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Michael Mawhinney is originally from Northern Ireland. He joined Oxford Brookes in 2015 as a research student in the Department of Clinical Health Care. His thesis title is 'Optimising the care of patients receiving oral systemic anti-cancer treatments: a mixed method study'.
I heard about Oxford Brookes through my partner who studied Psychology at Brookes in 2006 and spoke very positively about the University. I was aware Brookes had a nursing department, so I always kept up to date with what academic activity was happening surrounding my subject areas via www.findaphd.com and the university webpages.
Fortunately for my PhD project I managed to obtain an Oxford Brookes sponsored studentship. When the program was advertised it also specified a role within teaching; a keen interest of mine is being involved in nurse education. While Oxford remains a high cost area to live, when compared to living in London, it is easier to live on a student salary in Oxford.
Before my PhD I worked full time as a staff nurse; more than 3 years in acute Haematology/Oncology, 1 year in critical care and over 1 year in early phase cancer clinical trials. Alongside full-time shift work, I completed my MSc part time from UCL, with a specialist interest in Global health and HIV. I also trained as a disaster relief worker and spent some time working with an NGO in Haiti during the Cholera outbreak. I have since been registered with the UKIETR - United Kingdom International Emergency Trauma Response agency, which works in conjunction with the NHS to respond to global disasters.
I remain in the early stages of my PhD project, but to this stage I have been very well supported by my supervisors and also my fellow PhD students. There are several of us who work from the same building and there is a clear sense of camaraderie among the students, which has been most helpful. The staff have been both welcoming and supportive, expectations placed are clear and support for where I feel weaknesses lie has been made easily accessible. I am also looking forward to participating in the various PhD training programs available to students and to date have already benefited from a series of research seminars lead by Professor Mary Boulton.
Originating from a cancer nursing background, it is appropriate that my research project surrounds the care of patients receiving oral systemic anti-cancer treatments (SACTs). SACTs refer to any drug or medication, given via any route, which actively target cancer cells; a prime example being chemotherapy.
Historically chemotherapy was largely given intravenously (IV) through a cannula straight into the blood stream. While this remains the largest proportion of administration routes, there has been a stark increase in the availability of oral products and this is likely to increase further within the coming years..
In many ways oral products are more advantageous to patients. Treatments can be as effective, taken at home, require fewer hospital visits and the patient may feel more in control of their individual cancer treatment. While the advantages may be clear, the risks however remain similar and debatably larger.
Cancer treatments can have severe and life threatening side effects or adverse events (AEs). SACTs not only target cancer cells, they also can affect healthy cells resulting in AEs such as myelosuppression and gastro-intestinal disruptions to name but a few. These adverse events need to be treated promptly and appropriately to prevent further, potentially life threatening complications. If patients are having less clinical contact time and managing their care needs at home, it is vital these events are reported and acted upon accordingly. Within this context, pre-treatment education plays a vital role
Within chemotherapy services and day units, it is usual for staff nurses administering the IV chemotherapy to discuss with patients their treatment plans, expected side effects and the management of medical emergencies such as neutropenic sepsis. Understanding and concordance with this advice can be followed up regularly as the patients attend their treatments and follow-ups. When considering oral therapies, the patient contact is considerably reduced and it is vital patients grasp an understanding of their treatment and its associated risks before commencement.
The Oxford University Hospitals NHS Foundation Trust has devised and successfully implemented a specific clinic for patients receiving oral SACTs in response to recommendations from several healthcare governing bodies. The service encompasses patients with both Haematology and Oncology backgrounds and multiple tumour types receiving oral SACT. The SACT treatment regimens are varied, up to date and the staff are experienced in all regimes prescribed. My PhD project will seek to further evaluate this service and identify any areas where patient care could potentially be optimised and outcomes of treatment improved.
The research questions I seek to answer therefore surround the experience of patients receiving oral SACTs, the perceptions and experiences of HCPs and investigating the role of pre-treatment education in ensuring prompt escalation and actions upon treatment-related toxicities.
A mixed methods approach, encompassing both qualitative and quantitative research methods will be used. Following a systematic review of the relevant literature and the required ethical approvals, healthcare staff involved with the service in varying departments and roles will be interviewed. A questionnaire will be issued to patients who consent to involvement in the study. A further select number of patients will be invited to participate in semi-structured interviews.
Given the increasing nature and advancements of oral SACTs it is vital any NHS service provides the best care to patients and in consideration of the relevant literature, I propose to develop an intervention surrounding the role of follow up and support.
Outcomes of this study build upon previous recommendations and assist in developing guidelines for the rolling out of healthcare services within the context of safe oral SACT delivery.
The findings of this project will be disseminated at relevant conferences and journals where staff involved in cancer care can be reached to ensure maximum impact of findings, but ultimately to improve the care given to patients receiving oral systemic anti-cancer treatments.
Personally what I most enjoy is the fact that I know I am playing a role in improving NHS services that will have a direct outcome on patient care, and inevitably patient outcomes. I enjoy a challenge. While working within a clinical setting as a registered nurse poses its own challenges, the world of research and academia is vast with varying techniques and approaches all of which prove of interest and stimulation. My strategy in overcoming any challenge remains the same, maintaining an active support network - community and social relationships can facilitate endurance through the toughest of challenges I believe.
I feel the research training is well suited and flexible to meet the varying needs of students. It is important to recognise that PhD students will approach their projects from different backgrounds. Having completed MSc level modules in medical statistics there are aspects of qualitative research that I will be utilising which remain theoretical and new - the training offered as part of the PhD programme will support and encourage me with these new techniques.
My plans include finishing my PhD project on time and to a high standard. I am a qualified nurse and I shall always remain a qualified nurse. The dream job would be one akin to the NIHR pathway of a ‘clinical academic’. I plan to be in a patient facing role where I can give bedside nursing care, but also a role where I can further education and practice and expand the evidence base so critical to high quality healthcare. I would be keen also to further my skills and interests within a global health capacity and be involved in developing healthcare in developing countries. However, I recognise to have a beneficial and ethical input vast clinical experience is required, so this would be a long-term goal to work toward.