Recent Submissions

  • Experiences of deliberate practice orientated psychological skills training for cancer care staff: Barriers and facilitators to learning and implementation in practice

    Rathbone, James; Gibbons, Felicity; Brooks, Dan; Mays, Chloe; Malins, Samuel (2023)
    This study explored participant-reported facilitators and barriers to learning and implementation from a 2-day training in psychological assessment and intervention skills for cancer staff, involving deliberate practice and supervision. Twenty-six semi-structured interviews were analysed using thematic analysis leading to four meta-themes: perceived practicality of training, impact of training: practice and its effects, implementation transfer processes and supervision engagement. Analysis identified a learning process to implementation: observation and practice of techniques during training facilitated participant learning; personal use and relevance of training content encouraged reflection, which enabled selection of appropriate tools for clinical practice; gains in commitment and confidence to use techniques supported participants to adapt clinical consultations, and supervision further facilitated implementation. Changing practice increased confidence, sense of achievement and engagement with participants’ own wellbeing. Interactive training, deliberate practice and continuous learning were facilitators to implementation whilst time constraint and low confidence in using techniques in remote consultations were barriers.
  • Outcomes of psychological support skills training for cancer care staff: Skill acquisition, work engagement, mental wellbeing and burnout

    Malins, Samuel; Rathbone, James; Gibbons, Felicity; Mays, Chloe; Levene, Jo (2023)
    Objective Psychological support skills training has the potential to improve both the ability of cancer staff to help their patients, and staff wellbeing. However, few recent studies have assessed both these outcomes or incorporated current developments in psychological skills training, such as deliberate practice, which includes the use of iterative, corrective feedback to identify and improve individualised skill deficits. No studies have evaluated the contribution that psychological skills training could make to cancer care staff wellbeing and expertise in the wake of the COVID-19 pandemic. This study aimed to evaluate staff skill acquisition and work-related wellbeing following psychological support skills training that applied deliberate practice principles. Method A 2-day training and monthly supervision was offered to 145 cancer care staff that focused on brief assessment and intervention skills for patients experiencing mental health problems after cancer diagnosis and treatment. Deliberate practice principles were used to focus training on skills practice and feedback, over technique description. Self-reported ability to perform key skills taught, staff mental wellbeing, work engagement, and burnout were assessed at baseline, 3-month and 8-month follow-up. Results Significant improvements in skills, mental wellbeing, burnout and work engagement were reported at 8-month follow-up. Full engagement in both training sessions was predicted by poorer baseline mental wellbeing, more positive evaluation of initial training, supervision attendance, and shorter follow-up. Conclusion A 2-day psychological support skills training using deliberate practice principles may support improvement in staff skill, mental wellbeing, burnout and work engagement.
  • Receiving and breaking bad news: A qualitative study of family carers managing a cancer diagnosis and interactions with healthcare services

    Biswas, Sanchia (2022)
    AIMS: To explore family carer experiences of managing the process of receiving and breaking bad news about cancer. BACKGROUND: Family carers' experiences of bad news are underrepresented in the literature. This study involved oncology staff with personal experience of caregiving and carers to develop broader insights into the range of needs and difficulties experienced by family members in the process of managing a cancer diagnosis. This can help facilitate subsequent interactions with healthcare professionals and improve continuity of care. DESIGN: This is a descriptive qualitative study informed by the theory of social constructionism. Data were analysed using template analysis. METHODS: Data were collected using semi-structured interviews and focus groups with 4 healthcare professionals and 17 family carers between January and July 2018. A purposive sampling strategy was used. Interviews were transcribed verbatim to explore participant experiences and perspectives on family carers managing a cancer diagnosis. FINDINGS: Three key themes were identified: (1) receiving the bad news; (2) management of bad news and (3) interaction with healthcare and support services. These and associated subthemes are discussed, with recommendations for future research and practice. CONCLUSIONS: There was variability in the experiences and needs of carers involved in receiving and breaking the bad news. IMPACT: Although family members experienced a multitude of difficult emotions when the bad news was shared, they were not often able to discern help from healthcare professionals with sharing the diagnosis with the patient and others. This impacted on access to and use of healthcare and support services. Individualized approaches to communication are needed to enable carers to seek support and provide perspectives on the patient home environment and family structure. This can help tailor breaking the bad news and care plans. PUBLIC CONTRIBUTION: Anonymised results were shared with family carers to validate the congruency of the codes with their experiences.
  • Complete versus incomplete surgical resection in intramedullary astrocytoma: Systematic review with individual patient data meta-analysis

