North East London Research Articles

No one left to cope alone (NOLA): protocol for the development of a postdiagnostic intervention to support people newly diagnosed with dementia

IntroductionReceiving a diagnosis of dementia is a seminal moment in many people’s lives. It can be associated with anger and grief for both the person with dementia and their network....

Residential mobility and receipt of measles, mumps and rubella vaccination: analysis of linked primary care electronic health records in a disadvantaged London region

ObjectiveCoverage for the measles, mumps and rubella (MMR) vaccination in north-east London (NEL) is the lowest in the United Kingdom. It has been hypothesised that children who move home frequently are less likely to receive vaccinations. We examined the association between number of addresses in the first two years of life, and receipt of MMR vaccination by age two. ApproachWe derived households by pseudonymously linking the addresses of 178,028 children registered with a NEL general practitioner (GP) on their second birthday (2015-2021). We included 135,221 (76.0%) children (51.0% male) after excluding 42,807 with invalid household characteristics at age 24 months. The outcome was MMR vaccination by 24 months. Residential mobility was categorised by number of addresses (1, 2, ≥3) between earliest GP-registration and vaccination date/second birthday. We calculated the percentage receiving MMR by residential mobility and estimated adjusted odds (aOR; 95% confidence intervals [CI]) for MMR receipt. Results105,392 (77.9%) children received MMR by age two, and 26,652 (19.7%) had more than one address. Receipt of MMR decreased with increasing residential mobility: 80.9% (95% CI: 80.6,81.1), 66.5% (65.9,67.1), and 58.6% (56.2,60.9) for children with one, two, or three or more addresses respectively. Children with multiple addresses were less likely to receive MMR by age two: aOR: 0.53 (0.51,0.55); 0.36 (0.32,0.40) for 2 and ≥3 addresses respectively. Conclusions Uptake of MMR vaccine by two years of age is lower in children with multiple addresses. Further research is needed to identify actionable opportunities to improve MMR uptake in mobile populations.

Associations between household overcrowding and adult mental illness in an ethnically diverse urban population: cross-sectional study using linked primary care and housing records.

ObjectiveWe hypothesised that adults living in overcrowded households were more likely to be diagnosed with Serious Mental Illness (SMI) or depression after accounting for individual, household and area-level factors. ApproachWe linked primary care records of adults currently registered with all general practices in the north-east London region on 21/03/2021 to housing data using pseudonymised unique property reference numbers (pUPRNs), giving a sample of 762,718 adults in 329,948 households. Primary outcomes were a primary care diagnosis of SMI or depression. Overcrowding was defined as <32.5m2 per person. We estimated the adjusted odds (aOR) and 95% confidence intervals (CI) of SMI or depression when living in an overcrowded household, adjusting for individual (age, sex, ethnic group), household (size, composition), and area (Index of Multiple Deprivation) characteristics. We conducted logistic regression models with robust standard errors in RStudio. ResultsSMI and depression were diagnosed in 6,492 (0.9%) and 45,053 (5.9%) adults respectively; 584,515 (76.6%) adults lived in overcrowded households. In univariable analyses, household overcrowding was inversely related to risk of SMI or depression (aOR[CI]: 0.42 [0.39,0.44]; 0.62 [0.61,0.64]). The direction of effect reversed on adjustment for household size, composition, and area-level deprivation: 1.22 [1.12,1.33]; 1.07 [1.04,1.10] for SMI and depression respectively. ConclusionsWe found significant associations between SMI and depression and household overcrowding, using a novel method of record linkage to estimate household overcrowding but are not able to establish causality of observed associations in this cross-sectional study. ImplicationsMore research is needed to understand how housing conditions affect mental health.

SP6.13 - Management of Older Major Trauma Patients: Impact of a dedicated guideline for facilitating older trauma care within a Pan London Trauma Network

