Evaluating the effectiveness of mindfulness alone compared to exercise and mindfulness on fatigue in women with gynaecology cancer (GEMS): Protocol for a randomised feasibility trial.

BACKGROUND: In 2020 Globocan reported nearly 1.4 million new cases of gynaecology cancer worldwide. Cancer related fatigue has been identified as a symptom that can be present for gynaecology cancer patients many years after treatment. The current evidence around the management of this symptom suggests that exercise has the most positive outcome. However, some ambiguity remains around the evidence and whether it can address all areas of fatigue effectively. More recently, other interventions such as mindfulness have begun to show a favourable response to the management of symptoms for cancer patients. To date there has been little research that explores the feasibility of using both these interventions together in a gynaecology cancer population. This study aims to explore the feasibility of delivering an intervention that involves mindfulness and mindfulness and exercise and will explore the effect of this on fatigue, sleep, mood and quality of life. METHODS/DESIGN: This randomised control trial will assess the interventions outcomes using a pre and post design and will also include a qualitative process evaluation. Participants will be randomised into one of 2 groups. One group will undertake mindfulness only and the other group will complete exercise and mindfulness. Both groups will use a mobile application to complete these interventions over 8 weeks. The mobile app will be tailored to reflect the group the participants have drawn during randomisation. Self-reported questionnaire data will be assessed at baseline prior to commencing intervention and at post intervention. Feasibility will be assessed through recruitment, adherence, retention and attrition. Acceptability and participant perspective of participation (process evaluation), will be explored using focus groups. DISCUSSION: This trial will hope to evidence and demonstrate that combination of two interventions such as mindfulness and exercise will further improve outcomes of fatigue and wellbeing in gynaecology cancer. The results of this study will be used to assess (i) the feasibility to deliver this type of intervention to this population of cancer patients using a digital platform; (ii) assist this group of women diagnosed with cancer to manage fatigue and other symptoms of sleep, mood and impact their quality of life. TRIAL REGISTRATION: NCT05561413.

Evaluating the effects of lymphoedema management strategies on functional status and health-related quality of life following treatment for head and neck cancer: a systematic review.

PURPOSE: Patients living with head and neck lymphoedema (HNL) after completion of head and neck cancer (HNC) often can experience long-term functional challenges and overall poorer health-related quality of life (HRQOL). This systematic review aims to explore components of effective HNL interventions through identification and synthesising literature on existing HNL management interventions. METHODS: Five electronic databases (MEDLINE via Ovid and PubMed, CINAHL, CENTRAL, and Scopus) were systematically searched using Medical Subject Headings and free text, as well as citation tracking and Google Scholar for grey literature. RESULTS: A total of 1910 studies were screened, with 12 studies meeting the inclusion criteria. Findings indicated vast heterogeneity within HNL interventions. Patients' adherence to intervention strategies was reported as low and partially adhered to, particularly at home. This impacted on function domains and overall HRQOL during the post-treatment HNC phase, as well as further increasing the demands placed on healthcare professionals. CONCLUSIONS: Synthesis of the research findings highlighted a need to provide and educate patients with individualised HNL self-management intervention strategies. Promoting adherence was reported as being essential, with self-efficacy and behaviour change techniques being emphasised as a critical element to enhance motivation and therefore effective intervention delivery. Further work is important to address barriers to adherence and promote both motivation and behaviour change, to develop individualised self-management interventions for this cancer population. IMPLICATIONS FOR CANCER SURVIVORS: The findings from this systematic review will provide guidance in the development and delivery of individualised self-management HNL interventions for patients who have completed HNC treatment.

"You're always fighting": the lived experience of people with postural orthostatic tachycardia syndrome (POTS).

