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Background Recent studies have highlighted that people diagnosed with head and neck cancer (HNC) have complex information needs. They are subject to multiple clinical appointments with numerous healthcare professionals in preparation for their treatment. Speech and language therapists (SLTs) are core members of the HNC multidisciplinary team, providing assessment, prehabilitation and counselling regarding potential treatment effects on the critical functions, including swallowing and communication. We believed the purpose of the pre-treatment speech-language therapy (SLT) consultation within this pathway is not well understood by patients. Whilst the benefits of prophylactic swallowing exercise prescriptions continue to be explored, adherence is a frequently cited challenge in clinical trials. We sought to enhance pre-treatment dysphagia services for patients with head and neck cancer (HNC) undergoing chemoradiation. Methods A participatory action research approach called experience-based co-design (EBCD) was undertaken at a tertiary cancer hospital in the UK. People who had previous radical radiation treatment for head and neck cancer and staff members within the head and neck unit were recruited to take part in in-depth, one-to-one interviews about their experiences of the pre-treatment SLT head and neck radiation clinic. Patient interviews were video-recorded, analysed and edited down to a 30 min ‘trigger’ film. At a subsequent patient feedback event, the film was shown and an ‘emotional mapping’ exercise was undertaken. Through facilitated discussion, patient priorities for change were agreed and recorded. At a staff feedback event, key themes from the staff interviews were discussed and priority areas for change identified. The project culminated in a joint patient and staff event where the film was viewed, experiences shared and joint priorities for change agreed. Task and finish groups were developed to implement these changes. Results Seven patients and seven staff members participated. All seven patients had undergone radical (chemo-) radiation for HNC. At least 2 months had elapsed since their final treatment date and all participants were within 9 months of their definitive treatment. Staff members comprised a radiation oncologist, two clinical nurse specialists, two head and neck dietitians and two speech-language therapists. Patients reported that overall, their experience of the pre-treatment clinic is positive. Patients value experienced staff, consistency of staff and the messages they provide and a team approach. Patients highlighted the need for different information methods including online/digital information resources and further information regarding the longer-term effects of treatment. Patients valued the purposes of prophylactic exercises and again advocated for supporting resources to be available in a range of online/digital media. Staff members raised the need for flexibility in appointment times and clearer messaging as to the rationale for a pre-treatment SLT appointment, including a rebranding of the SLT service. Seven key areas for improvement were identified jointly by patients and staff members including revision of patient and carer information, development of a patient experience video, information on timelines for recovery, a buddy system for patients before, during and after treatment, flexibility of appointment scheduling, seamless transfer of care between settings and SLT department rebranding. Joint patient and staff task and finish groups were initiated to work on these seven priority areas. Conclusions We have worked in partnership with patients to co-design pre-treatment dysphagia services which are accessible and meet the individuals’ needs. Task and finish groups are ongoing with staff and patients are working together to address priority areas for change. This work provides a good example for other centres who may wish to engage in similar activities.

BackgroundMaternal and neonatal mortality in the UK remains high, underscoring safety concerns in maternity care. Incident reporting remains a key mechanism for identifying risks and driving improvement, yet challenges, including underreporting and limited organisational learning, persist.AimThe primary aim of the study was to explore clinicians’ preferences and behaviours in maternity patient safety reporting within a tertiary hospital.MethodsWe conducted a two-phase qualitative study in a UK tertiary teaching hospital maternity service. Phase 1 involved AI-supported Big Qualitative (Big Qual) thematic analysis (using Caplena and Infranodus) of the first 400 patient safety incident reports submitted via the local electronic reporting system over a 5-month period (June–November 2024). Phase 2 comprised semistructured interviews with 14 maternity clinicians conducted between April and June 2025 and informed by phase 1 findings. Interview data were analysed using a Rapid Assessment Procedure and framework-based thematic analysis. Findings from both phases were integrated at the interpretation stage to examine reporting practices, barriers and enablers and opportunities for organisational learning, drawing on sociotechnical systems and safety-II-informed concepts.ResultsThematic analysis of incident reports identified ten recurrent topics including staffing capacity, documentation discrepancies and communication issues. Interviews highlighted barriers such as psychological safety, form complexity and limited feedback, alongside enablers including visible learning and supportive leadership. Inconsistencies in reporting behaviours, feedback mechanisms and system integration were evident, with underreporting of near misses and staff conduct identified as key gaps.ConclusionsThis study offers a nuanced view on how incident reporting is enacted in practice within maternity care. By combining interview data with Big Qual incident analysis, it identifies actionable insights for improving safety and organisational learning. Recommendations include simplifying reporting systems, embedding psychological safety, standardising processes and enhancing feedback and cross-professional learning.