Abstract Background and Aim Older age trauma is an increasing challenge for trauma networks with many clinical protocols needing to adapt and reflect age-related changes in physiology and management. In 2018, our older trauma guidance was introduced into our trauma system to improve early recognition of injury, admission pathways, clinical management and outcomes for those aged ≥65yrs (LMTS Older Trauma Guidance). The aim of our study was to assess the impact of the guideline on our trauma processes and patient outcomes. Methods This retrospective analysis of TARN compared process and outcome data for patients aged ≥65yrs admitted to hospitals within the North East London and Essex Trauma Network, pre (01/01/2016-31/07/2018) and post (01/08/2018-31/07/2020) guidance introduction. The primary outcome was mortality at 30 days post injury. Results and conclusions There were 4317 patients pre and 3992 patient post guidance. Time to CT reduced on average by 57 minutes, Neurotrauma transfers decreased from 2116 patients to 1519 patients and more older patients were discharged for rehabilitation. Older trauma mortality reduced across the network post guidance (13.59% vs 10.64%). The greatest mortality reductions were seen in Trauma Units, (19.20% pre vs 6.99% post) with increasing benefit seen with advancing age: reduced 75-84 years by 2.20%; 85-94 years 2.41%; 95+ years by 7.44%. This analysis suggests that dedicated guidance highlighting the special needs and risk profiles of older trauma patients significantly improves processes and outcomes. Improvements in early assessment and time to imaging appear to result in enhanced survival. Further research at a system level is required.

COVID-19 pandemic impact on hypertension management in North East London: an observational cohort study using electronic health records

ObjectiveThere are established inequities in the monitoring and management of hypertension in England. The COVID-19 pandemic had a major impact on primary care management of long-term conditions such as hypertension....

Opportunistic offering of self-sampling to non-attenders within the English cervical screening programme: a pragmatic, multicentre, implementation feasibility trial with randomly allocated cluster intervention start dates (YouScreen)

Self-sampling has game-changing potential to tackle the declining participation and inequities seen in many organised cervical screening programmes. Wide variation in uptake between settings and mode of kit offer highlight the importance of local piloting. Furthermore, harnessing the benefits of self-sampling in real-world settings has been surprisingly challenging. The YouScreen study estimated the impact of offering self-sampling to non-attenders within the English Programme and evaluated large-scale opportunistic offering of self-sampling in primary care. A pragmatic modified stepped-wedge implementation feasibility trial with randomly-allocated cluster intervention start dates at primary care practices in England (133 participating, 62 non-participating). Eligible women were aged 25-64 years and ≥6 months overdue for screening ("non-attenders"). Between January 13, 2021 and 30 November, 2021 self-sampling kits were distributed to non-attenders via an opportunistic offer in primary care when they consulted for any reason and direct mailout to those unscreened 15-months after routine invitation. Primary outcomes were the proportion of non-attenders screened each month; change in coverage; and uptake (90 days). YouScreen is registered with ISRCTN:12759467. 8338 women provided self-samples following recruitment between January 13, 2021 and 30 November, 2021. Self-samples were returned from 65.5% (6061/9248) who accepted an opportunistically offered kit and 12.9% (2777/17,604) directly-mailed kits. Responders were representative of the ethnically diverse and deprived underlying non-attendee population (64% ethnic minority groups, 60% from the two most deprived national quintiles). The self-sampling intervention resulted in a 22% (95% CI 18-26) increase in non-attenders screened per month (per-protocol analysis) and 12% (95% CI 9-15) (intention-to-treat analysis). Change in coverage at participating (mean intervention duration 7.5 months) vs non-participating practices was 1.6% (95% CI 0.4-2.8). Adverse effects were not formally collected. Opportunistically offering self-sampling to under-screened women in primary care could increase coverage in England and potentially reach underserved populations. North Central London and North East London Cancer Alliance.

Faecal immunochemical testing (FIT) in primary care: a follow-up service evaluation

AimColorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute for Health and Care Excellence guidance for faecal immunochemical testing (FIT), we introduced a service...

Effective palliation of refractory ascites in cirrhosis is challenging.

