Visual reconstructions of endometriosis pain: An interdisciplinary visual methodology for illness representation.

OBJECTIVES: Endometriosis is a chronic condition in which tissue resembling the endometrium grows outside of the womb, causing severe chronic pain. Research demonstrates the physical, emotional and quality of life impact on people with endometriosis, but pain is reportedly difficult to communicate, resulting in lengthier diagnosis. This work aimed to gain insight into the value of imagery production as a pain communication strategy through a novel synergy of psychological and linguistic/socio-semiotic approaches. DESIGN: A qualitative, multimodal, participant-generated imagery study. METHODS: Interpretative phenomenological analysis (IPA) and conceptual metaphor and metonymy analysis were utilized to examine visual representations of endometriosis pain. Data were collected in two focus groups with four and six women, respectively; all with a diagnosis of endometriosis, aged 25-40 years old (M = 34.5, SD = 4.2) and a mean diagnosis delay of 8.4 years (SD = 3.6). RESULTS: The overarching theme across visual representations was 'Pain as Physical Violence' with 'colour as emotional representation', 'texture as sensory qualities' and 'materials as sensation' as sub-themes. These are realized through metaphorical and metonymical relations in both the visual representations as well as the accompanying linguistic representation of the process. CONCLUSIONS: This study demonstrates the value of a creative mixed-methodologies approach to capture experiential aspects of pain and its impact that are not verbalized in linguistic accounts alone. This can facilitate a deeper understanding of one's pain, acting as a medium for therapeutic adjustment to occur, while facilitating effective and empathic patient-professional conversations surrounding pain.

A COM-B and Theoretical Domains Framework Mapping of the Barriers and Facilitators to Effective Communication and Help-Seeking Among People With, or Seeking a Diagnosis Of, Endometriosis.

Endometriosis is a chronic condition in which tissue resembling the endometrium grows outside the womb, causing severe chronic pain. People with endometriosis report difficulty in help-seeking and communicating with healthcare professionals, contributing to diagnosis delays and ineffective management. The present study aimed to identify barriers and facilitators to effective communication using the Theoretical Domains Framework (TDF) and COM-B model to inform behavior change intervention development. This study was a qualitative semi-structured interview and open-ended survey design. Thematic Analysis was utilized to identify barriers and facilitators to effective communication which were mapped to the TDF and COM-B model. Four women aged 25 to 44 with a formal diagnosis of endometriosis participated in interviews. Thirty-three participants, aged 20-48 years, participated in the online survey, 21 of whom had a diagnosis of endometriosis (12 were currently seeking diagnosis). Five COM-B domains were identified: reflective motivation, social and physical opportunity, physical and psychological capability. Ten TDF domains were reflected in concerns surrounding dismissal, disempowerment, social norms, beliefs about consequences, cognitive resources, reinforcement, and environmental context and resources, among others. This is the first study to identify barriers and facilitators of effective communication and help-seeking in light of established behavioral change theory and frameworks for comprehensive intervention design. This provides a comprehensive explanation of challenges in help-seeking for endometriosis and represents the first step in the development of complex interventions to improve help-seeking and communication for people with endometriosis. Interventions targeting salient barriers will have greater potential to change behavior and improve outcomes.

Assessment of suitable referral, effectiveness and long-term outcomes of standard vs intensive pain management programmes for people with chronic pain.

