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Rodrigues LS, Pizato N, Carvalho KMB, Dutra ES, Botelho PB, Andrade LS, Moraes VD, Gonçalves VSS. Validation of a dietary advice protocol for adults with obesity in primary health care according to the Brazilian Dietary Guidelines. Fam Pract 2024; 41:587-595. [PMID: 36416351 DOI: 10.1093/fampra/cmac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obesity is a non-communicable chronic disease which carries a high cost for the Brazilian Unified Health System. Standardized protocols can help primary health care (PHC) professionals manage the disease. OBJECTIVES To describe the validation process of a protocol concerning dietary guidelines for adults with obesity in PHC by non-nutrition professionals. METHODS A validation study of a dietary advice protocol consisting of 6 recommendations was conducted according to Brazilian Dietary Guidelines. The topics incorporated into the recommendations were submitted to a panel of judges for content validity and achieved a Scale Content Validity Index (S-CVI) score >0.80. Subsequently, an online workshop was held and consisted of guiding questions to adequately improve current protocols. Face validity was assessed in a mediation workshop conducted with PHC non-nutrition professionals. Following the validation process, necessary adjustments were made to the eating protocol. RESULTS The validation process was conducted by a panel of 20 judges and 10 PHC professionals. The content was validated using a 0.98 S-CVI. The online workshop expert panel agreed the instrument provides a trustworthy foundation for appropriate dietary guidelines. Moreover, the judges suggested changes to the flowchart designed to support the professionals' decisions, discussed the absence of quantitative prescription guidelines, and offered additional suggestions to strengthen equity and encourage autonomy in non-nutrition healthcare professionals in PHC. CONCLUSION This study describes the validation process of a dietary advice protocol for people with obesity, as well as the importance of its integration into PHC.
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Affiliation(s)
| | - Nathalia Pizato
- Graduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | - Kenia M B Carvalho
- Graduate Program in Public Health, University of Brasilia, Brasilia, Brazil
- Graduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | - Eliane S Dutra
- Graduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | - Patrícia B Botelho
- Graduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | - Laila S Andrade
- Nutrition and Health Research Group-PENSA/UnB, University of Brasilia, Brasilia, Brazil
| | - Verena D Moraes
- Laboratory of Regional Endemic Situations, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Fallows E, Ells L, Anand V. Semaglutide and the future of obesity care in the UK. Lancet 2023; 401:2093-2096. [PMID: 37290459 DOI: 10.1016/s0140-6736(23)01083-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Ellen Fallows
- Brackley Medical Centre, Brackley NN13 6QZ, UK; The British Society of Lifestyle Medicine, Haddington, East Lothian, UK.
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Varun Anand
- Diadem Medical Practice and Hull Public Health Team, Hull, UK
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Paine K, Parker S, Denney-Wilson E, Lloyd J, Randall S, McNamara C, Nutbeam D, Osborne R, Saito S, Harris M. In it for the long haul: the complexities of managing overweight in family practice: qualitative thematic analysis from the Health eLiteracy for Prevention in General Practice (HeLP-GP) trial. BMC PRIMARY CARE 2023; 24:57. [PMID: 36850020 PMCID: PMC9972770 DOI: 10.1186/s12875-023-01995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/25/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Australia has one of the highest rates of overweight and obesity in the developed world, and this increasing prevalence and associated chronic disease morbidity reinforces the importance of understanding the attitudes, views, and experiences of patients and health providers towards weight management interventions and programs. The purpose of this study was to investigate patients, family practitioners and family practice nurses' perceptions and views regarding the receipt or delivery of weight management within the context of the HeLP-GP intervention. METHODS A nested qualitative study design including semi-structured interviews with family practitioners (n = 8), family practice nurses (n = 4), and patients (n = 25) attending family practices in New South Wales (n = 2) and South Australia (n = 2). The patient interviews sought specific feedback about each aspect of the intervention and the provider interviews sought to elicit their understanding and opinions of the strategies underpinning the intervention as well as general perceptions about providing weight management to their patients. Interviews were recorded and transcribed verbatim, and coding and management conducted using NVivo 12 Pro. We analysed the interview data using thematic analysis. RESULTS Our study identified three key themes: long-term trusting and supportive relationships (being 'in it for the long haul'); initiating conversations and understanding motivations; and ensuring access to multi-modal weight management options that acknowledge differing levels of health literacy. The three themes infer that weight management in family practice with patients who are overweight or obese is challenged by the complexity of the task and the perceived motivation of patients. It needs to be facilitated by positive open communication and programs tailored to patient needs, preferences, and health literacy to be successful. CONCLUSIONS Providing positive weight management in family practice requires ongoing commitment and an open and trusting therapeutic relationship between providers and patients. Behaviour change can be achieved through timely and considered interactions that target individual preferences, are tailored to health literacy, and are consistent and positive in their messaging. Ongoing support of family practices is required through funding and policy changes and additional avenues for referral and adjunctive interventions are required to provide comprehensive weight management within this setting.
