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Dr Sam Merriel

Clinical Senior Research Fellow

College House 1.18

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

Overview

I am a GP and Clinical Senior Research Fellow funded by the CanTest Collaborative, Cancer Research UK's inaugural Catalyst Award programme. Led by Prof Willie Hamilton (Exeter) and Prof Fiona Walter (QMUL/Cambridge), the CanTest Collaborative is a team of primary care cancer researchers who are investigating ways of developing and implementing new and improved cancer diagnostic tests into GP surgeries. I am a member of the Diagnosis of Symptomatic Cancer Optimally (DISCO) team within the Medical School studying the potential impact of Magnetic Resonance Imaging (MRI) as a diagnostic test for prostate cancer within primary care.

Qualifications

PhD - Doctor of Philosophy (Medical Studies), University of Exeter, UK (2018-2022)

MRCGP - Member of Royal College of General Practitioners, UK (August 2018)

AFHEA - Associate Fellowship of the Higher Education Academy, Advance HE (2020)

MSc - Masters of Science (Public Health), London School of Hygiene and Tropical Medicine, UK (2012-2013)

MBBS (Hons) - Bachelor of Medicine, Bachelor of Surgery (with honours), Monash University, Australia (2004 - 2009)

BMedSc (Hons) - Bachelor of Medical Science (with honours), Monash University, Australia (2007)

Career

I grew up and studied Medicine in Melbourne, Australia, on the land of the Wurundjeri people to whom I am endebted to. Prior to joining the DISCO team, I completed an NIHR Academic Clinical Fellowship in General Practice in Bristol, working within the Centre for Academic Primary Care at the University of Bristol. I obtained Membership of the Royal College of General Practitioners (MRCGP) in August 2018. I have also completed a Masters of Science (Public Health) at the London School of Hygiene & Tropical Medicine.

I am Associate Editor and Editorial Board member for the British Journal of General Practice (BJGP), and Senior Board Member for BMC Cancer. I am an early career primary care researcher supported by the NIHR Clinical Research Network West of England, and vice-chair of the Primary Care Academic Collaborative (PACT).

Research group links

Institute of Health Research

Research

Research interests

My primary research interests focus around the prevention and early detection of cancer in primary care. I am currently studying the potential impact of Magnetic Resonance Imaging (MRI) as a diagnostic test for prostate cancer within primary care. I am exploring the accepatability, cost effectiveness, and patient centred outcomes associated with MRI. I have conducted and published research employing systematic reviews and meta-analyses, observational studies using primary and secondary data, delphi studies, and qualitative interviews on a range of topics including prostate cancer diagnoses, hypoalbuminaemia and cancer risk in primary care, and HPV vaccination for cancer prevention.

Research projects

Current Projects:

Magnetic resonance imaging for prostate cancer diagnosis in primary care
Screening, Prevention and Early Diagnosis of cancer research: A systematic mapping review
Primary care models for the detection of clinically significant prostate cancer: the ProsDetect study
Evaluating ethnic differences in blood markers of cancer in primary care
Be Clear on Cancer 2018 fourth national ‘Blood in pee’ campaign final evaluation
How do we care for older housebound people? A feasibility study using the Primary care Academic CollaboraTive (PACT) model

Research networks

CanTest Collaborative

Society for Academic Primary Care

Primary care Academic CollaboraTive (PACT)

