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Biomedical subjects

Stephen Sutton

Publications and source records attributed to Stephen Sutton.

At least 19 recordsLinked to original sources
PubMed2007

Study comparing two types of screening provision for people with von Hippel-Lindau disease.

Patients diagnosed with von Hippel-Lindau disease (vHL) require life-long surveillance for this multi-system disease. It is therefore important to assess the comprehensiveness of screening provision, as well as identify what type of screening service is most likely to encourage regular patient attendance. This descriptive study reports on two types of screening service: single appointment One Stop (OS) clinics and multiple appointment Ad Hoc (AH) clinics. One hundred and seventeen vHL patients from eight regional genetics centres were approached to take part. Seventy-two (61.5%) returning a completed study questionnaire: fifty-four (75%) were screened at OS clinics and eighteen (25%) at AH clinics. Comprehensiveness of screening, attendance rates, patient ratings of quality of care and levels of psychological morbidity were compared between the two types of service. While levels of disease severity were similar in patients screened at OS and AH clinics, those seen at OS clinics were screened for twice as many site-specific vHL manifestations compared to those seen at AH clinics (P < 0.0001). More patients at OS clinics regularly attended their screening appointments compared to those at AH clinics (P = 0.0045). There was no difference in the quality of care reported by patients attending the two types of screening service and few problems were reported. Twenty-nine percent of respondents were categorised as clinically anxious and 13% as clinically depressed. These findings suggest that an optimum vHL screening service is one based on OS clinics offering regular comprehensive surveillance and psychological support.

Ambulatory Care↗
PubMed2006

Psychological impact of genetic counseling for familial cancer: a systematic review and meta-analysis.

BACKGROUND: Identification of a genetic basis underlying certain types of cancer has led to an increase in demand for genetic counseling about individual risks of the disease. We conducted a systematic review of the literature to determine the quality and strength of evidence relating to psychological outcomes of genetic counseling for familial cancer. METHODS: Six electronic databases were searched to identify controlled trials and prospective studies that examined the effect of genetic counseling on risk perception, knowledge, anxiety, cancer-specific worry, depression, and cancer surveillance. Twenty-one studies from 25 papers met inclusion criteria, including five controlled trials and 16 prospective studies. Analysis of each outcome was stratified by short-term (</=1 month) and long-term (>/=3 months) follow-up. Trial evidence was assessed with standardized differences of the means at follow-up between intervention and comparison groups, and these data were pooled by use of random-effects meta-analysis. RESULTS: Meta-analysis of controlled trials showed that genetic counseling improved knowledge of cancer genetics (pooled short-term difference=0.70 U, 95% confidence interval (CI)=0.15 to 1.26 U) but did not alter the level of perceived risk (pooled short-term difference=-0.10 U, 95% CI=-0.23-0.04 U). Prospective studies reported improvements in the accuracy of perceived risk. No effect was observed in controlled trials on general anxiety (pooled long-term effect=0.05 U, 95% CI=-0.21-0.31 U) or cancer-specific worry (pooled long-term difference=-0.14 U, 95% CI=-0.35-0.06 U), although several prospective studies demonstrated short-term reductions in these outcomes. Few studies examined cancer surveillance behaviors, and no studies attempted to measure informed choice. CONCLUSIONS: Genetic counseling for familial cancer is associated with improvement in knowledge but does not have an adverse effect on affective outcomes. We urge further investigation of these findings through well-designed, well-reported, randomized controlled trials with suitable comparison groups and additional outcome measures [J Natl Cancer Inst 2004; 96:122-33].

Attitude to Health↗
PubMed2006

Evaluating the effectiveness of proactive telephone counselling for smoking cessation in a randomized controlled trial.

