COLLEGE OF MEDICINE AND HEALTH
Medicine, Nursing and Allied Health Professions

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Dr Elizabeth Shephard

Dr Elizabeth Shephard

Research Fellow

 6030

 01392 726030

 College House 1.16

 

College House, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK

Overview

I am a research fellow working in the primary care cancer diagnostics field. I have been working in Professor Willie Hamilton’s Discovery group since 2010, specialising in producing risk assessment tools (RATs) for over eight cancers. Three of these RATs have contributed to new recommendations in the 2015 updated NG12 cancer guidelines from the National Institute for Health and Care Excellence (NICE). RATs have been piloted across GP surgeries in the UK. A description of RATs can be found on the Cancer Research UK website: https://www.cancerresearchuk.org/health-professional/diagnosis/suspected-cancer-referral-best-practice/risk-assessment-tool-rat

I am currently working on the ERICA trial (see links below). This large randomised control trial assesses the clinical and cost effectiveness of the electronic versions of six RATs (called eRATs) for lung, colorectal, bladder, kidney, oesophago-gastric and ovarian cancers. I am part of the practice recruitment team and will be responsible for interviewing GPs and patients as part of the process evaluation.

 

Further information:

  • I am a co-applicant on a Department of Health Policy Research Programme (PRP) grant investigating bowel disease in young adults. 
  • I am a co-supervisor to Dr Alex Burns who is investigating the uncertainty during cancer diagnosis in the ERICA trial. I have also co-supervised a successful PhD student within our team.
  • I run the cancer RSSU for year 3 students on the BMBS medical programme from 2017-ongoing.
  • I am also a chartered psychologist and member of the British Psychological Society.
  • I was a Scientific Communication Group (SCG) tutor for the Year 1 CSC1004 Fundamental Skills for Medical Scientists module from 2017-19.
  • I was a SSU Progress Support Tutor within the BMBS undergraduate medical programme from 2017-19.

Qualifications

PhD in Psychology - Language and literacy in children and young adults with Turner's syndrome. (University of Essex).

MSc in Developmental Neuropsychology. (University of Essex).

BSc in Psychology. (University of Surrey: Roehampton Institute).

Chartered Psychologist, British Psychological Society.

Links

Research group links

Research

Research interests

  • Primary care cancer diagnostics
  • Risk Assessment Tools (RATs) for calculating cancer risk
  • Use of observational data
  • The Clinical Practice Research Datalink (CPRD) electronic patient records
  • Process evaluation
  • GP and patient experience

My research interests centre around using observational data to investigate the early clinical features of cancer in primary care. Through using large electronic databases containing anonlymised patient records, we are able to study how thousands of cancer patients interact with their GP in the year preceding their diagnosis - we can investigate things like:

  • What symptoms do they report for each cancer site?
  • How many times do they consult their GP?
  • What test results are found in the months leading to their diagnosis?
  • What is the risk estimate for bladder cancer for a man over 70 with haematuria?
  • What are the symptoms of Hodgkin's versus non-Hodgkin's lymphoma?
  • How do these results affect clinical practice?

My research aims to look at these questions, and many more.

Research projects

Head and neck cancer in primary care: (PRU) Identifying the symptoms/test results sugestive of H&N cancer and quantifying their risk in patients 40 years of age and over.

Unexplained abdominal pain in primary care: establishing a clinical profile and diagnostic pathway for identifying cancer. DoH grant.

Abdominal pain is a symptom commonly reported to United Kingdom (UK) general practitioners (GPs). It can be a symptom of both transient illness and serious disease; often making its cause difficult for GPs to diagnose. This ambiguity influences GP decision making, such as where to refer the patient for further investigation – thus potentially causing delays in diagnosis. Existing research has shown abdominal pain to be a prior symptom of nine different cancers.

The aim of this research is to examine new cases of unexplained abdominal pain and to a) identify how many go on to have a cancer diagnosis in the next two years; b) categorise which cancers are diagnosed; c) investigate what co-symptoms are present for each cancer site and their impact on the chance of having cancer; d) use the results to recommend a best practice method of investigating abdominal pain; and, e) report what other diagnoses are found.

