Linda O'NEill

Background Pancreatic cancer is an aggressive malignancy, with a five-year survival rate of approximately 10%. It carries a high symptom burden across all stages of disease and treatment trajectories. Rehabilitation, which has demonstrated benefits in other cancer populations, remains a relatively underexplored concept in pancreatic cancer. Emerging studies suggest that structured interventions may improve function, treatment tolerance, and quality of life; however, heterogeneity in study design, outcome measurement, and reporting hampers evidence synthesis and the formulation of clinical recommendations. To address this gap, the development of a Core Outcome Set (COS) for pancreatic cancer rehabilitation is warranted. Methods This protocol follows the Core Outcome Set – STandardised Protocol Statement (COS-STAP) guidance and the Core Outcome Set Standards for development (COS-STAD) recommendations. The COS will apply to adults with histologically confirmed pancreatic ductal adenocarcinoma undergoing any rehabilitative intervention across the cancer continuum. The COS will be developed in three sequential phases. In Phase 1, potential outcomes will be identified through a systematic review of existing rehabilitative studies, and semi-structured interviews with key stakeholders (patients, family members/caregivers, and healthcare professionals/researchers). In Phase 2, outcomes identified in Phase 1 will be prioritised using a multi-round electronic Delphi survey. In Phase 3, a consensus meeting with representatives from all stakeholder groups will finalise the COS. Discussion This study will deliver the first COS specific to pancreatic cancer rehabilitation, addressing the current inconsistency in outcome reporting and ensuring that future research captures domains relevant to all stakeholders. The COS will support the generation of high-quality, comparable evidence to inform clinical practice, improve patient-centred care, and optimise resource allocation. Ultimately, it will provide a unifying framework to guide rehabilitation research and care in this high-need population. Registration: COMET database https://www.comet-initiative.org/Studies/Details/3383, PROSPERO database (CRD420250645743).

Clinical prediction models have progressed from traditional risk scores derived from epidemiological cohorts into sophisticated systems capable of integrating multimodal data, electronic health records, and machine learning approaches. This review provides a clinically focused synthesis of the clinical prediction model lifecycle, outlining their conceptual foundations and methodological evolution across health care settings, with particular emphasis on cardiovascular risk prediction. These predictive frameworks inform both population‐level public health strategies and individual clinical decision‐making. However, external validation studies frequently reveal a stark discrepancy between statistical performance and real‐world implementation, driven by temporal calibration drift, geographic transportability failures, and systemic sociodemographic or sex‐based biases. Importantly, clinical prediction models should not be viewed as replacements for randomized trial evidence; instead, they function as vital complementary mechanisms to dissect the heterogeneity of treatment effects and individualize treatment decisions by contextualizing average treatment effects at the bedside. As health care shifts toward data‐driven infrastructures, this review aims to contextualize the bench‐to‐bedside translational gap, offering an evidence‐based roadmap for clinicians, statisticians, and data scientists to safely harness predictive modeling and ensure meaningful improvements in patient outcomes.

Background As the number of people living with and beyond cancer grow, quality of life has become an increasing priority. Specialised tertiary care centres, as they follow patients throughout their cancer treatment and beyond, represent an opportunity to engage with and provide comprehensive support to patients. However, the support offered is often limited or fragmented, and patients consistently report unmet needs in survivorship, including addressing the short- and longer-term side effects of medical treatment, psychosocial, and physical needs. Additionally, the delivery of survivorship care in tertiary services still varies substantially across different facilities locally and internationally. Despite the widespread need for structured survivorship care, limited consensus exists regarding best practice, and evidence for the organisation and delivery of survivorship clinics or care. Accordingly, this scoping review aims to map current models of survivorship clinics/care in tertiary care to help inform future service development. Methods A comprehensive search will be conducted in Medline, CINAHL, Embase, Cochrane Library and Scopus, along with grey literature sources, following the PRISMA-ScR guidelines. The study selection will be guided by the PCC (Population, Concept, Context) framework, where the population will include adult cancer survivors (≥18 years), the concept will address models of cancer survivorship clinics/care, and the context will be tertiary cancer centres. Data will be extracted on service structure, organisation, multidisciplinary team composition, scope of care, and means of assessing and addressing survivorship needs. Discussion This scoping review will map and synthesise international models of cancer survivorship clinics/care in tertiary cancer centres, highlighting variations in service delivery, organisational structure, and patient involvement. By identifying gaps and inconsistencies in the existing literature, the findings will inform the development and refinement of survivorship services, including potential application within the Irish cancer centre system. Registration Open Science Framework: DOI: 10.17605/OSF.IO/N7UGV

