Using Social Constructivist Learning Theory to Unpack General Practitioners' Learning Preferences of End-of-Life Care: A Systematically Constructed Narrative Review.

General practitioners play a vital role in providing community-based palliative care to patients reaching end of life. In order for GPs to upgrade their skills at end-of-life care delivery, it is imperative that training programs be aligned to their learning needs and preferences. A narrative review was conducted using the electronic databases PubMed, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science, and Cochrane from 01/01/1990 to 31/05/2021. 23 articles (of 10037 searched) were included for the review. Following themes were generated: Value attributed to end-of-life care learning, experience and reflection as a departure point for learning, learning as embedded in the clinical context; autonomy to decide upon their learning needs and learning preferences, learning as a transformative process; and learning as embedded in social interaction and interpretation. Training programs that are aligned to the preferences of GPs will encourage a larger clientele of GPs to access them.

Change in mental health during the COVID-19 pandemic: a longitudinal study of residents of Indian metropolitan cities.

BACKGROUND: Initial studies have reported an increase in the incidence of mental health problems during the early months of COVID-19. Longitudinal studies of changes in mental health undertaken in Low and Middle Income countries during the pandemic remains an under-researched area. AIMS: The current study examines changes in mental health among adult residents of metropolitan cities of India, a middle-income country reporting the second-highest COVID cases and third-highest fatalities, during the pandemic. METHOD: Data was collected, based on a telephonic survey using the internationally accepted abridged Depression Anxiety Stress schedule (DASS-21), in August and September 2020 and July-August 2021. The sample size is 994. The data was analysed using an ordered logit model. RESULTS: At the onset of the pandemic, high levels of anxiety, stress and depression prevailed; their levels reduced after one year. Respondents who have experienced a decline in economic fortunes, have family members with pre-existing co-morbidity or had COVID in the family are significantly less likely to report improvement in mental health; less-educated respondents are also vulnerable. CONCLUSIONS: Specific sub-groups, identified as at risk, need monitoring and continued provisioning of tailor-made mental health services addressing their specific needs. Relief measures targeting economically affected households are also required.

Conference report: Introducing oncology to undergraduate medical and allied health sciences students: reflections from 2nd ecancer TMC Oncology Congress 2023 at Kolkata, India.

Despite the high cancer burden in low-middle-income-countries, medical students often have inadequate exposure to oncology. This may contribute to reduced interest in pursuing training in the field. The second ecancer TMC Oncology Congress at Kolkata on 30th September and 1st October 2023 was planned primarily to introduce undergraduate medical and allied health science students to oncology. There were separate sessions on breast cancer, thyroid cancer, myeloma and research methods so that students get exposure to a wide range of topics. Multi-disciplinary case-based discussions on common clinical presentations helped the students grasp the way a modern cancer hospital functions. Eighty-two percent (131/159, 82%) of the pre-registered delegates attended the congress alongside 44 national and international faculty from surgical oncology, radiation oncology, medical oncology, nuclear medicine, radiology, histopathology, psychiatry and palliative medicine. Of those who offered written anonymous feedback, 76% (70/91, 76%) rated the congress to be excellent. Broadly the following themes emerged from the qualitative feedback a) Delegates positively viewed the opportunity to 'interact and learn from some of the best of minds in the field of medicine' b) Suggestions included 'more interactive sessions through case histories, demonstrations of techniques, videos, quizzes, etc.' to make the learning experience more engaging. c) Considerable appreciation was expressed for learning about 'scientific writing' d) A few delegates were also inspired by the 'style' of some of the presentations and felt that this would help to design their presentations in the future. Introducing oncology early during their career may inspire undergraduate students to explore the option of pursuing a career in oncology and allied specialties. A video summarising the event is available at https://ecancer.org/en/video/11672-introducing-oncology-to-undergraduate-medical-and-allied-health-sciences-students. All the talks presented during the conference are available at https://ecancer.org/en/conference/1505-2nd-ecancer-tmc-kolkata-oncology-congress.

Preoperative risk factors associated with peri-operative psychiatric diagnosis in oral cancer patients.

