• Heuristic assessment of psychological interventions in schools (HAPI Schools)

      Platt, Ian A.; orcid: 0000-0003-2497-6713; email: iap1hss@bolton.ac.uk; Kannangara, Chathurika; orcid: 0000-0001-6955-8158; Carson, Jerome; orcid: 0000-0002-7596-116X; Tytherleigh, Michelle; orcid: 0000-0003-2498-8175 (2021-05-02)
      Abstract: Children spend more time in school than in any other formal setting and, with mental illness in children on the rise, there is more pressure on schools to intervene in student mental health than ever before. In the current study, two phases of semistructured interviews were conducted with school leaders and special educational needs coordinators (Phase 1, N = 23; Phase 2, N = 11), to investigate first‐hand experiences in dealing with student mental illness. Thematic analysis, drawing on Grounded Theory, was used to identify themes. The results identified deprivation as one of the main causes of mental ill‐health in students, with insufficient budgets, inappropriate mental health services, and overly long waiting times as barriers to intervention. Difficulties in identifying appropriate mental health interventions to use in school were also reported. The authors propose a simple four‐point heuristic, for assessing the quality of school‐based mental health interventions to be used by school staff, so that educators can more readily identify appropriate mental health support for their students.
    • Validation of CIP2A as a Biomarker of Subsequent Disease Progression and Treatment Failure in Chronic Myeloid Leukaemia

      Clark, Richard E.; email: clarkre@liverpool.ac.uk; Basabrain, Ammar A.; email: a.a.basabrain@liverpool.ac.uk; Austin, Gemma M.; email: gemmajon2003@yahoo.co.uk; Holcroft, Alison K.; email: alisonkholcroft@hotmail.co.uk; Loaiza, Sandra; email: sandra.loaiza@nhs.net; Apperley, Jane F.; email: j.apperley@imperial.ac.uk; Law, Christopher; email: K.C.Law@liverpool.ac.uk; Scott, Laura; email: l.scott1@liverpool.ac.uk; Parry, Alexandra D.; email: alexparry@virginmedia.com; Bonnett, Laura; orcid: 0000-0002-6981-9212; email: L.J.Bonnett@liverpool.ac.uk; et al. (MDPI, 2021-04-29)
      Background: It would be clinically useful to prospectively identify the risk of disease progression in chronic myeloid leukaemia (CML). Overexpression of cancerous inhibitor of protein phosphatase 2A (PP2A) (CIP2A) protein is an adverse prognostic indicator in many cancers. Methods: We examined CIP2A protein levels in diagnostic samples from the SPIRIT2 trial in 172 unselected patients, of whom 90 received imatinib and 82 dasatinib as first-line treatment. Results: High CIP2A levels correlated with inferior progression-free survival (p = 0.04) and with worse freedom from progression (p = 0.03), and these effects were confined to dasatinib recipients. High CIP2A levels were associated with a six-fold higher five-year treatment failure rate than low CIP2A levels (41% vs. 7.5%; p = 0.0002), in both imatinib (45% vs. 11%; p = 0.02) and dasatinib recipients (36% vs. 4%; p = 0.007). Imatinib recipients with low CIP2A levels had a greater risk of treatment failure (p = 0.0008). CIP2A levels were independent of Sokal, Hasford, EUTOS (EUropean Treatment and Outcome Study), or EUTOS long-term survival scores (ELTS) or the presence of major route cytogenetic abnormalities. No association was seen between CIP2A levels and time to molecular response or the levels of the CIP2A-related proteins PP2A, SET, SET binding protein 1 (SETBP1), or AKT. Conclusions: These data confirm that high diagnostic CIP2A levels correlate with subsequent disease progression and treatment failure. CIP2A is a simple diagnostic biomarker that may be useful in planning treatment strategies.
    • Women in British Buddhism: Commitment, Connection, Community

      LLewellyn, Dawn (Informa UK Limited, 2021-04-26)
    • Vitamin B12 status in health and disease: a critical review. Diagnosis of deficiency and insufficiency – clinical and laboratory pitfalls

      Sobczyńska-Malefora, Agata; orcid: 0000-0001-7349-9517; Delvin, Edgard; McCaddon, Andrew; Ahmadi, Kourosh R.; Harrington, Dominic J.; orcid: 0000-0003-4786-9240 (Informa UK Limited, 2021-04-21)
    • Sarcopenia estimation using psoas major enhances P-POSSUM mortality prediction in older patients undergoing emergency laparotomy: cross-sectional study.

