Dr Anna Cox


Post Doctoral Research Fellow
PhD, MSc, BSc
HSM
Monday - Wednesday

Academic and research departments

School of Health Sciences.

Biography

Areas of specialism

Understanding and improving the care experience of people with learning disabilities; Development and implementation of interventions to support the provision of quality care throughout the life course; Educational interventions to prepare the social care workforce to provide good quality care; E-health and Cancer Survivorship

My qualifications

2016
PhD - Cancer survivorship, supportive care and e-health
University of Surrey
2002
MSc Health Psychology (Distinction)
City University, London
1995
BSc (Hons) Psychology (2:1)
University of Plymouth

Affiliations and memberships

British Psychological Society
Chartered Psychologist

My publications

Highlights

Cox, A., Lucas, G., Marcu, A. Piano, M., Grosvenor, W., Mold, F., Maguire, R. & Ream, E. (2017) Cancer Survivors’ Experience With Telehealth: A Systematic Review and Thematic Synthesis. Journal of Medical Internet Research Vol 19, No 1.

 

 

Ream E, Hughes AE, Cox A, Skarparis K, Richardson A, Pedersen VH, Wiseman T, Forbes  A, Bryant  A. (2020) Telephone interventions for symptom management in adults with cancer. Cochrane Database of Systematic Reviews 2020, Issue 6.

Publications

Anna Cox, Treena Parsons, Scott Watkin, Ann Gallagher (2021)Supporting the delivery of good maternity care for parents with learning disabilities, In: Midwifery102103073 Elsevier Ltd

Despite directives to improve maternity care in general and to improve care for parents with learning disabilities, the maternity experience of parents with learning disabilities is often poor and lacking reasonable adjustments to care. The objective of this study was to develop resources - in collaboration with key stakeholders - to support the workforce in delivering good maternity care to parents with learning disabilities. A two-phase mixed-methods study. Phase 1: 16 key stakeholders (health and social care professionals, parents with learning disabilities and their informal supporters/carers) were interviewed to understand views of best practice and inform resource development. Phase 2: 20 healthcare professionals engaged with the resources and gave feedback via online survey or discussion group to further refine them. Thematic analysis of key stakeholder interviews indicated that good maternity care for parents with learning disabilities requires a positive and proactive approach to identifying need; reasonable adjustments to communication and providing information; and professionals working together to support and enable parents. Health and social care professionals identified barriers to the delivery of good maternity care for parents with learning disabilities, including how to identify whether a parent has learning disabilities. Professionals in maternity services require additional resources to ensure parents’ needs are recognised and they are provided with personalised preparation for parenthood and sufficient support. The Together Toolkit and Maternity Passport were coproduced to support the workforce to deliver good maternity care to parents with learning disabilities, these resources are free and accessible for use [https://www.surrey.ac.uk/research-projects/together-project-supporting-delivery-goodpractice-maternity-services-parents-learning-disabilities]. Further evaluation will explore acceptability and perceived impact of these resources in maternity services.

Emmanouela Konstantara, Tushna Vandrevala, Anna Cox, Benedict C Creagh-Brown, Jane Ogden (2016)Balancing professional tension and deciding upon the status of death: Making end-of-life decisions in intensive care units, In: Health Psychology Open3(1)pp. 1-9 SAGE Publications

This study investigated how intensivists make decisions regarding withholding and withdrawing treatment for patients at the end of their lives. This involved completing in-depth interviews from two sites of the South of England, United Kingdom by twelve intensivists. The data collected by these intensivists were analysed using thematic analysis. This resulted in the identification of three themes: intensivists’ role, treatment effectiveness, and patients’ best interest. Transcending these were two overarching themes relating to the balance between quantity and quality of life, and the intensivists’ sense of responsibility versus burden. The results are considered in terms of making sense of death and the role of beliefs in the decision-making process.

