Institute of Epidemiology & Health Care


Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis

Understanding the contribution of physician associates to referral and recognition of possible cancer in primary care

Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis is funded by the NIHR Policy Research Programme. The Unit has five-year work programme builds on a previous PRU (2011-2018) to research policy issues in the three broad areas of cancer awareness, cancer screening, and early diagnosis of cancer, to inform policies for improving stage at presentation of cancer and thus reducing mortality from the disease.

Most patients with cancer first present to primary care. Research to date has focused on GPs but in England the primary care skill mix is changing. This project seeks to understand how a new clinical profession – physician associates - might contribute to cancer recognition and referral in primary care. It is part of the Unit’s early diagnosis workstream.

In this study we have three objectives:

  • Characterise the landscape into which PAs will support recognition and referral of cancer in primary care through a rapid review of relevant literature and policy
  • Examine the clinical reasoning styles of final year student PAs using online patient simulations of possible cancer
  • Develop and convene an expert workshop to identify implications for policy and practice

    This work builds on prior research in the first PRU that first examined how doctors made decisions when faced with simulated patients with possible lung cancer and then used this knowledge to develop an educational intervention for future doctors. The educational intervention, eCREST, was trialled in three medical schools in the UK and has been or there are plans to implement it in medical schools internationally (Turkey, Cyrpus and Spain) and with independent pharmacy prescribers.

Principal Investigator:  Professor Rosalind Raine

Project Staff:     

Angela King, patient advocate with extensive experience of health services research and lived experience of delayed diagnosis

Paul Wilson, patient advocate with extensive expertise in service user advocacy and lived experience of a respiratory condition

Georgia Black, Qualitative researcher specialising in early diagnosis of cancer

Michelle Cornes, Senior Research Fellow, KCL and NIHR Health and Social Care Workforce Unit

Janina Iwaszko, Clinical Director Physician Associate Masters programme, University of Worcester; Principal Lecturer in Medical Education, with expertise in clinical reasoning research, and simulation

Anwar Khan, GP and Head of Workforce Planning, North East London

Jane Perry, Programmes Director (Nursing and Healthcare Education), University of East London.

Sandra Nicholson, Head of the Centre for Medical Education, QMUL

Ruth Plackett, Led evaluation of eCREST for medical students

Karen Roberts, Nationally recognised expert on PA education

Richard Roope, RCGP and CRUK National Clinical Lead for Cancer

Charlotte Scott-Wilson, HEE Physician Associate Ambassador for Primary Care

Collaborators:  The CASED Unit (https://www.cased.org.uk/) is a collaboration of 13 leading scientists from seven institutions, with Stephen Duffy of Queen Mary, University of London as director, Rosalind Raine of University College, London as deputy director and Peter Sasieni of Queen Mary, University of London as vice director. This project is in partnership with NIHR Health & Social Care Workforce Research unit: https://www.kcl.ac.uk/scwru/index

Funder:              NIHR Policy Research Programme

Contact:            Jessica Sheringham: j.sheringham@ucl.ac.uk