• Fear of cancer recurrence in oral and oropharyngeal cancer patients: An investigation of the clinical encounter

      Ozakinci, Gozde; Swash, Brooke; Humphris, Gerry; Rogers, Simon; Hulbert-Williams, Nicholas J.; University of St Andrews; University of Chester; Edge Hill University (Wiley-Blackwell, 2017-10-12)
      Fear of cancer recurrence (FCR) is common among individuals treated for cancer. Explorations of how this fear is expressed within an oncology setting and responded to are currently lacking. The aim was to investigate how head and neck cancer survivors in follow-up consultations express FCR, how a health care professional addresses recurrence fears, and examining how survivors experience this interaction. We recorded the follow-up consultations of those participants who have reported FCR as a concern on the Patient Concerns Inventory. We also conducted a follow-up phone interview with the participants. We analysed the transcripts using thematic analysis. Five men and six women were recruited, aged 55-87 (mean age = 64). Follow-up consultation analyses revealed that the consultant used ‘normalising FCR,’ ‘reassurance,’ and ‘offer of referral to a counsellor’. Interviews revealed themes around how they coped with FCR, relevance of personal history on FCR, and the impact of feeling gratitude towards the consultant on expression of FCR. Analyses indicate that patients may feel reluctant to raise their FCR with their clinician for fear of appearing ‘ungrateful’ or of damaging a relationship that is held in high esteem. Findings indicate the initiation of FCR with patients can be beneficial for patient support.
    • Nothing by mere authority: Evidence that in an experimental analogue of the Milgram paradigm participants are motivated not by orders but by appeals to science

      Haslam, S. Alexander; Reicher, Stephen D.; Birney, Megan E.; University of Queensland; University of St. Andrews; University of Exeter (Wiley-Blackwell, 2014-09-04)
      Milgram’s classic research in which people follow experimental instructions to continue administering shocks to another person is widely understood to demonstrate people’s natural inclination to obey the orders of those in authority. However, analysis of participants’ responses to prods that Milgram’s Experimenter employed to encourage them to continue indicates that the one that most resembled an order was the least successful. The present study examines the impact of prods more closely by manipulating them between-participants within an analogue paradigm in which participants are instructed to use negative adjectives to describe increasingly pleasant groups. Across all conditions, continuation and completion were positively predicted by the extent to which prods appealed to scientific goals but negatively predicted by the degree to which a prod constituted an order. These results provide no support for the traditional conformity account of Milgram’s findings, but are consistent with an engaged followership model which argues that participants’ willingness to continue with an objectionable task is predicated upon active identification with the scientific project and those leading it.
    • A systematic review of psychotherapeutic interventions for women with metastatic breast cancer: Context matters

      Beatty, Lisa; Kemp, Emma; Butow, Phyllis N.; Girgis, Afaf; Schofield, Penelope; Turner, Jane; Hulbert-Williams, Nicholas J.; Levesque, Janelle V.; Koczwara, Bogda (Wiley-Blackwell, 2017-05-16)
      Objectives: To summarise the evidence-base of psychological interventions for women with metastatic breast cancer (MBC), by mode of delivery (group, individual, or low-intensity interventions). To synthesise data regarding core intervention-elements (e.g., intervention duration) and context factors (trial setting, uptake and adherence, demographic characteristics). Methods: Four databases were searched (inception – May 2016): MEDLINE (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCO), and SCOPUS; reference lists were examined for additional publications. Grey literature was excluded. Outcome data were extracted for survival, distress, quality of life, coping, sleep, fatigue, and/or pain, and summarised through narrative synthesis. Results: Fifteen randomised clinical trials (RCTs), reported across 23 articles, met inclusion criteria: seven group, four individual, and four low-intensity interventions. Overall, interventions improved distress (8/13 RCTs); coping (4/5 RCTs); and pain (4/5 RCTs). No evidence of survival benefit was found. For remaining outcomes, evidence was either insufficient, or too mixed to draw conclusions. Group programs had the strongest evidence-base for efficacy; individual and low-intensity therapy had insufficient evidence to form conclusions. Group interventions had longest intervention durations and lowest uptake and adherence; low-intensity interventions had shortest durations and highest uptake and adherence. Disparities in uptake, adherence and reach were evident, with the demographic profile of participants polarised to young, Caucasian, English-speaking, partnered women. Conclusions: There remains a paucity of psychological interventions for women with MBC. Those that exist have an inconsistent evidence-base across the range of patient-reported outcomes. Further research is needed to evaluate accessible delivery formats that ensure efficacy as well as uptake.