Richard G Kyle

Cancer awareness among adolescents in Britain: a cross-sectional study

BackgroundLittle is known about adolescents’ cancer awareness and help-seeking behaviour in Britain. This study assessed adolescents’: awareness of cancer symptoms, common cancers, and the relationship between cancer and age; anticipated delay and perceived barriers to seeking medical advice; and examined variation by age, gender, ethnicity and whether individuals knew someone with cancer.MethodsA survey was conducted using a modified paper version of the Cancer Awareness Measure (CAM). The sample included 478 adolescents (male: n = 250, 52.3%) aged 11–17 years old (mean = 13.8, SD = 1.24) recruited from four British schools between August and October 2011.ResultsAdolescents’ cancer awareness was low. Half of all adolescents did not know the most common childhood (51%) or teenage (49%) cancers and most (69%) believed cancer was unrelated to age. Awareness of cancer symptoms was significantly higher among older adolescents (aged 13–17 years) (p = 0.003) and those who knew someone with cancer (p < 0.001). Three-quarters (74%) of adolescents indicated they would seek help for a symptom they thought might be cancer within 3 days, and half (48%) within 24 hours. The most endorsed barriers to help-seeking were ‘worry about what the doctor might find’ (72%), being ‘too embarrassed’ (56%), ‘too scared’ (54%) and ‘not feeling confident to talk about symptoms’ (53%). Endorsement of these emotional barriers was significantly higher among females (p ≤ 0.001).ConclusionThere are certain groups of adolescents with poor cancer awareness. Cancer messages need to be targeted and tailored to particular groups to prevent the emergence of health inequalities in adulthood. Interventions to raise adolescents’ cancer awareness have the potential for a life-long impact on encouraging early diagnosis and survival.

Case management vocational rehabilitation for women with breast cancer after surgery: a feasibility study incorporating a pilot randomised controlled trial

BackgroundThere is a paucity of methodologically robust vocational rehabilitation (VR) intervention trials. This study assessed the feasibility and acceptability of a VR trial of women with breast cancer to inform the development of a larger interventional study.MethodsWomen were recruited in Scotland and randomised to either a case management VR service or to usual care. Data were collected on eligibility, recruitment and attrition rates to assess trial feasibility, and interviews conducted to determine trial acceptability. Sick leave days (primary outcome) were self-reported via postal questionnaire every 4 weeks during the first 6 months post-surgery and at 12 months. Secondary outcome measures were change in employment pattern, quality of life and fatigue.ResultsOf the 1,114 women assessed for eligibility, 163 (15%) were eligible. The main reason for ineligibility was age (>65 years, n = 637, 67%). Of those eligible, 111 (68%) received study information, of which 23 (21%) consented to participate in the study. Data for 18 (78%) women were analysed (intervention: n = 7; control: n = 11). Participants in the intervention group reported, on average, 53 fewer days of sick leave over the first 6 months post-surgery than those in the control group; however, this difference was not statistically significant (p = 0.122; 95% confidence interval −15.8, 122.0). No statistically significant differences were found for secondary outcomes. Interviews with trial participants indicated that trial procedures, including recruitment, randomisation and research instruments, were acceptable.ConclusionsConducting a pragmatic trial of effectiveness of a VR intervention among cancer survivors is both feasible and acceptable, but more research about the exact components of a VR intervention and choice of outcomes to measure effectiveness is required. VR to assist breast cancer patients in the return to work process is an important component of cancer survivorship plans.Trial registrationISRCTN29666484

Scottish adolescents’ sun-related behaviours, tanning attitudes and associations with skin cancer awareness: a cross-sectional study