      Simpson, Gregory; orcid: 0000-0002-9779-1747; email: gregorysimpson@doctors.org.uk; Wilson, Jeremy; Vimalachandran, Dale; McNicol, Frances; Magee, Conor (2021-04-21)
      Emergency laparotomy is a considerable component of a colorectal surgeon's workload and conveys substantial morbidity and mortality, particularly in older patients. Frailty is associated with poorer surgical outcomes. Frailty and sarcopenia assessment using Computed Tomography (CT) calculation of psoas major area predicts outcomes in elective and emergency surgery. Current risk predictors do not incorporate frailty metrics. We investigated whether sarcopenia measurement enhanced mortality prediction in over-65 s who underwent emergency laparotomy and emergency colorectal resection. An analysis of data collected prospectively during the National Emergency Laparotomy Audit (NELA) was conducted. Psoas major (PM) cross-sectional area was measured at the L3 level and a ratio of PM to L3 vertebral body area (PML3) was calculated. Outcome measures included inpatient, 30-day and 90-day mortality. Statistical analysis was conducted using Mann-Whitney, Chi-squared and receiver operating characteristics (ROC). Logistic regression was conducted using P-POSSUM variables with and without the addition of PML3. Nine-hundred and forty-four over-65 s underwent emergency laparotomy from three United Kingdom hospitals were included. Median age was 76 years (IQR 70-82 years). Inpatient mortality was 21.9%, 30-day mortality was 16.3% and 90-day mortality was 20.7%. PML3 less than 0.39 for males and 0.31 for females indicated significantly worse outcomes (inpatient mortality 68% vs 5.6%, 30-day mortality 50.6% vs 4.0%,90-day mortality 64% vs 5.2%, p < 0.0001). PML3 was independently associated with mortality in multivariate analysis (p < 0.0001). Addition of PML3 to P-POSSUM variables improved area under the curve (AUC) on ROC analysis for inpatient mortality (P-POSSUM:0.78 vs P-POSSUM + PML3:0.917), 30-day mortality(P-POSSUM:0.802 vs P-POSSUM + PML3: 0.91) and 90-day mortality (P-POSSUM:0.79 vs P-POSSUM + PML3: 0.91). PML3 is an accurate predictor of mortality in over-65 s undergoing emergency laparotomy. Addition of PML3 to POSSUM appears to improve mortality risk prediction.
    • Vitamin B

      Sobczyńska-Malefora, Agata; orcid: 0000-0001-7349-9517; Delvin, Edgard; McCaddon, Andrew; Ahmadi, Kourosh R; Harrington, Dominic J; orcid: 0000-0003-4786-9240 (2021-04-21)
      Vitamin B (cobalamin) is an essential cofactor for two metabolic pathways. It is obtained principally from food of animal origin. Cobalamin becomes bioavailable through a series of steps pertaining to its release from dietary protein, intrinsic factor-mediated absorption, haptocorrin or transcobalamin-mediated transport, cellular uptake, and two enzymatic conversions ( methionine synthase and methylmalonyl-CoA-mutase) into cofactor forms: methylcobalamin and adenosylcobalamin. Vitamin B deficiency can masquerade as a multitude of illnesses, presenting different perspectives from the point of view of the hematologist, neurologist, gastroenterologist, general physician, or dietician. Increased physician vigilance and heightened patient awareness often account for its early presentation, and testing sometimes occurs during a phase of vitamin B insufficiency before the main onset of the disease. The chosen test often depends on its availability rather than on the diagnostic performance and sensitivity to irrelevant factors interfering with vitamin B markers. Although serum B is still the most commonly used and widely available test, diagnostics by holotranscobalamin, serum methylmalonic acid, and plasma homocysteine measurements have grown in the last several years in routine practice. The lack of a robust absorption test, coupled with compromised sensitivity and specificity of other tests (intrinsic factor and gastric parietal cell antibodies), hinders determination of the cause for depleted B status. This can lead to incorrect supplementation regimes and uncertainty regarding later treatment. This review discusses currently available knowledge on vitamin B , informs the reader about the pitfalls of tests for assessing its deficiency, reviews B status in various populations at different disease stages, and provides recommendations for interpretation, treatment, and associated risks. Future directions for diagnostics of B status and health interventions are also discussed.
    • Toward ‘Vaccine Internationalism’: The Need for an Equitable and Coordinated Global Vaccination Approach to Effectively Combat COVID-19

