Dr Danielle Selby

UK cancer survival has improved, leading to an increase in review patients and pressure on clinics. Use of the Internet for information exchange between patients and healthcare staff may provide a useful adjunct or alternative to traditional follow-up. This study aimed to develop and evaluate a website for use in follow-up cancer care in terms of usability, feasibility and acceptability. A website was developed and underwent iterative amendment following patient usability testing in focus groups. Patients on follow-up completed a Computer and Internet Usage Questionnaire. Internet users consented to a randomised crossover study to complete paper and online questionnaires, browse the website and participate in a website evaluation interview. Patient website use was tracked. Usability: Website changes were made following patient testing (n= 21). Patients would have liked a ‘personalized’ website with links to their clinical team, out with the scope of this study. Feasibility: The majority of participants (65%) had Internet access. Age remained a differentiating factor. Acceptability: Final evaluation (n= 103) was positive although many would like to maintain face-to-face hospital contact. User involvement in website design can ensure patient needs are met. A website model for follow-up will suit some patients but others will prefer clinical contact.

UK cancer survival has improved, leading to an increase in review patients and pressure on clinics. Use of the Internet for information exchange between patients and healthcare staff may provide a useful adjunct or alternative to traditional follow-up. This study aimed to develop and evaluate a website for use in follow-up cancer care in terms of usability, feasibility and acceptability. A website was developed and underwent iterative amendment following patient usability testing in focus groups. Patients on follow-up completed a Computer and Internet Usage Questionnaire. Internet users consented to a randomised crossover study to complete paper and online questionnaires, browse the website and participate in a website evaluation interview. Patient website use was tracked. Usability: Website changes were made following patient testing (n= 21). Patients would have liked a 'personalized' website with links to their clinical team, out with the scope of this study. Feasibility: The majority of participants (65%) had Internet access. Age remained a differentiating factor. Acceptability: Final evaluation (n= 103) was positive although many would like to maintain face-to-face hospital contact. User involvement in website design can ensure patient needs are met. A website model for follow-up will suit some patients but others will prefer clinical contact. © 2012 Blackwell Publishing Ltd.

Research has largely focused on how attentional bias to smoking-related cues and impulsivity independently influence the development and maintenance of cigarette smoking, with limited exploration of the relationship between these mechanisms. The current experiments systematically assessed relationships between multiple dimensions of impulsivity and attentional bias, at different stages of attention, in smokers varying in nicotine dependency and deprivation. Nonsmokers (NS; n = 26), light-satiated smokers (LS; n = 25), heavy-satiated smokers (HS; n = 23) and heavy 12-hour nicotine-deprived smokers (HD; n = 30) completed the Barratt Impulsivity Scale, delayed discounting task, stop-signal task, information sampling task and a visual dot-probe assessing initial orientation (200 ms) and sustained attention (2000 ms) toward smoking-related cues. Sustained attention to smoking-related cues was present in both HS and LS, while initial orientation bias was only evident in HS. HS and LS also had greater levels of trait motor and nonplanning impulsivity and heightened impulsive choice on the delay discounting task compared with NS, while heightened trait attentional impulsivity was only found in HS. In contrast, in HD, nicotine withdrawal was associated with no attentional bias but heightened reflection impulsivity, poorer inhibitory control and significantly lower levels of impulsive choice relative to satiated smokers. Trait and behavioral impulsivity were not related to the extent of attentional bias to smoking-related cues at any stage of attention, level of nicotine dependency or state of deprivation. Findings have both clinical and theoretical implications, highlighting the unique and independent roles impulsivity and attentional bias may play at different stages of the nicotine addiction cycle.

INTRODUCTION: Incentive Sensitisation theory suggests wanting and liking are dissociable concepts, with wanting, but not liking typically increasing with repeated drug use. Wanting is associated with anticipation of reward, whereas liking relates to pleasure derived from consummatory behaviour. However, numerous studies have conceptualised liking as an anticipatory cognition. This study explores whether levels of nicotine dependence differentially effect wanting and liking responses to smoking-related cues, and whether anticipated and consummatory liking are equivalent, and dissociable from wanting. METHOD: Heavy (HS, mean = 16 cigarettes/day) and light non-daily (LS, mean = 2 cigarettes/day) smokers completed wanting and anticipated liking questionnaires pre-, immediately post-exposure to smoking-related and neutral cues and at session-end. Consummatory liking was measured post-session, immediately after smoking. RESULTS: Wanting and anticipated liking responses were comparable. Smoking-related cues increased wanting and anticipated liking compared to neutral cues. This effect was maintained until session-end. No baseline differences were seen between HS and LS on wanting or anticipated liking, however after cue exposure, and at session-end, HS reported greater drug wanting and anticipated liking than LS. Conversely, HS and LS did not differ on consummatory liking. Analyses confirmed the relationship between wanting and anticipated liking was significantly stronger than wanting and consummatory liking or anticipated and consummatory liking. CONCLUSIONS: Wanting and anticipated liking appear to be overlapping constructs assessing expectations of reward, that are dissociable from consummatory liking. Furthermore, heavier smoking increases drug wanting, but not smoking pleasure. Future attempts to dissociate these concepts should ensure liking is measured during/immediately after consumption.