Cancer and serious mental illness – patient, caregiver and professional perspectives: study protocol

Aim: To explore the experience of serious mental illness and cancer from the perspective of patients, significant others and healthcare professionals involved in their care. Background: Serious mental illness is associated with poorer cancer outcomes. Those suffering from this comorbidity receive fewer specialist interventions and die earlier than the general population. Prior qualitative research in this area has comprised of a single study focussing on healthcare professionals and there is little evidence regarding the experiences of patients and caregivers.Design: A qualitative exploration using approximately 36 semi-structured interviews.Methods: Semi-structured digitally recorded interviews conducted with: adults living with serious mental illness and diagnosed with cancer; those providing them with informal support and care; and healthcare professionals. Questions will focus on the experience of having cancer and serious mental illness or caring for someone with this comorbidity, experiences of healthcare and priorities for patients and carers. Framework analysis will be used. Research Ethics Committee and Trust Research & Development approval was obtained. A steering group comprising six people with experience of either cancer or mental illness provided feedback and ratified the patient information sheets and interview schedules. Discussion: There is a paucity of research addressing stakeholder perspectives on the experience of cancer and of cancer services for people with serious mental illness. Dissemination of findings will inform practice relating to the care of an often neglected population, informing better support for their significant others and the professionals involved in their care.

Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based clinic

The problem-Musculoskeletal (MSK) symptoms are common within primary care but some GPs are not comfortable managing these; waiting times for hospital appointments are a major cause of patients’ complaints. Current UK healthcare policies emphasise a need for more community-based management. We aimed to pilot an innovative general practice-based clinic to improve the management of MSK and Sport and Exercise Medicine (SEM) symptoms within general practice.

The approach-This project was conducted in an inner-city practice of approximately 9,000 patients and 5 GP partners. The practice commissioned a novel monthly 4-hour clinic staffed by one GP with a specialist interest in MSK and SEM conditions. Each patient was allocated a 20-minute appointment. All primary care staff within the practice could refer any patient for whom they considered hospital referral appropriate, with no specific exclusion criteria. Management plans included injection therapy, exercise prescription and onward referral. After three months (August-October 2014) numbers of consultations, sources of referral, reasons for referral and management outcomes were described; patient satisfaction was assessed by questionnaire, offered to 10 randomly selected patients by reception staff and self-completed by patients. Costs of the clinic were compared to current options.

Findings- All patients (14 males; 21 females; aged 35-77 years), were seen within four weeks of referral (one third of orthopaedic referrals in 2013 waited over 9 weeks for appointment). Most were referred from other GPs; some came from physiotherapy and podiatry. Shoulder problems were the most frequent reason for referral. The commonest management option was steroid injection, with most patients being given advice regarding exercise and analgesia; there were 3 onward referrals (2 physiotherapy; 1 rheumatology).

Comparing August-October data in 2014 and 2013, total, orthopaedic and rheumatology referrals were reduced by 147, 2 and 3, respectively; within the practice MSK presentations and physiotherapy and x-ray referrals were 60, 47 and 90 fewer, respectively.

The cost per attendance at the clinic was £61; initial orthopaedic-ICAT assessments cost £82 and a consultant appointment £213.

Satisfaction questionnaires were returned by all 10 selected participants and provided positive feedback, expressing preference for community-based, rather than hospital, management.

Consequence- Our pilot study indicates that this novel service model has potential for efficient and effective management of MSK and SEM complaints in primary care, reducing the need for hospital referral and the clinical burden on general practices. The innovation deserves further evaluation in a full-scale trial to determine its generalisability to other practice settings and populations.

Understanding perception and action in sport:How can virtual reality technology help?

Although technology can facilitate improvements in performance by allowing us to understand, monitor and evaluate performance, improvements must ultimately come from within the athlete. The first part of this article will focus on understanding how perception and action relate to performance from two different theoretical viewpoints. The first will be predominantly a cognitive or indirect approach that suggests that expertise and decision-making processes are mediated by athletes accruing large knowledge bases that are built up through practice and experience. The second, and alternative approach, will advocate a more 'direct' solution, where the athlete learns to 'tune' into the relevant information that is embedded in their relationship with the surrounding environment and unfolding action. The second part of the article will attempt to show how emerging virtual reality technology is revealing new evidence that helps us understand elite performance. Possibilities of how new types of training could be developed from this technology will also be discussed. © 2014 Crown Copyright.

How to promote professional competence and identity in social work students

Background: Field placement experiences are frequently cited in the literature as having most impact on a student social worker’s learning as they emerge into the profession. Placements are integral to the development of practice competence and in acquiring a sense of social work identity. However research on the effectiveness of educational strategies used to deliver learning and assess competence during placement are scarce. Internationally, pressures to meet increasing numbers of student enrolments have raised concerns about the potential impact on the quality of placements and practice teaching provided. These pressures may also impact on the appropriate transfer and application of learning to the student’s practice.
Aim: To identify learning activities rated most useful for developing professional practice competence and professional identity of social work students.
Method: Data were collected from 396 students who successfully completed their first or final placement during 2013-2014 and were registered at one of two Universities in Northern Ireland. Students completed a self-administered questionnaire which covered: placement setting and service user group; type of supervision model; frequency of undertaking specific learning activities; who provided the learning; which activities contributed to their developing professional competence and identity and their overall satisfaction.
Our findings confirmed the centrality of the supervisory relationship as the vehicle to enable quality student learning. Shadowing others, receiving regular supervision and receiving constructive feedback were the tasks that students reported as ‘most useful’ to developing professional identity, competence and readiness to practice. Disturbingly over 50% of students reported that linking practice to the professional codes, practice foci and key roles were not valued as ‘useful’ in terms of readiness to practice, feeling competent and developing professional social work identity. These results offer strong insights into how both the University and the practice placement environment needs to better prepare, assess and support students during practice placements in the field.