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Biomedical subjects

J Corner

Publications and source records attributed to J Corner.

At least 19 recordsLinked to original sources
PubMed2005

Is late diagnosis of lung cancer inevitable? Interview study of patients' recollections of symptoms before diagnosis.

BACKGROUND: A study was undertaken to explore the pathway to diagnosis among a group of patients recently diagnosed with lung cancer. METHODS: A directed interview study triangulating patients' accounts with hospital and GP records was performed with 22 men and women recently diagnosed with lung cancer at two cancer centres in the south and north of England. The main outcome measures were the symptoms leading up to a diagnosis of lung cancer and patient and GP responses before diagnosis. RESULTS: Patients recalled having new symptoms for many months, typically over the year before their diagnosis, irrespective of their disease stage once diagnosed. Chest symptoms (cough, breathing changes, and pain in the chest) were common, as were systemic symptoms (fatigue/lethargy, weight loss and eating changes). Although symptoms were reported as being marked changes in health, these were not in the main (with the exception of haemoptysis) interpreted as serious by patients at the time and not acted on. Once the trigger for action occurred (the event that took patients to their GP or elsewhere in the healthcare system), events were relatively speedy and were faster for patients who presented via their GP than via other routes. Patients' beliefs about health changes that may indicate lung cancer appeared to have played a part in delay in diagnosis. CONCLUSION: Further investigation of the factors influencing the timing of diagnosis in lung cancer is warranted since it appears that patients did not readily attend GP surgeries with symptoms. Insight into patients' perspectives on their experience before diagnosis may help medical carers to recognise patients with lung cancer more easily so that they can refer them for diagnosis and treatment. Encouragement to present early with signs of lung cancer should be considered alongside other efforts to speed up diagnosis and treatment.

Adult↗
PubMed2004

Older patients' experiences of treatment for colorectal cancer: an analysis of functional status and service use.

Age and ageing are an important part of the context within which the care and treatment of people with cancer is provided. More information is needed about the effects of cancer treatment on the lives of older people following inpatient care. We conducted a 3-year study in which older people with colorectal cancer completed a detailed questionnaire on multidimensional function and service use before and after elective treatment. Here we present an analysis of changes in functional status and service use over the pre- to post-treatment period, and set out a detailed picture of older people's experiences before and after treatment. In total, 337 patients with colorectal adenocarcinoma aged 58-95 years were interviewed before treatment using the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), Rotterdam Symptom Checklist (RSCL) and a severity of morbidity score. Study end points were defined as post-treatment functional status, symptom distress, severity of morbidity and frequency of service use. Pre- and post-treatment data were compared using matched analyses. Logistic regression was used to assess associations between age and the main outcome measures, and frequency of service use after treatment was compared between age groups using the chi2 test. Overall, patients experienced both positive and negative outcomes following treatment. It was notable that patients aged > or = 75 years showed improvement in only one of the principal outcome measures. Patterns of service use following treatment suggest that support at home is a key issue for patients. With the exception of nursing care, however, help at home is provided on a majority of occasions by families themselves. This raises important questions about how much preparation patients and families receive or would like before they leave hospital after treatment for cancer. A collaborative, family-centred approach to meeting people's needs is called for in the months following inpatient care.

Adenocarcinoma↗
PubMed2003

Care and the older person with cancer.

Care of older people with cancer has received relatively little attention in the literature and this area of caring practice has yet to be firmly established in professional discourse. References to the increasing proportion of older people in the population are common, as are references to the problems associated with old age, whether these are seen as medical, or as inevitable consequences of natural processes. Health care for older people has sometimes been reported to be routinized or basic, and as taking little account of individual perspectives, and the 'discourse of senescence' represents a tendency to understand old age and the aged body in terms of degeneration and deterioration. Here, it is argued that older people are often portrayed as separate and diminished, and have little control over the definition of themselves as users of health services. This represents a constraint upon the possibilities of caring practice. Divesting ourselves of the 'discourse of senescence' may be a fundamental part of developing caring practice for older people with cancer in the future.