PURPOSE: Postural orthostatic tachycardia syndrome (POTS) is a debilitating and poorly understood disorder of the autonomic nervous system with many different causes, mostly seen in females of child-bearing age. This study used an illness representation framework to explore the lived experience of those living with a medical diagnosis of POTS. MATERIALS AND METHODS: Six individuals (aged 20-42) were recruited from two POTS online support groups. Individual semi-structured interviews were used to explore the five illness representations of identity, cause, consequences, timelines, and cure/controllability. Data were analysed using interpretative phenomenological analysis (IPA). RESULTS: Lived experiences were characterised by four overarching themes: "Fighting to be heard", "My individual self-management toolbox", "A mixed bag of emotions", and "I'm expensive in so many ways". CONCLUSIONS: Individuals faced considerable physical, psychosocial and financial challenges and felt underserved by healthcare and support provision. Early diagnosis and recognition of symptoms, along with education on self-management may help reduce associated mental health burdens. A biopsychosocial conceptualisation of this condition may help lead to a more integrated approach to care.Implications for rehabilitationLiving with POTS impacts on all aspects of life, including work, family, and social relationships/activities, and has financial burdens.Family doctors need education on the existence of POTS and the importance of providing biopsychosocial support services.More timely diagnosis of POTS is required, with access to specialists who understand the burden of living with POTS.

Prevalence, knowledge and factors associated with e-cigarette use among parents of secondary school children.

Objectives: Identify prevalence rates and attitudes towards e-cigarette use among parents to inform prevention strategies designed to reduce uptake in young people. Study design: A mixed methods sequential study guided by the Theory of Planned Behaviour. Methods: This research involved two phases. Phase one was an elicitation study using focus groups, interviews and open-ended questionnaires (N = 17) to elicit parental behavioural, normative, and control beliefs around e-cigarette use. Findings from phase 1 were used to inform a questionnaire administered to a sample of 612 parents in phase 2. The aim of phase 2 was to identify and explain factors that influence parental attitudes and motivations towards e-cigarette use. Parents were recruited through post-primary schools and were sent a link to an online survey. Results: Approximately 19% of parents had tried an e-cigarette, with 9% reporting current use. Sociodemographic variables, TPB constructs and knowledge of e-cigarettes, accounted for 43% and 60% of ever use and intention to use an e-cigarette, respectively. Intention, gender, age and free school meal entitlement were associated with ever use. Intention to use an e-cigarette was related to lower educational level, current smoking of traditional cigarettes, more positive attitudes, greater social pressure, having greater control over use and knowledge. Conclusions: Prevention strategies designed to reduce uptake in young people should raise awareness of the health risks of e-cigarette use, legislation and regulations and highlight the role parents play in encouraging young people to abstain from using an e-cigarette.

Effects of mindfulness-based interventions on fatigue and psychological wellbeing in women with cancer: A systematic review and meta-analysis of randomised control trials.

BACKGROUND: Cancer diagnosis and treatment can cause fatigue, stress and anxiety which can have a detrimental effect on patients, families and the wider community. Mindfulness-based interventions appear to have positive effects on managing these cancer-related symptoms. OBJECTIVE: To investigate the efficacy of mindfulness on cancer related fatigue (CRF) and psychological well-being in female cancer patients. METHODS: Five databases (CINHAL, Ovid Medline, Ovid Psych Info, Scopus, and Cochrane), and two trial registers (WHO and Clinicaltrials.gov) were searched for randomised control trials from inception to April 2021 and updated in August 2022. Meta-analysis was performed using Review Manager 5.4. The standardised mean difference (SMD) and 95% confidence intervals (CI) were used to determine the intervention effect. Subgroup analysis was performed for adaptation to types of mindfulness, length of intervention and types of comparator used. RESULTS: Twenty-one studies with a total of 2326 participants were identified. Mindfulness significantly improved CRF (SMD -0.81, 95% CI -1.17 to -0.44), depression (SMD-0.74, 95% CI -1.08 to -0.39) and anxiety (SMD -0.92, 95% CI -1.50 to -0.33). No effect was observed for quality of life (SMD 0.32, 95% CI -0.13-0.87) and sleep (SMD -0.65, 95% CI -1.34-0.04). Subgroup analysis revealed that there was little difference in SMD for adapted type of mindfulness (p = 0.42), wait list control compared to active comparator (p = 0.05) or length of intervention (p = 0.29). CONCLUSION: Mindfulness appears to be effective in reducing CRF and other cancer related symptoms in women. Adaptations to mindfulness delivery did not have negative impact on results which may aid delivery in the clinical settings.

Enhancing healthcare professional-led sexual support in cancer care: Acceptability and usability of an eLearning resource and its impact on attitudes towards providing sexual support.