Research grants

2022 CRUK
‘A multimodal electronic capsule for identification of visual and biological markers of early stage colorectal cancer - Samplecam’
2022 CRUK
‘Towards a ‘toothbrush’ sensor for passive biomarker monitoring – “Sens Or Pass”
2021 CRUK
‘Evaluating ethnic differences in blood markers of cancer in primary care’ Early Detection and Diagnosis Project Award (A31440) £136,365.88
2021 National Institute for Health Research, Research for Patient Benefit
‘Primary care models for the detection of clinically significant prostate cancer: the ProsDetect study’ Research for Patient Benefit competition 43 (NIHR202732) £149,710.00
2021 NIHR School for Primary Care Research
‘Presenting Complaints for Prostate Cancer in Primary Care: The PC3 study’
2021 NIHR School for Primary Care Research
‘Development of primary care referral guidelines for patients with Papilloedema and Pseudopapilloedema – the DIPP study’
2021 National Institute for Health HSR Programme
‘The SPOtting Cancer among Comorbidities (SPOCC) programme. Supporting clinical decision making in patients with symptoms of cancer and pre-existing conditions’
2020 Public Health England
Be Clear on Cancer 2018 fourth national ‘Blood in pee’ campaign final evaluation £7,500

Publications

Key publications | Publications by category | Publications by year

Publications by category

Journal articles

Merriel S (In Press). A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for Active Surveillance. BMC Urology

Merriel S, Hamilton W, Ball S, Hyde C (In Press). A prospective evaluation of the fourth be Clear on Cancer ‘Blood in Pee’ campaign in England. European Journal of Cancer Care

Bailey S, Green H, Merriel S, Oram R, Thirlwell C, Ruth K, Tyrrell J, Weedon M (In Press). Applying a genetic risk score for prostate cancer to men with lower urinary tract symptoms in primary care to predict prostate cancer diagnosis: a cohort study in the UK Biobank. British Journal of Cancer

Merriel SWD (In Press). Comparison of multiparametric magnetic resonance imaging and targeted biopsy with systematic biopsy alone for the diagnosis of prostate cancer. JAMA Network Open

Merriel S, Hamilton W (In Press). Experiences of ‘traditional’ and ‘one-stop’ MRI-based prostate cancer diagnostic pathways in England: a qualitative study with patients and GPs. BMJ Open

Merriel S, Martins T, Bailey S (In Press). Exploring the causes of death among patients with metastatic prostate cancer: a changing landscape. Jama Network Open

Merriel S, Hamilton W (In Press). Improving early cancer diagnosis in primary care. Prescriber

Merriel S (In Press). Lymphoma for GPs across the cancer continuum. InnovAiT

Merriel SWD, Gnanapragasam V (In Press). Prostate cancer treatment choices: the GP’s role in shared decision-making. British Journal of General Practice

Merriel SWD, Tsukagoshi S, Caesar S, Weaver R (In Press). Qualified GPs planning to work overseas: Go, enjoy yourself, and come back’. British Journal of General Practice

Merriel S (In Press). Retrospective cohort study evaluating clinical, biochemical and pharmacological prognostic factors for prostate cancer progression using primary care data. BMJ Open

Merriel SWD, Pocock L, Gilbert E, Creavin S, Walter FM, Spencer A, Hamilton W (In Press). Systematic Review &amp; Meta-Analysis of the Diagnostic Accuracy of Prostate Specific Antigen (PSA) for the Detection of Prostate Cancer in Symptomatic Patients.

Abstract
. BackgroundProstate Specific Antigen (PSA) is a commonly used test to detect prostate cancer. Attention has mostly focused on the use of PSA in screening asymptomatic patients, but the diagnostic accuracy of PSA for prostate cancer in patients with symptoms is less well understood.MethodsA systematic database search was conducted of Medline, EMBASE, Web of Science, and the Cochrane library. Studies reporting the diagnostic accuracy of PSA for prostate cancer in patients with symptoms were included. Two investigators independently assessed the titles and abstracts of all database search hits and full texts of potentially relevant studies against the inclusion criteria, and data extracted into a proforma. Study quality was assessed using the QUADAS-2 tool by two investigators independently. Summary estimates of diagnostic accuracy were calculated with meta-analysis using bivariate mixed effects regression.Results563 search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. 19 studies met the inclusion criteria, 18 of which were conducted in secondary care settings (one from a screening study cohort). All studies used histology obtained by Transrectal Ultrasound guided biopsy (TRUS) as a reference test, usually only for patients with elevated PSA or abnormal prostate examination. Pooled data from 14,489 patients found estimated sensitivity of PSA for prostate cancer was 0.93 (95% CI 0.88, 0.96) and specificity was 0.20 (95% CI 0.12, 0.33). The area under the receiving-operator characteristic curve was 0.72 (95% CI 0.68, 0.76). All studies were assessed as having a high risk of bias in at least one QUADAS-2 domain.ConclusionsCurrently available evidence suggests PSA is highly sensitive but poorly specific for prostate cancer detection. However, significant limitations in study design and reference test reduces the certainty of this estimate. There is very limited evidence for the performance of PSA in primary care, the healthcare setting where most PSA testing is performed.

