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

Abstract

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 (GPs), patients, and community members. A focused ethnography was embedded within the EBCD process, consisting of interviews and observations during the workshops. Field notes were analysed thematically to identify key considerations shaping the service design.

Results: Three overarching themes emerged:

Amplifying community pharmacy assets – emphasizing accessibility and building trust;

Strengthening inclusive practice – addressing privacy, cultural sensitivities, health literacy, and emotional factors;

Enabling service integration and quality – focusing on collaboration between pharmacies and GPs and pharmacy staff training needs. These insights led to a comprehensive ACF service model, including multilingual patient-facing materials, a training package for pharmacists, and protocols for GP communication. The co‑design ensured the service was closely aligned with community needs and perspectives.

Conclusion: This study delivers a co-designed model for pharmacy-based CRC ACF in underserved areas. It demonstrates how community pharmacies can significantly improve early cancer detection and help reduce health inequities, aligning with the NHS Long Term Plan goal of diagnosing 75% of cancers at stage 1 or 2 by 2028. While further research is needed to assess its effectiveness, this approach shows promise for application in other health contexts and settings.