The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.

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Using the framework method for the analysis of qualitative data in multi-disciplinary health research

Background: Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome.Purpose: The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea.Methods: An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members.Results: Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consist...

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An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer. Part II-2020 Update: Treatment of Relapsing and Metastatic Prostate Cancer

Summary Background Induction of a clinical complete response with chemoradiotherapy, followed by observation via a watch-and-wait approach, has emerged as a management option for patients with rectal cancer. We aimed to address the shortage of evidence regarding the safety of the watch-and-wait approach by comparing oncological outcomes between patients managed by watch and wait who achieved a clinical complete response and those who had surgical resection (standard care). Methods Oncological Outcomes after Clinical Complete Response in Patients with Rectal Cancer (OnCoRe) was a propensity-score matched cohort analysis study, that included patients of all ages diagnosed with rectal adenocarcinoma without distant metastases who had received preoperative chemoradiotherapy (45 Gy in 25 daily fractions with concurrent fluoropyrimidine-based chemotherapy) at a tertiary cancer centre in Manchester, UK, between Jan 14, 2011, and April 15, 2013. Patients who had a clinical complete response were offered management with the watch-and-wait approach, and patients who did not have a complete clinical response were offered surgical resection if eligible. We also included patients with a clinical complete response managed by watch and wait between March 10, 2005, and Jan 21, 2015, across three neighbouring UK regional cancer centres, whose details were obtained through a registry. For comparative analyses, we derived one-to-one paired cohorts of watch and wait versus surgical resection using propensity-score matching (including T stage, age, and performance status). The primary endpoint was non-regrowth disease-free survival from the date that chemoradiotherapy was started, and secondary endpoints were overall survival, and colostomy-free survival. We used a conservative p value of less than 0·01 to indicate statistical significance in the comparative analyses. Findings 259 patients were included in our Manchester tertiary cancer centre cohort, 228 of whom underwent surgical resection at referring hospitals and 31 of whom had a clinical complete response, managed by watch and wait. A further 98 patients were added to the watch-and-wait group via the registry. Of the 129 patients managed by watch and wait (median follow-up 33 months [IQR 19–43]), 44 (34%) had local regrowths (3-year actuarial rate 38% [95% CI 30–48]); 36 (88%) of 41 patients with non-metastatic local regrowths were salvaged. In the matched analyses (109 patients in each treatment group), no differences in 3-year non-regrowth disease-free survival were noted between watch and wait and surgical resection (88% [95% CI 75–94] with watch and wait vs 78% [63–87] with surgical resection; time-varying p=0·043). Similarly, no difference in 3-year overall survival was noted (96% [88–98] vs 87% [77–93]; time-varying p=0·024). By contrast, patients managed by watch and wait had significantly better 3-year colostomy-free survival than did those who had surgical resection (74% [95% CI 64–82] vs 47% [37–57]; hazard ratio 0·445 [95% CI 0·31–0·63; p Interpretation A substantial proportion of patients with rectal cancer managed by watch and wait avoided major surgery and averted permanent colostomy without loss of oncological safety at 3 years. These findings should inform decision making at the outset of chemoradiotherapy. Funding Bowel Disease Research Foundation.

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Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis

