More information about each of the projects, supervisors and duration are given below. Please contact supervisors for an informal discussion if you would like to know more about one of these projects. There is a modest stipend of £1000 for each internship.

The Centre for Academic Primary Care at the University of Bristol is a leading centre for primary care research and teaching in the UK, and one of nine centres that form the NIHR School for Primary Care Research. We are part of Bristol Medical School, an internationally recognised centre of excellence for population health sciences research and teaching.

To apply for a CAPC internship, please complete the Summer internship 2021 application form (Office document, 66kB) and return it to phc-info@bristol.ac.uk. Please share the details with anyone you think might be interested.

Closing date: 23 July 2021.

Project 1: Eliciting patients’ ideas, concerns & expectations: an observational study of routine general practice

Proposed supervisor(s): Peter Edwards, Rebecca Barnes
Supervisor email address: peter.edwards@bristol.ac.uk, rebecca.barnes@phc.ox.ac.uk
Proposed start date: July/August 2021
Duration: 4 weeks funded. Optional extension open for discussion

Project plan

Background

The importance of a holistic approach to patient care is well-established in general practice.¹ During undergraduate and postgraduate medical communication skills training, students are taught that best practice includes understanding the patient’s perspective. One of the most common training models advocates use of the ‘ICE’ questions: to elicit patients’ Ideas about a possible diagnosis, treatment, or prognosis; their Concerns (fears/worries) about a possible diagnosis or therapy; and their Expectations (what the patient wants) for treatment, diagnosis, or therapy.² However, evidence from observational studies in the US, Canada and Belgium has shown that patients’ perspectives are rarely explicitly addressed in this way by doctors. There is currently no evidence available on the extent to which UK GPs elicit patients’ perspectives on their care using the ICE questions.^3,4,5

Question

To address this evidence gap, our research question is: how, and to what extent, do UK GPs address patients’ ideas, concerns and expectations during routine face-to-face primary care consultations?

Methods

• This project is already underway and has NHS ethical approval (NHS REC 20/SC/038).
• You will be given access to an existing archive of 93 video-recordings and transcripts of primary care consultations between 23 GPs and unselected adult patients presenting with at least one new problem.⁶
• You will perform a subsection of the coding framework that can be discussed to suit your interest with research team. These include, but are not limited to:
  • Where does ICE occur in the consultation?
  • How do patients respond when asked about ICE?
  • How do doctors respond when patients voice their ICE?
  • How is the rate of new prescriptions influenced by the presence or absence of ICE or an individual component?
• There will also be an opportunity to undertake some statistical analysis under the guidance of Dr Edwards using Stata 16.1.
  • Dr Edwards can provide meetings 2-3 times per week (allowing for pre-arranged annual leave week commencing 26 July)
• You could also help with the drafting of the teams’ manuscript, e.g. paragraph in results section, specific part of discussion or extra information in the introduction section.

Anticipated Outcome

• There will be an opportunity to be a named author on the final paper and you will be encouraged to submit your subset of analysis work to a local/national conference.

Please note: The privacy of the patients and GPs in the archive is of upmost importance to the research team and you will be asked to keep all viewings of the videos/transcripts confidential in line with good medical/research practice.

References

1. British Medical Association National Survey of GPs. The Future of General Practice 2015. Full report December-February 2015 by ICM on behalf of the BMA.NHS England. General practice forward view. 2016. https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf (Accessed 24th May 2021)
2. Silverman J, Kurtz S and Draper J. Skills for Communicating with Patients. 3rd Edition. Boca Raton FL: CRC Press 2013
3. Marvel MK. Involvement with the Psychosocial Concerns of Patients. Arch Fam Med 1993; 2:629-633
4. Towle A, Godolphin W, Grams G, LaMarre A. Putting informed and shared decision-making into practice. Health Expect. 2005; 9(5): 321-332
5. Matthys J, Elwyn G, Van Nuland M, Van Maele G, De Sutter A, De Meyere M, Deveugele M. Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing Br J Gen Pract Jan 2009; 59: 29-36;
6. Jepson M, Salisbury C, Ridd MJ, Metcalfe C, Garside L, Barnes RK. The ‘One in a Million’ study: creating a database of UK primary care consultations. 2017. British Journal of General Practice. May;67(658):e345-e351. doi: 10.3399/bjgp17X690521. Epub 2017 Apr 10

Project 2: Intervention characteristics and patterns of engagement in a trial of a group behaviour change programme for domestic abuse perpetrators

Proposed supervisor(s): Helen Cramer, Karen Morgan
Supervisor email addresses: helen.cramer@bristol.ac.uk, karen.morgan@bristol.ac.uk
Proposed start date: Summer 2021. Duration 4 weeks. We are flexible as to the exact start date.