      Wong, Brian L. H.; email: b.wong@ucl.ac.uk; Green, Manfred S.; reid, John; Martin-Moreno, Jose M.; Davidovitch, Nadav; Chambaud, Laurent; Leighton, Lore; Sheek-Hussein, Mohamud; Dhonkal, Ranjeet; Otok, Robert; et al. (Frontiers Media S.A., 2021-04-14)
    • Tears evoke the intention to offer social support: A systematic investigation of the interpersonal effects of emotional crying across 41 countries

      Zickfeld, Janis H.; van de Ven, Niels; Pich, Olivia; Schubert, Thomas W.; Berkessel, Jana B.; Pizarro, José J.; Bhushan, Braj; Mateo, Nino Jose; Barbosa, Sergio; Sharman, Leah; et al. (Elsevier, 2021-04-13)
      Tearful crying is a ubiquitous and likely uniquely human phenomenon. Scholars have argued that emotional tears serve an attachment function: Tears are thought to act as a social glue by evoking social support intentions. Initial experimental studies supported this proposition across several methodologies, but these were conducted almost exclusively on participants from North America and Europe, resulting in limited generalizability. This project examined the tears-social support intentions effect and possible mediating and moderating variables in a fully pre-registered study across 7007 participants (24,886 ratings) and 41 countries spanning all populated continents. Participants were presented with four pictures out of 100 possible targets with or without digitally-added tears. We confirmed the main prediction that seeing a tearful individual elicits the intention to support, d = 0.49 [0.43, 0.55]. Our data suggest that this effect could be mediated by perceiving the crying target as warmer and more helpless, feeling more connected, as well as feeling more empathic concern for the crier, but not by an increase in personal distress of the observer. The effect was moderated by the situational valence, identifying the target as part of one's group, and trait empathic concern. A neutral situation, high trait empathic concern, and low identification increased the effect. We observed high heterogeneity across countries that was, via split-half validation, best explained by country-level GDP per capita and subjective well-being with stronger effects for higher-scoring countries. These findings suggest that tears can function as social glue, providing one possible explanation why emotional crying persists into adulthood.
    • Physiological Characteristics of Female Soccer Players and Health and Performance Considerations: A Narrative Review.

      Randell, Rebecca K; orcid: 0000-0003-1141-9766; email: rebecca.randell@pepsico.com; Clifford, Thomas; Drust, Barry; Moss, Samantha L; Unnithan, Viswanath B; De Ste Croix, Mark B A; Datson, Naomi; Martin, Daniel; Mayho, Hannah; Carter, James M; et al. (2021-04-12)
      Female soccer has seen a substantial rise in participation, as well as increased financial support from governing bodies over the last decade. Thus, there is an onus on researchers and medical departments to develop a better understanding of the physical characteristics and demands, and the health and performance needs of female soccer players. In this review, we discuss the current research, as well as the knowledge gaps, of six major topics: physical demands, talent identification, body composition, injury risk and prevention, health and nutrition. Data on female talent identification are scarce, and future studies need to elucidate the influence of relative age and maturation selection across age groups. Regarding the physical demands, more research is needed on the pattern of high-intensity sprinting during matches and the contribution of soccer-specific movements. Injuries are not uncommon in female soccer players, but targeting intrinsically modifiable factors with injury prevention programmes can reduce injury rates. The anthropometric and physical characteristics of female players are heterogeneous and setting specific targets should be discouraged in youth and sub-elite players. Menstrual cycle phase may influence performance and injury risk; however, there are few studies in soccer players. Nutrition plays a critical role in health and performance and ensuring adequate energy intake remains a priority. Despite recent progress, there is considerably less research in female than male soccer players. Many gaps in our understanding of how best to develop and manage the health and performance of female soccer players remain.
    • Volatile Liquid Detection by Terahertz Technologies

