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Reale S, Turner RR, Steed L, Taylor SJC, Rosario DJ, Bourke L, Morrissey D, Innes AQ, Sutton E. Using Normalisation Process Theory to explore the contribution of stakeholder workshops to the development and refinement of a complex behavioural intervention: the STAMINA lifestyle intervention. Implement Sci Commun 2024; 5:94. [PMID: 39223607 PMCID: PMC11370076 DOI: 10.1186/s43058-024-00629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) recommend that men with prostate cancer on androgen deprivation therapy (ADT) are offered twice weekly supervised aerobic and resistance exercise to address side effects of treatment. However, supervised exercise is not routinely offered in standard clinical practice. The STAMINA programme grant for applied research (PGfAR) has been designed to evaluate whether this recommendation can be delivered within standard NHS care. This paper describes how future implementation of NICE recommendations within the NHS was explored during complex intervention development to enable evaluation of a lifestyle intervention. METHODS Two stakeholder workshops were conducted to explore factors pertinent to future implementation of the STAMINA Lifestyle intervention (SLI). Normalisation Process Theory (NPT) provided the theoretical framework for discussion and analysis. Stakeholder workshop 1 focussed on intervention coherence and buy-in. Stakeholder workshop 2 explored barriers and facilitators for embedding SLI into the context of the NHS, with delivery partner Nuffield Health, in the future. RESULTS Workshops were attended by healthcare professionals (n = 16), exercise professionals (n = 17), members of public involved in PPI including patients (n = 12), health psychologists (n = 2), clinical commissioners (n = 4), cancer charities (n = 3), a cancer alliance (n = 1) and health economist (n = 1). Stakeholders agreed that professional training packages should emphasise the uniqueness of the SLI and underpinning theory and evidence (Coherence). To further engagement, the use of STAMINA champions and information about the delivery partner were recommended to enhance confidence and knowledge (Cognitive participation). Furthermore, a simple communication (Collective Action) and progress reporting system (Reflexive Monitoring) was suggested to fit into existing infrastructure within the NHS and community partner. CONCLUSIONS Application of NPT within two stakeholder workshops enhanced complex intervention development. Context-specific strategies to support implementation of SLI within the context of a trial were proposed, sensed-checked, and considered acceptable. The organisational implications of embedding and sustaining the intervention in preparation for wider NHS roll-out were considered (if proven to be effective) and will be explored in the qualitative component of a process evaluation underpinned by NPT. TRIAL REGISTRATION (ISRCTN: 46385239 ). Registered on July 30, 2020.
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Affiliation(s)
- Sophie Reale
- Allied Health Professions, College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield, UK.
| | - Rebecca R Turner
- Division of Medical Education, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Liz Steed
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Steph J C Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Derek J Rosario
- Sheffield Teaching Hospitals NHS Foundation Trust, Department of Urology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Liam Bourke
- Allied Health Professions, College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Dylan Morrissey
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, UK
| | | | - Eileen Sutton
- British Population Health Sciences Institute, University of Bristol, Bristol, UK
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Shen H, van der Kleij R, van der Boog PJM, Chavannes NH. Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach. JMIR Form Res 2024; 8:e48605. [PMID: 38869943 PMCID: PMC11211709 DOI: 10.2196/48605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/24/2023] [Accepted: 04/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited. OBJECTIVE This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention. METHODS We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR-Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group. RESULTS An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including "knowledge and beliefs" in the domain "individual characteristics," "quality and advantage of eHealth intervention" in the domain "intervention characteristics," "compatibility" in the domain "inner setting," and "cultural context" in the domain "outer setting." To ensure the effectiveness of the Dutch MD-based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention's appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app. CONCLUSIONS Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients' self-management skills and improve health status and quality of life. Moreover, our study's research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts. TRIAL REGISTRATION ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923.