Project plan

The intern would be working as part of the trial team on a randomised controlled trial of the effectiveness of domestic abuse behaviour change programmes in reducing abuse amongst perpetrators for their partners, ex partners and families. We anticipate that during this period they will work on one of a number of possible small mixed methods projects relating to:

• characterising intervention ‘dose’ – in our case the attendance patterns of male perpetrators on group programmes;
• characterising and describing one to one work that staff did with perpetrators or victims/survivors alongside the group intervention including one to one ‘holding’ work during the Covid-19 pandemic while the group interventions were paused;
• themes in engagement/non-engagement at weekly groups derived from weekly group case notes;
• intervention fidelity work comparing how the different trial sites delivered the groups and deviations from the programme manual;
• describing the risk profiles or mental health profiles of participants in the study.

An alternative small creative project could be to devise a study promotion campaign in a new outlet (e.g. football or rugby stadiums, counselling and mental health networks, faith groups, community groups) or format (e.g. radio, online, print advert etc) to help increase the number of self-referrals to the trial.

The strengths, interests and preferences of the candidate will be accommodated where possible.

Some of the datasets are already complete and ready for analysis while others are partially complete as we are still mid-trial and collecting data. The team will work with the intern to develop coding frameworks as appropriate before reviewing the data and support any work towards effective study promotion. The team could support up to two interns for the summer period.

For more information please contact either Helen or Karen by email quoting ‘SPCR Internship 2020’ in the subject line.

Further information on the REPROVIDE programme can be found at http://www.bristol.ac.uk/group-intervention-for-men.

Background

Previous studies have helped us to understand domestic abuse perpetrator programmes, but they have often over-relied on men’s self-reporting. They have also lacked an effective comparison group or sometimes over-relied on police data which may miss a huge proportion of what happens at home. Many studies have looked at court-mandated perpetrator programmes which is only a fraction of abusive men, and perhaps a group less ready to change. REPROVIDE has therefore been set up as a randomised controlled trial. This means that outcomes for men who take part in a group programme (the intervention group) will be compared against outcomes for men who have not taken part in a group programme (the comparison group). We will also be looking at the effects on the partners and ex-partners of the men taking part in the trial. Two-thirds of men who enrol on the trial will be offered a place on the group. Their outcomes will be compared against the one-third of men who continue with other forms of existing support.

Anticipated outcome

After completing the analysis, the intern will write a short 500-word report and have the opportunity to design a conference poster displaying their results. It may then be possible to present the poster at a scientific meeting.

Project 3: The Mistletoe And Breast cancer study (MAB): analysis of participant and/or staff interviews

Proposed supervisors: Lorna Duncan, Alyson Huntley
Supervisor email addresses: lorna.duncan@bristol.ac.uk, alyson.huntley@bristol.ac.uk
Proposed start date: Summer 2021. Duration 4 weeks.

Project plan

Rationale

Mistletoe is an herbal medicine used during the treatment of cancer. In mainland Europe, it is a very commonly used therapy by cancer patients and is part of standard cancer treatment programmes in Germany, Switzerland and the Netherlands. In Germany, it is estimated that a quarter to a half of cancer patients use mistletoe. Research suggests it may help people with breast cancer to feel better during chemotherapy, or chemotherapy in conjunction with radiotherapy, and possibly reduce the side effects of these treatments. It is not however a current NHS treatment for cancer in the UK.

A pilot randomised controlled trial (RCT) has recently been completed with 15 participants diagnosed with breast cancer and being treated at Bristol Haematology and Oncology Centre (BHOC). Interviews were undertaken with ten participants at the beginning and completion of their mistletoe treatment (2 interviews each). Topics covered included:

1. Previous knowledge and understanding of mistletoe
2. Expectations of the study therapy
3. Experiences and attitudes towards complementary and alternative medicine/ therapies
4. Acceptability of the questionnaires & patient diary used in the study
5. Adherence to therapy

In addition, five interviews took place with staff involved with the study at BHOC, for their perspectives. All interviews have been transcribed and anonymised. In this project, one or more themes of interest will be analysed across the patient and/or staff interviews.

Planned scheme of work

The student will develop a coding framework/undertake some coding of interviews alongside Dr Duncan (LD). Qualitative data analysis software (NVivo) will be used and assistance will be provided with this as required.

The student will then select a topic of interest, such as 1 to 5 above, and analyse the emergent themes across the patients and/or staff interviews, again using NVivo. They will prepare a report on this theme. If time allows, the student may select further themes. Again, assistance will be given as necessary.

Once the remaining analysis has been completed (LD), a paper of the qualitative work will be prepared for publication. This work will contribute to the overall analysis of the MAB study which, it is hoped, will lead to a full RCT.

Output: contribution to paper for publication; possible presentation at conference.