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How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives

Katie Jones, Joanne Connell, Arya Chandran, Stephen Farrington, Sohail Moosa, Janet Mackrell, Savita Shanbhag, Yeung Ng, Chris Hopkins, Rachel Gemine, Jaynie Rance Orcid Logo

BMJ Connections Oncology, Volume: 2, Issue: 1, Start page: e000031

Swansea University Authors: Katie Jones, Jaynie Rance Orcid Logo

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DOI (Published version): 10.1136/bmjconc-2025-000031

Abstract

Introduction Referral to a cancer diagnostic pathway is a stressful life event, yet distress may be exacerbated by long waiting times, miscommunications or other avoidable challenges. A model prostate cancer (PCa) rapid diagnostic pathway (RDP) called Prostad has been developed and trialled to reduc...

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Published in: BMJ Connections Oncology
ISSN: 3049-5784
Published: BMJ 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa70226
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A realist evaluation based on patient, caregiver and staff perspectives</title><swanseaauthors><author><sid>c0f2b73bae9ddb83529aecd6a191a7a4</sid><firstname>Katie</firstname><surname>Jones</surname><name>Katie Jones</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>14360f4993b452995fbc22db857cabf7</sid><ORCID>0000-0002-9504-0675</ORCID><firstname>Jaynie</firstname><surname>Rance</surname><name>Jaynie Rance</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2025-08-26</date><abstract>Introduction Referral to a cancer diagnostic pathway is a stressful life event, yet distress may be exacerbated by long waiting times, miscommunications or other avoidable challenges. A model prostate cancer (PCa) rapid diagnostic pathway (RDP) called Prostad has been developed and trialled to reduce the time between referral or diagnosis. This realist evaluation asks how, for whom and under which circumstances this model RDP may reduce anxiety for patients.Research design and methods We conducted semi-structured realist interviews with staff, carers/ partners of patients and patients exploring how, for whom and under which circumstances the PCa RDP produced intended and unintended outcomes. We also attended monthly programme development meetings and had access to documentation regarding the pathway and its development, which we used to produce theories regarding the contextual and mechanistic factors influencing patient experience of the RDP.Results We interviewed staff (n=12), patients (n=15) and partners or carers of patients (n=3) to produce five programme theories regarding how patients interact with Prostad to produce outcomes. These theories are organised under five themes: rapidity; communication and virtual consultations; communication and continuity; disempowerment and distress; agency mitigating anxiety.Conclusions Earlier diagnosis is viewed positively by participants; however, in a context where patients have low expectations of health services, the speed of RDPs needs to be adequately communicated at the time the pathway is introduced to the patient to avoid unnecessary concern regarding the rapidity. 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spelling 2025-09-25T14:38:52.5468106 v2 70226 2025-08-26 How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives c0f2b73bae9ddb83529aecd6a191a7a4 Katie Jones Katie Jones true false 14360f4993b452995fbc22db857cabf7 0000-0002-9504-0675 Jaynie Rance Jaynie Rance true false 2025-08-26 Introduction Referral to a cancer diagnostic pathway is a stressful life event, yet distress may be exacerbated by long waiting times, miscommunications or other avoidable challenges. A model prostate cancer (PCa) rapid diagnostic pathway (RDP) called Prostad has been developed and trialled to reduce the time between referral or diagnosis. This realist evaluation asks how, for whom and under which circumstances this model RDP may reduce anxiety for patients.Research design and methods We conducted semi-structured realist interviews with staff, carers/ partners of patients and patients exploring how, for whom and under which circumstances the PCa RDP produced intended and unintended outcomes. We also attended monthly programme development meetings and had access to documentation regarding the pathway and its development, which we used to produce theories regarding the contextual and mechanistic factors influencing patient experience of the RDP.Results We interviewed staff (n=12), patients (n=15) and partners or carers of patients (n=3) to produce five programme theories regarding how patients interact with Prostad to produce outcomes. These