The results will help to guide GPs into providing appropriate action for patients with abdominal pain. They will also help to inform future policy on how best to investigate abdominal pain: in the GP surgery using ultrasound or in a specialist diagnostic clinic. New specialist clinics have been established, but have no relevant evidence to help them select the best sequence of tests for patients.

Research grants

  • 2017 Department of Health
    Unexplained abdominal pain in primary care: establishing a clinical profile and diagnostic pathway for identifying cancer. The revised 2015 National Institute for health and Care Excellence (NICE) guidelines highlight abdominal pain as a feature of several cancers. This study aims to quantify the overall and individual cancer site risk of unexplained new abdominal pain episodes reported to primary care, stratified by age and gender, and by accompanying symptoms. There is a need for a more effective diagnostic pathway, which may include primary care testing or extend to investigation in the newly-established multidisciplinary diagnostic centres (MDC).
  • 2014 Department of Health
    Body Shop (Bowel Disease In Younger Adults: Selection For Investigation In Primary Care). The UK lags behind most of Europe in terms of survival from colorectal cancer. Diagnosis is often difficult, particularly in younger people, who are not well addressed by national guidance. Colorectal cancer (CRC) and inflammatory bowel disease (IBD) have overlapping features and both may be misdiagnosed as non-serious disease, often as irritable bowel syndrome. Diagnostic delays are therefore common in both. In CRC there is a widely accepted relationship between diagnostic delay and mortality: equally, delays in diagnosis of IBD allow further disease progression. However, no research has specifically investigated the features of CRC in younger age groups. Because the symptoms of CRC and IBD are so similar, it is logical to combine both conditions in a study aimed at identifying which patients warrant rapid investigation of their large bowel.

Publications

Key publications | Publications by category | Publications by year

Publications by category


Journal articles

Shephard EA, Parkinson MA, Hamilton WT (2019). Recognising laryngeal cancer in primary care: a large case-control study using electronic records. Br J Gen Pract, 69(679), e127-e133. Abstract.  Author URL.
Shephard EA, Hamilton WT (2018). Corrections: Selection of men for investigation of possible testicular cancer in primary care: a large case-control study using electronic patient records (British Journal of General Practice(2018) DOI: 10.3399/bjgp18X697949). British Journal of General Practice, 68(674). Abstract.
Koshiaris C, Van den Bruel A, Oke JL, Nicholson BD, Shephard E, Braddick M, Hamilton W (2018). Early detection of multiple myeloma in primary care using blood tests: a case-control study in primary care. Br J Gen Pract, 68(674), e586-e593. Abstract.  Author URL.  Full text.
Shephard EA, Hamilton WT (2018). Selection of men for investigation of possible testicular cancer in primary care: a large case-control study using electronic patient records. Br J Gen Pract, 68(673), e559-e565. Abstract.  Author URL.  Full text.
Stapley SA, Hamilton WT, Rubin GP, Alsina D, Rutter M, Shephard EA (2017). Clinical features of bowel disease in primary care: a large case-control study. British Journal of General Practice, 67, e336-e344. Full text.
Bailey SE, Ukoumunne OC, Shephard EA, Hamilton W (2017). Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data. Br J Gen Pract, 67(659), e405-e413. Abstract.  Author URL.  Full text.
Price SJ, Stapley SA, Shephard E, Barraclough K, Hamilton WT (2016). Is omission of free text records a possible source of data loss and bias in Clinical Practice Research Datalink studies? a case-control study. BMJ Open, 6(5). Abstract.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton W (2016). Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records. Br J Gen Pract, 66(644), e182-e188. Abstract.  Author URL.  Full text.
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2015). Does the GP method of recording possible cancer symptoms reflect the probability that cancer is present?. EUROPEAN JOURNAL OF CANCER CARE, 24, 30-30. Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton WT (2015). Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a case-control study using electronic records. Br J Gen Pract, 65(634), e289-e294. Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose P, Walter FM, Litt EJ, Hamilton WT (2015). Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case-control study using electronic records. Br J Gen Pract, 65(631), e106-e113. Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton WT (2015). Quantifying the risk of non-Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a large case-control study using electronic records. Br J Gen Pract, 65(634), e281-e288. Abstract.  Author URL.  Full text.
Shephard EA (2014). Erratum: Clinical features of bladder cancer in primary care (British Journal of General Practice (2012) DOI: 10.3399/bjgp12X654560). British Journal of General Practice, 64(620).
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. Br J Gen Pract, 64(626), e584-e589. Abstract.  Author URL.  Full text.
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). The risk of bladder cancer with non-visible haematuria: a primary care study using electronic records. EUROPEAN JOURNAL OF CANCER CARE, 23, 32-32. Author URL.  Full text.
Shephard E, Neal R, Rose P, Walter F, Hamilton WT (2013). Clinical features of kidney cancer in primary care: a case-control study using primary care records. Br J Gen Pract, 63(609), e250-e255. Abstract.  Author URL.  Full text.
Shephard EA, Stapley S, Neal RD, Rose P, Walter FM, Hamilton WT (2012). Clinical features of bladder cancer in primary care. Br J Gen Pract, 62(602), e598-e604. Abstract.  Author URL.  Full text.
Temple CM, Shephard EE (2012). Exceptional lexical skills but executive language deficits in school starters and young adults with Turners syndrome: Implications for X chromosome effects on brain function. Brain and Language, 120(3), 345-359.
Shephard E, Stapley S, Hamilton W (2011). The use of electronic databases in primary care research. Family Practice, 28(4), 352-354. Full text.