Aged↗
PubMed2003

Treatment decisions in older patients with colorectal cancer: the role of age and multidimensional function.

The aim of the study was to investigate the role of age and multidimensional functional status in treatment decisions in older patients with colorectal cancer. Three hundred and thirty-seven patients aged 58-95 years with adenocarcinoma of the colon or rectum were interviewed before and after treatment using the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), a self-reported severity of morbidity scale, and the Rotterdam Symptom Checklist (RSCL). The OMFAQ rates five dimensions of function: social resources, economic resources, mental and physical health and self-care capacity. The likelihood of patients with Duke's C colorectal cancer receiving adjuvant chemotherapy decreased significantly with age (P = 0.001, trend). Differences in treatment received were not explained by differences in morbidity, economic, mental or physical function, self-care capacity, or any of the RSCL measures. After controlling for age, Duke's C patients who received adjuvant chemotherapy were less impaired in social resources than Duke's C patients who did not (P = 0.06). No other significant pre-treatment differences in functional status were found. Differences in age and social resources exist between patients who do and do not receive adjuvant chemotherapy. Care should be taken to ensure that patients are not excluded from treatment with known survival benefits because of their age, and the question of providing appropriate social support during adjuvant chemotherapy should be re-examined.

Adenocarcinoma↗
PubMed2002

Nurses' experiences of cancer.

This paper provides an overview of research into nurses' experiences of working with cancer, both how nursing care is experienced by people with cancer and the effects on nurses of working in cancer treatment and care settings. The literature, although slim, suggests that the work of nurses is experienced as valuable and supportive, although this is not consistently the case. Although nurses find working with people with cancer rewarding, it is also emotionally demanding. Evidence for stress among nurses working in cancer settings is mixed and may be related to structural factors more than the difficulties of working with patients who may be dying, although this warrants further exploration. Studies of nurses' communication skills are limited by a measurement-orientated approach that measures behaviour against predetermined criteria. Observational studies provide rich insights into the complex relationship between how nurses work with people who have cancer, or who are dying, as they adjust to their predicament, how this is therapeutic, but also where it may go wrong. Little detailed or comparative work has been undertaken into the skills and experiences of nurses working in different roles, in particular those of nurse specialists. Research is needed to further elucidate themes identified, in particular to shed light on how nurses and other health professionals may be assisted to develop expert practice in working with cancer, but also to sustain health professionals in this work.

Attitude of Health Personnel↗
PubMed2001

Evaluation of nurse-led follow up for patients undergoing pelvic radiotherapy.

This study reports results from a randomised controlled trial of nurse-led care and was designed to determine whether nurse-led follow up improved patients morbidity and satisfaction with care in men treated with radical radiotherapy for prostate and bladder cancer. The aim was to compare outcomes in terms of toxicity, symptoms experienced, quality of life, satisfaction with care and health care costs, between those receiving nurse-led care and a group receiving standard care. The study population was of men prescribed radical radiotherapy (greater than 60 Gy). Participants completed self-assessment questionnaires for symptoms and quality of life within the first week of radiotherapy treatment, at week 3, 6 and 12 weeks from start of radiotherapy. Satisfaction with clinical care was also assessed at 12 weeks post-treatment. Observer-rated RTOG toxicity scores were recorded pre-treatment, weeks 1, 3, 6 and 12 weeks from start of radiotherapy. The results presented in this paper are on 115 of 132 (87%) of eligible men who agreed to enter the randomised trial. 6 men (4%) refused and 11 (8%) were missed for inclusion in the study. Data were analysed as a comparison at cross-sectional time points and as a general linear model using multiple regression. There was no significant difference in maximum symptom scores over the time of the trial between nurse-led follow-up care and conventional medical care. Differences were seen in scores in the initial self assessment of symptoms (week 1) that may have been as a result of early nursing intervention. Those men who had received nurse-led care were significantly more satisfied (P < 0.002) at 12 weeks and valued the continuity of the service provided. There were also significant (P < 0.001) cost benefits, with a 31% reduction in costs with nurse-led, compared to medically led care. Evidence from this study suggests that a specialist nurse is able to provide safe follow up for men undergoing radiotherapy. The intervention focused on coping with symptoms, and provided continuity of care and telephone support. Further work is required to improve the management of patients during and after radiotherapy.