Background: Chronic pain is a leading cause of disability, often requiring multidisciplinary management. 2021 NICE guidance has questioned the quality of the evidence surrounding the efficacy of pain management programmes (PMPs), with only minor benefit demonstrated in psychological and physical outcomes. There is need for further high-quality evidence for the efficacy of PMPs for a range of chronic pain conditions and to identify barriers to successful management of chronic pain. Objective: This service evaluation utilised routinely collected outcome data of 508 PMP attendees to investigate change in pain- and patient-related outcomes across two distinct PMPs; a standard and an intensive PMP, and establish their longer-term efficacy and appropriateness for patients with differing degrees of need. Results: More people with chronic widespread pain, fibromyalgia, and osteoarthritis were referred to the intensive PMP (reflecting greater disability and distress in these conditions). Those referred to the intensive PMP demonstrated greater distress (such as more severe depression and anxiety), lower pain acceptance and poorer physical function. Improvements were observed in all outcomes across both PMPs (including physical function, pain catastrophising and pain acceptance). Depression and disability demonstrated clinically meaningful improvements in the intensive PMP, and pain severity showed clinically meaningful improvement in both PMPs. However, depression severity, disability, pain severity, and pain interference significantly deteriorated at 6-month follow-up for those on the intensive PMP, with pain severity increasing to a clinically meaningful degree (by more than 10%), though these outcomes remained better than at baseline. Conclusion: This evaluation identified that people with chronic pain most at risk of deterioration in physical and psychological wellbeing after completing a PMP require early identification to mitigate such deterioration. Established and emerging PMPs need to be tailored to the needs of this group, particularly at follow-up to reduce risks of pain severity increasing, alongside establishing/reinforcing safeguards against deterioration post-PMP.

"It's been a double-edged sword": An online qualitative exploration of the impact of COVID-19 on individuals with spinal cord injury in the US with comparisons to previous UK findings.

OBJECTIVE: The impact of COVID-19 lockdowns and social distancing for persons with spinal cord injury (SCI) are poorly understood. This exploratory online qualitative study collected self-reported COVID-19 experiences from persons with SCI in the United States (US). To enrich understanding, these data were compared to similar previously-published data from a sample of SCI participants from the United Kingdom (UK). DESIGN: Explorative, online qualitative study. Participants completed an online survey of open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized to generate themes from the US data. These themes were compared to our previously-published thematic analysis of data from the UK. SETTING: Community-based sample of persons with SCI in the US. PARTICIPANTS: Participants were recruited via SCI-focused research registries and social media outlets serving the SCI community, using convenience sampling (n = 36). Key themes identified in the US data were compared to themes identified in a similar sample from the UK (n = 42) collected at the same time and published previously. RESULTS: Analysis resulted in three themes from the US data, each containing positive and negative qualitative reflections. Themes included (1) health and access to care, (2) making sense of the pandemic, and (3) daily life during the pandemic. Each theme captured common facets of life during the pandemic, often shared by those without physical disabilities, but included accounts particularly relevant to persons with disabilities. Comparisons to thematic findings from the UK study revealed similarities (e.g. healthcare access challenges, isolation) and differences (e.g. importance of previous SCI experiences). CONCLUSION: We detailed common experiences of COVID-19 pandemic lockdowns and their impact on people with SCI, while contrasting these with sense-making positive reflections and social benefits that appeared to be helpful in managing distress and coping with the pandemic.

Adaptations to mindfulness-based interventions for neurological impairment: The SMALL PROMPTS approach.

PURPOSE/OBJECTIVE: Standardized mindfulness-based interventions (MBIs), used for the management of physical and psychological symptoms associated with neurological impairment/injury (NI), have been problematized as lacking accessibility due to their focus on sensory presence and mindful walking. Research is needed to generate formalized recommendations regarding how MBIs may be best adapted to enhance their suitability for people with NI. RESEARCH METHOD/DESIGN: A two-phase qualitative study was completed. First, semistructured interviews were undertaken with eight accredited mindfulness teachers with NI. Interviews reviewed the adaptations participants made in their personal and teaching practice, using thematic analysis, and generated recommendations for adaptations to MBIs specific to people with NI. Second, using the DELPHI method, the adapted practice recommendations were reviewed and revised via three rounds, following cognitive interviews with an expert panel (N = 5 trained mindfulness teachers with NI). RESULTS: Ten core areas for adaptation are proposed and validated, acting as SMALL PROMPTS which can be used to adapt mindfulness-based teaching techniques to the specific requirements of people with NI: (a) Skin/bladder/bowel management; (b) mindful Movement; (c) Accessible training; (d) Language Leadership; (e) Permissive pRactice; (f) Optimizing timelines; (g) Management of posture; (h) inclusion of Pacing; (i) Teaching from experience; and (j) body Scanning. CONCLUSION/IMPLICATIONS: Mindfulness is a highly applicable approach for people with sensory loss, however significant, specific adaptations are required to improve inclusivity and accessibility. The SMALL PROMPTS adaptations increase the accessibility, applicability, and utility of MBIs for populations living with NI, enhancing effective management of physical and psychological wellbeing, and optimizing MBI delivery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mindfulness practice correlates with reduced exam-induced stress and improved exam performance in preclinical medical students with the "acting with awareness", "non-judging" and "non-reacting" facets of mindfulness particularly associated with improved exam performance.