Objectives To describe Scottish adolescents’ sun-related behaviours and tanning attitudes and assess associations with skin cancer awareness. Design Cross-sectional study. Setting 20 state secondary schools in one Scottish local authority (Glasgow City). Participants 2173 adolescents (females: 50.7%, n=1102) with a mean age of 12.4 (SD=0.55). Outcome measures Sun-related behaviour (suntan, sunbathing, sunburn, sunscreen use, sunbed use), tanning attitudes, skin cancer-related symptom and risk factor awareness. Results Adolescents reported poor sun-related practice: 51% of adolescents reported sunburn the previous summer of whom 38% indicated sunburn on more than one occasion. Skin cancer awareness was low: 45% recognised ‘change in the appearance of a mole’ as a cancer symptom, and 39% agreed that ‘getting sunburnt more than once as a child’ increased cancer risk. 42% and 26% of adolescents, respectively, reported that friends and family held protanning attitudes. Compared with males, females were statistically significantly more likely to: report sunbathing (p<0.001), use of lotions or oil to aid tanning (p=0.009) and sunburn (p<0.001); know that changes in the appearance of a mole was a skin cancer symptom (p=0.036) and sunburn more than once as a child was a skin cancer risk factor (p=0.005); perceive their friends to hold protanning attitudes (p<0.001) and indicate that a tan made them feel better about themselves (p<0.001), more attractive to others (p=0.011) and healthier (p<0.001). Conclusions Scottish adolescents had poor sun protection practice and low skin cancer awareness. Girls adopted riskier sun-related behaviour despite greater awareness of skin cancer-related risk. Urgent action is required to promote positive sun-related behaviour and increase skin cancer awareness among Scottish adolescents. However, further research is needed to inform the development of effective sun-safe interventions.

Readmission in children's emergency care: an analysis of hospital episode statistics

Aim To compare rates of emergency readmission following discharge for common paediatric conditions from a range of hospital services. Design Retrospective analysis of hospital episode statistics (HES) and telephone survey of service provision. Setting Twelve hospitals serving a metropolitan area in the North West of England. Outcome measures Emergency admissions to hospital within 7 days of discharge for breathing difficulty, feverish illness and/or diarrhoea. Results HES were obtained for all children under 15 years of age discharged following emergency admission for breathing difficulty, feverish illness and/or diarrhoea during 2005/2006 (n=20 354) or 2006/2007 (n=23 018). The readmission rate for all hospitals in 2006/2007 was 5.5%. The percentage of same day discharges was associated with readmission (Kendalls taub correlation=0.61, p=0.007). Readmissions were also associated with the proportion of same day discharges for breathing difficulty (Kendalls taub=0.83, p<0.001) and feverish illness (Kendalls taub=0.50, p=0.023) but not significantly so with diarrhoea (Kendalls taub=0.37, p=0.098). The total number of admissions at a hospital in the year was associated with its readmission rate (Kendalls taub=0.71, p=0.002). Most of the sample lived in the 40% most deprived areas in England, but there was no significant association between readmission and living in the 10% most deprived areas. Conclusions Readmission rates are associated with higher numbers of annual admissions and higher proportions of children discharged on the day of admission. Variations between hospitals suggest that other factors can also affect readmission rates. Readmission rates calculated from HES can contribute to assessments of the outcome of emergency services.

Increased cancer awareness among British adolescents after a school-based educational intervention: a controlled before-and-after study with 6-month follow-up