Background: Clinical research is essential for medical advancement but contributes to carbon emissions through activities such as travel, data management, and laboratory processes. As healthcare systems move towards net-zero targets, there is a growing need to understand public awareness of and attitudes towards environmental sustainability in clinical research. Public and patient involvement (PPI) can enhance the relevance and acceptability of research, however there is limited evidence on how best to co-develop tools to assess public understanding of sustainable clinical research. Methods: This study is a two-phase protocol. Phase I involves the co-development of an anonymous online survey with PPI partners through two structured workshops. Survey themes, topics, questions and format will be agreed collaboratively, and the co-development process will be evaluated using qualitative data collected during the workshops. These data will be analysed thematically, using Braun & Clarke’s (2006) framework. Phase II involves distribution of the survey to clinical research, patient and public networks using an online platform. Survey data will be analysed using descriptive statistics for quantitative data and inductive content analysis for qualitative responses. Discussion: This study will generate a co-developed survey instrument and provide insights into public understanding of sustainable clinical research. Reporting on both the survey findings and the PPI co-development process will inform future research and support the development of sustainable research clinical practices.

Background Clinical research is important for advancing medical knowledge, improving patient care, evaluating interventions, and developing new therapies. However, as with many activities, clinical research generates carbon emissions. The impact of rising emissions on the climate means that we need to examine factors that contribute to emission generation, including how these emissions are measured, as well identify mitigation strategies to reduce them. Emissions occur for various reasons, including travel for staff and research participants, the generation and disposal of research equipment, the collection and processing of laboratory samples, and data management. The aim of this review is to better understand how research activity emissions are measured, including which measurement methods and tools are identified, described and categorised.. Methods The review will include searches in seven electronic databases, including health (PubMed, Web of Science, CINAHL and Scopus) and non-health databases (EconBiz, GreenFile, and ProQuest). Primary research studies, as well as peer-reviewed grey literature sources, that may include dissertations and theses, reports, guidelines, case studies, and frameworks relevant to the aim of the review will be eligible for inclusion. Secondary research sources (i.e. reviews; systematic, scoping etc.), as well as non-peer reviewed grey literature will be excluded. Articles written entirely not in English will be excluded as the team do not have the resources to facilitate translation. Screening of titles and abstracts, and full text screening of included articles will be carried out independently by two researchers. A narrative synthesis approach will be taken to analyse the extracted data. Quality appraisal of included studies will not be carried out. Discussion The findings will inform better understanding of methods for measurement and quantification of emissions from reported research activities. Research domains assessed and units of measurement described. These findings can benefit a range of stakeholders, particularly those working within the clinical research environment.