BACKGROUND: Medical students demonstrate higher levels of psychological distress compared with the general population and other student groups, especially at exam times. Mindfulness interventions show promise in stress reduction for this group, and in the reduction of cortisol, an established clinical marker of the body's stress response. This study investigated the relationship of mindfulness to exam-induced stress, salivary cortisol and exam performance in undergraduate medical students. METHODS: A controlled pre-post analysis design with within-groups comparisons. 67 medical students completed the five facet mindfulness questionnaire (FFMQ) and provided saliva samples, from which cortisol was extracted, during group work (control/baseline) and immediately prior to end of year 2 examinations (experimental). Academic performance data was extracted for comparison with measures. RESULTS: Exam-induced salivary cortisol concentration showed a significant negative relation with exam performance. Total FFMQ score showed a significant positive relation with exam performance and a significant negative relation with exam-induced salivary cortisol. The specific mindfulness facets of acting with awareness, non-judging and non-reacting also showed a positive correlation with exam performance. CONCLUSIONS: This study suggests that there exists an important relationship between mindfulness and the physiological biomarker of stress, cortisol, and this manifests into improved assessment outcomes potentially through healthier, more adaptive coping and stress management strategies. In particular, this study identifies the acting with awareness, non-judging and non-reacting facets of mindfulness to be significantly associated with exam performance suggesting that these may be important facets for clinical educators to target when helping students with mindfulness practice.

Feasibility study of a new behavioural activation programme for young people with depressed mood.

BACKGROUND: Behavioural activation (BA) is effective in adults with depression but the evidence for young people (YP) is less clear. We therefore developed and tested a new coproduced BA programme. METHOD: In phase one (2014 to 2015 inclusive), we codeveloped with young people attending specialist child and adolescent mental health service (CAMHS) an 8-session BA workbook. In Phase two (2019 to 2020 inclusive), we ran an uncontrolled feasibility study in two specialist CAMHS, with BA being offered to YP by less specialised staff. RESULTS: In phase one, we tested the workbook with 15 YP with depression and other comorbidities. Satisfaction was good from both YP and staff, and 9 YP reported improvement in mood. In phase two, 51 YP were offered BA; 15 declined to take part. 36 consented with three dropping out after consent. 33 YP (mean age 14.6, 12 males, 24 females) continued treatment attending a mean of 6.6 sessions. At the end of treatment, youth-rated Mood and Feeling Questionnaire (MFQ) mean score decreased from 43.2 to 27.6, difference 14.6 (95% CI 8.7 to 20.2; n = 28), and Clinician Global Assessment Score (CGAS) mean score increased from 52.3 to 69.8, difference 18.0 (95% CI 11.9 to 24.2; n = 29). Of the 33 YP who participated in therapy, 12 (36%) recovered and were discharged. CONCLUSIONS: This programme demonstrated preliminary evidence for effectiveness and utility. Less specialised staff were able to use BA, and this may reduce secondary waits for more specialist therapy. More research is needed about the role of BA in specialist CAMHS.

'It reminds me that I should stop for the little moments': Exploring emotions in experiences of UK Covid-19 lockdown.

In this study, we explore how participants articulate experiences of emotions during Covid-19 lockdown in the UK. We posit that emotions fulfil experiential and interpersonal functions, which are construed and conveyed through language choices. An online narrative survey was carried out. About 88 responses were analysed. Participants were from England and Wales. The mean age was 48.9 years old (SD = 62). A mixed-method approach was used. This combined quantitative Corpus Linguistics analysis and qualitative Interpretative Phenomenological Analysis with linguistic analysis. The findings show similarities to the public health and medical literature that highlight negative emotions, such as fear, distrust and anger in participants. However, we also found positive emotions not considered elsewhere, including happiness, relaxation, safety, optimism for the future and connectedness arising from the thematic IPA analysis. Emotions were construed using language explicitly labelling emotions and language implicitly signalling emotions. Our study highlights implications for managing risk behaviours associated with transmission in public health practices such as social distancing, as indicated by negative emotions. We also bring to light implications with perceived benefits of engaging in protective behaviours and social support central to public health measures, as suggested by the communication of positive emotions.

