Maximizing Professional-Led Sexual Well-being Support in Cancer Care: Findings From a Qualitative Process Evaluation Following Healthcare Professionals' Engagement With an eLearning Resource.

BACKGROUND: Provision of healthcare professional (HP)-led sexual support in cancer care is lacking, perpetuated by barriers including a lack of HP awareness of sexual concerns and strategies to help patients and partners cope. In response, the Maximizing Sexual Wellbeing|Cancer Care eLearning resource (MSW|CC) was developed and demonstrated efficacy in reducing HPs' attitudinal barriers to the provision of sexual support. However, the mechanisms for such change are not yet known. OBJECTIVE: A qualitative process evaluation was used to explore mechanisms that influence HP engagement with MSW|CC and its adoption into practice. METHODS: Semistructured interviews were conducted with HPs providing cancer care in Northern Ireland upon MSW|CC completion. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. RESULTS: Seventeen participants were interviewed, and 4 key themes were identified: (1) MSW|CC raises HPs' awareness of the need for holistic sexual support as part of routine clinical care; (2) MSW|CC prepares and equips HPs to provide sexual support in cancer care; (3) MSW|CC is coherent, engaging, and acceptable; and (4) MSW|CC: moving forward. CONCLUSION: Participants derived benefits from MSW|CC, deeming it an acceptable resource. Insights into MSW|CC mechanisms of success were identified, including language to address sexual concerns, alongside patient referral resources. Perceived MSW|CC shortcomings from an earlier study were confirmed as a software issue.Implications for Practice:Healthcare professionals require training and resources to enhance sexual support provision in cancer care. Proactive implementation strategies used to maximize HP engagement with MSW|CC could equip HPs with tools to improve patient sexual outcomes after cancer.

A qualitative evaluation of a multi-modal cancer prehabilitation programme for colorectal, head and neck and lung cancers patients.

BACKGROUND: Growing evidence indicates patients' survivorship outcomes can be enhanced through active engagement in a multi-modal cancer prehabilitation programme (MCPP), although this intervention is not uniformly embedded as a standard of care. MCPP aims to optimise patients physiologically and psychologically for cancer treatments, shorten recovery time, reduce complications, promote healthier lifestyles and improve quality of life. South Eastern Health and Social Care Trust (SET) developed and evaluated a system-wide collaborative approach to MMCP across three tumour groups (colorectal, lung, head and neck cancer). Addressing the lack of qualitative evaluation of MCPPs, this novel paper explores mechanisms promoting feasibility and acceptability of MCPP from patients' and interdisciplinary professionals' perspectives. METHODS: Semi-structured virtual one-to-one interviews were conducted with 24 interdisciplinary professionals and nine patients. Transcripts were recorded, transcribed verbatim and themes developed using Framework Analysis. RESULTS: Analysis of findings identified three themes providing an in-depth understanding of key elements required to develop and promote system-wide delivery of a MCPP: 1) Equipping the team: Capability and capacity, 2) Timing of intervention and delivery timeframe and 3) Systems and processes. CONCLUSION: The system-wide collaborative approach to developing a MCPP was deemed both feasible and acceptable. Success was attributed to visionary leadership, alongside a diverse group of interdisciplinary professionals being engaged, motivated and committed to intervention delivery in an effort to improve patient outcomes. Iterative, responsive troubleshooting during initial delivery is required to facilitate successful implementation. Further training is required for greater adherence to provision of prescriptive high intensity exercise within the programme, which may further promote enhanced patient outcomes. To enable sustainability of MCPP, ongoing training for professionals and funding is required.

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.

Factors contributing to burnout and work-life balance in adult oncology nursing: An integrative review.

