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Martins A, Bennister L, Fern LA, Gerrand C, Onasanya M, Storey L, Wells M, Whelan JS, Windsor R, Woodford J, Taylor RM. A Qualitative Study of the Factors Influencing Patients' Experience of Soft Tissue Sarcoma in the United Kingdom. Cancer Nurs 2024; 47:84-92. [PMID: 36480349 DOI: 10.1097/ncc.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment of soft tissue sarcoma frequently involves extensive surgery, loss of mobility, and complex rehabilitation programs. Poorer patient-reported outcomes are reported in comparison to those from patients with other cancer types. Understanding patient experience is therefore important to support patients and improve care. OBJECTIVE The aim of this study was an in-depth exploration of patients' experience of being diagnosed with soft tissue sarcoma. METHODS Semistructured interviews and focus groups were conducted with 68 patients with soft tissue sarcoma (59% female; aged 23-82 years). These were analyzed using adapted framework analysis. RESULTS Two overarching themes explained the factors influencing patients' experiences: individual and social factors to manage the impact of soft tissue sarcoma; and context and processes of care. Access to professionals with sarcoma expertise and services in specialist hospitals had an impact on patients' well-being. Lack of access to specialist services and coordinated care were associated with worse experiences. These were influenced by age and support from family/friends/other patients and were crucial in patients' adaptation to living with and beyond a sarcoma diagnosis. CONCLUSION We describe factors that both negatively and positively influenced the experience of patients with soft tissue sarcoma. Access to specialist soft tissue sarcoma and rehabilitation services and support tailored to patients' age and disease trajectory are needed to improve these experiences. IMPLICATION FOR PRACTICE Nurses are important for helping patients manage the long-term effects and directing them to supportive care services. Rehabilitation services need to be available and easily accessible.
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Affiliation(s)
- Ana Martins
- Author affiliations: Cancer Division, University College London Hospitals NHS Foundation Trust (Drs Martins, Fern, Windsor, and Whelan and Mrs Onasanya); Waldenstrom's Macroglobulinaemia UK (Ms Bennister), London; Sarcoma Unit, Royal National Orthopaedic Hospital (Mr Gerrand and Mrs Woodford), Stanmore; Department of Psychology, Birmingham City University (Dr Storey); Nursing Directorate, Imperial College Healthcare NHS Trust, Charing Cross Hospital (Dr Wells), London; and Centre for Nurse, Midwifery and Allied Health Professional-led Research (CNMAR), University College London Hospitals NHS Foundation Trust (Dr Taylor), United Kingdom
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Martins A, Bennister L, Fern LA, Gerrand C, Onasanya M, Storey L, Wells M, Whelan JS, Windsor R, Woodford J, Taylor RM. Development of a patient-reported experience questionnaire for patients with sarcoma: the Sarcoma Assessment Measure (SAM). Qual Life Res 2020; 29:2287-2297. [PMID: 32227293 DOI: 10.1007/s11136-020-02481-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of the study was to develop a patient-reported outcome measure for patients with sarcoma-the Sarcoma Assessment Measure (SAM). METHODS AND RESULTS The systematic development of SAM included a three-stage, mixed-methods study using semi-structured interviews, focus groups and questionnaires, with all stages involving patients from across the United Kingdom. In-depth interviews were conducted with 121 patients (50% male; aged 13-82; with soft tissue sarcoma (62%), bone tumours (28%) and gastrointestinal stromal tumours (10%)). Content analysis of the interview transcripts identified 1415 post-diagnosis experience statements. Experience statements were reviewed, repetition was removed and sentences were refined to form 395 'items' which were included in an Item Reduction Questionnaire (IRQ) grouped as physical, emotional, social and financial wellbeing and sexuality. The IRQ was completed by 250 patients who rated each item on importance and worry. Items with a mean score above 5 (6 in the emotional domain) were removed, which reduced the list to 166 items. After review by the research team, 23 clinicians and 34 patients, 66 items were retained to test content validity. Items with a content validity ratio of < .33 were removed. Cognitive interviews were conducted with 10 patients on the final 22 items to test comprehension. Minor changes were made to four. CONCLUSION SAM comprises of 22 items reflecting physical, emotional, social, financial wellbeing and sexuality. This systematic process of using patient experience to develop the content of SAM will ensure that it measures what is important to patients.
