Cheryl Haslam

Cancer survivorship and work: symptoms, supervisor response, co-worker disclosure and work adjustment.

Introduction: Recent improvements in cancer treatment have not only increased cancer survivorship but also peoples’ ability to work during and following treatment. However, the impact that both diagnosis and treatment has on cancer survivors’ ability to fully engage in paid work is not yet entirely understood. This study aims to explore the role of symptoms, work adjustments and cancer disclosure to supervisors and co-workers on working during primary cancer treatment and return to work following treatment. Method: 328 cancer survivors responded to a 33 item questionnaire that assessed cancer-specific variables e.g. type and treatment, symptoms experienced during and following treatment, disclosure of cancer and adjustments and supports available at work. Multivariate logistic regressions were run to determine the association of symptoms, disclosure and work adjustments and working during treatment and returning to work following treatment. Results: The findings indicate that opportunities to work flexibly (OR=2.43, CI 1.21–4.02), disclosure to colleagues (OR=3.03, CI 1.28–8.19), difficulties managing fatigue (OR=2.08, CI 1.22–3.85), and paid time off to attend all medical appointments (OR=.4, CI .30–.87) were associated with continuing to work during treatment. Correlates of return to work included difficulties managing fatigue (OR=1.49, CI 1.42–6.18), managing the stress of cancer (OR=2.80, 1.05–5.34), managing physical changes associated with cancer (OR=.46, CI .13–.95), received advice from their doctor about work (OR=1.47, CI 1.09–2.84) and return to work meeting with employer (OR 1.99, 1.2–5.09). Conclusions: This study highlights the importance of symptom management in cancer survivors who work and the potential impact of workplace adjustments on the ability of cancer survivors to navigate in the world of work.

A preliminary investigation of post-traumatic stress symptoms among firefighters

Emergency service personnel are at high risk of developing post-traumatic stress disorder (PTSD). However, there is little in-depth information on the psychological responses of firefighters to the daily incidents that they attend. This preliminary study aimed to investigate the PTSD symptoms of firefighters in relation to traumatic events experienced by them, and the availability of social support. Thirty-one UK fire service workers completed an adapted version of the Post-traumatic Diagnostic Scale (PDS; Foa, 1995) to investigate the existence of post-traumatic stress disorder (PTSD). They were also individually interviewed to explore the symptoms they had experienced, what events these were related to, types of social support and coping strategies. Two participants reached the DSM-IV criteria for PTSD. Rumination and sleep disturbance were the most commonly reported PTSD symptoms. Participants reported high levels of social support from within the service and outside. The results suggest that fire service personnel are at risk of developing some symptoms of PTSD; however most had not experienced severe enough symptoms for PTSD to be diagnosed. The study suggests that high levels of social support may play a role in buffering firefighters from the development of PTSD.

Work Factors Related to Psychological and Health-Related Distress Among Employees with Chronic Illnesses

Objective: This study examined specific psychosocial factors associated with psychological and health-related distress amongst employees reporting different chronic illnesses. Methods: The sample consisted of 1029 employees managing either musculoskeletal pain (n=324), arthritis and rheumatism (n=192), asthma (n=174), depression and anxiety (n=152), heart disease (n=96) or diabetes (n=91). Information on psychological distress, work limitations, illness management, disclosure, absence, presenteeism, support and demographic factors were obtained through self-administered questionnaires. Results: Both low psychological well-being and high health-related distress were associated with an increase in work limitations (β=0.20, SE=.03; and β=0.19, SE=.01, respectively), poorer management of illness symptoms at work (β=−0.17, SE=.12; and β=−0.13, SE=.02), high presentieesm (β=0.19, SE=.25; and β=0.14, SE=.05) and low workplace support (β=−0.05, SE=.22; and β=−0.12, SE=.05). Health-related distress was additionally associated with disclosure of illness at work (β=0.18, SE=.08) and long-term sickness absence (β=0.10, SE=.06). Conclusions: To enable individuals to effectively manage both their illness and their work without serious repercussions, it is important for both healthcare professionals and employers alike, to improve the well-being of workers with chronic illness by supporting and facilitating their efforts to over-come health-related limitations at work.

The role of communication and support in return to work following cancer-related absence

Objective: Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post‐return period; and second, by drawing on a research sample working in the United Kingdom.

Sickness absence management: Encouraging attendance or ‘risk-taking’ presenteeism in employees with chronic illness?

Purpose. To investigate the organizational perspectives on the effectiveness of their attendance management policies for chronically ill employees. Methods. A mixed-method approach was employed involving questionnaire survey with employees and in-depth interviews with key stakeholders of the organizational policies. Results. Participants reported that attendance management polices and the point at which systems were triggered, posed problems for employees managing chronic illness. These systems presented risk to health: employees were more likely to turn up for work despite feeling unwell (presenteeism) to avoid a disciplinary situation but absence-related support was only provided once illness progressed to long-term sick leave. Attendance management polices also raised ethical concerns for ‘forced’ illness disclosure and immense pressures on line managers to manage attendance. Conclusions. Participants felt their current attendance management polices were unfavourable toward those managing a chronic illness. The policies heavily focused on attendance despite illness and on providing return to work support following long-term sick leave. Drawing on the results, the authors conclude that attendance management should promote job retention rather than merely prevent absence per se. They outline areas of improvement in the attendance management of employees with chronic illness.

