Self-management by older people living with cancer and multi-morbidity: a qualitative study.

PURPOSE: Over half of individuals diagnosed with cancer are aged over 70 years, and more than 75% of those with cancer report at least one other medical condition. Having multiple conditions alongside cancer in old age may lower functional status, greater likelihood of treatment complications and less favourable prognoses. This qualitative study explored how older people with long-term chronic conditions manage their health and meet their health-related goals after they have completed treatment for cancer. METHODS: One-to-one face-to-face qualitative interviews were conducted with 8 older people and 2 informal caregivers based in the UK. Older adults were eligible to participate if they were over 70 and had completed primary cancer treatment with curative intent and had at least one other chronic health condition. A semi-structured interview schedule developed a priori based on Shippee's cumulative complexity model was used. We aimed to explore experiences that could influence self-management, utilisation of healthcare services and health outcomes. A framework analysis was used to describe and interpret the data. RESULTS: Four overarching themes were identified in the analysis. These themes related to factors that influenced the everyday health-related workload and capacity of the participants. These factors included their health, resources, and opportunities, as well their motivation and sense of perceived control over their lives. CONCLUSIONS: Fragmented healthcare systems and relationships with healthcare professionals also influenced the participants' self-management of their health. Our findings highlight the interaction between an individuals' needs, capacity, treatment burden, and the services and resources available to them. These findings support calls to promote person-centred care to better support older adults to manage their health.

Material Citizenship: An ethnographic study exploring object-person relations in the context of people with dementia in care homes.

Materiality has become an increasingly important topic in sociological studies of health care. How objects support the identity of people with dementia in care homes is an emerging area. While early research has tended to focus on sentimental or cherished items (such as photographs or keepsakes), the present study focused on functional objects (such as curling tongs or a hairdryer) as a mechanism to actualise citizenship. This article presents findings from an ethnographic study into the everyday experiences of people with dementia living in a residential care home in southern England. Drawing on a framework analysis of observations of daily life, object-elicitation interviews with residents, in-depth interviews with staff and relatives and documentary research, the findings demonstrate that object relations are a critical but overlooked site for citizenship. Residents are rarely involved in decision-making relating to their personal possessions, lack control over objects and are often discouraged from material interactions important to the maintenance and cultivation of identity. We introduce a new concept 'material citizenship' to advance thinking and practice in this area and argue that it is valuable for care practices to combine a material citizenship approach with existing care practices; thus, elevating the importance of object-person relations in dementia care.

Kinematic and perceptual responses in heavy lifting and pulling: Are there differences between males and females?

This study investigated kinematic and perceptual differences between the sexes in a heavy lifting and pulling task. A 20 kg box was lifted from floor to chest height, and a 70 kg mannequin pulled across 20m. The effect of height, mass and average grip strength on kinematics and perceived workload was examined in 42 (19 females, 23 males) healthy individuals. A univariate linear regression analysis found females lifted with greater lumbar extension compared to males (p < 0.001), and adopted more hip (p = 0.006) and knee flexion (p = 0.036) in the pulling task. Females reported a greater perceived workload in both tasks (p < 0.001). After the multivariable analysis, only grip strength remained significant for perceived workload in the lift (p = 0.04), and height for knee flexion in the pull (p = 0.009). This highlights that height and strength are important factors driving kinematics and perceived workload. Clinicians may consider these factors in heavy manual tasks, more so than sex.

Association between Quality of Interactions Schedule ratings and care experiences of people with a dementia in general hospital settings: a validation study.

