• Are Prisoners More Psychopathic than Non-forensic Populations? Profiling Psychopathic Traits among Prisoners, Community Adults, University Students, and Adolescents

      Boduszek, Daniel; Debowska, Agata; Sherretts, Nicole; Willmott, Dominic; Kielkiewicz, Krzysztof; Popiolek, Katarzyna; Hyland, Philip (Informa UK Limited, 2019-09-12)
    • Shared meaning in representational and abstract visual art: an empirical study

      Schepman, Astrid; Rodway, Paul; University of Chester (American Psychological Association, 2019-09-12)
      A longstanding and important question is how meaning is generated by visual art. One view is that abstract art uses a universal language whereas representational art is tied to specific knowledge. This view predicts that meaning for abstract is shared across viewers to a greater extent than for representational art. This contrasts with a view of greater shared meaning for representational than abstract art, because of shared associations for the entities depicted in representational art, as supported by recent empirical findings. This study examined the contrasting predictions derived from these two views. 49 nonexpert adult participants wrote brief descriptions of meanings that they attributed to 20 abstract and 20 representational artworks, generating a corpus of 1918 texts. Computational analyses (semantic textual similarity, latent semantic analysis) and linguistic analysis (type-token ratio) provided triangulated quantitative data. Frequentist and Bayesian statistical analyses showed that meanings were shared to a somewhat greater extent for representational art, but that meanings for abstract artworks were also shared above baseline. Triangulated human and machine analyses of the texts showed core shared meanings for both art types, derived from literal and metaphoric interpretations of visual elements. The findings support the view that representational art elicits higher levels of shared meaning than abstract art. The empirical findings can be used to enhance theoretical and computational models of aesthetic evaluation, and the rigorous new methodologies developed can be deployed in many other contexts.
    • Acute physical exercise can influence the accuracy of metacognitive judgments

      Palmer, Matthew; Stefanidis, Kayla; Turner, Ashlee; Tranent, Peter; Breen, Rachel; Kucina, Talira; Brumby, Laura; Holt, Glenys; Fell, James; Sauer, James; et al. (Nature, 2019-08-27)
      Acute exercise generally benefits memory but little research has examined how exercise affects metacognition (knowledge of memory performance). We show that a single bout of exercise can influence metacognition in paired-associate learning. Participants completed 30- min of moderate-intensity exercise before or after studying a series of word pairs (cloudivory), and completed cued-recall (cloud-?; Experiments 1 & 2) and recognition memory tests (cloud-? spoon; ivory; drill; choir; Experiment 2). Participants made judgments of learning prior to cued-recall tests (JOLs; predicted likelihood of recalling the second word of each pair when shown the first) and feeling-of-knowing judgments prior to recognition tests (FOK; predicted likelihood of recognizing the second word from four alternatives). Compared to noexercise control conditions, exercise before encoding enhanced cued-recall in Experiment 1 but not Experiment 2 and did not affect recognition. Exercise after encoding did not influence memory. In conditions where exercise did not benefit memory, it increased JOLs and FOK judgments relative to accuracy (Experiments 1 & 2) and impaired the relative accuracy of JOLs (ability to distinguish remembered from non-remembered items; Experiment 2). Acute exercise seems to signal likely remembering; this has implications for understanding the effects of exercise on metacognition, and for incorporating exercise into study routines.
    • Brief Engagement and Acceptance Coaching for Community and Hospice Settings (the BEACHeS Study): Protocol for the development and pilot testing of an evidence-based psychological intervention to enhance wellbeing and aid transition into palliative care

