Jim Turner

Is group psychotherapy effective in older adults with depression? A systematic review

Earlier reviews and meta‐analyses have consistently concluded that psychological treatment of depression is effective in older adults. We conducted a systematic review randomised controlled trials of group psychotherapy to present the best available evidence in relation to its effectiveness in older adults with depressive disorders.

Psychological factors associated with emotional responses to receiving genetic risk information.

This study identified levels of distress, and predictors of levels of distress, in women undergoing assessment for genetic risk of breast/ovarian cancer based on their family history. It comprised a cohort study following 154 women who completed questionnaires at entry into a cancer genetic assessment programme and following risk provision. Independent significant associates of anxiety following risk provision were age, neuroticism, feeling hopeless about developing cancer, a perceived lack of control over developing cancer, lack of a social confidant, and a coping response involving acceptance/resignation. Depression was associated with age, neuroticism, feeling hopeless about developing cancer, lack of social confidant, and a coping response involving acceptance/resignation. To avoid high levels of psychological morbidity in future cohorts undergoing cancer genetic risk assessment, information should be given that emphasises that some degree of control over health outcomes through behaviour change or increased surveillance is possible.

Percentage prevalence of patient and visitor violence against staff in high-risk UK medical wards

Patient and visitor violence adversely affects staff and organisations; however, there are few UK data about patient and visitor violence on medical wards. Therefore, we conducted a cross-sectional study using a validated tool (Survey of Violence Experienced by Staff) in six medical wards in three North Wales district general hospitals to assess the prevalence of violence against healthcare staff. A total of 158 staff responded (12 men, 144 women, two not stated). We found that, within the previous 4 weeks, 83% of staff had experienced verbal aggression, 50% had been threatened and 63% had been physically assaulted. Of those assaulted, 56% sustained an injury, with three requiring medical assessment or treatment. Length of experience in the workplace correlated negatively with verbal abuse, but not with threats or assaults. Direct patient contact positively correlated with more overall incidents. There was no correlation between training in aggression management and the experience of incidents. Healthcare support workers and nurses reported a higher prevalence of patient and visitor violence compared with other groups of health worker.

Factors associated with intrusive cancer-related worries in women undergoing cancer genetic risk assessment

One hundred and twenty-eight women undergoing assessment for genetic risk of breast/ovarian cancer completed questionnaires at entry into the assessment process and following risk provision. The key variable of interest was the level of intrusive worries at each time, and factors associated with the level of intrusive worries following risk provision. Based on the CARA model (Renner, Pers Soc Psychol Bull 30:384–396, 2004), it was expected that an unexpected risk assessment (whether good or bad) would result in high levels of intrusive thoughts. Other potential moderators of worry included neuroticism, level of threat experienced (low control, high perceived risk), the use of differing coping efforts, and the available social support. Of note was that while levels of intrusive thoughts fell in all risk groups following risk provision, unexpectedly only women found to be at population risk reported an increase of active attempts to distract from intrusive worries at this time. The CARA model was not supported. However, intrusion scores were independently associated with higher levels of neuroticism, a lack of confidant support, and a confrontive coping response. Active avoidance scores were uniquely associated with being assigned as population risk, neuroticism, lack of confidant and affective support, and the use of avoidant coping. Together, these variables accounted for 33% of the variance in intrusion scores and 31% of the variance in avoidance scores. The implications of these findings is discussed.

Estimating the survival benefits gained from providing national cancer genetic services to women with a family history of breast cancer

The aim of this paper is to compare a service offering genetic testing and presymptomatic surveillance to women at increased risk of developing breast cancer with its predecessor of no service at all in terms of survival and quality-adjusted survival (QALYs) by means of a Markov cohort chain simulation model. Genetic assessment and presymptomatic care provided between 0.07 – 1.61 mean additional life years and 0.05 – 1.67 mean QALYs over no services. Prophylactic surgery and surveillance extended mean life expectancy by 0.41 – 1.61 and 0.32 – 0.99 years, respectively over no services for high-risk women. Model outcomes were sensitive to all the parameters varied in the sensitivity analysis. Providing cancer genetic services increase survival and as long as services do not induce adverse psychological effects they also provide more QALYs. The greatest survival and QALY benefits were found for women with identified mutations. As more cancer genes are identified, the survival and cost-effectiveness of genetic services will improve. Although mastectomy provided most additional life years, when quality of life was accounted for oophorectomy was the optimal strategy. Delayed entry into coordinated genetic services was found to diminish the average survival and QALY gains for a woman utilising these services.

