Despite evidence of high psychological distress and unmet needs, evaluated interventions for informal caregivers in palliative care are few. This study involved an observational outcome evaluation of attendees, and a comparison group, in specialist home palliative care. The measures included carer psychological status and patient physical status at baseline, 8 weeks, and 20 weeks. Qualitative data were collected regarding content, satisfaction with, and impact of intervention. Process data described the uptake, resources, and group activity. The intervention combined informal multiprofessional teaching with facilitated peer exchange and support, and was delivered over 6 sessions of 90 minutes per week. The uptake rate was 25%; carers were less likely to accept if they were in paid employment (OR=0.26, P=0.06), and more likely to accept if they utilized avoidance coping (OR=1.13, P=0.04) or their patient had worse physical status (OR=2.1, P=0.03). Attendees described significant support and knowledge gains from the multiprofessional input and peer group. Most relied on social comparison processes to appraise their situation. Potential detection of significant effects on global psychological scores (i.e. anxiety, depression, and burden) using multivariate analysis was disallowed due to attrition. This acceptable and accessible intervention provided information and support; further outcome studies are needed for a range of interventions. Short-term interventions are unlikely to affect global psychological scores, and future evaluations should include additional time points of data collection to demonstrate support during attendance.

This study underlines the importance of helping family members to develop a working understanding of the condition in the early stages.

content validity of the instrument were established and an exploratory factor analysis used to guide restructuring of the tool. Internal consistency/reliability was calculated using Cronbach's a . RESULTSUsing the scale showed that men with prostate cancer placed considerable importance on a broad range of information needs, most of which had been inadequately met. Age had a significant influence on the overall importance attributed to information, with younger patients having more need for information. The construct and content validity of the instrument were established. The factor analysis revealed four discrete factors which together explained > 68% of the variance, termed 'basics of prostate cancer care', 'disease management', 'physical well-being' and 'self-help' . Internal consistency/reliability was satisfactory ( a = 0.91). CONCLUSIONSThe basis of a tool capable of ascertaining the information needs of patients with prostate cancer was developed; it may offer clinicians a valid means of ascertaining information preferences and hence potentially enhance the quality of service provided. Further research is now required to refine the tool and test the effect of its longitudinal use in clinical practice on patient satisfaction and outcome. KEYWORDSprostate cancer, information needs, assessment scale OBJECTIVETo design, from first principles, a valid and reliable scale for assessing the importance of specific items of information needed by patients with prostate cancer that would be straightforward to use in clinical settings, as despite its prevalence, there is little research focusing specifically on the information needs associated with prostate cancer. PATIENTS AND METHODSSeveral stages of consultation and modification were used to inform the development of a scale which was then piloted on 96 patients with prostate cancer. Respondents were asked to rate the importance they placed on a range of prostate cancer-related topics of information, and the extent to which they felt these information needs had been met. The construct and

Owing to the large and increasing number of vacant consultant posts in psychiatry, and the suspicion that premature retirement was an important cause of this problem, a questionnaire was sent to all consultants who were believed to have retired from their National Health Service (NHS) posts before their 65th birthday during 1995 or 1996. One hundred and forty-two (82%) of 173 questionnaires were returned. Responses to these Indicated that disenchantment with some aspect of the previous Conservative Government's ‘NHS Reforms' was a more important reason for retirement than ill health, a wish to devote more time to other interests, or even bed closures. Increasing bureaucracy and paperwork was a key factor for many.

Informal carers of home palliative care patients have high unmet needs. However, interventions for carers are few. This research-based short-term group intervention addresses the information and support needs of carers. Multiprofessional informal teaching is combined with peer support. The intervention was designed by integrating the findings from a qualitative study and the evidence on needs and interventions, in order to address the key issues of feasibility, acceptability, and accessibility. Qualitative data from attendees showed that identifying with other carers and validating feelings, asking questions of professionals, and providing each other with support and encouragement were valuable outcomes from the group.

Despite an increasing interest in the experiences of people who have been diagnosed with dementia, there is still a dearth of research into how people cope with the onset of the illness.This study uses qualitative methodology to examine the appraisals and coping processes of 20 men diagnosed with early-stage Alzheimer's disease. Semi-structured interviews were conducted with the men and their wives.These were analysed using Interpretative Phenomenological Analysis.The men's accounts suggested that they attempted to manage their sense of self by balancing their wish to maintain a prior sense of self against their need to reappraise and construct a new sense of self. This seemed to be an ongoing, circular process. Ways in which services can assist men in the process of managing their sense of self are explored.

The objective of this study was to evaluate the impact of the Macmillan GP Facilitator Programme in Palliative Care on the knowledge, attitudes and confidence in symptom control of general practitioners (GPs), communication with patients and out-of-hours practice. GP Facilitators work on average for two sessions a week with practices in their locality. The design included a before and after study, with geographical controls matched on type of area (inner city, urban and rural) and broadly on Jarman scores using postal questionnaires sent to GPs. Scores measured change in GP awareness, attitudes and practice over two years of the intervention, derived from Likert scale responses to the postal questionnaires. Although overall few significant results were found, we did identify an increase in the use of palliative care guidelines in Facilitator districts, together with an increase in awareness of day care. The programme was associated with increased positive attitudes towards specialist palliative care services and results suggested increased satisfaction with out-of-hours services for patients. No change was found for confidence in symptom control and communication over diagnosis with cancer patients was less than in control districts. The design also incorporated a qualitative component, and from this we found the Facilitator programme to be popular with local GPs who valued the support of a colleague who knew the demands and constraints of general practice. In conclusion, we have demonstrated an impact of the GP Facilitator programme on GP awareness of, use and increased positive attitudes towards specialist palliative care services. By improving communication between primary and specialist palliative care, the programme should contribute substantially to improved care of the dying at home.

A number of models have been proposed to describe the processes of appraisal and coping in early-stage dementia, but possible gender differences remain to be explored. The present study focused specifically on women with early-stage Alzheimer's disease, and examined how they made sense of, and attempted to cope with, their situation. Transcripts of interviews with nine women were analysed using Interpretative Phenomenological Analysis. Ten key themes were identified, which were grouped into three higher-order themes: connectedness, protective strategies and adjustment. The women experienced memory problems as a threat to the sense of connectedness they derived from attachment to family and friends, affiliation with social roles and familiarity with their surroundings. A Level of Connectedness Model of the appraisal and coping processes of women with early-stage Alzheimer's disease is presented, which places coping in an interpersonal framework, whereby a woman's ability to maintain a sense of self is inherently dependent on the readiness of others to facilitate connectedness. This provides a focus for possible further development of psychosocial interventions that consider well-being in an interpersonal context.