Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours.

Implementing risk-stratified breast cancer screening is being considered internationally. It has been suggested that primary care will need to take a role in delivering this service, including risk assessment and provision of primary prevention advice. This systematic review aimed to assess the acceptability of these tasks to primary care providers. Five databases were searched up to July-August 2020, yielding 29 eligible studies, of which 27 were narratively synthesised. The review was pre-registered (PROSPERO: CRD42020197676). Primary care providers report frequently collecting breast cancer family history information, but rarely using quantitative tools integrating additional risk factors. Primary care providers reported high levels of discomfort and low confidence with respect to risk-reducing medications although very few reported doubts about the evidence base underpinning their use. Insufficient education/training and perceived discomfort conducting both tasks were notable barriers. Primary care providers are more likely to accept an increased role in breast cancer risk assessment than advising on risk-reducing medications. To realise the benefits of risk-based screening and prevention at a population level, primary care will need to proactively assess breast cancer risk and advise on risk-reducing medications. To facilitate this, adaptations to infrastructure such as integrated tools are necessary in addition to provision of education.

The Role of e-Health in the Delivery of Care for Patients with Hematological Cancers: A Systematic Literature Review.

Background: Hematological cancer survivors have significant unmet needs. The use of e-health interventions has been shown to be effective in improving patient experiences and outcomes in other diseases. The aim of this review is to explore the role of e-health interventions in the delivery of care for patients with hematological cancers across the illness trajectory. Methods: A systematic narrative review approach using thematic analysis was used to identify the key issues and themes in the literature. Medical subject headings and keywords were used in several databases: Medline, Embase, PsycInfo, CINAHL, and The Cochrane Collaboration Cochrane Review Database. This review focuses on the use of e-health interventions for patients with hematological cancers within any study design. Results: Twenty-three (n = 23) studies were identified in this review. The studies were of varying designs: randomized controlled trials (n = 6); pre- and postdesign (n = 1); feasibility and acceptability (n = 11) and varying methodological quality. Seven studies included patients with any cancer diagnosis rather than focusing specifically on hematology patients. Our thematic analysis identified four main categories of intervention: information provision (n = 4); self-help (n = 6); communication facilitation (n = 5); and patient-reported outcome recording or monitoring (n = 8). Conclusion: The clinical management of patients with hematological cancers, particularly those in survivorship, presents opportunities to explore e-health approaches to improve patient care. This review highlights that e-health tools may be acceptable and feasible to use with a hematology patient population, but more robust and well-designed trials that engage patients and health professionals are required to determine which and how interventions can be used most effectively.

Phase I cancer trials: a qualitative study of specialist palliative care.

OBJECTIVE: In recent years, a simultaneous care model for advanced cancer patients has been recommended meaning that palliative care services are offered throughout their cancer journey. To inform the successful adoption of this model in a phase I trial context, the study aimed to explore patients' care needs and their perceptions of specialist palliative care. METHODS: Semi-structured interviews were conducted with 10 advanced cancer patients referred to the Experimental Cancer Medicine team. Interviews were transcribed verbatim and thematically analysed with a framework approach to data organisation. RESULTS: Despite reporting considerable physical and psychological impacts from cancer and cancer treatment, participants did not recognise a need for specialist palliative care support. Understanding of the role of specialist palliative care was largely limited to end of life care. There was perceived conflict between considering a phase I trial and receiving specialist palliative care. Participants felt specialist palliative care should be introduced earlier and educational resources developed to increase patient acceptability of palliative care services. SIGNIFICANCE OF RESULTS: Patients with advanced cancer referred for phase I trials are likely to benefit from specialist palliative care. However, this study suggests patients may not recognise a need for support nor accept this support due to misperceptions about the role of palliative care. Developing a specific educational resource about specialist palliative care for this population would help overcome barriers to engaging with a simultaneous care model.

Beyond "planning": A meta-analysis of implementation intentions to support smoking cessation.

OBJECTIVE: Implementation intentions support behavior change by encouraging people to link critical situations with appropriate responses. Overall effectiveness for smoking cessation is unknown. This systematic review and meta-analysis aimed to evaluate the effectiveness of implementation intentions for smoking cessation. METHOD: Using PRISMA guidelines, 6 electronic databases were searched (updated February 2018) using key terms. Data were pooled for smoking cessation (categorical variable; yes/no) and entered into random effects models. Analyses assessed: (a) effectiveness as a single intervention, and (b) effectiveness when included as one of multiple intervention components. RESULTS: Twelve studies were identified. Implementation intentions were effective for smoking cessation at follow up, OR = 1.70, CI [1.32, 2.20], p < .001, average 10.7% quit rate for intervention participants (4.9% in controls). Implementation intentions as a single intervention were effective for smoking cessation, OR = 5.69, 95% CI [1.39, 23.25], p = .02 (average quit rate 14.3% in intervention participants vs. 3.6% in controls) and as part of multicomponent interventions, OR = 1.67, 95% CI [1.29, 1.66], p < .001 (average quit rate 8.2% in intervention participants vs. 5.8% in controls). CONCLUSIONS: Implementation intentions are effective at helping smokers quit although the review reported substantial heterogeneity across the limited number of included studies. The present review sets the agenda for future research in this area including longer term objectively verified abstinence and identification of potential moderators of effectiveness including population characteristics. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study.