Abstract.

Merriel S, Hamilton W (In Press). Systemic anticancer therapies and the role of primary care. Prescriber

Merriel S (In Press). Why test study protocol: a UK-wide audit using the Primary Care Academic Collaborative to explore the reasons for primary care testing. British Journal of General Practice

Hardy V, Yue A, Archer S, Merriel SWD, Thompson M, Emery J, Usher-Smith J, Walter FM (2022). Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review. BMJ Open, 12(1), e053732-e053732.

BackgroundMissed opportunities for diagnosing cancer cause patients harm and have been attributed to suboptimal use of tests and referral pathways in primary care. Primary care physician (PCP) factors have been suggested to affect decisions to investigate cancer, but their influence is poorly understood.ObjectiveTo synthesise evidence evaluating the influence of PCP factors on decisions to investigate symptoms of possible cancer.MethodsWe searched MEDLINE, Embase, Scopus, CINAHL and PsycINFO between January 1990 and March 2021 for relevant citations. Studies examining the effect or perceptions and experiences of PCP factors on use of tests and referrals for symptomatic patients with any cancer were included. PCP factors comprised personal characteristics and attributes of physicians in clinical practice.Data extraction and synthesisCritical appraisal and data extraction were undertaken independently by two authors. Due to study heterogeneity, data could not be statistically pooled. We, therefore, performed a narrative synthesis.Results29 studies were included. Most studies were conducted in European countries. A total of 11 PCP factors were identified comprising modifiable and non-modifiable factors. Clinical judgement of symptoms as suspicious or 'alarm' prompted more investigations than non-alarm symptoms. ‘Gut feeling’ predicted a subsequent cancer diagnosis and was perceived to facilitate decisions to investigate non-specific symptoms as PCP experience increased. Female PCPs investigated cancer more than male PCPs. The effect of PCP age and years of experience on testing and referral decisions was inconclusive.ConclusionsPCP interpretation of symptoms as higher risk facilitated testing and referral decisions for possible cancer. However, in the absence of 'alarm' symptoms or ‘gut feeling’, PCPs may not investigate cancer. PCPs require strategies for identifying patients with non-alarm and non-specific symptoms who need testing or referral.PROSPERO registration numberCRD420191560515.

Abstract.

Merriel SWD, Pocock L, Gilbert E, Creavin S, Walter FM, Spencer A, Hamilton W (2022). Systematic review and meta-analysis of the diagnostic accuracy of prostate-specific antigen (PSA) for the detection of prostate cancer in symptomatic patients. BMC Medicine, 20(1).

