NHS Setting Research Articles

What can a third sector organisation provide for people with breast cancer that public health services cannot? Developing support services in response to service evaluation

IntroductionBreast Cancer Haven (BCH) is a national UK breast cancer charity supporting people through the physical and emotional experience of breast cancer. This service evaluation aimed to identify what people expected/ hoped for from BCH, and to evaluate how well those expectations were met. MethodsA link to an on-line SurveyMonkey survey was emailed out during November 2014–January 2015 to 4804 people with breast cancer who had attended BCH centres in London, Yorkshire or Hereford since 2000. Frequency analyses of pooled responses to multiple choice questions were downloaded from the SurveyMonkey website. Individual free text responses were analysed by coding into common themes, clustered into categories. ResultsA total of 980 BCH users (98.0% female, peak age 50–54 years) completed the survey; 20.4% of those invited. Most attended a BCH centre during 2012–14, nearly half travelled 30–60 min, most visited 6–10 times. Emotional (77.6%) and physical (67.2%) were the most frequent concerns. Breast cancer information, nutritional therapy and the Welcome Day were considered the most helpful therapies. Main categories of expected/hoped for factors were information and advice, emotional support, a therapeutic space and therapeutic relationships. 84.0% participants got what they expected or much more than they expected. ConclusionsThe findings suggest that a third sector organisation like BCH provides a support service that meets the expectations of the majority of those attending. Regular service evaluations are needed to ensure that people with breast cancer receive those aspects of care that are often lacking in the NHS setting.

Evaluating \u2018enhancing pragmatic language skills for young children with social communication impairments\u2019 (E-PLAYS): protocol for a feasibility randomised controlled trial study

BackgroundA number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The proposal presented in this article describes a feasibility study for a trial to test an intervention (‘E-PLAYS’) aimed at supporting children with social communication impairments. E-PLAYS harnesses technology in the form of a novel computer game in order to develop collaborative and communication skills. Preliminary studies by the authors show that when E-PLAYS was administered by the research team, children with social communication impairments showed improvements on communication test scores and on observed collaborative behaviours. The study described here is a pragmatic trial to test the application of E-PLAYS delivered by NHS speech and language therapists together with schools.MethodsThis protocol outlines a two-arm feasibility cluster-randomised controlled trial of the E-PLAYS intervention with treatment as usual control arm, with randomisation at the level of the speech and language therapist. The aim of this study is to ascertain whether it will be feasible to progress to running a full-scale definitive trial to test the effectiveness of E-PLAYS in an NHS setting. Data relating to recruitment and retention, the appropriateness of outcomes and the acceptability of E-PLAYS to participants will be collected.Speech and language therapists will select suitable children (ages 4–7 years old) from their caseloads and deliver either the E-PLAYS intervention (experimental group) or treatment as usual (control group). Assessments will include blinded language measures and observations, non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. There will also be a qualitative process evaluation.DiscussionThe findings of this study will inform the decision as to whether to progress to a full-scale definitive randomised controlled trial to test the effectiveness of E-PLAYS when delivered by speech and language therapists and teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions.Trial registrationISRCTN 14818949 (retrospectively registered).

Support for staff support groups: A role for group analysts

Clinical psychologists in NHS settings are often called upon to facilitate ‘staff groups’. A survey of psychologists’ self-reported experiences of facilitating such groups indicated average levels of relevant training, moderate levels of confidence, but only average levels of effectiveness. The value and validity of quantitative evaluations of this kind are discussed. The findings suggest that more group therapies-related teaching and training are needed in clinical psychology training courses and in clinical environments in the NHS and other clinical settings. Group analysts are well placed to encourage, support and provide teaching and training opportunities such as these.

