1. Psychological impact of pre-eclampsia screening

Doctoral Researcher: James Harris BSc, RM

Supervisory Board: Professor Susan Michie, University College London; Dr Belinda Green, University College London Hospital; Professor Linda Franck, University of California, San Francisco; Professor Kypros Nicolaides, University College London Institute for Women’s Health

Background: Pre-eclampsia (PE) is the most prevalent of pregnancy complications, with the potential to harm both the mother and the foetus. A new PE screening test has been launched within two London hospitals and is offered to all women in their first trimester. There is currently no treatment available for the condition, although a woman’s behaviour may reduce the risk to her and the foetus - e.g. attending clinic appointments for surveillance, reducing smoking, increasing physical activity. Giving women knowledge about their PE risk may have a positive or negative impact on their behaviour, thinking and emotional state, but this has not, as yet, been evaluated.

Aims: This programme of research aims to:

1. Investigate how pregnant women conceptualise their risk when given a first trimester screening for pre-eclampsia
2. Explore the longitudinal emotional, cognitive and behavioural impact of prenatal PE screening
3. Inform health care providers of the best way of presenting screening information to be of most benefit to the women using the service.

Methods: This is a mixed methods PhD project, using Leventhal’s Self Regulation Model theory to inform its development. It will include a systematic review, semi-structured interviews analysed via content and thematic analysis, and the design and analysis of an appropriate Revised Illness Perception Questionnaire (IPQ-R) to test the longitudinal impact of the screening.

2. Clinician-patient communication about hereditary cancer with cancer patients: description and evaluation

Doctoral Researcher: Chris Jacobs MSc, BSc (Hons), DPSN, RN, Registered Genetic Counsellor

Supervisory Board: Professor Susan Michie, University College London; Professor Steven Pilling, University College London; Professor Jonathan A. Smith, Birkbeck College London; Dr Christine Patch, Guy’s and St Thomas’ NHS Foundation Trust

Background: Women who have had breast and ovarian cancer and are found to have a mutation in the BRCA1 or BRCA2 genes are at high risk of developing further primary cancers, as well as having implications for other family members. Until recently, these women have generally been referred for genetic counselling and genetic testing following the completion of cancer treatment. However, there is growing evidence that the results of BRCA testing early in diagnosis are important in planning surgical management and in determining eligibility for treatment trials. As high throughput, rapid genetic testing becomes increasingly available, more women are being offered genetic testing for BRCA mutations at diagnosis. As cancer genetics becomes increasingly mainstream, it is important to identify the key elements of effective practice in communicating about hereditary cancer with cancer patients.

Aims: The aim of this research is to lay the basis for evaluating and improving clinician-patient communication about hereditary cancer with cancer patients, by:

1. Identifying the components of effective practice in clinician-patient communication about hereditary cancer with cancer patients.
2. Developing a measure of effective communication for evaluating clinical practice in the clinical genetics and cancer setting.
3. Applying this measure to evaluate new methods of communication, specifically, those resulting from genetics referral at cancer diagnosis.

Methods: The components of effective practice in clinician-patient communication about hereditary cancer with cancer patients will be identified from systematic review of the literature and qualitative analysis (using Interpretative Phenomenological Analysis) of patients’ experiences. From these data, a measure of these elements will be developed. The reliability and validity of the measure will be tested in a pilot study of audio-taped clinician-patient consultations between genetics clinicians and cancer patients about hereditary cancer and in discussion with clinicians and users.

3. Gender differences in the relationship between work and psychological distress in hospital consultants

Doctoral Researcher: Cath Taylor PhD

Background: Levels of psychological distress amongst hospital consultants are high and have been attributed to the nature of their job.  Few studies have examined gender differences although there are known differences in some vulnerability and protective factors related to psychological distress, and women are more likely to be disadvantaged at work through lower pay and fewer opportunities for career progression.  It is therefore possible that their experience of work differs from that of male consultants.  The changing demography in medicine, with an increasing proportion of females entering the profession makes this an important issue to investigate.
 
Aims: To compare the experience of work for female and male hospital consultants and to investigate gender differences in the relationship between psychological distress and work in hospital consultants.

Methods: Mixed methods have been used including secondary analysis from a national survey of hospital consultants (n=1308), secondary analysis of NHS Staff Survey data (n=2207), and a qualitative interview study involving 26 male and 26 female consultants.   One further interview study is currently underway.

Results: An empirical and theoretical exploratory framework for poor mental health in hospital consultants has been developed based upon the literature and findings from all three studies.  Risk factors for poor mental health within this framework include having high job stress; low job satisfaction/job control; having low social support; having a poor work-life balance and/or responsibility for childcare; working part-time; and negative attitudes of co-workers/culture of organisation. 

Final study: An interview study is due to commence shortly to explore perceptions about flexible working and social support in male and female consultants.  It is hoped that findings from this study would directly inform possible interventions for improving the wellbeing of hospital consultants.