Patient-reported measurement of time to diagnosis in cancer: development of the Cancer Symptom Interval Measure (C-SIM) and randomised controlled trial of method of delivery

BackgroundThe duration between first symptom and a cancer diagnosis is important because, if shortened, may lead to earlier stage diagnosis and improved cancer outcomes. We have previously developed a tool to measure this duration in newly-diagnosed patients. In this two-phase study, we aimed further improve our tool and to conduct a trial comparing levels of anxiety between two modes of delivery: self-completed versus researcher-administered.MethodsIn phase 1, ten patients completed the modified tool and participated in cognitive debrief interviews. In phase 2, we undertook a Randomised Controlled Trial (RCT) of the revised tool (Cancer Symptom Interval Measure (C-SIM)) in three hospitals for 11 different cancers. Respondents were invited to provide either exact or estimated dates of first noticing symptoms and presenting them to primary care. The primary outcome was anxiety related to delivery mode, with completeness of recording as a secondary outcome. Dates from a subset of patients were compared with GP records.ResultsAfter analysis of phase 1 interviews, the wording and format were improved. In phase 2, 201 patients were randomised (93 self-complete and 108 researcher-complete). Anxiety scores were significantly lower in the researcher-completed group, with a mean rank of 83.5; compared with the self-completed group, with a mean rank of 104.0 (Mann-Whitney U = 3152, p = 0.007). Completeness of data was significantly better in the researcher-completed group, with no statistically significant difference in time taken to complete the tool between the two groups. When comparing the dates in the patient questionnaires with those in the GP records, there was evidence in the records of a consultation on the same date or within a proscribed time window for 32/37 (86%) consultations; for estimated dates there was evidence for 23/37 consultations (62%).ConclusionsWe have developed and tested a tool for collecting patient-reported data relating to appraisal intervals, help-seeking intervals, and diagnostic intervals in the cancer diagnostic pathway for 11 separate cancers, and provided evidence of its acceptability, feasibility and validity. This is a useful tool to use in descriptive and epidemiological studies of cancer diagnostic journeys, and causes less anxiety if administered by a researcher.Trial registrationISRCTN04475865

A micro costing of NHS cancer genetic services

This paper presents the first full micro costing of a commonly used cancer genetic counselling and testing protocol used in the UK. Costs were estimated for the Cardiff clinic of the Cancer Genetics Service in Wales by issuing a questionnaire to all staff, conducting an audit of clinic rooms and equipment and obtaining gross unit costs from the finance department. A total of 22 distinct event pathways were identified for patients at risk of developing breast, ovarian, breast and ovarian or colorectal cancer. The mean cost per patient were £97–£151 for patients at moderate risk, £975–£3072 for patients at high risk of developing colorectal cancer and £675–£2909 for patients at high risk of developing breast or ovarian cancer. The most expensive element of cancer genetic services was labour. Labour costs were dependent upon the amount of labour, staff grade, number of counsellors used and the proportion of staff time devoted to indirect patient contact. With the growing demand for cancer genetic services and the growing number of national and regional cancer genetic centers, there is a need for the different protocols being used to be thoroughly evaluated in terms of costs and outcomes.

Patient preferences and National Health Service costs: a cost-consequences analysis of cancer genetic services

The study has three aims; firstly to establish if, having been informed of their risk status and that gene testing is inappropriate for them, low and moderate risk patients have misunderstood or failed to grasp this and want a test that is inappropriate for them. Secondly, to elicit patients’ willingness to pay for cancer genetic services. Thirdly, to ascertain the aspects of cancer genetics services that are important to high risk patients and present service configurations prioritised in terms of preferences accompanied by their costs (cost-consequences analysis). Patient preferences were gathered from 120 patients returning a self-administered discrete choice questionnaire issued post genetic risk assessment. Patients at low and moderate risk of developing breast cancer desired inappropriate testing. Patients at high, moderate and low risk of developing genetic cancer were willing to pay up to £3,000 for genetic serviced, which exceeds the current estimated cost of providing testing and counselling. Counselling by a genetics associate accompanied by favourable levels of other attributes provided high utility and substantial cost savings.

The Impact of Breast Cancer Genetic Risk Assessment on Intentions to Perform Cancer Surveillance Behaviors

One hundred and fifty-four women undergoing breast/ovarian cancer genetic risk assessment completed questionnaires at entry into the Cancer Genetic Service for Wales (CGSW) assessment program and following risk provision, mapping the strength of intentions to engage in a number of preventive/surveillance behaviors, including seeing specialists, breast self-examination, and involvement in screening programs, including mammography. A number of potential predictors of intentions were also assessed, including participants’ mood and emotional response to receiving risk information, the perceived benefits (in terms of reassurance and early disease detection) of engaging in each preventive behavior, and the perceived desires of their family and General Practitioner. Intentions to self-examine did not change following risk provision, although strength of intentions to engage in some other preventive behaviors did lessen. Family and General Practitioners appeared to be strong social influences on behavioral intentions, as were the perceived benefits of gaining reassurance and/or early detection of disease.

Patient and visitor violence towards staff on medical and psychiatric wards in India.

BACKGROUND Patient and visitor violence (PVV) towards staff is common across health settings. It has negative effects on staff and treatment provision. Little data is available from the developing world. AIMS To examine the prevalence of PVV in India and make comparisons with the existing data. METHODS We administered an abbreviated version of the Survey of Violence Experienced by Staff (SOVES-A) in English in Mysore on medical and psychiatric wards. RESULTS 249 staff participated. 16% of staff in psychiatric wards were subjected to some form of PVV in the past 4 weeks which is lower than in the developed world. 57% of staff on medical wards experienced PVV which is similar to the developed world. Patients and Visitors were almost equal sources of this violence. Verbal abuse was more common than threats and physical assaults. Training in aggression management may be a protective factor. CONCLUSION PVV is a significant problem in India, especially on medical wards. Aggression management training may be a way to reduce the prevalence of PVV.