Welcoming peer workers in NHS settings: facilitating readiness with an Early Intervention in Psychosis team

Purpose A pilot project commissioned to assess feasibility and impact of peer support in an Early Intervention in Psychosis (EIP) service highlighted the importance of team readiness. The purpose of this paper is to reflect on the lessons learned in recognising and facilitating team readiness in an NHS setting. Design/methodology/approach The literature suggests that mental health teams need to be ready to implement peer support, if this is to be done successfully. The authors describe the process of preparing for peer support, obstacles that arose and ways that the team found to address these. Findings The team had actively sought to develop peer support for some time, and negotiated with Trust managers to agree these roles in principle. However, initially unspoken concerns about duty of care emerged as a key obstacle. An arguably paternalistic desire to protect potential peer worker colleagues from stress and distress could have resulted in unnecessary risk aversion and a narrowing of the role. Willingness and opportunity to reflect on the change in relationship from service user/professionals to colleagues enabled these concerns to be aired, and practical solutions agreed. Practical implications Team enthusiasm is not the same as team readiness. The team’s willingness to identify and reflect on implicit concerns facilitated an acceptance of the change in relationship with peer workers, which in turn enabled the development of standard operating procedures to ensure safe and effective peer support as “business as usual.” Originality/value This paper considers the process of welcoming peer workers in an EIP team and offers practical suggestions that may be of value to other teams seeking to implement peer support in similar adult mental health settings.

NHS Long Term Plan gives young people's mental health a boost

The government's 10-year vision for the NHS sets out key pledges to improve support for children and young people with mental health problems, including investing in crisis and community-based interventions

Reducing Expectations for Antibiotics in Primary Care: A Randomised Experiment to Test the Response to Fear-Based Messages About Antimicrobial Resistance

Background: Public health campaigns often provide fear-based information about antibiotic-use and antimicrobial-resistance (AMR). This study aimed to test the likely impact of fear-based messages on patient consultations/antibiotic-requests for influenza-like-illnesses. Methods: We hypothesised that fear-based messages containing empowering information about self-management without antibiotics would be more effective, particularly in a pre-specified subgroup with low AMR awareness. Respondents from an online research panel, representative of United Kingdom adults, were randomised to receive three different messages about antibiotic-use and AMR, designed to induce fear about AMR to varying degrees. Two messages (one 'strong-fear', one 'mild-fear') also contained empowering information regarding influenza-like-symptoms being easily self-managed without antibiotics. The main outcome measures were self-reported effect of information on likelihood of visiting a doctor, and requesting antibiotics, for influenza-like-illness; analysed separately according to whether the AMR information was very/somewhat new to respondents, pre-specified based on a previous non-randomised survey. Findings: The 'fear-only' message was very/somewhat new to 285/1,000(28·5%) respondents; 'mild-fear-plus-empowerment' to 336/1,500(22·4%); and 'strong-fear-plus-empowerment' to 388/1,500(25·9%) (p=0·002). Of those for whom the respective information was very/somewhat new, only those given the 'strong-fear-plus-empowerment' message said they would be less likely to request antibiotics if they visited a doctor for an influenza-like-illness (p<0·0001; 182/388(46·9%) 'much less likely'/'less likely', versus 116/336(34·5%) with 'mild-fear-plus-empowerment' versus 85/285(29·8%) with 'fear-alone'). Those for whom the respective information was not very/somewhat new said they would be less likely to request antibiotics for influenza-like-illness (p<0·0001) across all messages (interaction p<0·0001 versus very/somewhat new subgroup). The three messages had analogous self-reported effects on likelihood of visiting a doctor, and in subgroups defined by believing antibiotics would definitely/probably help an influenza-like-illness. Interpretation: Fear could be effective in public campaigns aimed at reducing antibiotic-use, but should be combined with messages empowering patients to self-manage symptoms effectively without antibiotics. Funding Statement: The research was funded by the National Institute for Health Research Health Protection Research Units (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford [grant number HPRU-2012-10041] and at Imperial College London [grant number HPRU-2012–10047], and the NIHR HPRU in Evaluation of Interventions at the University of Bristol [grant number HPRU-2012-10026], all in partnership with Public Health England (PHE). Michele Peters is an Associate Professor supported by the Department of Health funded Policy Research Unit on Quality and Outcomes of Person Centred Care (QORU), a collaboration between the London School of Economics and Political Science (LSE) and the Universities of Kent and Oxford. Tim Peto and A. Sarah Walker are NIHR Senior Investigators. Enrique Castro-Sanchez was supported by a Wellcome ISSF Faculty Fellowship at Imperial College London. Laurence S.J. Roope, Derrick Crook, Tim Peto, A. Sarah Walker, and Sarah Wordsworth are supported by funding from the NIHR Oxford Biomedical Research Centre (BRC). Declaration of Interests: All authors declare: no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could have influenced the submitted work. Ethical Approval Statement: This study is based on data from three surveys. The first survey data existed prior to this study, having been developed separately,24 on attitudes to antibiotics and awareness of AMR. This and the second survey (first wave of this study) were not submitted for ethical approval based on previous similar surveys, since they were undertaken outside the NHS setting and did not request personal health information, only views about health. Respondents had volunteered to receive information about such surveys from SSI. Completion of the survey was considered as indicating consent and respondents were able to refuse to participate in the survey at any stage in the process. The third survey (second wave of this study), which is identical to the second survey (first wave of this study), was approved by the University of Oxford’s Central University Research Ethics Committee – reference number R49463/RE001. Following approval of the third survey, the original and second survey were retrospectively considered by the same committee (reference number R57213/RE001) who deemed that “it is probable that, had the documentation and a full application been submitted for ethical opinion at the correct time, the committee would have granted ethical approval (perhaps subject to some amendments of the documentation).” Respondents gave informed consent before taking part. We attest that we have obtained appropriate permissions and paid any required fees for use of copyright protected materials.

