Ivonne Solis-Trapala

Enduring impact of communication skills training: results of a 12-month follow-up

The efficacy of a communication skills training programme was shown through a randomised trial. Oncologists (N=160) from 34 cancer centres were allocated to written feedback plus course; course alone; written feedback alone or control. Each clinician had 6 – 10 interviews with patients videotaped at baseline and 3 months postintervention. Analysis of videotapes revealed improvements in the communication skills of clinicians randomised to training (n=80) compared with others (n=80). A 12-month follow-up assessment is reported here. Robust Poisson conditional analyses of counts of changes in communication behaviours revealed no demonstrable attrition in those who had shown improvement previously, including fewer leading questions, appropriate use of focused and open-ended questions and responses to patient cues. Additional skills, not apparent at 3 months, were now evident; the estimated effect sizes corresponded to 81% fewer interruptions (P=0.001) and increased summarising of information to 38% (P=0.038). However, expressions of empathy (54%, P=0.001) declined. The overall results show that 12 – 15 months postintervention, clinicians had integrated key communication skills into clinical practice and were applying others. This is the first RCT to show an enduring effect of communication skills training with transfer into the clinic.

What Oncologists Believe They Said and What Patients Believe They Heard: An Analysis of Phase I Trial Discussions

UNLABELLED PURPOSE; Evaluation of the communication and informed consent process in phase I clinical trial interviews to provide authentic, practice-based content for inclusion in a communication skills training intervention for health care professionals. PATIENTS AND METHODS Seventeen oncologists and 52 patients from five United Kingdom cancer centers consented to recording of phase I trial discussions. Following each consultation, clinicians completed questionnaires indicating areas they felt they had discussed, and researchers conducted semistructured interviews with patients examining their recall and understanding. Patients and oncologists also completed the Life Orientation Test-Revised questionnaire, measuring predisposition toward optimism. Independent researchers coded the consultations identifying discussion of key information areas and how well this was done. Observed levels of agreement were analyzed for each consultation between oncologist-coder, oncologist-patient, and patient-coder pairs. RESULTS In several key areas, information was either missing or had been explained but was interpreted incorrectly by patients. Discussion of prognosis was a frequent omission, with patients and coders significantly more likely to agree that oncologists had not discussed it (odds, 4.8; P < .001). In contrast, coders and oncologists were more likely to agree that alternate care plans to phase I trial entry had been explained (odds, 2.5; P = .023). CONCLUSION These data indicate that fundamental components of communication and information sharing about phase I trial participation are often missing from interviews. Important omissions included discussion of prognosis and ensuring patient understanding about supportive care. These findings will inform educational initiatives to assist communication about phase I trials.

An online randomised controlled trial to assess the feasibility, acceptability and potential effectiveness of 'Living with Bipolar': a web-based self-management intervention for Bipolar Disorder.:trial design and protocol

BACKGROUND Bipolar Disorder (BD) is a common and severe form of mental illness. Pharmacotherapy is the main treatment offered, but has limited effectiveness, and there is increasing evidence that people with BD respond well to psychological interventions. Inequalities in access to face-to-face psychological interventions mean many people seek support outside of routine health services. AIM To assess a recovery informed web-based self-management intervention for BD to increase access to psychological support. METHOD A small online randomised controlled trial (RCT) will evaluate the feasibility, acceptability and potential effectiveness of the intervention compared to treatment as usual (TAU). Feasibility and acceptability will be assessed by recruitment, adherence and dropout rates, website usage statistics, user satisfaction scales and a series of qualitative interviews. Effectiveness will be assessed on a range of outcome measures including quality of life, mood symptoms, coping, recovery, and illness beliefs. ANALYSIS Rates of adherence and dropout will be analysed using logistic regression models with health, socioeconomic and treatment factors as explanatory variables. Changes in quality of life mean scores, contrasting between arms, will be assessed using random effects models. An exploratory analysis will be performed on the secondary outcomes. Thematic analysis (Braun & Clarke, 2006) will be used to analyse the qualitative interviews. DISCUSSION The benefits, challenges and methodological challenges of developing a web-based intervention and conducting an RCT online are discussed. CONCLUSION The results of this trial will inform a definitive trial; and the implementation phase will aim to assess the potential for use within the NHS.

Is the relationship of prosaccade reaction times and antisaccade errors mediated by working memory

The mechanisms that control eye movements in the antisaccade task are not fully understood. One influential theory claims that the generation of antisaccades is dependent on the capacity of working memory. Previous research also suggests that antisaccades are influenced by the relative processing speeds of the exogenous and endogenous saccadic pathways. However, the relationship between these factors is unclear, in particular whether or not the effect of the relative speed of the pro and antisaccade pathways is mediated by working memory. The present study contrasted the performance of healthy individuals with high and low working memory in the antisaccade and prosaccade tasks. Path analyses revealed that antisaccade errors were strongly predicted by the mean reaction times of prosaccades and that this relationship was not mediated by differences in working memory. These data suggest that antisaccade errors are directly related to the speed of saccadic programming. These findings are discussed in terms of a race competition model of antisaccade control.

Estimating food portions. Influence of unit number, meal type and energy density

Highlights • University staff/students showed poor awareness of appropriate portion sizes.• Unit number and meal classification affected portion size estimation.• Portion sizes in sugary drinks, pizza and pasta were underestimated by 30–46%.• Women were better at estimating food portion sizes than men.

