UK Setting Research Articles

SA6 Challenges in Economic Modelling of Adjuvant Cancer Therapy for Health Technology Assessments

Economic modelling of adjuvant cancer therapy is subject to several challenges, including post-recurrence treatment options and limited overall survival (OS) data, reducing applicability of traditional oncology approaches, such as partitioned-survival models. This study aimed to identify the most appropriate modelling approach for adjuvant therapies in the UK setting.

Hobson’s choice or a horned dilemma: a grounded theory on adherence to adjuvant endocrine therapy verified with breast cancer survivors

PurposeA literature review and meta-synthesis of qualitative research had enabled us to develop a grounded theory explaining the difficulties breast cancer survivors face with the initial decision to accept long-term endocrine therapy, and the everyday challenges of continuing or deciding to stop treatment early. Our objective was to interview a cohort of women in a UK setting to corroborate and complete the grounded theory with the end users’ primary involvement.MethodsA semi-structured interview schedule was written based on the existing grounded theory. Fourteen women with a history of hormone-positive breast cancer were recruited and interviewed. The audio-recorded interviews were transcribed and analysed against the existing grounded theory.ResultsThe findings were compatible with the core theory ‘Hobson’s choice or a horned dilemma’ and its constituent categories previously developed, with additional concepts identified and added to our paradigm models. Importantly, we found that some women who started with a strong sense of commitment to their treatment changed their mind as they experienced the medication side effects over time, impacting on their persistence with long-term endocrine therapy.ConclusionThe findings indicate an opportunity for health providers to intervene and influence women’s waning perceptions of the necessity of their treatment, for example upon experiencing the side effects. Interventions could involve the provision of side effect management strategies via accessible resources.

A qualitative exploration of patients' experience of mobile telephone-delivered contingency management to promote adherence to supervised methadone.

Despite an increasing evidence base for mobile telephone-delivered contingency management (mCM), there had been no previous qualitative exploration of patients' experience of receiving mCM and the factors that might influence that experience and outcome in a UK setting. The aim of this study was to understand patients' views and experience of receiving mCM by exploring their beliefs, expectations and perceived benefits within the context of the UK's first mCM intervention. Qualitative interviews (N=15) were conducted with patients undergoing opioid agonist treatment in a UK drug treatment service and receiving mCM to encourage adherence with supervised methadone as part of an existing study. Interviews were conducted at two time points and analysed using Framework to explore patients' expectations and beliefs during the early stage of the intervention (2 weeks) and their perceived benefits and experience at the end of the intervention (12 weeks). The mCM was perceived as a motivator, providing validation of achievement, and involving discreet and positive interactions. Perceived benefits included enhanced methadone adherence, reduced drug use and the development of a supportive and non-judgemental connection that resembled a therapeutic alliance. The mechanisms underpinning contingency management appeared to operate in the absence of human interaction, and the mCM intervention was deemed to be meaningful, acceptable and well received by patients. These findings not only provide support for the application of mCM in this context but also offer insight into the factors that influence outcomes and should be considered in the development of future mCM interventions.

Earthship buildings: opinions on their contribution towards sustainable alternative housing in the UK

Earthship buildings are marketed as being an epitome of sustainable alternative housing. Built by reusing or repurposing mostly reclaimed urban waste products, their design includes the utilisation of low-embodied-energy materials, passive solar heating and cooling, photovoltaic power systems, rainwater harvesting and solar hot water heating, along with black- and greywater-treatment systems. This study explores stakeholder opinions of whether Earthship buildings can contribute towards the future of alternative housing in the UK. Opinions were sought through a questionnaire completed by UK members of online social media groups whose shared focus is related to sustainability (n = 50). The results reveal that the public believe that the main benefits are their minimal environmental impact and also their reliance on renewable energy resources, while the main barriers are identifying suitable building plots and obtaining the necessary planning permissions. Notwithstanding that the participants included in this study already have sustainability interests, it is surmised that the public deem that the general principles of Earthships are an acceptable choice of alternative home/living. However, while the uptake of Earthship homes proves increasingly popular in some parts of the world, the utmost concern within the UK setting is the reality of finding somewhere suitable to build an Earthship and acquiring necessary authorisations to construct the building.