Isolated and anxious: A qualitative exploration of the impact of the COVID-19 pandemic on individuals living with spinal cord injury in the UK.

OBJECTIVE: People living with spinal cord injury (SCI) are often immunocompromised, and at increased risk of respiratory infection. Given the restrictions in response to the COVID-19 pandemic, those with SCI may be at increased risk of health deterioration, though how this is experienced is poorly understood. This study explored the experiences of people living with SCI during the COVID-19 pandemic. DESIGN: Participants completed an online survey consisting of demographic questions, and open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized for the analytical approach. SETTING: Community-based sample in the UK. PARTICIPANTS: Participants were recruited via social media outlets of UK-based SCI-specific support charities, and snowball sampling (N = 42, F = 34, M = 8). RESULTS: Key themes included: (1) lost access to health services and support, capturing concerns surrounding barriers to healthcare and rehabilitation, which intensified secondary consequences of SCI such as spasm and pain; (2) health anxiety, which was perpetuated by perceived heightened vulnerabilities to respiratory complications; (3) social isolation, with significantly reduced social contact, even with care providers, compounding health experiences. CONCLUSION: People living with SCI during the COVID-19 pandemic experienced a variety of personal physical, psychological, and social challenges, each of which could disrupt daily functioning and quality of life. Increased utilization of telehealth is recommended to support continued engagement in rehabilitation, and foster connection and community amongst others with SCI and health professionals.

COVID-19 and the spinal cord injury community: Concerns about medical rationing and social isolation.

PURPOSE/OBJECTIVE: To provide a descriptive account of the impact of the COVID-19 pandemic on the spinal cord injury (SCI) community focused on participants' concerns about medical discrimination and medical rationing, the impact of the pandemic on access to personal care attendants and medical supplies, and the impact of the pandemic on overall and mental health. Research Method/Design: Cross sectional, observational study among community-dwelling adults with SCI. Data were collected online between May 1, 2020 and August 31, 2020 (n = 187). The online questionnaire included questions regarding medical discrimination and rationing, the impact of the pandemic on access to care and medical supplies, and the impact of the pandemic on overall and mental health. RESULTS: Individuals with SCI have experienced difficulty accessing medical supplies due to the pandemic, and approximately half of our participants (52%) perceived that discrimination through medical rationing was occurring. Furthermore, compared to the general U.S. population, our sample reported that the pandemic had a greater negative impact on their mental health and access to medical supplies. CONCLUSION/IMPLICATIONS: Our findings suggest that the COVID-19 pandemic has negatively impacted mental health and increased concerns of social isolation as well as access to medical supplies among those with SCI. Rehabilitation psychologists must advocate alongside the disability community to limit health disparities and to conduct outreach, specifically with regard to mental health issues. Future research should focus on the effects of pandemic-related fears and social isolation, as well as resilience in the context of public health care threats. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

'We're all in the same boat': An Interpretative Phenomenological Analysis study of experiences of being an 'expert' during patient and public involvement within Child and Adolescent Mental Health Services (CAMHS).

BACKGROUND: Patient and Public involvement (PPI) has rapidly evolved into a key component in shaping the delivery of health services. However, little is known about what it is like to participate in involvement procedures that include representatives of multiple groups and in the context of developing new interventions for Child and Adolescent Mental Health Services (CAMHS). OBJECTIVE: This study explored participants' experiences of PPI, following attending a 'consensus conference', during which their views were sought in relation to the development of a proposed staff-based intervention and key questions about its design and implementation. DESIGN: Qualitative, semi-structured interview study. SETTING AND PARTICIPANTS: Six participants, including service users and various frontline clinical staff team members, who had experience of CAMHS were present at the consensus conference and then asked about their experiences of being involved via semi-structured interviews. The data were analysed using Interpretative Phenomenological Analysis (IPA). Young people, carers and frontline staff have been involved in the design and implementation throughout the broader programme of work of which this study forms part, although these groups were not directly involved in the design and implementation of this paper. RESULTS: Three key narratives were present: (a) Previous Experiences Driving Expectations, (b) 'We are all in the same boat' and (c) The Realization of Multiple Identities. The results suggest that PPI involvement is a complex process that may be driven by positive/negative expectations, but that individuals value learning about others and recognizing different perspectives while reaching shared goals in improving services. DISCUSSION AND CONCLUSION: This study demonstrates the complexity of experience that service users and clinical staff face when engaging in involvement activities in CAMHS. The findings demonstrate the value in engaging multiple stakeholder groups while also highlighting the importance of proper consideration of the procedures involved and facilitators of engagement.

