125th Anniversary Scholarship in Inflammation and Ageing

About the project

Lupus nephritis (LN) is an autoimmune inflammatory glomerulonephritis in which an over-active immune system causes inflammation in the kidney. Inadequate treatment of LN results in chronic kidney disease or end-stage kidney failure. Although several national and international guidelines for LN management exist, we have identified marked differences in physician's treatment preferences for LN across the UK, including differences between rheumatologists and nephrologists [1]. In a parallel study we are investigating the decision cues used by physicians to select treatment.

As effective clinical decision-making is a shared process between physicians and patients, it is critical to understand patient preferences with regards to treatment. This is important to inform patient-centred drug development, clinical guidelines, and tools to support shared decision-making. This project will allow you to study in detail patient preferences with respect to LN treatment, the relative importance of these and how they align with the opinions of other stakeholders.

Proposed methods

This mixed methods study will comprise 3 phases:

Phase 1: You will conduct semi-structured exploratory interviews with patients both with LN and with systemic lupus erythematosus (SLE) who have not developed LN but may be considered “at risk”. You will purposively recruit participants from ethnic minority and socially disadvantaged backgrounds to ensure a broad range of responses. You will analyse transcripts using content and inductive thematic analysis (full training will be given, see below).

Phase 2: You will conduct a survey involving Q methodology to define the relative importance of treatment attributes important for decision making that were identified in Phase 1.

Phase 3: You will hold focus groups with key stakeholders (patients, physicians, charity representatives, commissioners) will be used to explore the findings from phases 1 and 2 and triangulate these with data from our separate study of decision cues used by physicians to identify areas of commonality or critical differences.

Impact

This study will provide an essential understanding of patient preferences for treatment of LN and compare these to physician preferences, which we are investigating in a separate, complementary study. This study has clear relevance for pharmaceutical or biotech companies who are developing new treatments for LN as it is critical that new therapies are acceptable to patients, and that clinical trial design reflects patient treatment preferences.

Our findings will also inform future clinical guidelines for the treatment on LN, directly addressing treatment-related factors or attributes which are important for patients. Understanding differences in treatment preferences between patient groups will also inform future studies to address health inequalities and define how patient preferences relate to treatment adherence and ultimately outcomes for patients with LN.

Your supervisory team

The supervisors for this doctoral research project are Dr John Reynolds and Dr Marie Falahee. John leads both experimental and clinical research programmes aiming to understand the heterogeneity of lupus, why some patients have worse outcomes and how best to optimise treatment. Within this he has previously studied physicians’ approaches to treatment of systemic lupus (in terms of defining lupus remission) and more recently the management of lupus nephritis. Marie is a Lecturer in Behavioural Rheumatology with extensive experience in qualitative and mixed-methods studies. Marie is an expert in patient preference studies and their methodologies and has led a case study of treatment preferences for rheumatoid arthritis for IMI_PREFER which has directly informed international recommendations on the integration of patient preference information in drug development which are influencing regulatory policy [2-5]. Marie also has academic oversight of our NIHR commended Rheumatology Research Patient Partnership (R2P2) which supports patient involvement across the Rheumatology Research Group and our PhD student-patient partnership (the Student Patient Alliance (SPA)).

A unique aspect of this project is that it will be supported by an established expert panel comprised of 2 nephrologists (Imperial College London, Cambridge), 6 rheumatologists with expertise in the management of lupus (UCL, Southampton, Leeds, Birmingham, Liverpool, Newcastle) and 2-3 patient partners. It is anticipated that the panel will meet twice per year and provide you with advice in the development of the semi-structured interviews, interpretation of findings, development and interpretation of the survey and support during the co-development of a clinical decision tool. The panel will also be available to offer ad hoc advice if needed.

You will be based in the Department of Inflammation and Ageing which conducts a broad range of research from discovery science through to healthcare research. We have a thriving postgraduate research community and host regular internal and external seminars. We are a EULAR Centre of Excellence in Rheumatology Research and are also supported by the NIHR Biomedical Research Centre (BRC).

Research training and support

You be supported to pursue a tailored training plan with annual review and update; to build the methodological and empirical knowledge you need to complete the project.

You will attend a 5-day Qualitative Research Methods course at the university which covers the theory of qualitative research, approaches to qualitative analysis and the interpretation of qualitative data. Training in analysis of quantitative data obtained from Q-methodology will be provided by the supervisory team. Alongside specialist training in techniques such as semi-structed interviewing and survey development, you will develop transferable skills in research ethics and governance, good research practice, patient and public involvement, science communication and impact and engagement. You will also interact with both healthcare professionals and patients and experience working within a multi-disciplinary team.

