Jennifer O'DOnnell

Background: Without a cure for dementia, providing psychosocial support to people living with the condition is imperative. There is a developing evidence base for psychological and therapeutic support for people living with dementia. However, there is little to guide therapists working in this area, in terms of approaches and techniques that are likely to be successful. Methods: In the present study, we utilised different methods to engage people with dementia and their family members in discussions around ways in which psychotherapists could improve the delivery and accessibility of person‐centred therapy, to develop core competences for therapists. We brought together evidence from interviews with people with dementia, their families, and psychotherapists, with workshops utilising a World Café approach. Findings: We hosted four workshops with 47 participants in total. Using thematic analysis, we identified core themes across the different forms of data. We developed core competences in four areas: knowledge of dementia, therapeutic techniques and skills, therapeutic relationship and scope of practice. Discussion: The competences developed present an overview of expectations for those working therapeutically with families affected by dementia. It is hoped that their development leads to increased awareness of the specialist skills needed to engage with people with dementia, valuing of these skills for psychotherapists.

Introduction: This research explored the views of staff in secondary schools on school counselling for young people. Data were drawn from the Effectiveness and Cost Effectiveness Trial of Humanistic Counselling in Schools (ETHOS) study, an RCT of school counselling across 18 state‐funded secondary schools in London. Methods: Qualitative semi‐structured interviews were held with school staff ( n = 16) from a sub‐sample of 10 participating schools from the RCT. The interviews explored the perceived impact of school counselling on the school and students. Thematic analysis was conducted using the NVivo qualitative data analysis software. Results: Three key themes were identified: (1) school context: rising mental health need and varying provision for mental health; (2) school staff perspectives on the impact of counselling: increased openness and improvements in mood, dedicated space to open up, putting skills into practice, one size does not fit all, and role of personal connection; and (3) long‐term impact of counselling in schools: integration as central to success and counselling as a stepping stone for further support. Conclusion: This research provides insights into school staff views of secondary school counselling in the context of delivery through a research trial. Effective ways of integrating counselling services into schools are identified.

Objective: This study is part of the Student Counselling Outcomes Research and Evaluation (SCORE) initiative that is pooling university counselling service data to improve datasets and evidence for counselling in this sector. This study aimed to explore university counselling staff views about which data should be included in a national minimum data standard (MDS) to provide evidence for counselling in the sector.Method: Semi‐structured focus groups were conducted with university counselling staff including counsellors, service leaders and mental health advisors. They explored data to include in an MDS, current data collection practices, service and sector level data collection barriers. Two researchers performed content analysis involving identifying fields for inclusion. Thematic analysis was used to identify contextual issues surrounding data collection. Ten focus groups were conducted with 41 participants across 26 university counselling services.Results: Content analysis identified fields of information for the MDS within the categories of student characteristics, demographics, clinical assessment and service evaluation. Thematic analysis explored context and culture surrounding data collection, barriers and facilitators, institutional influence and ideal data collection practices. This highlights the need for service support and training around data collection, clear processes, and adequate IT infrastructure and staff resources.Discussion: These findings will inform the development of an MDS as part of the SCORE study. The next stage will involve further development of the MDS and piloting in services. The longer term aim is to implement an MDS across university counselling services, enabling the growth of evidence for the sector which may allow increased funding and service provision.

Cancer patients’ attitudes toward progression-free survival (PFS) gains offered by treatment are not well understood, particularly in the absence of overall survival (OS) gains. The objectives were to describe patients’ willingness to accept treatment that offers PFS gains without OS gains, to compare these findings with treatments offering OS gains, and to qualitatively summarize patients’ reasons for their preferences. A multicenter, cross-sectional, convergent mixed-methods study design recruited patients who had received at least 3 months of systemic therapy for incurable solid tumors. A treatment trade-off exercise determined the gains in imaging PFS that patients require to prefer additional systemic treatment for a scenario of a newly diagnosed, asymptomatic, incurable abdominal tumor. A qualitative, descriptive, thematic analysis explored factors influencing patients’ decisions, and a narrative method integrated the quantitative and qualitative findings. In total, 100 patients participated (63% were older than 60 years of age). If additional treatment with added toxicity offered no OS advantage, 17% would prefer it for no PFS benefit; 26% for some PFS benefit (range, 3-9 months), whereas 51% would decline it regardless of PFS benefit. Similarly, 71% preferred additional treatment offering a 6-month OS advantage dependent on described toxicity levels (P = .03). A spectrum of reasons for these preferences reflected the complexity of participants’ attitudes and values. Prolongation of time to progression was not universally valued. Most patients did not prefer treatments that negatively affect quality of life for PFS gains alone. Implications for individual decision making, policy, and trials research are discussed.

Background: A low number of older adults access Improving Access to Psychological Therapies (IAPT) services in England. Barriers include ageism and stigma. Routine outcome measures (ROMs) assess the effectiveness of counselling, although counsellor and service‐level barriers prevent uptake.Aims: Access rates of older adults to third sector (sometimes called voluntary or community sector) counselling and psychotherapy services were explored. The extent of ROM collection on psychological distress was assessed.Methodology: Data collected between 2018 and 2019 were pooled across six third sector counselling services in England, Scotland and Northern Ireland (N = 2,757). Access based on age and gender was assessed, and the chi‐square analysis was used to compare gender distribution within the age groups. Availability of pre‐ and post‐therapy ROMs was assessed, and the chi‐square analysis was used to explore the age and gender differences in completion.Findings: Lower access rates in people aged 65 and over (4.4%) were found compared with IAPT (7%). Access rates decreased further as age increased. Access of people aged 50 and over (24.5%) was below the 34.6% of the population in this age category. A third of people accessing counselling in all age groups were men. Only 28.6% completed a pre‐therapy ROM, and 29.5% of those clients subsequently completed a post‐therapy ROM.Implications: Mental health promotion and adapting communication during counselling may help engage older adults and men in counselling. Training on working with older people and long‐term conditions is also beneficial. Support in using ROMs can improve uptake although organisational barriers may restrict implementation in the third sector.

