Methods
Study Design
Topics such as this one that aim to explore in detail patients' attitudes and beliefs around issues related to their health care require a methodology that allows the researcher to delve in detail into the patient's thinking. Survey or experimental approaches are thus not well-suited to these types of research questions. Instead, we opted for a qualitative approach designed to enable exploration of participants' experiences and opinions. The focus group approach ensured feasibility of the research within our hospital setting (semistructured interviews were considered as a viable methodological alterative using the same topic guide; however, they were not feasible to carry out).
Setting
The study was conducted at two NHS District General Hospitals in England: Whipps Cross University Hospital, London, and The Royal Surrey County Hospital, Guildford. Whipps Cross Hospital has approximately 730 beds and is situated in northeast London. The hospital serves a range of populations from diverse ethnic populations from inner-city London to a more suburban Greater London and Essex population, which tends to be majority Caucasian British. The Royal Surrey County Hospital has approximately 520 beds and serves a population from a mixture of urban, suburban, and rural areas from Surrey and the surrounding counties. The major ity of the local population is of Caucasian British ethnicity. Both hospitals provide a range of services including emergency care and cancer services. Both hospitals have a number of groups for patients to join for social support, share their experiences, and participate in service improvement. We contacted the representatives from cancer patients' groups at each hospital asking if they would participate.
Sampling Strategy
Purposive sampling was used to recruit patients previously treated by MDTs and ensure a diverse sample that collects opinion from a range of social and cultural groups. Inclusion criteria were that participants must be adults, speak English, and have been diagnosed with or treated for cancer at an NHS hospital. Participants were recruited via local patient groups through group representatives. Three focus groups were organized because our research group's experience suggested this was when the emerging themes reached saturation point. Focus groups were planned to occur at NHS Trusts and last approximately two hours.
Ethical approval for the study was given by the South East London Research Ethics Committee as well as locally by the Research and Development departments of the NHS Trusts concerned. Informed written consent was sought from all participants prior to participation.
Interview Guide
The researcher followed a semi-structured open-ended list of questions to obtain and explore participants' views on MDTs in cancer care. The question list has been developed by the research team (which in cludes a patient safety researcher, urological surgeons, a health psychologist, and an oncologist) based on the literature outlined in the introduction. Several themes were identified based on our groups' extensive research on cancer MDTs and also the existing evidence base, which were then covered in a semi-structured manner such that the researchers used the topic guide in a flexible manner, taking into account the thought flow of participants. Themes included 1) patients' experience of cancer diagnosis and/or treatment, 2) awareness of the role and makeup of the MDT, 3) experiences of being treated by and/or interacting with a cancer MDTs, 4) information that is felt to be important for the MDT to consider, 5) patient representation and attendance at MDT meetings, 6) communication of MDT outcomes to patients, and 7) patient involvement in decision-making with the MDT.
Procedures
Three focus groups were held. The first was in Essex in October 2010 that was attended by eight participants (1 hour: 45 minutes); a second was in Surrey in August 2011 that was attended by six participants (1 hour: 30 minutes), and a third was in London in October 2012 that was attended by seven participants (1 hour: 24 minutes). All focus groups were carried out by a team of researchers with training and expertise in qualitative methodologies and good understanding of current cancer care pathways in the UK. Focus groups were all conducted in person, the first by a psychologist and a surgeon, the second by a surgeon alone, and the third by two surgeons. The focus groups were recorded with a digital voice recorder.
Data Analysis
A standard approach was taken in the analysis of the qualitative datasets that were derived from the focus groups. First, all focus groups were audio recorded and transcribed verbatim. Transcripts were then coded by one researcher before themes were checked for content by a second researcher. A grounded theory approach was applied whereby a skeleton coding framework was devised based on the topic guide and data were coded to those primary codes; new codes were then added as new themes emerged in the data. In other words, the coding scheme evolved in line with the emerging data from the transcripts (Pope, Ziebland, & Mays, 2000). The dual coding, which included a surgeon and a psychologist coders, ensured multidisciplinary expertise and a balanced approach to the transcript contents and the derived codes. Verbatim quotes were finally extracted to support and illustrate the codes.