OBJECTIVE: Barriers to healthcare professional (HP) (HP)-led sexual support in cancer care include lack of knowledge, skills and evidence-based educational interventions, to equip HPs to address sexual challenges faced by patients and partners. Consequently, sexual support is often avoided. This study examined HPs' acceptability and usability of the Maximising Sexual Wellbeing: Cancer Care (MSW|CC) eLearning resource for HPs and evaluated its impact on HPs' sexual attitudes and beliefs to providing sexual support in cancer care. METHODS: HPs (n = 87) completed pre and post-test surveys using the modified 12-item Sexual Attitudes and Beliefs Scale (SABS). Post-test, participants rated acceptability and usability of the MSW|CC, with optional free-text comments. A repeated measures t-test assessed changes in HPs' scores on the SABS. Descriptive statistics and reporting of free text comments were used to explore HPs' perspectives of the MSW|CC. RESULTS: SABS scores increased significantly from Time 1 (M = 35.1, SD = 4.8) to Time 2 (M = 40.1, SD = 4.3), t (86) = -10.2, p < 0.001 (two-tailed) with a medium effect size (d = 0.55); indicating a decrease in HPs' attitudinal barriers to providing sexual support. The MSW|CC was deemed acceptable, user-friendly and easy to navigate. Healthcare professionals would recommend the use of this eLearning resource to others (3.78/4, SD = 0.5), considered it a good informational resource (3.78/4, SD = 0.5) and straightforward to use (3.8/4, SD 0.42). DISCUSSION/CONCLUSION: The MSW|CC reduced HPs' attitudinal barriers towards the provision of HP-led sexual support in cancer care, whilst being acceptable and useable. The MSW|CC could support implementation of global clinical guidelines advocating for HP-led sexual support across the treatment trajectory.

Adapting and usability testing of an eLearning resource to enhance healthcare professional provision of sexual support across cancer care.

OBJECTIVES: To adapt the theory-driven and positively evaluated Maximising Sexual Wellbeing| Prostate Cancer (MSW|PC) eLearning resource to an eLearning resource suitable for health professionals (HPs) working with mixed cancer populations, followed by usability and acceptability testing. METHODS: Guided by Person-Based Approach (PBA) and Biopsychosocial Model, the MSW|PC was adapted by combining evidence from the literature, an expert group (n = 27: patients, partners, and HPs working in cancer care) and the research team. New content was developed relevant for a mixed cancer population. The Maximising Sexual Wellbeing| Cancer Care (MSW|CC) eLearning prototype was usability tested and modified with HPs using "think aloud" interviews (n = 18). RESULTS: Many identified sexual challenges were common across cancer populations, with additional information required for breast, colorectal, gynaecological, head and neck, and prostate cancers. During the testing phase, navigational difficulties were identified and resolved. HPs reported the MSW|CC as engaging, informative, and relevant with helpful communication and signposting tools to support practice. CONCLUSION: This systematic and iterative PBA yielded important insights to enhance the content and usability of MSW|CC. This novel resource provides HPs working across cancer care with tools to potentially address the gap in knowledge and skills and positively impact future sexual healthcare provision across cancer care.

Fatigue and Sleep Disturbance in Arabic Cancer Patients After Completion of Therapy: Prevalence, Correlates, and Association With Quality of Life.

BACKGROUND: Fatigue and sleep disturbance are 2 of the most common and distressing cancer symptoms that negatively affect quality of life. OBJECTIVE: The aim of this study was to assess the prevalence of, and factors contributing to, fatigue and sleep disturbance in Arabic-speaking cancer patients in Oman after completion of their cancer treatment. METHODS: A cross-sectional and descriptive correlational design was used. Data were collected using the Pittsburgh Sleep Quality Index where a score of >5 indicated as poorer sleep, the Functional Assessment of Cancer Therapy-Fatigue a score of ≤34 indicating clinically significant fatigue, and the Functional Assessment of Cancer Therapy-General. RESULTS: Of the 369 patients who participated, 77.5% (n = 286) reported clinically significant fatigue, and 78% (n = 288) reported poor sleep. Fatigue (P < .05) was significantly associated with age, cancer site, months since diagnosis, type of treatment received, and comorbidity. Those experiencing fatigue and poor sleep had the lowest quality of life among the cancer patients studied. CONCLUSION: Fatigue and sleep disturbance are significant problems for the Arabic patients diagnosed with cancer. Both fatigue and sleep disturbance should be routinely assessed in the case of such patients. IMPLICATIONS FOR PRACTICE: Routine assessments of fatigue and sleep disturbance are recommended so that appropriate interventions and treatment management plans can be introduced to reduce fatigue and improve sleep quality among patients with cancer.