Following visible successes on a wide range of predictive tasks, machine learning techniques are attracting substantial interest from medical researchers and clinicians. We address the need for capacity development in this area by providing a conceptual introduction to machine learning alongside a practical guide to developing and evaluating predictive algorithms using freely-available open source software and public domain data. We demonstrate the use of machine learning techniques by developing three predictive models for cancer diagnosis using descriptions of nuclei sampled from breast masses. These algorithms include regularized General Linear Model regression (GLMs), Support Vector Machines (SVMs) with a radial basis function kernel, and single-layer Artificial Neural Networks. The publicly-available dataset describing the breast mass samples (N=683) was randomly split into evaluation (n=456) and validation (n=227) samples. We trained algorithms on data from the evaluation sample before they were used to predict the diagnostic outcome in the validation dataset. We compared the predictions made on the validation datasets with the real-world diagnostic decisions to calculate the accuracy, sensitivity, and specificity of the three models. We explored the use of averaging and voting ensembles to improve predictive performance. We provide a step-by-step guide to developing algorithms using the open-source R statistical programming environment. The trained algorithms were able to classify cell nuclei with high accuracy (.94 -.96), sensitivity (.97 -.99), and specificity (.85 -.94). Maximum accuracy (.96) and area under the curve (.97) was achieved using the SVM algorithm. Prediction performance increased marginally (accuracy =.97, sensitivity =.99, specificity =.95) when algorithms were arranged into a voting ensemble. We use a straightforward example to demonstrate the theory and practice of machine learning for clinicians and medical researchers. The principals which we demonstrate here can be readily applied to other complex tasks including natural language processing and image recognition.

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Machine learning in medicine: a practical introduction

https://radar.brookes.ac.uk/radar/file/d70d4268-0877-4a1a-b24e-2bb150df5f7d/1/1-s2.0-S1877782119300311-main.pdf

Key factors associated with social distress after prostate cancer: Results from the United Kingdom Life after Prostate Cancer diagnosis study.

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Exploration and analysis of free-text comments from the 2013 Wales Cancer Patient Experience Survey (WCPES)

https://radar.brookes.ac.uk/radar/file/c3d1ed69-564a-407b-81bb-0da6678c9175/1/Prostate cancer - 2018 - Wagland et al.pdf

'Very difficult for an ordinary guy': Factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: Findings from a UK-wide mixed methods study.

Objective The number of younger men being diagnosed with prostate cancer (PCa; aged ≤65) is increasing. It is recognised that PCa and treatment side effects can have a significant impact on quality of life. This study explores the challenges faced by younger couples affected by PCa with dependent children (under 18 years) or young adults (18-29 years) in their families. Methods Twenty-three men with PCa and their partners were interviewed (separately) by telephone. Participants were recruited from respondents to the life after prostate cancer diagnosis (LAPCD) national survey. Men were 3 to 5 years postdiagnosis, and following a range of treatment pathways. Data were analysed using the Framework Approach. Results Younger couples affected by PCa felt challenged by issues relating to their parental role and the dynamics within the family. Five main themes emerged: difficult conversations about PCa diagnosis; parental perceptions of the impact of diagnosis on children; parental responses to the impact of PCa on the family; shielding, coping, and normalising strategies; and levels of support. Conclusions A diagnosis of PCa can cause significant disruption to the family unit and the quality of life of its members. Support programmes offering guidance to children/young adults affected by PCa in their family, and addressing the concerns of parents may help families to better adapt. Encouraging clinical professionals to initiate conversations with younger couples about their children may be a way forward in directing appropriate support. Further research is needed to elucidate appropriate, effective supportive interventions.

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The challenges on the family unit faced by younger couples affected by prostate cancer: A qualitative study.

This second interim report provides a summary of key findings from the National Evaluation of the Department of Health’s POPP Programme. These summary findings are based on data collected and analysed over the last two years of the POPP programme (April 2006 to March 2008) and are made available to support emerging learning around prevention and early intervention. As the majority of the pilot sites still have one year to run, these findings, outcomes and subsequent discussion may be subject to change. All the issues and evidence on which these findings are based will be made available in the Final Report of the National Evaluation to be published in Autumn 2009.

Richard Wagland

Papers

Key factors associated with social distress after prostate cancer: Results from the United Kingdom Life after Prostate Cancer diagnosis study.

Exploration and analysis of free-text comments from the 2013 Wales Cancer Patient Experience Survey (WCPES)

'Very difficult for an ordinary guy': Factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: Findings from a UK-wide mixed methods study.

The challenges on the family unit faced by younger couples affected by prostate cancer: A qualitative study.

National evaluation of partnerships for older people projects: interim report of progress