OBJECTIVES: Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. DESIGN: Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. SETTING: Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. PARTICIPANTS: Purposeful sample of 10 patients with a diagnosis of cancer-dementia, informal caregivers (n=9) and oncology HCPs (n=12). RESULTS: Four themes were identified: (1) leading to the initial consultation-HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information-informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care-patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment-there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. CONCLUSIONS: Although patients with cancer-dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway.

The acceptability and feasibility of lay-health led interventions for the prevention and early detection of cancer.

BACKGROUND: US-based evidence suggests that lay-health worker (LHW) interventions can increase awareness around cancer risk-related lifestyles, symptom recognition, and screening programme uptake. The suitability of LHW interventions in the UK and the potential barriers and facilitators for implementation is currently unknown. This study explored the acceptability and feasibility of developing LHW interventions for cancer prevention, screening, and early diagnosis. METHODS: Purposive sampling recruited 5 separate lay groups: (1) completed cancer treatment; (2) friends/family of cancer patients; (3) cancer hospital volunteers; (4) cancer charity volunteers; and (5) members of the public. Audio-recorded focus groups and semi-structured interviews were transcribed for thematic analysis using framework matrices. RESULTS: Forty-one people (66% female, aged 23-84 years) participated. Three main themes are reported: (1) scope of LHW roles, with a clear remit embedded within communities or primary care practices; (2) defining LHW tasks, with a focus on supporting people overcome barriers including lack of cancer symptom knowledge and non-attendance at screening; and (3) clear boundaries, with LHW training and on-going support from healthcare staff seen as key for intervention success. All groups were uncomfortable about having lifestyle-related risk conversations and potentially inflicting guilt. The post-treatment group expressed less concern about the possible emotional impact of discussing cancer symptoms, compared with the other groups. CONCLUSIONS: LHW interventions to promote early diagnosis or screening were generally considered acceptable in a UK context. LHW interventions focussing on reducing cancer risk may be less feasible.

Are community-based health worker interventions an effective approach for early diagnosis of cancer? A systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to assess the effectiveness of community-based health worker (CBHW) interventions for early detection of cancer. Secondary aims were to consider the extent that interventions were based on theory, and potential moderators including behaviour change techniques (BCTs). METHODS: Six databases were searched for randomized controlled trials. Random-effects meta-analyses were applied to 30 eligible studies with a cancer screening outcome. RESULTS: Participation in CBHW interventions was associated with increased receipt of screening (OR = 1.901, 95% CI: 1.60-2.26, P < 0.001) for breast, cervical, and bowel cancer. Larger effect sizes were observed in participants previously non-adherent with recommended schedules of cancer screening. Twenty-five out of 30 studies were conducted with ethnic minority groups. Only 15 (45%) studies explicitly reported a theoretical foundation for intervention. The number of BCTs used by CBHWs had a trend level association with observed effect size (P = 0.08). Study quality was generally poor, and common limitations were inadequate blinding and reliance on self-reported outcomes. CONCLUSIONS: Community-based health worker interventions are an effective resource for increasing uptake of all 3 types of cancer screening in ethnic minority groups. Those previously non-adherent with recommended schedules of cancer screening benefitted the most from the CBHW approach. However, better quality studies based on more explicit evidence-based theory are needed to optimise the effectiveness of CBHW interventions on screening uptake. Further research is needed to ascertain whether CBHWs can help promote symptom recognition and help-seeking behaviour to facilitate early diagnosis of cancer.

Evaluation of the current landscape of respiratory nurse specialists in the UK: planning for the future needs of patients.

INTRODUCTION: The National Health Service currently faces significant challenges and must optimise effective workforce planning and management. There are increasing concerns regarding poor workforce planning for respiratory medicine; a greater understanding of the role of respiratory nurse specialists will inform better workforce planning and management. METHODS: This was a survey study. Two surveys were administered: an organisational-level survey and an individual respiratory nurse survey. RESULTS: There were 148 and 457 respondents to the organisational and individual nurse survey, respectively. Four main themes are presented: (1) breadth of service provided; (2) patient care; (3) work environment; and (4) succession planning. The majority of work conducted by respiratory nurse specialists relates to patient care outside the secondary care setting including supporting self-management in the home, supporting patients on home oxygen, providing hospital-at-home services and facilitating early discharge from acute care environments. Yet, most respiratory nursing teams are employed by secondary care trusts and located within acute environments. There was evidence of multidisciplinary working, although integrated care was not prominent in the free-text responses. High workload was reported with one-quarter of nursing teams short-staffed. Respiratory nurses reported working unpaid extra hours and a lack of administrative support that often took them away from providing direct patient care. Nearly half of the present sample either plan to retire or are eligible for retirement within 10 years. CONCLUSIONS: This survey report provides a current snapshot of the respiratory nurse specialist workforce in the UK. This workforce is an ageing population; the results from this survey can be used to inform succession planning and to ensure a viable respiratory nurse specialist workforce in future.