      Norwood, Sabrina; Gillanders, David; Finucane, Anne; Spiller, Juliet; Strachan, Jenny; Millington, Sue; Swash, Brooke; Hulbert-Williams, Nicholas J.; University of Chester; University of Edinburgh; Marie Curie Hospice Edinburgh (BMC, 2019-08-20)
      Background: Cancer affects millions of individuals globally, with a mortality rate of over eight million people annually. Although palliative care is often provided outside of specialist services, many people require, at some point in their illness journey, support from specialist palliative care services, for example, those provided in hospice settings. This transition can be a time of uncertainty and fear and there is a need for effective interventions to meet the psychological and supportive care needs of people with cancer that cannot be cured. While Acceptance and Commitment Therapy (ACT) has been shown to be effective across diverse health problems, robust evidence for its effectiveness in palliative cancer populations is not extensive. Method: This mixed-methods study uses a single-case experimental design with embedded qualitative interviews to pilot test a novel intervention for this patient group. Between 14 and 20 patients will be recruited from two hospices in England and Scotland. Participants will receive five face-to-face manualised sessions with a psychological therapist. Sessions are structured around teaching core ACT skills (Openness, Awareness and Engagement) as a way to deal effectively with challenges of transition into specialist palliative care services. Outcome measures include: cancer-specific quality of life (primary outcome) and distress (secondary outcome), which are assessed alongside measures of psychological flexibility. Daily diary outcome assessments will be taken for key measures, alongside more detailed weekly self-report, through baseline, intervention and one-month follow-up phases. After follow-up, participants will be invited to take part in a qualitative interview to understand their experience of taking part, and acceptability and perceived effectiveness of the intervention and its components. Discussion: This study is the first investigation of using ACT with terminally ill patients at the beginning of their transition into palliative treatment. Using in-depth single-case approaches, we will refine and manualise intervention content by the close of the study for use in follow-up research trials. Our long-term goal is then to test the intervention as delivered by non-psychologist specialist palliative care practitioners thus broadening the potential relevance of the approach.
    • Perceived stress and professional quality of life in nursing staff: how important is psychological flexibility?

      Kent, William; Hochard, Kevin D.; Hulbert-Williams, Nicholas J.; University of Chester (Elsevier, 2019-08-14)
      Objectives: Nurses are at high risk of chronic stress. Tailored, evidence-based stress-management interventions may minimise absenteeism and staff turnover, whilst at the same time promoting good quality patient care. Current literature for nurse-focused stress-management interventions is varied in quality, with little focus on data-driven intervention development. This study explores how process measures related to Acceptance and Commitment Training (ACT) are associated with perceived stress and professional quality of life in nurses, in order to guide intervention development. Design: A cross-sectional, online psychometric survey was implemented using LimeSurvey software. Methods: One-hundred and forty-two nurses were recruited from various specialties across four English National Health Service (NHS) Trusts. Questionnaires assessed demographic and work-related sample characteristics, ACT processes (mindfulness, acceptance, cognitive defusion, self-as-context, values and committed action), and four work-related wellbeing outcomes (perceived stress, burnout, compassion fatigue and compassion satisfaction). Correlation and regression models were used to analyse data. Results: All six ACT processes negatively correlated with perceived stress, burnout and compassion fatigue, and positively correlated with compassion satisfaction (all p<.05). In regression models, these same processes explained significant variance for all outcomes (R2 range=.36-.61), above and beyond that explained by socio-demographic and work-related factors. Acceptance (β range: -.25 to -.55), mindfulness (β range: -.25 to -.39), and values-based processes (β range: -.21 to -.36) were frequent independent contributors to work-related wellbeing. Conclusions: This study demonstrates that the ACT framework provides a promising platform from which to develop nurse-focused stress-management interventions. Interventions focusing on acceptance, mindfulness, and values-linked processes may be most effective.
    • Exploring health visiting professionals' evaluations of early parent-infant interactions