Tushna Vandevala, Louisa Pavey, Olga Chelidoni, Nai-Feng Chang, Ben Creagh-Brown, Anna Cox (2017)Psychological rumination and recovery from work in intensive care professionals: Associations with stress, burnout, depression and health, In: Journal of Intensive Care5(1) BMC

Background The work demands of critical care can be a major cause of stress in intensive care unit (ICU) professionals and lead to poor health outcomes. In the process of recovery from work, psychological rumination is considered to be an important mediating variable in the relationship between work demands and health outcomes. This study aimed to extend our knowledge of the process by which ICU stressors and differing rumination styles are associated with burnout, depression and risk of psychiatric morbidity among ICU professionals. Methods Ninety-six healthcare professionals (58 doctors and 38 nurses) who work in ICUs in the UK completed a questionnaire on ICU-related stressors, burnout, work-related rumination, depression and risk of psychiatric morbidity. Results Significant associations between ICU stressors, affective rumination, burnout, depression and risk of psychiatric morbidity were found. Longer working hours were also related to increased ICU stressors. Affective rumination (but not problem-solving pondering or distraction detachment) mediated the relationship between ICU stressors, burnout, depression and risk of psychiatric morbidity, such that increased ICU stressors, and greater affective rumination, were associated with greater burnout, depression and risk of psychiatric morbidity. No moderating effects were observed. Conclusions Longer working hours were associated with increased ICU stressors, and increased ICU stressors conferred greater burnout, depression and risk of psychiatric morbidity via increased affective rumination. The importance of screening healthcare practitioners within intensive care for depression, burnout and psychiatric morbidity has been highlighted. Future research should evaluate psychological interventions which target rumination style and could be made available to those at highest risk. The efficacy and cost effectiveness of delivering these interventions should also be considered.

Anna Cox, Anne Arber, F Bailey, S Dargan, C Gannon, R Lisk, B Quinn, J Samarasinghe, M Wrigley, A Gallagher (2017)Developing, implementing and evaluating an end of life care intervention, In: Nursing Older People29(1)pp. 27-35 RCN Publishing

To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence. Aim To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence. Method A two-phase exploratory mixed methods design was used, evaluating the effect of an end of life care toolkit and associated training in care homes, facilitated by a specialist palliative care team. Six care homes in England were recruited to the intervention; 24 staff participated in discussion groups; 54 staff attended at least one training session; and pre- and post-intervention questionnaires were completed by 78 and 103 staff respectively. Results Staff confidence in receiving emotional and clinical support and managing end of life care symptoms increased post-intervention, but confidence in discussing death and dying with residents and relatives decreased. Audit data indicate greater reduction in the number of residents from participating care homes dying in hospital than those from comparison homes. Conclusion Collaborative end of life care interventions support care home staff to manage end of life and may enable residents to have choice about their place of death.

Emma Ream, Amanda Euesden Hughes, Anna Cox, Katy Skarparis, Alison Richardson, Vibe H. Pedersen, Theresa Wiseman, Angus Forbes, Andrew Bryant (2020)Telephone interventions for symptom management in adults with cancer (Review), In: Cochrane Database of Systematic Reviews(6)CD007568pp. 1-78 Wiley