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Affiliation(s)
- Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Lindsey Bennister
- Patient Representative, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Craig Gerrand
- London Sarcoma Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Maria Onasanya
- Patient Representative, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Lesley Storey
- Department of Psychology, Birmingham City University, Curzon Building, Birmingham, B4 7BD, UK
| | - Mary Wells
- Nursing Directorate, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Rachael Windsor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Julie Woodford
- London Sarcoma Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Rachel M Taylor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK. .,UCLH Cancer Clinical Trials Unit, 1st Floor East, 250 Euston Road, London, NW1 2PG, UK.
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Martins A, Storey L, Wells M, Fern L, Gerrand C, Bennister L, Woodford J, Onasanya M, Windsor R, Whelan J, Taylor R. Qualitative study of patients’ experiences of living with and beyond a soft tissue sarcoma diagnosis: The impact of sarcoma specialist services. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martins A, Whelan JS, Bennister L, Fern LA, Gerrand C, Onasanya M, Storey L, Wells M, Windsor R, Woodford J, Taylor RM. Qualitative study exploring patients experiences of being diagnosed and living with primary bone cancer in the UK. BMJ Open 2019; 9:e028693. [PMID: 31551374 PMCID: PMC6773292 DOI: 10.1136/bmjopen-2018-028693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study is to explore the experiences of patients with primary bone cancer. DESIGN Qualitative study design using semistructured interviews and focus groups. SETTING Hospitals across the UK and recruitment through UK sarcoma charities and support groups. METHODS Semistructured telephone/face-to-face interviews and focus groups with a purposive sample of 26 participants. Data were analysed using Framework Analysis. PARTICIPANTS Patients (n=26) with primary bone cancer aged 13-77 years. The majority were male (69%), white (85%); diagnosed within 4 years (54%); and had lower limb sarcoma (65%). Ten participants had undergone an upper/lower limb amputation (39%). RESULTS The health-related quality-of-life domains of physical, emotional and social well-being and healthcare professionals' role were the overarching themes of analysis. The physical domain anchored patient experiences. The intensity and length of treatment, the severity of side-effects, the level of disability after surgery and the uncertainty of their prognosis had an impact on patient's self-image, confidence, mood and identity, and caused disruption to various aspects of the patients' social life, including their relationships (emotional and sexual) and participation in work/school and leisure activities. Adaptation was influenced by the way patients dealt with stress and adversity, with some finding a new outlook in life, and others struggling with finding their 'new normal'. Family and friends were the main source of support. Healthcare professional's expertise and support was critical. Rehabilitation services had a considerable role in patient's physical and emotional well-being, but inequitable access to these services was apparent. CONCLUSIONS This study described the impact of primary bone cancer on patients' well-being and adjustment over time with the identification of influencing factors of better/worse experiences. It showed that impact was felt after end of treatment and affected patients at different life stages. Holistic models of survivorship care are needed.
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Affiliation(s)
- Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Craig Gerrand
- Sarcoma Service, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - Maria Onasanya
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lesley Storey
- Department of Psychology, Birmingham City University, Birmingham, UK
| | - Mary Wells
- Imperial College Healthcare NHS Trust, London, UK
| | - Rachael Windsor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Woodford
- Sarcoma Service, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - Rachel M Taylor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- CNMAR, University College London Hospitals NHS Foundation Trust, London, UK
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Li F, Morgan A, McCullagh A, Johnson A, Giles C, Greenfield D, Crawford G, Gath J, Lyons J, Andreyev J, Tobutt J, Tugwell J, Robb K, Cove-Smith L, Bennister L, Doyle N, Lee N, Nash R, Simcock R, Stephens R, Best S, Moug S, Staley K, Regan S, Ellis P, Griffiths S, Lewis I. Abstract 3348: Top 10 living with and beyond cancer research priorities. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
More and more people are living with the consequences of cancer and its treatment (living with and beyond cancer), yet the level of relevant research is low compared to other types of cancer research in the UK. NCRI aims to increase the level of research in this area and to ultimately improve the lives of those affected by cancer. Undefined research priorities in this broad area has been a barrier to research. The 2015 NHS Independent Cancer Taskforce report also recommends defining research priorities and to enable this research to happen. To address this barrier the NCRI has undertaken a James Lind Alliance Priority Setting Partnership (PSP) to identify priorities that matter most to people affected by cancer and the health and social care professionals.A PSP consists of patients and carers, health and social care professionals. PSPs have several stages and begin with a UK-wide survey to gather questions about uncertainties in living with and beyond cancer. Once the results were analysed, an interim exercise takes place to further prioritise the uncertainties. The last stage is a final workshop where partners debate and finally arrive at a top 10 list of shared uncertainties.The living with and beyond cancer PSP received 3500 questions submitted by people affected by cancer and healthcare professionals. Through a 18-month established rigorous process, the questions are prioritised down to the Top 10 living with and beyond cancer priorities for research in June 2018. This is the first time that clear research priorities have been identified in this area. They are the most impactful research questions that will help improve the lives of people affected by cancer. The Top 10 uncertainties will be publicised widely to ensure that researchers and those who fund research really understand what matters to people affected by cancer. The top uncertainties will be promoted to many research organizations and relevant funders in the UK. We anticipate they will directly influence future research.