PURPOSE: Occupational stress and burnout are highlighted as the most prevalent workplace issues for adult oncology nurses. With today's global nursing workforce shortage; coupled with oncology being an inherently challenging and complex speciality, this clearly indicates the need to understand factors that contribute to burnout in adult oncology nurses and improve work-life balance. The aim of this integrative review is to synthesis the evidence on burnout and work-life balance for adult oncology nurses. METHOD: A systematic search of four databases (CINAHL, Ovid Medline, PsycINFO and Scopus), identified 17 quantitative and three mixed-method studies. Studies were critically appraised using the Mixed Methods Appraisal Tool. Following data extraction, a qualitative evidence synthesis utilising an inductive approach was adopted to better understand influential factors, generating analytical themes. RESULTS: One study had a specific focus on what ameliorates work-life balance for oncology nurses; depicting an area that warrants further study. All studies reported on burnout, of which six analytical themes were further categorised into two broad themes, namely: (1) 'Inability to thrive': struggling with workplace burnout due to organisational challenges and (2) 'Personal perspectives influencing burnout', for adult oncology nurses. Burnout was influenced by multiple oncology-specific factors due to quantitative workload demands and disease acuity. Workplace culture, shift in additional hours being worked remotely and personal characteristics of the nurse, also influenced susceptibility for the development of burnout in oncology nurses. CONCLUSION: Confronting burnout and promoting wellness are the shared responsibility of both individual adult oncology nurses and their organisations to build resilience and help sustain and build workforce capacity.

Developing and testing a theory-driven e-learning intervention to equip healthcare professionals to communicate with parents impacted by parental cancer.

PURPOSE: Parents have a desire and need for instructive support from healthcare professionals on how best to communicate a cancer diagnosis with their dependent children. Healthcare professionals lack confidence to initiate and facilitate parent-child communication, reporting the need for training. To address the evident gap, this paper outlines the planning, development and testing phases of an e-learning intervention, using a person-based approach. METHODS: The planning and development phases combined evidence from reviews of qualitative and quantitative literature, an expert group and data generated from primary research of two focus groups with frontline oncology professionals (n = 23) to develop the e-learning intervention prototype. An iterative approach was adopted with 14 'think aloud' interviews for prototype usability testing, resulting in continuous movement between data collection, analysis and modification of the e-learning intervention. RESULTS: Involving end-users throughout all phases of this process, optimised the intervention development. As a result, a communication framework on how healthcare professionals can initiate these conversations with parents was integrated, alongside role-play videos and original artwork by children expressing their views associated with parental cancer. During the testing phase, think-aloud interviews identified key navigational difficulties which were modified and resolved. Minor modifications were made to the content and 'look and feel' of screen pages. CONCLUSIONS: The systematic and iterative, person-based approach, yielded important and complementary insights to enhance acceptability of the e-learning intervention. Providing a detailed description of the foundations that underpinned the development of this e-learning intervention, promotes transparency in the planning and design process, therefore aids methodological rigour.

Parents' experience of cancer who have young children: a literature review.

BACKGROUND: The National Cancer Institute estimates that 24% of adults with cancer are parenting children younger than 18 years. When a parent is diagnosed with cancer, this is a major stressor and often creates multiple problems for families. OBJECTIVE: The aim of this article was to conduct a comprehensive review of the literature on the experience of parents with cancer who are caring for young children. METHODS: A comprehensive review of the literature was undertaken using systematic review principles. The search strategy included five electronic bibliographic databases, using the search terms: parent, cancer, parents and cancer and communication. RESULTS: Thirteen studies were found that focused on parents' experience of cancer. Eleven of the 13 studies used solely qualitative methodology, and 2 studies used mixed methods. Of the studies identified, the majority focused on the experience of mothers, and mainly those with a diagnosis of breast cancer. Analysis of the 13 studies on parents' experience following a diagnosis of cancer revealed 3 predominant themes: (a) being a good parent, (b) telling the children, and (c) maintaining routine at home. CONCLUSION: The 3 themes highlight how parents with cancer struggle to know how best to talk to their children about cancer and the perceived lack of guidance and support from professionals, the feelings of guilt about not being "a good parent," and the effort required to maintain routine at home as a way of protecting their children. IMPLICATIONS FOR PRACTICE: Support for parents with cancer on relevant parenting issues should be acknowledged as an important facet of care for oncology nurses, as a mechanism of reducing parental stress and psychological distress for the whole family.

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.

Providing written information for patients with head and neck cancer.

Nurses in one Northern Ireland hospital asked patients, their relatives and members of the multidisciplinary care team for their input in compiling an information booklet for patients undergoing major surgery for head and neck cancer, with the aim of creating an information source which would be attractive to a range of patients with head and neck cancer.