Constraints on food choices of women in the UK with lower educational attainment.

OBJECTIVE Women of lower educational attainment have less balanced and varied diets than women of higher educational attainment. The diets of women are vital to the long-term health of their offspring. The present study aimed to identify factors that influence the food choices of women with lower educational attainment and how women could be helped to improve those choices. DESIGN We conducted eight focus group discussions with women of lower educational attainment to identify these factors. We contrasted the results of these discussions with those from three focus group discussions with women of higher educational attainment. SETTING Southampton, UK. SUBJECTS Forty-two white Caucasian women of lower educational attainment and fourteen of higher educational attainment aged 18 to 44 years. RESULTS The dominant theme in discussions with women of lower educational attainment was their sense that they lacked control over food choices for themselves and their families. Partners and children exerted a high degree of control over which foods were bought and prepared. Womens perceptions of the cost of healthy food, the need to avoid waste, being trapped at home surrounded by opportunities to snack, and having limited skill and experience with food, all contributed to their sense they lacked control over their own and their familys food choices. CONCLUSIONS An intervention to improve the food choices of women with lower educational attainment needs to increase their sense of control over their diet and the foods they buy. This might include increasing their skills in food preparation.

Why women of lower educational attainment struggle to make healthier food choices: The importance of psychological and social factors

Women of lower educational attainment are more likely to eat unhealthy diets than women of higher educational attainment. To identify influences on the food choices of women with lower educational attainment, 11 focus groups (eight with women of lower, and three with women of higher educational attainment) were held. Using a semi-structured discussion guide, environmental, social, historical and psychological factors known to be associated with food choice were explored. Audio recordings were transcribed verbatim and thematically analysed. Compared to women of higher educational attainment, women of lower educational attainment had less control over their families’ food choices, less support for attempts to eat healthily, fewer opportunities to observe and learn good food-related practices, more negative affect, more perceived environmental constraints and more ambiguous beliefs about the consequences of eating a nutritious diet. These findings provide a starting point for taking forward the design of an intervention to improve the diets of young women.

Health-Related Behavior and Beliefs of Pregnant Smokers

To determine the association of smoking with other health-compromising behavior and beliefs during pregnancy, a cross-sectional survey of 1,203 women in the United Kingdom assessed smoking status, stage of change, fetal health locus of control, alcohol consumption, folic acid intake, and use of vitamin and iron supplements. Twenty percent were current smokers, and 33% were alcohol users. Pregnant smokers (especially those in the precontemplative stage) were less likely to increase folic acid intake, less likely to take vitamin and iron supplements, and less likely to feel personally responsible for the health of the fetus. Infants of smokers may be placed at an intrauterine disadvantage, not only in terms of smoking, but also in terms of nutrition.

What constitutes effective manual handling training? A systematic review

BACKGROUND Injuries caused by manual handling are a major burden to society. Manual handling training programmes have been designed to reduce the likelihood of injury among the workforce; however, concerns have been raised over the efficacy of current manual handling training methods. AIMS To undertake a systematic review of the literature examining the effectiveness of different approaches to training in manual handling. METHODS Peer-reviewed publications along with published conference proceedings published in English, between 1980 and 2009, on the topic of manual handling training comprised the search criteria. A published checklist for reviewing papers was selected, which formed the basis for assessing the quality of the papers reviewed. RESULTS A total of 1827 papers were located. Following elimination of duplicates, 221 papers were collected and reviewed. Of these, 53 papers were intervention studies with the primary aim of investigating the effectiveness of manual handling training. The review identified little evidence supporting the effectiveness of both technique- and educational-based manual handling training. In addition, there was considerable evidence supporting the idea that the principles learnt during training are not applied in the working environment. Strength and flexibility training shows promise; however, further research is needed to ascertain whether such an intervention is sustainable over the long term. CONCLUSIONS The evidence collected indicates that manual handling training is largely ineffective in reducing back pain and back injury. High priority should be given to developing and evaluating multidimensional interventions, incorporating exercise training to promote strength and flexibility, which are tailored to the industrial sector.

Cognitive intervention for breast cancer patients undergoing adjuvant chemotherapy: a needs analysis.

Background: Evidence suggests women with breast cancer who had received chemotherapy experienced cognitive problems. Although these are largely subtle deficits, they can negatively impact a patients quality of life, ability to work, and subsequent employment decisions. Objective: The present study explored what healthcare information and support are available to help women understand the effects of chemotherapy on daily functioning at home and at work. It also explored what information and support they would find useful as interventions. Methods: Qualitative interviews were carried out with 31 patients attending a breast cancer clinic 4 months after treatment completion (phase 1) and with 5 oncology health professionals (phase 2). Fifteen women who took part in the interviews completed a short questionnaire on suitable interventions (phase 3). Results: Participants reported problems with fatigue, low mood, memory, and attention. Problems with remembering tasks at work were most common. Participants requested more information and support on cognitive difficulties. Oncology health professionals discussed the need for information and support for patients on managing cognitive problems. From the findings, 4 interventions and delivery modes were identified and validated. These were information and activites on cognitive strategies, help with emotional distress associated with cognitive difficulties, and advice for families and employers. Conclusion: Despite mixed evidence for cognitive problems associated with chemotherapy, there is a need for an intervention, and this may be related to managing emotional distress associated with perceived cognitive problems. Implications for Practice: Nurses should include potential cognitive problems when providing information to patients.