning process. Teaching in small group workshops that followed on from the tutorials was also more effective, allowing a better interaction with the students, encouraging confidence and deeper learning among students. The efficiency of teaching was also improved with reduced assessment times and less pressure on institutional resources (availability of large lecture halls). This study therefore supports the use of blended learning as a means of improving both the effectiveness and efficiency of large group teaching. (Contains 1 figure and 1 table.)

In this article, we discuss the findings of a study about how patients who have been diagnosed with cancer learn about their disease. This is a form of learning that is not often thought of as learning, within the practices in which it takes place. It involves learners who neither possess specific forms of knowledge, nor are sure about what knowledge there is to possess. In medical practice, this form of learning is often referred to in terms such as "information seeking," and the implemented practices of providing information do not always seem to take account of current understandings of teaching and learning amongst educational and psychological researchers. Here we report the findings of a U.K. Department of Health project concerned with the acceptability and usefulness of the Internet as a cancer information source. Post-Vygotskian theory is deployed in the interpretation of the data and the development of a model of the learning. (Contains 1 table.)

Purpose: The primary aim of the research reported here is to provide strategic guidance for the development of a national communication strategy to improve sun protection practice amongst young people. Design/methodology/approach: The research adopted an exploratory approach, employing qualitative focus groups to represent three population groups, mothers, teenagers and young adults living independently of the family home. A total of 12 focus groups were conducted (with six to eight participants per group) in the UK. Participants were recruited door-to-door using quota sampling methods. Findings: Consistent with other studies, awareness of sun protection measures was high compared with actual practice. A number of factors were identified which help to explain this behaviour deficit. These include environment and exposure context, financial cost, understanding of protection process, behavioural influence and control, experiential learning and benefits attached to tanning. Originality/value: While the findings highlight the importance of supporting parents through the provision of information and guidance, they also identified a need to develop initiatives specifically tailored to meet the needs of young people as they achieve independence. (Contains 1 table.)

The incidence of skin cancer has risen rapidly in the UK over the last 20 years, prompting public health organizations to try and raise awareness of the dangers of sun exposure and the need to practice sun-safe behaviour. This study aimed to assess baseline levels of sun-safe knowledge and behaviour in a British population-representative sample, prior to the launch of Cancer Research UK's "SunSmart" campaign. A face-to-face survey was conducted through the Office for National Statistics as part of their Omnibus survey. In total, 1848 men and women aged 18 and over were interviewed. Knowledge of what to do to reduce skin cancer risk was modest. Two-thirds mentioned avoiding the sun by seeking shade, 50% mentioned covering up and only 43% said to use high factor sunscreen. Practice of sun-safe behaviours was also poor, with only one-third saying they sought shade, covered up or used high factor sunscreen to protect themselves from the sun. Men and those from lower socioeconomic groups were least informed and least likely to report using sun-protective behaviours. Increases in both knowledge and use of appropriate sun-protective behaviours are needed if skin cancer incidence rates are to decrease.

The aim of this study was to improve understanding of smokers' potential reactions to genetic testing for smoking-related diseases. One thousand twenty-four respondents completed a postal survey; 186 were smokers. Questions addressed anticipated psychological and behavioral reactions to genetic test results using hypothetical scenarios. Of smokers, 65% anticipated being motivated to quit smoking upon receiving a positive genetic test result; 39% anticipated being demotivated by a negative result. More smokers anticipated being depressed in response to receiving a positive result for cancer than for heart disease (40% vs. 24%). Anticipated motivation was associated with higher desire to quit and lower nicotine addiction, anticipated depression with poorer understanding of genetic testing, and anticipated demotivation with lower education. Smokers who have a high desire to quit may use genetic testing as a motivational tool. Understanding of genetics may be important in determining how individuals respond to genetic tests for complex diseases. (Contains 5 tables and 1 figure.)