References

• Ibrahim ST, Edwards CJ, Ehrenstein MR, Griffiths B, Gordon C, Hewins P, Jayne D, Lightstone L, McLaren Z, Rhodes B, Vital EM, Reynolds JA. Differences in management approaches for lupus nephritis within the UK. Rheumatol Adv Pract. 2024;8:rkae017
• Wells I, Simons G, Kanacherril JP, Mallen CD, Raza K, Falahee M. Stakeholder perceptions of preventative approaches in rheumatoid arthritis: qualitative study of healthcare professionals’ perspectives on predictive and preventative strategies. BMC Rheumatology. 2023;7:35
• Simons G, Scholin Bywall K, Englbrecht M, Johansson EC, DiSantostefano RL et al. Exploring preferences of at-risk individuals for preventative treatments for rheumatoid arthritis. Sc J Rheumatol. 2023;52:449-59
• Simons G, Veldwijk J, DiSantostefano RL, Englbrecht M, Radawski C, Scholin Bywall K et al. Preferences for preventative treatments for rheumatoid arthritis: discrete choice survey in the UK, Germany and Romania. Rheumatology. 2023;62:596-605
• Falahee M, Simons G, Buckley CD, Hansson M, Stack RJ, Raza K. Patients’ perceptions of their relative’s risks of developing rheumatoid arthritis and the potential for risk communication, prediction and modulation. Arthritis Care Res. 2017;69:1558-65

Entry Requirements

Applicants will be expected to have a good Honours degree (First Class or Upper Second Class Honours degree) awarded by a recognised University in a relevant subject, or an alternative qualification, or experience of equal quality. In certain cases, a Masters degree or equivalent may be expected in a relevant subject.

Who can apply?

These scholarships are designed to create opportunities and address the underrepresentation of talented Black or Black mixed heritage students in academia. Applicants who meet all of the following criteria are eligible to apply:

1. Students classified as 'Home' for tuition fee payments
2. Members of one of the following ethnic groups:
   • Black African
   • Black Caribbean
   • Black Other
   • Mixed – White and Black Caribbean
   • Mixed – White and Black African
   • Other mixed background (to include Black African, Black Caribbean or Black Other)
3. Not already enrolled on a PhD programme at the University of Birmingham

What does the scholarship provide?

1. Financial Support: Recipients of these scholarships will receive substantial financial support, including a stipend at UKRI rates, which is set at £20,780 per year for the 2025/26 academic year, and will be paid to you in regular instalments. Successful awardees will also have their tuition fees covered at a minimum of £5,006 per year. This support is designed to alleviate the financial burden often associated with pursuing a doctoral degree, such as covering tuition fees, living expenses, and research-related costs.
2. Mentorship and Guidance: Scholarship recipients will benefit from mentorship opportunities and guidance from accomplished faculty members who are dedicated to helping them succeed in their academic and research endeavours.
3. Research Opportunities: We are committed to providing an exceptional research environment. Students will have access to state-of-the-art facilities, cutting-edge resources, and a vibrant scholarly community.
4. Community Building: A key component of the scholarship programme is the creation of a supportive community of Black British researchers pursuing PhDs. This network will foster collaboration and peer support among scholars.
5. Research Training Support Grant: In addition to financial support, scholarship recipients will receive a research training support grant at £2,250 across the duration of the PhD. This grant is intended to support conference attendance, fieldwork, and other essential activities that enhance their research and academic growth.
6. Commitment to Inclusivity: We are dedicated to building an inclusive academic environment that values diversity and ensures equitable access to education.

Contact the supervisor

Once applicants have familiarised themselves with the above project details, they are encouraged to contact the lead PhD supervisor to discuss the project and the applicant's suitability for the project. This is recommended before you submit an application to the PhD project.

The joint lead-supervisors for the PhD are Dr John Reynolds and Dr Marie Falahee. Dr John Reynolds is a Clinical Senior Lecturer in Rheumatology who leads both experimental and clinical research programmes aiming to understand the heterogeneity of lupus, why some patients have worse outcomes and how best to optimise treatment. Dr Marie Falahee is a Lecturer in Behavioural Rheumatology with extensive experience in qualitative and mixed-methods studies. Marie is an expert in patient preference studies and their methodologies. For further details on the supervisors, please view the 'your supervisory team' section above or read the staff profiles linked.

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