title: Reorganising specialist cancer surgery for the twenty-first century: a mixed methods evaluation (RESPECT-21).
abstract: There are longstanding recommendations to centralise specialist healthcare services, citing the potential to reduce variations in care and improve patient outcomes. Current activity to centralise specialist cancer surgical services in two areas of England provides an opportunity to study the planning, implementation and outcomes of such changes. London Cancer and Manchester Cancer are centralising specialist surgical pathways for prostate, bladder, renal, and oesophago-gastric cancers, so that these services are provided in fewer hospitals. The centralisations in London were implemented between November 2015 and April 2016, while implementation in Manchester is anticipated in 2017.
  
  
  
  This mixed methods evaluation will analyse stakeholder preferences for centralisations; it will use qualitative methods to analyse planning, implementation and sustainability of the centralisations ('how and why?'); and it will use a controlled before and after design to study the impact of centralisation on clinical processes, clinical outcomes, cost-effectiveness and patient experience ('what works and at what cost?'). The study will use a framework developed in previous research on major system change in acute stroke services. A discrete choice experiment will examine patient, public and professional preferences for centralisations of this kind. Qualitative methods will include documentary analysis, stakeholder interviews and non-participant observations of meetings. Quantitative methods will include analysis of local and national data on clinical processes, outcomes, costs and National Cancer Patient Experience Survey data. Finally, we will hold a workshop for those involved in centralisations of specialist services in other settings to discuss how these lessons might apply more widely.
  
  
  
  This multi-site study will address gaps in the evidence on stakeholder preferences for centralisations of specialist cancer surgery and the processes, impact and cost-effectiveness of changes of this kind. With increasing drives to centralise specialist services, lessons from this study will be of value to those who commission, organise and manage cancer services, as well as services for other conditions and in other settings. The study will face challenges in terms of recruitment, the retrospective analysis of some of the changes, the distinction between primary and secondary outcome measures, and obtaining information on the resources spent on the reconfiguration.
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. n.fulop@ucl.ac.uk.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Fulop
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
authors.forename: Angus I G
authors.initials: AI
authors.lastname: Ramsay
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Vindrola-Padros
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Aitchison
authors.affiliation: Alliance Manchester Business School, University of Manchester, Manchester, UK.
authors.forename: Ruth J
authors.initials: RJ
authors.lastname: Boaden
authors.affiliation: Patient representative, London, UK.
authors.forename: Veronica
authors.initials: V
authors.lastname: Brinton
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Clarke
authors.affiliation: University College London Hospitals NHS Foundation Trust, London, UK.|Barts Health NHS Trust, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Hines
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Rachael M
authors.initials: RM
authors.lastname: Hunter
authors.affiliation: University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Levermore
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Satish B
authors.initials: SB
authors.lastname: Maddineni
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
authors.forename: Mariya
authors.initials: M
authors.lastname: Melnychuk
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Moore
authors.affiliation: University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Muntzer M
authors.initials: MM
authors.lastname: Mughal
authors.affiliation: Alliance Manchester Business School, University of Manchester, Manchester, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Perry
authors.affiliation: University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Pritchard-Jones
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: David C
authors.initials: DC
authors.lastname: Shackley
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Vickers
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
mesh_terms: D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D011471:Prostatic Neoplasms / Q000601:surgery*; D000071077:Surgical Oncology / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Cancer; Cost-effectiveness; Discrete choice experiment; Health services research; Implementation; Improvement science; Organisational change; Service reorganisation