Large portion sizes increase bite size and eating rate in overweight women

OBJECTIVE Larger food portions lead to increased intake but the mechanism behind this effect is unclear. We investigated the effect of portion size on bite size, eating rate, deceleration rate, and meal duration. DESIGN AND METHODS Thirty-seven overweight women attended 5 visits after a 3 h fast and consumed a 229, 303, 400, 529 or 700 g portion of a lunch meal in random order. Meal eating parameters were measured with the Sussex Ingestion Pattern Monitor. Data were analyzed with mixed effects models. RESULTS Average bite size increased by 0.22 g for every 100 g increase in portion size (p=0.001); portion size had a non-linear effect on eating rate, increasing with portion sizes up to about 540 g (p=0.01). Deceleration rate (reduction in speed of eating) decreased by 20% (p<0.001) and meal duration increased by 22.5% for every 100 g increase in portion size (p<0.001), relative to the smallest portion. CONCLUSIONS Increasing portion size led to a larger bite size and faster eating rate, but a slower reduction in eating speed during the meal. These changes may underlie greater energy intakes with exposure to large portions. Interventions to reduce bite size and slow eating rate may provide individuals with strategies to reduce the risk of overconsumption.

Effect of reducing portion size at a compulsory meal on later energy intake, gut hormones, and appetite in overweight adults.

Larger portion sizes (PS) are associated with greater energy intake (EI), but little evidence exists on the appetitive effects of PS reduction. This study investigated the impact of reducing breakfast PS on subsequent EI, postprandial gastrointestinal hormone responses, and appetite ratings.

Patients' and oncologists' views on the treatment and care of advanced ovarian cancer in the UK: results from the ADVOCATE study

Background:Most patients presenting with advanced ovarian cancer (AOC) eventually relapse. Symptom palliation, maintenance of quality of life (QoL) and prolongation of life are primary therapeutic goals.Methods:Sixty-six UK oncologists completed an online survey about AOC management. Two hundred and two patients were interviewed about care, treatment experiences and expectations.Results:Prior to diagnosis, 34% (69 out of 202) of women had ⩾3 symptoms associated with AOC. Twenty-one per cent (43 out of 202) thought poor symptom recognition by general practitioners (GPs) delayed diagnosis. Amelioration of side effects experienced was variable, for example, only 54% (68 out of 127) distressed by alopecia had received sufficient information about it. Clinicians were asked ‘What minimum gain in progression-free survival (PFS) would make you feel it worthwhile to offer maintenance therapy?’; 48% (24 out of 50) indicated 5–6 months, but 52% (26 out of 50) believed patients would find PFS of 3–4 months acceptable. When patients were presented with hypothetical scenarios, 33% (52 out of 160) would require 1–2 months extra life, 6% (10 out of 160) 3–4 months, 31% (49 out of 160) 5–6 months, and 31% (49 out of 160) ⩾7 months. However, 86% (173 out of 202) would accept treatment that improved QoL without prolongation of life. When asked what was most important, 33% (67 out of 201) said QoL, 9% (19 out of 201) length of life and 57% (115 out of 201) said both were equally important.Conclusion:Clinicians’ and patients’ experiences, expectations and priorities about OC management may differ.

Early warning signs checklists for relapse in bipolar depression and mania: Utility, reliability and validity

BACKGROUND Recognising early warning signs (EWS) of mood changes is a key part of many effective interventions for people with Bipolar Disorder (BD). This study describes the development of valid and reliable checklists required to assess these signs of depression and mania. METHODS Checklists of EWS based on previous research and participant feedback were designed for depression and mania and compared with spontaneous reporting of EWS. Psychometric properties and utility were examined in 96 participants with BD. RESULTS The majority of participants did not spontaneously monitor EWS regularly prior to use of the checklists. The checklists identified most spontaneously generated EWS and led to a ten fold increase in the identification of EWS for depression and an eight fold increase for mania. The scales were generally reliable over time and responses were not associated with current mood. Frequency of monitoring for EWS correlated positively with social and occupational functioning for depression (beta=3.80, p=0.015) and mania (beta=3.92, p=0.008). LIMITATIONS The study is limited by a small sample size and the fact that raters were not blind to measures of mood and function. CONCLUSIONS EWS checklists are useful and reliable clinical and research tools helping to generate enough EWS for an effective EWS intervention.

Modelling the Interplay between Lifestyle Factors and Genetic Predisposition on Markers of Type 2 Diabetes Mellitus Risk.

The risk of developing type 2 diabetes mellitus (T2DM) is determined by a complex interplay involving lifestyle factors and genetic predisposition. Despite this, many studies do not consider the relative contributions of this complex array of factors to identify relationships which are important in progression or prevention of complex diseases. We aimed to describe the integrated effect of a number of lifestyle changes (weight, diet and physical activity) in the context of genetic susceptibility, on changes in glycaemic traits in overweight or obese participants following 12-months of a weight management programme. A sample of 353 participants from a behavioural weight management intervention were included in this study. A graphical Markov model was used to describe the impact of the intervention, by dividing the effects into various pathways comprising changes in proportion of dietary saturated fat, physical activity and weight loss, and a genetic predisposition score (T2DM-GPS), on changes in insulin sensitivity (HOMA-IR), insulin secretion (HOMA-B) and short and long term glycaemia (glucose and HbA1c). We demonstrated the use of graphical Markov modelling to identify the importance and interrelationships of a number of possible variables changed as a result of a lifestyle intervention, whilst considering fixed factors such as genetic predisposition, on changes in traits. Paths which led to weight loss and change in dietary saturated fat were important factors in the change of all glycaemic traits, whereas the T2DM-GPS only made a significant direct contribution to changes in HOMA-IR and plasma glucose after considering the effects of lifestyle factors. This analysis shows that modifiable factors relating to body weight, diet, and physical activity are more likely to impact on glycaemic traits than genetic predisposition during a behavioural intervention.