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This study sought to assess the value of multiparametric magnetic resonance image (mp-MRI) in patients with a prostate cancer (PCa) Gleason score of 6 or less under consideration for or already in active surveillance and to determine the rate of upgrading by target biopsy. Three hundred and fifty-four consecutive men with an initial transrectal ultrasound-guided (TRUS) biopsy-confirmed PCa Gleason score of 6 or less under clinical consideration for or already in active surveillance underwent mp-MRI and were retrospectively reviewed. One hundred and nineteen of 354 patients had cancer-suspicious regions (CSRs) at mp-MRI. Each CSR was assigned a Prostate Imaging Reporting and Data System (PI-RADS) score based on PI-RADS v2. One hundred and eight of 119 patients underwent confirmatory imaging-guided biopsy for CSRs. Pathology results including Gleason score (GS) and percentage of specimens positive for PCa were recorded. Associations between PI-RADS scores and findings at target biopsy were evaluated using logistic regression. At target biopsy, 81 of 108 patients had PCa (75%). Among them, 77 patients had upgrading (22%, 77 of 354 patients). One hundred and forty-six CSRs in 108 patients had PI-RADS 3 n = 28, 4 n = 66, and 5 n = 52. The upgraded rate for each category of CSR was for PI-RADS 3 (5 of 28, 18%), 4 (47 of 66, 71%) and 5 (49 of 52, 94%). Using logistic regression analysis, differences in PI-RADS scores from 3 to 5 are significantly associated with the probability of disease upgrade (20%, 73%, and 96% for PI-RADS score of 3, 4, and 5, respectively). Adding mp-MRI to patients under consideration for or already in active surveillance helps to identify undiagnosed PCa of a higher GS or higher volume resulting in upgrading in 22%.

This study sought to assess the value of multiparametric magnetic resonance image (mp-MRI) in patients with a prostate cancer (PCa) Gleason score of 6 or less under consideration for or already in active surveillance and to determine the rate of upgrading by target biopsy. Three hundred and fifty-four consecutive men with an initial transrectal ultrasound-guided (TRUS) biopsy-confirmed PCa Gleason score of 6 or less under clinical consideration for or already in active surveillance underwent mp-MRI and were retrospectively reviewed. One hundred and nineteen of 354 patients had cancer-suspicious regions (CSRs) at mp-MRI. Each CSR was assigned a Prostate Imaging Reporting and Data System (PI-RADS) score based on PI-RADS v2. One hundred and eight of 119 patients underwent confirmatory imaging-guided biopsy for CSRs. Pathology results including Gleason score (GS) and percentage of specimens positive for PCa were recorded. Associations between PI-RADS scores and findings at target biopsy were evaluated using logistic regression. At target biopsy, 81 of 108 patients had PCa (75%). Among them, 77 patients had upgrading (22%, 77 of 354 patients). One hundred and forty-six CSRs in 108 patients had PI-RADS 3 n = 28, 4 n = 66, and 5 n = 52. The upgraded rate for each category of CSR was for PI-RADS 3 (5 of 28, 18%), 4 (47 of 66, 71%) and 5 (49 of 52, 94%). Using logistic regression analysis, differences in PI-RADS scores from 3 to 5 are significantly associated with the probability of disease upgrade (20%, 73%, and 96% for PI-RADS score of 3, 4, and 5, respectively). Adding mp-MRI to patients under consideration for or already in active surveillance helps to identify undiagnosed PCa of a higher GS or higher volume resulting in upgrading in 22%.

Background Cottage Hospice is a new model of end-of-life service with care provided mainly by family caregivers and volunteers. An ageing demographic and increasing sector costs require innovative service delivery designs. This new service offers more choice, but could be viewed as a threat to existing hospice care, de-professionalising death and reducing specialist provision. Aims To use participatory action research (PAR) to evaluate the development of Cottage Hospice from inception to opening and to disseminate the knowledge gained to inform service innovation in the sector. Methods An embedded researcher implemented a PAR research approach in a UK hospice over 29 months. Documentary analysis was conducted using strategic records, internal meeting minutes, press releases and other written materials (n=120+). Semi-structured interviews (participants: n=36) captured stakeholder views on process and progress over time. A series of action cycles led by a Core Action Group identified key areas for solution focussed change. A patient and carer advisory panel contributed to data analysis. Results Participants struggled to envisage the nature of Cottage Hospice and its interactions with existing hospice services and the local healthcare economy. Stakeholder views varied. Some saw the development as an intermediate option between ‘traditional’ hospice care and death at home. Others welcomed the creative potential of a concept disruptive of the status quo, while some feared it might reduce the quality of end-of-life care, as a trade-off for cost-savings. Conclusion While once at the leading edge of innovation in UK palliative care, hospices have become an established cornerstone of end-of-life provision. Innovation may be welcomed, but can also give rise to confusion and concern among users of hospice care and the hospice workforce alike. As such, careful management of change, robust communication systems and ‘buy in’ from stakeholders at all levels will be needed.

