Dr Katie Sutton

Objective: To explore the perceptions and experiences of patients, carers and clinicians relating to treatment decision-making in older people with cancer, and to investigate the acceptability of the eFI as a tool to innuence decisions about SACT. Methods: Qualitative interviews were conducted with 28 participants (12 clinicians, 10 patients and 6 carers) at an NHS cancer day unit in South East England. Patients were > 60 years and had received at least one cycle of SACT. Data were analysed using framework analysis. Results: Two themes were identiied. .eme one highlighted that the assessment of frailty is a variable and complex task. However, an individualised assessment incorporating a balance between quality of life and the potential beneet of treatment is fundamentally important. .eme two identiied that eFI is an acceptable addition to SACT decision-making which must be discussed with the patient and considered within the context of each individual situation. Conclusion: e eFI is acceptable for use in assessing the frailty of older people with cancer prior to starting SACT. In-depth, individualised assessment prior to SACT is important in this population, but it is not always realistic. Incorporating the eFI into SACT decision-making ooers the potential to address this challenge.

Background Quality of life is an essential component of decision-making in veterinary oncology. Poor management of adverse events during chemotherapy can impair dogs’ quality of life and be life-threatening. Consequently, clientreported outcome measures (CROMs) are being proposed to help assess both clinical signs and quality of life. The purpose of this rapid review was to: (1) identify existing CROMs that have been used to assess dogs’ clinical signs and quality of life during chemotherapy; and (2) evaluate their methodological development to inform adaptation or development of a CROM for use in routine clinical practice, including remote monitoring. Databases (Scopus, Web of Science, PUBMED/MEDLINE) were searched for CROMs (questionnaires) completed by a non-expert family member about their companion dog. CROM content (domains measured) and scale quality were appraised. Results Ten CROMs were identified and three were variations of the same tool. Content of the CROMs varied considerably (range 3–17 domains) with gastrointestinal being the most frequently measured clinical sign cluster (9/10 studies), followed by mobility/ambulatory activity (7/10) and global quality of life (6/10). No CROMs adhered to quality standards for the development of questionnaires and most failed to include qualitative design methods and basic psychometric assessment to ensure reliability and validity (such as internal consistency, test-retest reliability or factor analysis). Conclusion The validity and reliability of existing chemotherapy CROMs for dogs remains under-tested. Although CROMs combined with remote digital monitoring have the potential to enhance patient care, as has been demonstrated with physician-based oncology, there is a need to apply quality standards to ensure optimal validation. Interdisciplinary collaborations would likely improve CROM quality and clinical utility thereby allowing veterinary healthcare professionals to better support their patients.

Aim:To evaluate an intervention (a film and electronic leaflet) disseminated via text message by general practices to promote COVID-19 preventative behaviours in Black and South Asian communities.Methods:We carried out a before-and-after questionnaire study of attitudes to and implementation of COVID-19 preventative behaviours and qualitative interviews about the intervention with people registered with 26 general practices in England who identified as Black or South Asian.  Results: In the 108 people who completed both questionnaires, we found no significant change in attitudes to and implementation of COVID-19 preventative behaviours, although power was too low to detect significant effects. A key qualitative finding was that participants felt they did not ‘belong’ to the group targeted by the intervention. Conclusion: Interventions targeting ethnic minorities in the UK need to acknowledge the heterogeneity of experience and circumstances of the target group so that people feel that the intervention is relevant to them.

Many jurisdictions legally mandate ‘reasonable adjustments’ in personnel selection, including within health professions, to support individuals with disabilities, such as neurodevelopmental conditions. These measures often depend on applicants having formal diagnoses or a willingness to disclose their needs, overlooking the natural heterogeneity in cognition, learning, and behaviour. Consequently, traditional selection methods may inadvertently disadvantage certain candidates, Thus, more inclusive personnel selection practices are needed. We aimed to evaluate the effect of co-designed interview modifications on differential performance between neurodivergent and neurotypical participants in a process evaluation. The co-design approach was employed to enhance an existing online interview that utilised the Multiple Mini Interview (MMI) methodology in an asynchronous digital format. The interview was evaluated in two configurations: standard and modified. The modified version enhanced the standard version by incorporating a practice portal and accessibility features identified by neurodivergent volunteers. A total of 292 individuals, comprising 148 neurotypical and 146 participants self-identifying as neurodivergent from across the United Kingdom, took part in mock MMIs scored by independent assessors using a seven-point Likert scale. Participants who self-identified as neurodivergent achieved significantly higher mean scores on the modified interview compared to the standard format (mean scores; 141.6 vs. 121.4 points; p

DERM is an AI algorithm for detecting skin cancer. Developed by Skin Analytics, the algorithm analyses images of skin lesions and determines if the lesion is likely to be cancerous. DERM is already being used by some NHS providers, and is integrated with existing skin cancer pathways, triaging patients before being assessed by dermatologists. The Department of Health and Social Care (DHSC) funded deployment and a real-world evaluation of DERM as part of the AI in Health and Care Award. The evaluation aimed to inform future implementation by assessing key domains such as safety, accuracy, effectiveness, value and sustainability. Working as a collaborative Technology Specific Evaluation Team (TSET), Unity Insights and University of Surrey conducted an evaluation of DERM in four NHS sites, across 9,649 patients between February 2022 and April 2023. The resulting evaluation report is presented in full.

