Stephanie Archer

The effect of creative psychological interventions on psychological outcomes for adult cancer patients: a systematic review of randomised controlled trials

This systematic review examined the effectiveness of creative psychological interventions (CPIs) for adult cancer patients. In particular, the findings of randomised controlled trials of art, drama, dance/movement and music therapies on psychological outcomes were examined.

Younger women’s experiences of deciding against delayed breast reconstruction post-mastectomy following breast cancer: An interpretative phenomenological analysis

Most women do not reconstruct their breast(s) post-mastectomy. The experiences of younger women who maintain this decision, although important to understand, are largely absent in the research literature. This interview-based study uses interpretative phenomenological analysis to explore the experiences of six women, diagnosed with primary breast cancer in their 30s/40s, who decided against delayed reconstruction. Findings reported here focus on one superordinate theme (decision-making) from a larger analysis, illustrating that the women’s drive to survive clearly influenced their initial decision-making process. Their tenacity in maintaining their decision is highlighted, despite non-reconstruction sometimes being presented negatively by medical teams. Patient-centred support recommendations are made.

Using a randomised controlled trial (RCT) methodology in CAM research with gynaecological cancer patients: A commentary on the perks and pitfalls.

This paper provides a commentary on several challenges faced by researchers when conducting randomised controlled trials (RCTs) utilising complementary therapies with cancer patients. Several factors, such as research design and recruitment to the intervention are discussed. Examples are drawn from an RCT conducted by the lead author regarding the use of yoga to improve the quality of life of gynaecological cancer patients undergoing treatment for their cancer. This paper gives methodological insights into some of the difficulties experienced when conducting research with cancer patients, and provides a number of recommendations based on the available evidence and practical application of these methods.

‘Do you mean I’m not whole?’: Exploring the role of support in women’s experiences of mastectomy without reconstruction

This study explores the role of others in supporting younger women who opt not to reconstruct their breast post-mastectomy. Semi-structured interviews were conducted with six women diagnosed with breast cancer in their 30s/40s. The women lived in England, had been diagnosed a minimum of 5 years previously and had undergone unilateral mastectomy. An interpretative phenomenological analysis revealed three themes: Assuring the self: ‘I’ll love you whatever’, Challenging the self: ‘Do you mean I’m not whole?’ and Accepting the self: ‘I’ve come out the other side’. The women’s experiences of positive support and challenges to their sense of self are discussed.

Identifying research priorities for patient safety in mental health: an international expert Delphi study

Objective Physical healthcare has dominated the patient safety field; research in mental healthcare is not as extensive but findings from physical healthcare cannot be applied to mental healthcare because it delivers specialised care that faces unique challenges. Therefore, a clearer focus and recognition of patient safety in mental health as a distinct research area is still needed. The study aim is to identify future research priorities in the field of patient safety in mental health. Design Semistructured interviews were conducted with the experts to ascertain their views on research priorities in patient safety in mental health. A three-round online Delphi study was used to ascertain consensus on 117 research priority statements. Setting and participants Academic and service user experts from the USA, UK, Switzerland, Netherlands, Ireland, Denmark, Finland, Germany, Sweden, Australia, New Zealand and Singapore were included. Main outcome measures Agreement in research priorities on a five-point scale. Results Seventy-nine statements achieved consensus (>70%). Three out of the top six research priorities were patient driven; experts agreed that understanding the patient perspective on safety planning, on self-harm and on medication was important. Conclusions This is the first international Delphi study to identify research priorities in safety in the mental field as determined by expert academic and service user perspectives. A reasonable consensus was obtained from international perspectives on future research priorities in patient safety in mental health; however, the patient perspective on their mental healthcare is a priority. The research agenda for patient safety in mental health identified here should be informed by patient safety science more broadly and used to further establish this area as a priority in its own right. The safety of mental health patients must have parity with that of physical health patients to achieve this.

Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards

Objectives To understand how frontline reports of day-to-day care failings might be better translated into improvement. Design Qualitative evaluation of an interdisciplinary team intervention capitalising on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS. Results PCTS fostered psychological safety—a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and staff found some comfort in avoiding accountability . At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described. Conclusions Prospective safety strategies relying on staff-volunteered data produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, these strategies give managers access to the realities of frontline cares, and support frontline staff to make incremental changes in their daily work. These are goals for learning healthcare organisations. Trial registration ISRCTN 34806867.

Patient safety and quality of care in mental health: a world of its own?