Parallel worlds and personified pain: A mixed-methods analysis of pain metaphor use by women with endometriosis.

OBJECTIVES: Endometriosis is a long-term condition in which endometrial-like tissue grows outside of the womb, causing intense chronic pain. Previous work has demonstrated the physical and emotional impact on women who live with endometriosis, and metaphors can play an influential role in communicating the experience of pain, but there exists little understanding of the role and impact of such language for women with endometriosis. DESIGN: A qualitative, semi-structured interview design. METHODS: Conceptual Metaphor Theory (CMT) and Interpretative Phenomenological Analysis (IPA) were utilized in a mixed-methods study to examine the prevalence, types, and meaning of metaphors and metaphor use as a health communication strategy. Twenty-one women aged between 23 and 53 years (mean age 36.1 years) with endometriosis took part in audio-recorded interviews. RESULTS: The women reported experiencing symptoms for an average of 11 years before receiving a formal diagnosis of endometriosis, and the mean age of diagnosis was 27.6 years. Seven distinct conceptual metaphors were identified in 221 metaphorical expressions used across all participants, with most common ones referring to pain as physical properties of elements such as temperature and pressure, physical damage, and an external attacker. IPA revealed three themes pertaining to the feeling of vulnerability and helplessness, pain being incomprehensible, and a drive to manage and conceal pain simultaneously. CONCLUSIONS: This study demonstrates the power of language in facilitating understanding and empathy in the listener, alongside the challenge of communicating endometriosis pain to others. Imagery-based techniques may assist in adaptation to, interpretation, and acceptance of pain to reduce pain-related distress.

'Trying to bring attention to your body when you're not sure where it is': An interpretative phenomenological analysis of drivers and barriers to mindfulness for people with spinal cord injury.

OBJECTIVES: Work is beginning to explore the impact of mindfulness in managing the physical and psychological health of people with spinal cord injury (SCI). However, no previous work has sought to understand what drives people with such conditions to try mindfulness, and what barriers are experienced in accessing mindfulness. DESIGN: An exploratory, qualitative, interview design, utilizing interpretative phenomenological analysis. METHODS: Semi-structured interviews were conducted with 11 people with SCI who had experience of mindfulness since sustaining their injury. Verbatim transcripts were analysed using IPA to understand the lived experience of mindfulness post-SCI. RESULTS: Analysis suggested that managing physical and mental health, and viewing mindfulness as proactive and protective were key drivers for exploring mindfulness. However, multiple barriers to accessing opportunities and developing capability impeded engagement. These included the focus on areas of the body that participants had reduced sensation in, physical environments that could not be navigated in a wheelchair, social stigma surrounding the use of mindfulness, and a sense of obligation and risk of failure implied by perceived requirements for engagement. CONCLUSIONS: The results demonstrate the need for specific interventions to accommodate the reduced sensory and physical function experienced by people with neurological conditions and to enhance sense of control and autonomy. In addition, recommendations include minimizing the stigma surrounding mindfulness, and the potentially demotivating impact of the perception of 'failing' to engage.

A systematic review and taxonomy of tools for evaluating evidence-based medicine teaching in medical education.