theories are organised under five themes: rapidity; communication and virtual consultations; communication and continuity; disempowerment and distress; agency mitigating anxiety.Conclusions Earlier diagnosis is viewed positively by participants; however, in a context where patients have low expectations of health services, the speed of RDPs needs to be adequately communicated at the time the pathway is introduced to the patient to avoid unnecessary concern regarding the rapidity. Patients value regular and consistent communication, which may help mitigate illness uncertainty and offer a sense of control. Journal Article BMJ Connections Oncology 2 1 e000031 BMJ 3049-5784 8 9 2025 2025-09-08 10.1136/bmjconc-2025-000031 COLLEGE NANME COLLEGE CODE Swansea University SU Library paid the OA fee (TA Institutional Deal) Funded by Cancer Research UK [2022/100013] 2025-09-25T14:38:52.5468106 2025-08-26T12:30:30.0043750 Faculty of Medicine, Health and Life Sciences School of Psychology Katie Jones 1 Joanne Connell 2 Arya Chandran 3 Stephen Farrington 4 Sohail Moosa 5 Janet Mackrell 6 Savita Shanbhag 7 Yeung Ng 8 Chris Hopkins 9 Rachel Gemine 10 Jaynie Rance 0000-0002-9504-0675 11 70226__35175__ae3a512fb6234aeaa667614b764b1edd.pdf 70226.VoR.pdf 2025-09-25T14:35:00.0530349 Output 1358914 application/pdf Version of Record true This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license. true eng https://creativecommons.org/licenses/by/4.0/
title How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives
spellingShingle How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives
Katie Jones
Jaynie Rance
title_short How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives
title_full How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives
title_fullStr How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives
title_full_unstemmed How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives
title_sort How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives
author_id_str_mv c0f2b73bae9ddb83529aecd6a191a7a4
14360f4993b452995fbc22db857cabf7
author_id_fullname_str_mv c0f2b73bae9ddb83529aecd6a191a7a4_***_Katie Jones
14360f4993b452995fbc22db857cabf7_***_Jaynie Rance
author Katie Jones
Jaynie Rance
author2 Katie Jones
Joanne Connell
Arya Chandran
Stephen Farrington
Sohail Moosa
Janet Mackrell
Savita Shanbhag
Yeung Ng
Chris Hopkins
Rachel Gemine
Jaynie Rance
format Journal article
container_title BMJ Connections Oncology
container_volume 2
container_issue 1
container_start_page e000031
publishDate 2025
institution Swansea University
issn 3049-5784
doi_str_mv 10.1136/bmjconc-2025-000031
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Psychology{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Psychology
document_store_str 1
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description Introduction Referral to a cancer diagnostic pathway is a stressful life event, yet distress may be exacerbated by long waiting times, miscommunications or other avoidable challenges. A model prostate cancer (PCa) rapid diagnostic pathway (RDP) called Prostad has been developed and trialled to reduce the time between referral or diagnosis. This realist evaluation asks how, for whom and under which circumstances this model RDP may reduce anxiety for patients.Research design and methods We conducted semi-structured realist interviews with staff, carers/ partners of patients and patients exploring how, for whom and under which circumstances the PCa RDP produced intended and unintended outcomes. We also attended monthly programme development meetings and had access to documentation regarding the pathway and its development, which we used to produce theories regarding the contextual and mechanistic factors influencing patient experience of the RDP.Results We interviewed staff (n=12), patients (n=15) and partners or carers of patients (n=3) to produce five programme theories regarding how patients interact with Prostad to produce outcomes. These theories are organised under five themes: rapidity; communication and virtual consultations; communication and continuity; disempowerment and distress; agency mitigating anxiety.Conclusions Earlier diagnosis is viewed positively by participants; however, in a context where patients have low expectations of health services, the speed of RDPs needs to be adequately communicated at the time the pathway is introduced to the patient to avoid unnecessary concern regarding the rapidity. Patients value regular and consistent communication, which may help mitigate illness uncertainty and offer a sense of control.
published_date 2025-09-08T14:18:06Z
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