Palliative care is often suboptimal for patients with end-stage liver disease (ESLD). Ascites remains the most common complication in ESLD. Though long-term abdominal drains (LTAD) are commonly used in refractory malignant ascites, the standard care for ESLD is hospital drainage (large volume paracentesis (LVP)). There is an ongoing National Institute for Health and Care Research (NIHR) funded trial (REDUCe 2 Study) (ISRCTN269936824) comparing palliative LTAD to LVP in ESLD. This 35-site trial is being conducted in England, Scotland and Wales. To understand the views and experience of healthcare professionals (HCP) on the use of palliative LTAD in ESLD. An electronic survey comprised of seven questions with fixed quantitative options and three exploratory questions was used between August-December 2019. The survey was distributed electronically via the British Association for Study of Liver newsletter and to relevant hospital departments in Southeast England and Northeast London. An email reminder was sent at 4 and 8 weeks after the initial invitation to the survey. There were 211 respondents (hepatologists (36.5%), specialist nurses (24.6%), gastroenterologists (16.6%), trainees (17%) and others (5.2%)). All respondents had access to LVP, 86% to a transjugular intrahepatic portosystemic shunt procedure for patients, 67% to LTADs and 10% to other options, such as the automated low-flow ascites (ALFA) pump. The majority of respondents to the survey (68%) reported their experience of using LTAD. Almost all respondents (91%) were willing to consider LTAD in ESLD. However, the main deterrents of this were the perceived risk of infection (90%), followed by LTAD management in community (57%). Some 51% of those with prior experience of using LTAD reported clinical complications for patients (including bleeding, infection and renal impairment), 41% reported technical issues and 35% inadequate community support. Almost all HCPs are willing to consider palliative LTAD in refractory ascites due to ESLD, but the main deterrents are the perceived infection risk and lack of published data to guide community management. The REDUCe 2 trial will clarify if these concerns are real and provide conclusive evidence on role, if any, of palliative LTADs in this vulnerable and under researched cohort with ESLD.

CSP2023: 10 - Attendance and re-referral rates in Musculoskeletal Physiotherapy in relation to demographic factors: a service evaluation protocol in North East London

CSP2023: 10 - Attendance and re-referral rates in Musculoskeletal Physiotherapy in relation to demographic factors: a service evaluation protocol in North East London

Determining households from patient addresses and unique property reference numbers in general practitioner electronic health records

IntroductionHouseholds are increasingly studied in population health research as an important context for understanding health and social behaviours and outcomes. Identifying household units of analysis in routinely collected data rather than traditional surveys requires innovative and standardised tools, which do not currently exist. ObjectivesTo design a utility that identifies households at a point in time from pseudonymised Unique Property Reference Numbers (UPRNs) known as Residential Anonymised Linkage Fields (RALFs) assigned to general practitioner (GP) patient addresses in electronic health records (EHRs) in north east London (NEL). MethodsRule-based logic was developed to identify households based on GP registration, address date, and RALF validity. The logic was tested on a use case on the household clustering of childhood weight status, and bias in success of identifying households was examined in the use case cohort and in a full population cohort. Results92.1% of the use case cohort was assigned a household. The most frequent dominant reason (55.3%) for a household not assigned was that a person had no valid household RALFs available across their patient registration address records. Other reasons are having none or multiple valid household RALFs, or not being alive at the event date. In the use case, children not assigned to a household were more likely to attend schools in City & Hackney and living in the third most deprived quintile of lower super output areas. 88.9% of the population cohort was assigned a household. Patients not assigned to a household were more likely to be aged 18 to 45 years, living in City & Hackney, and living in the second quintile of most deprived lower super output areas. ConclusionsWe have developed a method for deriving households from primary care EHRs that can be implemented quickly and in real-time, providing timely data to support population health research on households.

Are children living with obesity more likely to experience musculoskeletal symptoms during childhood? A linked longitudinal cohort study using primary care records

ObjectiveTo assess whether there is a higher incidence of musculoskeletal consultations in general practice among children with obesity.DesignLongitudinalSetting285 north-east London general practitioners (GPs).Participants63 418 (50.9% boys) Reception and 55 364...

The Adhesive Capsulitis Corticosteroid and Dilation (ACCorD) randomized controlled trial.

Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data. In the UK, the National Institute for Health and Care Excellence (NICE) advises that prompt early management of frozen shoulder is initiated in primary care settings with analgesia, physiotherapy, and joint injections; most people can be managed without an operation. Currently, there is variation in the type of joint injection: 1) CSI, thought to reduce the inflammation of the capsule reducing pain; and 2) HD, where a small volume of fluid is injected into the shoulder joint along with the steroid, aiming to stretch the capsule of the shoulder to improve pain, but also allowing greater movement. The creation of musculoskeletal hubs nationwide provides infrastructure for the early and effective management of frozen shoulder. This potentially reduces costs to individuals and the wider NHS perhaps negating the need for a secondary care referral. We will conduct a multicentre RCT comparing CSI and HD in combination with CSI alone. Patients aged 18 years and over with a clinical diagnosis of frozen shoulder will be randomized and blinded to receive either CSI and HD in combination, or CSI alone. Feasibility outcomes include the rate of randomization as a proportion of eligible patients and the ability to use routinely collected data for outcome evaluation. This study has involved patients and the public in the trial design, dissemination methods, and how to include groups who are underserved by research. We will disseminate findings among musculoskeletal clinicians via the British Orthopaedic Association, the Chartered Society of Physiotherapy, the Royal College of Radiologists, and the Royal College of General Practitioners. To ensure wide reach we will communicate findings through our established network of charities and organizations, in addition to preparing dissemination findings in Bangla and Urdu (commonly spoken languages in northeast London). If a full trial is shown to be feasible, we will seek additional National Institute for Health and Care Research funding for a definitive RCT. This definitive study will inform NICE guidelines for the management of frozen shoulder.

