The SPICT can support clinical judgment by multidisciplinary teams when identifying patients at risk of deteriorating and dying. It helped identify patients with multiple unmet needs who would benefit from earlier, holistic needs assessment, a review of care goals, and anticipatory care planning.

Objective To assess if family care givers of patients with lung cancer experience the patterns of social, psychological, and spiritual wellbeing and distress typical of the patient, from diagnosis to death. Design Secondary analysis of serial qualitative interviews carried out every three months for up to a year or to bereavement.Setting South east Scotland.Participants 19 patients with lung cancer and their 19 family carers, totalling 88 interviews (42 with patients and 46 with carers).Results Carers followed clear patterns of social, psychological, and spiritual wellbeing and distress that mirrored the experiences of those for whom they were caring, with some carers also experiencing deterioration in physical health that impacted on their ability to care. Psychological and spiritual distress were particularly dynamic and commonly experienced. In addition to the “Why us?” response, witnessing suffering triggered personal reflections in carers on the meaning and purpose of life. Certain key time points in the illness tended to be particularly problematic for both carers and patients: at diagnosis, at home after initial treatment, at recurrence, and during the terminal stage.Conclusions Family carers witness and share much of the illness experience of the dying patient. The multidimensional experience of distress suffered by patients with lung cancer was reflected in the suffering of their carers in the social, psychological, and spiritual domains, with psychological and spiritual distress being most pronounced. Carers may need to be supported throughout the period of illness not just in the terminal phase and during bereavement, as currently tends to be the case.

This paper will discuss the use of paired interviewing as the main method of generating data in a study exploring the social context of young people's smoking and cannabis use. The research, conducted as part of an on-going PhD, involved 59 participants of both genders, aged 13-15 from different socioeconomic backgrounds, and with a wide range of cigarette and cannabis use experience. Participants were offered the choice of an individual interview or a paired interview with a friend of their choice, most opting for the paired format. The paper will discuss many of the methodological and ethical features of this method. In particular, it will discuss the potential for paired interviewing to access accounts generated within close friendship bonds, making this method distinctive from larger focus groups. It will also explore how paired interviewing facilitates access to interactions between participants, shedding light on many aspects of young people's social relationships and allowing occasional glimpses into more private territory. It will argue that the paired interview method can make a novel and distinctive contribution to health education/promotion research, policy and practice, and to any research that aims more fully to understand aspects of young people's social worlds.

This paper reports findings from a qualitative study which explores the role of cannabis in young people's lives during their early teenage years. In particular, it focuses on the relationship between cannabis and tobacco-related beliefs and behaviour. Fifty-nine young people of both sexes, aged 13-15, from different socioeconomic backgrounds, and with a wide range of cigarette and cannabis use experience, took part in the study. All were recruited from youth club settings and most were interviewed in self-selected friendship pairs. The paper argues that, while many young people appear to hold predominantly negative views about cigarettes, particularly in relation to their potential to foster dependence, cannabis is often viewed as relatively benign. In spite of these beliefs, for some 'cannabis-oriented' young people, their cannabis use appears to support and reinforce their smoking habit. The paper concludes that a coordinated approach to the planning and delivery of services which addresses young people's health risk behaviours is required. Smoking cessation and drugs education practitioners need to break with tradition, and find ways of working more closely together.

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