Title: Understanding experience, completion and outcomes of colorectal cancer screening among participants with multi-morbidity
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background: The impact of multi-morbidity (the presence of two or more long-term conditions) on colorectal cancer screening experience, completion and outcomes is currently unknown. Moving away from a single disease focus is needed in research and health service provision as multi-morbidity is becoming the norm. This research will understand how current screening strategies do not fit this ‘new norm’ and generate solutions to overcome this. Aims: Identify strategies and interventions to overcome the impact that multi-morbidity has on colorectal cancer screening participants, the health professional who consult with them and the screening service Methods: A triangulation protocol will be developed and carried out to bring together the mixed method findings. This study is mixed-methods as it has quantitative and qualitative phases. The triangulation protocol will outline steps that need to be taken to bring the evidence from the different phases of work together. Phase 1: Data analysis will be conducting using data from three different sources. These will be screening data, GP data and hospital data. These will be brought together to describe investigative pathways in colorectal cancer screening. The analysis will focus on participants with and without multi-morbidity who have received a positive stool test. Analysis will explore the relationship between factors such as follow-up, test characteristics and outcomes with multi-morbidity. Phase 2: Qualitative interviews will explore screening participant (n=35-40) understanding of multimorbidity and perceptions of severity, illness representations, motivations, expectations, barriers and level of advice/support after a positive stool test. Phase 3: Qualitative interviews (n=15-20) with colorectal screening healthcare professionals will explore how multi-morbidity impacts decision making processes for referrals, illness representations and potential acceptance of tests. Phase 4: A triangulation protocol will be used to bring the findings from Phases 1-3 together. This will lead to understanding the interaction between screening participant and healthcare professional perceptions and observed screening completion characteristics. Phase 5: Strategies and intervention recommendations will be made for each of the findings from Phase 4. Recommendations will include how to address and implement the findings within the screening programme. These will form the basis for funding applications beyond the fellowship. How results will be used: This work will lead to understanding of factors affecting completion of colorectal cancer screening in terms of barriers, decision pathways and outcomes for people with multi-morbidity. It will also lead to the identification of tailored strategies and interventions that need to be developed at the participant, healthcare professional and system levels. A clear programme of work will follow the fellowship. This will include the development and evaluation of resources to support people with multi-morbidity and healthcare professionals who consult with them. It will also form a template for future work for other screening programmes and cancer interventions where competing factors may affect perceptions, mortality and quality of life.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;7.1 INDIVIDUAL CARE NEEDS
Health categories: CANCER AND NEOPLASMS