      Baxter, Harry W; Worrall, Adam A; Pang, Jie; Chen, Riqing; email: riqing.chen@fafu.edu.cn; Yang, Bin; email: b.yang@chester.ac.uk (Frontiers Media S.A., 2021-04-08)
      The prospect of being able to move through security without the inconvenience of separating liquids from bags is an exciting one for passengers, and there are important operational benefits for airports as well. Here, two terahertz (THz) systems, 100 GHz sub-THz line scanner and attenuation total reflection-based THz time domain spectroscopy (TDS), have been used to demonstrate the capability of identifying different liquid samples. Liquid samples’ THz complex permittivities are measured and their differences have contributed to the variation of 100 GHz 2D images of volatile liquids with different volumes inside of cannister bottles. The acquired attenuation images at 100 GHz can easily be used to distinguish highly absorbed liquids (Water, Ethanol, Fuel Treatment Chemicals) and low loss liquids (Petrol, Diesel, Kerosene and Universal Bottle Cleaner). The results give a promising feasibility for mm-wave imager and THz spectroscopy to efficiently identify different volatile liquids.
    • Design and finite element simulation of metal-core piezoelectric fiber/epoxy matrix composites for virus detection.

      Wang, Yinli; Shi, Yu; Narita, Fumio (2021-04-07)
      Undoubtedly, the coronavirus disease 2019 (COVID-19) has received the greatest concern with a global impact, and this situation will continue for a long period of time. Looking back in history, airborne transimission diseases have caused huge casualties several times. COVID-19 as a typical airborne disease caught our attention and reminded us of the importance of preventing such diseases. Therefore, this study focuses on finding a new way to guard against the spread of these diseases such as COVID-19. This paper studies the dynamic electromechanical response of metal-core piezoelectric fiber/epoxy matrix composites, designed as mass load sensors for virus detection, by numerical modelling. The dynamic electromechanical response is simulated by applying an alternating current (AC) electric field to make the composite vibrate. Furthermore, both concentrated and distributed loads are considered to assess the sensitivity of the biosensor during modelling of the combination of both biomarker and viruses. The design parameters of this sensor, such as the resonant frequency, the position and size of the biomarker, will be studied and optimized as the key values to determine the sensitivity of detection. The novelty of this work is to propose functional composites that can detect the viruses from changes of the output voltage instead of the resonant frequency change using piezoelectric sensor and piezoelectric actuator. The contribution of this detection method will significantly shorten the detection time as it avoids fast Fourier transform (FFT) or discrete Fourier transform (DFT). The outcome of this research offers a reliable numerical model to optimize the design of the proposed biosensor for virus detection, which will contribute to the production of high-performance piezoelectric biosensors in the future. [Abstract copyright: © 2021 Elsevier B.V. All rights reserved.]
    • Critical analysis of the Armed Forces Covenant Fund Trust Aged Veterans Fund.

      Di Lemma, Lisa C G; orcid: 0000-0001-9161-1779; Finnegan, A; orcid: 0000-0002-2189-4926; email: a.finnegan@chester.ac.uk; Howe, S (2021-03-31)
      Relatively little research is available regarding the specific needs of older military veterans and the services introduced to support them. In 2016, the Armed Forces Covenant Fund Trust launched the Aged Veterans Fund (AVF), to understand the impact that military service may have on ageing, and to support initiatives targeting their health and well-being. This fund was financed for 5 years and included 19 UK portfolio projects. The paper presents a retrospective evaluation on the processes and impact of the AVF, with the intent of informing policy, educational services, service providers and stakeholders of the lessons learnt. The inclusion criteria was veterans and their families aged 65 years of age or over. In 2019, data were drawn from documentary evidence related to the programmes. Qualitative analysis were performed on 78 eligible sources and 10 themes were identified. Programmes were rolled out via collaborative partnerships referrals, focusing on person-centred or skill-exchange approaches. Challenges were encountered, such as capacity and timelines issues. A limited amount of associated cost-savings was observed, even if examples of sustainability and high satisfaction were reported. Evidence was found of programmes boosting health and well-being outcomes, in raising awareness, and in positively impacting on clinical practice, such as re-admission rates. The AVF programmes were successful in their intent to provide support to older veterans and their families. The findings provide indicators of the next steps required for the support of ageing veterans. Further investigation of the cost-effectiveness of age-friendly veterans' services is needed. [Abstract copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.]
    • Evaluation of a ‘drop box’ doorstep assessment service to aid remote assessments for COVID-19 in general practice