Cross-Cultural Adaptation and Psychometric Properties of Quality of Life Scales for Arabic-Speaking Adults: A systematic review.

This review aimed to explore the psychometric properties of quality of life (QOL) scales to identify appropriate tools for research and clinical practice in Arabic-speaking adults. A systematic search of the Cumulative Index to Nursing and Allied Health Literature® (EBSCO Information Services, Ipswich, Massachusetts, USA), MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA), EMBASE (Elsevier, Amsterdam, Netherlands) and PsycINFO (American Psychological Association, Washington, District of Columbia, USA) databases was conducted according to Preferred Reporting Items Systematic Reviews and Meta-Analysis guidelines. Quality assessment criteria were then utilised to evaluate the psychometric properties of identified QOL scales. A total of 27 studies relating to seven QOL scales were found. While these studies provided sufficient information regarding the scales' validity and reliability, not all reported translation and cross-cultural adaptation processes. Researchers and clinicians should consider whether the psychometric properties, subscales and characteristics of their chosen QOL scale are suitable for use in their population of interest.

Healthcare professionals knowledge on cancer-related fatigue: A cross-sectional survey in Oman.

Cancer-related fatigue is a common and distressing cancer symptom that negatively affects quality of life. The main objective of this study was to determine health professionals' knowledge relating to cancer patients' fatigue in Oman and identify current management practices of cancer-related fatigue. A cross-sectional survey design using Qualtrics® software was performed. The survey had five sections and comprised 32 items. A total of 138 healthcare professionals working in Oman participated in the study (response rate 63.9%). Nearly three quarters of the participants were nurses (74.6%, n = 103). The mean level of knowledge of cancer-related fatigue was 16.6/23, with 50% of participants having the expected level of knowledge above 12. The result indicated that professional discipline and work experience each were significantly associated with overall level of knowledge. Participants identified the need for guidelines, assessment tools, and training for the oncology staff to help improve the quality of life of patients with cancer-related fatigue.

Psychometric properties and cultural adaptation of sleep disturbance measures in Arabic-speaking populations: A systematic review.

The aim of this review was to evaluate the psychometric properties and cross-cultural adaptation of sleep disturbance scales that have been translated into Arabic or originally developed in Arabic, and to identify appropriate scales that can be used in research and clinical practice intended for Arabic-speaking participants. The following databases were searched: CINAHL (2003-2019), MEDLINE (1946-2019), EMBASE (1980-2019), PsycINFO (1806-2019) and Cochrane Library (1806-2019). This review was conducted following PRISMA guidelines. Terwee et al. (J. Clin. Epidemiol., 60, 2007, 34) quality assessment was used to evaluate the psychometric properties of the studies, and cross-cultural adaptation was assessed using criteria from Guillemin, Bombardier, and Beaton (J. Clin. Epidemiol., 46, 1993, 1417). Seven studies met the inclusion criteria, which included four scales: the Epworth Sleepiness Scale, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Arabic Scale of Insomnia. Cross-cultural adaptations scored between good and poor; psychometric properties information was missing for most scales. The review suggested that Pittsburgh Sleep Quality Index may be a useful scale to measure sleep disturbance, as the scale showed good cultural adaptation and acceptable psychometric properties in an Arabic population. Furthermore, the scales measure seven different aspects of sleep quality. This review provides options to help researchers and clinicians select the most appropriate instrument for their practice. Further psychometric testing and cultural adaptation is required for sleep scales used in Arabic clinical populations to ensure validity and reliability in outcome measurement for research studies.

Psychometric Properties of the Arabic Version of the Functional Assessment of Chronic Illnesses Therapy-Fatigue in Arabic Cancer Patients.