Citation Format: Feng Li, Adrienne Morgan, Angela McCullagh, Anne Johnson, Ceinwen Giles, Diana Greenfield, Graeme Crawford, Jacqui Gath, Jane Lyons, Jervoise Andreyev, Jonathan Tobutt, Julia Tugwell, Karen Robb, Laura Cove-Smith, Lindsey Bennister, Natalie Doyle, Nicolas Lee, Rebecca Nash, Richard Simcock, Richard Stephens, Sabine Best, Susan Moug, Kristina Staley, Sandra Regan, Patricia Ellis, Stuart Griffiths, Ian Lewis. Top 10 living with and beyond cancer research priorities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3348.
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Affiliation(s)
- Feng Li
- 1National Cancer Research Institute, London, United Kingdom
| | | | - Angela McCullagh
- 3National Cancer Research Institute Consumer Forum, London, United Kingdom
| | | | | | - Diana Greenfield
- 6Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Graeme Crawford
- 7Bangor Health Centre, Northern Ireland, Bangor, United Kingdom
| | - Jacqui Gath
- 2Independent Cancer Patients' Voice, London, United Kingdom
| | | | - Jervoise Andreyev
- 9United Lincolnshire Hospitals NHS Trust, Lincolnshire, United Kingdom
| | | | - Julia Tugwell
- 3National Cancer Research Institute Consumer Forum, London, United Kingdom
| | - Karen Robb
- 11Transforming Cancer Services Team in London, London, United Kingdom
| | | | | | - Natalie Doyle
- 14The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nicolas Lee
- 15Macmillan Cancer Support, London, United Kingdom
| | - Rebecca Nash
- 15Macmillan Cancer Support, London, United Kingdom
| | - Richard Simcock
- 16Brighton and Sussex University Hospital Trust, Brighton, United Kingdom
| | - Richard Stephens
- 3National Cancer Research Institute Consumer Forum, London, United Kingdom
| | | | - Susan Moug
- 18Royal Alexandra Hospital Paisley, Glasgow, United Kingdom
| | | | - Sandra Regan
- 20NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | | | | | - Ian Lewis
- 1National Cancer Research Institute, London, United Kingdom
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Younger E, Husson O, Bennister L, Whelan J, Wilson R, Roast A, Jones RL, van der Graaf WT. Age-related sarcoma patient experience: results from a national survey in England. BMC Cancer 2018; 18:991. [PMID: 30333006 PMCID: PMC6192120 DOI: 10.1186/s12885-018-4866-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/26/2018] [Indexed: 01/04/2023] Open
Abstract
Background Sarcomas are rare, heterogeneous tumours affecting patients of any age. Previous surveys describe that sarcoma patients report a significantly worse experience than those with common cancers. Consequently, Sarcoma UK conducted a national survey and these data were examined for age- and tumour-related differences in patients’ experiences. Methods Patients were randomly selected from respondents to National Cancer Patient Experience Surveys (n = 900). Differences between patient groups according to age (Adolescents and Young Adults [AYA] 18–39 years, middle-aged 40–64 years, elderly 65 + years) and tumour type (soft-tissue [STS] vs. bone]) were analysed with t-tests or chi-square tests. Results Survey response rate was 62% (n = 558; STS 75%, bone sarcoma 25%). Delay in diagnosis was reported; 27% patients (n = 150) waited > 3 months and initial symptoms were incorrectly interpreted; AYA STS patients were significantly more likely to be treated for another condition, or advised that their symptoms were not serious, than older STS patients. Clinical trial participation was low (6%, n = 35). Symptom burden was high, most commonly daytime fatigue (48%, n = 277) and pain (44%, n = 248). AYAs were significantly more likely to report most side-effects and post-treatment concerns than older patients. Elderly patients were more satisfied with the information and emotional support provided than younger patients, however were significantly less likely to be referred to rehabilitation services. Conclusions This study identifies significant age-related differences in the sarcoma patient journey, which are not only related to variation in tumour-types. These results provide rationale for adopting an age-specific approach to the management of sarcoma patients in order to improve overall patient experience. Electronic supplementary material The online version of this article (10.1186/s12885-018-4866-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Olga Husson
- Sarcoma Unit, Royal Marsden Hospital, London, SW3 6JJ, UK.,Division of Clinical Studies, Institute of Cancer Research, London, SW7 3RP, UK
| | | | - Jeremy Whelan
- University College London Hospital (UCLH), London, NW1 2BU, UK
| | - Roger Wilson
- Sarcoma UK Registered Cancer Charity, London, N1 6AH, UK
| | - Andy Roast
- Sarcoma UK Registered Cancer Charity, London, N1 6AH, UK
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital, London, SW3 6JJ, UK.,Division of Clinical Studies, Institute of Cancer Research, London, SW7 3RP, UK
| | - Winette Ta van der Graaf
- Sarcoma Unit, Royal Marsden Hospital, London, SW3 6JJ, UK. .,Division of Clinical Studies, Institute of Cancer Research, London, SW7 3RP, UK.
