Reporting the whole story: Analysis of the 'out-of-scope' questions from the James Lind Alliance Teenage and Young Adult Cancer Priority Setting Partnership Survey

Objective

We conducted a UK‐wide survey to identify the top 10 research questions for young people's cancer. We conducted secondary analysis of questions submitted, which were ‘out‐of‐scope’ of the original survey aim. We sought to disseminate these questions, to inform practice, policy and the development of potential interventions to support young people with cancer.

Design

James Lind Alliance Priority Setting Partnership.

Participants

Young people aged 13‐24 with a current/previous cancer diagnosis, their families/friends/partners and professionals who work with this population.

Methods

Eight hundred and fifty‐five potential research questions were submitted, and 326 were classified as ‘out‐of‐scope’. These questions, along with 49 ‘free‐text’ comments, were analysed using thematic analysis.

Results

The 375 out‐of‐scope questions and comments were submitted by: 68 young people, 81 family members/partners/friends and 42 professionals. Ten overarching themes were identified: diagnostic experience; communication; coordination of care; information needs and lack of information; service provision; long‐term effects and aftercare support; family support; financial impact; end‐of life care; and research methods and current research.

Conclusions

The need to tailor services, information and communication is a striking thread evidenced across the ‘out‐of‐scope’ questions. Gaps in information highlight implications for practice in revisiting information needs throughout the cancer trajectory. We must advocate for specialist care for young people and promote the research priorities and these findings to funding bodies, charities, young people and health and social care policymakers, in order to generate an evidence base to inform effective interventions across the cancer trajectory and improve outcomes.

Patient/public contributions

Patients and carers were equal stakeholders throughout.

Research priorities for young people with cancer: a UK priority setting partnership with the James Lind Alliance

OBJECTIVES

To conduct a UK-wide survey of young people who have experienced cancer, carers and professionals, to identify and prioritise research questions to inform decisions of research funders and support the case for research with this unique cancer population.

DESIGN

James Lind Alliance Priority Setting Partnership.

SETTING

UK health service and community.

METHODS

A steering group oversaw the initiative and partner organisations were recruited. Unanswered questions were collected in an online survey. Evidence searching verified uncertainties. An interim survey was used to rank questions prior to a final prioritisation workshop.

PARTICIPANTS

Young people aged 13-24 years with a current or previous cancer diagnosis, their families, friends, partners and professionals who work with this population.

RESULTS

Two hundred and ninety-two respondents submitted 855 potential questions. Following a refining process and removal of 'out of scope' questions, 208 unique questions remained. Systematic evidence checking identified seven answered questions and 16 were the subject of ongoing studies. The interim survey was completed by 174 participants. The top 30 questions were prioritised at a workshop attended by 25 young people, parents and multidisciplinary professionals. The top three priorities are: (1) What psychological support package improves psychological well-being, social functioning and mental health during and after treatment? (2) What interventions, including self-care, can reduce or reverse adverse short-term and long-term effects of cancer treatment? (3) What are the best strategies to improve access to clinical trials? The remaining questions reflect the complete cancer pathway: new therapies, life after cancer, support, education/employment, relapse and end-of-life care.

CONCLUSIONS

We have identified shared research priorities for young people with cancer using a rigorous, person-centred approach involving stakeholders typically not involved in setting the research agenda. The breadth of priorities suggest future research should focus on holistic and psychosocial care delivery as well as traditional drug/biology research.

Metapopulation dynamics and space use by reintroduced elk (Cervus elaphus) in central Ontario

Understanding population structure and resource selection is essential for wildlife management and conservation. We assessed the population structure of elk (Cervus elaphus L.,1758) in central Ontario. We used fuzzy and hierarchical cluster analyses to elucidate elk population structure based on spatial data collected from 41 radio-collared elk. We assessed space use between core and satellite subpopulations with the minimum convex polygon (MCP) and fixed kernel methods. Both fuzzy and hard clustering indicated that elk in this part of central Ontario occur in a metapopulation that includes five subpopulations. The largest cluster consisted of a core group containing 22 radio-collared elk located in Burwash, with several satellite subpopulations spread along a 50 km long north–south axis and a small subpopulation to the west located in Worthington. Survival rates among subpopulations were similar, ranging from 0.71 to 0.83, and anthropogenic causes of mortality were predominant only in the Burwash subpopulation. Space use and density of elk differed between core and satellite subpopulations. Understanding population structure is important to develop appropriate management plans. Our results support the conclusion that metapopulation structure can be reliably assessed using spatial data.