Background People with cancer experience a variety of symptoms as a result of their disease and the therapies involved in its management. Inadequate symptom management has implications for patient outcomes including functioning, psychological well-being and quality of life (QoL). Attempts to reduce the incidence and severity of cancer symptoms have involved the development and testing of psycho-educational interventions to enhance patients' symptom self-management. With the trend for care to be provided nearer patients' homes, telephone-delivered psycho-educational interventions have evolved to provide support for the management of a range of cancer symptoms. Early indications suggest that these can reduce symptom severity and distress through enhanced symptom self-management. Objectives To assess the effectiveness of telephone-delivered interventions for reducing symptoms associated with cancer and its treatment. To determine which symptoms are most responsive to telephone interventions. To determine whether certain configurations (active ingredients, dosage) of telephone interventions mediate observed cancer symptom outcome effects. Search methods We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library; MEDLINE via OVID (1946 to January 2019); Embase via OVID (1980 to January 2019); CINAHL via Athens (1982 to January 2019); British Nursing Index (1984 to January 2019); and PsychINFO (1989 to January 2019). Additionally, we searched conference proceedings to identify published abstracts, and SIGLE and trial registers for unpublished studies. We also searched the reference lists of all included articles for additional relevant studies. Finally, we hand searched the following journals: Cancer, Journal of Clinical Oncology, Psycho-oncology, Cancer Practice, Cancer Nursing, Oncology Nursing Forum, Journal of Pain and Symptom Management, Palliative Medicine. Search was restricted to publications published in English. Selection criteria We included randomised control trials (RCTs) and quasi-RCTs which compared one or more telephone interventions with each other, or with other types of interventions (e.g. a face-to-face intervention) and/or usual care, with the stated aim of addressing any physical or psychological symptoms of cancer and its treatment, which recruited adult (over 18 years) men and women with a clinical diagnosis of cancer, regardless of tumour type, stage of cancer, type of treatment and time of recruitment (e.g. pre, during or post treatment). Data collection and analysis Two review authors independently selected articles, extracted data, and appraised methodological quality and risk of bias. Disagreements were resolved through discussion, involving the entire review team where necessary. Risk of bias was assessed using the Cochrane's risk of bias tool. We had planned to conduct meta-analyses using random effects models for symptoms where there were sufficient data to enable this. Heterogeneity between study outcomes was planned to be determined through visual inspection of forest plots and calculation of the I2 statistic. Where possible, outcomes are reported as standardised mean differences (SMDs) with 95% confidence intervals (CIs) and a descriptive synthesis of study findings is presented. Findings are reported on according to symptom addressed and intervention type (e.g. telephone only or telephone combined with other elements). As many studies had small samples, and baseline scores for study outcomes often varied for intervention and control groups, change scores and associated standard deviations were used. Main results Thirty-two studies were eligible for the review; most had moderate risk of bias, mostly related to blinding. Collectively they recruited 6250 people. Interventions were studied in people with a variety of cancer types and across the disease trajectory although many participants had breast cancer, early stage cancers and/or were starting treatment. Symptoms measured were anxiety, depression, emotional distress, uncertainty, fatigue, pain, sexuality-related symptoms and general symptom intensity and/or distress. Interventions were primarily (n = 24) delivered by nurses, most (n=16) had a background in oncology, research or psychiatry. Ten were delivered solely by telephone; the rest combined telephone with additional elements (face-to-face consultation, and digital/online/printed resources). Number of calls delivered ranged from 1 to 18; most provided 3 to 4 calls. Twenty‐one studies provided evidence on effectiveness of telephone‐delivered interventions and the majority appeared to reduce symptoms of depression compared to control. Nine studies contributed quantitative change scores (CSs) and associated standard deviation results (or these could be calculated). Likewise, many telephone interventions appeared effective when compared to control in reducing anxiety (16 studies; 5 contributed quantitative CS results); fatigue (9 studies; 6 contributed to quantitative CS results); and emotional distress (7 studies; 5 contributed quantitative CS results). Due to significant clinical heterogeneity with regards to interventions introduced, study participants recruited, and outcomes measured, meta‐analysis was not conducted. For other symptoms (uncertainty, pain, sexuality-related symptoms, dyspnoea and general symptom experience) there was limited evidence; meta-analysis was similarly not possible and the results from individual studies were largely conflicting making conclusions about their management through telephone-delivered intervention hard to draw. There was considerable heterogeneity across all trials for all outcomes. Overall, the certainty of the evidence was low for all outcomes in the review due to uncertainty over estimates. Outcomes were all downgraded due to concerns about overall risk of bias profiles being frequently unclear and due to inconsistencies in results and general heterogeneity. Unsubstantiated evidence suggests that telephone interventions in some capacity may have a place in symptom management for adults with cancer. However, in the absence of reliable and homogeneous evidence, caution is needed in interpreting the narrative synthesis. Further, there were no clear patterns across studies regarding which forms of interventions (telephone alone versus augmented with other elements) are most effective. It is impossible to conclude with any certainty which forms of telephone intervention are most effective in managing the range of cancer‐related symptoms that people with cancer experience. Authors' conclusions Telephone interventions provide a convenient way of supporting self-management of cancer-related symptoms in adults with cancer. They are becoming more important with the shift of care closer to patients' homes, need for resource/cost containment and potential for voluntary-sector providers to deliver healthcare interventions. There is some evidence supporting use of telephone-delivered interventions for symptom management in adults with cancer; most evidence relates to four commonly experienced symptoms - depression, anxiety, emotional distress and fatigue. Some telephone-delivered interventions were augmented by combining them with face-to-face meetings and provision of printed or digital materials. The review was unable to determine whether telephone alone or in combination with other elements provides optimal reduction in symptoms; it appears most likely that this will vary by symptom. It is noteworthy that, despite the potential for telephone interventions to deliver cost savings, none of the studies reviewed included any form of health economic evaluation. Further robust and adequately reported trials are needed across all cancer-related symptoms as the certainty of evidence generated in studies within this review was largely low to moderate, and reporting was of variable quality. Efforts are needed by researchers to reduce variability between studies in future. Studies in the review were characterised by both clinical and methodological diversity; the level of diversity hindered comparison across studies. At the very least, efforts should be made to standardise outcome measures. Finally, studies were compromised by having small samples, inadequate concealment of group allocation, lack of observer blinding and short length of follow up. Consequently, conclusions relating to symptoms most amenable to management by telephone-delivered intervention are tentative.