Background A UK hospice is launching a new model of end-of-life provision, Cottage Hospice, responding to demographic and cost challenges. Family members and volunteers will provide the majority of patient care, in a move to ‘bring death back to the community’. While presented as an innovation, this could equally be seen as a return to an emphasis on informal and unpaid care. Aims To use participatory action research (PAR) to evaluate the development of Cottage Hospice from inception to opening and to disseminate the knowledge gained to inform service innovation in the sector. Methods An embedded researcher implemented a PAR research approach in a UK hospice over 29 months. Documentary analysis was conducted using strategic records, internal meeting minutes, press releases and other written materials (n=120+). Semi-structured interviews (participants: n=36) captured stakeholder views on process and progress over time. A series of action cycles led by a Core Action Group identified key areas for solution focussed change. A patient and carer advisory panel contributed to data analysis. Results Some stakeholders embraced this vision, envisaging a constituency of people able and willing to provide end of life care for those close to them. Others remained doubtful about caregiver capacity – suggesting that older spouses might be too frail or unwell while younger family members might have domestic or work commitments – or felt that it would require too large an attitudinal shift. ‘Contracting’ with family caregivers was seen by some as potentially problematic in practice. These factors could limit take-up and threaten the viability of the initiative. Conclusion Delivering this new model of hospice care is highly contingent upon the capacity and willingness of family members to provide hands-on care in the final weeks of life. Our research suggests varied views on the proportion of people able to fulfil this role, highlighting a key risk to successful implementation.

Background Cottage Hospice is a new model of end-of-life service where care will be provided by family members and volunteers. Volunteers will multi-task, doing domestic cleaning and providing personal care – also overnight. Family caregivers are asked to sign an agreement to provide care and remain on the premises. While these roles offer greater involvement and control, they also represent a significant increase in (unpaid) responsibility and commitment. Aims To use participatory action research (PAR) to evaluate the development of Cottage Hospice from inception to opening and to disseminate the knowledge gained to inform service innovation in the sector. Methods An embedded researcher implemented a PAR approach in a UK hospice over 29 months. Documentary analysis was conducted using strategic records, internal meeting minutes, press releases and other written materials (n=120+). Semi-structured interviews (participants: n=36) captured stakeholder views on process and progress over time. A series of action cycles led by a Core Action Group identified key areas for solution focussed change. A patient and carer advisory panel contributed to data analysis. Results The research identified enthusiasm and support for the increased autonomy offered for patients and family caregivers in the dying phase, alongside some unease about the level of commitment being sought and how sustainable this might be for the individual and their wider family. Views also varied on how appealing the volunteer roles would be, and whether sufficient people with the appropriate skills and attitudes would come forward. Conclusion Delivering this innovative model of hospice care is highly contingent upon the capacity and willingness of family members and volunteers to provide hands-on care in the final days and weeks of life. It remains to be seen to what extent the ambitious scale of co-production currently envisaged will be embraced by service users and the wider local community.

Background Cottage Hospice is a new model of end-of-life service with care provided mainly by family caregivers and volunteers. An ageing demographic and increasing sector costs require innovative service delivery designs. This new service offers more choice, but could be viewed as a threat to existing hospice care, de-professionalising death and reducing specialist provision. Aims To use participatory action research (PAR) to evaluate the development of Cottage Hospice from inception to opening and to disseminate the knowledge gained to inform service innovation in the sector. Methods An embedded researcher implemented a PAR research approach in a UK hospice over 29 months. Documentary analysis was conducted using strategic records, internal meeting minutes, press releases and other written materials (n=120+). Semi-structured interviews (participants: n=36) captured stakeholder views on process and progress over time. A series of action cycles led by a Core Action Group identified key areas for solution focussed change. A patient and carer advisory panel contributed to data analysis. Results Participants struggled to envisage the nature of Cottage Hospice and its interactions with existing hospice services and the local healthcare economy. Stakeholder views varied. Some saw the development as an intermediate option between ‘traditional’ hospice care and death at home. Others welcomed the creative potential of a concept disruptive of the status quo, while some feared it might reduce the quality of end-of-life care, as a trade-off for cost-savings. Conclusion While once at the leading edge of innovation in UK palliative care, hospices have become an established cornerstone of end-of-life provision. Innovation may be welcomed, but can also give rise to confusion and concern among users of hospice care and the hospice workforce alike. As such, careful management of change, robust communication systems and ‘buy in’ from stakeholders at all levels will be needed.