Gary Latchford

The impact of head and neck cancer and facial disfigurement on the quality of life of patients and their partners

Psychological and physical stresses from head and neck cancer can be substantial for patients and partners. There is minimal research exploring treatment impact, particularly facial disfigurement after surgery.

Elective orthognathic treatment decision making: a survey of patient reasons and experiences

Objective Few studies have explored decisions about orthognathic treatment (OGT) from the patients perspective. This study describes the factors associated with the patients decision to have or not have orthognathic treatment, and assesses whether the process can be considered to be informed decision making. Design A cross-sectional survey employing both interview and questionnaire methods, conducted in four OGT services in Yorkshire. Sample Participants were patients aged over 16 years, either making an OGT decision over a 6-month period or had made their treatment choice 18–42 months prior to the study start date in 2003. Measures Questionnaires assessed patient demographics, dental history and psychopathology (anxiety, satisfaction with self, body satisfaction, facial appearance); interviews explored patients’ reasons for, and experiences of, orthognathic treatment. Results Of 138 patients approached, 61 participated (mean age 25 years, 66% female). Psychopathology scores were within the normal range. The thematic content analysis of interview transcripts found: reasons given for having OGT were to improve the ‘bite’, as well as gaining a more normal facial appearance; most patients reported the service information was satisfactory, but about half made negative comments, with some reporting staff communications made them feel worse; knowledge of OGT risks and benefits was poor; patients had strong emotions about their facial appearance and the orthognathic treatment they received, which did not seem to be addressed by current practice. Conclusions Some OGT patients do not appear to be making informed decisions about their treatment. They seem to have unmet needs in relation to support for their decision making, and managing the emotional effects of undergoing and adjusting to treatment. The implications for information provision, assessment and support during treatment are discussed.

Adherence to nebulised antibiotics in cystic fibrosis

OBJECTIVE To examine the adherence of patients with cystic fibrosis to nebulised antibiotics. METHODS A longitudinal design with adherence data collected over 12 weeks. 38 patients (mean age 24.6 years, S.D. 5.3) were recruited from an adult cystic fibrosis (CF) clinic. Adherence was electronically monitored using a Prodose adaptive aerosol delivery (AAD) device. RESULTS Three indices of adherence were calculated: mean percentage of times the nebuliser was used as prescribed was 50.0% (S.D.=39.7, range 1.1, 155.6); mean percentage of days fully adhered was 31.6% (S.D.=29.4, range 0, 97.2); mean percentage of days nebuliser used at least once was 57.1% (S.D.=34.2, range 3.3, 100). CONCLUSION Rates of adherence were generally low. Adherence was not associated with any variables apart from age. There were wide variations between individuals, and differences in rates of adherence depending on how this was defined, with potentially important health consequences for the patients. PRACTICE IMPLICATIONS Technology that improves medication administration may still be associated with low rates of adherence. Health professionals need to be mindful of the pattern of non-adherence for each individual, and factors which may be influencing this.

Attitudes to counselling via the Internet: A comparison between in‐person counselling clients and Internet support group users

Abstract E-therapy has emerged as an apparently popular alternative to face-to-face (f2f) therapy, with some evidence of effectiveness and of the ability of therapist and client to develop a good therapeutic relationship. As yet, however, little is known about those choosing this form of therapy. The present study investigated self disclosure style and attitudes towards e-therapy in three groups: current e-therapy clients, current users of Internet mental health support groups, and current f2f counselling clients. Participants completed a measure of self disclosure (the SD-40) and answered questions asking about the influence of factors thought to be potentially important in influencing a decision to undertake e-therapy, adapted by the authors. Two versions were used, pencil and paper and web-based. Unfortunately, too few e-therapy clients were recruited for the data to be analysed. There was no significant difference in self disclosure style between Internet support group users and f2f therapy users, tho...

Screening for depression in a single CF centre

INTRODUCTION The International Depression and Anxiety Epidemiological Study (TIDES) in CF attempts to provide prevalence data for mental distress in CF patients. The current study reports the results from the UK pilot in a single major CF centre in which the performances of different instruments were compared, and risk of self harm measured. METHODS Two mental health assessment screening instruments, the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire for depression (PHQ-9) were given to all adults with CF attending the Regional Adult CF Unit in Leeds, UK. RESULTS 232 patients took part. 13 (5.6%) scored in the clinical range for depression on the HADS and 78 (33.4%) on the PHQ9. The suicide risk item on the PHQ9 was endorsed by 24 patients (10.4%). DISCUSSION Major discrepancies were found in rates of depression detected by two popular screening tools. A significant minority of respondents indicated suicidal ideation. Work is needed to identify the most appropriate screening tool for depression in this population, and it is important that this includes an assessment of self harm.

