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.

Marginalised Mothers: Exploring Working Class Experiences

Successive moral panics have cast poor or socially excluded mothers - associated with social problems as diverse as crime, underachievement, unemployment and mental illness - as bad mothers. Their mothering practices are held up as the antithesis of good parenting and are associated with poor outcomes for children. Marginalised Mothers provides a detailed and much-needed insight into the lived experience of mothers who are frequently the focus of public concern and intervention, yet all too often have their voices and experiences overlooked. The book explores how they make sense of their lives with their children and families, position themselves within a context of inequality and vulnerability, and resist, subvert and survive material and social marginalisation. This controversial text uses qualitative data from a selection of working class mothers to highlight the opportunities and choices they face and to expose the middle class assumptions that ground much contemporary family policy. It will be of interest to students and researchers in sociology, social work and social policy, as well as social workers and policymakers.

Charabancs and Social Class in 1930s Britain

The renowned writer J. B. Priestley suggested in 1934 that the motor-coach had annihilated the old distinction between rich and poor passengers in Britain. This article considers how true this was by examining the relationship between charabancs, motor coaches and class. It shows that this important vehicle of inter-war working class mobility had a complicated relationship with class, identifying three distinct forms of this method of travel. It positions the charabanc alongside historical responses to unwelcome steamer and railway day-trippers, and examines how resorts provided separate class-based entertainment for these holidaymakers. Using the case study of a new charabancwelcoming pub, the Prospect Inn, it proposes that, in the late 1930s, some pubs were beginning to offer charabanc customers facilities that were almost the match of their middle class equivalent. Motor coaches and charabancs contributed to the process of social convergence in inter-war Britain.

The troubling concept of class: reflecting on our ‘failure’ to encourage sociology students to re-cognise their classed locations using autobiographical methods

The troubling concept of class: reflecting on our ‘failure’ to encourage sociology students to re-cognise their classed locations using autobiographical methods Abstract This paper provides a narrative of the four authors‟ commitment to auto/biographical methods as teachers and researchers in „new‟ universities. As they went about their work, they observed that, whereas students engage with the gendered, sexualised and racialised processes when negotiating their identities, they are reluctant or unable to conceptualise „class-ifying‟ processes as key determinants of their life chances. This general inability puzzled the authors, given the students‟ predominantly working-class backgrounds. Through application of their own stories, the authors explore the sociological significance of this pedagogical „failure‟ to account for the troubling concept of class not only in the classroom but also in contemporary society.

Looking Beyond ‘White Slavery’: Trafficking, the Jewish Association’s representation of ‘the potential victim’, and the dangerous politics of migration control in England, 1890-1910

This article seeks to revise Jo Doezema’s suggestion that ‘the white slave’ was the only dominant representation of ‘the trafficked woman’ used by early anti-trafficking advocates in Europe and the United States, and that discourses based on this figure of injured innocence are the only historical discourses that are able to shine light on contemporary anti-trafficking rhetoric. ‘The trafficked woman’ was a figure painted using many shades of grey in the past, with a number of injurious consequences, not only for trafficked persons but also for female labour migrants and migrant populations at large. In England, dominant organizational portrayals of ‘the trafficked woman’ had first acquired these shades by the 1890s, when trafficking started to proliferate amid mass migration from Continental Europe, and when controversy began to mount over the migration to the country of various groups of working-class foreigner. The article demonstrates these points by exploring the way in which the Jewish Association for the Protection of Girls and Women (JAPGW), one of the pillars of England’s early anti-trafficking movement, represented the female Jewish migrants it deemed at risk from being trafficked into sex work between 1890 and 1910. It argues that the JAPGW stigmatised these women, placing most of the onus for trafficking upon them and positioning them to a greater or a lesser extent as ‘undesirable and undeserving working-class foreigners’ who could never become respectable English women. It also contends that the JAPGW, in outlining what was wrong with certain female migrants, drew a line between ‘the migrant’ and respectable English society at large, and paradoxically endorsed the extension of the very ‘anti-alienist’ and Antisemitic prejudices that it strove to dispel.