BACKGROUND: The importance of teaching the skills and practice of evidence-based medicine (EBM) for medical professionals has steadily grown in recent years. Alongside this growth is a need to evaluate the effectiveness of EBM curriculum as assessed by competency in the five 'A's': asking, acquiring, appraising, applying and assessing (impact and performance). EBM educators in medical education will benefit from a compendium of existing assessment tools for assessing EBM competencies in their settings. The purpose of this review is to provide a systematic review and taxonomy of validated tools that evaluate EBM teaching in medical education. METHODS: We searched MEDLINE, EMBASE, Cochrane library, Educational Resources Information Centre (ERIC), Best Evidence Medical Education (BEME) databases and references of retrieved articles published between January 2005 and March 2019. We have presented the identified tools along with their psychometric properties including validity, reliability and relevance to the five domains of EBM practice and dimensions of EBM learning. We also assessed the quality of the tools to identify high quality tools as those supported by established interrater reliability (if applicable), objective (non-self-reported) outcome measures and achieved ≥ 3 types of established validity evidence. We have reported our study in accordance with the PRISMA guidelines. RESULTS: We identified 1719 potentially relevant articles of which 63 full text articles were assessed for eligibility against inclusion and exclusion criteria. Twelve articles each with a unique and newly identified tool were included in the final analysis. Of the twelve tools, all of them assessed the third step of EBM practice (appraise) and four assessed just that one step. None of the twelve tools assessed the last step of EBM practice (assess). Of the seven domains of EBM learning, ten tools assessed knowledge gain, nine assessed skills and-one assessed attitude. None addressed reaction to EBM teaching, self-efficacy, behaviours or patient benefit. Of the twelve tools identified, six were high quality. We have also provided a taxonomy of tools using the CREATE framework, for EBM teachers in medical education. CONCLUSIONS: Six tools of reasonable validity are available for evaluating most steps of EBM and some domains of EBM learning. Further development and validation of tools that evaluate all the steps in EBM and all educational outcome domains are needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018116203.

Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review.

BACKGROUND: Populations with reduced sensory and motor function, such as spinal cord injury (SCI) are at increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been developed with the aim of improving outcomes for people with SCI. To understand the value of MBIs, a systematic review was conducted pertaining to the use of MBIs, and interventions including elements of mindfulness, with people with SCI. METHODS: Databases were reviewed from 1996 to October 2018 (updated January 2020). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL), describe the use of mindfulness training as a component part of an intervention, or as the whole intervention. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilised for quality appraisals. Two assessors appraised the studies and demonstrated good agreement (Cohen's k = .848, p < .001). RESULTS: Five papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only one study reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 4) demonstrating no change. Four studies described reductions in depressive symptoms and three reported reductions in anxiety. Despite the importance of good QoL as a goal for people with SCI, few studies (n = 2) assessed this as an outcome with no improvements reported. Study quality ranged from high to low/weak. CONCLUSIONS: The findings in this review provide mixed support for the use of mindfulness to improve outcomes after SCI. In particular, findings indicate that mindfulness may be particularly effective for improving symptoms of depression and anxiety. This review highlights the requirement for more rigorous, high-quality research, particularly larger randomised-controlled trials with long-term follow-up, in this area. The small number of studies included in the present review mean that conclusions drawn are preliminary and thus reflects the paucity of the research in the area to date.

Depression in partner caregivers of people with neurological conditions; associations with self-compassion and quality of life.

Objectives: Informal caregivers are vulnerable to poor mental health and quality of life (QoL). Self-compassion may protect against this. This study investigated depression and QoL in partner caregivers of people with a long-term or neurological condition (e.g. dementia or spinal cord injury) and explored the extent to which QoL and self-compassion are predictive of depression.Design: A cross-sectional, questionnaire design.Methods: Participants were recruited from charities and support groups. Partner caregivers (N = 57) completed assessments of depression, QoL, and self-compassion.Results: Over half (61.8%) of caregivers experienced at least mild symptoms of depression, illustrating high prevalence among caregivers compared with the general population. Overall QoL was poor compared with non-caregivers. QoL was poorest in the physical domain (M = 51.9, SD = 10.1) and highest in the environmental domain (M = 64.9, SD = 15.8). Both self-compassion and QoL were significant predictors of depression (p < 0.05), explaining 48.8% of the variance. Hours spent providing care was also significantly predictive of depression (p < 0.05).Conclusion: Self-compassion and QoL may be important targets for supportive interventions for this population. This study underscores the importance of developing supportive interventions for informal partner caregivers, and developing self-compassion in these.