A Gallagher, RS Bousso, J McCarthy, H Kohlen, T Andrews, MC Paganini, NI Abu-El-Noor, A Cox, M Haas, A Arber, MK Abu-El-Noor, MF Baliza, KG Padilha (2015)Negotiated reorienting: A grounded theory of nurses' end-of-life decision-making in the intensive care unit, In: INTERNATIONAL JOURNAL OF NURSING STUDIES52(4)pp. 794-803 PERGAMON-ELSEVIER SCIENCE LTD

BACKGROUND: Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses' end-of-life (EoL) decision-making practice across cultures. OBJECTIVES: To understand nurses' EoL decision-making practices in ICUs in different cultural contexts. DESIGN: We collected and analysed qualitative data using Grounded Theory. SETTINGS: Interviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine. PARTICIPANTS: Semi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine). They were purposefully and theoretically selected to include nurses having a variety of characteristics and experiences concerning end-of-life (EoL) decision-making. METHODS: The study used grounded theory to inform data collection and analysis. Interviews were facilitated by using key questions. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EoL decision-making practices in the ICU. Ethical approval was granted in each of the participating countries and voluntary informed consent obtained from each participant. RESULTS: The core category that emerged was 'negotiated reorienting'. Whilst nurses do not make the 'ultimate' EoL decisions, they engage in two core practices: consensus seeking (involving coaxing, information cuing and voice enabling); and emotional holding (creating time-space and comfort giving). CONCLUSIONS: There was consensus regarding the core concept and core practices employed by nurses in the ICUs in the five countries. However, there were some discernible differences regarding the power dynamics in nurse-doctor relationships, particularly in relation to the cultural perspectives on death and dying and in the development of palliative care. The research suggests the need for culturally sensitive ethics education and bereavement support in different cultural contexts.

PURPOSE: The concept of providing personalised care plans for cancer survivors is receiving increasing attention; a recognised element of a care plan is to provide an indication of the risks and consequences of treatment. This paper reports health care professional (HCP) response to providing cancer survivors with information on potential late effects of their cancer treatment. METHODS: Eighteen HCPs from five cancer centres and three general practices in the UK completed semi-structured interviews which were digitally recorded, transcribed and qualitatively analysed using framework analysis. RESULTS: HCPs' view of health care was that it is currently focused on acute care and needs are responded to as they may arise, including those which are late effects of cancer treatments. The concept of pre-empting a discussion of potential late effects during the survivorship phase was felt to be discordant with this approach and could impact on adjustment to life after cancer treatment. CONCLUSION: Providing cancer survivors with information on potential late effects requires further consideration. Evidence for survivor preference for late effect information and the benefit afforded to survivors who receive it could inform the practice of HCPs. If a culture of proactivity is to be encouraged regarding discussions of future potential risk, HCPs may need support in considering ways of presenting survivors with reality whilst being mindful of their need to retain hope during the survivorship phase.