      Elmer, Jessica R. S.; O'Shaughnessey, Ruth; Bramwell, Ros; Dickson, Joanne M.; Tavistock & Portman NHS Foundation Trust, Alder Hey Children's NHS Foundation Trust, University of Chester, Edith Cowan University (Taylor & Francis, 2019-07-07)
      Abstract Objective: To examine the accuracy of Health Visitors (HVs) evaluations of the quality of parent-infant interactions. Background: HVs have been identified as key professionals in the early identification of difficulties in parent-infant interactions. The aim of this study was to explore how accurately HVs, Family Health Nurses (FHNs) and Community Nursery Nurses (CNNs) evaluate early parent-infant interactions. Method: A sample of 56 HVs, 4 FHNs and 14 CNN recruited from two National Health Service (NHS) Trusts, viewed video footage of six parent-infant interactions which had been categorised as ‘sensitive’, ‘mixed’, and ‘problematic’ using the CARE-Index. Participants evaluated the quality of the parent-infant interactions shown in these videos using the Parent-Infant Interaction Rating Questionnaire (PIIRQ). Results: On average, participants correctly rated the problematic videos as lowest in quality, the mixed as higher in quality than the problematic videos, and the sensitive videos as highest in quality. Interestingly, within the problematic category participants rated the ‘unresponsive’ pattern of interaction as significantly lower in quality than the ‘controlling’ interaction. Conclusions: The findings suggest participants were relatively accurate in their evaluations of parent-infant interactions. However, they indicate that participants were more likely to be concerned about unresponsive, as opposed to controlling, interactive behaviours. Recommendations for further research include exploration of potential differences in how health-visiting professionals evaluate particular patterns of parent-infant interactions.
    • Complex Sociality of Wild Chimpanzees Can Emerge from Laterality of Manual Gestures.

      Roberts, Anna I.; Murray, Lindsay; Roberts, Sam G. B. (Springer, 2019-06-24)
      Humans are strongly lateralized for manual gestures at both individual and population levels. In contrast, the laterality bias in primates is less strong, leading some to suggest that lateralization evolved after the Pan and Homo lineages diverged. However, laterality in humans is also context-dependent, suggesting that observed differences in lateralization between primates and humans may be related to external factors such as the complexity of the social environment. Here we address this question in wild chimpanzees and examine the extent to which the laterality of manual gestures is associated with social complexity. Right-handed gestures were more strongly associated with goal-directed communication such as repair through elaboration in response to communication failure than left-handed gestures. Right-handed gestures occurred in evolutionarily urgent contexts such as in interactions with central individuals in the network, including grooming reciprocity and mating, whereas left-handed gestures occurred in less-urgent contexts, such as travel and play. Right-handed gestures occurred in smaller parties and in the absence of social competition relative to left-handed gestures. Right-handed gestures increased the rate of activities indicating high physiological arousal in the recipient, whereas left-handed gestures reduced it. This shows that right- and left-handed gestures differ in cognitive and social complexity, with right-handed gestures facilitating more complex interactions in simpler social settings, whereas left-handed gestures facilitate more rewarding interactions in complex social settings. Differences in laterality between other primates and humans are likely to be driven by differences in the complexity of both the cognitive skills underpinning social interactions and the social environment.
    • Using Drug Development Methodology to Improve Survivorship and Supportive Care Intervention Trials.

      Howells, Lesley; Hulbert-Williams, Nicholas J.; Blagden, Sarah P.; Maggie's Centres, London; University of Chester; University of Oxford (Wiley, 2019-05-20)
    • Pain Processing in Psychiatric Conditions: A systematic review

      Vaughan, Sarah; Poole, Helen M.; Forshaw, Mark J.; McGlone, Francis; Failla, Michelle D.; Cascio, Carissa J.; Moore, David J.; University of Chester, Liverpool John Moores University, Vanderbilt University Medical Centre (American Psychological Society, 2019-04-29)
      Objective: Pain is a universal, multidimensional experience with sensory emotional, cognitive and social components, which is fundamental to our environmental learning when functioning typically. Understanding pain processing in psychiatric conditions could provide unique insight into the underlying pathophysiology or psychiatric disease, especially given the psychobiological overlap with pain processing pathways. Studying pain in psychiatric conditions is likely to provide important insights, yet, there is a limited understanding beyond the work outside depression and anxiety. This is a missed opportunity to describe psychiatric conditions in terms of neurobiological alterations. In order to examine the research into the pain experiences of these groups and the extent to which a-typicality is present, a systematic review was conducted. Methods: An electronic search strategy was developed and conducted in several databases. Results: The current systematic review included 46 studies covering five DSM-5 disorders: autism, attention deficit hyperactivity disorder, schizophrenia, personality disorder and eating disorders, confirming tentative evidence of altered pain and touch processing. Specifically, hyposensitivity is reported in schizophrenia, personality disorder and eating disorder, hypersensitivity in ADHD and mixed results for autism. Conclusions: Review of the research highlights a degree of methodological inconsistency in the utilisation of comprehensive protocols; the lack of which fails to allow us to understand whether a-typicality is systemic or modality-specific.
    • Technical Notation as a Tool for Basic Research in Relational Frame Theory

