• Beliefs about weight and breast cancer: An interview study with high risk women following a 12 month weight loss intervention

      Wright, Claire E.; Harvie, Michelle N.; Howell, Anthony; Evans, D. Gareth; Hulbert-Williams, Nicholas J.; Donnelly, Louise S.; University of Chester ; University Hospital of South Manchester ; University Hospital of South Manchester ; University of Manchester ; University of Chester ; University Hospital of South Manchester (BioMed Central, 2015-01-09)
      Breast cancer is the most common cancer in the UK. Lifestyle factors including excess weight contribute to risk of developing the disease. Whilst the exact links between weight and breast cancer are still emerging, it is imperative to explore how women understand these links and if these beliefs impact on successful behaviour change. Overweight/obese premenopausal women (aged 35–45) with a family history of breast cancer (lifetime risk 17–40%) were invited to a semi-structured interview following their participation in a 12 month weight loss intervention aimed at reducing their risk of breast cancer. Interviews were carried out with 9 women who successfully achieved ≥5% weight loss and 11 who were unsuccessful. Data were transcribed verbatim and analysed using thematic analysis. Three themes were developed from the analysis. The first theme how women construct and understand links between weight and breast cancer risk is composed of two subthemes, the construction of weight and breast cancer risk and making sense of weight and breast cancer risk. The second theme - motivation and adherence to weight loss interventions - explains that breast cancer risk can be a motivating factor for adherence to a weight loss intervention. The final theme, acceptance of personal responsibility for health is composed of two subthemes responsibility for one’s own health and responsibility for family health through making sensible lifestyle choices.Beliefs about weight and breast cancer risk were informed by social networks, media reports and personal experiences of significant others diagnosed with breast cancer. Our study has highlighted common doubts, anxieties and questions and the importance of providing a credible rationale for weight control and weight loss which addresses individual concerns.
    • Beyond using composite measures to analyze the effect of unmet supportive care needs on caregivers’ anxiety and depression

      Lambert, Sylvie D.; Hulbert-Williams, Nicholas J.; Belzile, Eric; Ciampi, Antonio; Girgis, Afaf; McGill University; University of Chester; University of New South Wales (Wiley, 2018-03-06)
      Objective: Caregiver research has relied on composite measures (e.g., count) of unmet supportive care needs to determine relationships with anxiety and depression. Such composite measures assume that all unmet needs have a similar impact on outcomes. The purpose of this study is to identify individual unmet needs most associated with caregivers’ anxiety and depression. Methods: 219 Caregivers completed the 44-item Supportive Care Needs Survey and the Hospital Anxiety and Depression scale [minimal clinically important difference (MCID)=1.5] at 6-8 months, 1, 2, 3.5, and 5 years following the patients' cancer diagnosis. The list of needs was reduced using Partial Least Square regression and those with a Variance Importance in Projection > 1 were analyzed using Bayesian Model Averaging. Results: Across time, eight items remained in the top 10 based on prevalence and were labelled “core”. Three additional ones were labelled “frequent”, as they remained in the top 10 from 1- year onwards. Bayesian Model Averaging identified a maximum of four significant unmet needs per time point – all leading to a difference greater than the MCID. For depression, none of the core unmet needs were significant, rather significance was noted for frequent needs and needs that were not prevalent. For anxiety, 3/8 core and 3/3 frequent unmet needs were significant. Conclusions: Prevalent Those unmet needs that are most prevalent are not necessarily the most significant ones, and findings provide an evidence-based framework to guide the development of caregiver interventions. A broader contribution is proposing a different approach to identify significant unmet needs.
    • Patient-reported depression measures in cancer: a meta-review

      Wakefield, Claire E.; Butow, Phyllis N.; Aaronson, Neil A.; Hack, Thomas F.; Hulbert-Williams, Nicholas J.; Jacobsen, Paul B.; University of Chester (Lancet, 2015-07)
      It is unclear which patient-reported depression measures perform best in oncology settings. We conducted a meta-review to integrate the findings of reviews of more than 50 depression measures used in oncology. We searched Medline, PsycINFO, EMBASE and grey literature from 1999-2014 to identify 19 reviews representing 372 primary studies. Eleven reviews were rated as being of high quality. The Hospital Anxiety Depression Scale (HADS) was most thoroughly evaluated, but was limited by cut-point variability. The HADS had moderate screening utility indices and was least recommended in advanced cancer/palliative care. The Beck Depression Inventory was more generalizable across cancer types/disease stages, with good indices for screening and case finding. The Centre of Epidemiology-Depression Scale was the best-weighted measure in terms of responsiveness. This meta-review provides a comprehensive overview of the strengths and limitations of available depression measures. It can inform the choice of the best measure for specific settings and purposes.
    • Patient-reported outcomes of sexual and gender minority cancer survivors in Australia

      Lisy, Karolina; Ward, Andrew; Schofield, Penelope; Hulbert-Williams, Nicholas J.; Bishop, Jim; Jefford, Michael; Peter MacCallum Cancer Centre, Melbourne; The Social Research Centre, Melbourne; Swinburne University, Melbourne; University of Chester, UK; Victorian Comprehensive Cancer Centre, Melbourne; University of Melbourne (Wiley, 2018-12-03)
      Five key points: This is the first population‐based survey of Australian cancer survivors to include lesbian, gay, bisexual, transgender, or intersex (LGBTI) identity. Few respondents (1.6%) identified as LGBTI, less than half the reported prevalence in Australia. LGBTI respondents were more likely to be younger, employed, and born in Australia. LGBTI people may experience more problems with anxiety/depression, body image and financial benefits, and greater needs for diet and lifestyle information. Commonly used patient‐reported outcome measures may not be sensitive to LGBTI issues; areas for future enquiry are proposed.