Towards a research-engaged teaching profession: insider reflections on a collaborative approach to developing teachers in Wales as professional enquirers

ABSTRACT There is a substantial body of literature related to action research in all its various forms. A small contribution to that work within a UK setting, this paper reflects on the early evolution of a state-led initiative designed to develop teachers in Wales as professional enquirers. Launched in 2018 and ongoing at the time of writing, the National Professional Enquiry Project (NPEP) is a genuinely collaborative effort involving schools, universities and the regional education consortia as key delivery partners. Whilst other attempts at building research capacity within the nation’s teaching workforce have been made, the project is unique in the Welsh context as it requires different parts of the education system to work in lockstep under the same banner. The paper explores one university’s emancipatory approach to professional enquiry, and provides insight into the ‘lived experience’ from the perspective of lead enquirer, university researcher and regional facilitator. Drawing on its authors’ privileged access as active participants, it uses autoethnography to crystalise what is learnt from these experiences into five guiding principles – foundational skills development, stakeholder coherence, dedicated time, professional autonomy and shared vulnerability – upon which a fruitful collaborative approach to developing teachers as professional enquirers should be founded.

Creative Clusters and Creative Multipliers: Evidence from UK Cities

Economic geographers have paid much attention to the cultural and creative industries, both for their propensity to cluster in urban settings, and their potential to drive urban economic development. However, evidence on the latter is surprisingly sparse. In this article, we explore the long-term, causal impacts of the cultural and creative industries on surrounding urban economies. Adapting Moretti’s local multipliers framework, we build a new twenty-year panel of UK cities, using historical instruments to identify causal effects of creative activity on noncreative firms and employment. We find that each creative job generates at least 1.9 nontradable jobs between 1998 and 2018. Prior to 2007, these effects seem more rooted in creative services employees’ local spending than visitors to creative amenities. Given the low numbers of creative jobs in most cities, the overall impact of the creative multiplier is small. On average, the creative sector is responsible for over 16 percent of nontradable job growth in our sample, though impacts will be larger in bigger clusters. We do not find the same effects for workplaces, and we find no causal evidence for spillovers from creative activity to other tradable sectors. In turn, this implies that creative city policies will have partial, uneven local economic impacts. Given extensive urban clusters of creative activity in many countries, our results hold value beyond the UK setting.

Patent foramen ovale closure: A prospective UK registry linked to hospital episode statistics.

AimsPFO closure is a percutaneous intervention, which aims to reduce risk of recurrent stroke by preventing paradoxical embolism. The objective of this study was to measure procedural safety and longer-term effectiveness of PFO closure in a UK setting.Methods and resultsProspective registry data from patients with cryptogenic stroke eligible for PFO closure were collected for up to 2 years and linked to routine data sources for additional follow-up. Outcomes of interest included procedural success rate, health related quality of life, and longer-term death and neurological event rates.A total of 973 PFO closure procedures in 971 patients were included in analysis. Successful device implantation was achieved in 99.4 [95% CI 98.6 to 99.8]% of procedures, with one in-hospital death. During median follow-up of 758 (Q1:Q3 527:968) days, 33 patients experienced a subsequent neurological event, 76% of which were ischaemic in origin. Neurological event rate was 2.7 [95%CI 1.6 to 3.9]% at 1-year (n = 751) and 4.1 [95% CI 2.6 to 5.5]% at 2-years (n = 463) using Kaplan-Meier analysis. Improvements in patient quality of life (utility and visual analogue scale) were observed at 6-weeks and 6-months follow-up.ConclusionOur observational study demonstrates that PFO closure for prevention of recurrent stroke is a relatively safe procedure but in routine clinical practice is associated with a slightly higher risk of recurrent neurological events than in randomised trials. We hypothesize that our study enrolled unselected patients with higher baseline risk, who were excluded from randomised trials, but who may benefit from a similar relative reduction in risk from the intervention.