Background: Head and neck cancers (HNCs) are one of the commonest cancers in low- and middle-income countries. There is a paucity of data on comorbid psychiatric problems associated with HNCs. The present study is aimed at reporting the pattern of psychiatric caseness in HNC patients who were referred to specialist psycho-oncology service and also investigate the predictors of psychiatric caseness in oral cancer patients. Methods: Case records of all patients with HNC referred to an integrated psycho-oncology service over 7 years (October 2011-December 2018) from a cancer hospital were analysed. All patients were assessed by a trained consultant psychiatrist and ICD-10 diagnoses were ascertained based on a clinical interview with the patients and family members. Associations of psychiatric caseness for consecutive oral cancer patients assessed by the psycho-oncology services over 2 years (January 2017-December 2018) were calculated by using univariate and multivariate statistical methods. Simple descriptive statistics of the referred patients were conducted, followed by logistic regression to find the associations of psychiatric caseness in oral cancer patients. Results: The psycho-oncology service assessed 771 HNC patients over 7 years. The commonest referrals were patients with oral cancer (75%, 558/771). For the years 2017-2018, 179 consecutive oral cancer patients were evaluated by the psycho-oncology service. Multivariate logistic regression analysis showed that being a woman (OR = 2.33; 95% CI = 1.02-5.32; p = 0.04); having worries about having pain in the post-operative period (OR = 2.55; 95% CI = 1.2-5.38; p = 0.01); worries about implications of the cancer and its treatment on the family (OR = 3.5; 95% CI = 1.19-10.57; p = 0.02); and longer duration of hospital stay period (OR = 1.08; 95% CI = 1.003-1.16; p = 0.04) were independently associated with psychiatric caseness even after controlling for confounders. Discussion: Specialist psycho-oncology services are important in the management of oral cancer patients and in addressing the mental health needs of this very vulnerable group of patients. A combination of psychoeducation, pragmatic psychological interventions and medications were used to treat these patients.

A public policy analysis with key stakeholders' insights to understand India's compliance with the WHO framework convention on tobacco control.

Background: Tobacco-related morbidity and mortality is a global public health challenge. India is the second largest consumer of tobacco in the world. The present paper synthesises the data from qualitative interviews of experts working in the field of tobacco control alongside a critical analysis of the national tobacco control policy of India. Methods: The research methods adopted for the present work included the following: 1) qualitative in-depth interview of experts and analysis of the qualitative data using thematic analysis; 2) searching existing literature and secondary data on the national tobacco policy and analysing the same using the methodological orientation of qualitative content analysis; and 3) health policy analysis of the national tobacco policy. Themes and sub-themes obtained from the two approaches were compared to generate meaning. Results: Nine experts (three women and six men) participated in the in-depth qualitative interviews from a variety of professional backgrounds (preventive oncology researcher, tobacco cessation specialist, public health expert, clinicians and human rights activists). The systematic and comprehensive literature search resulted in finding 14 research papers, reviews, policy documents and commentaries on the tobacco epidemic in India. The various themes that emerged from the qualitative interviews that found support from secondary data as well were: 'Conflicting policies of Government: Promoting tobacco production and at the same time restricting its use', 'Failure to shield from influence of tobacco industry', 'Demand reduction proposals through taxation and pricing', 'Legislation to protect from and reduce the harm of second-hand smoking', 'Health warning on packaging and labelling of tobacco products', 'Promotion and advertisement of tobacco products', 'Prohibiting production by and sale to minors'. Discussion: The control of a tobacco epidemic has multiple structural and functional challenges embedded in the complexity of the public-private interfaces, socio-economic forces, conflicting interests of the stakeholders and diverse nature of the problem. Any intervention planned to reduce the tobacco usage at a population level needs to take these factors into consideration.

Information-sharing experiences of professionals looking after children with cancer: a qualitative exploration from a specialist paediatric oncology unit in India.

Background: Childhood cancer often involves a long-term engagement of children and their parents with health services. During this journey, communications between professionals, parents and young people can be stressful for all the stakeholders. This study explores the communication preferences in paediatric oncology. Objectives: The objective of the present exploratory qualitative study was to understand the views of professionals regarding information exchange during cancer treatment of children and complement these findings with clinic-based ethnographic observation of real-life consultations. Methods: Using qualitative methods, in-depth interviews were conducted with paediatric oncology professionals. The interviews had been audio-recorded and transcribed verbatim. Alongside in-depth interviews, real-life interactions between parents, professionals and children were observed. Data were analysed using a thematic analysis framework as suggested by Braun and Clark. Results: Paediatric oncology professionals (n = 14) were interviewed from diverse professional backgrounds that included consultant paediatric oncologists, junior specialist trainees in paediatric oncology, paediatric oncology nurses, social workers, survivor counsellor and psychologists looking after children with cancer. Additionally, clinic-based ethnographic observations (n = 10) of interactions between professionals, parents and young people were also conducted. The following themes emerged from the interviews: a) Information needs of children were very different from adolescents. Children were more worried about 'here and now'; b) adolescents were, on the other hand, mostly worried about the 'impact of cancer on their broader life, friendships and academics'; c) parents were curious about the outcome, costs and effectiveness of treatment, and different patterns emerged for mothers and fathers; d) information needs were dynamic and different at the start of the treatment, during treatment, at remission or end of life; e) the journey of the clinicians themselves impacted information-sharing practices; and f) direct observation of consultations highlighted the importance of priming parents before delivery of information, having multiple family members during the conversation and managing intense emotions expressed during the session. Conclusion: Paediatric oncology professionals need to be sensitive about the dynamic nature of information needs while interacting with children and parents of children with cancer. The above findings may help tailor the discussions that professionals ought to have with families with a child with cancer. The results may contribute to the understanding as well as to developing training courses on communications in paediatric oncology for low- and middle-income countries.

