Working with people affected by cancer – Phase 1 of a mixed methods exploration of practitioner perspectives in nutritional therapy

Introduction - Nutritional therapy (NT) is a bioscience-based branch of complementary and alternative medicine (CAM) with National Occupational Standards (NOS) and accredited training courses which include compulsory clinical training. Approximately 900 practitioners are registered with the voluntary regulator, the Complementary and Natural Healthcare Council (CNHC), but the number of unregulated practitioners is unknown. Cancer is a leading cause of death worldwide; nutrition and lifestyle factors may affect recurrence and survival rates. Many cancer patients and survivors seek individualised advice on diet and use of supplements and appropriately skilled nutritional therapy practitioners (NTP) may be well-placed to safely provide this advice. Little is known of NTPs’ perspectives on working with people affected by cancer; this study seeks to explore their views on training, use of evidence and other resources, to support the development of safe evidence-based practice in this important clinical area. Methods – An on-line anonymised questionnaire collected data from participants recruited from all UK registered NTPs. Recruitment was facilitated by the British Association for Applied Nutrition and Nutritional Therapy (BANT). Quantitative data on practitioner characteristics, years in practice, other therapies practiced and work with cancer clients were collected. Qualitative data on types of evidence used, barriers to practice and perceived training and support needs when working with clients with cancer, were collected and analysed. SPSS was used to produce descriptive statistics. Preliminary Results – 274/888 (31%) of registered NTPs participated. 61% respondents had accredited NT qualifications of which 46% were at degree or post-graduate level. 73% (202) participants indicated they also had other higher education qualifications, including 153 (56%) at degree or above. When asked to describe their position on cancer work, 17% respondents (40/238) indicated no interest, and 35% (84/238) respondents already work with cancer clients (cancer practitioners - CP). A further 48% (114/238) respondents expressed interest in starting cancer work, and typically requested specialist training and practice guidelines to support this area of clinical practice. Cancer practitioners (CP) rated searches of peer-reviewed literature as most useful for information to support practice, whereas commercial product information was rated least useful. CPs requested engagement with mainstream medicine, more access to research evidence and professional recognition to facilitate and support work with cancer clients. A need for professional networking, mentorship and/or supervision was noted by CP and non-CP respondents, which is of interest since 81% all participants worked as sole practitioners exclusively or as part of their practice, <1% worked within the NHS. Discussion & Conclusions – This is the first detailed documentation of NTP perspectives on cancer work. A number of areas have been identified for further detailed evidence to be collected using focus groups and interviews, including detailed training needs, communication with mainstream cancer professionals, access to research evidence, and professional recognition. This work will inform and support the development of professional practice guidelines for NT and inform the development of specialist training and other resources.

Barriers to working with people affected by cancer: Preliminary qualitative data from a mixed methods exploration of practitioner perspectives in nutritional therapy

Introduction: Cancer is a leading cause of death worldwide. Nutrition may affect occurrence, recurrence and survival rates and many cancer patients and survivors seek individualized nutrition advice. Appropriately skilled nutritional therapy (NT) practitioners may be well-placed to safely provide this advice, but little is known of their perspectives on working with people affected by cancer. This mixed-methods study seeks to explore their views on training, barriers to practice, use of evidence, and other resources, to support the development of safe evidence-based practice. Preliminary data on barriers to practice are reported here. Methods: Two cohorts of NT practitioners were recruited from all UK registered NT practitioners, by an on-line anonymous survey. 84 cancer practitioners (CP) and 165 non-cancer practitioners (NCP) were recruited. Mixed quantitative and qualitative data was collected by the survey. Content analysis was used to analyze qualitative data on the use of evidence, barriers to practice and perceived needs for working with clients with cancer, for further exploration using interviews and focus groups. Preliminary results: For the NCP cohort, exploring themes of perceived barriers to working with people affected by cancer suggested that perceived complexity, risk and need for caution in this area of practice were important barriers. Insufficient specialist knowledge and skills also emerged as barriers. Some NCPs perceived opposition from medical practitioners and other mainstream healthcare professions as an obstacle to starting cancer practice. To overcome these barriers, specialist training emerged as most important. For the CP cohort, in exploring the skills they considered enabled them to undertake cancer work, specialist clinical and technical knowledge emerged strongly. Only 10% CP participants did not want more work with people affected by cancer. 10% CPs reported some NHS referrals, whereas most received clients by self-referral or from other practitioners. When considering barriers that impede their cancer practice, the dominant categories for CPs were hostility or opposition by mainstream oncology professionals, and lack of dialogue and engagement with them. To overcome these barriers, CPs desired engagement with oncology professionals and recognized specialist cancer NT training. For both NCPs and CPs, evidence resources, practice guidelines and practitioner support networks also emerged as potential enablers to cancer practice. Conclusions: This is the first detailed exploration of NT practitioners’ perceived barriers to working with people affected by cancer. Acquiring specialist skills and knowledge appears important to enable NCPs to start cancer work, and for CPs with these skills, the perceived barriers appear foremost in the relationship with mainstream cancer professionals. Further exploration of these themes, and other NT practitioner perspectives on working with people affected by cancer, is underway. This work will inform and support the development of professional practice, training and other resources.

