Trial of Optimal Personalised Care After Treatment-Gynaecological Cancer (TOPCAT-G): A Randomized Feasibility Trial.

OBJECTIVE: This study aimed to evaluate the feasibility of completing a parallel-group randomized controlled trial to compare usual follow-up care for women who have completed treatment of gynecological cancer against a nurse-led telephone intervention, known as Optimal Personalised Care After Treatment-Gynaecological. METHODS: The unblinded trial aimed to recruit patients who had completed treatment of cervical, endometrial, epithelial ovarian, or vulval cancer within the previous 3 months at 3 North Wales hospitals. We randomized participants to either usual hospital-based follow-up or specialist nurse-led telephone education, empowerment, and structured needs assessment follow-up. The primary outcomes assessed the feasibility of running a larger trial including patient eligibility, recruitment and retention rates, and outcome measure completion. Secondary outcomes were generic and health-related quality of life and a patient self-report health service use (Client Service Receipt Inventory) data collected at 3 time points (baseline, 3 months, and 6 months). RESULTS: Of the 58 women screened, 44 were eligible (76%) and 24 (55%) were recruited and randomized (12:12 to control and intervention, respectively). One participant was lost to follow-up. Recruited participants had a mean (SD) age of 60 (11.2) years and were approximately 5 months from their initial diagnosis (mean [SD], 159 [58] days). Seventeen (71%) of the participants had an endometrial cancer diagnosis. All outcome measure completion rates exceeded 96%. Although not a core feasibility objective, analyses of outcome measures indicated positive changes in quality of life and well-being within the Optimal Personalised Care After Treatment-Gynaecological group; exploratory cost consequence analysis indicated that the nurse-led intervention had a mean total service use cost of £27 per patient (bootstrapped 95% confidence interval, -£290 to £240) lower than did the standard care group. CONCLUSION: Eligibility, recruitment, and retention rates as well as outcome measure completion showed that the trial is feasible.

Identifying priorities for establishing bilingual provision in nurse education: a scoping study.

Research evidence demonstrates that offering language choice to patients enhances the quality of healthcare provision. This has implications for the preparation of nurses for practice in bilingual settings, where legislation often leads to demands for health services in both languages and bilingual competence amongst healthcare providers. This paper reports on a scoping study of bilingual provision in nurse education in the bilingual context of Wales, UK, as a means of informing the evidence base for national strategic planning. The study incorporated three elements: (i) literature analysis (ii) policy review and (iii) stakeholder consultation (n=70). Six themes emerged from the stakeholder consultation, reflecting the main drivers and barriers associated with bilingual provision in course delivery. These themes aligned with findings identified from the policy and literature review that related to strategic, organisational and individual influences on bilingual educational provision. Strategic planning for bilingual provision in nurse education in Wales should take account of the factors that affect provision at different levels. These factors feature across bilingual settings outside the UK, thus giving the study international relevance and scope to inform the delivery of nurse education that meets the needs of wider diverse language communities.

Communicative sensitivity in the bilingual healthcare setting: a qualitative study of language awareness.

AIM: This paper reports on the second phase of a national study in Wales. The research aimed to assess the level of Welsh language awareness amongst healthcare professionals across Wales, and to identify the factors that enhance language choice within service delivery. BACKGROUND: The literature suggests that language sensitive healthcare practice is central to ensuring high quality care. However, it is evident that language barriers continue to compromise the quality of care within nursing and other health services. One issue that has received little attention is the level of language awareness that healthcare professionals currently demonstrate. Furthermore the factors that influence language choice for bilingual/multilingual speakers are not well explored in the literature. METHODS: The study involved semi-structured interviews with a range of healthcare professionals in acute and community settings across Wales. Using a systematic sampling matrix, a purposeful sample of 83 professionals was selected to participate. Twenty-seven of the respondents were nurses, health visitors and midwives. The interviews focussed on the factors that facilitate or impede language sensitive healthcare practice. All interviews were audiotaped and, using a framework analysis approach, conceptual codes were developed and defined and categories and sub-categories were constructed to create thematic charts. FINDINGS: Three main themes were identified: care enhancement, which focussed on the process and outcome of offering language choice to bilingual patients; organizational issues, which reflected issues relating to the infrastructure of service provision; and training implications, which focused on Welsh language learning in health care. CONCLUSIONS: Complex dynamics of language use are in operation within bilingual healthcare settings and organizational as well as individual factors are important in facilitating appropriate language use. Many of the issues highlighted are not peculiar to the Welsh context, but apply to healthcare settings across the world, where other minority languages are in use.

Effects of orthographic transparency on reading and phoneme awareness in children learning to read in Wales.

The relationship between the development of reading skills and the consistency of the orthography (writing system) is investigated in a study that examines reading acquisition in children living in Wales. Performance of children learning to read Welsh (a transparent alphabetic orthography) on tests of reading and phoneme detection was compared with the performance of children learning to read English (an opaque alphabetic orthography). The children were tested during their second year of formal reading instruction at school when they were aged between 5 and 6 years, and again one year later. The children learning to read in Welsh performed significantly better at reading both real words and nonwords than children learning to read in English. The English readers made fewer phonologically based reading errors. The Welsh readers also performed better on a phoneme awareness task. These findings support the claim that children learn to read more quickly in a transparent orthography, and provide further evidence that the consistency of the orthography influences the initial adoption of different strategies for word recognition.