Journeys: understanding access, affordability and disruptions to cancer care in India.

BACKGROUND: Much of the global cancer burden is in low- and middle-income countries (LMICs). Along with the high incidence of cancer, most LMICs have unevenly distributed health care resources. This study is a qualitative exploration of the journey of patients accessing cancer care in India and their caregivers. METHODS: The study followed a cross-sectional qualitative design. Participants were recruited by stratified purposive sampling, and all common cancers in India as reported by the GLOBOCAN database were included in the study. Consenting patients and their caregivers were interviewed using in-depth interview techniques. The data was analysed using principles of qualitative content analysis. RESULTS: Cancer patients (n = 100) and their caregivers (n = 48) were interviewed for the study. The six themes that emerged were related to a) the journey of patients to access care, b) the psychological journey of patients, c) stigma of cancer patients, d) decision-making and adherence to treatment, e) economic costs of cancer care and its impact and f) modifiers to accessing cancer care. CONCLUSIONS: Planning and policymaking in the future of cancer care delivery need to consider the views expressed by the cancer patients and their caregivers as regards to access, adherence and disruptions to cancer care in India. Future policies will hopefully address some of the difficulties faced by patients.

Association of adult attachment with delays in accessing specialist care in women with ovarian cancer.

OBJECTIVE: Advanced stage at diagnosis and delayed presentation are common in ovarian cancer (OC). The objective of the current study was to explore the association of adult attachment pattern with delays in accessing specialist oncology care in patients with OC. METHODS: A cross-sectional structured interview study of patients with OC presenting to an Indian cancer center was undertaken. Consenting patients completed Experiences of Close Relationships-Relationship Style questionnaire (ECR-RS) and Medical Outcome Survey-Social Support Survey (MOS-SSS). Multivariate linear regression with "time to presentation to cancer specialist" as the dependent variable was undertaken. RESULTS: In all, 132 of 155 (85%) patients with OC who were invited were interviewed. An increased ECR-RS attachment anxiety score (P = .01) and being part of a multigenerational extended household (P = .04) were both independently associated with delay in presentation to a cancer specialist. There was no association between delay in presentation and social support. CONCLUSIONS: Among patients with OC, adult attachment may contribute to delays in presentation. It may be important for the cancer symptom awareness efforts in primary care to include educating physicians on recognizing and interacting with patients with insecure attachment styles. The association of delays in presentation for women with OC living in multigenerational extended households needs more indepth exploration.Supplemental data for this article is available online at https://doi.org/10.1080/07347332.2022.2025510 .

Trends in Axillary Management of Early Breast Cancer: a Questionnaire-Based Pattern of Practice Survey for India.

Surgical management of breast cancer (BC) has evolved from radical surgeries to conservative with better cosmetic and comparable oncological outcomes. For axillary staging, it has evolved from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB). No detailed information exists in terms of the clinical practice pattern of surgical management of axilla for BC patients in India. A questionnaire-based survey was developed. The survey was done at the annual meeting of the Association of Breast Surgeons of India (ABSI) in November 2018. Responses were recorded and analysed by SPSS 23. One hundred twelve out of 400 (28%) responded to the survey. Half of the respondents were surgical oncologist and 36.6% were performing > 150 BC surgeries/year. The primary technique for axillary staging in node-negative BC was SLNB for 68.5% of respondents. Majority of surgeons (47%) reported performing SLNB by methylene blue dye only. Unavailability of radioisotope (46.7%) and lack of frozen section (26.7%) were reported as two major barriers for not performing SLNB. Twenty-three percent did perform SLNB in post-NACT setting. Only 15.8% have omitted completion ALND in Z0011 trial eligible SLN-positive patients. 45.9% skipped completion ALND in SLN positive with micro metastasis only. Many surgeons in India are adopting SLNB as a method of axillary staging into their clinical practice. However, large number of surgeons still believe in conservative approach, most probably due to unavailability of resources and lack of Indian data. Barrier identified in this survey may be useful for future development.