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Papers by Elise Alexander

Eating and Weight Disorders-studies on Anorexia Bulimia and Obesity, Jul 30, 2022

Children (Basel), Jan 15, 2023

Children

Cancer patients’ children are vulnerable to psychosocial and behavioural issues. The mechanisms u... more Cancer patients’ children are vulnerable to psychosocial and behavioural issues. The mechanisms underlying how children are affected by their parent’s diagnosis are unknown, warranting further research. This study investigated how children are affected by their parent’s cancer diagnosis and provides a theoretical model conceptualising this experience. Informed by methods of grounded theory, embedded within a social constructivist framework, 38 informants (15 health professionals (HPs); 11 parents; 12 children (5 to 17 years)) were interviewed using a semi-structured format. Three themes were identified: (i) children were worried and distressed because they felt alone, (ii) parents were unable to tend to children’s needs because they were overwhelmed by practical factors, and (iii) HPs were not detecting children due to barriers that affected their visibility in clinical settings. The proposed Alexander’s Children’s Cancer Communication (ACCC) Model and clinical recommendations made ...

The American Journal of Medicine

Purpose Childhood trauma is associated with increased risk of obesity during adulthood, which may... more Purpose Childhood trauma is associated with increased risk of obesity during adulthood, which may be associated with the development of food addiction. This study examined whether food addiction mediated the relationship between childhood trauma and obesity in young adults. Methods A sample of 512 young adults, aged 18 to 30 years, living with overweight and obesity (Body Mass Index ≥ 25kg/m2), from the United Kingdom participated in the study. Participants completed the Childhood Trauma Questionnaire (CTQ), the Yale Food Addiction Scale, and provided their current height and weight to compute their Body Mass Index (BMI). Results Using the PROCESS macro, a mediation analysis found that food addiction accounted for 45% of variance in the relationship between childhood trauma and BMI. Post-hoc analyses were conducted to examine the mediating effect of food addiction across each of the five subscales of the CTQ (emotional/physical/sexual abuse and emotional/physical neglect). Food addi...

Obesity, 2021

Weight‐biased attitudes and views held by health care professionals can have a negative impact on... more Weight‐biased attitudes and views held by health care professionals can have a negative impact on the patient‐provider relationship and the provision of care, but studies have found mixed results about the extent and nature of bias, which warrants a review of the evidence.

European Journal of Cancer Care, 2020

OBJECTIVE How children are affected by their parent's diagnosis is limited in the literature,... more OBJECTIVE How children are affected by their parent's diagnosis is limited in the literature, and children are typically not considered in current clinical practice. Despite suggestion that the patient's oncology team are well placed to support their children, this is yet to be sufficiently explored. This study aimed to explore how oncology healthcare professionals (HPs) perceive children are affected by a parent's diagnosis of cancer. METHODS This qualitative study was informed by principles of grounded theory and embedded within a social constructivist framework. 15 health professionals working in oncology were interviewed using a semi-structured format. Data were analysed using methods of constant comparison. RESULTS From the perspective of HPs, when a parent is diagnosed with cancer, their dependent children are rendered invisible. Factors within the (a) clinical healthcare system and (b) the families' psychosocial context were identified, which contribute to the invisibility of children. CONCLUSION HPs are well-placed to facilitate an entry point into the healthcare system for patients' children; however, this is not occurring due to children's lack of visibility. Clinical and psychosocial barriers need to be addressed to ensure HPs are visibly aware of all children and thus able to appropriately support, intervene or refer on.

Patient Education and Counseling, 2019

 Empirically supported interventions are limited.  Evaluation studies are insufficiently conduc... more  Empirically supported interventions are limited.  Evaluation studies are insufficiently conducted.  Premature to say what works and what does not.  More methodologically robust research studies are required.  Theoretical model conceptualising how children are impacted would assist research.

Gut, 2020

We read the umbrella review and metaanalysis by Chapelle et al, which summarised the evidence fro... more We read the umbrella review and metaanalysis by Chapelle et al, which summarised the evidence from 80 metaanalyses examining medications and dietary factors associated with prevention of colorectal cancer. The main findings showed that aspirin, nonsteroidal antiinflammatory drugs, magnesium, folate and high consumption of fruits, vegetables, fibre and dairy products were associated with decreased incidence of colorectal cancer. Whereas frequent consumption of alcohol and meat were associated with increased incidence of colorectal cancer. Chapelle et al also reported the quality of evidence as overwhelmingly very low to low and concluded their review by suggesting that these findings will assist clinicians when advising average risk patients, yet they did not report the statistical result most relevant to an average risk patient living in the community: absolute risk. Absolute risk is the estimate of the likelihood of the occurrence of an outcome. For example, the estimated global absolute risk of colorectal cancer incidence is 2%. When examining whether medications and lifestyle factors are associated with increased or decreased risk of disease incidence (in this case, colorectal cancer) it is important that research findings are reported within the context of the overall absolute risk of disease incidence. 4 Research findings primarily reported as relative risk associations (such as those by Chapelle et al) provide an estimate of the difference in risk of colorectal cancer incidence between the groups of patients included in each study. However, due to the way in which relative risks are calculated they must first be transformed into absolute risk estimates before the potential benefit or harm of medications and lifestyle factors associated with risk of colorectal cancer (for an average risk population) can be communicated to researchers, clinicians and patients. For example, Chapelle et al reported consumption of fruits and vegetables as associated with up to a 49% relative risk reduction in the incidence of colorectal cancer, RR=0.51 (95% CI 0.19 to 1.32). However, a 49% reduction in relative risk converts to approximately a 1% reduction in the absolute risk of colorectal cancer in the broader population (eg, absolute risk of 2% * 0.49=0.98%). A similar result can be found for consumption of meat, where Chapelle et al reported up to a 25% relative risk increase in the incidence of colorectal cancer, RR=1.25 (95% CI 1.15 to 1.36). This estimate converts into a 0.5% increase in absolute risk (ie, 2% * 1.25=2.5%). It is important to note, however, that what may be perceived as a relatively small 1% reduction in absolute risk still equates to approximately 680 000 fewer cases and 347 000 fewer deaths from colorectal cancer globally each year. Nonetheless, it is imperative that studies report absolute risk estimates with relative risk estimates to permit a more meaningful interpretation of the evidence. Fruit and vegetable consumption was reported as the largest protective effect, potentially decreasing risk of colorectal cancer, whereas consumption of meat was reported as the largest effect potentially increasing risk of colorectal cancer. All other relative risks reported by Chapelle et al will likely translate into absolute risk estimates smaller than the results reported above. Furthermore, these small absolute risks are calculated from metaanalyses of observational studies classified as very low to low quality evidence. As expressed by others, 5 caution must be used by clinicians when counselling average risk patients based on the findings from studies solely reporting relative risks from low quality observational studies, and without reporting the associated absolute risks. To ensure researchers, clinicians and patients are provided with the most reliable and accurate evidence, absolute risk (in addition to relative risk) must be reported in future clinical trials, systematic reviews and metaanalyses. Blake J Lawrence , Elise Alexander, Hayley Grant, Moira O'Connor WA Cancer Prevention Research Unit, Curtin University, Perth, WA, Australia School of Psychology, Curtin University, Perth, WA, Australia