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Affiliation(s)
- Katrina Paine
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia. .,Centre for Primary Health Care and Equity, Faculty of Medicine and Health, University of New South Wales, Kensington, Australia.
| | - Sharon Parker
- Centre for Primary Health Care and Equity, Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
| | - Sue Randall
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Carmel McNamara
- College of Nursing and Health Science, Flinders University, Adelaide, Australia
| | - Don Nutbeam
- Public Health in the School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Richard Osborne
- Centre of Global Health and Equity, Swinburne University of Technology, Melbourne, Australia
| | - Shoko Saito
- Health Equity and Research Development Unit, Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
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Znyk M, Zajdel R, Kaleta D. Consulting Obese and Overweight Patients for Nutrition and Physical Activity in Primary Healthcare in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7694. [PMID: 35805379 PMCID: PMC9265845 DOI: 10.3390/ijerph19137694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the dietary and physical activity counseling provided to adults by family doctors. Predictors of counseling in primary healthcare were identified. A cross-sectional study was conducted from January 2020 to December 2021 among 896 adult primary care patients in the city of Łódź [Lodz], Poland. Almost 36% of the respondents were advised to change their eating habits, and 39.6% were advised to increase their physical activity. In a multivariate logistic regression analysis, people in poor health with chronic diseases related to overweight and obesity and with two, three or more chronic diseases, respectively, received advice on eating habits from their GP twice and three times more often than people in good health with no chronic conditions (OR = 1.81; p < 0.05 and OR = 1.63; p < 0.05; OR = 3.03; p < 0.001). People in the age groups 30−39 years and 40−49 years (OR = 1.71; p < 0.05 and OR = 1.58; p < 0.05), widowed (OR = 2.94; p < 0.05), with two, three or more chronic diseases (OR = 1.92; p < 0.01 and OR = 3.89; p < 0.001), and subjectively assessing overweight and obesity (OR = 1.61; p < 0.01) had a better chance of receiving advice on physical activity. The study found a higher proportion of advice on diet and physical activity provided to overweight and obese patients by primary care physicians than in other studies; however, still not all receive the necessary counseling. GPs should advise all patients not to become overweight and obese, not only those already affected by the problem.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Łódź, Poland;
| | - Radosław Zajdel
- Department of Computer Science in Economics, University of Lodz, POW 3/5, 90-255 Łódź, Poland;
| | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Łódź, Poland;
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McHale CT, Laidlaw AH, Cecil JE. Predictors of weight discussion in primary care consultations: A multilevel modeling approach. PATIENT EDUCATION AND COUNSELING 2022; 105:502-511. [PMID: 34253384 DOI: 10.1016/j.pec.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/14/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To understand how primary care weight-related communication processes are influenced by individual differences in primary care practitioner (PCP) and patient characteristics and communication use. METHODS Two multilevel logistic regression models were calculated to predict the occurrence of 1) weight-related discussion and 2) weight-related consultation outcomes. Coded communication data (Roter Interaction Analysis System) from 218 video-recorded consultations between PCPs and patients with overweight and obesity in Scottish primary care practices were combined with their demographic data to develop the multilevel models. RESULTS Weight-related discussions were more likely to occur when a greater proportion of PCP's total communication was partnership building and activating communication. More discrete weight discussions during a consultation predicted weight-related consultation outcomes. Patient BMI positively predicted both weight-related discussion and consultation outcomes. CONCLUSION This work demonstrates that multilevel modeling is a viable approach to investigating coded primary care weight-related communication data and that it can provide insight into the impact that various patient and PCP factors have on these communication processes. PRACTICE IMPLICATIONS Through the increased use of partnership building and activating communications, and by engaging in shorter, but more frequent, discussions about patient weight, PCPs may better facilitate weight-related discussion and weight-related consultation outcomes for their patients.
