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Successful Grants 2005-2009 1. Information for Choice: what people need, prefer and use 5. Reducing time to presentation with symptoms of lung cancer: phase II complex intervention study |
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1. Information for Choice: what people need, prefer and use Choice is at the heart of Government health policies but it is meaningless without information. This research focuses on people’s needs, preferences and use of information in relation to a range of types of choices (such as kind of treatment, whether to undergo screening, how to care for a loved one) that have different implications, are faced at different life stages, or are faced by high risk groups. The research focuses on five health issues throughout (antenatal screening (including the decision to end a pregnancy because of foetal abnormality); being at high risk of and screening for sickle cell disorder; caring for people with dementia; and having lymphoma) and is conducted in three stages.
The research will inform the development of policy relating to the provision of health information in a variety of ways. The researchers have consulted with policy makers already and have set up a ‘user group’ that will include people interested in the provision of health information to advise on the development of the research and the interpretation of its findings. In January 2009 stages 1 and 2 have been completed and interim reports approved by NIHR SDO. Stage 3 is due to report in November 2009. |
Sally Wyke Vikki Entwistle Kate Hunt Sue Ziebland Andy Thompson Ruth Jepson |
Stirling SDHI Edinburgh
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SDO |
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2. Response to being informed of weight status and body fat composition. Understandings, reactions and motivation to achieve a healthy weight
The most important preventable cause of cancer in non-smokers is excess body weight. Knowing one’s weight status and the health-related risks of obesity/overweight may motivate some people to lose weight but response to learning weight status is poorly understood. In order to target advice to the two thirds of British adults who are overweight or obese more effectively it is important to investigate response to the terms ‘overweight’ and ‘obese’; in particular whether being told weight status is motivational or demoralising in relation to losing weight. This project aims to to investigate response to terms such as ‘overweight’ and ‘obese’ in relation to motivation to lose weight. It will answer 5 research questions:
The West of Scotland Twenty-07 study is a population-based cohort study designed to investigate social inequalities in health. By September 2008 2300 participants will have completed structured interviews and measurements including height, weight, waist and hip measurements and percentage of body fat; they will also have received written feedback. Sub-sampling from this study offers a unique opportunity to access respondents who have recently been informed that they are overweight, but who may not be motivated to lose weight. The research will therefore be based on personal experiences rather than on hypothetical reasoning. A qualitative study allows investigation of people’s interpretations and reasoning as well as their behaviours. Sixteen focus group discussions and 16 individual interviews (8 of each with men and women; 4 of each with people of ‘normal’ weight and 12 of each with people who are overweight/obese) are being conducted and transcribed. Analysis will focus on answering the research questions, but with attention to unanticipated issues that arise. All analyses will focus on difference or similarity in accounts between people of ‘normal’ weight status compared to those who are overweight/obese, and to possible differences between men and women. Careful timetabling, good management and an advisory group will lead to the implications of the research for cancer prevention communications about obesity and risk being quickly available and widely disseminated. |
Sally Wyke Kate Hunt Annie Anderson M. Benzeval Cindy Gray |
Stirling Glasgow Dundee MRC |
CRUK |
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3. Responses to chest pain. Development and initial evaluation of an evidence-based information resource The aim of this PhD studentship was to develop, and undertake initial evaluation of, an information resource to help people with chest pain assess their pain and decide to seek early professional help. A multi phase study was conducted. First, in focus group discussions (n=6) and individual interviews (n=18), 24 men and 21 women talked about their experiences and expectations of chest pain or other symptoms of heart disease. Interviewees were from four patient groups: group A, people who had experienced symptoms which were later diagnosed as cardiac in origin; group B, patients who had been referred to a rapid access chest pain clinic who received a non-cardiac diagnosis for their symptoms; group C, spouses of people in Groups A & B; and group D, patients at high risk of heart disease. Secondly, selected excerts from these patient accounts were included in a draft information resource together with appropriate best-available medical guidance for people with symptoms of a potential heart attack. Thirdly, feedback on this draft resource was sought from patients in focus groups (n=3) and semi-structured interviews (n=8), and from health professionals. A further draft was produced and discussed, leading to the production of a third draft of the information resource. When groups A and B tried to make sense of their symptom experiences they drew on a wide range of biographical and common-sense knowledge about health, illness and in some cases either experiential or more formal knowledge about heart disease. Some immediately attributed their symptoms to something ‘serious’ and quickly sought professional help. These people described their pain as severe or they had a history of heart disease. However, most respondents did not seek immediate professional help because they attributed their symptoms to something other than heart disease, such as gastrointestinal complaints, on-going medical conditions and work-related injury or stress. Notably many respondents with cardiac and non-cardiac diagnoses (i.e. groups A and B) had similar accounts. Spouses played a role in their partner’s decision to seek medical help; once they became aware of their partner’s symptoms the decision to seek medical help quickly followed. Patients with experience of consulting for chest pain and related symptoms and those at high risk of heart disease were positive about including real patients’ accounts of their symptoms rather than a general description of symptoms. The research concluded that patient information resources need to be appropriate and correctly designed for their target audiences. This study combined the experiences of people in a number of patient groups with the guidelines on the management of chest pain. In line with policy and best practice guidelines, patient involvement was integral throughout the design and development process. The final resource produced was grounded in the patients’ experiences. The final report on the studentship has been accepted by CSO and the PhD thesis is near completion. |
Sally Wyke Kate Hunt Helen Richards Patricia Thomson |
Stirling SPHSRU MRC |
CSO PhD Studentship |
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4. Promoting the use of personal asthma plans in Scotland through development of an evidence-base for healthcare practice
