A Realist Evaluation of CloseHER2Home, a community pharmacy-led cancer treatment pathway

Lisa MacLeod, NHS National Services Scotland/University of Stirling

CloseHER2Home (C2H) was a project which looked at using community pharmacies to deliver cancer treatments. The aim of the project was to make it easier for patients to get treatment closer to home, at a pharmacy, instead of traveling to hospital.

The project has shown that community pharmacies can safely give treatment, and patients who took part preferred it to hospital.  The next step is to gather feedback from patients and healthcare workers to see if it could work in the real-world. This will be done through interviews then using two ways to study the information from those interviews (transcripts): Realist Evaluation and Normalisation Process Theory (NPT).

Realist Evaluation of healthcare is a way of studying how well healthcare services work in real life. Instead of asking “Does this work?” it asks “How, why, and for whom does it work?”. The idea is to understand what makes a healthcare service successful or not.  In this case, having cancer treatment in pharmacy might work well for some people but not for others.  Realist Evaluation looks at:

• Context (where or who the service is provided to)
• Mechanisms (what part of the service makes it work), and
• Outcomes (the results or impact it has)

Normalisation Process Theory (NPT) is a way to understand how new ways of doing things become a regular part of everyday practice in healthcare. It’s about understanding what makes people use a new service and how that service can become part of the daily routine in a pharmacy.

Together the findings will help create a plan to make pharmacy treatment a regular part of healthcare in cancer.  It may also help to understand if pharmacies could be used for other cancer treatments or other diseases using similar medicines.