Search

Context: The Covid-19 pandemic and implementation of measures to limit the spread of the virus significantly affected access to healthcare. Routine care in the UK was transformed; remote consultation was introduced for some services while others were disbanded. Public health messaging encouraged the public to stay at home to protect the NHS. Our study investigating the healthcare experience of people living with multimorbidity (presence of >2 long term conditions) including Rheumatoid Arthritis (RA) and persistent musculoskeletal (MSK) pain, was suspended because of the pandemic. Objective: To investigate the experiences of people living with RA or MSK pain during the pandemic. Study design and analysis: Semi-structured interviews were conducted with 47 people living with RA or persistent MSK pain, with and without multimorbidity. Data were analysed thematically, and findings mapped to the 'candidacy' theoretical framework. Setting and dataset: Participants were recruited from outpatient rheumatology clinics, pain clinics and primary care, in Scotland, UK. Participants were mostly female (31 female, 16 male) and aged between 24 and 92 years. Results: Our analysis identified themes related to: (1) Healthcare system impacts (remote consultations, delays and cancellations, difficulties accessing care, Covid information) and (2) Impacts on individuals (social and emotional wellbeing, pain and mobility, mental health, care seeking behaviour, employment/finance, understandings of Covid). Themes were mapped to the processes of candidacy. It was clear that the move towards remote consultations may have unintended consequences and should not be 'one-size fits all'. Conclusions: Our findings highlight experiences of people with RA/persistent MSK pain and multimorbidity during the Covid-19 pandemic. The health seeking behaviour of some patients has changed, and it is unclear if this will continue in the longer term. These findings support the need for discussion around the longer-term impact of the pandemic on individuals and changes within the healthcare system., Presenters Sara Macdonald, PhD, Susan Browne, PhD, MA, MPhil, Karen Wood, MA, Frances Mair, MD, FRCGP, Barbara Nicholl, PhD, [...]

Context: Burden of Treatment Theory (BOTT) proposes poorer outcomes when the work of managing illness (treatment burden) outweighs an individual's capacity. Treatment burden is greater for people experiencing multimorbidity, particularly when living in areas of high socioeconomic deprivation (SED), where factors that reduce capacity (e.g. car access) also cluster. It is likely community factors (e.g. local assets) can enhance, or diminish individual capacity, but how these factors interact is unclear. Objective Explore how individual and community factors influence self-management of multimorbidity in the context of high SED. Study Design: 30 Qualitative semi-structured interviews, analysed thematically. Setting/ Population: Individuals with >3 chronic conditions from a community experiencing high SED. Intervention: N/A Outcome Measures: N/A Results: Four key themes: biographical disruption as a catalyst--many successfully implemented lifestyle changes, almost all triggered by a diagnosis, most would not have made changes otherwise; 'being known': many described 'being known' in the community, creating security. However, there was also stigma of 'being known' from their area, experienced in multiple spheres, influencing experience of wider systems. 'Fear of failure' where attempts to make changes failed, it often resulted in fatalism, linked to experience of wider stigma. For these participants it was easier to not change, even if less than ideal, than risk failing/ being judged, again; Holistic care: people valued care where they were 'seen as a person', but experience was often biomedically focused. Interviewees recognised wider structural issues in the health service inhibiting this type of care eg. lack of time. For some reduced agency, particularly unwillingness to challenge staff, were key issues. Conversely, where people felt empowered to make decisions, that adapted to their context/values, this was generally in the context of strong relationships with primary care providers. Conclusion Capacity factors are important but rarely acknowledged, or addressed, by practitioners or health systems. The influence of social stigma on access/treatment decisions needs considered in health system delivery. Future research should explore interventions to empower people, particularly those experiencing stigma in their wider community. The biographical disruption of an illness should also be viewed as an opportunity for health promotion messages, Presenters Marianne McCallum, BMed, MBChB, MSc, MRCGP, Frances Mair, MD, FRCGP, Sara Macdonald, [...]

