Ezaydi Naseeb, Hind Daniel, Arif Atique, Kellar Ian, Matthews Rachel, Marbu Dana, Thomas Claire, Kurien Matthew
School of Medicine and Population Health, Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK.
Senior Research Fellow (Social Care Research and Development), School of Healthcare, University of Leeds, Leeds, UK.
Res Involv Engagem. 2025 Jun 10;11(1):59. doi: 10.1186/s40900-025-00740-0.
Colorectal cancer (CRC) is the fourth most common cancer and second leading cause of cancer deaths in the UK. Socioeconomic deprivation is associated with delayed diagnoses and poorer CRC outcomes. Community pharmacies, highly accessible in underserved areas, present an opportunity to address these health inequalities. This DETECT-CRC study aimed to develop a pharmacy-based active case-finding (ACF) service for CRC in underserved communities of Yorkshire, UK.
We used a modified Experience-Based Co-Design (EBCD) approach to develop the ACF service. Four co-design workshops were conducted over five months, bringing together pharmacists, general practitioners (GP), patients and community members. A focused ethnography was embedded within the EBCD process, consisting of interviews and observation of workshops. Field notes were analysed thematically to identify key considerations shaping the service design.
Three overarching themes emerged: 1) Amplifying community pharmacy assets, emphasising accessibility and trust-building; 2) Strengthening inclusive practice, highlighting privacy, cultural considerations, health literacy, and emotional factors; and 3) Enabling service integration and quality, stressing collaboration between pharmacies and GPs, and pharmacy training needs. These insights informed the development of a comprehensive ACF service model, including multilingual patient-facing materials, a training package for pharmacy staff, and protocols for GP communication. The co-design process ensured the resulting service was grounded in community needs and perspectives.
This study provides a co-designed model for pharmacy-based ACF of CRC in underserved areas. The model shows promise in addressing health inequalities and improving early cancer detection. It demonstrates how community pharmacies can play a pivotal role in cancer detection, contributing to the NHS Long Term Plan's ambition of diagnosing 75% of cancers at stage 1 or 2 by 2028. While further research is needed to evaluate its effectiveness, this approach holds potential for improving CRC outcomes in underserved communities and could be adapted for other health conditions and settings.
在英国，结直肠癌（CRC）是第四大常见癌症，也是癌症死亡的第二大主要原因。社会经济剥夺与诊断延迟和较差的结直肠癌治疗结果相关。社区药房在服务不足地区极易获取，为解决这些健康不平等问题提供了契机。这项DETECT-CRC研究旨在为英国约克郡服务不足社区的结直肠癌开发一种基于药房的主动病例发现（ACF）服务。
我们采用了一种改良的基于经验的协同设计（EBCD）方法来开发ACF服务。在五个月内举办了四次协同设计研讨会，召集了药剂师、全科医生（GP）、患者和社区成员。在EBCD过程中融入了重点人种志研究，包括对研讨会的访谈和观察。对实地记录进行主题分析，以确定影响服务设计的关键因素。
出现了三个总体主题：1）增强社区药房资产，强调可及性和建立信任；2）加强包容性实践，突出隐私、文化因素、健康素养和情感因素；3）实现服务整合与质量，强调药房与全科医生之间的合作以及药房培训需求。这些见解为全面的ACF服务模式的开发提供了依据，包括多语言面向患者的材料、药房工作人员培训包以及全科医生沟通协议。协同设计过程确保了最终的服务基于社区需求和观点。
本研究为服务不足地区基于药房的结直肠癌ACF提供了一种协同设计的模式。该模式在解决健康不平等和改善早期癌症检测方面显示出前景。它展示了社区药房如何在癌症检测中发挥关键作用，有助于实现英国国家医疗服务体系（NHS）长期计划中到2028年将75%的癌症在1期或2期诊断出来的目标。虽然需要进一步研究来评估其有效性，但这种方法在改善服务不足社区的结直肠癌治疗结果方面具有潜力，并且可以适用于其他健康状况和环境。