Adenocarcinoma↗
PubMed2001

Cancer nursing practice development: understanding breathlessness.

This paper considers methodological and philosophical issues that arose during a multi-centre, randomized controlled trial of a new nursing intervention to manage breathlessness with patients with primary lung cancer. Despite including a diverse range of instruments to measure the effects of the intervention, the uniqueness of individuals' experiences of breathlessness were often hidden by a requirement to frame the study within a reductionist research approach. Evidence from the study suggests that breathlessness is only partly defined when understood and explored within a bio-medical framework, and that effective therapy can only be achieved once the nature and impact of breathlessness have been understood from the perspective of the individual experiencing it. We conclude that to work therapeutically we need to know how patients interpret their illness and its resultant problems and that this demands methodological creativity.

Activities of Daily Living↗
PubMed2000

The prevalence and stability of an executive processing deficit, response inhibition, in people with chronic schizophrenia.

The current study investigates whether an executive processing measure, response inhibition, is stable over time and across new samples of patients with schizophrenia. Two groups of patients (with and without diagnoses of schizophrenia) were followed up 6 years after baseline data collection. Another separate group of patients with less institutionalized care also completed the same measures to determine whether the response inhibition difficulties had the same prevalence in this new sample.The response inhibition measure was stable over time only in the group of patients with a diagnosis of schizophrenia. The relationship between symptoms and response inhibition difficulties changed over time but was explicable in terms of the interaction between environmental demands and information processing difficulties. The level of response inhibition difficulties (about one-third) was identical in the new sample of patients, which suggests that response inhibition is not dependent on clinical history.

Adolescent↗
PubMed1999

Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer.

OBJECTIVE: To evaluate the effectiveness of nursing intervention for breathlessness in patients with lung cancer. DESIGN: Patients diagnosed with lung cancer participated in a multicentre randomised controlled trial where they either attended a nursing clinic offering intervention for their breathlessness or received best supportive care. The intervention consisted of a range of strategies combining breathing control, activity pacing, relaxation techniques, and psychosocial support. Best supportive care involved receiving standard management and treatment available for breathlessness, and breathing assessments. Participants completed a range of self assessment questionnaires at baseline, 4 weeks, and 8 weeks. SETTING: Nursing clinics within 6 hospital settings in the United Kingdom. PARTICIPANTS: 119 patients diagnosed with small cell or non-small cell lung cancer or with mesothelioma who had completed first line treatment for their disease and reported breathlessness. OUTCOME MEASURES: Visual analogue scales measuring distress due to breathlessness, breathlessness at best and worst, WHO performance status scale, hospital anxiety and depression scale, and Rotterdam symptom checklist. RESULTS: The intervention group improved significantly at 8 weeks in 5 of the 11 items assessed: breathlessness at best, WHO performance status, levels of depression, and two Rotterdam symptom checklist measures (physical symptom distress and breathlessness) and showed slight improvement in 3 of the remaining 6 items. CONCLUSION: Most patients who completed the study had a poor prognosis, and breathlessness was typically a symptom of their deteriorating condition. Patients who attended nursing clinics and received the breathlessness intervention experienced improvements in breathlessness, performance status, and physical and emotional states relative to control patients.

Anxiety↗
PubMed1999

The experience of breathlessness in lung cancer.