BACKGROUND: The Functional Assessment of Chronic Illness Therapy (FACIT) is a measurement system that was developed to assess the health-related quality of life among patients with cancer and other chronic illnesses. The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) is a 40-item questionnaire, and it is one of the most frequently used instruments to assess fatigue in cancer populations. The aim of this study was to evaluate the psychometric properties of the Arabic FACIT-F among patients diagnosed with cancer. METHODS: Following a translated and cross-cultural evaluation procedure of the FACIT-F Arabic version, a cross-sectional and descriptive correlational design was conducted. A total of 369 patients with cancer completed the FACIT-F, which consists of the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) and the 13-item Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). The scale was assessed in terms of acceptability, internal consistency, and validity. Construct validity was explored through confirmatory factor analysis. RESULTS: The FACT-G had acceptable fit in the four-factor model, whereas the FACIT-Fatigue was found to be acceptable for the one-factor model in Arabic patients diagnosed with cancer. The Cronbach's alpha coefficient for the Arabic FACIT-Fatigue was 0.92, whereas the total score for FACT-G was 0.92, which showed good reliability. There was evidence that discriminated validity analysis was generally very good for the FACIT-Fatigue and FACT-G Arabic versions. CONCLUSION: The Arabic versions of the FACIT-Fatigue and FACT-G demonstrated good reliability and validity for assessing fatigue and quality of life in patients diagnosed with cancer.

Quality assessment criteria: psychometric properties of measurement tools for cancer related fatigue.

Background: Fatigue is a common and distressing cancer symptom that negatively affects the quality of life. Many scales have been developed to assess cancer-related fatigue. The properties of the scales vary in terms of dimensionality, reliability, validity, length and method of administration. Insufficient of psychometric properties may affect the accuracy of scales findings, that may lead result obtained questionable. The main objective of this review was to conduct a quality assessment of the psychometric properties of cancer-related fatigue scales to identify appropriate scales that could be used in research and clinical practice. Method: A systematic search was carried out to identify validated scales that measure cancer-related fatigue. Five databases were searched: CINAHL, MEDLINE, EMBASE, PsycINFO, Cochrane Library. This review was conducted following the PRISMA and Terwee et al.'s quality assessment guidelines to evaluate the psychometric properties of the studies. Result: Seventy-one different studies published between 1970 and 2018 met the inclusion criteria. Twenty-five scales were identified. Of these, eighteen were multidimensional and seven were uni-dimensional, containing between 4 and 72 items. Reliability and/or validity information was missing for many scales. Four scales met the quality assessment criteria and were reported as the most appropriate for measuring fatigue in cancer patients. Conclusion: Further psychometric testing is required for other scales. Developing a universally-defined tool kit for the assessment of cancer-related fatigue may help clarify the concept of fatigue and promote a systematic approach to fatigue measurement.

Supporting and improving community health services-a prospective evaluation of ECHO technology in community palliative care nursing teams.

INTRODUCTION: Project ECHO (Extension for Community Healthcare Outcomes) uses teleconferencing technology to support and train healthcare providers (HCPs) remotely, and has improved care across the USA. A 6-month pilot was trialled in a community palliative care nursing setting to determine if ECHO would be effective in the UK in providing education and support to community hospice nurses (CHN). METHODS: The pilot involved weekly 2 hour sessions of teaching and case-based discussions facilitated by hospice staff linking with nine teams of CHN using video conferencing technology. A mixed-methods prospective longitudinal cohort study was used to evaluate the pilot. Each CHN provided demographic data, and completed a written knowledge assessment and a self-efficacy tool before and after the pilot. Two focus groups were also performed after the pilot. RESULTS: 28 CHNs completed the evaluation. Mean knowledge score improved significantly from 71.3% to 82.7% (p=0.0005) as did overall self-efficacy scores following the ECHO pilot. Pre-ECHO (p=0.036) and Retro-Pretest ECHO (p=0.0005) self-efficacy were significantly lower than post-ECHO. There was no significant difference between Pretest and Retro-Pretest ECHO self-efficacy (p=0.063). 96% recorded gains in learning, and 90% felt that ECHO had improved the care they provided for patients. 83% would recommend ECHO to other HCPs. 70% stated the technology used in ECHO had given them access to education that would have been hard to access due to geography. CONCLUSIONS: This study supports the use of Project ECHO for CHNs in the UK by demonstrating how a 6-month pilot improved knowledge and self-efficacy. As a low-cost high-impact model, ECHO provides an affordable solution to addressing growing need.

