Browsing by Author "Williamson, I."
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Item Open Access Coming out in cancer care: Is disclosure of sexual orientation beneficial?(Royal College of Nursing, 2019-02-13) Fish, Julie; Brown, Jayne; Williamson, I.Nurses and other health professionals are to ask about sexual orientation at every face-to-face contact across the NHS from 2019. However, there are concerns about the need for, and relevance of, sexual orientation disclosure and of the potential for discomfort and embarrassment. We conducted qualitative interviews with fifteen lesbian, gay and bisexual patients to investigate how experiences of cancer care are mediated by disclosure. Using thematic analysis, three themes emerged: identifying the barriers to disclosure, approaches to, and facilitators of, coming out, and small actions/big impact: nurses’ responses to disclosure. In conclusion, we situate disclosure within a model of holistic care recognising that patients’ individual needs constitute one of the eight principles of quality nursing. Treating the whole person means that patients are more likely to engage in positive health behaviours, have more knowledge, skills and confidence to manage their health and be more satisfied with their care.Item Open Access Coming out in cancer care: Is disclosure of sexual orientation beneficial?(Cancer Nursing Practice, 2018-11-08) Fish, Julie; Brown, Jayne; Williamson, I.Nurses and other health professionals are to ask about sexual orientation at every face-to-face contact across the NHS from 2019. However, there are concerns about the need for, and relevance of, sexual orientation disclosure and of the potential for discomfort and embarrassment. We conducted qualitative interviews with fifteen lesbian, gay and bisexual patients to investigate how experiences of cancer care are mediated by disclosure. Using thematic analysis, three themes emerged: identifying the barriers to disclosure, approaches to, and facilitators of, coming out, and small actions/big impact: nurses’ responses to disclosure. In conclusion, we situate disclosure within a model of holistic care recognising that patients’ individual needs constitute one of the eight principles of quality nursing. Treating the whole person means that patients are more likely to engage in positive health behaviours, have more knowledge, skills and confidence to manage their health and be more satisfied with their care.Item Open Access Disclosure in lesbian, gay and bisexual cancer care: towards a salutogenic healthcare environment(Springer Nature, 2019-07-10) Fish, Julie; Brown, Jayne; Williamson, I.Background: The literature on sexual orientation disclosure is arguably one of the most developed in the field of lesbian, gay and bisexual (LGB) people in healthcare in English speaking countries however, relatively little research has been conducted into disclosure in cancer care. Studies have been mainly undertaken in primary care where distinct circumstances pertain and where the benefits of disclosure include obtaining appropriate health information, treatment advice and avoiding misdiagnosis. Methods: We conducted an in-depth qualitative study primarily recruiting patients through oncology care in hospital settings and through LGB community cancer support groups. Data were gathered through semi-structured interviews with 30 LGB patients with different cancer types. Results: Data were analysed using thematic analysis and interpreted and interrogated through salutogenesis theory which offers a useful lens through which to consider the health promoting effects of sexual orientation disclosure in cancer care. We present three themes as part of the analysis: Authenticity as a driver for disclosure in cancer care, Partners as a (potential) salutogenic resource and Creating safe, healing environments conducive to disclosure. The findings are reported and discussed in relation to three inter-related concepts from current salutogenesis theorising including a sense of coherence, generalised resistance resources and healing environments which can facilitate sexual orientation disclosure. Conclusion: Our findings enable a more nuanced approach to understanding disclosure in this context. This study contributes to the literature through its articulation of the salutogenic potential of disclosure (if responded to appropriately) for LGB patients as individuals, in relationship to their partners or carers and the role of creating a visible healing-oriented optimal environment to promote quality of life and recovery.Item Open Access Exploring accounts of joint working between Speech and Language Therapists and Stroke Association Communication Support Coordinators(2016-11-28) Scantlebury, K.; Bixley, Morag; Williamson, I.Exploring accounts of joint working between Speech and Language Therapists and Stroke Association Communication Support Coordinators Introduction Both Speech and Language Therapists (SLTs) and Stroke Association Communication Support Coordinators (CSCs) are employed across the UK to provide services for people with communication difficulties following Stroke. The two roles are usually employed by different sectors and are subject to very different levels of qualification and professional regulation. Despite recommendations that the two roles work together, there is little existing literature examining current practices of joint working between SLTs and CSCs. Method Data were collected through a series of in