Testing the effectiveness of REACH Pregnancy Circles group antenatal care: protocol for a randomised controlled pilot trial

BackgroundAntenatal care is an important public health priority. Women from socially disadvantaged, and culturally and linguistically diverse groups often have difficulties with accessing antenatal care and report more negative experiences with care. Although group antenatal care has been shown in some settings to be effective for improving women’s experiences of care and for improving other maternal as well as newborn health outcomes, these outcomes have not been rigorously assessed in the UK. A pilot trial will be conducted to determine the feasibility of, and optimum methods for, testing the effectiveness of group antenatal care in an NHS setting serving populations with high levels of social deprivation and cultural, linguistic and ethnic diversity. Outcomes will inform the protocol for a future full trial.MethodsThis protocol outlines an individual-level randomised controlled external pilot trial with integrated process and economic evaluations. The two trial arms will be group care and standard antenatal care. The trial will involve the recruitment of 72 pregnant women across three maternity services within one large NHS Acute Trust. Baseline, outcomes and economic data will be collected via questionnaires completed by the participants at three time points, with the final scheduled for 4 months postnatal. Routine maternity service data will also be collected for outcomes assessment and economic evaluation purposes. Stakeholder interviews will provide insights into the acceptability of research and intervention processes, including the use of interpreters to support women who do not speak English. Pre-agreed criteria have been selected to guide the decision about whether or not to progress to a full trial.DiscussionThis pilot trial will determine if it is appropriate to proceed to a full trial of group antenatal care in this setting. If progression is supported, the pilot will provide authoritative high-quality evidence to inform the design and conduct of a trial in this important area that holds significant potential to influence maternity care, outcomes and experience.Trial registrationISRCTN ISRCTN66925258. Registered 03 April 2017. Retrospectively registered.

30-day complication rates and patient-reported outcomes following day case primary lumbar microdiscectomy in a regional NHS spinal centre

Advances in surgical and anaesthesia technique have reduced length of stay for lumbar discectomy. Current evidence suggests that daycase surgery is associated with improved patient satisfaction, faster recovery, reduced infection rates and financial savings. We present our microdiscectomy daycase protocol, together with 30-day postoperative complication rates and patient reported outcomes in an NHS setting. We retrospectively studied all patients that met a locally agreed daycase protocol for lumbar microdiscectomy and were operated upon and discharged on the same calendar day between 1 March 2013 and 31 December 2015. A total of 134 patients underwent primary daycase microdiscectomy (70 males, 64 females). The cohort had a mean age of 41 years (range 16-82 years). Some 96% (n=129) were single-level procedures, 93% were unilateral (n=125) and 81% (n=109) took place at either L4/L5 or L5/S1. All patients were discharged on the same day as admission and operation. Four patients re-presented to hospital within 30 days and three were discharged from the emergency department within four hours following a clinical review. One patient required an inpatient stay for a washout of a superficial postoperative infection. Significant improvements (P<0.05) were found postoperatively for back pain and leg pain on self-reported visual analogue scores and Oswestry Disability Index. In this study, we present a safe and effective protocol for day case lumbar microdiscectomy. Our 30-day postoperative complication rate of under 1% is comparable to that of traditional inpatient primary lumbar microdiscectomy. Patient-reported outcome measures revealed significant improvement in both pain and functional scores.