Exercise Interventions to Manage Fatigue in Women With Gynecologic Cancer: A Systematic Review.

PROBLEM IDENTIFICATION: Fatigue has a negative impact on the quality of life of patients with cancer. The aim of this review is to evaluate studies on the effectiveness of exercise interventions in reducing fatigue in women with gynecologic cancer. LITERATURE SEARCH: The review was conducted according to the PRISMA guidelines using the CINAHL®, MEDLINE®, EMBASE, PsycINFO®, and Cochrane Library databases. The Critical Appraisal Skills Programme was used for quality assessment. DATA EVALUATION: Five studies met the inclusion criteria. SYNTHESIS: Evidence suggests that exercise interventions result in significant reductions in fatigue in women with gynecologic cancer. However, the current evidence is limited. Additional studies are required to address the dose-dependent outcomes of exercise interventions on fatigue in women with gynecologic cancer. IMPLICATIONS FOR NURSING: Findings support the positive effects of exercise interventions in reducing fatigue in women with gynecologic cancer, suggesting that healthcare professionals may consider including exercise programs into management plans for this population.

A qualitative exploration of patient and healthcare professionals' views and experiences of palliative rehabilitation during advanced lung cancer treatment.

BACKGROUND: Limited evidence exists on the impact of palliative rehabilitation during systemic treatment of advanced cancer. AIM: To explore the experiences and perceptions of patients and healthcare professionals on the feasibility and acceptability of palliative rehabilitation during advanced lung cancer treatment. DESIGN: Qualitative design using individual semi-structured interviews transcribed verbatim and analysed thematically. SETTING/PARTICIPANTS: Eight patients and six healthcare professionals were recruited from a regional cancer centre in the United Kingdom following completion of a 6-week individualised behaviour change study which combined physical activity and nutritional guidance. RESULTS: Palliative rehabilitation and study participation were positively viewed by both participants and healthcare professionals. Five themes were identified from patient interviews within an overarching theme of living with and beyond an advanced cancer diagnosis: (1) challenges of living with incurable cancer, (2) personal and altruistic reasons for participating in rehabilitation, (3) applicability of palliative rehabilitation content, (4) barriers and facilitators to adherence and (5) positive impact on self and others. Three themes were identified from healthcare professionals, within an overarching theme of palliative rehabilitation: exploring the concept (1) pre-study-mixed perceptions of palliative rehabilitation, (2) perceived benefits for patients and families and (3) lessons for future research. CONCLUSION: Patients described personal benefits associated with setting their own goals for physical activity and dietary intake. Healthcare professionals who initially expressed a negative or indifferent stance towards palliative rehabilitation, displayed a mind-set change and were keen to explore further opportunities to expand the evidence base.

Reducing the decline in physical activity during pregnancy: a systematic review of behaviour change interventions.

PURPOSE: Physical activity (PA) typically declines throughout pregnancy. Low levels of PA are associated with excessive weight gain and subsequently increase risk of pre-eclampsia, gestational diabetes mellitus, hypertension disorders, delivery by caesarean section and stillbirth. Systematic reviews on PA during pregnancy have not explored the efficacy of behaviour change techniques or related theory in altering PA behaviour. This systematic review evaluated the content of PA interventions to reduce the decline of PA in pregnant women with a specific emphasis on the behaviour change techniques employed to elicit this change. SEARCH AND REVIEW METHODOLOGY: Literature searches were conducted in eight databases. Strict inclusion and exclusion criteria were employed. Two reviewers independently evaluated each intervention using the behaviour change techniques (BCT) taxonomy to identify the specific behaviour change techniques employed. Two reviewers independently assessed the risk of bias using the guidelines from the Cochrane Collaboration. Overall quality was determined using the GRADE approach. FINDINGS: A total of 1140 potentially eligible papers were identified from which 14 studies were selected for inclusion. Interventions included counselling (n = 6), structured exercise (n = 6) and education (n = 2). Common behaviour change techniques employed in these studies were goal setting and planning, feedback, repetition and substitution, shaping knowledge and comparison of behaviours. Regular face-to-face meetings were also commonly employed. PA change over time in intervention groups ranged from increases of 28% to decreases of 25%. In 8 out of 10 studies, which provided adequate data, participants in the intervention group were more physically active post intervention than controls. CONCLUSIONS AND IMPLICATIONS: Physical activity interventions incorporating behaviour change techniques help reduce the decline in PA throughout pregnancy. Range of behaviour change techniques can be implemented to reduce this decline including goals and planning, shaping knowledge and comparison of outcomes. A lack of high quality interventions hampers conclusions of intervention effectiveness.

