The ACPGBI initiated a formal research programme in 2013 by surveying its members using Delphi methodology to develop and prioritise a work programme. The Bowel Disease Research Foundation sponsored this exercise. Over 500 research questions were submitted and over a quarter of the ACPGBI’s membership contributed to the Delphi process that determined the 25 research questions in our final research agenda, published in Colorectal Disease 16 p965-70 in 2014.
Use of a modified Delphi approach to develop research priorities, Tiernan-et-al
Patient and public involvement
The research agenda was then explored for patient perspectives and prioritisation by the ORACLE (BOwel Research PAtient ConsuLtation Exercise) group in early 2015 and later taken to a mass lay audience for prioritisation at DDF in June 2015. ORACLE was published in Colorectal Disease 19 pO75-O85 in 2017.
A national patient and public colorectal research agenda, McNair et al
Patients have remained integral to what has become affectionately known as the ACPGBI ‘Delphi’ research programme. We are fortunate to be supported by our Patient Liaison Group, the BDRF’s Patient Trustees, and charities supporting patients with bowel disease including Bowel Cancer UK, Beating Bowel Cancer, IA the Ileostomy and Internal Pouch Support Group, Crohn’s and Colitis UK, the Colostomy Association, Bowel and Cancer Research, CORE, and Lynch Syndrome UK. Many individual patients have become involved in our PPI events through social media or through local clinical contacts.
Developing the programme
The BDRF put out a call for research champions to develop the Delphi questions and had 50 applications from consultant and trainee members. With support from Simon Bach and the Royal College of Surgeons, as well as BDRF, we held five brain-storming days during 2015 to bring Delphi research champions together and design research projects based on the Delphi research priorities. Each day had focus groups on two or three questions with a short summary of the planned research strategy by the end of the day, a designated leader and contact details of the groups.
During 2016, we hosted a number of Delphi research days supporting individual groups in their work to turn research ideas into funded studies and trials. The focus in 2016 was on bringing research partners together, harnessing trial units and identifying potential funders. Preliminary work to facilitate trial design has included detailed patient and public involvement, development of PROMS and core outcome sets, feasibility studies, consensus meetings, commissioned audits of current practice, and systematic literature reviews, as well as grant applications.
Several groups are now established and working on diverse Delphi topics including management of the malignant polyp, rectal cancer biomarkers, high risk genetic surveillance, early rectal cancer, rectal prolapse, ileocaecal and perianal Crohn’s disease, ileus, palliative cancer resection, timing of surgery in liver-limited stage IV cancer, parastomal hernia, survivorship, and defunctioning anastomoses.
Successful grant applications
The BDRF have continued to supported the Delphi research initiative by funding prioritised projects. Nine Delphi projects have now received pump-priming grants from BDRF. A further BDRF call for applications on Delphi research projects closes on 31 January 2017.
Congratulations to the two Delphi research groups who have been awarded funding from the NIHR HTA: Neil Smart for the prospective observational CIPHER study on parastomal hernias and Hugh Paterson for the ALLEGRO trial assessing impact of intravenous lidocaine on postoperative ileus (see Trials and research).
Highlights from the ACPGBI’s Delphi Research Programme were showcased in the plenary research session during the Edinburgh Annual Meeting. ACPGBI members were also invited to participate in a ‘Delphi on Delphi’ during the meeting: the ‘Edinburgh Delphi’ on the impact of personality and situation on decision-making around anastomoses was full to capacity. Participants engaged in a competitive tower-building icebreaker before getting down to business. We hope to offer our members similar opportunities in the future.
The Edinburgh meeting also hosted a poster round consultation around the Delphi topics of resection of the primary cancer in the palliative setting and of timing of surgery in liver-limited metastatic disease. Both groups continue to make progress and are in discussion with the NCRI Colorectal Subgroup about how to take these important research areas forward. Research into the surgical aspects of metastatic colorectal cancer will be a priority for 2017.
The other major areas of interest to be developed in 2017 will be gastrointestinal recovery after abdominal surgery, and management of postoperative pain. Need for further patient-centred work in these fields has become obvious as trials in perioperative care become established and will dovetail well with the ACPGBI’s support of the National Audit of Small Bowel Obstruction.