depth individual interviews with five CSCs and seven SLTs working within the East of England. Data were analysed inductively using Thematic Analysis (Braun & Clark, 2006). Results Six themes were developed which highlighted the perceived benefits and challenges in this example of cross sector working. Both SLTs and CSCs identified strong incentives for joint working. The themes developed suggested a number of processes are engaged in negotiating the joint working relationship. These include ‘Developing and earning trust and respect’; ‘Pushing to establish place’; and ‘Struggling against external pressures and threats’. In addition, two further themes were developed to explore the process of finding agreement in the division of workload: ‘Sharing Out’ of aphasia; and ‘Local level Negotiation and Matching of expectations’. Conclusions: The findings suggest a number of unique features which characterise joint working relationships between SLTs and CSCs. Clinical applications based on the findings are discussed, along with suggested areas for further research.Item Open Access Healthcare for Older People Research in Leicestershire(University of Nottingham, 2019-04) Conroy, Simon; Brown, Jayne; Bell, Katie; Haunton, Victoria; Robinson, T. G.; Bannerjee, J.; Martin, G.; Regen, E.; Phelps, K; O'Kelly, K.; Kondova, D.; Williamson, I.; Wildbur, D.; Fallmann, Sarah; Chen, L.; Oldridge, Louise; Larkin, M.; Wilson, A.; Agarwal, S.; Bankart, J.; Subramaniam, H.; Raghavan, Raghu; Panerai, R.; Clague-Baker, Nicola; Chung, E.; Stahl, Bernd Carsten, 1968-; Chen, F.; Triboan, D.; Psychoula, I.; Northcott, AndyAcademic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention.Item Metadata only It’s like the onion skins are stripped away; Caregiver accounts of supporting a long-term partner through cancer(2017-07) Bell, Katie; Williamson, I.; Wildbur, D.Purpose: To explore the experiences of caring for a long-term partner or spouse through cancer diagnosis, treatment and aftercare. Background: Although research around caregiving is becoming more theoretically advanced and nuanced, there continues to be a need for in-depth qualitative research into the experiences of caregiving in the context of different caregiver/care-recipient relationships and for different conditions - this is especially apt with cancer because of the serious side-effects of most treatments and possibility of metastasis. Methods: In-depth interviews were carried out in person with 8 long-term partners of an individual who was undergoing or who had recently completed treatment for cancer. Five participants were in opposite-sex relationships and three were in same-sex relationships. Their partners were experiencing a range of cancer types. Participants were interviewed in their homes, typically with their partner present. Data were audio-recorded, transcribed and analysed using interpretative phenomenological analysis. Findings: In this paper we explore some of the ways in which relationships change through cancer and its treatment with a focus on two related themes: "cancer has given us the bond" looks at how relationships evolve in the context of cancer threat with a particular focus on sexuality, spirituality and finding 'silver linings'. "we've had to be really inventive about what can we do together" explores the importance of maintaining or developing new shared everyday activities that reinforce intimacy and a sense of dyadic coping Conclusions: Methodological and ethical issues around interviewing couples and applications of the findings for interventions for the support of partners and couples are discussed.Item Open Access Promoting good outcomes in Lesbian, Gay and Bisexual cancer care: a qualitative study of patients’experiences in clinical oncology(De Montfort University., 2018-04-20) Fish, Julie; Williamson, I.; Brown, Jayne; Padley, Wendy; Bell, Kathleen; Long, J.EXECUTIVE SUMMARY Cancer inequalities, including differences in cancer outcomes and patient satisfaction, affect a range of groups including lesbian, gay and bisexual (LGB) people. In its strategy to reduce these inequalities, the Department of Health commissioned the Cancer Patient Experience Survey (CPES) providing baseline data in which LGB patients were more likely to say their experiences were less positive than those of heterosexual patients. These differences included accessible information, psychosocial support and the human rights concerns of dignity and respect. The CPES, which was carried out in four successive years (2010-2014), suggesting that these are intractable problems, found that LGB patients were more likely to disagree with statements such as they ‘never felt treated as a set of cancer symptoms rather than as a whole person’ or the ‘doctor never talked about me as if I wasn’t there’. The CPES did not collect qualitative data and consequently the reasons for these differences were not known. This De Montfort University study, funded by Macmillan, illuminates some of the reasons for these survey findings as we were able to gather people’s accounts of their treatment and care. This report identifies key moments in the cancer journey where care provided for LGB cancer patients can contribute to their recovery and well-being. Alongside this evidence of unmet need, NHS England (2017) has recently issued guidance to support the introduction of mechanisms for recording sexual orientation across all health services in England for patients over 16. It recommends that sexual