    Shokraneh, Farhad (2022)
    Study Design: Systematic review Background: Considering the infiltrative nature of intramedullary astrocytoma, the goal of surgery is to have a better patient related outcome. Objective(s): To compare the overall survival (OS) and neurologic outcomes of complete vs incomplete surgical resection for patients with intramedullary astrocytoma. Method(s): A comprehensive search of MEDLINE, CENTRAL and EMBASE was conducted by two independent reviewers. Individual patient data (IPD) analysis and multivariate Cox Proportional Hazard Model was developed to measure the effect of surgical strategies on OS, post-operative neurological improvement (PNI), and neurological improvement in the last follow up (FNI). Result(s): We included 1079 patients from 35 studies. Individual patient data of 228 patients (13 articles) was incorporated into the integrative IPD analysis. Kaplan-Meier survival analysis showed complete resection (CR) significantly improved OS in comparison with the incomplete resection (IR) (log-rank test, P =.004). In the multivariate IPD analysis, three prognostic factors had significant effect on the OS: (1) Extent of Resection, (2) pathology grade, and (3) adjuvant therapy. We observed an upward trend in the popularity of chemotherapy, but CR, IR, and radiotherapy had relatively stable trends during three decades. Conclusion(s): Our study shows that CR can improve OS when compared to IR. Patients with spinal cord astrocytoma undergoing CR had similar PNI and FNI compared to IR. Therefore, CR should be the primary goal of surgery, but intraoperative decisions on the extent of resection should be relied on to prevent neurologic adverse events. Due to significant effect of adjuvant therapy on OS, PNI and FNI, it could be considered as the routine treatment strategy for spinal cord astrocytoma.
  • Factors associated with psychological distress for couples facing head and neck cancer: A systematic literature review

    Tickle, Anna C.; Biswas, Sanchia (2021)
    Objectives: Cancer patients in supportive relationships display improved health and survival outcomes. Identifying factors that might respond to intervention for Head and Neck Cancer (HNC) dyads is important as HNC patients and their partners experience heightened distress. This article systematically reviewed and evaluated the research findings and methodological quality of studies which identified factors influencing psychological distress for couples facing HNC. Methods: PsycINFO, Medline, and CINAHL were searched. Studies were included if they used validated psychological distress measures and quantitative data collection methods. Eleven studies satisfied inclusion criteria. Results: Studies identified factors associated with the psychological distress experienced by couples facing HNC, with substantial effect size variation. These factors included clinical, sociodemographic, relational, and psychological variables. Factors associated with increased psychological distress included disease burden, reduced social contact, perception of reduced relationship quality, and less adaptive/assimilative coping although the effect sizes displayed considerable heterogeneity. Overall, studies possessed good methodological quality but generally could have been improved by minimising the risk of non-response bias and fully reporting relational characteristics. Conclusions: The implications of these results for clinical practice and future research are discussed. Further research is recommended to report effect sizes more consistently for both dyad members to gain greater insight into couple-level distress and to perform moderator analyses to identify which variables influence the magnitude of psychological distress.
  • Reducing dropout in acceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy for chronic pain and cancer patients using motivational interviewing

    Malins, Samuel; Biswas, Sanchia; Rathbone, James; Vogt, William; Pye, Naomi; Levene, Jo (2020)
    OBJECTIVEAcceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy are types of cognitive-behavioural therapy (CBT) group that improve physical and mental health in chronic pain or cancer. However, dropout is high due to group demands alongside physical impairments. Motivational interviewing (MI) is a well-evidenced means of enhancing treatment adherence. Few studies have investigated MI as an adjunct to CBT in cancer or chronic pain, and none have established the minimum MI duration required for adherence improvement. This study evaluated minimal-duration MI to improve adherence in three CBT group types for cancer and chronic pain.METHODSIn a cohort study of 99 cancer and chronic pain patients, 47 were given a 10- to 15-min structured MI telephone intervention (MI-call) after the first session. The remaining 52 received a CBT group without MI (no-MI).RESULTSOdds of completing group CBTs were five times greater for patients in the MI-call cohort versus no-MI. Effects remained when controlling for age, gender, diagnosis, group type, and baseline quality of life. The MI-call cohort attended one extra session per patient compared to no-MI, controlling for age, gender, and diagnosis.CONCLUSIONSA brief MI telephone intervention may improve adherence to group CBTs in cancer and chronic pain.PRACTITIONER POINTSA brief motivational interviewing (MI) telephone intervention may reduce dropout from group cognitive-behavioural therapies (CBTs) for cancer and chronic pain patients when administered after the first group session in routine care. Recipients of this intervention were five times more likely to complete a group CBT programme than those who did not receive it. Therefore, a minimal-dose MI intervention can have clinically important effects on dropout in group CBTs for patients with long-term conditions. It is unclear whether this intervention would also result in greater outcome improvements.
  • Brief training in psychological assessment and interventions skills for cancer care staff: A mixed methods evaluation of deliberate practice techniques