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Affiliation(s)
- Hongxia Shen
- School of Nursing, Guangzhou Medical University, Guangzhou, China
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
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McNaught E, Reale S, Bourke L, Brown JE, Collinson M, Day F, Hewison J, Farrin AJ, Ibeggazene S, Innes AQ, Mason E, Meads D, Scope A, Taylor C, Taylor SJ, Turner RR, Rosario DJ. Supported exercise TrAining for Men wIth prostate caNcer on Androgen deprivation therapy (STAMINA): study protocol for a randomised controlled trial of the clinical and cost-effectiveness of the STAMINA lifestyle intervention compared with optimised usual care, including internal pilot and parallel process evaluation. Trials 2024; 25:257. [PMID: 38610058 PMCID: PMC11010375 DOI: 10.1186/s13063-024-07989-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND UK national clinical guidance recommends that men with prostate cancer on androgen deprivation therapy are offered twice weekly supervised aerobic and resistance exercise to address iatrogenic harm caused by treatment. Very few NHS trusts have established adequate provision of such services. Furthermore, interventions fail to demonstrate sustained behaviour change. The STAMINA lifestyle intervention offers a system-level change to clinical care delivery addressing barriers to long-term behaviour change and implementation of new prostate cancer care pathways. This trial aims to establish whether STAMINA is clinically and cost-effective in improving cancer-specific quality of life and/or reducing fatigue compared to optimised usual care. The process evaluation aims to inform the interpretation of results and, if the intervention is shown to benefit patients, to inform the implementation of the intervention into the NHS. METHODS Men with prostate cancer on androgen deprivation therapy (n = 697) will be identified from a minimum of 12 UK NHS trusts to participate in a multi-centre, two-arm, individually randomised controlled trial. Consenting men will have a 'safety to exercise' check and be randomly allocated (5:4) to the STAMINA lifestyle intervention (n = 384) or optimised usual care (n = 313). Outcomes will be collected at baseline, 3-, 6- and 12-month post-randomisation. The two primary outcomes are cancer-specific quality of life and fatigue. The parallel process evaluation will follow a mixed-methods approach to explore recruitment and aspects of the intervention including, reach, fidelity, acceptability, and implementation. An economic evaluation will estimate the cost-effectiveness of the STAMINA lifestyle intervention versus optimised usual care and a discrete choice experiment will explore patient preferences. DISCUSSION The STAMINA lifestyle intervention has the potential to improve quality of life and reduce fatigue in men on androgen deprivation therapy for prostate cancer. Embedding supervised exercise into prostate cancer care may also support long-term positive behaviour change and reduce adverse events caused by treatment. Findings will inform future clinical care and could provide a blueprint for the integration of supervised exercise and behavioural support into other cancer and/or clinical services. TRIAL REGISTRATION ISRCTN 46385239, registered on 30/07/2020. Cancer Research UK 17002, retrospectively registered on 24/08/2022.
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Affiliation(s)
- Emma McNaught
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Sophie Reale
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Liam Bourke
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Janet E Brown
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2RX, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Florence Day
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jenny Hewison
- Division of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Saïd Ibeggazene
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Aidan Q Innes
- Nuffield Health, 2 Ashley Avenue, Epsom, Surrey, KT18 5AL, UK
| | - Ellen Mason
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Alison Scope
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Chris Taylor
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Steph Jc Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Rebecca R Turner
- Division of Psychology and Mental Health in the School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Derek J Rosario
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Sun Y, Ren T, Ji X. Influence of hyperbaric oxygen therapy-specialized care on limb motor function and mental state of cerebral infarction patients with hemiplegia. Technol Health Care 2024; 32:1967-1976. [PMID: 38393863 DOI: 10.3233/thc-231643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND Currently, cerebral infarction (CI) is mainly treated by emergency craniotomy or conservative treatment. However, some studies have questioned the functional recovery of patients after hyperbaric oxygen therapy (HBOT)-specialized care. OBJECTIVE This paper mainly explores the influence of HBOT-specialized care on limb motor function (LMF) and mental state of CI patients with hemiplegia. METHODS The medical records of 113 CI patients with hemiplegia treated in our hospital from March 2020 to March 2022 were collected. Of these, 53 received routine care nursing (conventional group) and 60 cases were given HBOT-specialized care (research group). Patient general data, scores of Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Self-rating Anxiety/Depression Scale (SAS/SDS) and Barthel Index (BI), and nursing efficiency were comparatively analyzed. RESULTS The two groups showed comparability in general data. FMA and BI scores were increased in the research group after rehabilitation treatment, higher than the baseline and those of the conventional group, while NIHSS, SAS, and SDS scores were reduced, lower compared with baseline and those of the conventional group. In addition, significantly higher nursing efficiency was determined in the research group. CONCLUSION HBOT-specialized care has beneficial effects on LMF, mental state, negative emotions and self-care ability of CI patients with hemiplegia and can enhance nursing efficacy, which deserves clinical popularization.
