Pediatric Cancer (Canada) PSP Protocol
Purpose of the PSP and background
The purpose of this protocol is to clearly set out the aims, objectives and commitments of the Pediatric Cancer Priority Setting Partnership (PSP) in line with James Lind Alliance (JLA) principles. The Protocol is a JLA requirement and will be published on the PSP’s page of the JLA website. The Steering Group will review the Protocol regularly and any updated version will be sent to the JLA.
The JLA is a non-profit making initiative, established in 2004. It brings patients, carers and clinicians together in PSPs. These PSPs identify and prioritise the evidence uncertainties, or ‘unanswered questions’, that they agree are the most important for research in their topic area. Traditionally PSPs have focused on uncertainties about the effects of treatments, but some PSPs have chosen to broaden their scope beyond that. The aim of a PSP is to help ensure that those who fund health research are aware of what really matters to patients, carers and clinicians. The National Institute for Health and Care Research (NIHR – www.nihr.ac.uk) coordinates the infrastructure of the JLA to oversee the processes for PSPs, based at the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), University of Southampton.
The PSP will come together in an effort to parse out priorities and ultimately develop research agendas for each of cancer patients and survivors to inform health research focused on their unique needs.
Steering group composition and guidance: To foster a truly patient-oriented exercise and ensure the knowledge-user (KU) voice and perspective is incorporated throughout this project, an expert steering group, comprised of pediatric cancer patients and survivors, family members, and clinicians meeting the scope inclusion criteria for this Partnership, will be established. This group will receive training, ongoing educational and decisional support throughout the study, and compensation. Dr. Jibb and a neutral JLA-affiliated advisor will co-chair the steering group, facilitate online meetings (occurring every 6 weeks) and will ensure all knowledge user voices are represented in decision-making. To further support active participation, a charter detailing member roles, responsibilities, and code of conduct will be struck and ratified by all steering group members. The Research Family Advisory Council at the Hospital for Sick Children (SickKids) has established standards related to high-quality patient and family engagement in research and will approve the charter and provide training to patient and family steering group members. The steering group will oversee all study Priority-Setting Partnership activities including approving the study objectives, guiding the methods and outcomes for each step, and will take a lead role in result dissemination.
Collaborative partners: We have developed a collaborative pan-Canadian network of pediatric cancer care and advocacy partners to support this Partnership, promote data collection, increase broad engagement of patients, survivors, family members and clinicians, and support decision-making by the steering group when required. Our partner organization panel includes the C17 Children’s Cancer and Blood Disorders Council, which is a consortium of leadership from all 17 pediatric cancer centres in Canada and acts as the authoritative voice for the interests of Canadian children with cancer. C17 is chaired by our Principal KU (Dr. Whitlock) and fosters and funds research across the consortium. In addition, have partnered with Advocacy for Canadian Childhood Oncology Research Network (Ac2orn), Childhood Cancer Survivor Canada (CCSC), Helena’s Hope, Kids Cancer Care Foundation of Alberta (KCCFA), Ontario Parents Advocating for Children with Cancer (OPACC), Leucan, Childhood Cancer Survivor Canada, Wellspring Cancer Support and Pediatric Oncology Group of Ontario (POGO).
Aims, objectives and scope of the PSP
The aim of the Pediatric Cancer PSP is to identify the unanswered questions about pediatric cancer treatment and survivorship from patient, carer and clinical perspectives and then prioritise those that patients, carers and clinicians agree are the most important for research to address.
The objectives of the PSP are to:
- work with patients, carers and clinicians to identify uncertainties about pediatric cancer research questions needed to prioritize investment
- to agree by consensus a prioritised list of those uncertainties, for research
- to publicise the results of the PSP and process
- to take the results to research commissioning bodies to be considered for funding.
The scope of the Pediatric Cancer PSP is defined as:
English-and French-speaking and/or reading Canadian children (up to age 18 years) who are receiving cancer treatment at the time of Priority-Setting Partnership involvement, survivors (i.e., a person of any age who has completed childhood cancer treatment), family members (e.g., parents, grandparents, siblings, partners) of children with cancer and survivors as defined, and clinicians who spend at least 50% of their time providing direct care to children with cancer and/or survivors. Because of the wide variation in childhood cancer diagnoses, treatments, and experiences, this Priority-Setting Partnership will be kept purposefully broad. Research questions related to any aspect of the pre-diagnosis period, diagnosis, treatment, relapse, survivorship, palliative care, and end-of-life care will be included.