Purpose: To identify women's sources of information about cervical cancer screening, information which women report receiving during Pap consultations, information they would like to receive, and the relationships between perceived information needs, personal characteristics and information sources. Design/methodology/approach: Logistic regression analysis of questionnaire data obtained from 408 screen-eligible women resident in east central UK. Findings: Programme documentation and the Pap consultation represent the main sources of information, although a sizeable proportion rely on other sources (e.g. mass media). The range and frequency of information services which women report receiving during their Pap consultations are variable, and around one-sixth of women report never receiving information. "Always wanting information" is predictable from subject characteristics, which do not map precisely, owing to the variation in frequency of information being supplied. Age and women's main sources of information are significant predictors of perceived information shortfall, and such shortfalls are associated with dissatisfaction with the screening programme. Originality/value: Covers all aspects of women's attitudes towards satisfactory or unsatisfactory availability of external information in the matter of screening for cervical cancer in the UK. (Contains 6 tables.)

Objective: To evaluate the effect of a needs-based, nutrition education leaflet on nutritional knowledge. Design: Comparison of nutritional knowledge levels before and after exposure to a nutrition education leaflet. Setting: A regional colorectal out-patient clinic in Edinburgh. Method: A nutrition education leaflet, based on an earlier needs-assessment, was used in the study. Patients attending an out-patient clinic with colorectal symptoms were invited to participate. Nutritional knowledge was determined using a validated questionnaire in a semi-structured interview. In Group A, nutritional knowledge was determined at baseline and after exposure to the leaflet. In Group B, nutritional knowledge was determined after exposure to the leaflet and again one month later. Results: In Group A (n = 35), there was a significant increase in awareness of the "5 fruit and vegetables a day" (46 per cent v 91 per cent, p less than 0.001 ) and "what constitutes a portion of fruit and vegetable" messages (38 per cent v 71 per cent, p less than 0.05), compared with baseline. In Group B (n = 52), knowledge levels were maintained after one month, and during this time, 12 (23 per cent) subjects reported an increase in their fruit and vegetable intake. Conclusion: Targeted nutrition education significantly increased levels of nutritional knowledge, which was sustained one month later. Nearly a quarter of the cohort reported improvements in their dietary intake, which suggests that this method of nutrition education may be particularly cost-effective in facilitating dietary change. (Contains 5 tables.)

Objective: To establish the dietary knowledge, attitudes and potential barriers to change of patients attending a colorectal outpatient clinic. Design: Use of a semistructured interview to generate qualitative and quantitative data. Setting: A regional colorectal outpatient clinic within Edinburgh. Method: Patients attending clinic with colorectal symptoms were invited to participate in a semistructured interview using a validated questionnaire. Results: Fifty patients (mean age 62 plus or minus SD 15.1 years; male:female = 22:28) were interviewed. Twenty-three (46 per cent) knew that five portions of fruit and vegetable were recommended daily, but 31 (62 per cent) were unclear what constituted a portion. Only three (6 per cent) and two (4 per cent) could name three foods high in fat and fibre, respectively. Twenty-three (46 per cent) were unable to identify why healthy eating is important, while only four (8 per cent) were aware of an association between diet and cancer. Women had significantly higher nutrition knowledge scores than men (16.3 plus or minus SD7.1 v 12.3 plus or minus SD5.1, p less than 0.05 ). There was a significant relationship between educational attainment and nutritional knowledge (r = 0.534, p less than 0.001). Potential barriers to change included the belief that their diet was already healthy (n = 35, 70 per cent) and lack of time (n = 25, 50 per cent). Conclusion: Patients attending a colorectal clinic lack practical dietary knowledge and the majority are unaware of the link between diet and cancer. Targeted health promotion strategies are needed to raise awareness in this group. (Contains 3 tables.)

Assumptions about the equal reliability of competing accounts of risk deserve to be examined empirically while the scope for interpretative flexibility when addressing risk issues is clearly extensive. Indicates that the U.K. evaluation was not only less precautionary than its U.S. equivalent but was also less well-constructed and therefore less reliable. (Contains 64 references.) (Author/YDS)

An account is given of growing up as a child blinded as a result of a cancer of the eye known as retinoblastoma. The role of his mother is brought out, variously as a source of objective knowledge, of one's personal worth, and of the worth of other people in one's community. The strengths and weaknesses of his first school in his home area and then of the specialist residential school he attended are described and in part judged. His later awareness of the nature and implications of the cancer are set out, as also how the news was communicated to him.