Emily D Williams, Anna Cox, Rachel Cooper (2019)Ethnic differences in functional limitations by age across the adult life course, In: The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Oxford University Press (OUP)

Background: Despite compelling evidence from the US of ethnic inequalities in physical functioning and ethnic differences in risk factors for poor physical functioning, very little is known about ethnic differences in the UK. Furthermore, the life stage at which these ethnic differentials are first observed has not been examined. Methods: Using cross-sectional data from Wave 1 of the UK Household Longitudinal Study (UKHLS), we compared self-reported physical functioning among 35,816 White British, 4450 South Asian and 2512 African Caribbean men and women across different stages of adulthood (young adulthood, early middle age, late middle age, older age). Regression analyses examined ethnic differences in functional limitations, with adjustment for socioeconomic and clinical covariates. Ethnicity by sex and ethnicity by age-group interactions were examined, and subgroup heterogeneity was explored. Results: Compared with White British adults over the age of 60, older South Asian men and women reported higher odds of functional limitations (OR 2.77 (95% CI: 2.00-3.89) and OR 3.99 (2.61-6.10) respectively); these ethnic differentials were observed as early as young adulthood. Young African Caribbean men had lower odds of functional limitations than White British men (OR 0.56 (0.34-0.94)), yet African Caribbean women reported higher odds of functional limitations in older age (OR 1.84 (1.21-2.79)). Conclusions: There is an elevated risk of functional limitations relating to ethnicity, even in young adulthood where the impact on future health and socioeconomic position is considerable. When planning and delivering health care services to reduce ethnic inequalities in functional health, the intersectionality with age and sex should be considered.

T Vandevala, L Pavey, Olga Chelidoni, N-F Chang, Ben Creagh-Brown, Anna Cox (2017)Psychological rumination and recovery from work in Intensive Care Professionals: Associations with stress, burnout, depression, and health, In: Journal of Intensive Care5(16) BioMed Central

Background The work demands of critical care can be a major cause of stress in intensive care unit (ICU) professionals and lead to poor health outcomes. In the process of recovery from work, psychological rumination is considered to be an important mediating variable in the relationship between work demands and health outcomes. This study aimed to extend our knowledge of the process by which ICU stressors and differing rumination styles are associated with burnout, depression and risk of psychiatric morbidity among ICU professionals. Methods Ninety-six healthcare professionals (58 doctors and 38 nurses) who work in ICUs in the UK completed a questionnaire on ICU-related stressors, burnout, work-related rumination, depression and risk of psychiatric morbidity. Results Significant associations between ICU stressors, affective rumination, burnout, depression and risk of psychiatric morbidity were found. Longer working hours were also related to increased ICU stressors. Affective rumination (but not problem-solving pondering or distraction detachment) mediated the relationship between ICU stressors, burnout, depression and risk of psychiatric morbidity, such that increased ICU stressors, and greater affective rumination, were associated with greater burnout, depression and risk of psychiatric morbidity. No moderating effects were observed. Conclusions Longer working hours were associated with increased ICU stressors, and increased ICU stressors conferred greater burnout, depression and risk of psychiatric morbidity via increased affective rumination. The importance of screening healthcare practitioners within intensive care for depression, burnout and psychiatric morbidity has been highlighted. Future research should evaluate psychological interventions which target rumination style and could be made available to those at highest risk. The efficacy and cost effectiveness of delivering these interventions should also be considered.

Anna Cox, Grace Lucas, Afrodita Marcu, M Piano, Wendy Grosvenor, Freda Elizabeth Mold, Roma Maguire, Emma Ream (2017)Cancer survivors' experience of telehealth: A Systematic Review and Thematic Synthesis, In: Journal of Medical Internet Research19(1)e11 JMIR Publications

Background: Net survival rates for cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer care of cancer survivors - individuals living with and beyond cancer - to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and healthcare professionals, is an important contributor to this evolving model of care and may offer additional benefits to cancer survivors. Telehealth is a complex intervention and understanding patient experiences of it is important in evaluating its impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth have yet to be synthesised. Objective: Systematically identify, appraise and synthesise qualitative research evidence on the experiences of adult cancer survivors participating in telehealth intervention(s), to characterise the patient experience of telehealth interventions for this group. Methods: Medline (PubMed), PsychINFO, CINAHL (Cumulative Index for Nursing and Allied Health Professionals), Embase and Cochrane Central Register of Controlled Trial were searched on 14th August 2015 and 8th March 2016 for English-language papers published between 2006 and 2016. Inclusion criteria were: adult cancer survivors aged 18 and over; cancer diagnosis; experience of participating in a telehealth intervention (defined as remote communication and/or remote monitoring with a healthcare professional(s) delivered by telephone, internet, or hand-held/mobile technology); reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) Checklist for Qualitative Research was used to assess paper quality. The results section of each included article was coded line by line and all papers underwent inductive analysis, involving comparison, re-examination and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies. Results: 22 papers were included. Three analytical themes emerged, each with three descriptive subthemes: 1. Influence of telehealth on the disrupted lives of cancer survivors a. Convenience b. Independence c. Burden 2. Personalised care in a virtual world a. Time b. Space c. The human factor 3. Remote reassurance – a safety net of healthcare professional connection a. Active connection b. Passive connection c. Slipping through the net Telehealth interventions represent a convenient approach which can potentially minimise treatment burden and disruption to cancer survivors’ lives. Telehealth interventions can facilitate an experience of personalised care and reassurance for those living with and beyond cancer, but it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden. Conclusions: Telehealth interventions can provide cancer survivors with both independence and reassurance; both important for everyday life or wellbeing. Future telehealth interventions need to be developed iteratively and in collaboration with a broad range of cancer survivors to maximise engagement and benefit.