BackgroundThere is a lack of evidence around the effectiveness of school-based interventions designed to raise adolescents’ cancer awareness. To address this deficit this study assessed the impact of an intervention delivered in the United Kingdom by Teenage Cancer Trust on: recall (open question) and recognition (closed question) of cancer warning signs; knowledge of common childhood, teenage, male and female cancers; awareness of the relationship between cancer and age; anticipated medical help-seeking delay; perceived barriers to seeking medical advice about cancer; and examined variation of intervention effect by gender and whether adolescents reported that they knew someone with cancer.MethodsThe Cancer Awareness Measure (CAM) was completed by 422 adolescents (male: 221, 52.4%) aged 11-17 years old (mean age=13.8, standard deviation=1.26) two weeks before and two weeks after the intervention in three schools, and on two occasions four weeks apart in a fourth (control) school. Intervention schools were followed-up 6-months post-intervention.ResultsRecognition of nine common cancer warning signs significantly increased two weeks after the intervention (4.6 to 6.8, p<0.001) and was maintained at 6-month follow-up (6.2, p<0.001). Endorsement of emotional barriers to help-seeking ‘not confident to talk about symptoms’ (53% to 45%, p=0.021) and ‘worried about what the doctor might find’ (70% to 63%, p=0.021) significantly decreased two weeks after the intervention but changes were not maintained at 6-months. The intervention had a greater impact on females and those who knew someone with cancer.ConclusionsThe intervention is an effective way to raise adolescents’ cancer awareness, especially of cancer symptoms. Further development and evaluation is required to maximise intervention impact, particularly on barriers to help-seeking behaviour.

Childhood disadvantage and emergency admission rates for common presentations in London: An exploratory analysis

Aim To determine whether emergency hospital admission rates (EAR) for common paediatric conditions in Greater London are associated with measures of child well-being and deprivation. Design Retrospective analysis of hospital episode statistics and secondary analysis of the Index of Multiple Deprivation (IMD) 2007 and Local Index of Child Well-Being (CWI) 2009. Setting 31 Greater London primary care trusts (PCTs). Outcome measures EAR in PCTs for breathing difficulty, feverish illness and/or diarrhoea. Results 24 481 children under 15 years of age were discharged following emergency admission for breathing difficulty, feverish illness and/or diarrhoea during 2007/2008. The EAR for breathing difficulty was associated with the IMD (Spearmans rho 0.59, p<0.001) and IMD indicators of: overcrowding (Spearmans rho 0.62, p<0.001), houses in poor condition (Spearmans rho 0.55, p=0.001), air quality (Spearmans rho 0.53, p=0.002), homelessness (Spearmans rho 0.44, p=0.013), and domains of the CWI: housing (Spearmans rho 0.64, p<0.001), children in need (Spearmans rho 0.62, p<0.001), material (Spearmans rho 0.58, p=0.001) and environment (Spearmans rho 0.53, p=0.002). There were no statistically significant relationships between the EAR of children admitted for feverish illness and diarrhoea or aged under 1 year for any condition, and the IMD, either IMD indicators or CWI domains. Conclusions Housing and environmental factors are associated with childrens demand for hospital admission for breathing difficulty. Some associations are stronger with the CWI than the IMD. The CWI has potential to identify priority PCTs for housing and environment interventions that could have specific public health benefits for respiratory conditions.

Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children’s Nursing Teams

BackgroundChildren’s emergency admissions in England are increasing. Community Children’s Nursing Teams (CCNTs) have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs) and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs.MethodsSemi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children’s Nurses (CCNs), consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8.ResultsFive facilitators were identified: 1) CCN/CCNT visibility; 2) clear clinical governance procedures; 3) financial and organisational investment in the role of CCNTs in acute care pathways; 4) access and out of hours availability; 5) facilitative financial frameworks.ConclusionGPs required confidence in CCNs’ competence to safely manage acutely ill children at home and secure rapid referral if a child’s condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.

Vocational rehabilitation services for patients with cancer: design of a feasibility study incorporating a pilot randomised controlled trial among women with breast cancer following surgery

