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To review the evidence of how nurse and pharmacist roles have been incorporated into the management of patients undergoing systemic anti-cancer therapy (SACT) services and their impact on patient experience and care provision.Systematic Review.Seven databases were searched on 10 April 2022.Research studies that met defined inclusion criteria were included. Quantitative findings were converted into textual descriptions and combined with qualitative results for thematic analysis. Data were categorized and aggregated into themes. Heterogeneity of studies meant meta-analysis was not possible.Fifteen papers were included. Three main themes were identified: advanced clinical practice (ACP) SACT service development; ACP skills and qualifications; and the impact of ACP SACT services on patient care and outcomes. There is a variation in tasks undertaken by nurses and pharmacists and role integration is restricted by limited physician engagement. Role titles used and skills and qualifications acquired differ and professional autonomy is variable. Qualitative studies were limited.Evidence of how nursing and pharmacist ACP roles are implemented, what skills are essential and how roles are impacting patient experience and outcomes is limited. More research is required to explore patient and physician experience of, and satisfaction with multi-professional care, alongside further evaluation of clinical delivery models.

Rates of self-harm among children and adolescents have risen significantly over the past decade and clinical guidelines place children's nurses at the heart of their care. This article reports on the evaluation of 'Our Care Through Our Eyes', an online self-harm learning programme for children's nurses. A self-selected, convenience sample of registered children's nurses (n = 42) completed scales pre- and postlearning programme that captured their attitudes, beliefs, empathy, anxiety, and confidence. Mean change scores were assessed, and qualitative comments captured postintervention were thematically summarized. There were small improvements in participants' attitudes, empathy and confidence were reported. Anxiety scores increased in a small number of items. Qualitative comments confirmed the value of the online learning programme for improving children's nurses' knowledge and understanding of self-harm among CYP. Our findings demonstrate that children's nurses agree on the importance of mental health training in self harm, and this could be a catalyst for renewal of both pre- and postregistration education including support structures within the National Health Service. This study is the first to explore the feasibility of evaluating 'Our Care Through Our Eyes' delivered using e-leaning and could be used to inform further investigations.

Nurse-patient therapeutic engagement on acute mental health wards is beneficial to service users' outcomes and nurses' job satisfaction. However, engagement is not always fulfilled in practice and interventions to improve engagement are sparse and ineffective. We explored the experiences of service users, carers, and clinicians drawing from 80 hours of non-participant observations in an acute mental health ward and semi-structured interviews with 14 service users, two carers, and 12 clinicians. Analysis of these data resulted in 28 touchpoints (emotionally significant moments) and eight overarching themes. Service users, carers, and clinicians identified a lack of high-quality, person-centred, collaborative engagement and recognized and supported efforts to improve engagement in practice. Potential solutions to inform future intervention development were identified. Our findings align with previous research highlighting negative experiences and support the need to develop multicomponent interventions through participatory methods.

This study used a descriptive phenomenological approach to explore the lived experience of women diagnosed with VTE in pregnancy and the perinatal period. The study setting was a London, university affiliated hospital. The sample consisted of nine women with deep vein thrombosis or pulmonary embolism in pregnancy or up to six weeks post-partum, diagnosed in the last two years. Semi-structured interviews were undertaken using an interview guide. Interviews were transcribed and analysed using phenomenological descriptive analysis. Clustered invariant constituents that represented the lived experience of subjects emerged. The study revealed that the experience of pregnancy-related venous thrombosis is an overwhelmingly negative one with the journey through diagnosis and treatment being fraught with challenges, uncertainty and anxiety. Four main themes that contributed to the women's lived experience were identified: 1. Challenges in establishing a diagnosis; 2. Dealing with diagnosis; 3. Coping with treatment; and 4. Fears for the future. This is the first study to explore the experience of pregnancy-related venous thrombosis and offers valuable insight into the phenomenon. There is opportunity for clinicians to enhance the experience of pregnancy-related venous thromboembolism (PRVTE) by improving communication and information given to patients, clarifying diagnostic and treatment pathways and improving awareness of the condition.

