Daniella Louise Jones

Objectives To understand the experiences of young adults with cancer for whom cure is not likely, in particular what may be specific for people aged 16–40 years and how this might affect care. Design We used data from multiple sources (semi-structured interviews with people with cancer, nominated family members and healthcare professionals, and workshops) informed by a preliminary programme theory: realist analysis of data within these themes enabled revision of our theory. A realist logic of analysis explored contexts and mechanisms affecting outcomes of care. Setting Three cancer centres and associated palliative care services across England. Participants We aimed for a purposive sample of 45 people with cancer from two groups: those aged 16–24 years for whom there may be specialist cancer centres and those 16–40 years cared for through general adult services; each could nominate for interview one family member and one healthcare professional. We interviewed three people aged 16–24 years and 30 people 25–40 years diagnosed with cancer (carcinomas; blood cancers; sarcoma; central nervous system tumours) with a clinician-estimated prognosis of ˂12 months along with nominated family carers and healthcare professionals. 19 bereaved family members and 47 healthcare professionals participated in workshops. Results Data were available from 69 interviews (33 people with cancer, 14 family carers, 22 healthcare professionals) and six workshops. Qualitative analysis revealed seven key themes: loss of control; maintenance of normal life; continuity of care; support for professionals; support for families; importance of language chosen by professionals; and financial concerns. Conclusions Current care towards end of life for young adults with cancer and their families does not meet needs and expectations. We identified challenges specific to those aged 16–40 years. The burden that care delivery imposes on healthcare professionals must be recognised. These findings can inform recommendations for measures to be incorporated into services.

This project evaluated the predictive validity of the Dynamic Appraisal of Situational Aggression – Inpatient Version (DASA-IV) in a high-secure psychiatric hospital in the UK over 24 hours and over a single nursing shift. DASA-IV scores from three sequential nursing shifts over a 24-hour period were compared with the mean (average of three scores across the 24- hour period) and peak (highest of the three scores across the 24-hour period) scores across these shifts. In addition, scores from a single nursing shift were used to predict aggressive incidents over each of the following three shifts. The DASA-IV was completed by nursing staff during handover meetings, rating 43 male psychiatric inpatients over a period of 6 months. Data were compared to incident reports recorded over the same period. Receiver operating characteristic (ROC) curves and generalized estimating equations assessed the predictive ability of various DASA-IV scores over 24-hour and single-shift timescales. Scores from the DASA-IV based on a single shift had moderate predictive ability for aggressive incidents occurring the next calendar day, whereas scores based on all three shifts had excellent predictive ability. DASA-IV scores from a single shift showed moderate predictive ability for each of the following three shifts. The DASAIV has excellent predictive ability for aggressive incidents within a secure setting when data are summarized over a 24-hour period, as opposed to when a single rating is taken. In addition, it has moderate value for predicting incidents over even shorter timescales.

Anxiety is one of the most prevalent mental health problems; it is known to impede cognitive functioning. It is believed to alter preferences for feedback-based learning in anxious and non-anxious learners. Thus, the present study measured feedback processing in adults ( N = 30) with and without anxiety symptoms using a probabilistic learning task. Event-related potential (ERP) measures were used to assess how the bias for either positive or negative feedback learning is reflected by the feedback-related negativity component (FRN), an ERP extracted from the electroencephalogram. Anxious individuals, identified by means of the Penn State Worry Questionnaire, showed a diminished FRN and increased accuracy after negative compared to positive feedback. Non-anxious individuals exhibited the reversed pattern with better learning from positive feedback, highlighting their preference for positive feedback. Our ERP results imply that impairments with feedback-based learning in anxious individuals are due to alterations in the mesolimbic dopaminergic system. Our finding that anxious individuals seem to favor negative as opposed to positive feedback has important implications for teacher–student feedback communication.