ProblemPatient safety incident reporting in maternity care is central for improving safety, yet inconsistencies in reporting practices and limited understanding of system functionalities may reduce its effectiveness.BackgroundReporting incidents allows healthcare providers to identify safety issues and implement improvements. However, variations in reporting practices, particularly in maternity care, have been found across different healthcare settings. Despite the growing use of electronic systems, challenges such as under-reporting, lack of feedback and insufficient organisational learning persist.AimThis review explores how patient safety incidents are reported in maternity care, identifies the systems used globally, examines potential barriers and enablers to reporting, and highlights gaps in existing research and practice.MethodsA systematic review was conducted, analysing studies that focused on incident reporting practices in maternity care. An artificial intelligence text analysis tool (Caplena) was used to aid the synthesis of the study data. Methodologies included quantitative surveys, qualitative interviews and mixed methods approaches.FindingsA total of 15 studies from seven different countries were analysed. Reporting systems ranged from traditional paper-based methods to electronic platforms. Barriers included organisational culture, time pressures and inadequate reporting platforms. Enablers involved supportive leadership, training and user-friendly reporting systems. Substantial gaps included the under-reporting of near misses, lack of feedback mechanisms and insufficient attention to staff experiences.DiscussionThe findings highlight the need for consistent, user-friendly reporting systems and fostering a supportive, non-punitive culture. Strengthening and improving feedback mechanisms is also critical to enhance reporting practices. Recommendations are provided for designing future reporting systems.ConclusionImproving patient safety incident reporting in maternity care requires system improvements, cultural changes and further research to address identified gaps and optimise incident management systems.

Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.

Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people. To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness. A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach. A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions. Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.

Head and neck cancer (HNC) and its treatment can have a significant impact on physical and psychosocial wellbeing.A multidisciplinary team (MDT) approach is critical to reduce the potential acute, long-term and late effects of treatment by optimising function at baseline, supporting people during treatment and with rehabilitation post treatment. The key focus for speech and language therapists is to support the holistic needs of people with a focus on speech, swallowing, voice and mouth opening. Effective management is reliant on working with MDT members and interventions are implemented against the background of robust multidimensional baseline evaluation. There have been significant advances in treatment modalities for both primary and recurrent HNC. These include highly conformal radiotherapy modalities, including: image-guided radiotherapy; parotid-sparing and dysphagia-optimised intensity-modulated radiotherapy; and the introduction of intensity-modulated proton therapy, as well as immunotherapy, transoral robotic surgery and surgery with advanced reconstructive techniques. Such treatment advances coupled with a changing patient demographic means that people with HNC are now living longer. However, this is not always without consequences and late treatment effects are a new challenge facing MDTs, requiring high levels of support and rehabilitation. Key points Speech and language therapists (SLTs) are key members of the multidisciplinary team. All individuals should see a SLT as part of their treatment pathway if there is an existing or likely treatment-related impact on communication and/or swallowing. SLTs use a combination of multidimensional assessment, education and rehabilitation interventions to optimise functional outcomes.

