{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:47:28Z","timestamp":1785934048419,"version":"3.56.0"},"reference-count":53,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006058","name":"St. Baldrick\u2019s Foundation","doi-asserted-by":"publisher","award":["696781"],"award-info":[{"award-number":["696781"]}],"id":[{"id":"10.13039\/100006058","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,9]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cancer is the most common cause of disease-related mortality in children, highlighting the urgent need for improved care in this population. It is estimated that &gt;15% of children diagnosed with cancer harbour a germline pathogenic variant in a cancer predisposition gene which confers an increased risk to develop cancer. There are over 100 genes associated with cancer predisposition syndromes (CPSs) and greater availability and acceptability of genetic testing in the last decade has facilitated their recognition in childhood. However, individually, each of these CPSs is rare, impeding robust research and advancement of clinical care. Once a specific CPS is diagnosed, current recommendations for clinical care are based primarily on expert consensus with a \u2019one size fits all\u2019 approach to management. Detailed knowledge of genotype-phenotype associations and the impact of genetic modifiers is lacking, and due to strong ascertainment bias of children already diagnosed with cancer predominantly being tested for a CPS, the true cancer risk is likely overestimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analyses<\/jats:title>\n                    <jats:p>\n                      The Childhood Cancer Predisposition Study (CCPS) is a multi-centre registry and biorepository for children and adolescents aged 0\u201321 years with a clinical or molecularly confirmed CPS and their family members (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04511806\">NCT04511806<\/jats:ext-link>\n                      ). The study objectives are to characterise the natural history of each CPS, correlate the natural history phenotype with CPS genotype, evaluate the efficacy of standard surveillance strategies and allow future investigation into the feasibility and effectiveness of novel surveillance strategies. The principal study question is whether adherence to recommended tumour surveillance guidelines is associated with earlier detection of tumours and\/or improved survival. We will also address what barriers exist that prevent adherence to surveillance guidelines. Data collected from primary subjects includes detail about the CPS, genomic data, cancer history and family cancer history, as well as information about tumour surveillance. Required biospecimen collection includes germline DNA samples, with optional collection of serial blood and stool samples. Planned enrolment is 1050 primary subjects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>CCPS was reviewed and approved by a central IRB (WCG IRB 2020P002450) and the Research Ethics Board at The Hospital for Sick Children in Toronto (1000072286). Written informed consent is obtained from all participants. Data and specimens are available to qualified investigators by request to address specific research questions through a standardised research application process. In addition, de-identified data are available through the Pediatric Cancer Data Commons for exploration. Analysed data will be disseminated in peer-reviewed publications and at conferences including meetings inclusive of patient and family advocacy groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04511806\">NCT04511806<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120576","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:34Z","timestamp":1785930934000},"page":"e120576","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Childhood cancer predisposition study: a prospective registry and biorepository protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct04511806","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04511806","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0598-7102","authenticated-orcid":false,"given":"Melissa R","family":"Perrino","sequence":"first","affiliation":[{"name":"St Jude Children\u2019s Research Hospital, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne P","family":"MacFarland","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Maese","sequence":"additional","affiliation":[{"name":"Huntsman Cancer Institute, Primary Children\u2019s Hospital, University of Utah Health, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie","family":"Vagher","sequence":"additional","affiliation":[{"name":"Huntsman Cancer Institute, Primary Children\u2019s Hospital, University of Utah Health, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junne","family":"Kamihara","sequence":"additional","affiliation":[{"name":"Dana-Farber Cancer Institute, Harvard Medical School and Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surya","family":"Rednam","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Texas Children\u2019s Hospital, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J","family":"Lupo","sequence":"additional","affiliation":[{"name":"Aflac Cancer & Blood Disorders Center, Children\u2019s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett M","family":"Brodeur","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Schiffman","sequence":"additional","affiliation":[{"name":"Huntsman Cancer Institute, Primary Children\u2019s Hospital, University of Utah Health, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Diller","sequence":"additional","affiliation":[{"name":"Dana-Farber Cancer Institute, Harvard Medical School and Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0991-8155","authenticated-orcid":false,"given":"Lauren","family":"Desrosiers-Battu","sequence":"additional","affiliation":[{"name":"Cancer and Hematology Centers, Texas Children\u2019s Hospital, Houston, Texas, USA"},{"name":"Pediatrics, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon E","family":"Plon","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Texas Children\u2019s Hospital, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5581-6555","authenticated-orcid":false,"given":"Kim E","family":"Nichols","sequence":"additional","affiliation":[{"name":"St Jude Children\u2019s Research Hospital, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel L","family":"Volchenboum","sequence":"additional","affiliation":[{"name":"The University of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Malkin","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Villani","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8774-0180","authenticated-orcid":false,"given":"Christopher C","family":"Porter","sequence":"additional","affiliation":[{"name":"Aflac Cancer & Blood Disorders Center, Children\u2019s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"2026080504552078000_16.8.e120576.