The PSP will exclude from its scope questions about:
- No questions will be excluded from the PSP at this time. Any uncertainties concerning relevant questions will be handled on a case-by-case basis by the steering committee.
The Steering Group is responsible for discussing what implications the scope of the PSP will have for the evidence-checking stage of the process. Resources and expertise will be put in place to do this evidence checking.
The Steering Group
The Steering Group includes membership of patients and carers and clinicians, as individuals or representatives from a relevant group.
The Pediatric Cancer PSP will be led and managed by a Steering Group involving the following:
Patient and carer representative/s:
- Kathy Brodeur-Robb (Executive Director of the C17 Council)
- Adrienne Roode (Helena’s Hope Leadership Team Member, mother of childhood cancer survivor)
- Caroline Wai (Helena’s Hope Leadership Team Member, mother of childhood cancer survivor)
- Antonia Palmer (Advocacy for Canadian Childhood Oncology Research Network, mother of childhood cancer survivor)
- Sarah Calderwood (Helena’s Hope Leadership Team Member, mother of childhood cancer survivor)
- Helena Kirk (Advocate and Founder of Helena’s Hope, childhood cancer survivor)
- Geoffrey Fang (Childhood cancer survivor, SickKids Patient Ambassador)
- Dr. James Whitlock (Division Head of SickKids Department of Haematology/ Oncology and head of The C17 Council)
- Dr. Michael Taccone (Neurosurgery Resident and PhD Student, childhood cancer survivor)
- Dr. Daniel Morgenstern (Staff Oncologist at SickKids Division of Hematology/ Oncology)
- Rachel Hamilton (Staff nurse at SickKids Division of Hematology/ Oncology, Pediatric Cancer Survivor)
- Perri Tutelman (Clinical Psychology Trainee)
Elham Hashemi, SickKids Hospital
James Lind Alliance Adviser and Chair of the Steering Group:
Tamara Rader, JLA
Lily Ren (Research Librarian)
The Steering Group will agree the resources, including time and expertise that they will be able to contribute to each stage of the process, with input and advice from the JLA.
Organisations and individuals will be invited to be involved with the PSP as partners. Partners are organisations or groups who will commit to supporting the PSP, promoting the process and encouraging their represented groups or members to participate. Organisations which can reach and advocate for these groups will be invited to become involved in the PSP. Partners represent the following groups:
- Pediatric cancer patients or survivors
- Carers of children who have had or currently have pediatric cancer
- Health and social care professionals - with experience of pediatric cancer.
- Helena’s Hope
- The C17 Council
- The Advocacy for Canadian Childhood Oncology Research Network
- Kids Cancer Care Foundation of Alberta (KCCFA)
- Ontario Parents Advocating for Children with Cancer (OPACC)
- Childhood Cancer Survivor Canada
- Pediatric Oncology Group of Ontario (POGO)
- Wellspring Cancer Support
Some organisations may be judged by the JLA or the Steering Group to have conflicts of interest. These may be perceived to potentially cause unacceptable bias as a member of the Steering Group. As this is likely to affect the ultimate findings of the PSP, those organisations will not be invited to participate. It is possible, however, that interested parties may participate in a purely observational capacity when the Steering Group considers it may be helpful.
The methods the PSP will use
This section describes a schedule of proposed steps through which the PSP aims to meet its objectives. The process is iterative and dependent on the active participation and contribution of different groups. The methods used in any step will be agreed through consultation between the Steering Group members, guided by the PSP’s aims and objectives. More details of the method are in the Guidebook section of the JLA website at www.jla.nihr.ac.uk where examples of the work of other JLA PSPs can be seen.
Step 1: Identification and invitation of potential partners
Potential partner organisations will be identified through a process of peer knowledge and consultation, through the Steering Group members’ networks. Potential partners will be contacted and informed of the establishment and aims of the Pediatric Cancer PSP.
Step 2: Awareness raising
PSPs will need to raise awareness of their proposed activity among their patient, carer and clinician communities, in order to secure support and participation. Depending on budget, this may be done by a face-to-face meeting, or there may be other ways in which the process can be launched, e.g. via social media. It may be carried out as part of steps 1 and/or 3. The Steering Group should advise on when to do this. Awareness raising has several key objectives:
- to present the proposed plan for the PSP
- to generate support for the process
- to encourage participation in the process
- to initiate discussion, answer questions and address concerns.
