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Rimmer B, Balla M, Dutton L, Williams S, Araújo-Soares V, Gallagher P, Finch T, Lewis J, Burns R, Menger F, Sharp L. Barriers and facilitators to self-management in people living with a lower-grade glioma. J Cancer Surviv 2024:10.1007/s11764-024-01572-9. [PMID: 38512564 DOI: 10.1007/s11764-024-01572-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/16/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Self-management can have clinical and quality-of-life benefits. However, people with lower-grade gliomas (LGG) may face chronic tumour- and/or treatment-related symptoms and impairments (e.g. cognitive deficits, seizures), which could influence their ability to self-manage. Our study aimed to identify and understand the barriers and facilitators to self-management in people with LGG. METHODS We conducted semi-structured interviews with 28 people with LGG across the United Kingdom, who had completed primary treatment. Sixteen participants were male, mean age was 50.4 years, and mean time since diagnosis was 8.7 years. Interviews were audio-recorded and transcribed. Following inductive open coding, we deductively mapped codes to Schulman-Green et al.'s framework of factors influencing self-management, developed in chronic illness. RESULTS Data suggested extensive support for all five framework categories ('Personal/lifestyle characteristics', 'Health status', 'Resources', 'Environmental characteristics', 'Healthcare system'), encompassing all 18 factors influencing self-management. How people with LGG experience many of these factors appears somewhat distinct from other cancers; participants described multiple, often co-occurring, challenges, primarily with knowledge and acceptance of their incurable condition, the impact of seizures and cognitive deficits, transport difficulties, and access to (in)formal support. Several factors were on a continuum, for example, sufficient knowledge was a facilitator, whereas lack thereof, was a barrier to self-management. CONCLUSIONS People with LGG described distinctive experiences with wide-ranging factors influencing their ability to self-manage. IMPLICATIONS FOR CANCER SURVIVORS These findings will improve awareness of the potential challenges faced by people with LGG around self-management and inform development of self-management interventions for this population.
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Affiliation(s)
- Ben Rimmer
- Population Health Sciences Institute, Newcastle University, Newcastle University Centre for Cancer, Ridley Building 1, Newcastle Upon Tyne, NE1 7RU, England.
| | - Michelle Balla
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, England
| | - Lizzie Dutton
- Population Health Sciences Institute, Newcastle University, Newcastle University Centre for Cancer, Ridley Building 1, Newcastle Upon Tyne, NE1 7RU, England
| | - Sophie Williams
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, England
| | - Vera Araújo-Soares
- Population Health Sciences Institute, Newcastle University, Newcastle University Centre for Cancer, Ridley Building 1, Newcastle Upon Tyne, NE1 7RU, England
- Centre for Preventive Medicine and Digital Health, Department for Prevention, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne, England
| | - Joanne Lewis
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, England
| | - Richéal Burns
- Faculty of Science, Atlantic Technological University, Sligo, Ireland
- Health and Biomedical Strategic Research Centre, Atlantic Technological University, Sligo, Ireland
| | - Fiona Menger
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle Upon Tyne, England
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle University Centre for Cancer, Ridley Building 1, Newcastle Upon Tyne, NE1 7RU, England
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Rimmer B, Balla M, Dutton L, Lewis J, Brown MC, Burns R, Gallagher P, Williams S, Araújo-Soares V, Finch T, Menger F, Sharp L. Identifying and understanding how people living with a lower-grade glioma engage in self-management. J Cancer Surviv 2023:10.1007/s11764-023-01425-x. [PMID: 37450254 DOI: 10.1007/s11764-023-01425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Lower-grade gliomas (LGG) are mostly diagnosed in working-aged adults and rarely cured. LGG patients may face chronic impairments (e.g. fatigue, cognitive deficits). Self-management can improve clinical and psychosocial outcomes, yet how LGG patients self-manage the consequences of their tumour and its treatment is not fully understood. This study, therefore, aimed to identify and understand how LGG patients engage in the self-management of their condition. METHODS A diverse group of 28 LGG patients (age range 22-69 years; male n = 16, female n = 12; mean time since diagnosis = 8.7 years) who had completed primary treatment, were recruited from across the United Kingdom. Semi-structured interviews were conducted. Informed by a self-management strategy framework developed in cancer, directed content analysis identified and categorised self-management types and strategies used by patients. RESULTS Overall, 20 self-management strategy types, comprising 123 self-management strategies were reported; each participant detailed extensive engagement in self-management. The most used strategy types were 'using support' (n = 28), 'creating a healthy environment' (n = 28), 'meaning making' (n = 27), and 'self-monitoring' (n = 27). The most used strategies were 'accepting the tumour and its consequences' (n = 26), 'receiving support from friends (n = 24) and family' (n = 24), and 'reinterpreting negative consequences' (n = 24). CONCLUSIONS This study provides a comprehensive understanding of the strategies used by LGG patients to self-manage their health and wellbeing, with a diverse, and substantial number of self-management strategies reported. IMPLICATIONS FOR CANCER SURVIVORS The findings will inform the development of a supported self-management intervention for LGG patients, which will be novel for this patient group.