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Affiliation(s)
- Calum T McHale
- School of Medicine, University of St Andrews, St Andrews, UK.
| | - Anita H Laidlaw
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Joanne E Cecil
- School of Medicine, University of St Andrews, St Andrews, UK
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Eisenberg D, LaVela SL, Frayne SM, Chen R, Barreto NB, Wu J, Nevedal AL, Davis K, Arnow KD, Harris AH. Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked? Obes Facts 2022; 15:451-457. [PMID: 35263742 PMCID: PMC9209967 DOI: 10.1159/000523917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Individuals with spinal cord injury (SCI) are vulnerable to obesity. Annual obesity screening using body mass index (BMI) is the standard of care mandated by US Veterans Health Administration (VHA) guidelines. Our objective was to determine the rates, variability, and predictors of guideline-concordant annual screening for obesity, given potential challenges of height and weight measurements in individuals with SCI. METHODS This is a cross-sectional retrospective study using US national VA databases. We identified all VHA patients with chronic SCI in the fiscal year (FY) 2019, their treating facility and frequency of recorded height and weight. We applied mixed-effects logistic regression models to assess associations between annual BMI screening and patient- and facility-level characteristics. RESULTS Of 20,978 individuals with chronic SCI in VHA in FY19, guideline-concordant annual BMI screening was lacking in 37.9%. Accounting for facility-level factors (geographic region, SCI facility type, volume of patients with SCI treated at the facility), a mixed-effects logistic regression model demonstrated that lack of annual obesity screening was significantly associated with older patient age (p < 0.001) and fewer outpatient encounters (p < 0.001) but not other patient-level factors such as sex, race, level of injury, or rurality. The rate of obesity screening among different facilities within VHA varied widely from 11.1% to 75.7%. CONCLUSION A large proportion of persons with SCI receiving care in VHA do not receive guideline-concordant annual obesity screening, an especially acute problem in some facilities. Older patients with fewer outpatient encounters are more likely to be missed. To inform the design of interventions to improve identification and documentation of obesity, further study is needed to assess potential barriers to obesity screening in the population with SCI.
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Affiliation(s)
- Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
- *Dan Eisenberg,
| | - Sherri L. LaVela
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Susan M. Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Rui Chen
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
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Primary care clinicians' perspectives on clinical decision support to enhance outcomes of online obesity treatment in primary care: A qualitative formative evaluation. ACTA ACUST UNITED AC 2021; 6:515-526. [PMID: 34722861 DOI: 10.1007/s41347-021-00206-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective Online behavioral treatment for obesity produces clinically-meaningful weight losses among many primary care patients. However, some patients experience poor outcomes (i.e., failure to enroll post-referral, poor weight loss, or premature disengagement). This study sought to understand primary care clinicians' perceived utility of a clinical decision support system (CDSS) that would alert clinicians to patients' risk for poor outcome and guide clinician-delivered rescue interventions to reduce risk. Methods Qualitative formative evaluation was conducted in the context of an ongoing pragmatic clinical trial implementing online obesity treatment in primary care. Interviews were conducted with 14 nurse care managers (NCMs) overseeing patients' online obesity treatment. Interviews inquired about the potential utility of CDSS in primary care, desired alert frequency/format, and priorities for alert types (non-enrollment, poor weight loss, and/or early disengagement). We used matrix analysis to generate common themes across interviews. Results Nearly all NCMs viewed CDSS as potentially helpful in clinical practice. Alerts for patients at risk for disengagement were of highest priority, though all alert types were generally viewed as desirable. Regarding frequency and delivery mode of patient alerts, NCMs wanted to balance the need for prompt patient intervention with minimizing clinician burden. Concerns about CDSS emerged, including insufficient time to respond promptly and adequately to alerts and the need to involve other support staff for patients requiring ongoing rescue intervention. Conclusions NCMs view CDSS for online obesity treatment as potentially feasible and clinically useful. For optimal implementation in primary care, CDSS must minimize clinician burden and facilitate collaborative care.