Abstract
. Background
. Prostate-specific antigen (PSA) is a commonly used test to detect prostate cancer. Attention has mostly focused on the use of PSA in screening asymptomatic patients, but the diagnostic accuracy of PSA for prostate cancer in patients with symptoms is less well understood.
.
. Methods
. A systematic database search was conducted of Medline, EMBASE, Web of Science, and the Cochrane library. Studies reporting the diagnostic accuracy of PSA for prostate cancer in patients with symptoms were included. Two investigators independently assessed the titles and abstracts of all database search hits and full texts of potentially relevant studies against the inclusion criteria, and data extracted into a proforma. Study quality was assessed using the QUADAS-2 tool by two investigators independently. Summary estimates of diagnostic accuracy were calculated with meta-analysis using bivariate mixed effects regression.
.
. Results
. Five hundred sixty-three search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. Nineteen studies met the inclusion criteria, 18 of which were conducted in secondary care settings with one from a screening study cohort. All studies used histology obtained by transrectal ultrasound-guided biopsy (TRUS) as a reference test; usually only for patients with elevated PSA or abnormal prostate examination. Pooled data from 14,489 patients found estimated sensitivity of PSA for prostate cancer was 0.93 (95% CI 0.88, 0.96) and specificity was 0.20 (95% CI 0.12, 0.33). The area under the hierarchical summary receiver operator characteristic curve was 0.72 (95% CI 0.68, 0.76). All studies were assessed as having a high risk of bias in at least one QUADAS-2 domain.
.
. Conclusions
. Currently available evidence suggests PSA is highly sensitive but poorly specific for prostate cancer detection in symptomatic patients. However, significant limitations in study design and reference test reduces the certainty of this estimate. There is very limited evidence for the performance of PSA in primary care, the healthcare setting where most PSA testing is performed.
.

Abstract.

Merriel SW, Lee L, Neal R (2021). Community diagnostic centres: bringing diagnostics closer to home. Br J Gen Pract, 71(713), 534-535. Author URL.

Duncan P, Payne RA, Merriel S (2020). A new collaborative model of primary care research: could it provide trainees and clinicians with more opportunities to get involved?. British Journal of General Practice, 70(698), 430-431.

Merriel SWD (2020). Active surveillance for prostate cancer: an update. Trends in Urology and Men’s Health

Merriel SWD, Hardy V, Thompson MJ, Walter FM, Hamilton W (2020). Patient-Centered Outcomes from Multiparametric MRI and MRI-Guided Biopsy for Prostate Cancer: a Systematic Review. J Am Coll Radiol, 17(4), 486-495. Abstract. Author URL.

Martins T, Merriel SWD, Hamilton W (2020). Routes to diagnosis of symptomatic cancer in sub-Saharan Africa: systematic review. BMJ Open, 10(11), e038605-e038605.

BackgroundMost cancers in sub-Saharan Africa (SSA) are diagnosed at advanced stages, with limited treatment options and poor outcomes. Part of this may be linked to various events occurring in patients’ journey to diagnosis. Using the model of pathways to treatment, we examined the evidence regarding the routes to cancer diagnosis in SSA.Design and settingsA systematic review of available literature was performed.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Between 30 September and 30 November 2019, seven electronic databases were searched using terms relating to SSA countries, cancer and routes to diagnosis comprising the population, exposure and outcomes, respectively. Citation lists of included studies were manually searched to identify relevant studies. Furthermore, ProQuest Dissertations & Theses Global was searched to identify appropriate grey literature on the subject.Results18 of 5083 references identified met the inclusion criteria: eight focused on breast cancer; three focused on cervical cancer; two each focused on lymphoma, Kaposi’s sarcoma and childhood cancers; and one focused on colorectal cancer. With the exception of Kaposi’s sarcoma, definitive diagnoses were made in tertiary healthcare centres, including teaching and regional hospitals. The majority of participants initially consulted within primary care, although a considerable proportion first used complementary medicine before seeking conventional medical help. The quality of included studies was a major concern, but their findings provided important insight into the pathways to cancer diagnosis in the region.ConclusionThe proportion of patients who initially use complementary medicine in their cancer journey may explain a fraction of advanced-stage diagnosis and poor survival of cancer in SSA. However, further research would be necessary to fully understand the exact role (or activities) of primary care and alternative care providers in patient cancer journeys.

Abstract.

Merriel SWD, Hetherington L, Seggie A, Castle JT, Cross W, Roobol MJ, Gnanapragasam V, Moore CM, Prostate Cancer UK Expert Reference Group on Active Surveillance (2019). Best practice in active surveillance for men with prostate cancer: a Prostate Cancer UK consensus statement. BJU Int, 124(1), 47-54. Abstract. Author URL.

