Diamond, Cara (2013) Patient experience of admission to critical care unit

147 Pages·2013·6.84 MB·English

Diamond, Cara (2013) Patient experience of admission to critical care
unit (CCU) during Haematopoietic Stem Cell Transplant (HSCT); and
clinical research portfolio. D Clin Psy thesis.

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Patient experience of admission to critical care unit (CCU) during Haematopoietic Stem
Cell Transplant (HSCT)

And Clinical Research Portfolio

Volume 1

(Volume 2 bound separately)

Cara Diamond

July 2013

Mental Health and Wellbeing
Institute of Health and Wellbeing
University of Glasgow

Submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical
Psychology (DClinPsy)

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Table of Contents

Page

Declaration of Originality 3

Acknowledgements 4

Chapter 1: Systematic Review 5

Returning to work after cancer: A qualitative systematic review

Chapter 2: Major Research Project 48

Patient experience of admission to critical care unit (CCU) during
Haematopoietic Stem Cell Transplant (HSCT)

Chapter 3: Advanced Clinical Practice I – Reflective Critical Account 94
(Abstract only)

Communication through consultancy: increasing confidence in an unfamiliar
role

Chapter 4: Advanced Clinical Practice II – Reflective Critical Account 95
(Abstract only)

Incorporating the role of researcher into the professional identity of a clinical
psychologist

Appendices 96

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Declaration of Originality
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Acknowledgements

I would like to give my sincerest thanks to the participants who took part in this study.
Thank you for taking the time to share your experiences with me. Without you, this study
would not have been possible.

I would like to thank my supervisors Dr Sarah Wilson and Dr Christopher Hewitt for
their expertise, guidance, support and encouragement. Thanks also to Dr Kenneth Mullen
for his advice. I am also grateful to Laura Meehan and Anne Gaffney at the Beatson West
of Scotland Cancer Centre for their assistance during the recruitment process.

Thank you to my classmates for the support and the laughs! Completing this doctorate
alongside you all meant that I never felt alone, even at the most demanding times.

Thank you to my family and friends for their support and for providing much needed
distraction from the world of psychology! Special thanks to my mum and dad for always
encouraging and supporting me. I love you both.

Last, but not least, thank you to my husband Chris. You’ve been by my side every step
of the way and your support and encouragement has never wavered. You’ve always
believed in me, even when I didn’t believe in myself, and for that, I’m truly grateful.
Now we can clear out that room I call my study and get on with our lives!

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Chapter 1: Systematic Review

Returning to work after cancer: A qualitative systematic review

Cara Diamond
University of Glasgow
Mental Health and Wellbeing
Administration Building
Gartnavel Royal Hospital
1055 Great Western Road
Glasgow G12 0XH

Prepared in accordance with guidelines for submission to the European Journal of Cancer
Care (Appendix 1)

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Abstract

This article presents a systematic review of qualitative studies investigating the experiences
of cancer survivors returning to work. Meta-ethnography was used to select, critically
appraise and synthesise the studies. The search strategy involved a search for articles in
EMBASE, MEDLINE, CINAHL and PsychINFO databases. A hand search of relevant
journals and reference lists was also undertaken. Ten studies were identified for inclusion.
Quality was assessed using a rating scale based on a quality-rating framework. Six themes
were identified; returning to work means returning to normal, employer and colleague
reactions, effects of cancer and treatment on work ability, changed priorities, financial
pressure to return to work and advice from health professionals. These themes suggest that
cancer survivors strongly link being able to return to work with returning to normal life
although it was also clear that there are barriers that impact on this return. This article
discusses the relevance of these themes with regard to the treatment and care of these
patients.

Keywords: Qualitative systematic review, lived experience, cancer, return to work

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Introduction
Every year, approximately 300,000 people in the UK are diagnosed with cancer (Cancer
Research UK, 2010). Improvements in early detection and treatment have resulted in an
increasing number of cancer survivors (Aziz and Rowland, 2003), the definition of a survivor
being an individual who has been diagnosed with cancer and is still living (National Coalition
for Cancer Survivorship, 2005). A great many of these survivors will be of working age and
returning to work will be an important step in their recovery.

Previous studies examining the experience of returning to work after cancer have highlighted
the importance of work for several reasons. It provides a sense of identity and purpose and is
a strong source of social connection. Returning to work can also provide a distraction from
cancer and can enable the survivor to regain a sense of normality and control (Peteet, 2000).
Cancer diagnosis and its subsequent treatment can be a lonely, isolating, abnormal
experience. Survivors can feel cut off from their ‘normal’ life and detached from reality.
Therefore, returning to work after cancer treatment can be viewed as an important milestone
in the process of recovery. Also, from an economic perspective, it is important to explore and
hopefully reduce absences from work through ill health. Greater understanding of the factors
that impact on cancer survivors returning to work could lead to a reduction in unnecessary
work cessation.

Spelten et al. (2002) in their literature review examined the factors reported to influence
cancer survivors’ return to work and found that the rate of return to work varies from 30-93%
with a mean rate of 62%. They found that return to work was facilitated by a supportive work
environment and that manual or physically demanding work is negatively associated with
return to work. With regard to disease and treatment related factors, they found that patients
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with head and neck cancer, are at a particular disadvantage when returning to work, whereas
patients with testicular cancer experience relatively few problems. This variance across
cancer types could be due to psychosocial and physical factors, for example, testicular cancer
generally affects a younger age group and has a good prognosis however, head and neck
cancer tends to affect an older age group and often results in disfigurement, which could
impact on return to work. A further literature review by Mehnert (2011) consolidated these
findings, reporting that 63.5% of cancer survivors returned to work after a mean duration of
absence of 151 days.

Previous studies of people treated for cancer have reported a variety of problems at work
including job loss, unwanted changes in work situation, problems with co-workers and
diminished work capacity (Maunsell et al., 1999). It is therefore clear that returning to work
after cancer is not simply a matter of deciding to do so and being able to slip back into
previously filled roles. There are clearly factors that influence how successful a survivor is in
their attempt to return to work and it would be helpful to explore these in more detail in order
to deepen understanding of this experience.

The majority of the research conducted on returning to work after cancer has used
quantitative methods. Although this has provided important information regarding prevalence
rates and barriers and facilitators to work return, it has not been able to contribute to the
understanding of the experience of returning to work after cancer. The aim of qualitative
research is to ‘provide an in-depth understanding of people’s experiences, perspectives and
histories in the context of their personal circumstances and settings’ (Spencer et al., 2003).
Adopting this approach when conducting research with this population, allows for the
possibility of providing insight into the lived experience of returning to work after cancer.
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Therefore, this present study aims to systematically review qualitative research on the
experience of returning to work after cancer.

Synthesising themes from qualitative studies will not only provide an insight into the unique
experience of returning to work after cancer, it could also offer theoretical insight and help to
develop appropriate supports or interventions aimed at improving the experience of returning
to work after cancer. This is especially important when it is considered that in 2005, the
Disability Discrimination Act was extended to cover people with cancer, from the point of
initial diagnosis. This means that employers are expected to make reasonable adjustments for
individuals living with cancer to enable them to return to work. In order to be able to fully
comply with this Act, employers must increase their understanding of the experience of
returning to work after cancer. In addition, physicians, cancer care clinicians and
occupational health departments may have a role to play in contributing towards survivors’
successful return to work and they would therefore benefit from increasing their
understanding of such an experience.

Aim
The aim is to explore experiences of returning to work for cancer survivors by systematically
reviewing published qualitative studies in this area.

Review question
What is the experience of returning to work after cancer diagnosis and treatment?

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