Simple Summary: People living in rural areas are less likely to survive cancer than those living in urban areas. There is evidence suggesting that poorer survival amongst rural cancer patients may be because these patients take longer to be diagnosed, particularly in the time between their symptoms beginning and them going to hospital to see a specialist. This study explored the experiences of people with symptoms of bowel cancer, in rural Northern England, to examine whether there were any common causes of 'delay' for these patients. Participants reported that their health beliefs and self-reliance, concerns about losing time at work, and having a poor relationship with their GP, could all influence whether they consulted the GP early about their symptoms. Having identified these unique barriers for rural patients, in relation to seeing the GP about bowel symptoms, we can develop ways to support earlier consultations with GPs, to improve the outcomes of rural patients who develop cancer. Rural cancer inequalities are evident internationally, with rural cancer patients 5% less likely to survive than their urban counterparts. There is evidence to suggest that diagnostic delays prior to entry into secondary care may be contributing to these poorer rural cancer outcomes. This study explores the symptom appraisal and help-seeking decision-making of people experiencing symptoms of colorectal cancer in rural areas of England. Patients were randomly invited from 4 rural practices, serving diverse communities. Semi-structured interviews were undertaken with 40 people who had experienced symptoms of colorectal cancer in the preceding 8 weeks. Four key themes were identified as influential in participants' willingness and timeliness of consultation: a desire to rule out cancer (facilitator of help-seeking); stoicism and self-reliance (barrier to help-seeking); time scarcity (barrier to help-seeking); and GP/patient relationship (barrier or facilitator, depending on perceived strength of the relationship). Self-employed, and "native" rural residents most commonly reported experiencing time scarcity and poor GP/patient relationships as a barrier to (re-)consultation. Targeted, active safety-netting approaches, and increased continuity of care, may be particularly beneficial to expedite timely diagnoses and minimise cancer inequalities for rural populations. [ABSTRACT FROM AUTHOR]

Background: It is estimated that nearly 600 000 cancer cases in the UK could have been avoided in the past 5 years if people had healthier lifestyles, with the principle modifiable risk factors being smoking, obesity, alcohol consumption, and inactivity. There is growing interest in the use of cancer risk information in general practice to encourage lifestyle modification. Aim: To explore the views and experiences of patients and practitioners in relation to cancer prevention and cancer risk discussions in general practice. Design & setting: Qualitative study among patients and practitioners in general practices in Glasgow, UK. Method: Semi-structured interviews were conducted with nine practitioners (five GPs and four practice nurses, recruited purposively from practices based on list size and deprivation status), and 13 patients (aged 30-60 years, with two or more specified comorbidities). Results: Currently, cancer risk discussions focus on smoking and cancer, with links between alcohol and/or obesity and cancer rarely made. There was support for the use of the personalised cancer risk tool as an additional resource in primary care. Practitioners felt practice nurses were best placed to use it. Use in planned appointments (for example, chronic disease reviews) was preferred over opportunistic use. Concerns were expressed, however, about generating anxiety, time constraints, and widening inequalities. Conclusion: Health behaviour change is complex and the provision of information alone is unlikely to have significant effects. Personalised risk tools may have a role, but important concerns about their use remain, particularly in areas of socioeconomic disadvantage. [ABSTRACT FROM AUTHOR]

Abstract Background Depression is frequently cited as the reason for sickness absence, and it is estimated that sickness certificates are issued in one third of consultations for depression. Previous research has considered GP views of sickness certification but not specifically in relation to depression. This study aimed to explore GPs views of sickness certification in relation to depression. Methods A purposive sample of GP practices across Scotland was selected to reflect variations in levels of incapacity claimants and antidepressant prescribing. Qualitative interviews were carried out between 2008 and 2009. Results A total of 30 GPs were interviewed. A number of common themes emerged including the perceived importance of GP advocacy on behalf of their patients, the tensions between stakeholders involved in the sickness certification system, the need to respond flexibly to patients who present with depression and the therapeutic nature of time away from work as well as the benefits of work. GPs reported that most patients with depression returned to work after a short period of absence and that it was often difficult to predict which patients would struggle to return to work. Conclusions GPs reported that dealing with sickness certification and depression presents distinct challenges. Sickness certificates are often viewed as powerful interventions, the effectiveness of time away from work for those with depression should be subject to robust enquiry.

Background: Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed 'treatment burden' and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective. Methods and Findings: The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce. Conclusions: Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems. Systematic Review Registration: International Prospective Register of Systematic Reviews CRD42011001123 Please see later in the article for the Editors' Summary., Introduction The Concept of Treatment Burden 'Treatment burden' is a novel concept describing the self-care practices that patients with chronic disease must perform to enact management strategies and respond to [...]