How do we teach clinicians to talk about the end of life?

Image of Doctor and patient

Image credit: Doctor and patient – Government of Alberta. Creative Commons License 2.0 (Non-commercial No Derivatives). Source: Flickr

By Dr Lucy Selman Research Fellow (Qualitative Research in Randomised Trials) Centre for Academic Primary Care  University of Bristol

In a systematic review published this month, we identified 153 communication skills training interventions for generalists in end of life care. In randomised controlled trials, training improved showing empathy and discussing emotions in simulated interactions (i.e. with actor patients) but evidence of effect on clinician behaviours during real patient interactions, and on patient-reported outcomes, was inconclusive.

The global increase in the proportion of older people and length of life means providing end of life care is now increasingly the responsibility of generalist as well as specialist palliative care providers. But many clinicians find communicating about end of life issues challenging: how do you best discuss imminent mortality, limited treatment options, what to expect when you’re dying, or a patient’s preferences for end of life care?

When this communication is done poorly, or not done at all, patients are confused and less satisfied with their care, experience inadequate symptom relief, and have worse quality of life. Staff who feel insufficiently trained in communication skills are more likely to provide depersonalised care and suffer from burnout.

While research in clinical communication has grown in recent years, there is little consensus on optimal training strategies and the most effective teaching methods. Continue reading

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Using administrative data for labour market research: getting the balance right

Isabel Stockton, PhD Student, School of Economics, Finance and Management, and panel participant in Research without Borders 2017

Administrative data: it’s one of those phrases that can generate much excitement among economists and some other social scientists, but will never make for scintillating party conversation in any other setting.

However, the possibilities and limits on the use of administrative data for research can have a big impact on the policymaking process and raise tricky ethical questions, so it is important that the conversation is as broad as it can possibly be.

What is administrative data?

Administrative data is collected by the government for a non-research purpose.

For example, as part of my doctoral research I analyse national insurance data on jobs, wages and commuting distances in Germany.

Whenever someone starts or leaves a job, starts to claim unemployment benefits, is assigned to a jobseekers’ training programme or goes on parental or sick leave, this leaves a paper trail.

Economists in particular are very interested in this information: Many of us still subscribe to the traditional credo “Believe what people do, not what they say”. Continue reading

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Why healthcare services have a problem with gambling

Image of electronic gambling machines.

“I have a problem with gambling. There’s not enough of it.”

Dr  Sean Cowlishaw, Research Fellow at the Centre for Academic Primary Care, University of Bristol

That was the admission from billionaire Steve Wynn, a major figure in the casino industry, speaking at a recent gambling research conference in (where else?) Las Vegas. And sure, it made for a good quote. But it’s also a rather glib dismissal of a serious issue that affects many thousands of people across the world.

The UK certainly has a problem with gambling. At least it has since 2007, when laws were changed to allow for huge growth in gambling opportunities and exposure. It has been hard to ignore the subsequent explosion in industry advertising, which increased by around 500% between 2007 and 2013. By contrast, you may have missed the increased numbers of high intensity electronic gambling machines, called Fixed-Odds Betting Terminals (FOBTs), which now occupy the high street (within betting shops) and allow punters to wager up to £100 every 20 seconds.

Yet Britain doesn’t have much insight into its problem with gambling. Compared to most other addictive behaviours, involving drugs or alcohol for example, gambling is largely ignored by health services and public health agencies. This is partly because gambling is a hidden concern. It does not manifest with physical warning signs. Indicators are usually visible in extreme cases only, and generally following major life crises such as extreme debt or relationship breakdown. Continue reading

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Research, Impact and the UK Parliament – Event Report

Katie Drax, Honorary Research Assistant at the Tobacco and Alcohol Research Group (TARG)

Science can inform how society is run so research can have implications for public and private policy. But how? How can research feed into policy-making, i.e. evidence-based policy? For those who don’t have a clue about parliamentary actions or how they relate to academics’ work the “Research, Impact and the UK Parliament” event series is a good way to get to grips with Parliament and research.

Starting at 10 a.m. we pinned name badges to our shirts and busied ourselves by riffling through the Houses of Parliament tote bags placed on our seats. Thankfully the event did not require much prior knowledge since it was assumed the majority of attendees were ignorant about the workings of Parliament and so the first presentation was a 30 minute crash course on the subject. Continue reading

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Scientific Ecosystems and Research Reproducibility

