No Time for Waste! Co-Producing Practice Guidelines and Research Recommendations to Promote Earlier Diagnosis of...

In the United Kingdom, community pharmacists (CPs) are increasingly being used to provide supplemental care for patients with specific conditions while the NHS is under pressure from declining GP numbers alongside a rising demand for services. CPs are ideally placed to contribute to early diagnosis of colorectal cancer (CRC) through extended services, especially amongst deprived areas where access is higher across all deprivation deciles in urban areas. However, they need to be embedded within integrated pathways with clear lines of communication and co-operation between CPs and other healthcare professionals. There is not yet a clear understanding of the challenges and barriers to this integration, or the best way forward to expand CP services to include earlier CRC diagnosis. The present study aimed to co-produce a set of practice guidelines and research recommendations about how community pharmacy can facilitate early CRC diagnosis.

We ran a series of three co-production workshops across two sites (six total) in London and Newcastle (2023-2024). Nominal Group Technique was chosen to structure each co-production session and provided the basis of our workshop guide. Workshops were audio recorded and transcribed for qualitative analysis using both a framework approach and an inductive content analysis, which is the focus of this paper.

The salient issues CP staff face include assessing individual risk, incorporating additional services into existing workloads and financial constraints, advertising these services effectively, better use of physical space to allay CP users' privacy concerns, and finding ways better with other healthcare providers.

Expanding CP services to include screening efforts for CRC is achievable in the short term through practical actions. Key recommendations include addressing privacy concerns for pharmacy customers when discussing CRC symptoms, better utilising and expanding digital communication tools to facilitate closer working relationships between CPs and other healthcare professionals, and providing adequate incentives, screening and support materials to CPs, including FIT kits.

PPIE input was central throughout all stages of this study including study conception via our public co-applicant (L. B.), methodology and study conduct. We held meetings of both a patient advisory group and a steering committee of academics and PPIE representatives throughout the project. Our steering committee held two meetings, once at the onset of study development, and again prior to our final dissemination workshop. This consisted of nine people, one of whom was a patient representative. Our patient advisory group met twice during our project, comprised of ten people, five of whom were patient representatives along with five members of the research team. This group met to review our process after completion of the first workshop at each site, and then again after completion of all workshops to plan our final consolidation meeting. Each workshop was also facilitated by our public co-applicant and, in some cases, other patient representatives, who met regularly with other facilitators during the organising and running of each workshop. Members of our PPIE group contributed to the paper write up as co-authors and led on the creation of study dissemination materials, including a video podcast and website.