P1110 Collagenous colitis, clinical features, risk factors and treatment outcome: A large case series from the largest teaching Hospital in London, UK

Abstract Background Microscopic colitis is a cause of chronic watery, non-bloody diarrhoea diagnosed mainly on histology after taking biopsy from macroscopically normal colonoscopy. Thereby mainly two subtypes can be identified: Lymphocytic and collagenous colitis. So far, no biomarkers for the diagnosis of microscopic colitis have been identified. Here, we looked at, risk factors and treatment outcome of collagenous colitis in large series of cases. Methods In this study, we analysed all cases of collagenous colitis diagnosed from 2018-2022 in the Northeast London from 5 different teaching hospitals. 104 cases were identified and their electronic health record from hospital and from the primary care physicians (GP) were manually reviewed. Results In this cohort, 24% male, 76% female with ratio of (1:3), with mean age of 65 years. Forty percent were active or ex-smoker. PPI uses were associated with in 81% cases. While NSAIDS and statin were associated in 56% and 49% cases respectively. We also found that SSRI use were noted about 31% cases. Painless watery diarrhoea was the main cause for referral in 90% of cases, while complaint of abdominal pain noted in only 39% cases. Thirty-five (35%) cases noted to have history of weight loss. Forty-eight (48%) patients received treatment with Budesonide, 46% treated with loperamide, 5% with Immunomodulator or Biologics and 1% Bismuth Subsalicylates respectively. Other autoimmune disease were associated in 6% cases and 2% cases were associated with Coeliac disease. in Nineteen (19%) of cases symptoms improved immediately after stopping above associated drugs without any specific therapy. Twenty-five (25%) percent relapses 6 months after stopping of therapy. Patients present with abdominal pain, and arthralgia were significantly (p<0.001) higher risk of relapsing compared to patients with other symptoms. Conclusion In this large series of collagenous colitis, we found that in addition to associated drug use is not only risk, patient presents with abdominal pain and arthralgia have higher risk of relapse, after stopping of therapy of collagenous colitis . Further studies are needed to identify biomarker of this frustrating disease which has significant impact on patients of quality of life.

P1186 Unveiling the reality of Collagenous colitis: Beyond its Benign Façade

Abstract Background Microscopic colitis is a cause of chronic watery, non-bloody diarrhoea diagnosed mainly on histology after taking biopsy from essentially normal colonoscopy. Thereby mainly two subtypes can be identified: Lymphocytic and collagenous colitis. So far, no biomarkers for the diagnosis of microscopic colitis have been identified. Hower, despite being benign nature of this disease .it often trigger Two weeks wait (cancer path way) of the in the UK. Methods In this study, we analysed all cases of collagenous colitis diagnosed from 2018-2022 in the Northeast London from 5 different teaching hospitals. 104 cases were identified and their electronic health record from hospital and from the primary care physicians (GP) were manually reviewed. Results In this cohort, 24% male, 76% female with ratio of (1:3), with mean age of 65 years. Forty percent were active or ex-smoker. Painless watery diarrhoea was the main cause for referral in 90% of cases, 7% had painless bloody diarrhoea, whilst 3% complaint painful bloody diarrhoea. Abdominal pain noted in only 39% cases. Thirty-five (35%) cases noted to have history of weight loss. Among these patients, 27% had Haemoglobin < 130g/L, including 7% had <105g/L. Twenty nine percent had Faecal calprotectin (FCP) > 50 microgram/gm of stool and 14% had FCP >200. Seventeen percent had serum inflammatory marker raised CRP (normal 0-10). Thirteen percent (13%) of these patient trigger two weeks pathway referral as they had positive Faecal immunochemical test (FIT) which used for bowel cancer screening test, Twenty-seven (27%) presents did not require any treatment, got better after stopping suspected medication as a cause, while 73 % require treatment, of whom 5% require treatment with immunomodulator/ Biologics. Conclusion In this large series of collagenous colitis, we found that, despite being benign condition, it can present with alarming features which both health care provider and patient should be aware of, in order to avoid unnecessary anxiety. Further studies are needed to identify biomarker of this condition.