Ann Gallagher, Matthew Peacock, Magdalena Zasada, T Coucke, Anna Cox, N Janssens (2016)Care-givers’ Reflections on an Ethics Education Immersive Simulation Care Experience:  A Series of Epiphanous Events, In: Nursing Inquiry24(3)e12174 Wiley

There has been little previous scholarship regarding the aims, options and impact of ethics education on residential care-givers. This manuscript details findings from a pragmatic cluster trial evaluating the impact of three different approaches to ethics education. The focus of the article is on one of the interventions, an immersive simulation experience. The simulation experience required residential care-givers to assume the profile of elderly care-recipients for a 24-hr period. The care-givers were student nurses. The project was reviewed favourably by a university ethics committee, and participants provided informed consent. Data from six postsimulation experience focus groups were analysed thematically and three themes were identified: the experience of vulnerability, dignity in care and the organisation of care. Findings suggest that the immersive simulation experience had a powerful immediate impact as participants described epiphanous insights relating to their care experiences. It is suggested that reflecting on and recording epiphanous events has the potential to sustain ethical care practices. Further research is required to evaluate the impact of different ethics education interventions in different cultural contexts. Exploration is also required regarding the meaning and significance of care epiphanies, those “most delicate and evanescent of moments,” for the sustainability of ethical care.

V Jenkins, L Fallowfield, A Cox (2005)The preferences of 600 patients for different descriptions of randomisation, In: BRITISH JOURNAL OF CANCER92(5)pp. 807-810 NATURE PUBLISHING GROUP
S Catt, L Fallowfield, V Jenkins, C Langridge, A Cox (2005)The informational roles and psychological health of members of 10 oncology multidisciplinary teams in the UK, In: BRITISH JOURNAL OF CANCER93(10)pp. 1092-1097 NATURE PUBLISHING GROUP
A Cox, M Illsley, W Knibb, C Lucas, M O'Driscoll, C Potter, A Flowerday, S Faithfull (2011)The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer., In: Palliat Med

E-technology is increasingly used in oncology to obtain self-reported symptom assessment information from patients, although its potential to provide a clinical monitoring tool in palliative care is relatively unexplored in the UK. This study aimed to evaluate the support provided to lung cancer patients post palliative radiotherapy using a computerized assessment tool and to determine the clinical acceptability of the tool in a palliative care setting. However, of the 17 clinicians identified as managing patients who met the initial eligibility criteria for the study, only one clinician gave approval for their patient to be contacted regarding participation, therefore the benefits of this novel technology could not be assessed. Thirteen key clinicians from the centres involved in the study were subsequently interviewed. They acknowledged potential benefits of incorporating computerized patient assessment from both a patient and practice perspective, but emphasized the importance of clinical intuition over standardized assessment. Although clinicians were positive about palliative care patients participating in research, they felt that this population of patients were normally too old, with too rapidly deteriorating a condition to participate in a study using e-technology. In order to encourage acceptance of e-technology within palliative care, emphasis is needed on actively promoting the contribution of technologies with the potential to improve patient outcomes and the patient experience.