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General Practitioner's Knowledge about Bariatric Surgery Is Associated with Referral Practice to Bariatric Surgery Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910055. [PMID: 34639357 PMCID: PMC8508327 DOI: 10.3390/ijerph181910055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Patients seeking treatment for obesity and related diseases often contact general practitioners (GPs) first. The aim of this study was to evaluate GPs’ knowledge about weight loss surgery (WLS) and potential stereotypes towards obese patients. (2) Methods: For this prospective cohort study, 204 GPs in the region of the bariatric surgery center at the University Hospital Aachen were included. The participants filled out a questionnaire comprising general treatment of obese patients, stigmatization towards obese patients (1–5 points) as well as knowledge regarding WLS (1–5 points). (3) Results: The mean age of the GPs was 54 years; 41% were female. Mean score for self-reported knowledge was 3.6 points out of 5. For stigma-related items, the mean score was 3.3 points out of 5. A total of 60% of the participants recognized bariatric surgery as being useful. Knowledge about bariatric surgery significantly correlated with the number of referrals to bariatric surgery centers (p < 0.001). No significant correlation was found between stigma and referral to surgery (p = 0.057). (4) Conclusions: The more GPs subjectively know about bariatric surgery, the more often they refer patients to bariatric surgery specialists—regardless of potentially present stereotypes. Therefore, GPs should be well informed about indications and opportunities of WLS.
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Birch JM, Critchlow N, Calman L, Petty R, Rosenberg G, Rumgay H, Vohra J. The Frequency and Content of Discussions About Alcohol Use in Primary Care and Application of the Chief Medical Officer's Low-Risk Drinking Guidelines: A Cross-Sectional Survey of General Practitioners and Practice Nurses in the UK. Alcohol Alcohol 2021; 56:433-442. [PMID: 33179022 DOI: 10.1093/alcalc/agaa120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/18/2020] [Accepted: 10/12/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To examine how often general practitioners (GPs) and practice nurses (PNs) working in primary care discuss alcohol with patients, what factors prompt discussions, how they approach patient discussions and whether the Chief Medical Officers' (CMO) revised low-risk drinking guidelines are appropriately advised. METHODS Cross-sectional survey with GPs and PNs working in primary care in the UK, conducted January-March 2017 (n = 2020). A vignette exercise examined what factors would prompt a discussion about alcohol, whether they would discuss before or after a patient reported exceeded the revised CMO guidelines (14 units per week) and whether the CMO drinking guidelines were appropriately advised. For all patients, participants were asked how often they discussed alcohol and how they approached the discussion (e.g. used screening tool). RESULTS The most common prompts to discuss alcohol in the vignette exercise were physical cues (44.7% of participants) or alcohol-related symptoms (23.8%). Most practitioners (70.1%) said they would wait until a patient was exceeding CMO guidelines before instigating discussion. Two-fifths (38.1%) appropriately advised the CMO guidelines in the vignette exercise, with PNs less likely to do so than GPs (odds ratio [OR] = 0.77, P = 0.03). Less than half (44.7%) reportedly asked about alcohol always/often with all patients, with PNs more likely to ask always/often than GPs (OR = 2.22, P < 0.001). Almost three-quarters said they would enquire by asking about units (70.3%), compared to using screening tools. CONCLUSION Further research is required to identify mechanisms to increase the frequency of discussions about alcohol and appropriate recommendation of the CMO drinking guidelines to patients.
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Affiliation(s)
- Jack M Birch
- MRC Epidemiology Unit, University of Cambridge School of Clinical, Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK.,Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Nathan Critchlow
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK.,Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Robert Petty
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
| | - Gillian Rosenberg
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
| | - Harriet Rumgay
- Cancer Intelligence, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
| | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
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