Sequential simulation (SqS) of clinical pathways: a tool for public and patient engagement in point-of-care diagnostics

• Published in: BMJ open 2016-09, Vol.6 (9), p.e011043-e011043
• Main Authors: Huddy, Jeremy R, Weldon, Sharon-Marie, Ralhan, Shvaita, Painter, Tim, Hanna, George B, Kneebone, Roger, Bello, Fernando
• Format: Article
• Language: English
• Subjects: Breath Tests; Case studies; Critical Pathways - standards; Diagnostic tests; Endoscopy; Esophageal cancer; Esophageal Neoplasms - diagnosis; Gastroesophageal reflux; Health Personnel - education; Humans; Innovations; London; Patient care planning; Patient Care Team; Patient Participation - methods; Patient-Centred Medicine; Point of care testing; R&D; Research & development; Simulation; Simulation Training - methods; Surveys and Questionnaires; VOCs; Volatile organic compounds; Workshops
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-011043

ObjectivesPublic and patient engagement (PPE) is fundamental to healthcare research. To facilitate effective engagement in novel point-of-care tests (POCTs), the test and downstream consequences of the result need to be considered. Sequential simulation (SqS) is a tool to represent patient journeys and the effects of intervention at each and subsequent stages. This case study presents a process evaluation of SqS as a tool for PPE in the development of a volatile organic compound-based breath test POCT for the diagnosis of oesophagogastric (OG) cancer.SettingThree 3-hour workshops in central London.Participants38 members of public attended a workshop, 26 (68%) had no prior experience of the OG cancer diagnostic pathway.InterventionsClinical pathway SqS was developed from a storyboard of a patient, played by an actor, noticing symptoms of oesophageal cancer and following a typical diagnostic pathway. The proposed breath testing strategy was then introduced and incorporated into a second SqS to demonstrate pathway impact. Facilitated group discussions followed each SqS.Primary and secondary outcome measuresEvaluation was conducted through pre-event and postevent questionnaires, field notes and analysis of audiovisual recordings.Results38 participants attended a workshop. All participants agreed they were able to contribute to discussions and like the idea of an OG cancer breath test. Five themes emerged related to the proposed new breath test including awareness of OG cancer, barriers to testing and diagnosis, design of new test device, new clinical pathway and placement of test device. 3 themes emerged related to the use of SqS: participatory engagement, simulation and empathetic engagement, and why participants attended.ConclusionsSqS facilitated a shared immersive experience for participants and researchers that led to the coconstruction of knowledge that will guide future research activities and be of value to stakeholders concerned with the invention and adoption of POCT.