Quality and safety in healthcare, as an academic discipline, has made significant progress over recent decades, and there is now an active and established community of researchers and practitioners. However, work has predominantly focused on physical health, despite broader controversy regarding the attention paid to, and significance attributed to, mental health. Work from both communities is required in order to ensure that quality and safety is actively embedded within mental health research and practice and that the academic discipline of quality and safety accurately represents the scientific knowledge that has been accumulated within the mental health community.

A systematic review of patient safety in mental health: a protocol based on the inpatient setting.

BackgroundDespite the growing international interest in patient safety as a discipline, there has been a lack of exploration of its application to mental health. It cannot be assumed that findings based upon physical health in acute care hospitals can be applied to mental health patients, disorders and settings. To the authors’ knowledge, there has only been one review of the literature that focuses on patient safety research in mental health settings, conducted in Canada in 2008. We have identified a need to update this review and develop the methodology in order to strengthen the findings and disseminate internationally for advancement in the field. This systematic review will explore the existing research base on patient safety in mental health within the inpatient setting.MethodsTo conduct this systematic review, a thorough search across multiple databases will be undertaken, based upon four search facets (“mental health”, “patient safety”, “research” and “inpatient setting”). The search strategy has been developed based upon the Canadian review accompanied with input from the National Reporting and Learning System (NRLS) taxonomy of patient safety incidents and the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). The screening process will involve perspectives from at least two researchers at all stages with a third researcher invited to review when discrepancies require resolution. Initial inclusion and exclusion criteria have been developed and will be refined iteratively throughout the process. Quality assessment and data extraction of included articles will be conducted by at least two researchers. A data extraction form will be developed, piloted and iterated as necessary in accordance with the research question. Extracted information will be analysed thematically.DiscussionWe believe that this systematic review will make a significant contribution to the advancement of patient safety in mental health inpatient settings. The findings will enable the development and implementation of interventions to improve the quality of care experienced by patients and support the identification of future research priorities.Systematic review registrationPROSPERO CRD42016034057

Worlds within worlds: a strategy for using interpretative phenomenological analysis with focus groups

ABSTRACT There is increasing interest in applying interpretative phenomenological analysis (IPA) to focus group data and in developing appropriate strategies for doing so. These strategies should exploit the unique features of focus groups, which provide a rich canvas of experiences not seen in individual interviews, while remaining true to the personal, phenomenological perspective of IPA. We present a four-stage approach with specific group focused analytical strategies: looking for “groupness,” clustering reoccurring group interactions, identifying interactional relationships, and incorporating group elements into an analysis. These stages are illustrated with worked examples developed while working with data from focus groups of women with gynaecological cancer discussing a yoga intervention, and explain how these can enrich our understanding of participants’ lived experiences. This approach demonstrates a suggested framework for developing IPA themes from focus group data by analysing and interpreting the group setting. We discuss links to psychological concepts, potential applications and limitations. This empirically based methodology is presented as a practical guide for other researchers grappling with this type of data.

7 Exploring healthcare professionals’ attitudes to future care planning with older adults in hospital: qualitative research co-design through multi-professional patient and carer involvement

Introduction Despite evidence that advance care planning in older hospital inpatients improves the quality of end-of-life care (Detering 2010) future care planning (FCP) with older adults remains to be normalised in hospital culture. It is therefore crucial to understand the attitudes of healthcare professionals to FCP in older patients in the hospital setting. Co-design with patients carers and healthcare professionals can generate more detailed meaningful data through better conversations. Aims To co-design a semi-structured interview (SSI) topic guide to explore healthcare professionals’ attitudes to FCP with older adults in hospital. Methods A multi-professional research group including a panel of patient and carer representatives co-designed an in-depth topic guide for a SSI exploring healthcare professionals’ attitudes to FCP with older adults in hospital. Results The co-designed topic guide encourages participants to explore personal and system-level factors that may influence attitudes to FCP and practice in hospital amongst healthcare staff. Co-designed topics for inclusion in the SSI schedule include: Potential differences between specialist and generalist approaches to FCP The influence of perceived hierarchy and emergency–decision making ability in professionals on FCP discussions The relevance to transitions of care Attitudes to FCP beyond the biomedical paradigm including perceived well–being and psychosocial aspects of care Digital FCP tools including patient–led FCP. Conclusion Co-designing qualitative research with older people and multi-disciplinary professionals may narrow translational gaps in implementing FCP by setting joint research priorities. Data generated from a co-designed study may expand understanding of hospital-based anticipatory decision-making with older adults. Reference . Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ23 March 2010;340:c1345.