Improving access to psychological therapies (IAPT) for people with bipolar disorder: Summary of outcomes from the IAPT demonstration site

Access to structured psychological therapy recommended for bipolar disorder (BD) is poor. The UK NHS Improving Access to Psychological Therapies initiative commissioned a demonstration site for BD to explore the outcomes of routine delivery of psychological therapy in clinical practice, which this report summarises.All clinically diagnosed patients with BD who wanted a psychological intervention and were not in acute mood episode were eligible. Patients were offered a 10-session group intervention (Mood on Track) which delivered NICE congruent care. Outcomes were evaluated using an open (uncontrolled), pre-post design.Access to psychological therapy increased compared to preceding 6 years by 54%. 202 people began treatment; 81% completed >5 sessions; median 9 sessions (range 6–11). Pre-post outcomes included personal recovery (primary outcome), quality of life, work and social functioning, mood and anxiety symptoms (secondary outcomes). Personal recovery significantly improved from pre to post-therapy; medium effect-size (d = 0.52). Secondary outcomes all improved (except mania symptoms) with smaller effect sizes (d = 0.20–0.39). Patient satisfaction was high. Use of crisis services, and acute admissions were reduced compared to pre-treatment.It is possible to deliver group psychological therapy for bipolar disorder in a routine NHS setting. Improvements were observed in personal recovery, symptoms and wider functioning with high patient satisfaction and reduced service use.

Nicotine preloading for smoking cessation: the Preloading RCT.

Nicotine preloading means using nicotine replacement therapy prior to a quit date while smoking normally. The aim is to reduce the drive to smoke, thereby reducing cravings for smoking after quit day, which are the main cause of early relapse. A prior systematic review showed inconclusive and heterogeneous evidence that preloading was effective and little evidence of the mechanism of action, with no cost-effectiveness data. To assess (1) the effectiveness, safety and tolerability of nicotine preloading in a routine NHS setting relative to usual care, (2) the mechanisms of the action of preloading and (3) the cost-effectiveness of preloading. Open-label randomised controlled trial with examination of mediation and a cost-effectiveness analysis. NHS smoking cessation clinics. People seeking help to stop smoking. Nicotine preloading comprised wearing a 21 mg/24 hour nicotine patch for 4 weeks prior to quit date. In addition, minimal behavioural support was provided to explain the intervention rationale and to support adherence. In the comparator group, participants received equivalent behavioural support. Randomisation was stratified by centre and concealed from investigators. The primary outcome was 6-month prolonged abstinence assessed using the Russell Standard. The secondary outcomes were 4-week and 12-month abstinence. Adverse events (AEs) were assessed from baseline to 1 week after quit day. In a planned analysis, we adjusted for the use of varenicline (Champix®; Pfizer Inc., New York, NY, USA) as post-cessation medication. Cost-effectiveness analysis took a health-service perspective. The within-trial analysis assessed health-service costs during the 13 months of trial enrolment relative to the previous 6 months comparing trial arms. The base case was based on multiple imputation for missing cost data. We modelled long-term health outcomes of smoking-related diseases using the European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) model. In total, 1792 people were eligible and were enrolled in the study, with 893 randomised to the control group and 899 randomised to the intervention group. In the intervention group, 49 (5.5%) people discontinued preloading prematurely and most others used it daily. The primary outcome, biochemically validated 6-month abstinence, was achieved by 157 (17.5%) people in the intervention group and 129 (14.4%) people in the control group, a difference of 3.02 percentage points [95% confidence interval (CI) -0.37 to 6.41 percentage points; odds ratio (OR) 1.25, 95% CI 0.97 to 1.62; p = 0.081]. Adjusted for use of post-quit day varenicline, the OR was 1.34 (95% CI 1.03 to 1.73; p = 0.028). Secondary abstinence outcomes were similar. The OR for the occurrence of serious AEs was 1.12 (95% CI 0.42 to 3.03). Moderate-severity nausea occurred in an additional 4% of the preloading group compared with the control group. There was evidence that reduced urges to smoke and reduced smoke inhalation mediated the effect of preloading on abstinence. The incremental cost-effectiveness ratio at the 6-month follow-up for preloading relative to control was £710 (95% CI -£13,674 to £23,205), but preloading was dominant at 12 months and in the long term, with an 80% probability that it is cost saving. The open-label design could partially account for the mediation results. Outcome assessment could not be blinded but was biochemically verified. Use of nicotine-patch preloading for 4 weeks prior to attempting to stop smoking can increase the proportion of people who stop successfully, but its benefit is undermined because it reduces the use of varenicline after preloading. If this latter effect could be overcome, then nicotine preloading appears to improve health and reduce health-service costs in the long term. Future work should determine how to ensure that people using nicotine preloading opt to use varenicline as cessation medication. Current Controlled Trials ISRCTN33031001. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 41. See the NIHR Journals Library website for further project information.