Ulster PD Scheme: Using e-portfolios and professional conversations to evidence recognition claims

Vicky Davies and Sarah Maguire are Professional Development Managers at the University of Ulster. They have many years of experience in delivering and assessing Higher Education Academy claims for recognition via accredited provision for new teaching staff and post-graduate students. More recently they led the development of the University of Ulster’s Professional Development Scheme http://www.ulster.ac.uk/centrehep/pds/ . The core elements of the PD Scheme are the production of an e-portfolio and an assessed professional conversation. This workshop will explore the learning they have acquired through developing this process and piloting it with applicants. You will have the opportunity to discuss this and to identify any transferability to your own practice.

Understanding citizen media as practice: agents, processes, publics

Much recent commentary on citizen media has focused on online platforms as means through which citizens may disseminate self-produced media content that challenges dominant discourses or makes visible hidden realities. This chapter goes beyond a concern with media content to explore the much broader range of socially situated practices that develop around citizen media. Drawing on Couldry’s proposal for a practice paradigm in media research, it suggests shifting the focus from ‘citizen media’ to ‘citizen media practices’ and demonstrates, through a case study of communication activism in the World Social Forum, how this framework can bring into view a broad range of citizen media practices (beyond those directly concerned with the production and circulation of media content), the different forms of agency that such practices make possible, and the social fabric they can help generate. I conclude by arguing that a practice framework necessitates a rethink of the way that the concept of (counter-) publics is used in the context of citizen media. Citizen media practices of the kind described here can be understood not only as practices of ‘making public’ previously unreported issues and perspectives, but as practices of public¬-making: practices that support the formation of publics.

The costs of urban growth at the fringe of a Chinese city: evidence from Jinshi Village in Suzhou

The rate of city growth in China today correlates well with an overall loss of the most fertile agricultural areas of the country. A consequence of this growth includes the rapid reshaping of peri-urban livelihoods in their densely populated fringe. The policy response from central government has focused on containing city growth and pursuing modern rural development. Both policy directions have failed, in part, to acknowledge the intrinsic nature of the urban fringe in China. This paper explores the features of the fringe of Suzhou, a fast growing city in the Yangtze River Delta. The aim is to outline potential social costs of this current policy framework, through analysing the case study of Jinshi Village. The paper advocates a different regionalist approach to policy implementation.

Digital evidence as a means of proof before the International Court of Justice

This article discusses the use of digital evidence as a means of proof before the International Court of Justice (ICJ). The absence of specific Court rules and procedures for digital evidence (with the exception of Practice Direction IX bis) is not necessarily an obstacle to its production and evaluation before the ICJ, as the general evidentiary rules can also be applied to digital evidence. The article first looks at the rules on the production of documentary evidence and then examines the specific issues related to audiovisual evidence. Finally, it examines the admissibility of digital evidence unlawfully obtained by a litigant through unilateral transborder access to data. The article concludes that, even if specific regulation may be needed as to the specific way in which authenticity and accuracy of digital evidence are to be established, the particular facts of the case and the grounds of challenge can vary widely, and it is doubtful that any regulation could be sufficiently flexible to deal with this in advance.