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Younger E, Whelan J, Jones R, Bennister L, van der Graaf W. Patient perspective of the diagnostic sarcoma pathway; results from a national sarcoma patient survey in England. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw388.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kager L, Whelan J, Dirksen U, Hassan B, Anninga J, Bennister L, Bovée JVMG, Brennan B, Broto JM, Brugières L, Cleton-Jansen AM, Copland C, Dutour A, Fagioli F, Ferrari S, Fiocco M, Fleuren E, Gaspar N, Gelderblom H, Gerrand C, Gerß J, Gonzato O, van der Graaf W, Hecker-Nolting S, Herrero-Martín D, Klco-Brosius S, Kovar H, Ladenstein R, Lancia C, LeDeley MC, McCabe MG, Metzler M, Myklebost O, Nathrath M, Picci P, Potratz J, Redini F, Richter GHS, Reinke D, Rutkowski P, Scotlandi K, Strauss S, Thomas D, Tirado OM, Tirode F, Vassal G, Bielack SS. The ENCCA-WP7/EuroSarc/EEC/PROVABES/EURAMOS 3rd European Bone Sarcoma Networking Meeting/Joint Workshop of EU Bone Sarcoma Translational Research Networks; Vienna, Austria, September 24-25, 2015. Workshop Report. Clin Sarcoma Res 2016; 6:3. [PMID: 27315524 PMCID: PMC4794847 DOI: 10.1186/s13569-016-0043-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/10/2016] [Indexed: 11/15/2022] Open
Abstract
This report summarizes the results of the 3rd Joint ENCCA-WP7, EuroSarc, EEC, PROVABES, and EURAMOS European Bone Sarcoma Network Meeting, which was held at the Children’s Cancer Research Institute in Vienna, Austria on September 24–25, 2015. The joint bone sarcoma network meetings bring together European bone sarcoma researchers to present and discuss current knowledge on bone sarcoma biology, genetics, immunology, as well as results from preclinical investigations and clinical trials, to generate novel hypotheses for collaborative biological and clinical investigations. The ultimate goal is to further improve therapy and outcome in patients with bone sarcomas.
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Affiliation(s)
- Leo Kager
- Department of Paediatrics, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria
| | | | - Uta Dirksen
- Universitätsklinikum Münster, Munster, Germany
| | | | - Jakob Anninga
- Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | - Marta Fiocco
- Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Emmy Fleuren
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | - David Herrero-Martín
- Sarcoma Research Group, Molecular Oncology Laboratory, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Ruth Ladenstein
- Department of Paediatrics, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria.,Children's Cancer Research Institute, Vienna, Austria
| | - Carlo Lancia
- Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | | | | | | | | | - Michaela Nathrath
- Technische Universität München, Munich, Germany.,Klinikum Kassel, Kassel, Germany
| | | | | | | | | | - Denise Reinke
- Sarcoma Alliance through Research and Collaboration, Ann Arbor, USA
| | - Piotr Rutkowski
- Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | | | | | - David Thomas
- Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Oscar M Tirado
- Sarcoma Research Group, Molecular Oncology Laboratory, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Stefan S Bielack
- Universitätsklinikum Münster, Munster, Germany.,Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
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