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 psychosocial approach to understanding pilot and controller acceptance of change in ATM, based on three CDA case studies

Next generation ATM systems cannot be implemented in a technological vacuum. The further ahead we look, the greater the likely impact of societal factors on such changes, and how they are prioritised and promoted. The equitable sustainability of travel behaviour is rising on the political agenda in Europe in an unprecedented manner. This paper examines pilot and controller attitudes towards Continuous Descent Approaches (CDAs). It aims to promote a better understanding of acceptance of change in ATM. The focus is on the psychosocial context and the relationships between perceived societal and system benefits. Behavioural change appeared more correlated with such benefit perceptions in the case of the pilots. For the first time in the study of ATM implementation, and acceptance of change, this paper incorporates the Seven Stages of Change model, based on the constructs of the Theory of Planned Behaviour. It employs a principal components (factor) analysis, and further explores the intercorrelations of benefit perceptions, known in psychology as the ‘halo effect’. Disbenefit perceptions may break down this effect, it appears. For implementers of change, this evidence suggests an approach in terms of reinforcing the dominant benefit(s) perceived, for sub-groups within which a halo effect is evident. In the absence of such an effect, perceived disbenefits, such as with respect to workload and capacity, should be off-set against specific, perceived benefits of the change, as far as possible. This methodology could be equally applied to other stakeholders, from strategic planners to the public. The set of three case studies will be extended beyond CDA trials. A set of concise guidelines will be published with a strong focus on practical advice, in addition to continued work enabling a better understanding of the expected, increasing psychosocial contributions to successful and unsuccessful efforts at ATM innovation and change.

Repeat-measures longitudinal study evaluating behavioural and gastrointestinal symptoms in children with autism before, during and after visceral osteopathic technique (VOT)

Summary: This study investigated the influence of visceral osteopathic technique (VOT) on the behaviour and gastrointestinal (GI) symptoms of children with autism using a validated questionnaire to measure outcome. Methods: The 49 recruited autistic children suffered GI symptoms and impaired social interaction and communication, but were otherwise healthy. Thirty minute VOT sessions were applied to the abdomens of the children over a 6 week period whilst their GI and behavioural parameters were recorded. Outcomes were measured using a modified Autism Research Institute Secretin Outcomes Survey Form, the ‘S.O.S Form’. Four questionnaires were completed by parents before treatment (control period), four completed during treatment (treatment period) and one completed six weeks after the last treatment (post treatment period). Subjects acted as their own controls. Results: Results from repeat ANOVA demonstrated a positive, overall significant, symptomatic improvement (p < 0.05) in ‘social behaviour and communication’ and ‘digestive signs’ subscales of the questionnaire comparing before and after VOT. Significant improvement in vomiting (p = 0.00029), poor appetite (p = 0.039) and eye contact (p = 0.035) was also demonstrated after VOT application. Discussion and conclusion: The experimental hypothesis has been supported indicating a positive effect of VOT on some of the measured GI symptoms and behavioural patterns in this group of children with autism. This data indicates that the application of VOT may be of benefit to children with autism and GI disturbance.