Prisoner perspectives on mental health problems and help-seeking

Little is known about how prisoners perceive mental health problems or prospective sources of help. Applying a personal construct psychology approach, interviews were conducted with 12 adult male prisoners. Information from these interviews was used to construct a dependency grid, with problem situations on one axis, and possible help-sources on the other. A questionnaire containing this grid was completed by 177 prisoners. Recorded intentions to seek help from different sources varied considerably depending on the problem. Reasons given for help-source choice included the expected response, trust issues and perceived source skill level. Older participants recorded intentions to use a significantly narrower range of help-sources (χ2 (4, n = 168) = 9.57, p = 0.048) and greater intentions to use more formal help sources (χ2 (4, n = 162) = 12.73, p = 0.013). The study highlighted the importance of both formal and informal sources of help for mental health problems in prison, and suggested ways in which support might be improved.

Supported self-management for adults with type 2 diabetes and a learning disability (OK-Diabetes): study protocol for a randomised controlled feasibility trial

BackgroundIndividuals with a learning disability (LD) are at higher risk of developing type 2 diabetes, but LD is not straightforward to define or identify, especially at the milder end of the spectrum, which makes case finding difficult. While supported self-management of health problems is now established, current material is largely educational and didactic with little that facilitates behavioural change. The interaction between the person with diabetes and others supporting their care is also largely unknown. For these reasons, there is considerable work needed to prepare for a definitive trial. The aim of this paper is to publish the abridged protocol of this preparatory work.Methods/DesignPhase I is a prospective case-finding study (target n = 120 to 350) to identify and characterise potential participants, while developing a standardised supported self-management intervention. Phase II is a randomised feasibility trial (target n = 80) with blinded outcome assessment. Patients identified in Phase I will be interviewed and consented prior to being randomised to (1) standard treatment, or (2) supported self-management. Both arms will also be provided with an ‘easy read’ accessible information resource on managing type 2 diabetes. The intervention will be standardised but delivered flexibly depending on patient need, including components for the participant, a supporter, and shared activities. Outcomes will be (i) robust estimates of eligibility, consent and recruitment rates with refined recruitment procedures; (ii) characterisation of the eligible population; (iii) a standardised intervention with associated written materials, (iv) adherence and negative outcomes measures; (v) preliminary estimates of adherence, acceptability, follow-up and missing data rates, along with refined procedures; and (vi) description of standard treatment.DiscussionOur study will provide important information on the nature of type 2 diabetes in adults with LD living in the community, on the challenges of identifying those with milder LD, and on the possibilities of evaluating a standardised intervention to improve self-management in this population.Trial registrationCurrent Controlled Trials ISRCTN41897033 (registered 21 January 2013).

Motivational Interviewing for Adherence Problems in Cystic Fibrosis; Evaluation of Training Healthcare Professionals

Background Motivational interviewing (MI) offers effective strategies for enhancing behaviour change and is particularly useful for patients who exhibit poor adherence. This study evaluated MI training for cystic fibrosis (CF) teams, which comprised of one 4-hour workshop on MI principles, followed 6 months later by another on applying MI during brief consultations. Methods Health professionals (N = 60) from 7 teams completed questionnaires on learning outcomes 6 months after the first workshop, but before the second. Eleven participated in telephone-interview, 3 months after the second workshop. Results Quantitative analysis showed all participants used MI with a patient at least once after the first workshop and felt the approach was potentially helpful. Although self-appraisal of skill and confidence in MI was ‘moderate’, all felt confident in their ability to develop their skills and almost all intended to use MI in the future. Qualitative analysis confirmed the positive experiences of training and of using MI in practice, particularly in relationship building. However MI was utilised depending on team support and workload pressures. Conclusions This study showed that initial MI training with CF team-members resulted in increased knowledge and confidence about acquiring and applying MI techniques. However, this was balanced with consideration of barriers to application, further training needs and ongoing team-based support.

Randomized controlled feasibility trial of supported self-management in adults with Type 2 diabetes mellitus and an intellectual disability: OK Diabetes

To undertake a feasibility randomized controlled trial of supported self‐management vs treatment as usual in a population of adults with obesity, Type 2 diabetes and an intellectual disability.

The impact of chronic illness in suicidality : a qualitative exploration

Objectives: To explore the experiences of patients with chronic physical illness in relation to suicidal behaviours and ideas. Design: A qualitative study using semi-structured interviews. Methods: Fourteen patients with either multiple sclerosis or stage 5 chronic kidney disease were interviewed. Grounded theory was used to analyse the data. Results: Suicidal ideation was commonly reported by the study participants, and the relationship between the impact of a chronic physical illness, suicidality and risk factors was described. Several participants reported having planned suicide attempts as a consequence of finding living with their illness intolerable, and some had used non-adherence to treatment as a deliberate method to end their life. Conclusion: The findings suggest suicidality may be a relatively common experience in those with chronic illness facing a future of further losses, and that alongside passive thoughts of not being alive this may also include active thoughts about suicide. Health professionals should be alert to intentional non-adherence to treatment as an attempt to end ones life.