Using a whole person approach to support people with cancer: a longitudinal, mixed methods service evaluation

Introduction: Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this paper is to (1) evaluate short and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC); (2) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods: Longitudinal mixed-methods service evaluation (n=135). Data collected included health related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity - MYCaW); lifestyle behaviour (bespoke questionnaire) and participants’ experiences over 12 months post course. Results: Statistically and clinically significant improvements from baseline - 12 months in severity of MYCaW Concerns (n=64; p<0.000) and mean total HRQoL (n=66; p<0.000). The majority of MYCaW concerns were ‘psychological and emotional’ and about participants’ wellbeing. Spiritual, emotional and functional wellbeing contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. 3-6 months post-course was identified as the time when more support was most likely to be needed. Conclusions: Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behaviour change were also identified. These data then informed wider and more person-centred clinical provision to increase the maintenance of positive long-term behaviour changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed.

A Knowledge Management Process-Based Approach to Support Corporate Crisis Management

In the crisis-prone and complex contemporary business environment, modern organisations and their supply chains, large and small, are challenged by crises more than ever. Knowledge management has been acknowledged as an important discipline able to support the management of complexity in times of crisis. However, the role of effective knowledge retrieval and sharing in the process of crisis prevention, management and survival has been relatively underexplored. In this paper, it is argued that organisational crises create additional challenges for knowledge management, mainly because complex, polymorphic and both structured and unstructured knowledge must be efficiently harnessed, processed and disseminated to the appropriate internal and external supply chain actors, under specific time constraints. In this perspective, a process-based approach is proposed to address the knowledge management needs of organisations during a crisis and to help management in establishing the necessary risk avoidance and recovery mechanisms. Finally, the proposed methodological approach is applied in a knowledge- intensive Greek small and medium enterprise from the pharmaceutical industry, producing empirical results, insights on knowledge pathologies during crises and relevant evaluations.

Genetic programming for the minimum time swing up and balance control acrobot problem

This work describes how genetic programming is applied to evolving controllers for the minimum time swing up and inverted balance tasks of the continuous state and action: limited torque acrobot. The best swing-up controller is able to swing the acrobot up to a position very close to the inverted ‘handstand’ position in a very short time, shorter than that of Coulom (2004), who applied the same constraints on the applied torque values, and to take only slightly longer than the approach by Lai et al. (2009) where far larger torque values were allowed. The best balance controller is able to balance the acrobot in the inverted position when starting from the balance position for the length of time used in the fitness function in all runs; furthermore, 47 out of 50 of the runs evolve controllers able to maintain the balance position for an extended period, an improvement on the balance controllers generated by Dracopoulos and Nichols (2012), which this paper is extended from. The most successful balance controller is also able to balance the acrobot when starting from a small offset from the balance position for this extended period.