ObjectivesThe review aimed to 1) explore the constituents of nurse-patient therapeutic engagement on acute mental health wards; 2) map factors that influence engagement to the Theoretical Domains Framework and 3) integrate results into a conceptual model of engagement to inform the development of interventions to improve engagement.DesignA systematic integrative review using an established framework specific to the integrative review methodology.Data sourcesDatabase searches (CINAHL, PsycINFO, BNI and Cochrane Library) and hand searching identified 3,414 articles. After screening, applying eligibility criteria, and quality appraisal, 37 articles were included: n = 27 empirical research studies, n = 10 expert opinion pieces, n = 1 case study and n=1 theoretical paper.Review methodsPeer-reviewed empirical studies, theoretical reports or expert opinion pieces that explored therapeutic engagement as a stated aim and were conducted in acute mental health inpatient settings from the patient or nurse perspective were included. Data were extracted from the introduction, results and discussion sections of empirical research, and the complete article of theoretical and expert opinion pieces. Data were coded then grouped into subthemes and themes. Data relating to influencing factors were further categorised according to the Theoretical Domains Framework. Results were synthesised into a conceptual model of engagement.ResultsFive conceptually distinct, but closely related constructs of engagement – called the “Principles of Engagement” – emerged: 1) Understanding the person and their experiences; 2) Facilitating growth; 3) Therapeutic use of self; 4) Choosing the right approach and 5) Authoritative vs. emotional containment. Influences on engagement ranged across all 14 theoretical domains of the Theoretical Domains Framework.ConclusionA holistic understanding of the essential components of engagement may make it easier for nurses to recognise what they do, and to do it well. The model can be used to generate testable hypotheses about how and where to target behavioural change interventions. The Principles of Engagement must be reflected in the development of interventions to improve engagement.

PurposePhysical activity (PA) is central to self-management for people with colorectal cancer (CRC) to support health behaviour and function secondary to cancer treatment. However, there is limited evidence on how health professionals (HPs) promote PA during cancer treatment. This study aimed to investigate how and when PA is promoted throughout the chemotherapy pathway among colorectal cancer survivors.MethodsA qualitative study was conducted with adults with CRC receiving chemotherapy at a large cancer centre. Cross-sectional observation of clinical consultations was conducted at four points during the chemotherapy pathway: prior, midpoint, final cycle, and 8 weeks following chemotherapy. Following completion of treatment, audio-recorded, semi-structured interviews were conducted with patients and HPs and transcribed verbatim. Codes and themes were identified and triangulated from all the data using framework analysis. Observational themes are reported and complimented by interview data.ResultsThroughout the chemotherapy pathway (pre, midpoint, end), many opportunities were missed by HPs to promote PA as a beneficial means to maintain functioning and ameliorate cancer treatment side effects. When discussed, PA levels were used only to determine fitness for future oncological treatment. No PA promotion was observed despite patients reporting low PA levels or treatment side effects. Post-treatment, PA promotion was more routinely delivered by HPs, as evidenced by problem-solving and onward referrals to relevant HPs.ConclusionPA promotion was largely absent during treatment despite it being a key component of patient self-management following treatment. This suggests considerable missed opportunities for HPs to provide cancer survivors with PA evidence-based interventions. Further research is necessary to identify how best to ensure PA is promoted throughout the cancer journey.Implication for cancer survivorsThese findings suggest many may not be receiving support to be physically active during treatment.