Patient-centered medical education: A proposed definition.

Multiple papers have been presented to define patient-centered care, with regulatory bodies such as the General Medical Council mapping this in their professional standards. Educational institutions clearly value instilling appreciation of patient-centredness in medical training, and attempts have been made to make medical education more patient-centered in practice. Such attempts are often limited to expert patients sharing personal stories, and public involvement in teaching. Despite the drive towards patient-centered care and medical education, there has been no attempt to formally define what patient-centered medical education is and what it means to medical educators globally. This paper proposes a definition of patient-centered medical education that is about the patients, with the patients, and for the patients, to ensure current and future doctors remain sensitive to all of the needs of the people they care for. This should be considered at both the micro and macro community levels.

Efficacy of Internet-Delivered Mindfulness for Improving Depression in Caregivers of People With Spinal Cord Injuries and Chronic Neuropathic Pain: A Randomized Controlled Feasibility Trial.

OBJECTIVES: To explore the feasibility and efficacy of web-based mindfulness training for carers of people with spinal cord injury (SCI). DESIGN: Randomized controlled feasibility study with 3-month follow-up. SETTING: Community setting. PARTICIPANTS: Spouses or family caregivers (N=55) of people with SCI and chronic neuropathic pain were recruited via the direct care team and advertisements. Participants were older than 18 years (no upper age limit), with Internet access for the duration of the study. Participants were randomly allocated to an 8-week online mindfulness training intervention (n=28), or to receive 8 weeks of psychoeducational materials on SCI and chronic pain (n=27). INTERVENTIONS: An established web-based, mindfulness training course was delivered over 8 weeks. Participants completed 10 minutes of mindfulness practices, twice per day, 6 days per week, totaling 960 minutes. The control group received a weekly e-mail with psychoeducational materials (based on the established elements) on SCI and pain for 8 weeks. MAIN OUTCOME MEASURE: Depression severity. RESULTS: Mindfulness reduced depression severity more than psychoeducation at T2 (mean difference= -.891; 95% confidence interval,-1.48 to -.30) and T3 (mean difference=-1.96; 95% confidence interval, -2.94 to -.97). Mindfulness training also reduced anxiety at T2 (mean difference=-.888; 95% confidence interval, -1.40 to -.38) and T3 (mean difference=-2.44; 95% confidence interval, -3.20 to -1.69). CONCLUSIONS: Results indicate that Internet-delivered mindfulness training offers unique benefits and is viable for caregivers of people with SCI and chronic neuropathic pain. Further work should explore the feasibility of combined education and mindfulness training incorporating both patient and caregiver, for optimum benefit.

Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial.

STUDY DESIGN: Between-subjects, randomized controlled feasibility study. OBJECTIVES: Populations with reduced sensory and motor function are at increased risk of depression, anxiety and pain, and may be less geographically mobile. This study explored the efficacy and feasibility of web-based mindfulness training for people with spinal cord injury (SCI). SETTING: UK community sample. METHODS: Participants were randomly allocated to an 8-week online mindfulness intervention (N = 36), or to internet-delivered psychoeducation (N = 31). Depression symptom severity was the primary outcome. Secondary outcomes included anxiety, quality of life (QoL), pain perception, pain catastrophizing and mindfulness. Measures were taken before (T1), at completion of, (T2), and 3 months following the intervention (T3). RESULTS: At T2, ten participants discontinued mindfulness training, and five discontinued psychoeducation. Dropouts were of significantly older age. Nine participants were lost to follow-up. Mindfulness reduced depression significantly more than psychoeducation at T2 (mean difference = -1.50, 95% CI [-2.43, -0.58]) and T3 (mean difference = -2.34, 95% CI [-3.62, -1.10]). Anxiety, pain unpleasantness and catastrophizing were significantly reduced compared with psychoeducation. Total mindfulness scores, and all facets of mindfulness except observing were significantly higher following mindfulness training. At follow-up, reductions in anxiety and catastrophizing persisted. CONCLUSIONS: Internet-delivered mindfulness training offers unique benefits and is viable for people with reduced sensory awareness. Future work should explore the feasibility of combined education and mindfulness training. The use of brief interventions shows promise in maximizing participant retention.