Role of multilevel policy initiatives in promoting the earlier diagnosis of cancer – what can we learn from the Detect Cancer Early Programme in Scotland?

Background: Early cancer detection and early diagnosis have a key role in multilevel policy initiatives aiming to improve cancer outcomes. In Scotland, the Detect Cancer Early (DCE) Programme was launched in 2012 with the aim to increase the proportion of lung, breast and bowel cancers diagnosed at Stage I by 25%. Initiatives such as DCE are complex, with many interacting components, and influenced by the context. It is important to investigate such initiatives to ensure accountability, to learn from their experience, and inform other strategies. This PhD aimed to investigate the role of multilevel policy initiatives in promoting the earlier diagnosis of cancer, using the DCE Programme as a case study. Objectives were: 1) to understand the international landscape of multilevel policy initiatives promoting earlier cancer diagnosis; 2) to evaluate DCE’s first three years (2012-2015); 3) to compare DCE with other initiatives; and 4) to provide recommendations for policy. Methods: Three studies were carried out: 1) a systematic review (Study 1) synthesising characteristics of multilevel policy initiatives promoting the earlier diagnosis of cancer, their target populations, outcomes and stakeholder views; 2) development and refinement of a mixed-methods, theory-based evaluation (Study 2), carried out through documentary analysis and stakeholder interviews, guided by the Medical Research Council Framework for Process Evaluation of Complex Interventions, complexity theory/systems thinking, and theory-based evaluation in order to elicit programme theory, implementation assumptions and mechanisms of impact; 3) an evaluation of the DCE programme (Study 3); its outcomes (through secondary analyses of data) and processes (whether assumptions and mechanisms were confirmed by stakeholders, barriers and facilitators, and unanticipated outcomes) through stakeholder interviews and an online questionnaire. Results: Study 1: eighteen initiatives from 10 countries were included and grouped as strategies to improve public cancer awareness and/or knowledge, professional education, referral pathways based on cancer symptoms or combinations of these strategies. Most of them targeted patients suspected of having cancer based on high-risk symptom criteria. Very few of them reported on high-level outcomes such as survival (inconclusive results), mortality (one study; higher mortality associated with low use of urgent referral pathways) and tumour staging (some positive results). Other outcomes included positive changes in knowledge/awareness (but limited impact on behaviour) and reduced diagnostic intervals. Views on initiatives were often positive. Study 2: 160 documents were analysed and a logic model was developed; nine stakeholders were interviewed – this resulted in a refined logic model, development of a textual programme theory and outcomes chains, and elicited assumptions and mechanisms to be examined in the evaluation. Study 3: a) outcome evaluation: DCE objectives were often aspirational, with limited outcome measures and data availability – DCE’s key aim was not met, although there were improvements in tumour staging; there was increase in awareness of cancer symptoms and signs, in consultations due to breast symptoms and in requests for bowel screening kits, but barriers to help-seeking persisted; b) process evaluation: 25 stakeholders were interviewed and 53 completed the questionnaire. There was support for an early detection initiative, and most agreed that DCE was part of their role. Increasing diagnostic resources was challenging when there was no staff available to recruit. Communication challenges influenced engagement and sense of ownership. Demand drove action but resulted in frustration, especially when strategies attracted the worried well seeking reassurance. Targets negatively influenced engagement when they were perceived to be unachievable and to have limited clinical relevance. Several barriers and facilitators were described, in addition to unanticipated outcomes. By being a government initiative, DCE brought early cancer detection to the centre of attention, but also generated conflict due to short timescales (not conducive to long-term changes). Discussion: Multilevel policy initiatives give prominence to earlier diagnosis of cancer. There are mixed findings on their benefits, and the ability to measure impact is affected by variation in outcome measures, data availability, and the short-term aspect of government initiatives. In Scotland, the aspirational nature of objectives and limited definition of outcome measures hindered outcome assessment, while the process evaluation highlighted support for DCE, provided that communication is efficient, efforts are acknowledged, structural barriers are recognised and stakeholders are able to see that they can make a difference. Recommendations for policy refer to data quality, relevance and availability; setting measurable objectives; targeting populations at risk; communication and dissemination; and considering contextual influencers. Results show that much can be learned from available initiatives promoting the earlier diagnosis of cancer

Challenges for engineering students working with authentic complex problems

Engineers are important participants in solving societal, environmental and technical problems. However, due to an increasing complexity in relation to these problems new interdisciplinary competences are needed in engineering. Instead of students working with monodisciplinary problems, a situation where students work with authentic complex problems in interdisciplinary teams together with a company may scaffold development of new competences. The question is: What are the challenges for students structuring the work on authentic interdisciplinary problems? This study explores a three-day event where 7 students from Aalborg University (AAU) from four different faculties and one student from University College North Denmark (UCN), (6th-10th semester), worked in two groups at a large Danish company, solving authentic complex problems. The event was structured as a Hackathon where the students for three days worked with problem identification, problem analysis and finalizing with a pitch competition presenting their findings. During the event the students had workshops to support the work and they had the opportunity to use employees from the company as facilitators. It was an extracurricular activity during the summer holiday season. The methodology used for data collection was qualitative both in terms of observations and participants’ reflection reports. The students were observed during the whole event. Findings from this part of a larger study indicated, that students experience inability to transfer and transform project competences from their previous disciplinary experiences to an interdisciplinary setting

Exploring the practical use of a collaborative robot for academic purposes

This article presents a set of experiences related to the setup and exploration of potential educational uses of a collaborative robot (cobot). The basic principles that have guided the work carried out have been three. First and foremost, study of all the functionalities offered by the robot and exploration of its potential academic uses both in subjects focused on industrial robotics and in subjects of related disciplines (automation, communications, computer vision). Second, achieve the total integration of the cobot at the laboratory, seeking not only independent uses of it but also seeking for applications (laboratory practices) in which the cobot interacts with some of the other devices already existing at the laboratory (other industrial robots and a flexible manufacturing system). Third, reuse of some available components and minimization of the number and associated cost of required new components. The experiences, carried out following a project-based learning methodology under the framework of bachelor and master subjects and thesis, have focused on the integration of mechanical, electronic and programming aspects in new design solutions (end effector, cooperative workspace, artificial vision system integration) and case studies (advanced task programming, cybersecure communication, remote access). These experiences have consolidated the students' acquisition of skills in the transition to professional life by having the close collaboration of the university faculty with the experts of the robotics company.Postprint (published version