Objectives: Walking is an adaptable, inexpensive and accessible form of physical activity. However its impact on quality of life and symptom severity in people with advanced cancer is unknown. This study aimed to assess the feasibility and acceptability of a randomised controlled trial (RCT) of a community-based walking intervention to enhance quality of life (QoL) in people with recurrent/metastatic cancer. Design: We used a mixed-methods design comprising a two-centre RCT and nested qualitative interviews. Participants: Patients with advanced breast, prostate, gynaecological or haematological cancers randomised 1:1 between intervention and usual care. Intervention: The intervention comprised Macmillan’s ‘Move More’ information, a short motivational interview with a recommendation to walk for at least 30 minutes on alternate days and attend a volunteer-led group walk weekly. Outcomes: we assessed feasibility and acceptability of the intervention and RCT by evaluating study processes (rates of recruitment, consent, retention, adherence and adverse events), and using end of study questionnaires and qualitative interviews. Patient reported outcome measures (PROMS) assessing quality of life (QoL), activity, fatigue, mood and self-efficacy were completed at baseline and 6, 12 and 24 weeks. Results: We recruited 42 (38%) of eligible participants. Recruitment was lower than anticipated (goal n=60), the most commonly reported reason being unable to commit to walking groups (n=19). Randomisation procedures worked well with groups evenly matched for age, sex and activity. By week 24, there was a 45% attrition rate. Most PROMs whilst acceptable were not sensitive to change and did not capture key benefits. Conclusions: The intervention was acceptable, well tolerated and the study design was judged acceptable and feasible. Results are encouraging and demonstrate that exercise was popular and conveyed benefit to participants. Consequently, an effectiveness RCT is warranted, with some modifications to the intervention to include greater tailoring and more appropriate PROMs selected.

Purpose The aim of this paper was to briefly describe how the experience-based co-design (EBCD) approach was used to identify and implement improvements in the experiences of breast and lung cancer patients before (1) comparing the issues identified as shaping patient experiences in the different tumour groups and (2) exploring participants' reflections on the value and key characteristics of this approach to improving patient experiences. Methods Fieldwork involved 36 filmed narrative patient interviews, 219 h of ethnographic observation, 63 staff interviews and a facilitated co-design change process involving patient and staff interviewees over a 12-month period. Four of the staff and five patients were interviewed about their views on the value of the approach and its key characteristics. The project setting was a large, inner-city cancer centre in England. Results Patients from both tumour groups generally identified similar issues (or 'touchpoints') that shaped their experience of care, although breast cancer patients identified a need for better information about side effects of treatment and end of treatment whereas lung cancer patients expressed a need for more information post-surgery. Although the issues were broadly similar, the particular improvement priorities patients and staff chose to work on together were tumour specific. Interviewees highlighted four characteristics of the EBCD approach as being key to its successful implementation: patient involvement, patient responsibility and empowerment, a sense of community, and a close connection between their experiences and the subsequent improvement priorities. Conclusion EBCD positions patients as active partners with staff in quality improvement. Breast and lung cancer patients identified similar touchpoints in their experiences, but these were translated into different improvement priorities for each tumour type. This is an important consideration when developing patient-centred cancer services across different tumour types.

Increasing numbers of people in the UK are living with recurrent or metastatic cancer, many of whom experience reduced quality of life resulting from the physical and psychosocial consequences of cancer and its treatment. While drug treatments are important at alleviating some symptoms, there is increasing evidence of the benefits of exercise in enhancing quality of life and health outcomes. Walking is an inexpensive and accessible form of exercise. To our knowledge, no studies have investigated whether a walking intervention is sufficient to enhance quality of life and alleviate symptoms in people with recurrent or metastatic cancer across a range of tumor types. This paper describes the CanWalk study protocol, which aims to assess the feasibility and acceptability of undertaking a randomized controlled trial of a community-based walking program to enhance quality of life and well-being in people with recurrent or metastatic cancer. A mixed methods feasibility study includes an exploratory two-center randomized controlled trial and qualitative interviews. A minimum of 60 participants will be recruited from two London NHS Trusts and randomized 1:1 between the walking intervention and standard care using minimization. The walking intervention consists of the initial provision of written/online information followed by a short motivational interview. Participants are instructed to walk for 30 min on alternate days and attend an organized volunteer-led walk once a week. Half of all participants will be asked to use a pedometer. Postal questionnaires will be completed at baseline (pre-randomization) and at 6, 12 and 24 weeks. A subsample of participants and stakeholders will be interviewed at the end of the study. Primary outcomes will be the acceptability and feasibility of the intervention and trial. A range of secondary outcome assessments needed to design a main study, including estimates of recruitment, adherence and variability in quality of life, will be evaluated. Data from this study will be used to refine the walking intervention, investigate the acceptability of the intervention and study design, and determine the most appropriate outcome measures thereby providing estimates of the factors needed to design the main study. ISRCTN42072606 .