    Malins, Samuel; Levene, Jo; Biswas, Sanchia (2020)
    OBJECTIVE: Unaddressed anxiety and depression is common among cancer patients and has significant adverse consequences. Cancer staff training is recommended for psychological assessment and interventions to address depression and anxiety, to increase access to psychosocial oncology care. However, psychological skills training has a poor track-record for improving clinical effectiveness. "Deliberate practice", receiving feedback on therapeutic micro-skills and rehearsing modifications, can enhance clinical effectiveness. This study applied deliberate practice to maximise benefits of brief psychological skills training for cancer care staff. METHOD: Seventeen one-day training workshops were provided to 263 cancer care staff, aiming to improve confidence in assessing anxiety and depression, and delivering problem-solving therapy. Training used deliberate practice methods at the expense of didactic lecturing. Staff confidence was assessed in key teaching domains using pre-post confidence ratings. Anonymous comments from 152 training attendees were examined using thematic analysis. RESULTS: One-day psychological skills training significantly improved cancer staff confidence in assessment of anxiety and depression, and delivery of brief psychological interventions. Thematic analysis indicated that focusing on practical skills was valued by participants and contributed to staff commitments to change practice. However, some participants felt the one-day training was over-filled and would be better delivered over more days. CONCLUSION: Similar results can be achieved by providing psychological skills training on a single-day, as compared to an established five-day programme, by abbreviating didactic teaching and focusing time on deliberate practice of skills. Training may increase the likelihood of changes in practice, but more training time may be required for maximum benefit. This article is protected by copyright. All rights reserved.
  • Using smart-messaging to enhance mindfulness-based cognitive therapy for cancer patients: A mixed methods proof of concept evaluation

    Malins, Samuel; Biswas, Sanchia; Sweeney, Timothy; Levene, Jo (2019)
    OBJECTIVE Depression and anxiety lead to reduced treatment adherence, poorer quality of life, and increased care costs amongst cancer patients. Mindfulness-Based Cognitive Therapy (MBCT) is an effective treatment, but dropout reduces potential benefits. Smart-message reminders can prevent dropout and improve effectiveness. However, smart-messaging is untested for MBCT in cancer. This study evaluates smart-messaging to reduce dropout and improve effectiveness in MBCT for cancer patients with depression or anxiety. METHODS Fifty-one cancer patients attending MBCT in a psycho-oncology service were offered a smart-messaging intervention, which reminded them of prescribed between-session activities. Thirty patients accepted smart-messaging and 21 did not. Assessments of depression and anxiety were taken at baseline, session-by-session and one-month follow-up. Logistic regression and multilevel modelling compared the groups on treatment completion and clinical effectiveness. Fifteen post-treatment patient interviews explored smart-messaging use. RESULTS The odds of programme completion were eight times greater for patients using smart-messaging compared with non-users, controlling for age, gender, baseline depression, and baseline anxiety (OR = 7.79, 95% CI 1.75 to 34.58, p = .007). Smart-messaging users also reported greater improvement in depression over the programme (B = -2.33, SEB = .78, p = .004), when controlling for baseline severity, change over time, age, and number of sessions attended. There was no difference between groups in anxiety improvement (B = -1.46, SEB = .86, p = .097). In interviews, smart-messaging was described as a motivating reminder and source of personal connection. CONCLUSIONS Smart-messaging may be an easily integrated telehealth intervention to improve MBCT for cancer patients.
  • How patients adjust psychologically to the experience of head and neck cancer: A grounded theory