How does community pharmacy support patients living with asthma?

Abstract Introduction Asthma is a chronic respiratory condition that is currently an increasing issue worldwide. Particularly in the United Kingdom, 185 people are admitted to hospital because of an attack and 3 people die daily despite the National Healthcare Service (NHS) spending £1 billion on asthma care.1 Community pharmacies are taking on a more clinical role in the NHS but the extent of their role in primary care, specifically regarding helping patients living with asthma is unknown. Aim This study aimed to identify how community pharmacists reduced the general practitioners (GPs) workload by helping patients living with asthma. Methods The study used a 30-question survey to collect data from community pharmacists in North-East London boroughs (n=206 pharmacies). The survey consisted of both closed and open-ended questions, exploring the asthma interventions pharmacists conducted and the impact this had on patients, as well as the medication or devices that patients were struggling with the most and how confident pharmacists felt about all aspects of asthma. The paper-based survey was handed to each responsible pharmacist for completion. Data was input into SPSS for analysis. The study received ethical approval from Kingston University. Results Participants found the New Medicines Service to be the most helpful service (4.4/5) for patients living with asthma, followed by influenza vaccine (4/5), Community Pharmacy Consultation Service (CPCS) (3.8/5) and inhaler technique checks (3.8/5). The percentage of referrals to the GP that resulted from these services were 0-20% of patients in an average week. The most frequently referred medication was salbutamol (56.5%) due to its overuse or exacerbation of symptoms with Clenil® (15.2%) the second most referred medicine due to side-effects such as a sore throat. The most frequent inhaler device dispensed was the metered dose inhalers (94%), however the most troublesome inhalers were dry powder inhalers (50.8%) due to patient’s poor inhalation capacity, dexterity, inability to load the capsules and poor knowledge. Overall, pharmacists were confident in their ability to help asthma patients, however, younger pharmacists were less likely to check inhaler technique at every dispensing (p=0.016), more likely to check it only upon patient request (p=0.042) and were more likely to refer patients to the GP after consultations. Contrastingly, nearly all participants (93.2%) found their training for asthma and its services to be sufficient, with 62.5% using centre for pharmacy postgraduate education as their training provider. Discussion/Conclusion The results suggest that most of the time pharmacists were well trained, addressed patients concerns adequately and were able to support with adherence and usage of inhalers.2 It was clear that pharmacists do play an active role in the lives of asthma patients through the services they conduct. Their training allows pharmacists to be confident when carrying out these services so that majority of patient’s concerns are addressed within the pharmacy and only a few require GP referral. It may be beneficial to carry out technique checks more frequently, conduct asthma reviews within the pharmacy and provide additional resources to newly qualified pharmacists to aid their confidence in helping asthma patients.

“We're potentially worsening health inequalities”: Evaluating how delivery of the 2022 London polio booster campaign was tailored to Orthodox Jewish families to reduce transmission vulnerability

A polio booster campaign targeting all children aged 1–9 was implemented across London between August–December 2022 as part of a national enhanced poliovirus incident response. Orthodox Jewish (OJ) children were particularly vulnerable to transmission due to disparities in childhood vaccination coverage and the transnational spread of poliovirus affecting linked populations in New York and Israel. This study aimed to evaluate how the polio booster campaign was tailored to increase uptake and enable access for OJ families in northeast and north central London boroughs, and the impact of the campaign on local-level vaccine inequities. Semi-structured in-depth interviews (n = 36) were conducted with participants involved in the implementation and delivery of the polio booster campaign, and OJ mothers. Site visits (n = 5) were conducted at vaccine clinics, and rapid interviews (n = 26) were held to explore parental perceptions of the poliovirus incident and childhood immunisations. Enablers to vaccination during the campaign included the production of targeted printed communications and offering flexible clinic times in primary care settings or complementary delivery pathways embedded in family-friendly spaces. Barriers included digital booking systems. Mothers reported being aware of the poliovirus incident, but the majority of those interviewed did not feel their children were at risk of contracting polio. Healthcare provider participants raised concerns that the vaccine response had limited impact on reducing disparities in vaccine uptake. While OJ families were recognised as a priority for public health engagement during the poliovirus incident response, this evaluation identified limitations in reducing transmission vulnerability during the booster campaign. Lessons for future campaign delivery include effectively conveying transmission risk and the urgency to vaccinate. Priorities for mitigating vaccine inequities include public engagement to develop messaging strategies and strengthening the capacity of primary care and complementary delivery pathways to serve families with higher-than-average numbers of children.