Elwenspoek MMC, Sheppard AL, McInnes MDF, Merriel SWD, Rowe EWJ, Bryant RJ, Donovan JL, Whiting P (2019). Comparison of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy with Systematic Biopsy Alone for the Diagnosis of Prostate Cancer: a Systematic Review and Meta-analysis. JAMA Netw Open, 2(8).

Importance: the current diagnostic pathway for patients with suspected prostate cancer (PCa) includes prostate biopsy. A large proportion of individuals who undergo biopsy have either no PCa or low-risk disease that does not require treatment. Unnecessary biopsies may potentially be avoided with prebiopsy imaging. Objective: to compare the performance of systematic transrectal ultrasonography-guided prostate biopsy vs prebiopsy biparametric or multiparametric magnetic resonance imaging (MRI) followed by targeted biopsy with or without systematic biopsy. Data Sources: MEDLINE, Embase, Cochrane, Web of Science, clinical trial registries, and reference lists of recent reviews were searched through December 2018 for randomized clinical trials using the terms "prostate cancer" and "MRI." Study Selection: Randomized clinical trials comparing diagnostic pathways including prebiopsy MRI vs systematic transrectal ultrasonography-guided biopsy in biopsy-naive men with a clinical suspicion of PCa. Data Extraction and Synthesis: Data were pooled using random-effects meta-analysis. Risk of bias was assessed using the revised Cochrane tool. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. All review stages were conducted by 2 reviewers. Main Outcomes and Measures: Detection rate of clinically significant and insignificant PCa, number of biopsy procedures, number of biopsy cores taken, and complications. Results: Seven high-quality trials (2582 patients) were included. Compared with systematic transrectal ultrasonography-guided biopsy alone, MRI with or without targeted biopsy was associated with a 57% (95% CI, 2%-141%) improvement in the detection of clinically significant PCa, a 33% (95% CI, 23%-45%) potential reduction in the number of biopsy procedures, and a 77% (95% CI, 60%-93%) reduction in the number of cores taken per procedure. One trial showed reduced pain and bleeding adverse effects. Systematic sampling of the prostate in addition to the acquisition of targeted cores did not significantly improve the detection of clinically significant PCa compared with systematic biopsy alone. Conclusions and Relevance: in this meta-analysis, prebiopsy MRI combined with targeted biopsy vs systematic transrectal ultrasonography-guided biopsy alone was associated with improved detection of clinically significant PCa, despite substantial heterogeneity among trials. Prebiopsy MRI was associated with a reduced number of individual biopsy cores taken per procedure and with reduced adverse effects, and it potentially prevented unnecessary biopsies in some individuals. This evidence supports implementation of prebiopsy MRI into diagnostic pathways for suspected PCa.

Abstract. Author URL.

Kesten JM, Flannagan C, Ruane-McAteer E, Merriel SWD, Nadarzynski T, Shapiro G, Rosberger Z, Prue G (2019). Mixed-methods study in England and Northern Ireland to understand young men who have sex with men's knowledge and attitudes towards human papillomavirus vaccination. BMJ Open, 9(5).