Step 3: Identifying evidence uncertainties
The Pediatric Cancer PSP will carry out a consultation to gather uncertainties from patients, carers and clinicians. A period of two months will be given to complete this exercise (which may be revised by the Steering Group if required).
The Pediatric Cancer PSP recognises that the following groups may require additional consideration.
- Childhood cancer patients and survivors
- Caregivers of childhood cancer patients
The Steering Group will use the following methods to reach the target groups
- Social Media Accounts (Twitter, Instagram, LinkedIn)
- A website
Existing sources of evidence uncertainties may also be searched.
Step 4: Refining questions and uncertainties
The consultation process will produce ‘raw’ questions and comments indicating patients’, carers’ and clinicians’ areas of uncertainty. These raw questions will be categorised and refined by Dr. Lindsay Jibb and Elham Hashemi into summary questions which are clear, addressable by research, and understandable to all. Similar or duplicate questions will be combined where appropriate. Out-of-scope and ‘answered’ submissions will be compiled separately. The Steering Group will have oversight of this process to ensure that the raw data is being interpreted appropriately and that the summary questions are being worded in a way that is understandable to all audiences. The JLA Adviser will observe to ensure accountability and transparency.
This will result in a long list of in-scope summary questions. These are not research questions and to try and word them as such may make them too technical for a non-research audience. They will be framed as researchable questions that capture the themes and topics that people have suggested.
The summary questions will then be checked against evidence to determine whether they have already been answered by research. This will be done by Dr. Lindsay Jibb and Elham Hashemi. The PSP will complete the JLA Question Verification Form, which clearly describes the process used to verify the uncertainty of the questions, before starting prioritisation. The Question Verification Form includes details of the types and sources of evidence used to check uncertainty. The Question Verification Form should be published on the JLA website as soon as it has been agreed to enable researchers and other stakeholders to understand how the PSP has decided that its questions are unanswered, and any limitations of this.
Questions that are not adequately addressed by previous research will be collated and recorded on a standard JLA template by Elham Hashemi. This will show the checking undertaken to make sure that the uncertainties have not already been answered. The data should be submitted to the JLA for publication on its website on completion of the priority setting exercise, taking into account any changes made at the final workshop, in order to ensure that PSP results are publicly available.
The Steering Group will also consider how it will deal with submitted questions that have been answered, and questions that are out of scope.
Step 5: Prioritisation – interim and final stages
The aim of the final stage of the priority setting process is to prioritise through consensus the identified uncertainties about Pediatric Cancer. This will involve input from patients, carers and clinicians. The JLA encourages PSPs to involve as wide a range of people as possible, including those who did and did not contribute to the first consultation. There are usually two stages of prioritisation.
- Interim prioritisation is the stage where the long list of questions is reduced to a shorter list that can be taken to the final priority setting workshop. This is aimed at a wide audience, and is done using similar methods to the first consultation. With the JLA’s guidance, the Steering Group will agree the method and consider how best to reach and engage patients, carers and clinicians in the process. The most highly ranked questions (around 25) will be taken to a final priority setting workshop. Where the interim prioritisation does not produce a clear ranking or cut off point, the Steering Group will decide which questions are taken forwards to the final prioritisation.
- The final priority setting stage is generally a one-day workshop facilitated by the JLA. With guidance from the JLA and input from the Steering Group, up to 30 patients, carers and clinicians will be recruited to participate in a day of discussion and ranking, to determine the top 10 questions for research. All participants will declare their interests. The Steering Group will advise on any adaptations needed to ensure that the process is inclusive and accessible.
Dissemination of results
The Steering Group will identify audiences with which it wants to engage when disseminating the results of the priority setting process, such as researchers, funders and the patient and clinical communities. They will need to determine how best to communicate the results and who will take responsibility for this. Previous PSPs’ outputs have included academic papers, lay reports, infographics, conference presentations and videos for social media.
It should be noted that the priorities are not worded as research questions. The Steering Group should discuss how they will work with researchers and funders to establish how to address the priorities and to work out what the research questions are that will address the issues that people have prioritised. The dissemination of the results of the PSP will be led by Dr. Lindsay Jibb.
The JLA encourages PSPs to report back about any activities that have come about because of the PSP, including funded research. Please send any details to firstname.lastname@example.org.
Agreement of the Steering Group
The Pediatric Cancer PSP Steering Group agreed the content and direction of the original protocol on October 30, 2020 and agreed to this version on September 7, 2021.