Experience-based co-design of an active case finding service for colorectal cancer in community pharmacies: findings from a focused ethnography

Background

Colorectal cancer (CRC) is the fourth most common cancer and second leading cause of cancer deaths in the UK. Socioeconomic deprivation is associated with delayed diagnoses and poorer CRC outcomes. Community pharmacies, highly accessible in underserved areas, present an opportunity to address these health inequalities. This DETECT-CRC study aimed to develop a pharmacy-based active case-finding (ACF) service for CRC in underserved communities of Yorkshire, UK.

Methods

We used a modified Experience-Based Co-Design (EBCD) approach to develop the ACF service. Four co-design workshops were conducted over five months, bringing together pharmacists, general practitioners (GP), patients and community members. A focused ethnography was embedded within the EBCD process, consisting of interviews and observation of workshops. Field notes were analysed thematically to identify key considerations shaping the service design.

Results

Three overarching themes emerged: 1) Amplifying community pharmacy assets, emphasising accessibility and trust-building; 2) Strengthening inclusive practice, highlighting privacy, cultural considerations, health literacy, and emotional factors; and 3) Enabling service integration and quality, stressing collaboration between pharmacies and GPs, and pharmacy training needs. These insights informed the development of a comprehensive ACF service model, including multilingual patient-facing materials, a training package for pharmacy staff, and protocols for GP communication. The co-design process ensured the resulting service was grounded in community needs and perspectives.

Conclusion

This study provides a co-designed model for pharmacy-based ACF of CRC in underserved areas. The model shows promise in addressing health inequalities and improving early cancer detection. It demonstrates how community pharmacies can play a pivotal role in cancer detection, contributing to the NHS Long Term Plan’s ambition of diagnosing 75% of cancers at stage 1 or 2 by 2028. While further research is needed to evaluate its effectiveness, this approach holds potential for improving CRC outcomes in underserved communities and could be adapted for other health conditions and settings.