Relieving pressure – An evaluation of Shiatsu treatments for cancer & palliative care patients in an NHS setting

IntroductionThe study investigated the effectiveness of Shiatsu therapy in relation to the management of health and wellbeing concerns of cancer and palliative care patients in an out-patient clinic. MethodPatients are referred to the Complementary Therapies Service for symptom management, particularly stress and anxiety, but also other symptoms such as nausea or insomnia. Data was collected following use of the Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire, which was designed for evaluating supportive care interventions. ResultsMean changes in post-intervention MYCaW scores were highly significant (p < 0.001), demonstrating considerable improvements in both presenting symptoms and perceptions of wellbeing. Based on a significance level of 0.05, both the Wilcoxon signed-ranks test and the two-tailed t-test indicated that post-treatment ranks and means were statistically significantly lower than pre-treatment ranks and means in the categories. ConclusionAnxiety, stress management and pain scores were the most improved. Wellbeing scores also improved, on average, by two points on the Likert scale. Patients stated that ‘being listened to’ and ‘being heard’ were important factors when describing how Shiatsu had helped.We suggest that a study using larger numbers is necessary in order to provide more robust evidence rather than emerging trends.

Evaluation of a peer support specialist led group

PurposeThe purpose of this paper is to evaluate a Peer Support Specialist (PSS) and NHS practitioner co-produced “Enabling Recovery” group that supports service-users’ recovery whilst providing pathways for appropriate transition from mental health teams.Design/methodology/approachThe sample included 23 service-users (f=10, m=13) with a range of mental health conditions. The evaluation set out to assess how the attendees experienced the group and the impact of the group on subsequent contact with services. The design involved a content analysis of focus groups and group evaluation forms; an assessment of direct and indirect contacts made in the three months prior, and following, the group; and a record of the number of discharges and referrals made following the group.FindingsGroup content and social contact were rated as most helpful and cognitive demands and paperwork as least helpful. Number of direct and indirect contacts significantly reduced, four attendees were discharged due to improved mental health and 17 began accessing third-sector/community organisations.Research limitations/implicationsFuture evaluations could seek feedback from service-users who disengaged from the group and indirect contacts could be broadened to include service initiated contacts.Practical implicationsFindings suggest that PSS and NHS Practitioner co-produced group interventions are effective in reducing service demand and increasing service-user satisfaction.Originality/valueThis paper adds a novel contribution to the PSS literature offering support to the utility of co-produced PSS interventions in an NHS setting.

Supporting parents and children prior to parental death in an NHS setting

The Children and Families Service in Fife Specialist Palliative Care adopts a psycho-educational model of support which offers advice and information to enable parents to prepare themselves and their children for parental dying, death and bereavement. The role of the Children and Families Practitioner is to support the family as early as possible, through each stage of their journey through bereavement, as far as possible. Working closely with school staff and other services ensures that everyone concerned has the information they need from us to support the children and young people concerned.