This is the fourth in a series of articles concerned with safety in school science. This article presents some facts about eight types of carcinogenic chemicals and suggests precautions in their use in British schools. A safety bibliography is also included. (HM)

Objective: To examine the content of Instagram posts about oral cancer and assess its usefulness in promoting oral cancer awareness and early detection practices. Methods: A systematic search of Instagram for posts about oral (mouth) cancer was conducted using the hashtags #oral cancer and #mouth cancer. Posts usefulness in promoting awareness and early detection was assessed using the early detection usefulness score, and caption readability was assessed using the Flesch Kincaid readability score. Results: A total of 81,000 posts were identified, and 200 posts were thoroughly evaluated. Included posts gathered a total of 48,118 (mean = 420.59 likes) and 27,898 views. Most posts (81.5%) were educational to the lay person, and India and the UK were the major contributors. The most discussed topics were prevention and early detection (55%). Representative clinical images were present in 35.5% of posts. Only 9.5% of posts mentioned the source of information, and the mean usefulness score was only 2.1 out of 10. The mean reading ease score was 56.7 ± 43.8 (range from 1 to 98 out of 100). Conclusion: Instagram shows potential for promoting oral cancer awareness, particularly in prevention and early detection. However, concerns regarding content quality, scientific validity, and clarity persist. [ABSTRACT FROM AUTHOR]

Background: Family carers of people living with comorbid dementia and cancer (CDC) play a vital supportive role, but this may be particularly burdensome and adversely impact their own health and wellbeing. Objective: To examine the experiences and psychosocial support needs of caregivers of people with CDC. Methods: A flyer advertising the study was distributed to relevant UK voluntary sector organisations and shared across social media. 13 carers of people with CDC were recruited. In-depth semi-structured interviews were conducted and transcripts were analysed using reflexive thematic analysis, underpinned by an inductive phenomenological approach. Results: Complex interactions of dementia and cancer resulted in heightened responsibility for carers, who played a crucial role in recognition/management of symptoms, performing difficult cancer-related care, and treatment decision-making that posed difficult ethical challenges. Care-recipients had reduced insight into their cancer diagnosis and prognosis, so carers often carried the emotional burden alone. Responsibilities faced by carers were compounded by a lack of targeted, accessible information/support for CDC. Carers expressed a desire to talk to and learn from others who understand the unique challenges of navigating cancer-related decision-making, treatment and care for people who are also living with dementia. Conclusions: Cancer alongside dementia presents complex challenges for carers, who desire more cancer-related information and support which is tailored to people living with dementia and their family caregivers. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware of national guidance recommending that all people with endometrial cancer should be tested for Lynch syndrome • To recognise that after a diagnosis of endometrial cancer, patients should be informed of their screening result for Lynch syndrome • To understand the importance of healthcare professionals providing patients with information about Lynch syndrome, and making clinical genetics referrals where appropriate. Lynch syndrome is an autosomal dominant inherited condition which predisposes individuals to developing certain cancers, including endometrial, colorectal and/or ovarian cancer. However, most people with Lynch syndrome are not aware that they have the condition. National Institute for Health and Care Excellence (NICE) guidance recommends that all patients with endometrial cancer should be tested for Lynch syndrome and that healthcare professionals should inform patients of the possible implications of test results for themselves and their relatives, and should make clinical genetics referrals where appropriate. This article details a cross-sectional survey that was undertaken to determine the level of awareness and understanding of Lynch syndrome among patients with endometrial cancer in the UK and to identify best practice and areas for improvement. Of the 144 eligible respondents, most were neither aware of Lynch syndrome before their cancer diagnosis nor that NICE recommends testing for the syndrome. Many respondents diagnosed with Lynch syndrome did not receive verbal or written information on the condition or referral to a clinical geneticist. This is necessary to increase patient uptake of testing and support them in sharing information with their relatives. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To read about the experiences of people with chronic cancer in developing expertise in their condition • To be aware of areas in which CNSs can support people with chronic cancer to develop expertise in their condition • To recognise the need for specialised nurse-led services to support people with chronic cancer to manage and understand their condition. Background: The lifting of the coronavirus disease 2019 (COVID-19) pandemic restrictions in the UK has meant a near-full return to normal life for the general population. However, for patients with chronic cancer, the risk of severe illness from COVID-19 remains high because they are immunocompromised, and they may have various unmet support needs. Aim: To identify areas in which clinical nurse specialists (CNSs) can support people with chronic cancer in the UK to develop expertise in their condition, acting to minimise the risks of anxiety and depression in this population. Method: Narrative online interviews were conducted with seven people with chronic lymphocytic leukaemia. Transcripts were analysed using thematic and narrative methodologies. Findings: Two themes were identified. The first theme, holes in the system, explored the perceived position of chronic cancers at the bottom of the cancer hierarchy, which can cause patients to feel overlooked in terms of NHS service provision. The second theme, co-developed expertise, explored the mechanisms used by patients with chronic cancer to develop expertise in their condition and the role of specialised healthcare professionals in co-developing this expertise. Conclusion: Although the participants often felt let down by the healthcare system, support from CNSs was beneficial and empowered them to develop expertise in their condition. This indicates that there is a need for dedicated nurse-led chronic cancer pathways to minimise the risk of cancer-related anxiety and depression. [ABSTRACT FROM AUTHOR]

