Mrs Fiona Matley

Objectives: Standardised reporting of patient and public involvement (PPI) in research studies is needed to facilitate learning about how to achieve effective PPI.  The aim of this evaluation was to explore the impact of PPI in a large UK study, the Life After Prostate Cancer Diagnosis (LAPCD) study, and to explore the facilitators and challenges experienced.

Design:  Mixed methods study using an online survey and semi-structured interviews. Survey and topic guide were informed by systematic review evidence of the impact of PPI and by realist evaluation.  Descriptive analysis of survey data and thematic analysis of interview data were conducted. Results are reported using the GRIPP2 reporting guidelines.

Setting: Life After Prostate Cancer Diagnosis (LAPCD) study, a UK-wide patient-reported outcomes study

Participants: User Advisory Group (UAG) members (n=9) and researchers (n=29) from the LAPCD study

Results: Impact was greatest on improving survey design and topic guides for interviews, enhancing clarity of patient facing materials, informing best practice around data collection, and ensuring steering group meetings were grounded in what is important to the patient. Further impacts included ensuring patient focussed dissemination of study findings at conference presentations and in lay summaries.

Facilitating context factors included clear aims, time to contribute, confidence to contribute, and feeling valued and supported by researchers and other UAG members.  Facilitating mechanisms included embedding the UAG within the study as a separate work-stream, allocating time and resources to the UAG reflecting the value of input, and putting in place clear communication channels.  Hindering factors included time commitment, geographical distance, and lack of standardised feedback mechanisms.

Conclusion: Including PPI as an integral component of the LAPCD study and providing the right context and mechanisms for involving the UAG helped maximise the programme’s effectiveness and impact.  

Introduction: The effect of socioeconomic status on adolescent substance abuse may be mediated by family socialization practices. However, traditional mediation analysis using a product or difference method is susceptible to bias when assumptions are not addressed. We aimed to use a potential outcomes framework to assess assumptions of exposure‐mediator interaction and of no confounding of the results.

Method: We revisited a traditional mediation analysis with a multiple mediator causal mediation approach using data from 17,761 Norwegian young people (13–18 years), 51% female. Data were collected through a print questionnaire. Socioeconomic status was operationalized as parental education and employment status (employed or receiving welfare); drinking behavior as the frequency of alcohol consumption and frequency of intoxication in the past year; and socialization practices as general parenting measures, alcohol‐related parental permissiveness, and parent drinking behavior.

Results: There was no consistent evidence of exposure‐mediator interaction. Formal sensitivity analysis of mediator‐outcome confounding was not possible in the multiple mediator model, and this analysis supported the hypothesis that socioeconomic status effects on adolescent substance abuse are fully mediated by family socialization practices, with apparently stronger effects in younger age groups observed in plots.

Conclusion: We found that the effect of socioeconomic status on adolescent substance abuse was fully mediated by family socialization practices. While our analysis provides more rigorous support for causal inferences than past work, we could not completely rule out the possibility of unmeasured confounding.

Objectives. To explore UK clinicians’ beliefs and behaviours around recommending e-cigarettes as a smoking cessation aid for patients with cancer.

Design. Cross-sectional online survey.

Setting. England, Wales, Scotland and Northern Ireland.

Participants. Clinicians involved in the care of patients with cancer.

Primary and secondary outcomes. Behavioural Change Wheel capability, opportunity and motivation to perform a behaviour, knowledge, beliefs, current practice around e-cigarettes and other smoking cessation practices.

Method. Clinicians (n=506) completed an online survey to assess beliefs and behaviours around e-cigarettes and other smoking cessation practices for patients with cancer. Behavioural factors associated with recommending e-cigarettes in practice were assessed.

Results. 29% of clinicians would not recommend e-cigarettes to patients with cancer who continue to smoke. Factors associated with recommendation include smoking cessation knowledge (OR 1.56, 95% CI 1.01 to 2.44) and e-cigarette knowledge (OR 1.64, 95% CI 1.06 to 2.55), engagement with patients regarding smoking cessation (OR 2.12, 95% CI 1.12 to 4.03), belief in the effectiveness of e-cigarettes (OR 2.36 95% CI 1.61 to 3.47) and belief in sufficient evidence on e-cigarettes (OR 2.08 95% CI 1.10 to 4.00) and how comfortable they felt discussing e-cigarettes with patients (OR 1.57 95% CI 1.04 to 2.36).

Conclusion. Many clinicians providing cancer care to patients who smoke do not recommend e-cigarettes as a smoking cessation aid and were unaware of national guidance supporting recommendation of e-cigarettes as a smoking cessation aid.

Personal, Social, Health and Economic Education (PSHE) is undergoing changes within UK schools, and many topics, including healthy lifestyles, sex and relationships, and mental resilience/wellbeing will become statutory parts of the curriculum.  The overall aim of this study was to describe teachers’ views about these topics and how they should be delivered.  A cross sectional online survey was completed by 167 teachers (87.8% female).  Questions were asked about what was currently covered in schools, and which topics were important, and appropriate.  Rating scales were used to garner attitudes and open ended questions probed for more details from the participants.  Peer pressure about drugs and alcohol was commonly discussed (72% of participants) however pleasurable effects of drugs were rated inappropriate by 38.1%.  Sexting (75.4%), sexual consent (69.5%) were the most frequently discussed in the sex and relationship topics, while 26.5% said that sexually transmitted diseases were not appropriate to talk about in school. Resilience (94.3%), body image/appearance (91.9%) had high levels of coverage, while 41.8% said treatments for mental health conditions were not discussed but should be. For all topics, most teachers rated their access to training as insufficient. Confidence in talking about the topic of mental health and wellbeing was lower than for the other topics. Issues highlighted by these findings should be addressed when new curriculums are being planned. Teachers witness the challenges faced by their pupils on a daily basis and their experiences, alongside further engagement with pupils, should be used to meaningfully inform the new PSHE curriculum.