A randomised controlled trial, cost-effectiveness and process evaluation of the implementation of self-management for chronic gastrointestinal disorders in primary care, and linked projects on identification and risk assessment

BackgroundChronic gastrointestinal disorders are major burdens in primary care. Although there is some evidence that enhancing self-management can improve outcomes, it is not known if such models of care can be implemented at scale in routine NHS settings and whether or not it is possible to develop effective risk assessment procedures to identify patients who are likely to become chronically ill.ObjectivesWhat is the clinical effectiveness and cost-effectiveness of an intervention to enhance self-management support for patients with chronic conditions when translated from research settings into routine care? What are the barriers and facilitators that affect the implementation of an intervention to enhance self-management support among patients, clinicians and organisations? Is it possible to develop methods to identify patients at risk of long-term problems with functional gastrointestinal disorders in primary care? Data sources included professional and patient interviews, patient self-report measures and data on service utilisation.DesignA pragmatic, two-arm, practice-level cluster Phase IV randomised controlled trial evaluating outcomes and costs associated with the intervention, with associated process evaluation using interviews and other methods. Four studies around identification and risk assessment: (1) a general practitioner (GP) database study to describe how clinicians in primary care record consultations with patients who experience functional lower gastrointestinal symptoms; (2) a validation of a risk assessment tool; (3) a qualitative study to explore GPs’ views and experiences; and (4) a second GP database study to investigate patient profiles in irritable bowel syndrome, inflammatory bowel disease and abdominal pain.SettingSalford, UK.ParticipantsPeople with long-term conditions and professionals in primary care.InterventionsA practice-level intervention to train practitioners to assess patient self-management capabilities and involve them in a choice of self-management options.Main outcome measuresPatient self-management, care experience and quality of life, health-care utilisation and costs.ResultsNo statistically significant differences were found between patients attending the trained practices and those attending control practices on any of the primary or secondary outcomes. The intervention had little impact on either costs or effects within the time period of the trial. In the practices, self-management tools failed to be normalised in routine care. Full assessment of the predictive tool was not possible because of variable case definitions used in practices. There was a lack of perceived clinical benefit among GPs.LimitationsThe intervention was not implemented fully in practice. Assessment of the risk assessment tool faced barriers in terms of the quality of codting in GP databases and poor recruitment of patients.ConclusionsThe Whole system Informing Self-management Engagement self-management (WISE) model did not add value to existing care for any of the long-term conditions studied.Future workThe active components required for effective self-management support need further study. The results highlight the challenge of delivering improvements to quality of care for long-term conditions. There is a need to develop interventions that are feasible to deliver at scale, yet demonstrably clinically effective and cost-effective. This may have implications for the piloting of interventions and linking implementation more clearly to local commissioning strategies.Trial registrationCurrent Controlled Trial ISRCTN90940049.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.

A protocol for an economic evaluation of a polypill in patients with established or at high risk of cardiovascular disease in a UK NHS setting: RUPEE (NHS) study

IntroductionThe ‘Use of a Multi-drug Pill in Reducing cardiovascular Events’ (UMPIRE) trial was a randomised controlled clinical trial evaluating the impact of a polypill strategy on adherence to indicated medication...

Practical strategies to help develop dementia-friendly hospital wards.

Hospital stays can have significant negative effects for people with dementia. This article explores methods of improving dementia care in general hospital wards. Taking its starting point as the importance of person-centred care, it explores ways of improving the ward environment, meaningful activities, personal history work, involving carers, and identifying and treating delirium. Practical strategies are suggested in each of these areas. The article acknowledges that implementing change can be challenging in NHS settings where wards are understaffed, and time is precious. However, it encourages all nurses working in these settings to recognise the importance of person-centred care for people with dementia and to make even small changes that can have a significant effect.