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Affiliation(s)
- Yi Sun
- Hyperbaric Oxygen Department, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
- Hyperbaric Oxygen Department, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Tao Ren
- Key Laboratory of Sports Rehabilitation and Training, Nanjing Sport Institute, Nanjing, Jiangsu, China
- Hyperbaric Oxygen Department, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Xueli Ji
- Emergency Medical Center, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
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Depenbusch J, Haussmann A, Wiskemann J, Tsiouris A, Schmidt L, Sieverding M, Ungar N, Steindorf K. The Relationship between Exercise Self-Efficacy, Intention, and Structural Barriers for Physical Activity after a Cancer Diagnosis. Cancers (Basel) 2022; 14:cancers14102480. [PMID: 35626083 PMCID: PMC9139255 DOI: 10.3390/cancers14102480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Despite numerous benefits of physical activity for cancer patients, the majority is insufficiently active. Previous research has shown that structural barriers negatively affect patients’ physical activity behavior. Identifying underlying mechanisms could help to develop effective strategies that alleviate those barriers and increase physical activity levels. In the current survey study, we investigated whether cancer patients’ self-efficacy, i.e., their confidence in their ability, and their intention to exercise mediated the relationship between structural barriers and physical activity. The results revealed a negative relation between structural barriers and patients’ self-efficacy. Lower self-efficacy, in turn, decreased patients’ intention and their likelihood to engage in physical activity. This mediating effect especially applied to those individuals who were sufficiently active before the diagnosis. Thus, the findings suggest that interventions directly addressing the perception of structural barriers or patients’ self-efficacy in dealing with these barriers might be effective in improving the physical activity levels of cancer patients. Abstract Previous research has shown that structural barriers negatively influence the physical activity (PA) behavior of cancer patients, but underlying mechanisms are unclear. The aim of the current study was to explore the potential mediating role of social-cognitive factors, namely PA self-efficacy and PA intention in this context. A total of 856 cancer patients completed a questionnaire on sociodemographic and medical characteristics, pre- and post-diagnosis PA, PA self-efficacy, PA intention, and PA impediment by structural barriers. A serial mediation model was used to test whether the association between structural barriers and post-diagnosis PA was mediated by PA self-efficacy and/or PA intention, in the overall sample and in subsamples defined by individuals’ pre-diagnosis PA. The results confirmed that structural barriers were not directly (95%CI [−0.45; 0.10]) but indirectly associated with post-diagnosis PA. Higher impediment by structural barriers decreased the likelihood of sufficient post-diagnosis PA via lower PA self-efficacy (95%CI [−0.25; −0.06]) and via the serial pathway of lower PA self-efficacy and lower PA intention (95%CI [−0.19; −0.05]). Investigating differences in these mediations by pre-diagnosis PA yielded significance only among previously active cancer patients. Both structural barriers and PA self-efficacy might hence be relevant target points for interventions aiming to improve PA behavior, especially among pre-diagnosis active cancer patients.
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Affiliation(s)
- Johanna Depenbusch
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; (J.D.); (A.H.)
- Medical Faculty, Heidelberg University, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; (J.D.); (A.H.)
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; (J.W.); (A.T.)
| | - Angeliki Tsiouris
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; (J.W.); (A.T.)
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
| | - Laura Schmidt
- Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117 Heidelberg, Germany; (L.S.); (M.S.); (N.U.)
| | - Monika Sieverding
- Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117 Heidelberg, Germany; (L.S.); (M.S.); (N.U.)
| | - Nadine Ungar
- Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117 Heidelberg, Germany; (L.S.); (M.S.); (N.U.)
- Faculty of Healthcare and Nursing, Catholic University of Applied Sciences Mainz, Saarstraße 3, 55122 Mainz, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; (J.D.); (A.H.)
- Correspondence: ; Tel.: +49-6221-422351
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Reale S, Turner RR, Sutton E, Steed L, Taylor SJC, Morrissey D, Doherty P, Greenfield DM, Collinson M, Hewison J, Brown J, Ibeggazene S, Mason M, Rosario DJ, Bourke L. Embedding supervised exercise training for men on androgen deprivation therapy into standard prostate cancer care: a feasibility and acceptability study (the STAMINA trial). Sci Rep 2021; 11:12470. [PMID: 34127735 PMCID: PMC8203669 DOI: 10.1038/s41598-021-91876-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/17/2021] [Indexed: 11/09/2022] Open
Abstract
Lifestyle interventions involving exercise training offset the adverse effects of androgen deprivation therapy in men with prostate cancer. Yet provision of integrated exercise pathways in cancer care is sparse. This study assessed the feasibility and acceptability of an embedded supervised exercise training intervention into standard prostate cancer care in a single-arm, multicentre prospective cohort study. Feasibility included recruitment, retention, adherence, fidelity and safety. Acceptability of behaviourally informed healthcare and exercise professional training was assessed qualitatively. Despite the imposition of lockdown for the COVID-19 pandemic, referral rates into and adherence to, the intervention was high. Of the 45 men eligible for participation, 79% (n = 36) received the intervention and 47% (n = 21) completed the intervention before a government mandated national lockdown was enforced in the United Kingdom. Patients completed a mean of 27 min of aerobic exercise per session (SD = 3.48), at 77% heart rate maximum (92% of target dose), and 3 sets of 10 reps of 3 resistance exercises twice weekly for 12 weeks, without serious adverse event. The intervention was delivered by 26 healthcare professionals and 16 exercise trainers with moderate to high fidelity, and the intervention was deemed highly acceptable to patients. The impact of societal changes due to the pandemic on the delivery of this face-to-face intervention remain uncertain but positive impacts of embedding exercise provision into prostate cancer care warrant long-term investigation.
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Affiliation(s)
- Sophie Reale
- Allied Health Professionals, Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, UK
| | - Rebecca R Turner
- Allied Health Professionals, Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, UK
| | - Eileen Sutton
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Liz Steed
- Institute for Population Health Sciences, Queen Mary University of London, London, UK
| | - Stephanie J C Taylor
- Institute for Population Health Sciences, Queen Mary University of London, London, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Diana M Greenfield
- Specialised Cancer Services, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jenny Hewison
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Janet Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Saïd Ibeggazene
- Allied Health Professionals, Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, UK
| | | | - Derek J Rosario
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Liam Bourke
- Allied Health Professionals, Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, UK.
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