OBJECTIVES: Men who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when received prior to sexual debut, at genitourinary medicine clinics in the UK. In September 2019, the national HPV vaccination programme will be extended to boys. This study aimed to understand young MSM's (YMSM) knowledge and attitudes towards HPV vaccination. DESIGN: Questionnaires assessed YMSM demographics, sexual behaviour, culture, knowledge and attitudes towards HPV vaccination and stage of vaccine decision-making using the precaution adoption process model. Focus groups explored sexual health information sources, attitudes, barriers and facilitators to vaccination and strategies to support vaccination uptake. Questionnaire data were analysed using descriptive statistics and focus group data were analysed thematically. SETTING: Questionnaires were completed online or on paper. Focus groups were conducted within Lesbian Gay Bisexual Transgender Queer organisational settings and a university student's union in England and Northern Ireland. PARTICIPANTS: Seventeen YMSM (M=20.5 years) participated in four focus groups and 51 (M=21.1 years) completed questionnaires. RESULTS: over half of YMSM were aware of HPV (54.9%), yet few (21.6%) had previously discussed vaccination with a healthcare professional (HCP). Thematic analyses found YMSM were willing to receive the HPV vaccine. Vaccination programmes requiring YMSM to request the vaccine, particularly prior to sexual orientation disclosure to family and friends, were viewed as unfeasible. Educational campaigns explaining vaccine benefits were indicated as a way to encourage uptake. CONCLUSIONS: This study suggests that to effectively implement HPV vaccination for YMSM, this population requires clearer information and greater discussion with their HCP. In support of the decision made by the Joint Committee on Vaccination and Immunisation, universal vaccination is the most feasible and equitable option. However, the absence of a catch-up programme will leave a significant number of YMSM at risk of HPV infection.

Abstract. Author URL.

Merriel SW, Nadarzynski T, Kesten JM, Flannagan C, Prue G (2018). 'Jabs for the boys': time to deliver on HPV vaccination recommendations. Br J Gen Pract, 68(674), 406-407. Author URL.

Merriel SWD, Flannagan C, Kesten JM, Shapiro GK, Nadarzynski T, Prue G (2018). Knowledge and Attitudes of General Practitioners and Sexual Health Care Professionals Regarding Human Papillomavirus Vaccination for Young Men Who Have Sex with Men. Int J Environ Res Public Health, 15(1). Abstract. Author URL.

Nicholson BD, Shinkins B, Price S, Verbakel JY, Merriel S (2018). National cancer control plans. The Lancet Oncology, 19(12).

Romero Y, Trapani D, Johnson S, Tittenbrun Z, Given L, Hohman K, Stevens L, Torode JS, Boniol M, Ilbawi AM, et al (2018). National cancer control plans: a global analysis. The Lancet Oncology, 19(10), e546-e555.

Merriel SWD, May MT, Martin RM (2018). Predicting prostate cancer progression: protocol for a retrospective cohort study to identify prognostic factors for prostate cancer outcomes using routine primary care data. BMJ Open, 8(1).

INTRODUCTION: Prostate cancer is the most common cancer in men in the UK, with nearly 40 000 diagnosed in 2014; and it is the second most common cause of male cancer-related mortality. The clinical conundrum is that most men live with prostate cancer rather than die from it, while existing treatments have significant associated morbidity. Recent studies have shown very low mortality rates (1% after a median of 10-year follow-up) and no treatment-related reductions in mortality, in men with localised prostate cancer. This study will identify prognostic factors associated with prostate cancer progression to help differentiate aggressive from more indolent tumours in men with localised disease at diagnosis, and so inform the decision to adopt conservative (active surveillance) or radical (surgery or radiotherapy) management strategies. METHODS AND ANALYSIS: the Clinical Practice Research Datalink (CPRD) contains 57 318 men who were diagnosed with prostate cancer between 1 January 1987 and 31 December 2016. These men will be linked to the Office for National Statistics (ONS) and the National Cancer Registration and Analysis Service registry databases for mortality, TNM stage, Gleason grade and treatment data. Men with a diagnosis date prior to 1 January 1987 and men with lymph node or distant metastases at diagnosis will be excluded. A priori determined prognostic factors potentially associated with prostate cancer mortality, the end point of cancer progression, will be measured at baseline, and the participants followed through to development of cancer progression, death or the end of the follow-up period (31 December 2016). Cox proportional hazards regression will be used to estimate crude and mutually adjusted HRs. Mortality risk will be predicted using flexible parametric survival models that can accurately fit the shape of the hazard function. ETHICS AND DISSEMINATION: This study protocol has approval from the Independent Scientific Advisory Committee for the UK Medicines and Healthcare products Regulatory Agency Database Research (protocol 17_041). The findings will be presented in peer-reviewed journals and local CPRD researcher meetings.