Breathlessness is a common problem in advanced cancer ranked amongst the 10 most common symptoms in patients admitted to palliative care units. Alongside coughing, it is the most commonly reported symptom in lung cancer. Despite the prevalence of breathlessness, little research has been undertaken on the experience of the symptom, or on the restrictions it imposes on daily life. The data reported in this paper were collected as part of a study piloting new non-pharmacological intervention for patients with breathlessness as a result of lung cancer. Data on the experience of breathlessness from assessment notes recorded by nurses during conversations with 52 patients with lung cancer, were analysed using content analysis. Both physical and emotional sensations were associated with descriptions of breathlessness, such as the feeling of being unable to get enough breath, or of panic or impending death. Breathlessness was only continuous in eight patients, the remainder (85%) had an intermittent pattern of the symptom, usually triggered by exertion or, less commonly, emotion. Numerous restrictions on activity were reported as a result of breathlessness, on functioning inside and outside the home, to social life, and its implications for feelings about oneself. Most patients had attempted to find ways of managing the problems for themselves since, prior to receiving nursing intervention, little or no help had been forthcoming from health professionals.

Activities of Daily Living↗
PubMed1999

Interface between research and practice in psycho-oncology.

Examination of the interface between research and practice in any field inevitably raises questions over whether the most important issues are addressed by researchers, or indeed whether the findings of studies have sufficient relevance to practice. As a field of study develops its own research methods and language, a chasm often opens between the producers of research findings and the consumers. Psychosocial oncology is no different. Early work which highlighted the psychosocial impact of a cancer diagnosis, and how health professionals helped or hindered coping with the disease, was ground breaking, and highly relevant to the way cancer services subsequently developed. However, as psychosocial oncology has evolved into an established research discipline, it has become increasingly oriented around measurement (e.g., quality of life, psychopathology, communication skills). The paradox here is that the more reliable psychosocial measures become, the less direct relevance they appear to have for everyday practice in cancer treatment centres. Solutions to this problem could be found through reintegrating psychological and physical aspects of cancer; by changing the orientation of research from measurement of the disruption imposed by cancer and its treatment, to evaluations of more clinically relevant models of care; and by using collaborative models of research in studies in order to promote closer involvement of health professionals and people who have cancer.

Adaptation, Psychological↗
PubMed1999

The effects of neurocognitive remediation on executive processing in patients with schizophrenia.

Approaches to cognitive remediation have differed across studies. Most of the larger studies have concentrated on group treatments designed without the benefit of recent laboratory-based studies. The current study describes a randomized trial of an intensive cognitive remediation program involving individual daily sessions of 1 hour for up to 3 months. It targets executive functioning deficits (cognitive flexibility, working memory, and planning) that are known to be problematic in people with schizophrenia. Procedural learning, as well as the principles of errorless learning, targeted reinforcement, and massed practice, was the basis of the intervention. The program was compared with an alternative therapy (intensive occupational therapy) to control for some of the effects of therapeutic contact. Some improvements in cognition followed both therapies. A differential effect in favor of cognitive remediation therapy was found for tests in the cognitive flexibility and the memory subgroups. There was a trend for those receiving atypical antipsychotic medication to benefit more from cognitive remediation for tests of cognitive flexibility. Although there were no consistent changes in symptoms or social functioning between groups, if improvement in cognitive flexibility tasks reached a threshold then there is some evidence that social functioning improved, even over the short duration of the trial. In addition, cognitive remediation differentially improved self-esteem. This study supports the view that cognitive remediation can reduce cognitive deficits and that this reduction may affect social outcome, at least in the short term.

Adult↗
PubMed1999

Development of a breathlessness assessment guide for use in palliative care.

The complex nature of breathlessness in advanced cancer makes it a difficult symptom to understand and control. Measurement instruments applied to breathlessness have thus far failed to consider the multivariant components of this symptom. This study developed a breathlessness assessment guide for use in the clinical practice setting, that may be completed by any member of the health care team. The guide aims to encourage breathlessness to be addressed as a multidimensional problem, in which the emotional experience of breathlessness is inseparable from the sensory experience and the causative biological mechanisms. This guide provides the foundation for understanding the symptom of breathlessness in advanced cancer, and in turn promotes the development of management strategies to deal with this complex symptom.

Activities of Daily Living↗