The cost-effectiveness, of pegcetacoplan compared with ravulizumab for the treatment of paroxysmal nocturnal hemoglobinuria, in a UK setting.

Aim: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disorder characterized by hemolytic anemia, bone marrow failure and thrombosis. We evaluated, the cost-effectiveness of pegcetacoplan, a novel proximal C3 inhibitor, versus ravulizumab in patients with PNH and hemoglobin levels <10.5 g/dl despite eculizumab treatment in the UK healthcare and social services setting. Materials & methods: A Markov cohort framework model, based on the data from the pivotal trial of pegcetacoplan (PEGASUS/NCT03500549), evaluated lifetime costs and outcomes. Patients transitioned through 3 PNH hemoglobin level/red blood cell transfusion health states. Results: Pegcetacoplan provides lower lifetime costs/greater quality-adjustedlifeyears (£6,409,166/14.694QALYs, respectively) versus ravulizumab (£6,660,676/12.942QALYs). Conclusion: Pegcetacoplan is associated with enhanced anemia control, greater QALYs and reduced healthcare costs versus ravulizumab in the UK healthcare and social services setting.

Remote and rural surgery training and recruitment: a national attitudinal survey of Scottish surgical trainees.

Scotland's healthcare system includes six rural general hospitals (RGHs) which provide a full surgical service to the most remote and rural populations. Constraints of geography and finance, and population need, mean that local delivery of surgical services will be required for the foreseeable future. These RGHs face difficulties in recruiting suitably trained general surgeons. This study aimed to describe Scottish surgical trainees' attitudes towards training and working in remote and rural surgery, perceived barriers to recruitment and potential solutions. A survey was distributed in paper and electronic forms to all Scottish trainees in core surgery (early-stage trainees) and general surgery (later-stage trainees). The survey collected data describing demographics, life and career experiences, and attitudes towards training in remote and rural environments. Univariate and multivariate analyses of influences on interest in rural training and recruitment were carried out, and thematic analysis of free-text responses. There were 152 respondents (response rate 59%). Most (81%) felt that surgical training should be offered in rural environments and 43% were personally interested in some rural training. On multivariate analysis, interest in rural training was associated with being a core trainee (odds ratio (OR) 7.54, 95% confidence interval (CI) 2.79-22.76), and rural work experience following graduation (OR 5.12, 95%CI 1.85-15.39). Respondents stating that they were likely to work in a rural environment (9.2%), were more likely on multivariate analysis to be core trainees (OR 5.70, 95%CI 1.37-28.99) and to have previously lived in a rural location (OR 5.49, 95%CI 1.33-25.93). When trainees were asked for their views on how RGH jobs could be made more attractive, themes identified were as follows: increasing and improving training opportunities in RGHs, increasing the breadth of surgical training, optimising links with referral centres, and improving pay and conditions. This is the first study in a UK setting to describe the views of surgical trainees towards training and working in rural environments. There is substantial support and interest for rural surgical training among Scottish surgical trainees. A minority are interested in a rural surgical career, with interest more likely in core trainees and in those who have lived rurally. Increasing surgical training opportunities in rural environments and maximising medical school intake from rural areas may be important in addressing recruitment concerns.

Cost-effectiveness analysis of KTE-X19 CAR T therapy versus real-world standard of care in patients with relapsed/refractory mantle cell lymphoma post BTKi in England