INTRODUCTION: Establishing methods to evaluate interactions between hospital staff and patients with a dementia is vital to inform care delivery. This study aimed to assess the validity of Quality of Interactions Schedule (QuIS) ratings in relation to the care experiences of people with a dementia in a general hospital setting. METHODS: Four hundred and ninety face-to-face interactions between staff and patients with a dementia (n = 107) on six medicine for older people wards in a UK National Health Service hospital were observed and rated using QuIS and the Psychological Well-Being in Cognitively Impaired Persons (PWB-CIP) tool. We also invited patient ratings for longer interactions (n = 217). Analyses explored associations between QuIS ratings, PWB-CIP ratings and patient ratings. RESULTS: When QuIS was rated negative, the mean researcher-rated patient psychological well-being was lower (PWB = 7.9 out of maximum score of 10) than when QuIS was non-negative (PWB = 8.8, p = 0.036). Negative QuIS ratings were associated with negative ratings on seven out of ten individual PWB-CIP items. When QuIS was rated negative, the associated patient rating was 4% less likely to be 'happy'. The patient was also 4% more likely to rate the interaction as 'kind'. Patients struggled to participate in care ratings. CONCLUSIONS: Some patients found responding to researcher questions difficult or not relevant, reflecting the need for development of more suitable methods in this field. Our findings of an association between lower quality QuIS-rated interactions and lower psychological well-being lend support to the use of QuIS with patient populations that include people with a dementia.

Joining the dots: Day to day challenges for practitioners in delivering integrated dementia care.

Despite the increasing policy focus on integrated dementia care in the UK, little is known about the opportunities and challenges encountered by practitioners charged with implementing these policies on the ground. We undertook an extensive, mixed-methods analysis of how a contemporary multidisciplinary dementia pathway in the UK was experienced and negotiated by service providers. Our pragmatic mixed methods design incorporated three types of research interaction with practitioners: (a) Semi-structured interviews (n = 31) and focus group discussions (n = 4), (b) Practitioner 'shadowing' observations (n = 19), and (c) Service attendance and performance metrics reviews (n = 8). Through an abductive analysis of practitioner narratives and practice observations, we evidenced how inter-practitioner prejudices, restrictive and competitive commissioning frameworks, barriers to effective data sharing and other resource constraints, all challenged integrative dementia care and led to unintended consequences such as practice overlap and failure to identify and respond to people's needs. In order to more successfully realise integrated dementia pathways, we propose innovative commissioning frameworks which purposefully seek to diffuse power imbalances, encourage inter-provider respect and understanding, and determine clear lines of responsibility.

Planning and optimising CHAT&PLAN: A conversation-based intervention to promote person-centred care for older people living with multimorbidity.

BACKGROUND: Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions. METHODS: A theory-, evidence- and person-based approach to intervention development was undertaken. The intervention planning and development process included reviewing relevant literature and existing guidelines, developing guiding principles, conducting a behavioural analysis and constructing a logic model. Optimisation of the intervention and its implementation involved qualitative interviews with older adults with multimorbidity (n = 8), family caregivers (n = 2) and healthcare professionals (HCPs) (n = 20). Data were analysed thematically and informed changes to the intervention prototype. RESULTS: Review findings reflected the importance of HCPs taking a person-centred (rather than disease-centred) approach to their work with older people living with multimorbidity. This approach involves HCPs giving health service users the opportunity to voice their priorities, then using these to underpin the treatment and care plan that follow. Findings from the planning stage indicated that taking a structured approach to interactions between HCPs and health service users would enable elicitation of individual concerns, development of a plan tailored to that individual, negotiation of roles and review of goals as individual priorities change. In the optimisation stage, older adults and HCPs commented on the idea of a structured conversation to promote person-centred care and on its feasibility in practice. The idea of a shared, person-centred approach to care was viewed positively. Concerns were raised about possible extra work for those receiving or delivering care, time and staffing, and risk of creating another "tick-box" exercise for staff. Participants concluded that anyone with the appropriate skills could potentially deliver the intervention, but training was likely to be required to ensure correct utilisation and self-efficacy to deliver to the intervention. CONCLUSIONS: CHAT&PLAN, a structured person-centred conversation guide appears acceptable and appealing to HCPs and older adults with multimorbidity. Further development of the CHAT&PLAN intervention should focus on ensuring that staff are adequately trained and supported to implement the intervention.