Simple Summary: Healthcare professionals recognise the importance of fertility preservation and their responsibility to initiate discussions. However, despite advanced training within respective fields, discrepancies in knowledge remain regarding techniques of fertility preservation, referral pathways and existing educational resources available to patients, preventing efficient implementation of services. Further education and training regarding the methods of fertility preservation and how to refer patients to specialist services are required. Many of the personal barriers faced by healthcare professionals could be overcome through regular teaching on communication skills used for breaking bad news. (1) Background: This study aims to establish the knowledge, attitudes and current behaviours towards female fertility preservation (FP) services amongst healthcare professionals (HCPs) in the UK. (2) Methods: An online survey was advertised publicly on the social media platform Instagram between 25 February 2021 and 11 March 2021. (3) Results: In total, 415 participants fulfilled the inclusion criteria and completed the survey. The majority of HCPs discussed FP techniques either never 39.5% (n = 164), once a year 20.7% (n = 86) or once a month 17.8% (n = 74). The majority rated their knowledge of each type of FP method as 'very poor' or 'poor' and strongly disagreed 14.2% (n = 59) or disagreed 42.2% (n = 175) with the statement they 'felt confident to counsel a patient on FP'. The majority either agreed 37.8% (n = 157) or strongly agreed 22.2% (n = 92) that it was their responsibility to discuss FP and 38.1% (n = 158) agreed or strongly agreed 19.5% (n = 81) they considered the desire for future fertility when planning treatment. The majority 87.2% (n = 362) had not experienced formal training on FP. (4) Conclusions: Discrepancies in knowledge remain regarding techniques of FP, referral pathways, awareness of facilities offering services and existing educational resources. Many HCPs recognise the importance of FP and their responsibility to initiate discussions. The knowledge that FP may not delay the treatment of cancer has also improved; however, training in FP is scarce. [ABSTRACT FROM AUTHOR]

This article explores men's experiences and management of uncertainty following treatment for prostate cancer. Qualitative interviews with 29 men, recruited from two prostate cancer support groups (PCSGs) in the Southeast of England, explored prostate cancer and post-treatment experiences of uncertainty. Data were analysed thematically using a constructivist grounded theory approach. Four common uncertainties were identified: (1) fear of cancer recurrence from continued biomedical monitoring following treatment; (2) fear of cancer recurrence from unexplained bodily symptoms; (3) concerns about post-treatment side effects; and (4) concern with having made the 'right' treatment choice. Three strategies for how men managed these uncertainties were also identified: (1) interpreting biomedical knowledge; (2) planning for future uncertain events; and (3) engaging with support groups that served as vigilance networks. Nuanced strategies of vigilance are identified, of reinterpreted pasts and imagined futures to manage uncertainties. These strategies temporally displace the uncertain present and are employed individually and communally as part of vigilance networks. This article adds to theoretical resources for understanding uncertainty management and evidences the chronicity of men's post-treatment experiences of prostate cancer. [ABSTRACT FROM AUTHOR]

