Ziv Amir

Getting the most out of multidisciplinary teams: A multi‐sample study of team innovation in health care

Driven by the assumption that multidisciplinarity contributes positively to team outcomes teams are often deliberately staffed such that they comprise multiple disciplines. However, the diversity literature suggests that multidisciplinarity may not always benefit a team. This study departs from the notion of a linear, positive effect of multidisciplinarity and tests its contingency on the quality of team processes. It was assumed that multidisciplinarity only contributes to team outcomes if the quality of team processes is high. This hypothesis was tested in two independent samples of health care workers (N = 66 and N = 95 teams), using team innovation as the outcome variable. Results support the hypothesis for the quality of innovation, rather than the number of innovations introduced by the teams.

Cancer survivors' views of work 3 years post diagnosis: a UK perspective.

The impact of cancer on peoples working lives is an increasingly important concern but knowledge on this issue is very limited in the UK. Forty-one people of working age were purposively selected from the North Western Cancer Intelligence Service and interviewed by telephone to describe their experiences to returning to work following diagnosis and treatment. The data was subject to qualitative thematic analysis using NVIVO software. The results indicated the importance of returning to work from diagnosis and through treatment which was then followed by a re-assessment of work-life balance when people recovered from primary treatment and were back in employment. The principle motivations for returning to work were a quest for normality and financial pressures. One barrier to returning to work was the lack of medical advice from cancer specialists and general practitioners regarding the appropriate time to get back to work. A good relationship with their employer/manager was a major influence on returning to work and appeared to be related to duration of service rather than occupational status. These findings demonstrate the importance of paid work to people diagnosed with cancer and highlight the need to improve the support from medical professionals, especially oncology nurses.

The physical and practical problems experienced by cancer survivors: A rapid review and synthesis of the literature

PURPOSE A rapid and comprehensive review to identify what is known and not known about the physical and practical problems faced by adult cancer survivors. METHODS A systematic literature review process was used. This focused on published reviews to enable a fast but rigorous identification of both the gaps and well-researched areas within survivorship. RESULTS The search identified 5121 reviews, of which 42 were screened and 9 met the quality and inclusion criteria. The majority of papers focused on physical well being (n = 6) with the remaining papers focusing on practical well being (employment and finance). The quality of the reviews varied (ranging from weak to good). Gaps identified include sexual function, lower-limb lymphoedema, peripheral neuropathy, bladder and GI problems, hormonal sequelae, older cancer survivors, work impact of cancer and context-specific unmet supportive care needs. The review found a lack of standardised nomenclature for survivorship and methodological limitations. CONCLUSIONS Four main gaps in knowledge relating to the practical and physical problems associated with cancer survivorship have been identified. These are key symptoms, unmet supportive care needs, employment and older cancer survivors, and should be addressed by future research and systematic literature reviews. Work is also needed to address the nomenclature of survivorship and to improve the methodology of research into cancer survivors (including standardised measures, theoretical frameworks, longitudinal design, inclusion of older survivors and age-matched controls for comparison). The review highlighted the need for better research within the identified areas in order to improve the experiences of cancer survivors.

Knowledge, ignorance and priorities for research in key areas of cancer survivorship: findings from a scoping review

Background:Patients who have completed initial cancer treatment (cancer survivors) have been relatively neglected. We need data to help us better understand the needs of this group and to underpin evidence-based service development.Methods:Scoping reviews of research published in the last two decades focussing on the problems faced by cancer survivors, and the effectiveness of interventions for these problems were undertaken. The aim was to identify what we know, what we do not know and opportunities where research could provide new information. We searched for, retrieved and rapidly appraised systematic reviews sourced from the most common electronic databases supplemented by more recently published individual studies.Results:The research evidence is surprisingly limited. We have some knowledge of the prevalence and nature of depression, pain and fatigue in cancer survivors. We know much less about cognitive and physical impairment, employment, financial well-being and relationships. Even where we have evidence, it is mostly of only moderate quality, is most often only for breast cancer and focuses almost exclusively on the early phase of survivorship. We have good evidence for the effectiveness of drug treatments for pain and moderate evidence for fatigue and depression, but not for other symptoms. Interventions based on rehabilitative and self-management approaches remain in the early stages of evaluation.Interpretation:There has been a substantial amount of research describing many of the problems experienced by the cancer survivors. This is strongest in the area of symptoms in the period soon after treatment. However, the quality of the evidence is often poor, and some topics have been little examined. We urgently need data on the natural evolution and scale of the problems of cancer survivors obtained from well-designed, large-scale cohort studies and the robust testing of interventions in clinical trials. Given the current financially constrained research funding environment, we suggest areas in which strategic investment might give findings that have the potential to make a major impact on patient well-being in a 5-year time scale.