      Tyndall, Ian; Mulhern, Teresa; Ashcroft, Sam; McLoughlin, Shane; University of Chester; University of Chichester (Springer Verlag, 2019-04-08)
      A core overarching aim of Relational Frame Theory (RFT) research on language and cognition is the prediction and influence of human behavior with precision, scope, and depth. However, the conceptualization and delineation of empirical investigations of higher-order language and cognition from a relational framing theoretical standpoint is a challenging task that requires a high degree of abstract reasoning and creativity. To that end, we propose using symbolic notation as seen in early RFT experimental literature as a possible functional-analytical tool to aid in the articulation of hypotheses and design of such experiments. In this article, we provide examples of aspects of cognition previously identified in RFT literature and how they can be articulated rather more concisely using technical notation than in-text illustration. We then provide a brief demonstration of the utility of notation by offering examples of several novel experiments and hypotheses in notation format. In two tables, we provide a “key” for understanding the technical notation written herein, which other basic-science researchers may decide to draw on in future. To conclude, this article is intended to be a useful resource to those who wish to carry out basic RFT research on complex language and cognition with greater technical clarity, precision, and broad scope.
    • Registered nurses’ experiences of communicating respect to patients: influences and challenges

      Clucas, Claudine; Chapman, Hazel M.; Lovell, Andy; University of Chester (SAGE Publications, 2019-04-04)
      Background: Respectful care is central to ethical codes of practice and optimal patient care, but little is known on influences on and challenges in communicating respect. Research question: What are the intra- and inter-personal influences on nurses’ communication of respect? Research design and participants: Semi-structured interviews with 12 hospital-based United Kingdom registered nurses were analysed using interpretative phenomenological analysis to explore their experiences of communicating respect to patients and associated influences. Ethical considerations: The study was approved by the Institutional ethics board and National Health Service Trust. Findings: Three interconnected superordinate themes were identified: ‘private self: personal attitudes’, ‘outward self: showing respect’ and ‘reputational self: being perceived as respectful’. Respectful communication involved a complex set of influences, including attitudes of respect towards patients, needs and goals, beliefs around the nature of respectful communication, skills and influencing sociocultural factors. A tension between the outward self as intended and perceived presented challenges for nurses’ reputational self as respectful, with negative implications for patient care. Discussion: The study offers an in-depth understanding of intra- and interpersonal influences on communicating respect, and sheds light on challenges involved, helping provide practical insights to support respectful care.
    • Implicit knowledge and memory for musical stimuli in musicians and non-musicians.

      Thorpe, Lisa; Cousins, Margaret; Bramwell, Ros; University of Chester (Sage, 2019-03-21)
      The phoneme monitoring task used by Bigand, Tillmann, Poulin, D’Adamo and Madurell (2001) is a musical priming paradigm that demonstrates that both musicians and non-musicians have gained implicit understanding of prevalent harmonic structures. Little research has focused on implicit music learning in musicians and non-musicians. This current study aimed to investigate whether the phoneme monitoring task would identify any implicit memory differences between musicians and non-musicians. It focuses on both implicit knowledge of musical structure and implicit memory for specific musical sequences. Thirty-two musicians and non-musicians (19 female and 13 male) were asked to listen to a seven-chord sequence and decide as quickly as possible whether the final chord ended on the syllable /di/ or /du/. Overall, musicians were faster at the task, though non-musicians made more gains through the blocks of trials. Implicit memory for musical sequence was evident in both musicians and non-musicians. Both groups of participants reacted quicker to sequences that they had heard more than once but showed no explicit knowledge of the familiar sequences.
    • Evaluating unmet needs in patients undergoing surgery for colorectal cancer: A patient reported outcome measures (PROMS) study