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Affiliation(s)
- Ben Rimmer
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle Upon Tyne, England.
| | - Michelle Balla
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, England
| | - Lizzie Dutton
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle Upon Tyne, England
| | - Joanne Lewis
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, England
| | - Morven C Brown
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle Upon Tyne, England
| | - Richéal Burns
- Faculty of Science, Atlantic Technological University, Sligo, Ireland
- Health and Biomedical Strategic Research Centre, Atlantic Technological University, Sligo, Ireland
| | | | - Sophie Williams
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, England
| | - Vera Araújo-Soares
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle Upon Tyne, England
- Centre for Preventive Medicine and Digital Health, Department for Prevention of Cardiovascular and Metabolic Disease, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne, England
| | - Fiona Menger
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle Upon Tyne, England
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle Upon Tyne, England
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Menger F, Cresswell H, Lewis J, Volkmer A, Sharp L. Speaking up for the lost voices: representation and inclusion of people with communication impairment in brain tumour research. Support Care Cancer 2023; 31:355. [PMID: 37237058 DOI: 10.1007/s00520-023-07804-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Brain tumours and their associated treatments can lead to progressive impairments of communication, adversely affecting quality-of-life. This commentary explores our concerns that people with speech, language, and communication needs face barriers to representation and inclusion in brain tumour research; we then offer possible solutions to support their participation. Our main concerns are that there is currently poor recognition of the nature of communication difficulties following brain tumours, limited focus on the psychosocial impact, and lack of transparency on why people with speech, language, and communication needs were excluded from research or how they were supported to take part. We propose solutions focusing on working towards more accurate reporting of symptoms and the impact of impairment, using innovative qualitative methods to collect data on the lived experiences of speech, language, and communication needs, and empowering speech and language therapists to become part of research teams as experts and advocates for this population. These solutions would support the accurate representation and inclusion of people with communication needs after brain tumour in research, allowing healthcare professionals to learn more about their priorities and needs.
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Affiliation(s)
- Fiona Menger
- Speech and Language Sciences, School of Education, Communication and Language Sciences, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK.
| | | | - Joanne Lewis
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Anna Volkmer
- Psychology and Language Sciences, University College London, London, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Rimmer B, Bolnykh I, Dutton L, Lewis J, Burns R, Gallagher P, Williams S, Araújo-Soares V, Menger F, Sharp L. Health-related quality of life in adults with low-grade gliomas: a systematic review. Qual Life Res 2023; 32:625-651. [PMID: 35931881 PMCID: PMC9992080 DOI: 10.1007/s11136-022-03207-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Low-grade glioma (LGG) patients may face health-related quality-of-life (HRQoL) impairments, due to the tumour, treatment and associated side-effects and prospects of progression. We systematically identified quantitative studies assessing HRQoL in adult LGG patients, for: aspects of HRQoL impacted; comparisons with non-cancer controls (NCC) and other groups; temporal trends; and factors associated with HRQoL. METHODS MEDLINE, CINAHL, Embase, PubMed, and PsycINFO were systematically searched from inception to 14th September 2021. Following independent screening of titles and abstracts and full-texts, population and study characteristics, and HRQoL findings were abstracted from eligible papers, and quality appraised. Narrative synthesis was conducted. RESULTS Twenty-nine papers reporting 22 studies (cross-sectional, n = 13; longitudinal, n = 9) were identified. Papers were largely good quality, though many excluded patients with cognitive and communication impairments. Comparators included high-grade gliomas (HGG) (n = 7); NCCs (n = 6) and other patient groups (n = 3). Nineteen factors, primarily treatment (n = 8), were examined for association with HRQoL. There was substantial heterogeneity in HRQoL instruments used, factors and aspects of HRQoL assessed and measurement timepoints. HRQoL, primarily cognitive functioning and fatigue, in adult LGG patients is poor, and worse than in NCCs, though better than in HGG patients. Over time, HRQoL remained low, but stable. Epilepsy/seizure burden was most consistently associated with worse HRQoL. CONCLUSION LGG patients experience wide-ranging HRQoL impairments. HRQoL in those with cognitive and communication impairments requires further investigation. These findings may help clinicians recognise current supportive care needs and inform types and timings of support needed, as well as inform future interventions.