Abstract. Author URL.

Merriel SWD, Funston G, Hamilton W (2018). Prostate Cancer in Primary Care. Adv Ther, 35(9), 1285-1294.

Prostate cancer is a common malignancy seen worldwide. The incidence has risen in recent decades, mainly fuelled by more widespread use of prostate-specific antigen (PSA) testing, although prostate cancer mortality rates have remained relatively static over that time period. A man's risk of prostate cancer is affected by his age and family history of the disease. Men with prostate cancer generally present symptomatically in primary care settings, although some diagnoses are made in asymptomatic men undergoing opportunistic PSA screening. Symptoms traditionally thought to correlate with prostate cancer include lower urinary tract symptoms (LUTS), such as nocturia and poor urinary stream, erectile dysfunction and visible haematuria. However, there is significant crossover in symptoms between prostate cancer and benign conditions affecting the prostate such as benign prostatic hypertrophy (BPH) and prostatitis, making it very challenging to distinguish between them on the basis of symptoms. The evidence for the performance of PSA in asymptomatic and symptomatic men for the diagnosis of prostate cancer is equivocal. PSA is subject to false positive and false negative results, affecting its clinical utility as a standalone test. Clinicians need to counsel men about the risks and benefits of PSA testing to inform their decision-making. Digital rectal examination (DRE) by primary care clinicians has some evidence to show discrimination between benign and malignant conditions affecting the prostate. Patients referred to secondary care for diagnostic testing for prostate cancer will typically undergo a transrectal or transperineal biopsy, where a number of samples are taken and sent for histological examination. These biopsies are invasive procedures with side effects and a risk of infection and sepsis, and alternative tests such as multiparametric magnetic resonance imaging (mpMRI) are currently being trialled for their accuracy and safety in diagnosing clinically significant prostate cancer.

Abstract. Author URL.

(2017). Abstracts of the 2017 World Congress of Psycho-Oncology, 14-18 August 2017, Berlin, Germany. Psychooncology, 26 Suppl 3, 3-167. Author URL.

Merriel SWD, Turner EL, Walsh E, Young GJ, Metcalfe C, Hounsome L, Tudge I, Donovan J, Hamdy F, Neal D, et al (2017). Cross-sectional study evaluating data quality of the National Cancer Registration and Analysis Service (NCRAS) prostate cancer registry data using the Cluster randomised trial of PSA testing for Prostate cancer (CAP). BMJ Open, 7(11).

OBJECTIVES: to compare the completeness and agreement of prostate cancer data recorded by the National Cancer Registration and Analysis Service (NCRAS) with research-level data specifically abstracted from medical records from the Cluster randomised triAl of prostate specific antigen (PSA) testing for Prostate cancer (CAP) trial. DESIGN: Cross-sectional comparison study. PARTICIPANTS: We included 1356 men from the CAP trial cohort who were linked to the NCRAS registry. PRIMARY AND SECONDARY OUTCOME MEASURES: Completeness of prostate cancer data in NCRAS and CAP and agreement for tumour, node, metastases (TNM) stage (T1/T2; T3; T4/N1/M1) and Gleason grade (4-6; 7; 8-10), measured by differences in proportions and Cohen's kappa statistic. Data were also stratified by year and pre-2010 versus post-2010, when NCRAS reporting standards changed. RESULTS: Compared with CAP, completeness was lower in NCRAS for Gleason grade (41.2% vs 76.7%, difference 35.5, 95% CI 32.1 to 39.0) and TNM stage (29.9% vs 67.6%, difference 37.6, 95% CI 34.1 to 41.1). NCRAS completeness for Gleason grade (pre-2010 vs post-2010 31.69% vs 64%; difference 32.31, 95% CI 26.76 to 37.87) and TNM stage (19.31% vs 55.50%; difference 36.19, 95% CI 30.72 to 41.67) improved over time. Agreement for Gleason grade was high (Cohen's kappa, κ=0.90, 95% CI 0.88 to 0.93), but lower for TNM stage (κ=0.41, 95% CI 0.37 to 0.51) overall. There was a trend towards improved agreement on Gleason grade, but not TNM stage, when comparing pre-2010 and post-2010 data. CONCLUSION: NCRAS case identification was very high; however, data on prostate cancer grade was less complete than CAP, and agreement for TNM stage was modest. Although the completeness of NCRAS data has improved since 2010, the higher completeness rate in CAP demonstrates that gains could potentially be achieved in routine registry data. This study's findings highlight a need for improved recording of stage and grade data in the source medical records.