      Sutton, Paul; Bourdon-Pierre, R; Smith, Carly M.; Appleton, Nathan; Lightfoot, Tina; Gabriel, Claire; Richards, B.; Mohamed, S.; Mason-Whitehead, Elizabeth; Hulbert-Williams, Nicholas J.; et al. (Wiley, 2019-03-03)
      Aim Patient reported outcome measures (PROMs) are self-reported measures of patients’ health status or health related quality of life at a single point in time. We aimed to evaluate the use of a colorectal PROM, and conducted a focus group to further explore this and other unmet needs in our patient population treated surgically for colorectal cancer. Method A multidisciplinary research group consisting of colorectal surgeons, nurse specialists, psychologists, sociologists and patient representatives devised a composite tool of new and existing outcome measures which was piloted in our local population (n=35). Participants were subsequently invited to attend a semi-structured focus group during which the PROM was reviewed and an unmet needs analysis performed. Thematic analysis of focus group transcripts was undertaken for emergent themes. Results Initial consensus was for a tool including the EQ-5D, FACT-C, the distress thermometer, a validated measure of stigma, an unmet needs analysis, and questions assessing the psychological impact of cancer. Median and IQR values suggested all metrics were discriminatory with the exception of FACT-C. All participants agreed the tool was acceptable, and reflected the current state of their health and emotions. Thematic analysis of focus group transcripts identified four major themes: Physical symptoms, emotional response, information provision and coping mechanisms. Conclusion Through expert consensus, local piloting and patient focus groups we have evaluated a novel PROM for colorectal cancer. Furthermore, through our direct engagement with patients we have identified several unmet needs which we are currently exploring within the clinical service.
    • Internet use and preferences among women living with advanced breast cancer

      Kemp, Emma; Koczwara, Bogda; Turner, Jane; Girgis, Afaf; Schofield, Penelope; Hulbert-Williams, Nicholas J.; Levesque, Janelle V.; Spence, Danielle; Vatandoust, Sina; Kichenadasse, Ganessan; et al. (Wiley, 2019-02-21)
      Despite high distress and unmet informational and psychosocial needs, and recommendations for development of advanced breast cancer (ABC)-specific resources, there remains a paucity of appropriate, accessible psychological interventions. This survey study examined internet use and preferences of women with ABC, to the gauge feasibility of providing an ABC- specific internet intervention. Most participants (83%) used the internet daily. Results indicated most women with ABC would find an ABC-specific internet intervention helpful, and that it would address gaps in current internet resources, including provision of strategies to manage treatment side effects and fear of cancer progression.
    • Safeguarding children who are exposed to Abuse Linked to Faith or Belief

      Oakley, Lisa; University of Chester, StepsSA, Thirtyone:eight, Victoria Climbie Foundation (John Wiley & Sons, 2019-02-18)
      Cases of child abuse linked to faith or belief (CALFB) continue to be documented. However, there is limited research and understanding of CALFB. Further, there is a lack of clarity of definition. These factors then impact upon effective practice. Recognising this, the National Working Group for CALFB called for research on which to develop evidence-based practice. This paper reports on key findings from a mixed-method online survey which was completed by 1361 participants from a range of practitioner and community groups. The participants identified the importance of policy and multiagency working in this area, but they acknowledged the complexity and challenges associated with developing and implementing good practice. Recommendations from the study include a review of relevant policy to evaluate its application to CALFB, the development of faith literacy training for frontline practitioners and the creation of a space in which statutory, faith and community groups can dialogue.
    • A Quantitative Sensory Testing Approach to Pain in Autism Spectrum Disorders

      Vaughan, Sarah; McGlone, Francis; Poole, Helen; Moore, David J.; University of Chester; Liverpool John Moores University (Springer Verlag, 2019-02-15)
      Sensory abnormalities in autism has been noted clinically, with pain insensitivity as a specified diagnostic criterion. However, there is limited research using psychophysically robust techniques. Thirteen adults with ASD and 13 matched controls completed an established Quantitative Sensory Testing (QST) battery, supplemented with measures of pain tolerance and central modulation. The ASD group showed higher thresholds for light touch detection and mechanical pain. Notably, the ASD group had a greater range of extreme scores (the number of z-scores outside of the 95% CI >2), dynamic mechanical allodynia and paradoxical heat sensation; phenomena not typically seen in neurotypical individuals. These data support the need for research examining central mechanisms for pain in ASD and greater consideration of individual difference.
    • Gestural repertoire size is associated with social proximity measures in wild chimpanzees.

