The primary aim of this project was to explore the attitudes of doctors employed by Leeds and York Partnership NHS Foundation Trust (LYPFT) towards climate change and sustainability issues. Secondary aims were to ascertain psychiatrists’ knowledge of current efforts to mitigate the impact of healthcare on the climate, and to identify barriers to action against the climate crisis.

This was a cross-sectional study using a self-completed questionnaire designed by the team on an online platform (Survey Monkey, www.surveymonkey.co.uk). It was open from 23 August to 19 September 2022 and shared via email with doctors of all grades employed by LYPFT (n = 211). Likert-scale and multiple-choice responses were analysed using descriptive statistics and two-sided t-tests. Free-text responses were analysed independently by four researchers (DH, DR, HO, GS) using thematic analysis. Participants were required to agree to an online consent statement before proceeding. The study was carried out in accordance with University of Leeds ethical protocols.

66 doctors completed the questionnaire (31.3% response rate) of whom 24 (36.3%) were consultants and 42 (63.6%) were junior doctors. 57 (86.3%) respondents agreed that climate change is harmful to mental and physical health. 42 (63.6%) indicated that the climate emergency was relevant to their role, and 46 (69.7%) felt that climate and sustainability issues should be included in educational curricula for all healthcare professionals. Only 4 (6.1%) were aware of the Trust's strategies to mitigate its impact on the climate, and 7 (10.6%) were familiar with the remit and content of the Greener NHS Plan. There were no statistical differences in responses to these questions between consultants and junior doctors.

The most commonly perceived barriers to reducing the Trust's impact on the climate were a lack of willingness to change current practice (n = 28, 42.4%), poor awareness of the impact of the healthcare industry on the climate (n = 16, 24.2%), and an absence of guidance on sustainable practice (n = 15, 22.7%). Three themes emerged among free-text responses to this question: clinical priorities taking precedent, extensive use of pharmaceuticals and a lack of appropriate infrastructure and resources.

LYPFT doctors appreciated the significance of the climate crisis and its relevance to their role as healthcare professionals. However, there is a lack of awareness of local and national efforts to mitigate the impact of healthcare on the climate. Future work should raise awareness of the association between planetary and human health and encourage stakeholders to prioritise sustainability issues.

Radiation-induced nausea and vomiting (RINV) is a common side effect of single fraction palliative radiotherapy. Patients experiencing RINV have significantly reduced quality of life and a prescription of prophylactic antiemetics, principally 5-HT3 antagonists, is recommended. There is a growing body of evidence relating to indications for this, but as yet there are no national guidelines.

A retrospective audit aimed to determine the extent to which patients at high and moderate emetogenic risk receiving single fraction radiotherapy were prescribed prophylactic emetic medication in line with the current evidence base.

A total of 60 patients were included in the audit; of these patients, 50 were consented for the risk of nausea and/or vomiting. Prophylactic antiemetics were only prescribed to 28 (46·7%) of all audited patients. Out of the 50 patients who provided informed consent, only 24 (48%) were prescribed an antiemetic prior to their treatment.

Antiemetic prescribing for single fraction patients at moderate to high emetogenic risk at a large regional centre is underutilised in relation to published evidence. Amended guidance and further audits are recommended to ensure that this patient group is best supported.