    Biswas, Sanchia; Tickle, Anna C. (2019)
    Numerous physical and psychological challenges are recognised as consequences of head and neck cancer and its treatment, but little is known about how patients adjust psychologically to these experiences. This study aimed to develop a theoretical understanding of the processes patients engage in when adjusting to head and neck cancer. Twelve patients participated in semi-structured interviews conducted individually and transcribed verbatim. Data were analysed using grounded theory methodology. Analysis generated a core category of "modifying my relationship to the changes cancer brings," which encompassed 11 processes patients engaged in throughout their adjustment: "survive mode," "instrumental support from others," "making a choice," "developing own understanding," "acceptance," "talking with others," "making changes," "redefining or regaining normality," "managing emotions/distressing thoughts," "putting things into perspective" and "barriers to progress." Contrasting findings are discussed, and a model of psychological adjustment to head and neck cancer is proposed. The study found that patients engage in a series of processes throughout adjustment to head and neck cancer, which broadly map on to the cancer treatment trajectory, though these processes did not appear to be specific to head and neck cancer. The proposed model may be used as a framework to guide psychological interventions.
  • Challenges related to the cancer care role

    Fathers, Dean (2019)
    Background: Cancer caregiving occurs across all the settings in which care is delivered and often involves interacting with numerous providers, back and forth transitions from hospital to home, and eventually end-of-life care. The journey is nonlinear and each phase of the care process brings with it new challenges for the carers. Family members make a vital, hidden contribution to the health and well-being of the nation, however their care roles and needs remain largely unaddressed, and are omitted from conversations with healthcare providers. Aim(s): In line with the NCRI research priorities announced in November 2018, the aim of this study was to gain insight about carers' experienced challenges while providing support to a close one diagnosed with cancer at main transition points in the journey. Method(s): Data were collected through in-depth interviews and two focus groups with carers residing in the East Midlands of England. Data were thematically analysed. Result(s): Twenty four participants took part in the study (4 males; 20 females; age range 37-76; 4 HCPs). Themes emerged from the data explained aspects related to (1) specialist services (lack of access to facilities, lack of timely and right information about treatment sideeffects, follow-up care, and use of medical devices, undignified care, and service discontinuity) and (2) patient's diagnosis and decisions (comorbidities, treatment discontinuity, and refusal to communicate). Conclusion(s): This study has identified carers' challenges related to their roles and responsibilities. It highlights the need of coordinated and family oriented services to empower carers to manage the illness throughout the diagnostic and treatment journey.
  • Lung cancer screening: does pulmonary nodule detection affect a range of smoking behaviours?

    das Nair, Roshan (2018)
    Background: Lung cancer screening can reduce lung cancer mortality by 20%. Screen-detected abnormalities may provide teachable moments for smoking cessation. This study assesses impact of pulmonary nodule detection on smoking behaviours within the first UK trial of a novel auto-antibody test, followed by chest x-ray and serial CT scanning for early detection of lung cancer (Early Cancer Detection Test-Lung Cancer Scotland Study). Methods: Test-positive participants completed questionnaires on smoking behaviours at baseline, 1, 3 and 6 months. Logistic regression compared outcomes between nodule (n = 95) and normal CT groups (n = 174) at 3 and 6 months follow-up. Results: No significant differences were found between the nodule and normal CT groups for any smoking behaviours and odds ratios comparing the nodule and normal CT groups did not vary significantly between 3 and 6 months. There was some evidence the nodule group were more likely to report significant others wanted them to stop smoking than the normal CT group (OR across 3- and 6-month time points: 3.04, 95% CI: 0.95, 9.73; P = 0.06). Conclusion: Pulmonary nodule detection during lung cancer screening has little impact on smoking behaviours. Further work should explore whether lung cancer screening can impact on perceived social pressure and promote smoking cessation.
  • Lung cancer CT screening: Psychological responses in the presence and absence of pulmonary nodules

    das Nair, Roshan (2018)
    Pulmonary nodules are commonly found on CT scans screening for lung cancer (LC). Some non-UK studies show negative psychological impacts of pulmonary nodule diagnosis. We explored psychological impacts of nodule diagnosis during LC screening in the UK. There was little impact on affect, health anxiety, worry, illness perception or risk perception. There were fewer short-term avoidance symptoms in those diagnosed with nodules.
  • Within and between day repeatability of the incremental shuttle walking test in patients with thoracic cancer