Abstract. Author URL.

Lim RS, Evans L, George AP, de Alwis N, Stimpson P, Merriel S, Giddings CEB, Billah B, Smith JA, Safdar A, et al (2017). Do demographics and tumour-related factors affect nodal yield at neck dissection? a retrospective cohort study. J Laryngol Otol, 131(S1), S36-S40. Abstract. Author URL.

Merriel A, Murove BT, Merriel SWD, Sibanda T, Moyo S, Crofts J (2017). Implementation of a modified obstetric early warning system to improve the quality of obstetric care in Zimbabwe. INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS, 136(2), 175-179. Author URL.

Merriel SWD (2017). Management of angina in primary care. Nurse Prescribing, 15(10), 492-497. Abstract.

Merriel SWD, Carroll R, Hamilton F, Hamilton W (2016). Association between unexplained hypoalbuminaemia and new cancer diagnoses in UK primary care patients. Fam Pract, 33(5), 449-452. Abstract. Author URL.

Merriel A, van der Nelson H, Merriel S, Bennett J, Donald F, Draycott T, Siassakos D (2016). Identifying Deteriorating Patients Through Multidisciplinary Team Training. Am J Med Qual, 31(6), 589-595. Abstract. Author URL.

Merriel S (2015). Critically appraising the evidence. InnovAiT: Education and inspiration for general practice, 8(9), 562-568. Abstract.

Merriel SWD, Salisbury C, Metcalfe C, Ridd M (2015). Depth of the patient-doctor relationship and content of general practice consultations: cross-sectional study. BRITISH JOURNAL OF GENERAL PRACTICE, 65(637), E545-E551. Author URL.

Merriel SWD, Andrews V, Salisbury C (2014). Telehealth interventions for primary prevention of cardiovascular disease: a systematic review and meta-analysis. PREVENTIVE MEDICINE, 64, 88-95. Author URL.

Merriel SWD, Andrews V, Salisbury C (2014). Telehealth interventions for primary prevention of cardiovascular disease: a systematic review and meta-analysis (vol 64, pg 88, 2014). PREVENTIVE MEDICINE, 67, 343-343. Author URL.

Conferences

Prue GE, Flannagan C, Ruane-McAteer E, Merriel SWD, Nadarzynski T, Shapiro GK, Rosberger Z, Kesten JM (2018). "The only way round it is if every male child is vaccinated"; exploring the views of young men-who-have-sex-with-men towards HPV vaccination: a qualitative study. Author URL.

Fildes A, Aicken C, Merriel SWD, Llewellyn C (2017). Developing a communication toolbox for primary care practitioners to raise the issue of weight with parents of preschool children: a qualitative study. Author URL.

Prue G, Flannagan C, Kesten J, Merriel S, Shapiro G, Rosberger Z (2017). Exploring views regarding targeted HPV vaccination in young men who have sex with men and their healthcare professionals. Author URL.

Merriel SWD, Turner EL, Walsh E, Young G, Metcalfe C, Hounsome L, Tudge I, Donovan J, Hamdy F, Neal D, et al (2016). Validation of the National Cancer Registration and Analysis Service prostate cancer registry with data from the CAP study. Author URL.

Publications by year

In Press