What are the perceptions and concerns of people living with diabetes and National Health Service staff around the potential implementation of AI-assisted screening for diabetic eye disease? Development and validation of a survey for use in a secondary care screening setting

IntroductionThe English National Health Service (NHS) Diabetic Eye Screening Programme (DESP) performs around 2.3 million eye screening appointments annually, generating approximately 13 million retinal images that are graded by humans...

Going beyond remedial learning support: reframing learning development as a catalyst for practice learning. A case study exploring father involvement in social work education.

This conference paper presents Learning Development as transcending remedial and deficit notions of academic support. A Learning Developer based at London Metropolitan University, presents a case study that illustrates the values and impact of Learning Development and Praxis.
 This research project piloted a Problem Based Learning (PBL) methodology in the curriculum area of Social Work. The project worked in collaboration with social work students, lecturers and university partners between 2019 to 2021. This session may be of particular interest to those working with students in the social professions and work based learning courses.
 Key challenges and implications for practice:
 
 Subject specialists seeing the Learning Developer role as one of ‘fixing students’.
 Potential of Problem Based Learning as part of accredited Social Work courses.
 Integrating Learning Development; embedded vs bolt on quick fixes.
 Learning Development as scaffolding reflective writing practice.
 
 The project overcame these issues with a reach that rippled across six north east London Local Authorities as part of a Teaching Partnership. It has also been included as a topical issue for reflection, titled: ‘Promoting Positive Father Involvement’ as part of modules in practice learning. Both students and staff engaged in a workshop programme that scaffolded a dialogue between them, addressing issues of father engagement as part of practice.
 Students were able to synthesise themes of theory, policy, legislation and its application to practice. As a result, some students developed substantial case studies at both level 5 and 6, and these even informed their later dissertations and research projects. This demonstrates the social value and wider impact that Learning Development has had on improving outcomes for not only students, but fathers, children and their families.

Two-year recall for people with no diabetic retinopathy: a multi-ethnic population-based retrospective cohort study using real-world data to quantify the effect

Background/aimsThe English Diabetic Eye Screening Programme (DESP) offers people living with diabetes (PLD) annual screening. Less frequent screening has been advocated among PLD without diabetic retinopathy (DR), but evidence for...

Patient decision aids in mainstreaming genetic testing for women with ovarian cancer: A prospective cohort study.

To evaluate patient preference for short (gist) or detailed/extensive decision aids (DA) for genetic testing at ovarian cancer (OC) diagnosis. Cohort study set within recruitment to the Systematic Genetic Testing for Personalised Ovarian Cancer Therapy (SIGNPOST) study (ISRCTN: 16988857). North-East London Cancer Network (NELCN) population. Women with high-grade non-mucinous epithelial OC. A more detailed DA was developed using patient and stakeholder input following the principles/methodology of IPDAS (International Patients Decision Aids Standards). Unselected patients attending oncology clinics evaluated both a pre-existing short and a new long DA version and then underwent mainstreaming genetic testing by a cancer clinician. Appropriate inferential descriptive and regression analyses were undertaken. Satisfaction, readability, understanding, emotional well-being and preference for long/short DA. The mean age of patients was 66 years (interquartile range 11), and 85% were White British ethnicity. Of the participants, 74% found DAs helpful/useful in decision-making. Women reported higher levels of satisfaction (86% versus 58%, p < 0.001), right amount of information provided (76.79% versus49.12%, p < 0.001) and improved understanding (p < 0.001) with the long DA compared with the short DA. There was no statistically significant difference in emotional outcomes (feeling worried/concerned/reassured/upset) between 'short' and 'long' DA; 74% of patients preferred the long DA and 24% the short DA. Patients undergoing treatment (correlation coefficient (coef) = 0.603; 95% CI 0.165-1.041, p = 0.007), those with recurrence (coef = 0.493; 95% CI 0.065-0.92, p = 0.024) and older women (coef = 0.042; 95% CI 0.017-0.066, p = 0.001) preferred the short DA. Ethnicity did not affect outcomes or overall preference for long/short DA. A longer DA in OC patients has higher satisfaction without increasing emotional distress. Older women and those undergoing treatment/recurrence prefer less extensive information, whereas those in remission preferred a longer DA.