A substantial body of evidence supports the role of exercise in mitigating many effects of cancer and its treatments. However, services for survivors remain scarce, highlighting a significant research-to-practice gap. To address this gap, it is essential to explore strategies that could enhance the dissemination of evidence, supporting the translation of exercise oncology trial findings into clinical practice. To this end, this qualitative study aimed to explore the viewpoints of stakeholders (patients/healthcare professionals (HCPs)/policy makers/researchers) on the dissemination of exercise oncology trials. Stakeholders were invited to take part in a one-to-one semi-structured interview exploring their experiences of and preferences for exercise oncology trial dissemination. Interviews were audio-recorded, transcribed verbatim, and analysed using a thematic approach. Thirty stakeholders were recruited: patients with a history of cancer (n = 14), healthcare professionals (HCPs) (n = 3), researchers (n = 10), and policy makers/healthcare management (n = 3). Median interview length was 14 min and 10 s (range 8 min 16 s to 37 min and 23 s). Three main themes were identified: (i) the need for enhanced dissemination strategies, (ii) engaging stakeholders throughout the study lifespan as key to facilitating effective dissemination, and (iii) tools to support closing the research-to-practice gap. Results indicate that stakeholders want dissemination approaches tailored to the intended audience and presented in formats that are accessible both linguistically and practically, recognising the individuality of each stakeholder group. To support this, three main recommendations were generated: (i) engage all stakeholders throughout the entire research project, from planning to dissemination, to ensure that dissemination avenues are appropriately targeted; (ii) implement a multi-component dissemination strategy that incorporates multiple avenues, blending traditional and innovative approaches to address the priorities of specific stakeholder groups; (iii) adopt multiple communication approaches that extend beyond written format alone and use stakeholder-specific language which is understandable to target audience while maintaining credibility and rigour.

Background: Clinical research is essential for medical advancement but contributes to carbon emissions through activities such as travel, data management, and laboratory processes. As healthcare systems move towards net-zero targets, there is a growing need to understand public awareness of and attitudes towards environmental sustainability in clinical research. Public and Patient Involvement (PPI) can enhance the relevance and acceptability of research, however there is limited evidence on how best to co-develop tools to assess public understanding of sustainable clinical research. Methods: This study is a two-phase protocol. Phase I involves the co-development of an anonymous online survey with PPI partners through two structured workshops. Survey themes, topics, questions and format will be agreed collaboratively, and the co-development process will be evaluated using qualitative data collected during the workshops. These data will be analysed thematically, using Braun & Clarke’s (2006) framework. Phase II involves distribution of the survey to clinical research, patient and public networks using an online platform. Survey data will be analysed using descriptive statistics for quantitative data and inductive content analysis for qualitative responses. Discussion: This study will generate a co-developed survey instrument and provide insights into public understanding of sustainable clinical research. Reporting on both the survey findings and the PPI co-development process will inform future research and support the development of sustainable research clinical practices.

Exercise is an effective intervention at mitigating many of the sequalae of cancer and its treatments. However, a scarcity of exercise services for cancer survivors remains, highlighting a research-to-practice gap. Accordingly, there is considerable rationale to explore strategies to enhance the implementation of exercise oncology trial findings into clinical practice. Dissemination is the active process of spreading research findings to key stakeholders and is crucial to the implementation of evidence base practice. However, little is known regarding the optimal methods of disseminating results of exercise oncology trials. To this end, this project aimed to explore the viewpoints of stakeholders (patients/ health care professionals (HCPs)/ policy makers/ researchers) on the dissemination of exercise oncology trials. Stakeholders were invited to take part in a one-to-one semi-structured interview exploring their experiences of and preferences for exercise oncology trial dissemination. Interviews were audio recorded, transcribed verbatim, and analyzed using a thematic approach. Thirty stakeholders were recruited: patients with a history of cancer (n=14), health care professionals (HCPs) (n=3), researchers (n=10), and policy makers/ health care management (n=3). Median interview length was 14 minutes and 10 seconds (range 8 minutes 16 seconds to 37 minutes and 23 seconds). Three main themes were identified: i) The need for enhanced dissemination strategies, ii) engaging stakeholders throughout the study lifespan is key to facilitating effective dissemination and iii) tools to facilitate closing the research to practice gap. Stakeholders acknowledged that there is limited awareness amongst the public regarding the benefits of exercise across the cancer trajectory, and that accessible and trustworthy information delivered through a variety of mediums to target different stakeholders is required. Stakeholders felt strongly that research outputs need to be targeted to the interests of key stakeholders to aid the integration of evidence into practice, and that buy-in from clinicians is paramount to integrating exercise into usual care. Results of this qualitative study highlight there is a need for more widespread and targeted dissemination of exercise oncology trial results. Stakeholders recommended a comprehensive approach to dissemination to help mitigate the research to practice gap.