Reorganising specialist cancer surgery for the twenty-first century: a mixed methods evaluation (RESPECT-21)

Abstract

BackgroundThere are longstanding recommendations to centralise specialist healthcare services, citing the potential to reduce variations in care and improve patient outcomes. Current activity to centralise specialist cancer surgical services in two areas of England provides an opportunity to study the planning, implementation and outcomes of such changes. London Cancer and Manchester Cancer are centralising specialist surgical pathways for prostate, bladder, renal, and oesophago-gastric cancers, so that these services are provided in fewer hospitals. The centralisations in London were implemented between November 2015 and April 2016, while implementation in Manchester is anticipated in 2017.Methods/DesignThis mixed methods evaluation will analyse stakeholder preferences for centralisations; it will use qualitative methods to analyse planning, implementation and sustainability of the centralisations (‘how and why?’); and it will use a controlled before and after design to study the impact of centralisation on clinical processes, clinical outcomes, cost-effectiveness and patient experience (‘what works and at what cost?’). The study will use a framework developed in previous research on major system change in acute stroke services. A discrete choice experiment will examine patient, public and professional preferences for centralisations of this kind. Qualitative methods will include documentary analysis, stakeholder interviews and non-participant observations of meetings. Quantitative methods will include analysis of local and national data on clinical processes, outcomes, costs and National Cancer Patient Experience Survey data. Finally, we will hold a workshop for those involved in centralisations of specialist services in other settings to discuss how these lessons might apply more widely.DiscussionThis multi-site study will address gaps in the evidence on stakeholder preferences for centralisations of specialist cancer surgery and the processes, impact and cost-effectiveness of changes of this kind. With increasing drives to centralise specialist services, lessons from this study will be of value to those who commission, organise and manage cancer services, as well as services for other conditions and in other settings. The study will face challenges in terms of recruitment, the retrospective analysis of some of the changes, the distinction between primary and secondary outcome measures, and obtaining information on the resources spent on the reconfiguration.

Centralising specialist cancer surgery services in England: survey of factors that matter to patients and carers and health professionals

“… Probability the patient undergoing surgery dies from cancer within the next 12 months. Deaths from cancer might fall if outcomes are better in centres carrying out more operations [9, 10, 18, 19]. Having the opportunity to take part in clinical trials of specialist cancer care to test new treatments.…”

“…The study is part of a larger project, “Reorganising specialist cancer surgery for the 21 st century: a mixed methods evaluation (RESPECT-21)”, that analyses the centralisation of specialised cancer surgical services in the areas covered by London Cancer and Greater Manchester Cancer [19]. The larger study will address gaps in the evidence about the centralisation of these services, including processes, impact, and cost-effectiveness of changes, as well as identifying lessons that will guide centralisation work in other areas of specialist services (NIHR study reference 14/46/19).…”

“…The larger study uses a conceptual framework designed to understand the key processes involved in major system change (Additional file 1). These processes include: making the decision to change, developing and agreeing new service models, implementing the changes, and adhering to the new model [19]. Stakeholder preferences, considered in this study, might be especially important during early stages of major system change such as making the decision to change and deciding on which service model to implement.…”

Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis

“…This perspective supports a potentially unique role for holistic mind-body therapeutic approaches that target multiple physical and psychosocial aspects of cancer symptoms, and that may offer the patient a flexible toolset for addressing their experience of the disease. [5–8]…”

The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England

“…Although data could be obtained from reports and interviews with stakeholders, some of the knowledge of the true cost of implementation would have been lost. This knowledge and the importance of collecting in-depth data on the cost of implementation has assisted with the design of other studies [ 29 ].…”