Simon Pini

The detection and management of emotional distress in cancer patients: the views of health‐care professionals

Objective: Emotional distress (ED) is an under‐diagnosed problem in cancer patients and over the last decade a number of national guidelines have recommended an assessment and management model based on appropriate health professional response to a hierarchy of patient need. This study explores the views of cancer professionals regarding their current roles and responsibilities in the detection and management of ED, use of screening tools and access to expert psychological support.

What effect does a cancer diagnosis have on the educational engagement and school life of teenagers? A systematic review

A diagnosis of cancer during the teenage years arrives at an important stage of development, where issues of normality, identity and independence are crucial. Education provides opportunity for peer contact, achievement and development for teenagers. This systematic review examined the impact of a diagnosis of cancer on the educational engagement and school life of teenagers.

A Needs-led Framework for Understanding the Impact of Caring for a Family Member With Dementia

Abstract Background and Objectives Approximately half the care for people with dementia is provided by families. It is therefore imperative that research informs ways of maintaining such care. In this study, we propose that a needs-led approach can provide a useful, novel means of conceptualizing the impact of caring on the lives of family carers. Our aim was to develop and present a needs-led framework for understanding how providing care impacts on carers’ fulfilment of needs. Design and Methods In this qualitative study, we conducted 42 semistructured interviews with a purposively diverse sample of family carers to generate nuanced contextualized accounts of how caring impacted on carers’ lives. Our inductive thematic analysis focused upon asking: “What need is being impacted here?” in order to generate a needs-led framework for understanding. Results Nine themes were widely endorsed. Each completed the sentence: “Being a carer impacts on fulfilling my need to/for….”: Freedom; feel close to my relative; feel in control of my life; be my own person; protect my relative; share/express my thoughts and feelings; take care of myself; feel connected to the people around me; get things done. Discussion and Implications These needs echo those from other research areas, with relational needs emerging as particularly central. The needs-led approach offers a perspective that is able to capture both stresses and positive aspects of caregiving. We recommend that clinical interviewing using Socratic questioning to discover human needs that are being impacted by caring would provide a valuable starting point for care planning.

Development of an item pool for a needs-based measure of quality of life of carers of a family member with dementia

Background and ObjectivesThis paper describes the development of an item pool for a needs-based self-report outcome measure of the impact of caring for a relative, friend or neighbour with dementia on carer quality of life. The aims are to give a detailed account of the steps involved and describe the resulting item pool.MethodsSeven steps were followed: generation of an initial item set drawing on 42 needs-led interviews with carers; a content and face validity check; assessment of psychometric potential; testing of response formats; pre-testing through cognitive interviews with 22 carers; administration rehearsal with two carers; and final review.ResultsAn initial set of 99 items was refined to a pool of 70 to be answered using a binary response format. Items were excluded due to overlap with others, ceiling effects, ambiguity, dependency on function of the person with dementia or two-part phrasing. Items retained covered a breadth of areas of impact of caring and were understandable and acceptable to respondents.ConclusionsThe resulting dementia carer-specific item pool reflects the accounts of a diverse sample of those who provide care for a person with dementia, allowing them to define the nature of the impact on their lives and resulting in a valid, acceptable set of items.

Management of emotional distress in cancer patients: is there a role for antidepressants?

Abstract Introduction Depression is common in cancer patients and often associated with increased morbidity, hospitalisation and reduced quality of life. Current opinion supports the use of antidepressants (AD) for moderate and severe depression in physical illness. However, AD may be inadequately prescribed to oncology patients and factors other than need may influence prescribing practice. Aims To explore oncology professionals views on the use of AD in the management of emotional distress in cancer patients. Methods 18 randomly selected professionals from the Yorkshire Cancer Network (oncologists, surgeons, clinical nurse specialists and ward nurses) participated in a qualitative interview study. To explore their views on AD use in oncology they were asked: What leads you to prescribe AD? or Do you have any views on the use of AD? key themes were extracted via framework analysis. Results Despite recognising the value of AD in cancer care, professionals were reluctant to prescribe AD stressing a lack of knowledge I would be very worried about my ability to do that and overwhelmingly saw the general practitioner (GP) as most appropriate for this role. Overreliance on AD was voiced as were views that taking AD was defeatist medicating them is a slippery slope. Conclusion These findings highlighted a need for training on the use of AD in cancer care and to counteract negative views contributing to exclusion from treatment plans. A key prescribing role for the GP is described however it is unclear whether referrals are made. Future work should determine the role of the GP and map prescribing patterns elsewhere.