AIM: To evaluate the effectiveness of repeated-contact proactive telephone counselling for smoking cessation in a UK setting. DESIGN: Randomized controlled trial. SETTING: The Quitline, an established national telephone counselling service available throughout the UK. PARTICIPANTS AND INTERVENTION: A total of 1,457 callers to the Quitline in 2000 and 2001 were allocated randomly to a Control group to receive usual care or to a Repeated Contact group to be offered five proactive calls in addition to usual care. MEASUREMENTS Prolonged abstinence and 24-hour point-prevalent abstinence 6 and 12 months after recruitment, quit attempts and 24-hour periods of abstinence in non-quitters. FINDINGS: No significant differences were found between the Repeated Contact and Control groups on prolonged or point-prevalent abstinence. On an intention-to-treat basis, 9.5% of the Control group were abstinent for longer than 6 months at the 12-month follow-up, compared with 9.3% of the Repeated Contact group; 18.9% and 20.2%, respectively, were point-prevalent abstinent at the 6-month follow-up. Significantly more non-quitters in the Control group made a quit attempt in the first 6 months following recruitment than in the Repeated Contact group (62.6%/56.1%, P < 0.05). CONCLUSIONS Proactive telephone counselling did not significantly increase abstinence rates, and appeared to decrease quit attempts, in callers to the Quitline. A non-structured, client-led counselling protocol and insufficient pre-quit motivational counselling could account for the lack of effect.

Adult↗
PubMed2006

Personal and social comparison information about health risk: reaction to information and information search.

This study extended previous research on the impact of personal and social comparison information about health risk by asking respondents what other information they require. A total of 197 students responded to 1 of 12 vignettes describing hypothetical risks of developing pancreatic disease. These vignettes varied in terms of personal risk, comparison group risk and disease severity. Higher threat manipulations elicited higher ratings of negative affect, although perceived ambiguity moderated this effect. When information was more threatening, respondents requested more information, especially about controlling the disease threat. These results indicate the importance of providing unambiguous information, information about how to control a threat and information people want.

Analysis of Variance↗
PubMed2005

Sociodemographic and attitudinal correlates of cervical screening uptake in a national sample of women in Britain.

Sociodemographic and attitudinal correlates of self-reported cervical screening uptake were investigated among 1307 women in the target age group who participated in two national surveys conducted in Britain in 1999. Evidence for inequalities in screening uptake was mixed. Of the socioeconomic indicators, only age of completed full-time education showed a significant effect in the multivariate analysis. The strong effects of car ownership and housing tenure in the univariate analyses were eliminated by controlling for marital status, which showed a robust association with uptake. Uptake was highest among married and separated women and lowest among single and widowed women. There was no evidence that the effects of marital status and education were mediated by the attitudinal variables. Anticipated embarrassment and attitudes to screening (e.g., "There's no point going for screening if you don't have any symptoms") were significant independent predictors of uptake. These findings suggest that information campaigns need to address feelings of embarrassment and lack of understanding of the rationale for screening and that efforts should be made to encourage single and widowed women to attend.

Adult↗
PubMed2005

Development of a risk assessment tool for women with a family history of breast cancer.

BACKGROUND: Innovative technologies that enable the collection of family history information and the assessment of breast cancer risk have a potential to enhance the quality of preventive care. We developed a computerized tool that supports stratification of breast cancer risk, genetic risk assessment in the clinical environment (GRACE). METHODS: In a preliminary evaluation of the tool's impact, we randomized women with a family history of breast cancer (n=72) to either use the GRACE tool or undergo risk counseling by a nurse specialist. RESULTS: There was no statistically significant differences between the GRACE and nurse counselling groups in risk perceptions (F=.03, P>.05) and cancer-related worries (F=.80, P>.05). However, patients reported more positive attitudes toward working with the nurse. CONCLUSION: It was feasible to use GRACE in a Clinic. Additional research is required to identify solutions for providing emotional support in conjunction with the tool.

Adolescent↗
PubMed2005

A causal modelling approach to the development of theory-based behaviour change programmes for trial evaluation.