PurposeSupporting someone through chemotherapy can be emotionally and physically demanding. However, research has yet to establish the type of support carers require or the best way to provide this. This study tested the feasibility and acceptability of a complex intervention for carers that was co-designed by staff and carers of patients starting chemotherapy.MethodsForty-seven carers were recruited, randomised between the intervention (n?=?24) and control (n?=?23) groups. A questionnaire was completed pre- and post-intervention measuring knowledge of chemotherapy and its side effects, experience of care, satisfaction with outpatient services, coping and emotional wellbeing. The intervention process was evaluated by carers and healthcare professionals (HCPs) in focus groups.ResultsRecruitment to the study was unproblematic and attrition from it was low, suggesting the intervention and study processes were acceptable to patients and carers. Carers in receipt of the ‘Take Care’ intervention reported statistically significantly better understanding of symptoms and side effects and their information needs being more frequently met than carers in the control. Confidence in coping improved between baseline and follow-up for the intervention group and declined for the control although differences were insufficient to achieve statistical significance. There was no significant difference between the two groups’ emotional wellbeing. HCP and carer focus groups confirmed the feasibility and acceptability of the intervention.ConclusionsThe ‘Take Care’ intervention proved acceptable to carers and HCPs and demonstrates considerable promise and utility in practice. Study findings support the conduct of a fully powered RCT to determine the intervention’s effectiveness and cost-effectiveness.

This paper examines how Muslim women perceive and experience prenatal testing. In addition, we look at women's partners and their opinions relating to prenatal testing. The paper is based on in-depth interviews with immigrant women who identify themselves as followers of Islam and are now living in Australia. The women have, in general, positive attitudes toward prenatal testing, particularly ultrasound. However, some are ambivalent about amniocentesis. Despite their doubts, women tend to accept prenatal testing as they believe it is routine in antenatal care and confirms their own perceptions of being a 'normal mother', who should accept advice from their doctors. Women's partners also play an important role in the acceptance of prenatal testing among women in this study. We argue that women's perceptions and subjective experience of prenatal testing should be taken into account when providing prenatal services to them. Women need to be given a choice rather than being pressured and made to conform to the routinization of prenatal testing which as taken place in the Australian health care system. Only then will we see sensitive health care provided for women in general and for Muslim immigrant women in particular.

Background Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process. Methods One dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified. Results There were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’ aspects and were not always sufficiently detailed to identify specific improvement actions. Conclusions Our analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience.

To evaluate brief communication skills training for healthcare professionals (HCPs) in offering antenatal sickle cell and thalassaemia (SCT) screening in primary care.Descriptive study within a cluster randomised controlled trial in 17 inner city practices.126 HCPs were invited to attend a training session. Outcome measures were: attendance; perceived usefulness of training; comfort and confidence in offering screening; offering screening at pregnancy confirmation consultations; gestational age at test uptake.62% (78/126) HCPs attended training and 61 completed both pre- and post-training questionnaires. There were 49 new joiners and locums not in post at the start of the trial. After training, HCPs reported greater comfort [4.8 vs 5.4, p = 0.05] and confidence [4.6 vs 5.6, p0.001] in offering screening. Pregnant women consulting trained HCPs were offered screening more frequently and at an earlier gestational age than those consulting untrained HCPs (75% vs 44%, χ(2) = 122, p0.001; 91.5 days (attending training) vs 98.5 days (did not attend training) vs 101.8 days (new joiners and locums), F = 8.49, df 1069,2 p = 0.001).Brief communication skills training for HCPs in offering antenatal SCT screening in primary care is feasible and can be effective.Ways of maximising HCP attendance in training sessions requires consideration.