Anna Cox, Anne Arber, Ann Gallagher, M MacKenzie, Emma Ream (2016)Establishing priorities for UK cancer nursing research: Nurse and patient collaboration in a UK Oncology Nursing Society Delphi survey, In: Oncology Nursing Forum44(2)pp. 192-203 Oncology Nursing Society

Purpose: Obtain consensus on research priorities for cancer nursing research in the UK. Design: A 3-round online Delphi survey Setting: Oncology nurses were invited via the UK Oncology Nursing Society (UKONS) database. Patient participation was invited through patient organisations. Sample: 50 oncology nurses and 18 patients Methods: Eligible and consenting individuals reported five priorities for cancer nursing research (round 1), rated their level of agreement with them (round 2), and re-stated/revised their responses in light of the group’s (round 3). Consensus was defined as 80% agreement. Findings: Consensus was reached on 50/107 research priorities. These priorities reflected the entire cancer pathway, from diagnosis to palliative care. Highest agreement was reached within and across groups on the need for research relating to prevention, screening and early diagnosis and psychological care across the cancer trajectory. Little consensus was reached regarding symptoms and sideeffects. There was some evident divergence: only patients reached consensus regarding palliative care research and only nurses on eHealth and technology research. Conclusions: Oncology nurses and patients do not necessarily prioritise the same research areas. Prevention, screening and early diagnosis are considered of highest priority for future research across both oncology nurses and patients. Implications for nursing: Patients usually play little part in priority setting for research. This study provided the opportunity for meaningful patient and nurse involvement in setting a research agenda for cancer nursing that is relevant and beneficial to both cancer nurses and patients.

AC Cox, LJ Fallowfield (2007)After going through chemotherapy I can't see another needle, In: EUROPEAN JOURNAL OF ONCOLOGY NURSING11(1)pp. 43-48 ELSEVIER SCI LTD
A Cox, V Jenkins, S Catt, C Langridge, L Fallowfield (2006)Information needs and experiences: An audit of UK cancer patients, In: EUROPEAN JOURNAL OF ONCOLOGY NURSING10(4)pp. 263-272 ELSEVIER SCI LTD
L Fallowfield, L Atkins, S Catt, A Cox, C Coxon, C Langridge, R Morris, M Price (2006)Patients' preference for administration of endocrine treatments by injection or tablets: results from a study of women with breast cancer, In: ANNALS OF ONCOLOGY17(2)pp. 205-210 OXFORD UNIV PRESS
AC Cox, LJ Fallowfield, VA Jenkins (2006)Communication and informed consent in phase 1 trials: a review of the literature, In: SUPPORTIVE CARE IN CANCER14(4)pp. 303-309 SPRINGER
A Cox, E Bull, J Cockle-Hearne, W Knibb, C Potter, S Faithfull (2008)Nurse led telephone follow up in ovarian cancer: A psychosocial perspective, In: European Journal of Oncology Nursing12(5)pp. 412-417 ELSEVIER SCI LTD
Ann Gallagher, Matthew Peacock, Anna Cox (2019)Experiences of Care-givers Assuming the Profile of Care-Recipients in a Domiciliary Ethics-in-Care Simulation Pilot Project, In: Nursing Standard RCN Publishing (RCNi)

This paper discusses findings from an immersive simulation pilot project whereby six domiciliary care-givers took on the profile of people receiving domiciliary care. Five domiciliary care-givers received care in their own homes and one received care in the training area of their domiciliary care company. Care was delivered by 2nd and 3rd year student nurses with support from a registered nurse. The following themes from post-intervention interviews and a focus group with the care-givers who assumed the profile of a care-recipient (simulants) are discussed: Recognising the need for stimulation; Reflecting on the importance of person-centred communication; The value of companionship and confidence in care-givers; Understanding boundaries and vulnerabilities; and Empathy and practice changes. After the experience most participants reported viewing care differently and being more attuned to the wishes of care-recipients.

N Carey, Nouf Alkhamees, Anna Cox, Marta Sund-Levander, Pia Tingström, Freda Elizabeth Mold (2020)Exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and manager’s in nursing homes in England and Sweden: a survey protocol, In: BMJ Open10(10)e038390 BMJ Publishing Group

Introduction In order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic. We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden. Methods and analysis An international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents. Ethics and dissemination This study was approved using the self-certification process at the University of Surrey and Linköping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information. This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost–benefit analyses as the work progresses.