orientation monitoring occurs at every face to face contact with the patient. The collection of this monitoring data has implications; not only for cancer professionals, but also that patients themselves understand why this information is being requested. The report draws on LGB cancer patients’ motivations and methods for disclosing their sexual orientation and the perceived benefits of doing so for their quality of life. The findings will contribute to understanding the health benefits of coming out and how disclosure might be facilitated in hospital settings. This study provides compelling data about some of the factors underpinning inequalities in the experiences and, potentially, cancer outcomes for LGB patients. Managing the worry about whether it is safe to disclose their sexual orientation to professionals and the uncertainty about how this will be received presents an additional burden for LGB people with cancer. Participants in this study were sometimes hesitant to disclose because the opportunity did not arise or they were uncertain about its relevance. The report identifies some moments that matter in the care relationship where professionals could seek to facilitate disclosure thus contributing to Achieving World Class Cancer Outcomes (Department of Health, 2015) for LGB patients. In addition, the findings point to the importance of creating an inclusive care environment; participants noted that even in the Cancer Centres of Excellence, there were few visible signs of inclusion for LGB cancer patients. Steps to promote inclusion may entail a diversity policy statement, imagery on walls or the display of a LGB staff network on a hospital notice-board. participants also shared experiences where they were accepted in an everyday manner by hospital staff. They often talked about a whole hospital approach where they were acknowledged by staff from porters, health care assistants, nurses and consultants. These cancer narratives also highlight the need for LGB cancer support groups and tailored resources. The lack of LGB support groups in the UK mean that some participants were coping with their cancer with few forms of social and emotional support and they found few sources of information which addressed their needs. There was a clear demand for a greater range of LGB support resources that were relevant to the challenges and concerns of specific cancer types and reports of rather patchy provision in this regard, with differences influenced primarily by geographic location and cancer type. Finally, our findings suggest that participants had heterogeneous expectations of cancer care requiring complex .skills from professionals. Yet there is little or no curricula content in university programmes of Medicine or Nursing. This might suggest a lack of recognition of distinctive cancer care needs and may explain why participants reported different patient experiences even within the same hospital. The inclusion of research with LGB patients alongside heterosexual populations and relevant case studies to underpin Learning and Development and Continuous Professional Development to inform understanding of patient experience, psychosocial concerns and cancer risk is urgently needed.Item Open Access Using every day client and advocate clinical interviews to gather outcome measurements – a mixed methods framework(2018-11-14) Bixley, Morag; Williamson, I.; Scase, M. O.Abstract introduction Aphasia is a multimodality language difficulty experienced by people who have a left sided stroke. Speech and Language Therapists (SLTs) who work with People with Aphasia (PWA) often provide word finding therapy because word finding difficulties (wfd) are one of the most debilitating effects of aphasic language loss. The majority of published word finding research uses mixed therapy techniques in which PWA practise accessing, using and combining sounds and words. This therapy trial is one of only three case studies that describe PWA receiving therapy that is purely semantic. Semantic therapy is particularly relevant to people with severe aphasia. This is because the evidence base underpinning language therapy for PWA supports therapy for people who can talk: very little research addresses the problems of those who have very limited access to output. This case study was designed to add to the evidence base that supports language therapy for people with severe aphasia who have no access to propositional speech. Abstract Method This paper reports on a single therapy trial conducted within a cohort of ten individual semantic therapy trails. Research design incorporated best practise recommendations for therapy studies (Brady et al, 2012, Tate et al, 2008 and Moher et al 2001). In the first six weeks of this single therapy trial, P participated in six therapy sessions of semantic therapy with word finding (SAT with). In a further six weeks of therapy P was provided with semantic therapy without word finding (SAT without). Results and conclusions Descriptive and statistical analysis of the impact of therapy suggested that P’s word finding skills improved after both types of semantic therapy. The effects of therapy generalised and were permanent. There was some suggestion that SAT with therapy was more successful that SAT without therapy, but this difference may have been attributable to an order effect. This abstract provides single clinical case evidence to support impairment based semantic therapy for people with severe aphasia.