To describe the acceptability to women of being offered antenatal Sickle cell and Thalassaemia (SCT) screening in primary and secondary care at the visit to confirm pregnancy; and to explore the implications of their views for participating in decisions about their health care.Qualitative semi-structured interviews were conducted with twenty-one ethnically diverse women registered at twenty-five general practices in two English inner-city Primary Care Trusts. The material was analysed thematically, using the method of constant comparison.Women generally welcomed the opportunity of early diagnosis, although they expected screening to confirm they were carrying a healthy child. Women felt general practitioners did not present antenatal screening as a choice, but they did not necessarily see this as a problem. Doctors were believed to be acting out of concern for the women's well being.Women were generally positive about being offered screening in primary care at the first visit to confirm pregnancy. To this extent it was acceptable to them, although this was largely informed by assumptions associated with being a 'good mother' rather than a straightforward enactment of informed choice, assumed by health-care policy. This represents the context in which women participate in decisions about their health care.

Background Timely antenatal sickle cell and thalassaemia (SC&T) screening for all women in primary care facilitates informed decision making, but little is known about its implementation. Aim To assess the feasibility of offering antenatal SC&T screening in primary care at the time of pregnancy confirmation. Design of study Cross-sectional investigation of GPs9 beliefs and perceived practices. Method Informal face-to-face interviews with 34 GPs. Setting Seventeen inner-city general practices that offered antenatal SC&T screening as part of a trial. Results GPs identified both barriers and facilitators. Organisational barriers included inflexible appointment systems and lack of interpreters for women whose first language was not English. Professional barriers included concerns about raising possible adverse outcomes in the first antenatal visit. Perceived patient barriers included women9s lack of awareness of SC&T. Hence, GPs presented the test to women as routine, rather than as a choice. Organisational facilitators included simple and flexible systems for offering screening in primary care, practice cohesion, and training. Professional facilitators included positive attitudes to screening for SC&T. Perceived patient facilitators included women9s desire for healthy children. Conclusion GPs reported barriers, as well as facilitators, to successful implementation but the extent to which screening could be regarded as offering ‘informed choice’ remained fundamental when making sense of these barriers and facilitators.

Objective: To evaluate the effectiveness of offering antenatal screening for sickle cell disease and thalassaemia in primary care as a way of facilitating earlier uptake of screening.\ud Design: Partial factorial cluster randomised controlled trial.\ud Setting: 25 UK general practices from deprived inner city areas.\ud Participants: Anonymised data on all pregnant women attending participating practices during a six month period before randomisation and a seven month period after randomisation. This included 1708 eligible women.\ud Intervention: Practices were randomised to three groups for seven months: parallel testing in general practice (tests for sickle cell disease and thalassaemia offered to both parents when pregnancy was first reported); sequential testing in general practice (tests offered to mothers when pregnancy was first reported, and subsequently to the partners of women who were found to be carriers); and midwife care (tests offered to mothers at first consultation with a midwife).\ud Main outcome measures: The primary outcome (available for all women) was the proportion of eligible women screened before 10 weeks’ (70 days’) gestation. Secondary outcomes were an offer of screening to women before 10 weeks’ gestation, gestational age at testing, mean interval from first visit to the general practice visit to screening, and women’s knowledge of the carrier status of their baby’s father before 77 days’ (11 weeks’) gestation. The study was designed to detect a 20% absolute increase in screening uptake. Cluster level analyses were adjusted for age group, parity, ethnic group, primary care organisation, and number of general practitioners per practice.\ud Results: Data were analysed for 1708 eligible women. In the midwife care arm, 2% (9/441) of women were screened before 10 weeks’ gestation compared with 24% (161/677) in the GP parallel testing arm and 28% (167/590) in the GP sequential testing arm. The estimated adjusted difference between the midwife care and GP parallel testing arms was 16.5% (95% confidence interval 7.1% to 25.8%; P=0.002) and between the midwife care and GP sequential testing arms was 27.8% (14.8% to 40.7%; P