Reports

Bailey SER, Ukoumunne OC, Shephard EA, Hamilton W (2014). How useful is thrombocytosis in predicting an underlying cancer in primary care?: systematic review protocol. Full text.
Bailey SER (2014). PROTOCOL: How useful is thrombocytosis in predicting underlying cancer? a systematic review.  Full text.

Publications by year


2019

Shephard EA, Parkinson MA, Hamilton WT (2019). Recognising laryngeal cancer in primary care: a large case-control study using electronic records. Br J Gen Pract, 69(679), e127-e133. Abstract.  Author URL.

2018

Shephard EA, Hamilton WT (2018). Corrections: Selection of men for investigation of possible testicular cancer in primary care: a large case-control study using electronic patient records (British Journal of General Practice(2018) DOI: 10.3399/bjgp18X697949). British Journal of General Practice, 68(674). Abstract.
Koshiaris C, Van den Bruel A, Oke JL, Nicholson BD, Shephard E, Braddick M, Hamilton W (2018). Early detection of multiple myeloma in primary care using blood tests: a case-control study in primary care. Br J Gen Pract, 68(674), e586-e593. Abstract.  Author URL.  Full text.
Shephard EA, Hamilton WT (2018). Selection of men for investigation of possible testicular cancer in primary care: a large case-control study using electronic patient records. Br J Gen Pract, 68(673), e559-e565. Abstract.  Author URL.  Full text.

2017

Stapley SA, Hamilton WT, Rubin GP, Alsina D, Rutter M, Shephard EA (2017). Clinical features of bowel disease in primary care: a large case-control study. British Journal of General Practice, 67, e336-e344. Full text.
Bailey SE, Ukoumunne OC, Shephard EA, Hamilton W (2017). Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data. Br J Gen Pract, 67(659), e405-e413. Abstract.  Author URL.  Full text.

2016

Price SJ, Stapley SA, Shephard E, Barraclough K, Hamilton WT (2016). Is omission of free text records a possible source of data loss and bias in Clinical Practice Research Datalink studies? a case-control study. BMJ Open, 6(5). Abstract.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton W (2016). Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records. Br J Gen Pract, 66(644), e182-e188. Abstract.  Author URL.  Full text.