The psychological impact of cancer is becoming well‐acknowledged. Given its prevalence, practitioners will encounter cancer in their therapy rooms. There is limited research on the experience and application of psychodynamic therapy for clients with cancer. This study generates a new understanding through the experience of psychodynamic practitioners. Semi‐structured interviews were conducted with eight UK psychodynamic therapists on their lived experience of working with client(s) with a recent (less than 5 years) diagnosis of cancer. The data were analysed using Interpretative Phenomenological Analysis. The findings reveal that psychodynamic therapists' experience with clients with cancer is emotionally demanding, mentally stimulating and deeply personal. They point to the unique space that psychodynamic therapy provides and highlight some of the challenges. The analysis is understood through the framework of psychodynamic theory and practice. [ABSTRACT FROM AUTHOR]

Drawing on fieldwork in Facebook support groups, in this article I explore how people, now patients, learnt to live with Barrett’s esophagus, a risk state or “precancer” for a type of esophageal cancer. This diagnosis brought the possibility of both facing and averting cancerous futures into the present. Far from passive recipients, members worked to foreground speculations of “wanted futures” in which prompt surveillance successfully prevented cancer deaths, transforming cancer risk into an opportunity for hope. Speculation here was an ambivalent and active process, involving not only the “observation of potentiality,” but the opening up and foreclosing of both desirable and undesirable potentialities. [ABSTRACT FROM AUTHOR]

Objective: Lateral neck dissection (LND) is performed for staging/treatment of head and neck lesions. This traditionally includes placement of a drain and inpatient admission. Drainless, day‐case head and neck surgery is attractive due to cost‐effectiveness and reduced length of stay, but evidence is lacking in LND. We aim to investigate Artiss™ as an alternative to drain placement, facilitating day‐case LND. Methods: A prospective review was conducted of patients who underwent LND in a UK hospital over a 22‐month period. Results: Thirty‐nine patients were identified (27 Artiss™ only; 12 Artiss™ with a drain). Eight Artiss™ only patients were day‐case. All drains were removed by post‐operative day 2. There was no statistically significant difference in the number of complications between the two groups. Conclusion: This observational study demonstrates that for selected patients, Artiss™ could facilitate drainless, day‐case LND. Further controlled studies with matched groups and larger numbers are required to validate this. [ABSTRACT FROM AUTHOR]

Introduction: Translation of cancer research into practice takes around 15 years. Programs informed by implementation science methods and frameworks offer potential to improve cancer outcomes by addressing the implementation gap. Methods: We describe the development of a Test Evidence Transition (TET) program which provides funding and support to health system delivery teams and project design and evaluation partners working together to achieve three objectives: Test innovations to support optimal cancer pathways that transform clinical practice; Evidence the process, outcome, and impact of implementation; and work with strategic partners to ensure the Transition of best practice into effective and equitable adoption across UK health systems. Results: Phase 1 launched in April 2023. Teams with the capability and motivation to implement evidence-based pathway innovations were identified and invited to submit expressions of interest. Following peer-review, teams were supported to develop full proposals with input from academics specializing in health services research, evaluation, and implementation science. Projects were selected for funding, providing an opportunity to implement and evaluate innovations with support from academic and health system partners. Conclusions: TET aims to improve cancer outcomes by identifying and addressing local-level barriers to evidence-based practice and translating findings into consistent and equitable adoption across health systems. Phase 1 projects focus on pathway innovations in diagnosis for breast and prostate cancer. We are now launching Phase 2, focusing on colorectal cancer. [ABSTRACT FROM AUTHOR]