Objectives To assess the effectiveness, cost-effectiveness, acceptability and feasibility of offering universal antenatal sickle cell and thalassaemia (SCT) screening in primary care when pregnancy is first confirmed and to model the cost-effectiveness of early screening in primary care versus standard care. Design A population-based cohort study, cluster randomised trial and refinement of a published decision model. Setting Twenty-five general practices from two UK primary care trusts (PCTs) in two inner city boroughs with a high proportion of residents from minority ethnic groups. Participants Practices were considered eligible if they agreed to be randomised and they were able to provide anonymous data on all eligible pregnant women. Participants were at least 18 years old and consented to take part in the evaluation. Interventions Practices were allocated to intervention, using minimisation and stratifying for PCT and number of partners at the practice, as follows: screening in primary care with parallel father testing (test offered to mother and father simultaneously; n = 8 clusters, 1010 participants); screening in primary care with sequential father testing (test offered to father only if mother identified as carrier; n = 9 clusters, 792 participants); and screening in secondary care with sequential father testing (standard care; n = 8 clusters, 619 participants). Main outcome measures Data on gestational age at pregnancy confirmation and screening date were collected from trial practices for 6 months before randomisation in the cohort phase. The primary outcome measure was timing of SCT screening, measured as the proportion of women screened before 70 days’ (10 weeks’) gestation. Other outcomes included: offer of screening, rates of informed choice and proportion of women who knew the carrier status of their baby’s father by 77 days (11 weeks). Results For 1441 eligible women in the cohort phase, the median [interquartile range (IQR)] gestational age at pregnancy confirmation was 7.6 weeks (6.0 to10.7 weeks) and 74% presented in primary care before 10 weeks. The median gestational age at screening was 15.3 weeks (IQR 12.6 to 18.0 weeks). Only 4.4% were screened before 10 weeks. The median delay between pregnancy confirmation and screening was 6.9 weeks (4.7 to 9.3 weeks). In the intervention phase, 1708 pregnancies from 25 practices were assessed for the primary outcome measure. Completed questionnaires were obtained from 464 women who met eligibility criteria for the main analysis. The proportion of women screened by 10 weeks (70 days) was 9/441 (2%) in standard care, compared with 161/677 (24%) in primary care with parallel testing, and 167/590 (28%) in primary care with sequential testing. The proportion of women offered screening by 10 weeks (70 days) was 3/90 (3%) in standard care (note offer of test ascertained for questionnaire respondents only), compared with 321/677 (47%) in primary care with parallel testing, and 281/590 (48%) in primary care with sequential testing. The proportion of women screened by 26 weeks (182 days) was similar across the three groups: 324/441 (73%) in standard care, 571/677 (84%, 0.09) in primary care with parallel testing, and 481/590 (82%, 0.148) in primary care with sequential testing. The screening uptake of fathers was 51/677 (8%) in primary care with parallel testing, and 16/590 (3%) in primary care with sequential testing, and 13/441 (3%) in standard care. The predicted average total cost per pregnancy of offering antenatal SCT screening was estimated to be £13 in standard care, £18.50 in primary care with parallel testing, and £16.40 in primary care with sequential testing. The incremental cost-effectiveness ratio (ICER) was £23 in primary care with parallel testing and £12 in primary care with sequential testing when compared with standard care. Women offered testing in primary care were as likely to make an informed choice as those offered screening by midwives later in pregnancy, but less than one-third of women overall made an informed choice about screening. Conclusions Offering antenatal SCT screening as part of pregnancy-confirmation consultations significantly increased the proportion of women screened before 10 weeks (70 days), from 2% in standard care to between 16% and 27% in primary care, but additional resources may be required to implement this. There was no evidence to support offering fathers screening at the same time as women. Trial registration Current Controlled Trials ISRCTN00677850. Funding The National Institute for Health Research Health Technology Assessment programme.

