• The cancer care experiences of gay, lesbian and bisexual patients: A secondary analysis of data from the UK Cancer Patient Experience Survey.

      Hulbert-Williams, Nicholas J.; Plumpton, C.; Flowers, Paul; McHugh, Rhian; Neal, Richard; Semlyen, Joanna; Storey, Lesley; University of Chester; Bangor University; Glasgow Caledonian University; University of Leeds; University of East Anglia; Queen's University (Wiley, 2017-02-27)
      Understanding the effects of population diversity on cancer-related experiences is a priority in oncology care. Previous research demonstrates inequalities arising from variation in age, gender and ethnicity. Inequalities and sexual orientation remain underexplored. Here, we report, for the first time in the UK, a quantitative secondary analysis of the 2013 UK National Cancer Patient Experience Survey which contains 70 questions on specific aspects of care, and six on overall care experiences. 68,737 individuals responded, of whom 0.8% identified as lesbian, gay or bisexual. Controlling for age, gender and concurrent mental health comorbidity, logistic regression models applying post-estimate probability Wald tests explored response differences between heterosexual, bisexual and lesbian/gay respondents. Significant differences were found for 16 questions relating to: (a) a lack of patient-centred care and involvement in decision making, (b) a need for health professional training and revision of information resources to negate the effects of heteronormativity, and (c) evidence of substantial social isolation through cancer. These findings suggest a pattern of inequality, with less positive cancer experiences reported by lesbian, gay and (especially) bisexual respondents. Poor patient-professional communication and heteronormativity in the healthcare setting potentially explain many of the differences found. Social isolation is problematic for this group and warrants further exploration.
    • Psychological flexibility correlates with patient-reported outcomes independent of clinical or sociodemographic characteristics

      Hulbert-Williams, Nicholas J.; Storey, Lesley (Springer, 2015-12-17)
      Purpose: The evidence for the effectiveness of psychological interventions for cancer patients is currently unclear. Acceptance and Commitment Therapy (ACT), which increases individual’s levels of psychological flexibility, may be more effective than other frameworks of psychological intervention, but good quality research is needed to inform adoption and implementation. This study explored the correlation between psychological flexibility and patient reported outcomes to assess the viability of this intervention for cancer survivors. Methods: Recruitment was co-ordinated through a regional cancer centre. 129 respondents completed a cross-sectional postal questionnaire. They were of mixed gender, diagnosis and cancer stage; a mean 61 years old; and a mean 207 days post-diagnosis. Self-report questionnaires assessed psychological flexibility, mood, anxiety, depression, stress, quality of life and benefit finding. Results: Psychological flexibility was a strong and consistent correlate of outcome; effects were maintained even when potentially confounding clinical and socio-demographic characteristics were controlled. Conclusions: Psychological flexibility can be modified through ACT-based interventions. Given the strong correlational evidence found in this study, it seems that such interventions might be useful for cancer survivors. High quality and well-designed controlled trials are now needed to establish effectiveness.
    • Psychological interventions for patients with cancer: Psychological flexibility and the potential utility of Acceptance and Commitment Therapy

      Hulbert-Williams, Nicholas J.; Storey, Lesley; Wilson, Kelly G.; University of Chester ; Queen’s University Belfast ; University of Mississippi; Department of Psychology; University of Chester; Chester UK; School of Psychology; Queen's University Belfast; Belfast UK; University of Mississippi; University MS USA (Wiley, 2014-08-06)
      Cancer is an illness affecting patients' physical and psychosocial well-being: high numbers report problematic levels of distress at many points through diagnosis, treatment and survivorship. Conclusive evidence for the long-term benefits of psychological interventions is lacking and this may be because (1) they employ a too limited scope of underlying therapeutic model; or (2) that they are too focused on improving psychopathological outcomes. Acceptance and Commitment Therapy (ACT) may add components not emphasised elsewhere and may provide a more suitable model of adjustment and coping. Following a comprehensive literature search a theoretical and conceptual discussion of the potential for ACT-based oncology interventions is presented.
    • What are the experiences of cancer care in gay, lesbian and bisexual patients, and how do these differ from heterosexual cancer patients

      Hulbert-Williams, Nicholas J.; Plumpton, C.; McHugh, Rhian; Semlyen, Joanna; Flowers, Paul; Storey, Lesley; Rearn, Emma; Neal, Richard; University of Chester ; Bangor University ; University of Chester ; London Metropolitan University ; Glasgow Caledonian University ; Queen's University, Belfast ; King's College, London ; Bangor University (Wiley, 2015-04-28)
      Lesbian, gay and bisexual (LBG) people frequently experience inequality within healthcare, and are an underserved population in cancer research.