Thesis Development and Evolution

Therefore, this led me to a desire to examine these issues further, and particularly explore interventions for improving psychosocial health and health behaviours in men and single men with cancer.

At this time, I was commencing my ‘Stage 2’ training in health psychology; a 2-year full time position with NHS Fife which led to Chartered status as a Health Psychologist through completion of the professional health psychology qualification with the British Psychological Society. Exploring interventions for men and single men with cancer was one of two primary projects to be undertaken as part of this training. Soon after commencing Stage 2 training, I also registered for a PhD at the University of St Andrews, with the view to expand further on the research

undertaken as part of my NHS post. Accordingly, around one third of the research undertaken as part of my thesis presented here was conducted as part of my 2- year NHS post. The remainder has been undertaken fully in my own time and has been self-funded.

Since my PhD was undertaken part-time, the literature, policy and clinical practice that are relevant to this work have all evolved during this time. This is particularly so in relation to men’s health, but also the broader cancer intervention literature and how behaviour change interventions are described. Regarding men’s health, much literature around the time of PhD commencement highlighted the dearth of intervention studies in men’s health, along with the worse status of men’s health (in general and specific to cancer) compared to women’s health (e.g.,

Konski et al., 2006; Lai et al., 1999; O’Brien & White, 2003; White & Banks, 2004). Men’s health, in and outwith the cancer field, has become more prominent

throughout the writing of the thesis, with the worse health status cited to a greater extent and factors affecting this (e.g., men’s poorer help seeking) highlighted (e.g., All Party Parliamentary Group on Cancer, 2009; Banks, 2009; Berrino et al., 2009; National Cancer Intelligence Network, 2009; Oberoi et al., 2014).

Similarly, the development of interventions for men (including men with cancer) have developed further, in part as a result of the increasing literature and policy development on men’s health (e.g., Gray et al., 2013; also see the update review, which found nine relevant interventions in the period from 2008-2015, compared to a total of 11 papers with a slightly broader inclusion criteria pre-2008 for the original systematic review). In relation to the update review undertaken in this thesis, the more recent men’s cancer literature reflects the broader shift in intervention development around health behaviour change. This includes the greater specification of intervention components within behaviour change interventions, incorporating specifically defined behaviour change techniques (Bourke et al., 2014; Michie et al., 2013). Some more recent literature also

suggests that particular modes of intervention are important, such as the tailoring of interventions to individuals targeting men with cancer (e.g., Anderson et al., 2010). Therefore, literature such as this has been incorporated into the discussion and recommendations.

Interventions targeting psychosocial issues in men with cancer, appear to have evolved to a lesser extent throughout the thesis, reflecting that the general

cancer patients in general has grown, for example, to include the recommendation for mindfulness interventions. As discussed under 8.5.2, however, caution is used when discussing these, since they are not aimed solely at men with cancer. The literature showing that lifestyle interventions can have positive effects on mental health and wellbeing has also grown, however, again, much of this is in the general population, or both male and female cancer patients. Therefore, there may be limited specific recommendations made around lifestyle interventions for mental wellbeing.

A further area of research that has grown is around ‘gender-comparative’ studies in the field of cancer. This area has largely emerged since the

commencement of this thesis. This type of research can reveal important areas of difference (or not) between men and women, and may have been an option for consideration had this area been well known at the time of study design. Lastly, work around the health care system, including integrated model of care, has evolved and grown in publicity since 2008 (e.g., Graves, 2013).

The increasing focus on men’s health, the shift around specifying the behaviour change content of lifestyle interventions and the development of

integrated models of care did not specifically influence decisions made within the thesis. Yet, these factors have affected some of the discussion of findings and recommendations. For example, the recommendation around the use of behaviour change techniques (incorporated from the update review) is influenced by this shift in the reporting of, and evidence around interventions. Recommendations to embed psychological support within integrated models of care within cancer are

due to this emerging literature. More generally, the increased emphasis on the need to target men with cancer around psychosocial issues and health behaviours helps support the recommendations and could potentially assist in pushing these forward in practice.

In addition to the evolution of some relevant literature, Scottish Government policies around cancer have evolved throughout the time of undertaking the thesis. Better Cancer Care (The Scottish Government, 2008b) was part of a changed approach to cancer in recognising that more people are surviving cancer. More recently, The Scottish Government’s Transforming Care After Treatment

programme, in partnership with MacMillan Cancer Support, has built on Better Cancer Care to further develop services to support cancer patients who are surviving after treatment (NHS Scotland, 2013). The increasing shift towards acknowledging that cancer can be a long term condition is seen within these policy documents, which are part of the broader survivorship agenda in cancer, also reflected in policy throughout the UK (Department of Health, 2011; MacMillan Cancer Support, 2009). As such, the primary policy shift related to psychosocial issues and health behaviours has been towards recognising that cancer patients are living longer and many experience cancer as a long term condition, or consider themselves to be ‘survivors’ of cancer. Given the thesis focused on post-treatment interventions, the policy shift has not significantly impacted. However, it provides further support for the recommendations that are made here.

support discussed here focuses on what is available to men with cancer in the localities that the studies were undertaken in. However, it reflects similar patterns of increasing support provided elsewhere in Scotland and the UK. Psychosocial support had been relatively strong for cancer patients for several years prior to commencement of this thesis, for example, Maggie’s centres were available in the three main Health Boards in the East of Scotland, MacMillan Cancer Support offered a range of face-to-face and telephone services, and the Health Boards had psychologists working in oncology. Since the commencement of this thesis, online support offered by charities including MacMillan and the Maggie’s centres have developed, support groups (often facilitated by the NHS and/or Maggie’s) have grown in number, and some Maggie’s centres have offered groups for men. In addition, with the shifting understanding and acceptance around prevention and management of cancer, lifestyle support has been developed to support cancer patients to improve their health in the voluntary and NHS sectors, including through the Self Management Fund (Lee et al., 2015; the Scottish Government, 2010). Therefore, there is a recognition that support in a range of settings and modes is available to patients, however the challenges can lie more in assisting some men to access services when needed, which is reflected in the findings of, and

recommendations from the thesis.