Aims The objective of this study is to estimate the cost-effectiveness of KTE-X19 versus standard of care (SoC) in the treatment of patients with relapsed/refractory (R/R) mantle cell lymphoma (MCL) post-Bruton tyrosine kinase inhibitor (BTKi) treatment from a UK healthcare perspective. Materials and Methods A three-state partitioned survival model (pre-progression, post-progression and death) with a cycle length of one month was used to extrapolate progression-free and overall survival over a lifetime horizon. Population inputs along with KTE-X19 (brexucabtagene autoleucel) efficacy and safety data were derived from the single-arm trial ZUMA-2 (NCT02601313). The composition of SoC was informed by a literature-based meta-analysis, SoC efficacy data were obtained from the SCHOLAR-2 real-world study. Survival was modelled using standard parametric curves for SoC and a mixture-cure methodology for KTE-X19. It was assumed that patients whose disease had not progressed after five years experienced long-term remission. Costs, resource use and utility, and adverse event disutility inputs were obtained from published literature and publicly available data sources. An annual discount rate of 3.5% was applied to costs and health outcomes. Modelled outcomes for KTE-X19 and SoC included expected life years (LY), quality-adjusted life years (QALY) and total costs. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed. Results Estimated median survival was 5.96 years for KTE-X19 and 1.38 for SoC. Discounted LYs, QALYs and lifetime costs were 8.27, 5.99 and £385,765 for KTE-X19 versus 1.98, 1.48 and £79,742 for SoC, respectively. The KTE-X19 versus SoC cost per QALY was £67,713 and the cost per LY was £48,645. Influential scenario analyses use alternative KTE-X19 survival curves and discount rates, and shorter time horizons. Conclusion Considering the survival and quality of life benefits compared to SoC, KTE-X19 for R/R MCL appears as a cost-effective treatment in the real-world UK setting.

Universal delivery of a dialectical behaviour therapy skills programme (DBT STEPS-A) for adolescents in a mainstream school: feasibility study

The social and emotional wellbeing of young people is an area of increased focus for policy and practice. Schools are required to provide a holistic approach to education that includes teaching and implementing programmes designed to promote resilience and address difficult behaviours. Preliminary studies in the USA have shown promise for DBT STEPS-A (Dialectical Behavior Therapy- Skills for Emotional Problem Solving- Adolescents) but there have been no published UK evaluations. The aim of this study was to adapt DBT STEPS-A for a UK setting and test the feasibility of training teachers to deliver this universal programme as part of a mainstream school curriculum. The programme was delivered by teachers to students aged 13–14 years (n = 183) using a waitlist (non-randomised) controlled design. We investigated potential changes in level of emotional and behavioural problems using the Strength and Difficulties Questionnaire (SDQ) and Difficulties of Emotion Regulation Scale (DERS) and changes in psychological skills using the Child and Adolescent Mindfulness Measure (CAMM) and DBT Ways of coping checklist (DBT-WCCL). The views of students (n = 50) and teachers (n = 4) were explored using a participant satisfaction questionnaire. Feasibility outcomes indicate that it is possible to recruit participants from a school setting and to train teachers in the delivery of DBT STEPS-A. A statistically significant treatment effect was observed on the SDQ prosocial subscale (p = 0.04) with a large effect size (0.92). The intervention and some measures were acceptable to participants and teachers. Areas to improve future implementation are discussed.

The role of the Royal Air Force Deployed Readiness Preparation Team in the UK.

Royal Air Force (RAF) Waddington and Cranwell are both based in Lincolnshire and have Defence Primary Health Care Dental Centres on Station to provide dental care to service personnel. The facility at RAF Waddington was temporarily closed for refurbishment early 2020 and this saw the amalgamation of the two Dental Centres. This, alongside COVID, significantly impacted on the ability to deliver dental care to a combined patient group. Military dental teams are routinely deployed overseas to provide care for patients; however, the Deployed Readiness Preparation Team (DRPT) had not previously been activated in the UK in support of RAF Dental Centres. This UK-based deployment was to be innovative and able to demonstrate the wider utility of the military dental teams and portable equipment, to expand the facility at RAF Cranwell.The aim of this paper is to highlight the key principles and utility of deployable Defence dentistry by discussing the establishment and use of portable dental equipment to facilitate the increased clinical output of a dental centre. Through energetic and focused leadership, training and assurance, dentistry can be delivered with an occupational focus to provide a responsive and deployable care capability in a UK setting.

Cost-Effectiveness of Prostate Cancer Detection in Biopsy-Naïve Men: Ultrasound Shear Wave Elastography vs. Multiparametric Diagnostic Magnetic Resonance Imaging.

