Aim of PhD

A fully funded NWCR PhD which explores and determines the factors associated with inequalities experienced by people with cancer, with particular focus on delays in recognising palliative care needs. This is a novel PhD which will develop expertise in high quality mixed research methods and in health inequalities.

Background

Early palliative care in cancer consistently leads to better patient and caregiver outcomes but often the need for palliative care is not recognised. Socioeconomic position and other factors are known to have an impact on accessing palliative care services and place of death, but these factors have mostly been investigated regarding access to specialist palliative care services or data using hospital records. The global pandemic and the recent report from the Chief Medical Officer, Professor Whitty have highlighted the urgent need to tackle health inequalities in coastal communities. This project will use a unique large dataset of primary care and linked secondary care data and qualitative interviews, to explore inequalities in recognising palliative care need among people with cancer in a coastal area of North West England.

What the student will do?

The student will conduct a mixed method study with three concurrent phases and a final consensus and prioritisation of recommendations phase. There is some flexibility in the approach, depending on the student’s interests.

Phase 1 is a systematic literature review to identify factors associated with inequalities in recognising a need for palliative care among people with cancer.

Phase 2 is a cross sectional analysis of contemporaneously collected GP and linked hospital records of cancer decedents (2018-2020) in a North West area to determine the impact of patient characteristics (e.g. age, gender, social deprivation) on outcomes relevant to palliative care (such as recognition of palliative care, death in hospital and hospital admissions in the last year of life).

Phase 3 uses indepth interviews with General Practitioners (GPs) in the North West to explore perceived factors associated with inequalities in recognising when a palliative care approach is needed.

Phase 4 utilises the results from phases 1-3 with a panel of key stakeholders (clinicians, policy makers, commissioners, academics and research partners) to identify and develop recommendations about how the factors associated with inequalities for people with cancer can be overcome.

Training available

As well as the fortnightly supervision, training is provided across all stages of the programme, with emphasis placed on the elements of particular relevance to this PhD (including research ethics, systematic literature reviews, secondary data analysis, qualitative data collection and analysis etc). Alongside the training offered as part of the Division of Health Research PhD programme, additional quantitative data analysis training and support can be accessed through Lancaster Medical School’s postrgraduate courses and from the Maths and Stats Hub (MASH) at Lancaster University.

PhD students within the Faculty of Health and Medicine are encouraged to access a range of interdisciplinary research training from across the university, and to engage with the Lancaster University Doctoral Academy (www.lancaster.ac.uk/research/doctoral-academy).

Salary and additional benefits

A three year fully funded PhD studentship, which includes UK home tuition fees, stipend of £19,000 per year and all research costs including salary for data analysist and Public Patient Involvement (PPI) coordinator, remuneration for GP participants, equipment and dissemination costs. Total studenship award £99,189.

Eligibility

The award is available to applicants with a home fee status only.

Start date 1^st October 2022.

For informal enquires please contact Dr. Amy Gadoud a.gadoud@lancaster.ac.uk.

Selection process

Send CV and supporting letter detailing how your interests and experience relate to the project to Dr Amy Gadoud a.gadoud@lancaster.ac.uk by Thursday 4^th August. Interviews will be held via Teams on 11^th August. Shortlisted candidates will be asked to give a five minute presentation on: How do social inequalities affect health in the UK?

A PhD scholarship funded by Lancashire Teaching Hospitals NHS Trust is available to study how we improve the quality of health services at scale. This is an exciting and timely project given that the NHS Long Term Plan identified the role of quality improvement in building a sustainable NHS for the future, highlighting the need for local health systems to have the capability to implement change effectively.

Starting date for the studentship will be spring 2022.

Research about how organisations have successfully adopted quality improvement approaches and what the critical factors for success are, is limited. There is a growing body of evidence which explores how individual organisations have adopted robust quality improvement methods, but there is a gap in the current evidence for translating improvement at an organisational level to a system level – such as at the level of an Integrated Care System. The aim of this project is to therefore investigate the adoption of quality improvement at a system level and to identify the critical factors for success.

This will be a mixed methods study, addressing the following objectives:

• To determine the influence of QI on cultural and leadership behaviours to positively impact patient and staff experience and outcomes.
• To explore the experiences of the board and senior leadership team and staff in adopting a QI approach as business as usual.
• To explore the fidelity of the quality improvement methods when used at a system level.
• To investigate the impact of using data for improvement to engage staff to lead improvements at a system level.

The project proposal and approach will be shaped by the student and supervisors in collaboration with an advisory group, including patients and the public.

Skills and disciplines: We are open to applicants from all disciplinary backgrounds, but preference will be given to candidates with experience in health and/or social care, and in using qualitative approaches.

You will need excellent communication skills, and a willingness to work as part of a team.

Applicants should hold a 1^st or 2.1 honours degree in a relevant discipline to the PhD area.

Applications should be made directly to Prof Jo Rycroft-Malone at j.rycroft-malone1@lancaster.ac.uk and should include:

1. CV (max 2 A4 sides), including details of two academic references

2. A cover letter outlining your qualifications and interest in the studentship (max 2 A4 sides)

Closing date for applications - 29th November 2021

We encourage you to contact either Prof Jo Rycroft-Malone at j.rycroft-malone1@lancaster.ac.uk and/or Dr Ailsa Brotherton Ailsa.Brotherton@lthtr.nhs.uk to discuss your application.