    Taylor, Vicky (2018)
    Background Breathlessness is common in patients with thoracic cancer but difficult to manage. The Incremental Shuttle Walking Test (ISWT) can help assess new treatments, but its repeatability has not been described in this group. Aim To examine within and between day repeatability of the ISWT in this setting. Methods Patients with incurable thoracic cancer were recruited from outpatient clinics at a University Hospital. Two ISWTs were completed one hour apart on two consecutive days, with the first test for familiarization purposes only. Repeatability of distance walked was examined using Bland and Altman plots and assessed as the single determination (within subject) standard deviation of the difference between tests and its 95% range. Results Forty-one patients participated and completed all tests. Mean (SD) distance walked was 333 (134), 349 (129) and 353 (130) m over the three tests, with the mean difference significantly different from zero between days (16 m, 95% CI 8–24 m, P = 0.043) but not within days (5 m, 95% CI –2 to 12 m, P = 0.47). Within and between day single determination SD and 95% ranges were 30 (−31 to 91) m and 36 (−37 to 109) m respectively. Conclusions These data help inform the design of studies making use of the ISWT and the interpretation of their findings.
  • The effect of psychological interventions on quality of life in patients with head and neck cancer: A systematic review and meta-analysis

    Calver, Louise; Tickle, Anna C.; Biswas, Sanchia (2017)
    This systematic review and meta-analysis aimed to evaluate the effectiveness of psychological interventions in improving quality of life for head and neck cancer patients. Five databases were systematically searched in July 2016. Studies were included if they reported original empirical data from intervention studies utilising psychological approaches (excluding psychoeducational-only interventions) and provided data on quality of life outcomes. Six studies, involving 185 participants, fulfilled eligibility criteria. Study designs included a case study, single-group designs, non-randomised controlled trials and one randomised controlled trial. Meta-analysis of two studies did not provide support for the effectiveness of psychological intervention improving total quality of life scores (or subscales) compared to control groups at end of intervention. Intervention studies evaluating psychological interventions for patients with head and neck cancer have produced insufficient data to support their effectiveness for improving quality of life. This review further highlights the limited evidence base within this area. Existing studies are based on small samples and are inconsistent regarding: intervention type, duration and intensity; follow-up measurement periods; and methodological quality. Further research, addressing these limitations, is required for more definitive conclusions to be drawn about the effectiveness of psychological interventions with this population.
  • The relationship between coping style and psychological distress in people with head and neck cancer: A systematic review

    Morris, Nicole; Tickle, Anna C.; Biswas, Sanchia (2017)
    OBJECTIVE: Individuals diagnosed with head and neck cancer (HNC) are at an elevated risk of experiencing psychological distress and a reduced quality of life. The aim of this review was to systematically examine and assess the quality of empirical evidence on the associations between coping mechanisms and psychological distress among people with HNC. METHODS: CINAHL, MEDLINE, PsycINFO, EMBASE and Web of Science were accessed to conduct this review. Studies were included if they used reliable and valid measures to investigate the relationship between coping style and psychological distress. Study quality was assessed and rated according to pre-set criteria, and showed variability in relation to selection methods. RESULTS: 12 studies (nine cross-sectional and three prospective designs) involving 1281 patients were reviewed. There was considerable heterogeneity in study samples and coping measures. Moderate to large associations between disengagement coping mechanisms (e.g. avoidance) and psychological distress were observed. Engagement coping strategies (e.g. direct action) were not consistently associated with psychological distress across studies. CONCLUSIONS: Several studies observed a significant relationship between coping styles aimed at disengaging and distancing from cancer and increased psychological distress. To understand directionality of these associations and further develop an understanding of temporal features of the relationship between coping styles and distress, longitudinal designs could be used in future research.
  • A large scale pragmatic validation of the HADS for major depression in an ethnically diverse cancer population