Health psychology and acronyms: Defining a well-PACED profession and an A-Z guide to Stage 2 health psychology training

Over the last decade, there has been increasing attention on the identity and role of health psychologists (Hamlet et al., 2017; Hilton &amp; Johnston, 2017), including stage 2 training experiences (Hemingway, 2014; Jenkinson &amp; Naqvi, 2013; Tonk, 2001), both within the NHS (Gilinsky, 2011; Marks, 2011; Smith, 2017) and public health settings (Bunten, 2015). Such discussions suggest a need for further clarity on the work and training experiences of health psychologists. Here, Dr Jan Smith, a former trainee health psychologist, outlines key work undertaken by many health psychologists using a new acronym: PACED, and presents her A–Z guide of Stage 2 Health Psychology training experiences.

Cost-effectiveness of laparoscopic versus open distal pancreatectomy for pancreatic cancer.

BackgroundA recent Cochrane review compared laparoscopic versus open distal pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy for pancreatic cancer.MethodModel based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. A time horizon of 5 years was used. One-way and probabilistic sensitivity analyses were undertaken.ResultsThe probabilistic sensitivity analysis showed that the incremental net monetary benefit was positive (£3,708.58 (95% confidence intervals (CI) -£9,473.62 to £16,115.69) but the 95% CI includes zero, indicating that there is significant uncertainty about the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy. The probability laparoscopic distal pancreatectomy was cost-effective compared to open distal pancreatectomy for pancreatic cancer was between 70% and 80% at the willingness-to-pay thresholds generally used in England (£20,000 to £30,000 per QALY gained). Results were sensitive to the survival proportions and the operating time.ConclusionsThere is considerable uncertainty about whether laparoscopic distal pancreatectomy is cost-effective compared to open distal pancreatectomy for pancreatic cancer in the NHS setting.

Development and use of a tool for quantifying physiotherapy treatment of people with subacromial impingement syndrome/rotator cuff tendinopathy

Purpose: Physiotherapy is a key treatment approach for people with subacromial impingement syndrome/rotator cuff tendinopathy (SIS/RCT). However the individualised and multi-faceted nature of physiotherapy treatment makes it a complex intervention. For trials which incorporate physiotherapy to have content validity, it is essential that they reflect routine clinical practice. Capturing the content of physiotherapy treatment is therefore a requisite precursor stage. The purpose of this study therefore was to (i) develop a tool to (ii) quantify the nature of physiotherapy treatment of people with SIS/RCT in a secondary care, NHS setting.

PROPEL: implementation of an evidence based pelvic floor muscle training intervention for women with pelvic organ prolapse: a realist evaluation and outcomes study protocol

BackgroundPelvic Organ Prolapse (POP) is estimated to affect 41%–50% of women aged over 40. Findings from the multi-centre randomised controlled “Pelvic Organ Prolapse PhysiotherapY” (POPPY) trial showed that individualised pelvic floor muscle training (PFMT) was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. However, provision of PFMT for prolapse continues to vary across the UK, with limited numbers of women’s health physiotherapists specialising in its delivery. Implementation of this robust evidence from the POPPY trial will require attention to different models of delivery (e.g. staff skill mix) to fit with differing care environments.MethodsA Realist Evaluation (RE) of implementation and outcomes of PFMT delivery in contrasting NHS settings will be conducted using multiple case study sites. Involving substantial local stakeholder engagement will permit a detailed exploration of how local sites make decisions on how to deliver PFMT and how these lead to service change. The RE will track how implementation is working; identify what influences outcomes; and, guided by the RE-AIM framework, will collect robust outcomes data. This will require mixed methods data collection and analysis.Qualitative data will be collected at four time-points across each site to understand local contexts and decisions regarding options for intervention delivery and to monitor implementation, uptake, adherence and outcomes. Patient outcome data will be collected at baseline, six months and one year follow-up for 120 women. Primary outcome will be the Pelvic Organ Prolapse Symptom Score (POP-SS). An economic evaluation will assess the costs and benefits associated with different delivery models taking account of further health care resource use by the women. Cost data will be combined with the primary outcome in a cost effectiveness analysis, and the EQ-5D-5L data in a cost utility analysis for each of the different models of delivery.DiscussionStudy of the implementation of varying models of service delivery of PFMT across contrasting sites combined with outcomes data and a cost effectiveness analysis will provide insight into the implementation and value of different models of PFMT service delivery and the cost benefits to the NHS in the longer term.