      Irving, Greg; orcid: 0000-0002-9471-3700; Lawson, David; Tinsley, Adele; Parr, Helen; Whittaker, Cheryl; Jones, Hayley; Cox, Stephen (BMJ Publishing Group, 2021-03-28)
      The COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed without obtaining objective recording of vital signs and face-to-face examination. Some regions have formed hot hubs to facilitate the review of suspected COVID-19 cases and keep their practice site ‘clean’ including the use of doorstep observations in avoiding the risk of face-to-face examination. To support the safe, effective and efficient remote assessment of suspected and confirmed patients with COVID-19, we established a doorstep assessment service to compliment telephone and video consultations. This allows physiological parameters such as temperature, pulse, blood pressure and oxygen saturation to be obtained to guide further triage. Quality improvement methods were used to integrate and optimise the doorstep assessment and measure the improvements made. The introduction of a doorstep assessment service increased the proportion of assessments for patients with suspected COVID-19 in routine care over weeks. At the same time we were able to dramatically reduce face-to-face assessment over a 6-week period by optimising through a range of measures including the introduction of a digital stethoscope. The majority of patients were managed by their own general practitioner following assessment supporting continuity of care. There were no adverse events during the period of observation; no staff absences related to COVID-19. Quality improvement methods have facilitated the successful integration of doorstep assessments into clinical care.
    • Evaluation of a ‘drop box’ doorstep assessment service to aid remote assessments for COVID-19 in general practice

      Irving, Greg; orcid: 0000-0002-9471-3700; Lawson, David; Tinsley, Adele; Parr, Helen; Whittaker, Cheryl; Jones, Hayley; Cox, Stephen (BMJ Publishing Group, 2021-03-28)
      COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed without obtaining objective recording of vital signs and face-to-face examination. Some regions have formed hot hubs to facilitate the review of suspected COVID-19 cases and keep their practice site ‘clean’ including the use of doorstep observations in avoiding the risk of face-to-face examination. To support the safe, effective and efficient remote assessment of suspected and confirmed patients with COVID-19, we established a doorstep assessment service to compliment telephone and video consultations. This allows physiological parameters such as temperature, pulse, blood pressure and oxygen saturation to be obtained to guide further triage. Quality improvement methods were used to integrate and optimise the doorstep assessment and measure the improvements made. The introduction of a doorstep assessment service increased the proportion of assessments for patients with suspected COVID-19 in routine care over weeks. At the same time we were able to dramatically reduce face-to-face assessment over a 6-week period by optimising through a range of measures including the introduction of a digital stethoscope. The majority of patients were managed by their own general practitioner following assessment supporting continuity of care. There were no adverse events during the period of observation; no staff absences related to COVID-19. Quality improvement methods have facilitated the successful integration of doorstep assessments into clinical care.
    • Differences in the vertical and horizontal force-velocity profile between academy and senior professional rugby league players, and the implications for strength and speed training.

      Dobbin, Nick; email: N.Dobbin@mmu.ac.uk; Cushman, Simon; Clarke, Jon; Batsford, Jakes; Twist, Craig (2021-03-26)
      This study compared the vertical and horizontal force-velocity (FV) profile of academy and senior rugby league players. Nineteen senior and twenty academy players from one professional club participated in this study. The vertical FV profile was determined using a series of loaded squat jumps (0.4 to 80 kg) with jump height recorded. The horizontal FV profile involved a 30-m over-ground sprint with split times recorded at 5, 10, 15, 20 and 30 m. Theoretical maximal force (F0), velocity (V0) and power (Pmax), optimal F0 and V0, and activity specific variables (e.g. vertical FV imbalance) were determined. Absolute F0 and Pmax from the vertical and horizontal profile were moderately different between groups (standardised mean difference (SMD) = 0.64-1.20, P <0.001-0.026), whilst for V0, differences were small (SMD = 0.33-0.41, P = 0.149-0.283). Differences in relative F0, Pmax and optimal F0 during both assessments were trivial to moderate (SMD = 0.03-0.82, P = 0.021-0.907). These results highlight senior and academy players present with different FV profiles and highlight some potential developmental opportunities for senior and academy rugby league players that sport scientists, strength and conditioning and rugby coaches can implement when designing programmes and considering long-term athlete development.
    • Evaluating the impact of COVID-19 on supportive care needs, psychological distress and quality of life in UK cancer survivors and their support network.