This exploratory study investigates the cost-effectiveness of ultrasound shear wave elastography (SWE) imaging in comparison to pre-biopsy multiparametric magnetic resonance imaging (mpMRI) in men with suspected prostate cancer. This research is motivated by the early evidence of the good performance of SWE in distinguishing cancerous from benign prostate tissues. We used a decision analysis model representing the care-pathways of men referred with a high prostate specific antigen (PSA) and/or abnormal digital rectal examination (DRE) in a UK setting from the payer’s perspective with results reported in 2016 GBP. We then appraised the cost-effectiveness of a novel approach based on SWE compared to the more conventional and widely practiced mpMRI-based approaches using data reported in the literature. Deterministic and probabilistic sensitivity analyses were used to address uncertainty regarding the parameter values utilised. Our exploratory results implied that SWE approach yielded an additional quality-adjusted life year (QALY) at the cost of GBP 10,048 compared to the standard mpMRI-based approach in the UK. This is lower than the official willingness to pay threshold of GBP 20,000 (the UK healthcare system guidelines) and is therefore a suitable replacement for the current practice. Sensitivity analyses confirmed the robustness of our results.

Practitioner perspectives on best practice in non-treatment factors that support the delivery of repetitive transcranial magnetic stimulation (rTMS) for depression.

Accessible SummaryWhat is known about the subject? The practices of mental health nurses in the administration of repetitive transcranial magnetic stimulation (rTMS) treatments for depression in outpatient clinic are crucial for patient outcomesTo date, most research has focused directly on procedural aspects of treatment delivery with limited focus on the delivery of holistic care and treatment.There is a lack of best practice guidance based on the experiences of those involved in clinical delivery to inform and improve rTMS practices What this paper adds to existing knowledge? This study provides unique insights into service and personalized non‐treatment factors associated with rTMS delivery that may reduce stress and improve the experiences of rTMS patientsIt reviews and updates understanding of the factors that contribute to the delivery of effective rTMS. What are the implications for practice? The need to apply findings for the development of best practice guidanceFactors to improve practice include (a) rTMS machine demonstrations; (b) constructive, individualized, friendly, and therapeutic conversations; (c) a relaxing, comfortable, 'homely' physical environment; (d) long term supportive management; and (e) careful engagement of nursing and support staff.

POSA46 Cost Analysis of Lurasidone for the Treatment of Schizophrenia in Adults within the United Kingdom

An economic model was built to establish the incremental costs of lurasidone, a second-generation atypical antipsychotic, when introduced as a first-line adult schizophrenia treatment in the UK. The incremental cost of the following treatment sequences was estimated: lurasidone, cariprazine, brexpiprazole, clozapine versus cariprazine, brexpiprazole, lurasidone and clozapine. The costs of either lurasidone or cariprazine were compared as first-line options because there are currently no restrictions on treatment lines of schizophrenia therapy. A Markov model incorporating the following health states was developed: stable (receiving, or temporarily discontinued from, treatment) and relapse. Patient movement between health states was dependent on six-weekly probabilities of relapse and discontinuation due to intolerable side effects or any other reasons. All efficacy data were obtained from network meta-analyses. A six-week cycle length was used and a 3.5% discount rate was applied to costs over a five-year time horizon. Resource use and unit costs were reflective of the NHS and were obtained from published literature. Costs included treatment, outpatient, adverse events, primary and residential care. An increased mortality risk associated with schizophrenia was applied to all patients. Deterministic sensitivity analysis was undertaken to assess the uncertainty of the economic Results: The treatment sequence containing lurasidone as a first-line treatment resulted in a cost-saving of £816 per patient. First-line lurasidone was associated with increased treatment, stable health state and adverse event costs (£570, £107 and £6 per patient respectively). However, these costs were outweighed by the cost-savings within the relapse health state (savings of £1,499 per patient). Deterministic sensitivity analysis demonstrated the results were most sensitive to discontinuation rates, relapse rates and relapse residential costs. However, no variation in inputs caused first-line lurasidone to become cost-incurring. Lurasidone is a cost-saving intervention for the treatment of schizophrenia in adults when received first-line in a UK setting.