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Affiliation(s)
- Ben Rimmer
- Population Health Sciences Institute, Newcastle University, Newcastle University Centre for Cancer, Ridley Building 1, Newcastle upon Tyne, NE1 7RU, Newcastle, England.
| | - Iakov Bolnykh
- Faculty of Medical Sciences, Newcastle University, Newcastle, England
| | - Lizzie Dutton
- Population Health Sciences Institute, Newcastle University, Newcastle University Centre for Cancer, Ridley Building 1, Newcastle upon Tyne, NE1 7RU, Newcastle, England
| | - Joanne Lewis
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, England
| | - Richéal Burns
- Department of Health and Nutritional Sciences, Sligo, IT, Ireland
| | | | - Sophie Williams
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, England
| | - Vera Araújo-Soares
- Population Health Sciences Institute, Newcastle University, Newcastle University Centre for Cancer, Ridley Building 1, Newcastle upon Tyne, NE1 7RU, Newcastle, England.,Faculty of Behavioural, Management and Social Sciences, Department of Health Technology and Services Research, University of Twente, Twente, The Netherlands
| | - Fiona Menger
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle, England
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle University Centre for Cancer, Ridley Building 1, Newcastle upon Tyne, NE1 7RU, Newcastle, England
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Menger F, Deane J, Patterson JM, Fisher P, O’Hara J, Sharp L. The nature and content of rumination for head and neck cancer survivors. Front Psychol 2022; 13:995187. [DOI: 10.3389/fpsyg.2022.995187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHead and neck cancer (HNC) diagnosis and treatment can be a significant life trauma. Some HNC survivors experience post-traumatic growth (PTG), which has been linked with better health-related quality-of-life. Empirical research on PTG, and theoretical models, point to the importance of being able to purposely make sense of the traumatic experience. Intrusive rumination, by contrast, is linked to poorer outcomes. This study explored HNC survivors’ experiences of rumination.MethodsTwenty HNC survivors between 9 months and 5 years post-diagnosis were recruited (11 male, 9 female, age range 46–83). They had a range of HNC sub-types and cancer treatments. Participants underwent a semi-structured interview about their cancer diagnosis and treatment. Reflexive thematic analysis identified themes and sub-themes around rumination.ResultsFour themes with linked subthemes on the content and process of rumination were identified. Theme 1 was rumination and worry related to diagnosis. Here, survivors discussed how the HNC diagnosis and plans for treatment had dominated their initial thoughts. Theme 2 was processing the trauma of HNC. This theme reflected rumination on the traumatic experience of diagnosis and treatment and how the participant was reacting to it. Theme 3 was considering the impact. This theme encompassed retrospective thinking (e.g., on treatment decisions made) and comparisons between the participant now versus the early days after diagnosis. Theme 4 was continued rumination. This theme included ongoing intrusive and distressing rumination about the trauma and impact of cancer. Those who expressed ongoing rumination revisited fears (e.g., concerns about their future) or returned to negative experiences (e.g., distressing exchanges with healthcare professionals or what they perceived as poor care).ConclusionThis study uniquely describes the nature and content of rumination following HNC. Early intrusive rumination is common and may reflect perceptions of cancer as an existential threat. Over time, rumination can become more reflective and move towards deliberate meaning-making. Some HNC survivors may benefit from interventions to reduce barriers to this transition. The content of distressing and difficult to control rumination (commonly focused on ongoing fears or inability to resolve difficult experiences) helps to identify those who may benefit from more directed psychological support.
