{
  "abstract": "Introduction Referral to a cancer diagnostic pathway is a stressful life event, yet distress may be exacerbated by long waiting times, miscommunications or other avoidable challenges. A model prostate cancer (PCa) rapid diagnostic pathway (RDP) called Prostad has been developed and trialled to reduce the time between referral or diagnosis. This realist evaluation asks how, for whom and under which circumstances this model RDP may reduce anxiety for patients.Research design and methods We conducted semi-structured realist interviews with staff, carers/ partners of patients and patients exploring how, for whom and under which circumstances the PCa RDP produced intended and unintended outcomes. We also attended monthly programme development meetings and had access to documentation regarding the pathway and its development, which we used to produce theories regarding the contextual and mechanistic factors influencing patient experience of the RDP.Results We interviewed staff (n=12), patients (n=15) and partners or carers of patients (n=3) to produce five programme theories regarding how patients interact with Prostad to produce outcomes. These theories are organised under five themes: rapidity; communication and virtual consultations; communication and continuity; disempowerment and distress; agency mitigating anxiety.Conclusions Earlier diagnosis is viewed positively by participants; however, in a context where patients have low expectations of health services, the speed of RDPs needs to be adequately communicated at the time the pathway is introduced to the patient to avoid unnecessary concern regarding the rapidity. Patients value regular and consistent communication, which may help mitigate illness uncertainty and offer a sense of control.",
  "authors": [
    {
      "affiliations": [
        "Swansea University Faculty of Medicine Health and Life Science, Swansea, UK"
      ],
      "name": "Katie Jones"
    },
    {
      "affiliations": [
        "TriTech Institute, Hywel Dda University Health Board, Carmarthen, UK"
      ],
      "name": "Joanne Connell"
    },
    {
      "affiliations": [
        "TriTech Institute, Hywel Dda University Health Board, Carmarthen, UK"
      ],
      "name": "Arya Chandran"
    },
    {
      "affiliations": [
        "TriTech Institute, Hywel Dda University Health Board, Carmarthen, UK"
      ],
      "name": "Stephen Farrington"
    },
    {
      "affiliations": [
        "Hywel Dda University Health Board, Carmarthen, UK"
      ],
      "name": "Sohail Moosa"
    },
    {
      "affiliations": [
        "Hywel Dda University Health Board, Carmarthen, UK"
      ],
      "name": "Janet Mackrell"
    },
    {
      "affiliations": [
        "Hywel Dda University Health Board, Carmarthen, UK"
      ],
      "name": "Savita Shanbhag"
    },
    {
      "affiliations": [
        "Hywel Dda University Health Board, Carmarthen, UK"
      ],
      "name": "Yeung Ng"
    },
    {
      "affiliations": [
        "TriTech Institute, Hywel Dda University Health Board, Carmarthen, UK"
      ],
      "name": "Chris Hopkins"
    },
    {
      "affiliations": [
        "TriTech Institute, Hywel Dda University Health Board, Carmarthen, UK"
      ],
      "name": "Rachel Gemine"
    },
    {
      "affiliations": [
        "Swansea University—Singleton Park Campus, Swansea, UK"
      ],
      "name": "Jaynie Rance"
    },
    {
      "affiliations": [],
      "name": "on behalf of West Wales Prostate Cancer Support Group"
    }
  ],
  "title": "How and under which circumstances does a rapid diagnostic pathway for prostate cancer work to reduce anxiety for patients? A realist evaluation based on patient, caregiver and staff perspectives",
  "uid": "55783bc8-73ca-5cc4-9900-cbbd1cace90f"
}