The objective of this research was to investigate how best to encourage health professionals to promote, and for people with asthma to use, asthma action plans. A systematic review of randomised controlled trials published between 1960 and 2006 was undertaken, using multiple electronic databases. Unpublished and on-going studies were identified by contacting asthma experts internationally. Included trials reported outcome data for the promotion of action plans including issue by health professionals, and patient ownership and use. Fourteen trials satisfied our study inclusion criteria. Of these, only four studies reported data for action plan use. Interventions including education of doctors and people with asthma, telephone reinforcement, partially completed action plans and postal prompts inviting patients for general practice review, school asthma clinics and asthma management systems (the 3+ plan with patient recall for review and Internet-based physician monitoring) increased action plan ownership, use or facilitation of use. Two of the highest quality papers were conducted in primary care and demonstrate the effectiveness of interventions directed at the organisation of asthma care in promoting action plan use. The study concluded that primary care professionals could encourage the ownership and use of action plans through the implementation of proactive practice-based organisational systems, though further research is required to assess their practicality and effect on sustaining use long-term. Multi-disciplinary teams working in areas where asthma action plan ownership and use is sub-optimal should therefore consider how such interventions could be incorporated into existing practices and healthcare systems. |
Nicola Ring Sally Wyke Cari Malcolm S MacGillivray Diane Dixon Gaylor Hoskins Hilary Pinnock Aziz Sheikh |
Stirling Abertay Edinburgh |
NHS QIS |
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5. Reducing time to presentation with symptoms of lung cancer: phase II complex intervention study
Lung cancer survival rates in the United Kingdom are poor compared with other developed countries and an important explanatory factor is later stage disease at diagnosis. The total time between onset of symptoms and diagnosis is frequently long, with the longest component before presentation (median time 99 days). There are calls for strategies to reduce time to presentation, but no evaluated means to achieve this. If time to presentation could be shortened, there is potential for more lung cancers to be diagnosed at a stage when they are treatable. This could improve lung cancer survival rates. This project aims to investigate whether a theoretically-based educational intervention in primary care can reduce time between onset of, and presentation with, lung cancer symptoms. Guided by the MRC framework, we have developed a complex intervention to be delivered in primary care. Our intervention is targeted at high risk patients (>55 years smokers and ex-smokers) and delivered by nurse consultation and a self-management manual. It has been developed using a causal modelling approach and uses evidence-based behavioural interventions. Key components will 1) increase the salience and personal relevance of symptoms, 2) improve knowledge of symptoms by introducing chest disease "prototypes", 3) reinforce the benefits of early intervention in lung cancer and other chest diseases, 3) "sanction" early consultation and encourage sanctioning by others, 4) tackle barriers to consulting, and 5) provide personalised action plans. In a focus group study, we have identified barriers and facilitators in order to optimise implementation. In a phase II randomised trial of 200 high risk participants in two general practices, we are evaluating how our intervention affects consulting behaviour. Secondary process and behavioural outcomes are being used to track our intervention's effects on its theoretical mechanisms of action. In a parallel qualitative study of 10 additional patients, 10 health professionals and 10 participants in the phase II randomised trial, we are exploring positive and negative reactions of participating patients and professionals to the intervention. |
Neil Campbell Sarah Smith Peter Murchie Sally Wyke Lewis Ritchie M Nicolson Marie Johnston Amanda Lee Rachel Power |
Aberdeen Stirling Aberdeen Royal Infirmary |
CRUK |
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6. Living well with multiple morbidity. The development and evaluation of a primary care-based complex intervention to support patients with multiple morbidities
Scotland has increasing numbers of people with long-term conditions such as heart disease, diabetes, obesity, and arthritis. The challenge of managing long-tern condition is of huge concern to policy makers, the NHS and to our wider society because of the rising costs of healthcare and their impact on both quality and quantity of life. Inequalities in health and healthcare are also a problem; people living in poorer areas have worse health and die at a younger age on average than people living in richer areas. In these areas the provision of healthcare does not match the need for it. Long-term conditions often come together; multiple morbidity (the co-existence of 2 or more long-term conditions in an individual) is the norm rather than the exception and in deprived areas occurs at a younger age. Primary health care teams - GPs, primary and community care nurses and other health professionals - are often in the best position to help people manage their complex multiple health problems but there is very little research evidence about what kind of help is most likely to work and why. What we do know is that help and support is most likely to work when it is based around individuals’ own needs and problems and they have an active role in manageing their conditions better. To do this we need changes in the way the health system operates, in the way health professionals work to support and care for patients, and in the way patients respond and manage their health. This is called a ‘whole system’ approach. Our overall aim is to develop and evaluate a primary care-led whole-system intervention that helps people to live well with multiple morbidity There are five inter-linked workstreams. Workstream 1 will determine how common multiple morbidity is in deprived areas of Scotland (compared with less deprived areas) and establish how to ‘target’ it for maximum benefit. Workstream 2 will develop the background for the complex intervention through literature and website review, expert opinion and input from professional, patient and voluntary sector groups. Workstream 3 will evaluate the feasibility of the delivery of the intervention. Workstream 4 will evaluate the likely economic impact of the programme. Workstream 5 will be an exploratory ‘randomised controlled trial’ (RCT) where GP practices will be randomly selected to receive the intervention or not, in order to assess the feasibility and likely benefit of the intervention, including the likely cost-effectiveness. The expected outcomes and benefits for health service provision, patients, and the public are; a thorough understanding of the healthcare (including self-care) needs of patients with multiple chronic conditions in Scotland, including the scale of the problem, how best to identify and target those who stand to gain most from an intervention, and what the individual parts of a whole system intervention should be. The feasibility and likely impact of the intervention will be established, leading the way to a future large-scale definitive evaluation. |
Graham Watt Stewart Mercer Sally Wyke E Fenwick Bruce Guthrie Terry Findlay |
Glasgow Dundee Stirling |
CSO |
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