Marcus Munafo, Professor of Biological Psychology, University of Bristol

In 2005 a seminal article by John Ioannidis argued that various biases in how science is conducted, such as the use of small sample sizes and emphasising on novel, eye-catching findings, conspire to reduce the likelihood that a piece of published research is in fact correct. Since then, there has been growing interest in what has become known as the reproducibility crisis, stimulated in part by growing empirical evidence that many published research findings cannot be replicated. For example, in 2011 scientists from the pharmaceutical company Bayer reported that they were only able to replicate ~20-25% of results published in academic journals. Interest in the question of what proportion of published research findings are actually true, and whether we can do better, has grown – in 2015 the Academy of Medical Sciences in the UK held a symposium on the topic, while the House of Commons Science and Technology Committee is currently undertaking an inquiry on these issues. Continue reading

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Sharing stories of migration and belonging

Dr Devyani Prabhat, Lecturer in Law, School of Law

Dr Devyani Prabhat, Lecturer in Law, School of Law

Last month I led an ESRC Funded Thinking Futures Event on Migration and Belonging at the St Werburgh’s Community Centre, Bristol. The event was attended by twenty-six people who had experience of applying for British citizenship or had personal stories to share about migration. Storytelling gives a direct voice to research participants and this was the theme of the event. Artist Sam Church who is a graphic artist simultaneously sketched the stories which were being shared. Continue reading

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Working with the media can be beneficial but linking to and citing your research should be compulsory

 

Andy Tattersall, Information Specialist at the School of Health and Related Research (ScHARR)

Andy Tattersall, Information Specialist, ScHARR, University of Sheffield.

It’s great when academic research is covered by the media but too often this coverage fails to link back to or properly cite the research itself. It’s time academics insisted on this and Andy Tattersall outlines the benefits of doing so. As well as pointing more people to your work, the use of identifiers allows you to track this attention and scrutinise where and how your research has been used. At a time when academic work is vulnerable to misreporting, such a simple step can help ensure the public are able to view original research for themselves.

Academics are increasingly being sold the benefits of working with the media as an effective way of gaining impact and presenting their work to a wider audience. Yet all too often media coverage of research has no direct link to the research it is referring to. The general public are used to seeing news stories that say ‘researchers have found’ or ‘researchers from the university of’ yet these reports are often lacking when it comes to linking to or citing the actual research. Academics dealing with the media should make a point of insisting on linking to their original research outputs where applicable as there are several benefits. Given that Oxford Dictionaries just named ‘post-truth’ as their word of 2016, we need to do everything we can to ensure fact retains its importance in the reporting of research.

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The UK Diet and Diabetes Questionnaire: A new tool for assessing dietary habits

clare_england

Dr Clare England, Senior Research Associate and Specialist Diabetes Dietitian, in the Centre for Exercise, Nutrition and Health Sciences and the NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle.

Dr Clare England discusses the challenges of providing individualised dietary advice for people with Type 2 diabetes and introduces a new, validated assessment tool, the UKDDQ, that may offer a solution.

Diabetes UK estimates that over 3 million people in the UK are living with Type 2 diabetes, and a further 5 million are at high risk. Complications (for example, increased cardiovascular disease, kidney failure, blindness, foot ulcers and amputations) caused by poorly controlled Type 2 diabetes, costs the NHS an estimated at £7.0 billion.

There is an increasing choice of medication available for Type 2 diabetes which can help to reduce blood glucose, cholesterol and blood pressure, but a healthy diet, regular physical activity and good weight management underpin successful control.

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‘Solidari-tea’ with Helen from The Archers

Dr Emma Williamson, Senior Research Fellow in The Centre for Gender and Violence Research, University of Bristol.

Dr Emma Williamson, Senior Research Fellow in The Centre for Gender and Violence Research, University of Bristol.

Dr Emma Williamson discusses how the current storyline in The Archers raises the question of what justice means when it comes to abuse.

Social media has once again been a-twitter with discussion about The Archers.

I wrote back in April about the domestic violence and coercive control storyline and how the producers had managed to shine a light on the often hidden aspects of abuse. As the story moves this week into the Courts, the media is once again gripped by the drama, with people posting their pictures of solidari-tea with the central character, Helen. The Mail Online even ran a story with Barristers discussing the fictional case .

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Life in the House of Commons Library

Madeline Burke, PhD Student, Bristol Centre for Functional Nanomaterials

Madeline Burke, PhD Student, Bristol Centre for Functional Nanomaterials, University of Bristol

As a PhD student I rarely get exposed to aspects of academic life such has grant writing, policy and management.  So when the opportunity came up to apply for a 3 month internship at the Parliamentary Office of Science and Technology (POST), funded by the Engineering and Physical Sciences Research Council (EPSRC), I jumped at the chance.

POST, as it is known, is based at the heart of Westminster. It serves both Houses of Parliament in providing impartial advice to parliamentarians on science and technology policy issues; often in the form of briefing papers called POSTnotes. POST was formed by a group of MPs and Peers concerned at the lack of scientific evidence available to influence Parliamentary policy and in 2001 both Houses decided that POST should be established as a permanent bicameral institution.

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