2015

Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2015). Does the GP method of recording possible cancer symptoms reflect the probability that cancer is present?. EUROPEAN JOURNAL OF CANCER CARE, 24, 30-30. Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton WT (2015). Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a case-control study using electronic records. Br J Gen Pract, 65(634), e289-e294. Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose P, Walter FM, Litt EJ, Hamilton WT (2015). Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case-control study using electronic records. Br J Gen Pract, 65(631), e106-e113. Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton WT (2015). Quantifying the risk of non-Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a large case-control study using electronic records. Br J Gen Pract, 65(634), e281-e288. Abstract.  Author URL.  Full text.

2014

Shephard EA (2014). Erratum: Clinical features of bladder cancer in primary care (British Journal of General Practice (2012) DOI: 10.3399/bjgp12X654560). British Journal of General Practice, 64(620).
Bailey SER, Ukoumunne OC, Shephard EA, Hamilton W (2014). How useful is thrombocytosis in predicting an underlying cancer in primary care?: systematic review protocol. Full text.
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. Br J Gen Pract, 64(626), e584-e589. Abstract.  Author URL.  Full text.
Bailey SER (2014). PROTOCOL: How useful is thrombocytosis in predicting underlying cancer? a systematic review.  Full text.
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). The risk of bladder cancer with non-visible haematuria: a primary care study using electronic records. EUROPEAN JOURNAL OF CANCER CARE, 23, 32-32. Author URL.  Full text.

2013

Shephard E, Neal R, Rose P, Walter F, Hamilton WT (2013). Clinical features of kidney cancer in primary care: a case-control study using primary care records. Br J Gen Pract, 63(609), e250-e255. Abstract.  Author URL.  Full text.

2012

Shephard EA, Stapley S, Neal RD, Rose P, Walter FM, Hamilton WT (2012). Clinical features of bladder cancer in primary care. Br J Gen Pract, 62(602), e598-e604. Abstract.  Author URL.  Full text.
Temple CM, Shephard EE (2012). Exceptional lexical skills but executive language deficits in school starters and young adults with Turners syndrome: Implications for X chromosome effects on brain function. Brain and Language, 120(3), 345-359.

2011

Shephard E, Stapley S, Hamilton W (2011). The use of electronic databases in primary care research. Family Practice, 28(4), 352-354. Full text.

Elizabeth_Shephard Details from cache as at 2019-10-20 12:58:39

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Teaching

Teaching roles:

Research Special Study Unit (RSSU) BMBS - Cancer

Since 2017 I have run the cancer topic RSSU for third year medical students.

  • 2017-18: Topic – cancer of the larynx. Winner of the year 3 poster prize (Molly Parkinson). Molly is also co-author on the resulting published paper: ‘Recognising laryngeal cancer in primary care: a large case-control study using electronic records’.
  • 2018-19: Topic – cancer of the naso-sinus and nasopharynx. Students Tuba Khan and Yusera El-Sockary presented the work at the 2019 SAPC conference in Exeter (July 3rd-5th). They are authors on the paper currently being written up for submission.
  • 2019-20: [With Dr Sarah Price] Topic – new and unexplained abdominal pain in primary care. Currently underway.


PhD (co-)supervisor

Dr Alex Burns will be exploring how patients and GPs deal with uncertainty during potential cancer diagnoses in the ERICA trial. (2019-2022).

 

Professional Training Year (PTY) supervisor.

Lead supervisor to a 3rd year Medical Sciences undergraduate student on their professional training year (2018-2019). Topic: Microcytosis as a risk marker for cancer in primary care: a cohort study using electronic patient records. Paper in preparation.

 

Academic tutor to 8 BSc Medical Sciences students (2018-2021).

Progress Support Tutor within the BMBS medical programme (2017-2019).

Tutor on the Fundamental Skills for Medical Sciences undergraduate programme (2018-2019).

Supervision / Group

Postgraduate researchers

  • Sarah Bailey Co-supervisor.Thrombocytosis as a risk marker for cancer

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