      Hulbert-Williams, Nicholas J; orcid: 0000-0001-9041-5485; Leslie, Monica; Hulbert-Williams, Lee; Smith, Eilidh; Howells, Lesley; Pinato, David J (2021-03-25)
      The COVID-19 pandemic is having considerable impact on cancer care, including restricted access to hospital-based care, treatment and psychosocial support. We investigated the impact on unmet needs and psychosocial well-being. One hundred and forty four participants (77% female), including people with cancer and their support networks, were recruited. The most prevalent diagnosis was breast cancer. Forty-one participants recruited pre-pandemic were compared with 103 participants recruited during the COVID-19 pandemic. We measured participants' unmet supportive care needs, psychological distress and quality of life. Half of our patient respondents reported unexpected changes to treatment following pandemic onset, with widespread confusion about their longer-term consequences. Although overall need levels have not increased, specific needs have changed in prominence. People with cancer reported significantly reduced anxiety (p = 0.049) and improved quality of life (p = 0.032) following pandemic onset, but support network participants reported reduced quality of life (p = 0.009), and non-significantly elevated anxiety, stress and depression. Psychological well-being of people with cancer has not been detrimentally affected by pandemic onset. Reliance on home-based support to compensate for the lost availability of structured healthcare pathways may, however, explain significant and detrimental effects on the well-being and quality of life of people in their support and informal care networks. [Abstract copyright: © 2021 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.]
    • Social network analysis of small social groups: Application of a hurdle GLMM approach in the Alpine marmot ( Marmota marmota )

      Panaccio, Matteo; orcid: 0000-0002-1903-154X; Ferrari, Caterina; Bassano, Bruno; Stanley, Christina R.; orcid: 0000-0002-5053-4831; von Hardenberg, Achaz; orcid: 0000-0002-9899-1687 (Wiley, 2021-03-24)
    • Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme

      Hulbert-Williams, Nicholas J; orcid: 0000-0001-9041-5485; Hulbert-Williams, Lee; orcid: 0000-0001-5892-6488; Patterson, Pandora; orcid: 0000-0002-1686-3252; Suleman, Sahil; Howells, Lesley (BMJ Publishing Group, 2021-03-24)
      Background: Psychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently developed interventions such as Acceptance and Commitment Therapy (ACT). Aims: We developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach. Method: We report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data were collected from 53 participants (at either 2-week or 3-month follow-ups, or both) using self-report survey, including both quantitative and free-text questions. Results: At 2 week follow-up, 73% of trainees rating our course as having relevance to their work, and at 3 month follow-up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees’ stress levels, nor did implementation of this new way of working negatively affect staff well-being. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility. Discussion: Acceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward.
    • Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme.

      Hulbert-Williams, Nicholas J; orcid: 0000-0001-9041-5485; email: n.hulbertwilliams@chester.ac.uk; Hulbert-Williams, Lee; orcid: 0000-0001-5892-6488; Patterson, Pandora; orcid: 0000-0002-1686-3252; Suleman, Sahil; Howells, Lesley (2021-03-24)
      Psychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently developed interventions such as Acceptance and Commitment Therapy (ACT). We developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach. We report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data were collected from 53 participants (at either 2-week or 3-month follow-ups, or both) using self-report survey, including both quantitative and free-text questions. At 2 week follow-up, 73% of trainees rating our course as having relevance to their work, and at 3 month follow-up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees' stress levels, nor did implementation of this new way of working negatively affect staff well-being. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility. Acceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward. [Abstract copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.]