POSA234 The Value of a Large Care Network in Delivering Continuity of Care to Clinically Extremely Vulnerable People During a Global Pandemic: A UK Case Study

Dialysis patients require continuity of life-sustaining care and are clinically extremely vulnerable to COVID-19. The pandemic challenged service providers to re-examine delivery of care. This has provided opportunities to reset services to support patients and deliver value-based healthcare. Here we examine whether a large global kidney care network adds value from a clinical and economic perspective to the UK setting during the COVID-19 pandemic.

P-OGC55 Current treatment modalities and median survival for patients with gastric and oesophagogastric cancers with isolated peritoneal metastasis

Abstract Background Gastric cancer with peritoneal metastases carries a median survival of only 3-7 months without treatment. Meanwhile, cancers arising from the oesophago-gastric junction (OGJ) are rapidly increasing in incidence in the Western population and are also commonly associated with peritoneal metastases. In order to measure the efficacy of emerging modes of treatment for peritoneal disease, it is essential to describe the treatments patients currently receive and the impact of these on survival – data for which is poorly described in the literature and lacking in the UK setting. Methods This was a single hospital-based retrospective cohort study covering the period from March 2012 to January 2020 at a tertiary referral centre. 50 patients were identified from multidisciplinary team (MDT) meeting records receiving a diagnosis of gastric adenocarcinoma with isolated peritoneal disease. 31 patients were identified receiving a diagnosis of true (Siewert II or III) junctional adenocarcinoma with isolated peritoneal disease. We calculated median survival time for all patients and also by treatment modality. Results Mean age of patients with gastric adenocarcinoma and isolated peritoneal disease was 71 years (range 44-90). Overall median survival was 6.6 months (IQR 2.4-19.3). Median survival was 11.2 months (IQR 3.7-21.5) for patients receiving systemic chemotherapy (n = 26) and 2.4 months (IQR 1.2-5.1) for patients receiving best supportive care alone (n = 15). Mean age of patients with junctional adenocarcinomas and isolated peritoneal disease was 70 years (range 37-89). Overall median survival was 7 months (IQR 3-19). Median survival was 10.5 months (IQR 6.5-20.5) for patients receiving systemic chemotherapy (n = 20) and 3.5 months (IQR 2-6) for patients receiving best supportive care alone (n = 6). Conclusions Our results demonstrate the poor prognosis of both gastric and oesophagogastric cancer patients with isolated peritoneal disease. Prognosis figures are comparable between the two cancer types. Findings are in line with previous studies performed outside the UK which have shown that available treatments extend survival by no more than 3-9 months, highlighting the desperate need for new treatment modalities.

Lifetime cost-effectiveness simulation of once-weekly exenatide in type 2 diabetes: A cost-utility analysis based on the EXSCEL trial

AimsThe Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial assessed once-weekly exenatide (EQW) vs. placebo, added to usual care in 14,752 patients with type 2 diabetes mellitus (Clinicaltrials.gov: NCT01144338). We assessed the lifetime cost-effectiveness of adding EQW vs. usual care alone from a healthcare perspective. MethodsMedical resource use and EQ-5D utilities were collected throughout the study. Within-trial results were extrapolated to a lifetime horizon using the UK Prospective Diabetes Study Outcomes Model version 2 (UKPDS-OM2), predicting predict cardiovascular and microvascular events. Cost-effectiveness was evaluated separately for US and UK settings, with outcomes measured in quality-adjusted life-years (QALYs). ResultsEQW plus usual care gained 0.162 QALYs at an additional cost of $41,545/patient, compared with usual care in a US setting. The incremental cost-effectiveness ratio (ICER) was $259,223/QALY. In a UK setting, the QALY gain was 0.151 at an additional cost of £6357: an ICER of £42,589/QALY. Sensitivity analyses ranged between $34,369–$269,571 and £3430–£46,560 per QALY gained. ConclusionsIn a lifetime extrapolation, adding EQW to usual care increased QALYs and costs compared with usual care alone. The base-case ICERs exceeded the commonly-cited cost-effectiveness thresholds of $100,000/QALY and £20,000/QALY. However, ICERs were considerably lower in some subgroups, and in sensitivity analyses.