AbstractBackgroundDue to improvements in cancer survival the number of people of working age living with cancer across Europe is likely to increase. UK governments have made commitments to reduce the number of working days lost to ill-health and to improve access to vocational rehabilitation (VR) services. Return to work for people with cancer has been identified as a priority. However, there are few services to support people to remain in or return to work after cancer and no associated trials to assess their impact. A pilot randomised controlled trial among women with breast cancer has been designed to assess the feasibility of a larger definitive trial of VR services for people with cancer.MethodsPatients are being recruited from three clinical sites in two Scottish National Health Service (NHS) Boards for 6 months. Eligible patients are all women who are: (1) aged between 18 and 65 years; (2) in paid employment or self-employed; (3) living or working in Lothian or Tayside, Scotland, UK; (4) diagnosed with an invasive breast cancer tumour; (5) treated first with surgery. Patients are randomly allocated to receive referral to a VR service or usual care, which involves no formal employment support. The primary outcome measure is self-reported sickness absence in the first 6 months following surgery. Secondary outcome measures include changes in quality of life (FACT-B), fatigue (FACIT-Fatigue) and employment status between baseline and 6- and 12-months post-surgery. A post-trial evaluation will be conducted to assess the acceptability of the intervention among participants and the feasibility of a larger, more definitive, trial with patients with lung and prostate cancer.DiscussionTo our knowledge this is the first study to determine the feasibility of a randomised controlled trial of the effectiveness of VR services to enable people with cancer to remain in or return to employment. The study will provide evidence to assess the relevance and feasibility of a larger future trial involving patients with breast, prostate or lung cancer and inform the development of appropriate VR services for people living with cancer.Trial RegistrationISRCTN: ISRCTN29666484 Registration date: 07/10/10; Randomisation of first patient: 03/12/10

Inside-out: Connecting Indoor and Outdoor Spaces of Informal Education through the Extraordinary Geographies of The Boys’ Brigade Camp

Scholarly interest in informal education stretches back several decades. Historians were the first to frame this field through studies that described the emergence of organised youth work in the Victorian era (Eager, 1953; Wilkinson, 1969; Dawes, 1975; Springhall, 1977) and charted the trajectory of youth organisations, including The Boys’ Brigade (Springhall et al., 1983), Church and Jewish Lads’ and Girls’ Brigades (Kadish, 1995), Scouts (Warren, 1986; Proctor, 2009) and Woodcraft Folk (Davis, 2000). Only relatively recently have academic geographers begun to write geographies of informal education that explore the spatialities of specific youth organisations, such as The Boys’ Brigade (Kyle, 2006) and Scouts (Mills, 2013). Yet, despite increased attention on the geographical accomplishment (Philo and Parr, 2000) of informal education, to date there has been a tendency to examine indoor and outdoor spaces of informal education in relative isolation, with little consideration of their interconnection (although see Mills, Chapter 5, this volume). This chapter challenges this approach and offers an alternative theorisation of the interrelationship between indoor and outdoor educational environments. It does so through an empirical examination of the practices, purposes, histories and geographies of camping in The Boys’ Brigade (BB), a volunteer-led Christian uniformed youth organisation.

Enhancing parents' confidence to care in acute childhood illness: triangulation of findings from a mixed methods study of Community Children's Nursing.

BACKGROUND Childrens emergency hospital use is of concern internationally, but there has been little examination of home care by nurses. AIMS To examine the care provided by community childrens nurses during acute illness. DESIGN Triangulation of findings from case studies of three Community Childrens Nursing Teams. METHODS Parents or carers (n = 763) completed questionnaires between 2008-2010 about their contacts with nurses and satisfaction with aspects and overall assessment of nursing care provided. Eighty-one individuals participated in semi-structured interviews: 29 parents/carers described their experiences and explained their questionnaire responses in more detail; 13 children talked about their care both in hospital and at home; and 39 nurses and other healthcare providers explained how nurses supported care of children at home. Questionnaire data were analysed descriptively and interview data qualitatively. The findings were integrated by triangulation of methods (questionnaires and interviews) and of data from different informants (children, parents, healthcare providers). RESULTS Nursing care most frequently took the form of advice and education by either home visits or telephone contact. Parents and children were reassured by access to nurses and it gave them confidence to care at home. Most respondents thought that it reduced the time their children spent in hospital. CONCLUSIONS Nurses can make an important contribution to supporting parents to care confidently for their children at home to reduce or even to avoid hospitalization for acute conditions and give them confidence to manage future episodes of illness.