Over 10 million operations are carried out every year in the UK, improving millions of lives. While most operations are low-risk, some result in patients having poor outcomes. Preoperative assessment evaluates a patient's health prior to surgery to identify risks and where possible minimise them through optimisation. However, this preoperative assessment often takes place close to the planned date of surgery, meaning there is little time to optimise patients' health. Early preoperative screening is the process of evaluating a patient's health earlier in the surgical pathway. In 2023, NHS England introduced a new programme where all hospitals were to implement early screening, triaging, risk assessment and health optimisation with the aim of increasing safety through reduced perioperative complications, increased efficiency (e.g., through reductions in last-minute cancellations), reductions in length of hospital stay, and identifying people who can undergo surgery without requiring an overnight stay. Here we describe the protocol to examine the implementation and impact of this new programme. A mixed methods research design will be used to evaluate this new programme. We will conduct a formative implementation evaluation using rapid qualitative methods consisting of interviews with staff members and patients across three broadly representative specialities (colorectal cancer surgery, repair of abdominal aorta and knee replacement) and observations of key meetings held regarding implementation activities. An interrupted time series analysis will address patient centered outcomes (days alive and out of hospital at 30, 180 and 365 days after surgery; postoperative hospital length of stay; emergency re-admission within 30 days) using routinely collected electronic health records. This study will provide lessons on the barriers and facilitators to implementation and will highlight staff and patient experiences of the new programme. It will also assess impact on patient centred outcomes using routinely collected hospital data and quasi-experimental research methods.

IntroductionHistorically, patients diagnosed with recurrent head and neck cancer (rHNC) had a poor prognosis with the majority receiving best supportive care. Significant treatment advances over the past decade have changed the landscape for curative and non-curative management of rHNC with more treatment options for patients. This requires providing large amounts of information about treatment options and patients may experience different short-, medium- and long-term toxicities. To address complex discussions on treatment decisions and to identify potential unmet needs and provide timely support, the study aim is to co-produce a bespoke Patient Decision Aid (PDA) and a Patient Concerns Inventory (PCI) for the rHNC population.Methods and analysisThis study uses a five-stage, multiple methods design. Stage 1 will include the creation of a steering group and Stage 2, a systematic review and evidence synthesis. Stages 3 and 4 are conducted as two parallel workstreams. The development of the PDA (Workstream 1) includes patient interviews and focus groups and that of the PCI (Workstream 2) patient focus groups and a Delphi survey for clinicians. Both workstreams conclude in Stage 5 with the steering group review and final comments. Patient and public involvement and engagement representatives will work in partnership with the study team and the steering group throughout the study. Analysis will include descriptive statistics and thematic analysis. This work will culminate in the development of a prototype Patient Decision Aid for patients with rHNC (PDA HN-R) and a Patient Concerns Inventory for patients with rHNC (PCI HN-R).Ethics and disseminationAll participants will receive detailed study information and give written informed consent before data collection. Ethical approval was obtained from the Health Research Authority, Research Ethics Committee and National Health Service (NHS) Research and Development Departments. All data collection will follow all legislative rules regarding data protection, also following the Declaration of Helsinki. Study results will be disseminated in peer-reviewed journals, presented at international conferences and charities.

Background Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service users’ and carers’ experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018. Methods We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service users’ or carers’ experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach. Results Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews. Conclusions Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences. Protocol registration The study protocol has been registered in the PROSPERO database on 30th May 2023 (CRD42023423439).

BackgroundDysphagia can occur in advanced lung cancer due to direct tumour invasion or nerve compression. Anti-cancer treatments and co-morbid conditions may also cause or compound dysphagic symptoms. Speech and language therapy (SLT), medical and surgical interventions are available to address dysphagic symptoms in patients with lung cancer, however, management options are not described in national guidelines. Given the potentially short prognoses for patients with lung cancer, the aim of care should be to reduce symptom burden and maximise quality of life (QOL). Central to that aim is the identification and treatment of swallowing difficulties.PurposeThis study sought to identify the prevalence and impact of dysphagia on QOL in patients with advanced lung cancer.MethodsA single-site, prospective, exploratory study was undertaken. Previously validated patient-reported outcome measures of swallowing were used to identify the presence and impact of dysphagia on QOL: EAT-10 assessment and the SWAL-QOL assessment.ResultsSeventy-two participants were recruited with 18.1% identified as having dysphagia on completion of the EAT-10 assessment. On further evaluation using the SWAL-QOL, compromised quality of life was noted with increased fatigue and meal time duration, difficulties with food selection and reduced eating desire. Frequent throat clearing, coughing and perceived pharyngeal stasis were reported.ConclusionsDysphagia is a potential symptom in advanced lung cancer which may impact QOL. Patients, carers and healthcare professionals should be aware of this so that early referral to SLT can be expedited. More robust prevalence and interventional studies are required to inform optimal management of this distressing condition.