The Finding My Way UK Clinical Trial: Adaptation Report and Protocol for a Replication Randomized Controlled Efficacy Trial of a Web-Based Psychological Program to Support Cancer Survivors.

BackgroundCancer survivors frequently report a range of unmet psychological and supportive care needs; these often continue after treatment has finished and are predictive of psychological distress and poor health-related quality of life. Web-based interventions demonstrate good efficacy in addressing these concerns and are more accessible than face-to-face interventions. Finding My Way (FMW) is a web-based, psycho-educational, and cognitive behavioral therapy intervention for cancer survivors developed in Australia. Previous trials have demonstrated that FMW is acceptable, highly adhered to, and effective in reducing the impact of distress on quality of life while leading to cost savings through health resource use reduction.ObjectiveThis study aims to adapt the Australian FMW website for a UK cancer care context and then undertake a single-blinded, randomized controlled trial of FMW UK against a treatment-as-usual waitlist control.MethodsTo an extent, our trial design replicates the existing Australian randomized controlled trial of FMW. Following a comprehensive adaptation of the web resource, we will recruit 294 participants (147 per study arm) from across clinical sites in North West England and North Wales. Participants will have been diagnosed with cancer of any type in the last 6 months, have received anticancer treatment with curative intent, be aged ≥16 years, be proficient in English, and have access to the internet and an active email address. Participants will be identified and recruited through the National Institute for Health Research clinical research network. Measures of distress, quality of life, and health economic outcomes will be collected using a self-report web-based questionnaire at baseline, midtreatment, posttreatment, and both 3- and 6-month follow-up. Quantitative data will be analyzed using intention-to-treat mixed model repeated measures analysis. Embedded semistructured qualitative interviews will probe engagement with, and experiences of using, FMW UK and suggestions for future improvements.ResultsThe website adaptation work was completed in January 2021. A panel of cancer survivors and health care professionals provided feedback on the test version of FMW UK. Feedback was positive overall, although minor updates were made to website navigation, inclusivity, terminology, and the wording of the Improving Communication and Sexuality and Intimacy content. Recruitment for the clinical trial commenced in April 2021. We aim to report on findings from mid-2023.ConclusionsReplication studies are an important aspect of the scientific process, particularly in psychological and clinical trial literature, especially in different geographical settings. Before replicating the FMW trial in the UK setting, content updating was required. If FMW UK now replicates Australian findings, we will have identified a novel and cost-effective method of psychosocial care delivery for cancer survivors in the United Kingdom.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 14317248; https://www.isrctn.com/ISRCTN14317248International Registered Report Identifier (IRRID)DERR1-10.2196/31976

"I've Lived that Thing that We do with Families": Understanding the Experiences of Practitioners' Undertaking a Three-Year Open Dialogue UK Training Programme.

Open dialogue is a systemically-based approach to mental healthcare, originating from Finland. Growing numbers of practitioners are being trained internationally, but little is known about the impact of such trainings within a UK setting. This study used interpretative phenomenological analysis of focus group data to explore the experiences of thirteen individuals undertaking a three-year UK open dialogue training. Four themes emerged: (1) a powerful experiential process; (2) personal therapeutic change; (3) deeper and more open relationships and (4) altered relationships to power in working practice. The findings suggest that open dialogue trainees experience greater depth in relationships with both clients and colleagues as a result of training, even participants who already had therapeutic training backgrounds. The findings also contribute to Transformational Learning literature regarding how experiential, non-hierarchical, dialogical teaching methods may enhance learning on therapeutic programmes and, therefore, lead to positive changes within clinical practice.