Theory-based intervention programmes to support health-related behaviour change aim to increase health impact and improve understanding of mechanisms of behaviour change. However, the science of intervention development remains at an early stage. We present a causal modelling approach to developing complex interventions for evaluation in randomized trials. In this approach a generic model links behavioural determinants, causally through behaviour, to physiological and biochemical variables, and health outcomes. It is tailored to context, target population, behaviours and health outcomes. The development of a specific causal model based on theory and evidence is illustrated by the ProActive programme, supporting increased physical activity among individuals at risk of Type 2 diabetes. The model provides a rational guide to appropriate measures, intervention points and intervention techniques, and can be tested quantitatively. Causal modelling is critically compared to other approaches to intervention development and evaluation, and research directions are indicated.

Behavioral Research↗
PubMed2005

Are techniques used in cognitive behaviour therapy applicable to behaviour change interventions based on the theory of planned behaviour?

The Theory of Planned Behaviour (TPB) is increasingly being used to inform the development of interventions to promote health behaviour change. However, although the theory can be used to identify the determinants of particular health-related behaviours, it offers little guidance on how to change these determinants and hence how to promote behaviour change. There is evidence that Cognitive Behaviour Therapy (CBT) can be used to support health behaviour change. This article discusses the similarities and differences between the two approaches, and considers whether techniques used in CBT are applicable to interventions based on the TPB.

Cognitive Behavioral Therapy↗
PubMed2005

Perceived difficulty in the theory of planned behaviour: perceived behavioural control or affective attitude?

A study was conducted to explore (a) the dimensional structure of perceived behavioural control (PBC), (b) the conceptual basis of perceived difficulty items, and (c) how PBC components and instrumental and affective attitudes, respectively, relate to intention and behaviour. The material stemmed from a two-wave study of Norwegian graduate students (N = 227 for the prediction of intention and N = 110 for the prediction of behaviour). Data were analysed using confirmatory factor analysis (CFA) and multiple regression by the application of structural equation modelling (SEM). CFA suggested that PBC could be conceived of as consisting of three separate but interrelated factors (perceived control, perceived confidence and perceived difficulty), or as two separate but interrelated factors representing self-efficacy (measured by perceived difficulty and perceived confidence or by just perceived confidence) and perceived control. However, the perceived difficulty items also overlapped substantially with affective attitude. Perceived confidence was a strong predictor of exercise intention but not of recycling intention. Perceived control, however, was a strong predictor of recycling intention but not exercise intention. Affective attitudes but not instrumental attitudes were identified as substantial predictors of intentions. The findings suggest that at least under some circumstances it may be inadequate to measure PBC by means of perceived difficulty. One possible consequence may be that the role of PBC as a predictor of intention is somewhat overestimated, whereas the role of (affective) attitude may be similarly underestimated.

Adult↗
PubMed2004

The ProActive trial protocol - a randomised controlled trial of the efficacy of a family-based, domiciliary intervention programme to increase physical activity among individuals at high risk of diabetes [ISRCTN61323766].

BACKGROUND: Increasing prevalence of obesity and disorders associated with sedentary living constitute a major global public health problem. While previous evaluations of interventions to increase physical activity have involved communities or individuals with established disease, less attention has been given to interventions for individuals at risk of disease. METHODS/DESIGN: ProActive aims to evaluate the efficacy of a theoretical, evidence- and family-based intervention programme to increase physical activity in a sedentary population, defined as being at-risk through having a parental family history of diabetes. Primary care diabetes or family history registers were used to recruit 365 individuals aged 30-50 years, screened for activity level. Participants were assigned by central randomisation to three intervention programmes: brief written advice (comparison group), or a psychologically based behavioural change programme, delivered either by telephone (distance group) or face-to-face in the family home over one year. The protocol-driven intervention programme is delivered by trained facilitators, and aims to support increases in physical activity through the introduction and facilitation of a range of self-regulatory skills (e.g. goal setting). The primary outcome is daytime energy expenditure and its ratio to resting energy expenditure, measured at baseline and one year using individually calibrated heart rate monitoring. Secondary measures include self-report of individual and family activity, psychological mediators of behaviour change, physiological and biochemical correlates, acceptability, and costs, measured at baseline, six months and one year. The primary intention to treat analysis will compare groups at one-year post randomisation. Estimation of the impact on diabetes incidence will be modelled using data from a parallel ten-year cohort study using similar measures. DISCUSSION: ProActive is the first efficacy trial of an intervention programme to promote physical activity in a defined high-risk group accessible through primary care. The intervention programme is based on psychological theory and evidence; it introduces and facilitates the use of self-regulatory skills to support behaviour change and maintenance. The trial addresses a range of methodological weaknesses in the field by careful specification and quality assurance of the intervention programme, precise characterisation of participants, year-long follow-up and objective measurement of physical activity. Due to report in 2005, ProActive will provide estimates of the extent to which this approach could assist at-risk groups who could benefit from changes in behaviours affecting health, and inform future pragmatic trials.