238 Background: Peer review (PR) in radiation oncology (RO) has been endorsed as an indicator of treatment quality in North America and internationally. The direct benefits of PR include quality assurance (QA) on individual treatment plans. The indirect benefits for radiation oncology departments or programs (ROPs) have been postulated but not systematically evaluated. We used a rigorous and comprehensive qualitative approach to explore the indirect benefits of PR across a jurisdiction of cancer care, and to identify factors that facilitate PR, barriers to implementation, and strategies for expansion of PR across centers. Methods: Semi-structured qualitative interviews were held with all RO heads and Radiation therapy Managers (or delegate) in all 14 Radiation Oncology Programs (ROPs) in Ontario, Canada. The interview questions were developed using a Knowledge Translation Theoretical Domains Framework (TDF), guided by the results of a previous survey of Ontario cancer centers and by expert consensus. Interviews were audiotaped and abstracted for relevant themes by two independent analysts. Results: All interviewees endorsed numerous direct and indirect benefits of PR, and identified multiple facilitators and barriers to the implementation of PR. Thematic saturation was achieved. The structure-process-outcome model was used to categorize the results. Key findings included the identification of 34 independent benefits (structure n = 4, process n = 17, outcome n = 13), 40 key barriers (structure n = 9, process n = 26, outcome n = 5), and 22 facilitators (structure n = 4, process n = 15, outcome n = 3). Beyond QA, commonly endorsed benefits included enhanced knowledge sharing, efficiency, standardization, and education. Multiple potential strategies for the expansion of PR activities were revealed. Conclusions: The qualitative exploration of Ontario ROPs acknowledges that multiple barriers and facilitators to PR exist while clearly establishing the indirect benefit of PR on ROPs. Understanding reported barriers and facilitators and exploration of suggested strategies will inform continued implementation and expansion of PR activities, and seem generalizable to other jurisdictions.

Background: The use of aspirin is well established for secondary prevention of cardiovascular disease. However, a proportion of patients suffer repeat cardiovascular events despite being prescribed aspirin treatment. It is uncertain whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity. This report aims to investigate whether or not insufficient platelet function inhibition by aspirin (‘aspirin resistance‘), as defined using platelet function tests (PFTs), is linked to the occurrence of adverse clinical outcomes, and further, whether or not patients at risk of future adverse clinical events can be identified through PFTs.Objectives: To review systematically the clinical effectiveness and cost-effectiveness evidence regarding the association between PFT designation of ‘aspirin resistance’ and the risk of adverse clinical outcome(s) in patients prescribed aspirin therapy. To undertake exploratory model-based cost-effectiveness analysis on the use of PFTs.Data sources: Bibliographic databases (e.g. MEDLINE from inception and EMBASE from 1980), conference proceedings and ongoing trial registries up to April 2012.Methods: Standard systematic review methods were used for identifying clinical and cost studies. A risk-of-bias assessment tool was adapted from checklists for prognostic and diagnostic studies. (Un)adjusted odds and hazard ratios for the association between ‘aspirin resistance’, for different PFTs, and clinical outcomes are presented; however, heterogeneity between studies precluded pooling of results. A speculative economic model of a PFT and change of therapy strategy was developed.Results: One hundred and eight relevant studies using a variety of PFTs, 58 in patients on aspirin monotherapy, were analysed in detail. Results indicated that some PFTs may have some prognostic utility, i.e. a trend for more clinical events to be associated with groups classified as ‘aspirin resistant’. Methodological and clinical heterogeneity prevented a quantitative summary of prognostic effect. Study-level effect sizes were generally small and absolute outcome risk was not substantially different between ‘aspirin resistant’ and ‘aspirin sensitive’ designations.No studies on the cost-effectiveness of PFTs for ‘aspirin resistance’ were identified. Based on assumptions of PFTs being able to accurately identify patients at high risk of clinical events and such patients benefiting from treatment modification, the economic model found that a test–treat strategy was likely to be cost-effective. However, neither assumption is currently evidence based.Limitations: Poor or incomplete reporting of studies suggests a potentially large volume of inaccessible data. Analyses were confined to studies on patients prescribed aspirin as sole antiplatelet therapy at the time of PFT. Clinical and methodological heterogeneity across studies precluded meta-analysis. Given the lack of robust data the economic modelling was speculative.Conclusions: Although evidence indicates that some PFTs may have some prognostic value, methodological and clinical heterogeneity between studies and different approaches to analyses create confusion and inconsistency in prognostic results, and prevented a quantitative summary of their prognostic effect. Protocol-driven and adequately powered primary studies are needed, using standardised methods of measurements to evaluate the prognostic ability of each test in the same population(s), and ideally presenting individual patient data. For any PFT to inform individual risk prediction, it will likely need to be considered in combination with other prognostic factors, within a prognostic model.Study registration: This study is registered as PROSPERO 2012:CRD42012002151.Funding: The National Institute for Health Research Health Technology Assessment programme.