What type of service provision do patients with chronic pain want from primary care providers?

PURPOSE: The aim of this study was to explore what types of service provision patients with chronic pain wanted from their general practitioners (GP). METHOD: A small scale survey measured anxiety and depression and quantified the extent to which patients wanted four different types of help from their GP (explanation and understanding, medical treatment, psychological support and information). An opportunistic sample of 155 patients (30.3% male and 69.7% female) was recruited from three general practice surgeries in the northwest region of Northern Ireland. Ninety-one participants self-reported chronic pain and there were 64 in the no pain group. RESULTS: Even after statistically controlling for anxiety and depression, individuals in the chronic pain group had a greater need for emotional/psychological support and explanation and understanding from their GPs. There were no significant differences between the groups with respect to the need for more information or medical treatment. CONCLUSIONS: A biopsychosocial approach should be employed in the management of chronic pain, however as this study shows, some primary care patients are still being treated within a biomedical framework. To address the unmet needs of this patient population, there is a need for clinical guidelines in the management of chronic pain in primary care settings. Limitations of the present research, with recommendations for future study are offered.

Development and evaluation of a problem-focused psychosocial intervention for patients with head and neck cancer.

GOALS OF THE WORK: Patients with head and neck cancer have complex needs that affect many basic functions of life and contribute to substantial psychosocial problems. The aim of this study was to evaluate the effectiveness of a problem-focused intervention for patients with psychosocial dysfunction who had completed treatment for head and neck cancer. PATIENTS AND METHODS: Using a quasi-experimental design, 54 participants who were above pre-determined cutoff points for psychosocial dysfunction (hospital and depression scale, work and social adjustment scale) were given the opportunity to self-select into either the experimental group for the psychosocial intervention programme which was delivered in an individualised format, with bibliotherapy as an adjunct, or the control group for usual care. MAIN RESULTS: Analysis of covariance results demonstrated a reduction in psychological distress (anxiety, p = 0.001; depression, p = 0.005), improving social functioning (p = 0.048) and quality of life scores (p = <0.05) for the experimental group, all of which were sustained into the 3-month follow-up period. No such improvements were evident for the control group. CONCLUSIONS: This study suggests that head and neck cancer patients with post-treatment psychosocial dysfunction can benefit from a problem-focused psychosocial intervention. Such evidence can inform practice, policy and future research, aimed at improving post-treatment quality of life for patients with head and neck cancer.

Changes and challenges to patients' lifestyle patterns following treatment for head and neck cancer.

AIM: This paper is a report of a study to explore the changes and challenges to patients' lifestyles following treatment for head and neck cancer. BACKGROUND: Head and neck cancer affects some of the most basic aspects of daily functioning, such as eating and speaking. There has been a rapid increase in the number of studies on the quality of life for people with head and neck cancer, but most studies have used quantitative methodology. METHODS: Using a qualitative approach, data were collected in 2004 using semi-structured interviews with a purposive sample of 10 participants who had completed treatment 6-12 months earlier for head and neck cancer. A thematic analysis was employed to interpret the findings. FINDINGS: Following thematic analysis seven broad themes were identified, five of which covered areas of changes and challenges to participants' lifestyles following treatment. These were: physical changes, concerns about cancer, work and day-to-day tasks, interpersonal relationships and social functioning. The concerns and challenges experienced following treatment were not limited to one aspect of an individual's lifestyle but spanned a number of the themes identified, highlighting the complexity of needs following treatment for head and neck cancer. The other two themes concerned personal attributes that facilitated or inhibited posttreatment coping and specific information needs in the posttreatment period. CONCLUSION: Specific posttreatment concerns and challenges cannot be viewed as unitary or discrete aspects of life, but should be considered within a biopsychosocial context, to address patients' needs holistically.