    Baker-Glenn, Elena A. (2010)
    OBJECTIVES: There is considerable interest in the accuracy of the Hospital Anxiety and Depression Scale in cancer. The HADS is the single most commonly applied tool for depression, tested to date in 22 analyses against major depressive disorder (MDD). However, only one previous study had a sample size over 300 (Walker et al. 2007 J Psychosom Res 63: 83-91). METHOD: We analysed data collected from Leicester Cancer Centre from 2007-2009 involving approximately 1000 people approached by a research nurse, research physician and two therapeutic radiographers. The researcher applied DSMIV criteria of major depressive disorder (MDD). We collated full data on 690 patient assessments of whom 12.9% had MDD, 121 were palliative and 115 (16.7%) were from ethnic minorities (largely British South Asian of India descent). RESULTS: Sensitivity and specificity were as follows HADS-A 87.6%/72.3; HADS-D 86.5%/80.1% and HADS-T 95.5%/76.3%. The AUC was highest for HADS-T > HADS-D > HADS-A. In ethnic minorities sensitivity and specificity were as follows HADS-A 93.1%/66.3%; HADS-D 86.2%/65.1% and HADS-T 96.6%/66.3%. AUC was poor for the HADS-D from the ethnic group and HADS-A/HADS-T were preferred. There was no difference by cancer stage. CONCLUSIONS: This is the largest validation study of the HADS in cancer and suggests that in an ethnically diverse population the HADS-T may be the optimal version based on accuracy alone; regardless of cancer stage. The HADS-D may have weaker validity in patients from ethnic minority populations.
  • Jo's story: The journey of one woman's experience of having cancer and a 'learning disability'

    Martean, Melissa H. (2014)
    With increasing longevity amongst people with learning disabilities, it is not surprising that prevalence and incidence rates of cancer are growing at a significant rate. Much of the research undertaken in the area of psycho-oncology has focused on the 'general population', and over the last decade, there has been increasing interest in using a narrative approach to explore the lived experiences of people who have had cancer. Traditionally, research into cancer amongst people with learning disabilities has focused upon epidemiology or palliative care. However, the present article uses a narrative analysis to explore the lived and told experience of a person with a learning disability, who has been given a diagnosis of cancer. This article highlights the need and provides justification, for more qualitative research to be undertaken in this area. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Desire for psychological support in cancer patients with depression or distress: Validation of a simple help question

    Baker-Glenn, Elena A.; Park, Bert G. (2011)
    Objectives: Despite documented high rates of psychological distress, it is not clear how to identify those who are willing to accept help. The aim of this study was to investigate whether asking patients receiving chemotherapy if they want help with emotional problems is valuable and to investigate the type of help they want.; Methods: Patients attending a chemotherapy suite were asked to complete the Hospital Anxiety and Depression Scale, the Brief Patient Health Questionnaire (PHQ) and the Emotion Thermometers tools. Results were compared with a single question on desire for help.; Results: In this study, 128 patients completed questionnaires for distress, depression, anxiety and desire for help at initial interview. Only one in five unselected patients had a perceived need for help, and in distressed patients only 36% expressed a desire for help. The addition of the help question to the two questions (PHQ-2) about mood and interest improved the ability to rule-in depression by increasing the specificity. However, by addition of this question, sensitivity was significantly reduced. Desire for help was modestly associated with severity of distress, anxiety and depression.; Conclusions: The addition of a help question appears to have limited value in screening for psychological symptoms, but it may highlight those who are willing to accept addition support. Clinicians should attempt to offer a range of psychosocial interventions that will be acceptable to patients with distress.; Copyright © 2010 John Wiley & Sons, Ltd.
  • Breast reconstruction following cancer: Its impact on patients' and partners' sexual functioning

    Marshall, Catherine (2005)
    Previous literature lacks a theoretical conceptualisation of breast reconstruction and its impact on patients' and partners' sexual functioning. The aims of the present study were to identify factors that impact on the sexual relationship, to explore coping strategies used by patients and partners, and to highlight service needs. In total, 12 women who had undergone breast reconstructive surgery within the last three years and their partners (10 men) took part in the study. Grounded theory methodology was used to analyse the data and identify key categories for both patients and partners. Patients' key categories included anxiety and worry, influencing factors, self-image and sexual changes. All women experienced some degree of sexual change and sexual anxiety, and a minority reported a loss of sexual self. Partners' key categories included anxiety and stress, influencing factors and negotiating sexual changes. The majority of partners reported that initially, their priority was their partner's survival rather than sexual concerns; however the majority of men acknowledged some degree of sexual anxiety. The study highlighted the lack of information and discussion about sexual issues for both patients and partners, and the timing of such information if it were to be provided. It also stresses the need for services to include partners throughout the process.

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