      Roberts, Anna I.; Chakrabarti, Anwesha; Roberts, Sam G. B. (2019-02-01)
      Studying the communication systems of primates can provide insights into the evolutionary origins of human language. Some theories propose that language evolved to help meet the demands of managing complex social relationships. Examining the associations between sociality and communication in the great apes can help to identify the specific selection pressures that may have been important for language evolution. In particular, gestural communication is believed to be important because it is a relatively recent trait seen only in primates and particularly in the great apes. However, the extent to which more complex gestural communication plays a role in managing social relationships, as compared to less complex gestural communication, is not well understood. Using social network analysis, we examined the association between complex gesturing (indexed as repertoire size) and complexity of social relationships indexed as proximity (the duration of time spent within 10 m, per hour spent in same party) in wild chimpanzees (Pan troglodytes schweinfurthii). Repertoire size (the total number of gesture types a focal subject produced toward other individuals) and dyadic repertoire size (the number of gesture types produced toward the dyad partner, per hour spent within 10 meters) were positively associated with proximity at the level of the group (centrality in the proximity network) and the dyad (proximity duration between dyads), respectively. Further, the repertoire size of visual and auditory short-range gestures was positively associated with proximity, while the repertoire size of tactile gesture was negatively associated with proximity. Overall these results suggest that gestural repertoire size has important implications for maintaining social relationships in wild chimpanzees and more broadly that gestural communication may have played an important role in language evolution. [Abstract copyright: © 2019 Wiley Periodicals, Inc.]
    • Participant Concerns for the Learner in a Virtual Reality Replication of the Milgram Obedience Study

      Gonzalez-Franco, Mar; Slater, Mel; Birney, Megan E.; Swapp, David; Haslam, S. Alexander; Reicher, Stephen D.; Microsoft Research; University College London; University of Barcelona; University of Chester at University Centre Shrewsbury; University of Queensland; University of St. Andrews (Public Library of Science, 2018-12-31)
      In Milgram’s seminal obedience studies, participants’ behaviour has traditionally been explained as a demonstration of people’s tendency to enter into an ‘agentic state’ when in the presence of an authority figure: they attend only to the demands of that authority and are insensitive to the plight of their victims. There have been many criticisms of this view, but most rely on either indirect or anecdotal evidence. In this study, participants (n = 40) are taken through a Virtual Reality simulation of the Milgram paradigm. Compared to control participants (n = 20) who are not taken through the simulation, those in the experimental conditions are found to attempt to help the Learner more by putting greater emphasis on the correct word over the incorrect words. We also manipulate the extent to which participants identify with the science of the study and show that high identifiers both give more help, are less stressed, and are more hesitant to press the shock button than low identifiers. We conclude that these findings constitute a refutation of the ‘agentic state’ approach to obedience. Instead, we discuss implications for the alternative approaches such as ‘engaged followership’ which suggests that obedience is a function of relative identification with the science and with the victim in the study. Finally, we discuss the value of Virtual Reality as a technique for investigating hard-to-study psychological phenomena.
    • The Influence of Oxytocin on Eating Behaviours and Stress in Women with Bulimia Nervosa and Binge Eating Disorder