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Menger F, Mohammed Halim NA, Rimmer B, Sharp L. Post-traumatic growth after cancer: a scoping review of qualitative research. Support Care Cancer 2021; 29:7013-7027. [PMID: 34018030 PMCID: PMC8464569 DOI: 10.1007/s00520-021-06253-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
Purpose Interest is growing in post-traumatic growth (PTG) after cancer prompted, in part, by observations of positive associations with health-related quality of life. Qualitative research provides valuable insight into survivors’ experiences. We conducted a scoping review of qualitative evidence on PTG in cancer, determining the number, nature, range and scope of studies, and gaps in the literature. Methods We systematically searched Medline, Scopus, CINAHL, Web of Science, and PsycINFO for qualitative research exploring positive changes after cancer published from 1996. From eligible studies, we extracted: terms used for PTG; design, methodological orientation, and techniques, and participant characteristics. Using descriptive mapping, we explored whether study findings fit within Tedeschi and Calhoun’s PTG framework, and evidence for unique positive changes post-cancer. Results Twenty-eight studies were eligible. Cancer sites included were: breast, 14; mixed, 6; haematological, 4; head and neck cancer, 2; bone, 1, and testis, 1. Multiple studies were conducted in: the USA (12), Australia (3), Iran (2), and the UK (2). Twenty-three studies collected data using individual interviews (21) or focus groups (2). Definitions of PTG varied. Studies largely focused on descriptive accounts of PTG. Findings mapped onto existing PTG dimensions; health behaviour changes were often reported, under ‘new possibilities’. Conclusions A range of PTG outcomes can occur after cancer. Positive health behaviour changes warrant further exploration. Future research should include more diverse patient populations, collect longitudinal data, and focus on pathways towards positive changes. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06253-2.
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Affiliation(s)
- Fiona Menger
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | | | - Ben Rimmer
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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Menger F, Patterson J, O'Hara J, Sharp L. Research priorities on post-traumatic growth: Where next for the benefit of cancer survivors? Psychooncology 2020; 29:1968-1970. [PMID: 32691475 DOI: 10.1002/pon.5490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/24/2020] [Accepted: 07/10/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Fiona Menger
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Joanne Patterson
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | - James O'Hara
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Abstract
Purpose: This study compared Internet use post-stroke in people with aphasia (n = 25) and without aphasia (n = 17). The purpose was to understand how people with aphasia were using the Internet and to investigate the impact of aphasia on their use.Materials and methods: A face-to-face supported questionnaire explored the use of technologies, types of Internet use, traditional and Internet communication, the perception of abilities, and possible barriers to acquiring or improving Internet skills. Descriptive and inferential statistics were used to analyze the data.Results: Internet use ranged from fully independent to by proxy across both groups. Most participants perceived their aphasia as a barrier, but for the majority, it was not the sole reason for failing to acquire or improve skills. Aphasia was related to difficulties with technology-based written communication. Educational attainment was related to participant's feelings about their own skills. Whilst aphasia was important, analysis revealed that age was a stronger predictor of Internet use per se.Conclusions: It is clear that aphasia often negatively affects Internet use and proficiency. However, this research clearly demonstrates that it is important to consider the influence of factors such as age, proxy use, education, and previous technology use and experience.Implications for rehabilitationPost-stroke aphasia contributes negatively to Internet use, particularly in the use of online communication tools such as email and messaging services.Sub-groups of people with aphasia are likely to be more vulnerable to exclusion from the benefits of the Internet; specifically, older people and those with lower levels of educational attainment.It is common for both older adults with and without aphasia to use the Internet via a proxy. Independent use may not always be the desired goal within rehabilitation.People with aphasia may perceive their age and disability as barriers to using the Internet and may lack confidence in their own ability or potential.
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Affiliation(s)
- Fiona Menger
- Speech and Hearing Sciences, Queen Margaret University, Edinburgh, UK
| | - Julie Morris
- Speech and Language Sciences, Newcastle University, Newcastle, UK
| | - Christos Salis
- Speech and Language Sciences, Newcastle University, Newcastle, UK
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