Gloucestershire Evidence & Research Repository

Background: How do practitioners in service settings respond to communication support needs of people with intellectual disabilities? Conversation Analysis (CA) uses recordings of everyday encounters to understand the challenges practitioners face. Method: Following specialist guidance on systematically reviewing CA research, we reviewed 65 CA research articles examining staff communication in healthcare, education, social care and the police. Results: We identified five themes in the synthesis. Two were categories of interactional practices (Questions and Answers; Decision-Making), one examined non-verbal communication (Embodied and Non-Verbal Communication) and two considered contributions of other material and human agents (Communication Aids and Supports; Involvement of Companions). In each theme, we saw examples of competency-enhancing and competency-inhibiting practices. Conclusions: Practitioners face interactional dilemmas: (1) Orienting to the Person's Self-determination versus Getting the Job Done; (2) Adapting Communication versus Downplaying Difference. Future research should build on this review to develop and evaluate communication training for staff. Plain language summary Need for communication support: People with intellectual disabilities often need communication support in order to present their views, make decisions and engage in activities, but there is not much research that shows how this support is delivered by practitioners in real life. Using Conversation Analysis research to understand everyday interactions: We reviewed existing research that used a method called Conversation Analysis (CA) to understand how ordinary ways that staff ask questions, offer choices, use communication aids and respond to body language strongly shape whether people with intellectual disabilities are heard, understood and treated as competent decision‐makers. Support can both help and hinder: The research demonstrated that strategies intended to help—such as simplifying language, guiding decisions or speaking on someone's behalf—can unintentionally limit autonomy and participation if they prioritise efficiency or control over listening and choice. Implications for practice and research: Practitioners can improve their practice by being aware of the implications of offering support in different ways. This review provides information that can underpin evidence‐based communication training at a level of detail beyond what is currently available.

Objectives: To investigate the potential of the Haematuria Cancer Risk Score (HCRS) to improve the real-world investigation pathway for suspected bladder cancer. Materials and methods: Data were retrospectively analysed for all consecutive patients referred with suspected urinary tract cancer on a faster diagnostic pathway to five UK institutions between January and April 2025. The HCRS cut-off score of ≥82 was used to define a 'HCRS high risk' population. The co-primary outcomes were the ability to calculate HCRS in the referred population from the information provided by primary care and the cancer detection rate. Results: In total, 1944 referrals were received, median age of 71 years (IQR 61-78), 1186/1944 (61%) were male, and 1586/1944 (82%) had sufficient information to calculate the HCRS. Of the cohort with HCRS scores, overall 165/1586 (10%) had bladder cancer. The HCRS was ≥82 in 176/437 (40%) of those with non-visible haematuria (NVH); in total, 6/176 (3%) had bladder cancer; and using HCRS in the NVH group alone, no case of muscle-invasive bladder cancer (MIBC) would have been missed. The HCRS was ≥82 in 1062/1149 (92%) with visible haematuria (VH), of whom 150/1062 (14%) had bladder cancer. Adopting a strategy of using HCRS and upper tract imaging in combination for the whole cohort would have resulted in two cases of NMIBC being missed for the NVH cohort and one case of NMIBC being missed for the VH cohort. No cases of MIBC or upper tract urothelial cancer would have been missed. Conclusion: HCRS is a simple innovation, which demonstrates clear potential when combined with upper tract imaging to improve current UK risk stratification to determine which patients referred with haematuria need flexible cystoscopy. Keywords: bladder cancer; haematuria; radical cystectomy; transurethral resection of bladder tumour.