Adult↗
PubMed2004

Psychological impact of genetic counseling for familial cancer: a systematic review and meta-analysis.

BACKGROUND: Identification of a genetic basis underlying certain types of cancer has led to an increase in demand for genetic counseling about individual risks of the disease. We conducted a systematic review of the literature to determine the quality and strength of evidence relating to psychological outcomes of genetic counseling for familial cancer. METHODS: Six electronic databases were searched to identify controlled trials and prospective studies that examined the effect of genetic counseling on risk perception, knowledge, anxiety, cancer-specific worry, depression, and cancer surveillance. Twenty-one studies from 25 papers met inclusion criteria, including five controlled trials and 16 prospective studies. Analysis of each outcome was stratified by short-term (< or =1 month) and long-term (> or = 3 months) follow-up. Trial evidence was assessed with standardized differences of the means at follow-up between intervention and comparison groups, and these data were pooled by use of random-effects meta-analysis. RESULTS: Meta-analysis of controlled trials showed that genetic counseling improved knowledge of cancer genetics (pooled short-term difference = 0.70 U, 95% confidence interval [CI] = 0.15 to 1.26 U) but did not alter the level of perceived risk (pooled short-term difference = -0.10 U, 95% CI = -0.23 to 0.04 U). Prospective studies reported improvements in the accuracy of perceived risk. No effect was observed in controlled trials on general anxiety (pooled long-term effect = 0.05 U, 95% CI = -0.21 to 0.31 U) or cancer-specific worry (pooled long-term difference = -0.14 U, 95% CI = -0.35 to 0.06 U), although several prospective studies demonstrated short-term reductions in these outcomes. Few studies examined cancer surveillance behaviors, and no studies attempted to measure informed choice. CONCLUSIONS: Genetic counseling for familial cancer is associated with improvement in knowledge but does not have an adverse effect on affective outcomes. We urge further investigation of these findings through well-designed, well-reported, randomized controlled trials with suitable comparison groups and additional outcome measures.

Affect↗
PubMed2003

Psychological impact of colorectal cancer screening.

This article examines the psychological impact of participating in sigmoidoscopy screening for colorectal cancer prevention. The 1st study examined psychological well-being at 3 months, in relation to screening outcome, in 4,153 individuals. The 2nd study used longitudinal data to examine changes in psychological functioning from before to after screening in relation both to screening outcome and baseline indicators of vulnerability. There were few psychological differences between those who had received negative results or had polyps detected. These findings were confirmed in the longitudinal study, which also found no evidence for vulnerability to adverse effects among those who were initially most anxious or who perceived their risk of cancer to be higher. The longitudinal data suggested that screening might produce transient positive effects.

Anxiety↗
PubMed2003

Increasing attendance at colorectal cancer screening: testing the efficacy of a mailed, psychoeducational intervention in a community sample of older adults.

This article describes a trial of a psychoeducational intervention designed to modify negative attitudes toward flexible sigmoidoscopy screening and thereby increase screening attendance. The intervention materials addressed the multiple barriers shown to be associated with participation in earlier studies. Adults ages 55-64 (N = 2,966), in a "harder-to-reach" group were randomized either to receive an intervention brochure or to a standard invitation group. Attitudes and expectations were assessed by questionnaire, and attendance at the clinic was recorded. Compared with controls, the intervention group had less negative attitudes, anticipated a more positive experience, and had a 3.6% higher level of attendance. These results indicate that psychoeducational interventions can provide an effective means of modifying attitudes and increasing rates of screening attendance.