      Leslie, Monica; Leppanen, Jenni; Paloyelis, Yannis; Treasure, Janet; King's College London (Elsevier, 2018-12-21)
      The current study aimed to test the influence of oxytocin on palatable food intake, 24-hour caloric consumption, and stress in women with bulimia nervosa and binge eating disorder. We recruited 25 women with DSM-5 bulimia nervosa or binge eating disorder, and 27 weight-matched comparison women without history of an eating disorder. We employed a double-blind, placebo-controlled crossover design in which each participant attended the lab for two experimental sessions, receiving a divided dose of 64IU intranasal oxytocin in one session and equivalent volume of placebo nasal spray in the opposite session. The order of administration was pseudo-randomised across participants. We hypothesised that a divided dose of 64IU intranasal oxytocin administration would reduce subjective hunger, the immediate consumption of palatable food, 24-hour calorie consumption, and the incidence of binge eating when compared to placebo. We also hypothesised that oxytocin administration would be associated with lower levels of stress and salivary cortisol, and that there would be an interaction with participant group such that oxytocin would reduce eating behaviour and stress to a greater degree in women with bulimia nervosa or binge eating disorder, compared to women without history of an eating disorder. We did not find a significant effect of oxytocin on any of the measurements of eating behaviour, subjective stress, or salivary cortisol. We recommend that future studies test the dose-response effect of oxytocin on eating behaviours and stress in human populations with eating disorders to further clarify the moderating factors for oxytocin’s effect on eating.
    • Cancer Experiences in People with Intellectual Disabilities

      Hulbert-Williams, Nick; Hulbert-Williams, Lee; Bramwell, Ros; Flynn, Samantha (University of Chester, 2018-12-20)
      People with intellectual disabilities are increasingly being diagnosed with cancer due, in part, to increases in life expectancy for this population. Despite the growing number of people with cancer and intellectual disabilities, the cancer-related experiences of people with intellectual disabilities are under-researched. Person-centred approaches to research are needed to better understand the needs and psychosocial outcomes of people with cancer and intellectual disabilities. This thesis aims to better understand the cancer-related experiences of people with intellectual disabilities, and the impact on the people who support them. The thesis comprises four related studies: (1) a systematic review of psychosocial experiences of cancer in people with intellectual disabilities; (2) a qualitative study of cancer experiences in people with intellectual disabilities using thematic analysis informed by grounded theory; (3) a survey of UK oncology nurses’ attitudes and care perceptions towards people with intellectual disabilities; and (4) a feasibility study of an intervention to improve healthcare professionals’ perceptions of communicating with people with cancer and intellectual disabilities. Five themes emerged from the ten papers included in the systematic review: delayed diagnosis; information, communication, and understanding; negative psychological consequences; negative physical consequences; and social support. Six of the ten papers included data from the same ethnographic study of 13 people, highlighting a paucity of empirical research regarding the psychosocial cancer experiences of people with intellectual disabilities. The qualitative study indicated that people with intellectual disabilities were often excluded from conversations about their diagnosis, treatment, and ongoing care, and expressed confusion and anxiety about their cancer. Attempts to protect them from distress inhibited communication, but where additional support was offered, participants engaged more meaningfully in their experience and this should, therefore, be encouraged. In the qualitative study, oncology nurses were reported to be important figures in the care of patients with intellectual disabilities. The survey of oncology nurses highlighted that caring for cancer patients with intellectual disabilities may intensify their already difficult role; however, previous experience may ameliorate negative consequences. This sample identified their need for training about communicating with people with intellectual disabilities. The first three studies informed the development of a novel, brief, online, video-based intervention for healthcare professionals working with people with intellectual disabilities and cancer. The feasibility trial of this intervention indicated that there were problems with recruitment, high attrition, and intervention adherence. These problems were, most likely due to participants finding the content and delivery method to be unacceptable. It is clear that the intervention is not feasible in its current format, and that further theoretical and modelling work is needed before the intervention is feasibility tested again ahead of a definitive trial. This body of work has demonstrated that people with intellectual disabilities and cancer face multiple barriers to accessing cancer care, including informative and understandable communication with healthcare professionals. With appropriate support, psychological and physical outcomes can be improved for people with intellectual disabilities and cancer, but caring for people with cancer and intellectual disabilities can be challenging for paid and informal carers, and oncology staff. Difficulties with communication are bi-directional, and improving communication might be an appropriate first step to improving cancer experiences for this population, but developing effective interventions presents numerous feasibility challenges.