Cancer survivorship and employment: epidemiology

Survivorship following cancer diagnosis is increasing in prevalence; however, the research literature relating to the process of return to work is sparse. The limited literature suggests four groups of factors associated with return to work: (i) impact of cancer site, (ii) impact of treatment, (iii) occupational status and (iv) the roles of others. The extent to which these findings can be generalized to UK settings is limited as most research originates in countries with social welfare arrangements differing significantly from those in place in the UK. Therefore, there is a need for more evidence to inform better guidance for clinicians, survivors and work organizations about how to manage cancer in the workplace.

Return to Work After Cancer in the UK: Attitudes and Experiences of Line Managers

Introduction With improvements in diagnosis, treatment and survival rates, returning to work after cancer is of increasing importance to individuals and employers. Although line managers can play a potentially important role in the return to work process, research thus far has focused on the return to work process from the perspective of cancer survivors. Aim To explore the attitudes of line managers towards employees with a cancer diagnosis. Methods A short self-administered, on-line questionnaire was circulated to managers in the North East of England. Factorial structures of the line managers’ attitudes survey was examined using exploratory factor analysis and the effect of demographic characteristics and organisational variable on the attitudes of line managers was examined using multivariate analysis of variance (MANOVA). Results Line managers’ attitudes can be conceptualized according to five empirical factors: (a) fearful attitudes towards cancer survivors, (b) supportive attitudes, (c) line-managers’ perceived burden, (d) maintaining normality, and (e) financial benefits issues. Overall, line-managers hold relatively positive attitudes toward cancer survivors and are willing to support them in their effort to return to work. However, managers tend to harbour negative attitudes regarding the individual cancer survivors’ ability both to engage in work related activities and in meeting the demands of employment. MANOVA results also indicated that female managers hold more positive attitudes than male managers toward cancer diagnosis, less concerned about workload burdens of working with cancer survivors, and more willing to help cancer survivors maintain normality. Conclusions The results of this study suggest that employers/line-managers need to be provided with training, support, and resources to help them facilitate employment and job retention of employees diagnosed with cancer.

Critical appraisal guidelines for assessing the quality and impact of user involvement in research

Background  The involvement of service users in the design and conduct of health research has developed significantly in the UK in recent years. Involving service users is now seen as a core component of good research practice for all forms of health research. Given the important role that users have in health research, it is necessary to develop guidelines for their effective involvement. Whilst guidelines are currently being formulated, there remain no criteria with which to assess user involvement in published studies and funding applications.

The meaning of cancer: implications for family finances and consequent impact on lifestyle, activities, roles and relationships

This study explores the impact that cancer‐related financial hardship/worries can have on family life.

Helping Cancer Survivors Return to Work: What Providers Tell Us About the Challenges in Assisting Cancer Patients with Work Questions

Introduction Cancer patients and survivors report receiving little work-related advice from healthcare providers about how to manage their work during treatment or when to return after completing primary treatment. This study explores the extent to which health professionals involved with colorectal cancer patients address work matters during active treatment. Methods Eighteen health professionals from oncology, occupational health and general practice were interviewed. Interviews were transcribed verbatim and analysed using thematic analysis. Results Health professionals provide conflicting and limited information to patients regarding ability to work during treatment, or when to return to work thereafter. Lack of knowledge about impacts of treatment and symptoms on work ability and sustainability, particularly in relation to different occupations and work tasks resulted in providers offering minimal guidance to patients. Current practices relied on providers’ previous experiences with employed patients, rather than a sound evidence-base. Conclusions The type of work-related information given to patients by providers is not systematic. It is necessary to develop a better knowledge base about the impacts of cancer and its treatment on work ability, sustainability and return to work that would help providers to offer more tailored advice to patients, consistently. Therefore, it is appropriate to recommend that formal training for providers is necessary. Enhancing the quality of information and training for health professionals to provide better work-related support to patients during the early stages of treatment could enable individuals to manage their work more effectively and facilitate a successful transition from patient to survivor.

Additional financial costs borne by cancer patients: A narrative review

PURPOSE To review out-of-pocket costs related to cancer that are borne by patients and their families. METHODS A literature search using key terms relating to out-of-pocket costs incurred by cancer patients and their families was undertaken to generate a comprehensive narrative synthesis of the information available. RESULTS Four themes were identified: measuring costs; sources of costs; the impact of costs and reducing costs. The wide variety of measures for ascertaining hidden costs makes comparison of findings difficult; some articles cover a very narrow range of costs. Qualitative research is useful for elucidating a wide range of costs. Costs pertaining to hospital visits, nutrition and clothing are widely mentioned. Low additional expenditure may indicate that needs/wants are going unmet. Financial capacity to cope and subjective perception of impact are important. Low income, younger age, chemotherapy and living rurally are associated with greater impact. Extra expense can exert long-term effects on family finances. Primary care follow-up, telemedicine and treatments that entail fewer visits may serve to reduce patient costs. CONCLUSIONS The key question is how to organise/deliver cancer care in order to reduce additional expenses to patients and families. Future research could identify critical time-points and demographic groups susceptible to significant additional costs, in order to target support at those most in need.