Attitude to Health↗
PubMed2003

Using the Internet to conduct surveys of health professionals: a valid alternative?

OBJECTIVE: The purpose of this study was to examine whether Internet-based surveys of health professionals can provide a valid alternative to traditional survey methods. METHODS: (i) Systematic review of published Internet-based surveys of health professionals focusing on criteria of external validity, specifically sample representativeness and response bias. (ii) Internet-based survey of GPs, exploring attitudes about using an Internet-based decision support system for the management of familial cancer. RESULTS: The systematic review identified 17 Internet-based surveys of health professionals. Whilst most studies sampled from professional e-directories, some studies drew on unknown denominator populations by placing survey questionnaires on open web sites or electronic discussion groups. Twelve studies reported response rates, which ranged from nine to 94%. Sending follow-up reminders resulted in a substantial increase in response rates. In our own survey of GPs, a total of 268 GPs participated (adjusted response rate = 52.4%) after five e-mail reminders. A further 72 GPs responded to a brief telephone survey of non-respondents. Respondents to the Internet survey were more likely to be male and had significantly greater intentions to use Internet-based decision support than non-respondents. CONCLUSIONS: Internet-based surveys provide an attractive alternative to postal and telephone surveys of health professionals, but they raise important technical and methodological issues which should be carefully considered before widespread implementation. The major obstacle is external validity, and specifically how to obtain a representative sample and adequate response rate. Controlled access to a national list of NHSnet e-mail addresses of health professionals could provide a solution.

Attitude of Health Personnel↗
PubMed2003

Let's ask them: a national survey of definitions of quality of life and its enhancement among people aged 65 and over.

This study aimed to explore older peoples' definitions of, and priorities for, a good quality of life for themselves and their peers. Nine hundred and ninety-nine people aged 65 and over, living at home in Britain, were interviewed for the study. Good social relationships were the most commonly mentioned constituent that gave respondents' lives quality (mentioned by 81 percent). Other important factors were social roles and activities, health, psychological outlook and well-being, home and neighborhood, finances, and independence. Poor health was most often mentioned as taking quality away from life (by 50 percent). Social relationships and health were judged to be the most important areas. Having health and enough money were the two most frequently mentioned things that would improve the quality of their own lives and those of their peers (though in different order of magnitude). The need for dynamic, multidimensional, and integrated models of quality of life in older age is suggested by these results.

Adaptation, Psychological↗
PubMed2002

Assessing 'stage of change' in current and former smokers.

AIMS: The concept of 'stage of change' is widely used by researchers and clinicians in the field of smoking cessation. Our aim was to assess the validity of three staging questionnaires and of the concept of 'stage of change' itself. SETTING AND PARTICIPANTS: Survey on the Internet in 1025 ever smokers, retest after 8 days in 318 people (31%), follow-up after 32 days in 451 people (44%). MEASUREMENTS: Three measures of 'stage of change'. FINDINGS: Participants (83-93%) were classified in the same stage by all pairs of questionnaires, and 15% changed stage during an interval of 8 days. Including quit attempts in the 'preparation' stage had a large impact on stage distributions, because 18-24% of smokers who had decided to quit in the next 30 days were downgraded to the 'contemplation' stage as they had not made a quit attempt in the previous year. The 'action' stage included 5-7% of occasional smokers. Quit attempts during the past 7 days and 30 days were better predictors of smoking cessation than quit attempts during the past 12 months. Baseline stage and a continuous measure of intention predicted smoking abstinence at follow-up. CONCLUSIONS: These results reflect theoretical and methodological problems with the concept of stage of change. 'Stage' covers four different variables: current behaviour, quit attempts, intention to change and time since quitting. These variables are combined in a somewhat haphazard manner, none of them is measured comprehensively, and intention and time are continuous variables categorized by arbitrary cutpoints. Measuring each of these four variables independently may be preferable to using an incomplete mix of these elements.

Adolescent↗