Objective: to examine satisfaction with care and services in relation to antenatal care and prenatal testing and to present what women say about what can be done better to improve antenatal care for women from an Islamic background. Design: in-depth interviews of women's perceptions and experiences of care received relating to prenatal testing and antenatal care. Setting: Melbourne Metropolitan Area, Victoria, Australia. Participants: 15 women of Islamic background who are now living in Melbourne. Findings: in general, women had positive experiences with care relating to antenatal care and prenatal testing in Australia. This is particularly so when they compared care in Australia with that of their own country. However, women indicated several issues of concern where they were dissatisfied and they believed need to be improved for pregnant women from an Islamic background. Firstly, there was a lack of sufficient communication between health care providers and the women. This was not only due to a language problem, but also a lack of cultural appreciation among health care providers. Secondly, women identified the issue of gender of health care providers as important; women stated clearly their need to have female doctors for their care. Conclusions: the findings of this study have implications for antenatal care and prenatal testing services in Australia and elsewhere. Women provided several suggestions for the improvement of care including the need for sufficient information of prenatal testing and antenatal care and the need for culturally sensitive services. In providing services for women of an Islamic background, it is imperative that health care providers take into account individual women's preferences and personal circumstances and go beyond an assumption based on women's religion and ethnicity.

Background and aims This project sought to design better experiences for patients and health care staff from the breast and lung cancer services within two large teaching hospitals in England. Experience based co-design (EBCD) was the chosen action research approach.1 EBCD is a new and innovative methodology combining (1) a user-centred orientation (by adopting a narrative storytelling approach) and (2) a participatory, collaborative change process, allowing staff to ‘see the person in the patient’ and placing patient and staff experience at the centre of service development. Methods and results The project involved an in-depth qualitative study of how care was delivered by staff and received by patients, focusing on patients9 emotional ‘journey’. It included 36 filmed patient narratives, capturing the key emotional ‘touch points’, 60 staff interviews about their experience of providing services, and ethnographic observation of clinical areas. Patient and staff interviews were analysed to identify themes and issues for which were feedback to patients and staff at various group events. For example, a composite 30 min film of breast and lung cancer patients’ experiences, was created and used to feedback patient narratives to staff. Through a facilitated three-stage change process which will be described, patients and staff agreed on joint priorities for improvement and then worked together in co-design groups that focused on identified priority areas (for example information provision, day surgery, continuity of care, diagnosis and outpatient care). Discussion and conclusions The paper reflects on lessons learned for improving patient/staff experiences through the use of EBCD. It explores the value of the EBCD approach, the use of narratives, observation and film (excerpts will be shown) as a way of humanising health care and engaging staff and patients in a change process to facilitate meaningful and lasting improvements in service provision.

We examine the influence of Islam on women's perceptions of pregnancy, the use of prenatal testing, and abortion. It is based on an in-depth interview study on women's perceptions and experiences of prenatal testing conducted in Melbourne, Australia in 1999. It is clear that Islam has a marked influence on women's perceptions and practices relating to pregnancy, prenatal testing, and abortion. Pregnancy is encouraged and praised by Islam. Women who become mothers are seen as followers who spread Islam in the world. Islam encourages prenatal technology, which will not harm the individual's health and wellbeing. If the possibility exists that technology could have a harmful effect on the foetus, it is not acceptable. Islam in general, prohibits abortion. However, abortion is acceptable by Islam if the mother's health is endangered or the foetus has severe defects to the extent that it would be unable to function as a human being. Health care providers who work with women from Islamic background during their pregnancies need to be aware of women's religious beliefs so that a better understanding can be achieved, and hence culturally sensitive care can be provided. This might make the experience of pregnancy for Muslim women in their new homeland a more enjoyable one.