Professor Brendan Delaney, an academic GP and Chair in Medical Informatics and Decision Making at Imperial College London, recently received a Project Award from our Population Research Committee (PRC) to advance his group’s research into earlier diagnosis of cancer. Here he gives advice on applying to the PRC for funding and writing a successful proposal.
Applying for a PRC Early Diagnosis award
How did you decide to apply for funding from CRUK?
I’ve had an interest in diagnosis since medical school and led a large EU programme in this area. I became involved with CRUK from 2013 onwards, as I realised that cancer is a good exemplar in terms of measurable outcomes and impact from improving GP diagnosis. There were personal reasons too, since cancer has affected my family.
Applying for funding through CRUK is a very different experience to seeking funding from other organisations, who may take a hands-off and non-interventional approach. Funding high quality science with outstanding potential is more important to CRUK than an applicants’ experience, track record or where they are based. Therefore, the Research Funding Managers guide and provide advice on any aspect of the proposal ahead of submission, which makes a really big difference. Do talk to the office staff about any uncertainties.
What do you hope to achieve in your recently funded PRC Early Diagnosis Project Award?
My co-investigator, Dr Olga Kostopoulou (Imperial College London), has studied the problem of GPs not considering cancer when a patient consults them with potential early cancer symptoms. Her work involves ways to make it more likely that a GP will contemplate cancer in patients and take appropriate action, therefore avoiding possible delays of up to six months before a diagnosis is made. This has a tremendous patient benefit, as patients that are diagnosed sooner are more likely to be at an early stage of cancer, and therefore have a dramatically increased chance of survival.
My interest is in implementing this as a diagnostic decision support for GPs during the consultation, embedded within electronic health records, and managing this as part of a ‘Learning System’ for diagnosis. This involves capturing data, analytics based on that data, decision rules based on those analytics, decision rules representing a computable way of integrating into the NHS system and then thinking about where and how this should be presented in the context of the GP-patient interaction.
This is a good example of a highly multi-disciplinary project that brings in people from data science, computer science, electronic health research and decision psychology. It illustrates what PRC looks for in a proposal, where there is collaboration with researchers who are not necessarily working in the cancer sphere.
How does your project fit into PRC’s early diagnosis remit?
It is important to highlight the differences between early detection and early diagnosis of cancer in the context of the funding opportunities that CRUK offers. CRUK’s early detection funding schemes will consider applications that seek to detect early signals of cancer, through novel technology or discovery research.
By contrast, the early diagnosis stream in PRC funds research that aims to implement validated cancer signals in the population, through interventions that involve patients and healthcare professionals. It is advisable to check on the CRUK webpage for the distinctions between the remits of these schemes. The Research Funding Managers will be happy to chat if you’re unsure where your research best fits.
As a GP, diagnosis to me means the working diagnosis – my thoughts about a patient’s condition during the consultation and the actions that can be taken to manage that process, therefore my project falls within the PRC remit.
What do you consider to be the exciting areas of research in early diagnosis and early detection?
One theme of the recent Early Detection Conference in Portland is that there needs to be much better linkage between basic, behavioural and data sciences, moving away from silo work so that scientific and technological innovation is translated into benefit for patients. It’s exciting that this problem has been recognised and is now being addressed, in part through the multidisciplinary networking opportunities that CRUK is creating for early detection and diagnosis researchers.
People working in the fields of data science and early detection technologies – particularly digital technologies that impact on GP or hospital diagnosis – need to think whether their ideas could be relevant to cancer. We’re in a wave of technological innovation in healthcare, particularly through leverage of large scale and improved quality data from various sources. There are innovative ways of using that data and the knowledge generated to focus on interventions. The intervention aspect is critical. We need to be working towards interventions that improve diagnosis and population health relevant to cancer.
How do you see the work funded through the early diagnosis stream in PRC meeting CRUK’s strategic goal of achieving 3 in 4 survival by 2034?
As CRUK’s Research Strategy itself states, earlier diagnosis has an immense potential to transform outcomes for patients and make progress towards the 3 in 4 goal. PRC is very focused on this aim of maximising patient benefit, and alignment to this strategy is an important factor influencing the funding decision. PRC looks for research proposals which will complete the translational journey by having a practical application in the clinic or on healthcare policy.
Given otherwise equally weighted applications, PRC prioritises proposals which address cancers of substantial unmet need (e.g. lung, pancreatic, oesophageal cancers and brain tumours), where outcomes are typically poor, in large part due to late stage diagnosis.
Writing a successful application
As a member of PRC’s Early Diagnosis Expert Review Panel, what do you look for in an application?
A typical Panel has three people who will have read the proposal in detail – one lead speaker and two other designated speakers. Panel members read numerous applications, so making life easy for them, by writing a well laid out proposal that is a pleasure to read, is very important. You’ll need the following to get the Panel on your side:
Clear aims and a robust methodology. This is crucial to get right. Most applications fail because the aims are not articulated well, or the means by which the aims are to be achieved do not stand up to external scrutiny. Writing a single paragraph summary and getting input from colleagues and collaborators is a useful way of flushing out any confusion or lack of clarity early on.
Appropriate expertise. Having the right skills mix in the team is very important, and the Panel will recognise if the appropriate expertise is not represented in your application. The Panel will also look at the comments of the expert peer reviewers, and your response to them, so make sure you address any criticisms thoroughly. It’s wise to spend time on an application and have the appropriate expertise on board, even if that means waiting for the next deadline.
Patient and Public involvement (PPI). It’s important to write proposals emphasising clear benefits to patients with cancer. You should demonstrate that PPI has had some influence on the design of the study, ideally by having a PPI representative on the application. CRUK has a lot of guidance to help with this.
Alignment to CRUK’s Research Strategy. In addition to its scientific merit, an application will be assessed on how it will help CRUK achieve the goals set in its Research Strategy. It’s worth reading through the strategy and highlighting in your application where your research aligns with the priorities it sets out.
As an applicant, what aspects of the application process did you find needed the most effort?
The initial preparation and making the proposal robust is key. The idea needs to be worked on for some time in advance of the deadline, with input from all the co-applicants and collaborators. It cannot be done in a short period of time before the submission date. The final step of writing the proposal and costing it is relatively straightforward.
Where can you seek support ahead of submitting an application?
Read the PRC guidelines for Programmes, Projects and Postdoctoral fellowships on the website thoroughly. The PRC resources page is also very helpful. Do talk to the office staff if in doubt about anything.
The relevant NCRI Clinical Studies Groups (e.g. for Primary Care) are happy to consider initial ideas. It is possible to speak in their meetings to get direct feedback. The NIHR Research Design Service (not restricted to NIHR studies) is also a great source of advice around aspects such as sample size and methodology. For studies that require recruitment or access to practices, talking to the Clinical Research Networks locally will really add to the believability of the research.
Profile: Professor Brendan Delaney
Brendan joined Imperial in July 2015 as Chair in Medical Informatics and Decision Making. He is a practicing GP in south east London with a research interest in ‘The Learning Health System’, using informatics tools to link both knowledge generation and knowledge utilisation to routine healthcare IT systems. Brendan’s focus is on decision support for diagnosis and the role of artificial intelligence in creating, curating and improving diagnostic evidence. Brendan became the Vice-Chair of the Cancer Research UK Early Diagnosis Expert Review Panel in 2015.