12009 Background: Older and frail patients with cancer (Ca) often receive less aggressive treatment and as a result have worse survival. Current methods of assessing fitness (performance status) for intensive treatment such as chemotherapy are inadequate. The complexity of geriatric assessments, lack of training and time pressures in busy clinics, mean that better solutions are needed. A UK initiative - the electronic frailty index (eFI) - is derived from a cumulative deficit frailty model and provides a measure of frailty alongside pre-existing conditions such as issues with mobility, fractures, falls, memory, sight, hearing , anaemia, tremor, diabetes, heart, thyroid, skin, respiratory, cerebrovascular, circulation, social vulnerability, and polypharmacy (36 fields) (Clegg et al). Patients are classified into the following groups: no frailty, mild, moderate or severe frailty. We used the same methodology to investigate whether eFI predicts adverse outcomes of chemotherapy in frail patients with Ca. Methods: The study conducted retrospective data analysis of Ca patients treated with chemotherapy from Public Health England (PHE) Systemic Chemotherapy Dataset (SACT) years 2015-2018. Eligible patients had stage II - III breast Ca, stage III colon Ca or stage IIIB–IV non-small-cell lung Ca (NSCLC). The data from SACT was linked with hospital episodes' statistics (obtained from NHS-Digital) to calculate 30-day SACT mortality, overall survival and hospital admissions. EFI was calculated from the above 35 fields; polypharmacy was not available from NHS-Digital data. Results: The eFI was calculated for 78799 patients: colorectal 17951, lung 22052, and breast 38796. 20388 patients were ≥ 70y. o. and 58411 were < 70y.o. Most patients were fit with an eFI score of 0-69% (54563), 19% (15,295) had mild frailty, 7.7% (6104)- moderate, and 3.6% (2837) had severe frailty. 4.2% (3356) of patients died within 30 days of SACT. For colorectal Ca patients the risk of dying within 30 days of SACT in patients ≥70y.o was twice that of the < 70y.o (OR 2.04 -CI 1.58 - 2.64); patients with mild eFI did not differ- OR: 1.07 (CI 0.78-1.45), moderate frailty: 1.6 (CI 1.1-2.33) and severe frailty: 2.13 (CI 1.34-3.39). In breast Ca patients, 30-day mortality for ≥70y.o. was 6.38 times higher than for < 70y.o (95% CI 4.29-9.49); eFI for mild frailty- OR of 1.45 (95% CI 0.78-2.71), moderate frailty-OR of 3.5 (95%CI 1.82-6.75) and severe frailty 5.73 (95% CI 2.66-12.3). The 30-day mortality in lung cancer in ≥70y.o and < 70y.o did not differ with OR 0.95 (95% CI 0.88-1.03) for ≥70y.o. Patients with mild frailty had OR for 30-day mortality of 1.17 (95% CI 1.07-1.28), moderate frailty-OR of 1.28 (95%CI 1.15-1.44) and severe frailty 1.48 (95% CI 1.28-1.77). Conclusions: The eFI closely predicts poor outcomes from SACT, particularly in early breast and colon cancer, and requires further evaluation in a prospective study.

Background: The COBHAM study involved the production of a culturally appropriate intervention to provide information on protective behaviours for people from Black and Asian populations. The intervention comprises an e-leaflet and a 3.5-minute film disseminated via a link in a text message sent from GP Practices. We conducted a preliminary evaluation of this intervention to explore how people from the relevant communities understand and interpret the intervention's messages. Aim: To share our experiences of collecting sensitive qualitative data during the Covid-19 pandemic through entirely remote means. The aim being to convey lessons learned about navigating discussions on contentious issues with participants who have strongly held beliefs. Methods: Potential participants were highlighted through an online survey, which asked for their phone number should they be happy to be contacted for an interview. A member of the research team then contacted potential participants to discuss recruitment to the trial. If in agreement, Microsoft Teams meetings were arranged. Information sheets and consent forms were sent via email. Consent was video-recorded at the start of the interview by asking participants to read and agree to the statements in the consent form. Results: Collecting data from people specifically related to a protected characteristic (in this case ethnicity) on potentially sensitive issues (such as protective behaviours relating to covid transmission) required a high level of sensitivity and self-awareness, which was fully integrated into data collection planning. The rapid expansion of using video-conferencing software such as Microsoft Teams meant that people were generally familiar with their use. Conducting the interviews remotely facilitated a comfortable and safe forum for discussion.

The intention of this study was to offer an alternative perspective to the quantitative findings of larger randomised controlled trials by using a phenomenological approach to explore the impact on Quality of Life (QoL) for people with brain tumours of entering a research trial involving new anti-cancer agents. Given the subjective nature of the proposed topic, a phenomenological approach was adopted. Sample size was limited to five participants. A semi-structured interview technique was used. Interviews were digitally audio recorded with permission from those involved. In order to guide data analysis for this study, Colaizzi's framework was utilised. As a result of data analysis, two major themes were identified. These were ‘Hope and optimism’ and ‘The therapeutic relationship’. Three minor themes were also found. These were ‘A complex symptom profile’, ‘The importance of non-medical coping strategies’ and ‘Impressions of the QoL tools used’. This phenomenological study has highlighted key themes relating to QoL which are not addressed in some of the widely used assessment tools such as the EORTC QLQ C30 and BN20. They generally focus on health status, and do not capture issues identified in this study as being of significant importance to the QoL of participants such as hope and optimism, and the importance of the therapeutic relationship. They also omit reference to coping and management strategies.