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.10080"},{"key":"2026080504552078000_16.8.e120576.2","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1001\/jamaoncol.2015.5699","article-title":"Diagnostic Yield of Clinical Tumor and Germline Whole-Exome Sequencing for Children With Solid Tumors","volume":"2","author":"Parsons","year":"2016","journal-title":"JAMA Oncol"},{"key":"2026080504552078000_16.8.e120576.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1508054"},{"key":"2026080504552078000_16.8.e120576.4","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1001\/jamaoncol.2015.5689","article-title":"Multicenter Feasibility Study of Tumor Molecular Profiling to Inform Therapeutic Decisions in Advanced Pediatric Solid Tumors: The Individualized Cancer Therapy (iCat) Study","volume":"2","author":"Harris","year":"2016","journal-title":"JAMA Oncol"},{"key":"2026080504552078000_16.8.e120576.5","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-17-0702"},{"key":"2026080504552078000_16.8.e120576.6","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.23283"},{"key":"2026080504552078000_16.8.e120576.7","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/s43018-022-00474-y","article-title":"The clinical utility of integrative genomics in childhood cancer extends beyond targetable mutations","volume":"4","author":"Villani","year":"2023","journal-title":"Nat Cancer"},{"key":"2026080504552078000_16.8.e120576.8","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1158\/1940-6207.CAPR-22-0215","article-title":"Collaboration to Promote Research and Improve Clinical Care in the Evolving Field of Childhood Cancer Predisposition","volume":"15","author":"MacFarland","year":"2022","journal-title":"Cancer Prevention Research"},{"key":"2026080504552078000_16.8.e120576.9","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-17-2026"},{"key":"2026080504552078000_16.8.e120576.10","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.22827"},{"key":"2026080504552078000_16.8.e120576.11","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.21.1920"},{"key":"2026080504552078000_16.8.e120576.12","doi-asserted-by":"publisher","DOI":"10.1186\/1748-717X-5-104"},{"key":"2026080504552078000_16.8.e120576.13","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2005.036319"},{"key":"2026080504552078000_16.8.e120576.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2007.05.001"},{"key":"2026080504552078000_16.8.e120576.15","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-2264(200002)27:2<124::AID-GCC2>3.0.CO;2-M"},{"key":"2026080504552078000_16.8.e120576.16","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/90.8.606"},{"key":"2026080504552078000_16.8.e120576.17","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30248"},{"key":"2026080504552078000_16.8.e120576.18","first-page":"1233","article-title":"American Society of Human Genetics Board of Directors, American College of Medical Genetics Board of Directors","volume":"57","year":"1995","journal-title":"Am J Hum Genet"},{"key":"2026080504552078000_16.8.e120576.19","doi-asserted-by":"publisher","DOI":"10.1542\/peds.107.6.1451"},{"key":"2026080504552078000_16.8.e120576.20","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1093\/pch\/8.1.42","article-title":"Guidelines for genetic testing of healthy children","volume":"8","year":"2003","journal-title":"Paediatr Child Health"},{"key":"2026080504552078000_16.8.e120576.21","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.03.189"},{"key":"2026080504552078000_16.8.e120576.22","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/00008480-199402000-00009","article-title":"Screening for cancer susceptibility in children","volume":"6","author":"Malkin","year":"1994","journal-title":"Curr Opin Pediatr"},{"key":"2026080504552078000_16.8.e120576.23","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1006\/scbi.1996.0007","article-title":"Genetic predisposition to cancer--issues to consider","volume":"7","author":"Malkin","year":"1996","journal-title":"Semin Cancer Biol"},{"key":"2026080504552078000_16.8.e120576.24","doi-asserted-by":"crossref","first-page":"2581","DOI":"10.1158\/1078-0432.CCR-25-0423","article-title":"Pediatric Cancer Predisposition and Surveillance Update: Summary Perspective and Future Directions","volume":"31","author":"Brodeur","year":"2025","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.25","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-24-1098"},{"key":"2026080504552078000_16.8.e120576.26","doi-asserted-by":"crossref","first-page":"4566","DOI":"10.1158\/1078-0432.CCR-24-0953","article-title":"Pediatric Cancer Screening in Hereditary Gastrointestinal Cancer Risk Syndromes: An Update from the AACR Childhood Cancer Predisposition Working Group","volume":"30","author":"MacFarland","year":"2024","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.27","doi-asserted-by":"crossref","first-page":"4286","DOI":"10.1158\/1078-0432.CCR-24-0685","article-title":"Update on Recommendations for Surveillance for Children with Predisposition to Hematopoietic Malignancy","volume":"30","author":"Maese","year":"2024","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.28","doi-asserted-by":"crossref","first-page":"3378","DOI":"10.1158\/1078-0432.CCR-23-3994","article-title":"Clinical Updates and Surveillance Recommendations for DNA Replication Repair Deficiency Syndromes in Children and Young Adults","volume":"30","author":"Das","year":"2024","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.29","doi-asserted-by":"crossref","first-page":"3628","DOI":"10.1158\/1078-0432.CCR-24-3860","article-title":"Updated Recommendations for Pediatric Surveillance in Hereditary Endocrine Neoplasia Syndromes: Multiple Endocrine Neoplasias, Hyperparathyroidism\u2013Jaw Tumor Syndrome, and Carney Complex","volume":"31","author":"Wasserman","year":"2025","journal-title":"Clinical Cancer Research"},{"key":"2026080504552078000_16.8.e120576.30","doi-asserted-by":"crossref","first-page":"3368","DOI":"10.1158\/1078-0432.CCR-24-4354","article-title":"Update on Tumor Surveillance for Children with Hereditary Pheochromocytoma\/Paraganglioma Syndromes","volume":"31","author":"Rednam","year":"2025","journal-title":"Clinical Cancer Research"},{"key":"2026080504552078000_16.8.e120576.31","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1158\/1078-0432.CCR-24-3525","article-title":"Update on Surveillance in Von Hippel\u2013Lindau Disease","volume":"31","author":"Rednam","year":"2025","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.32","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1158\/1078-0432.CCR-24-3301","article-title":"Update on Cancer Screening Recommendations for Individuals with Li\u2013Fraumeni Syndrome","volume":"31","author":"Achatz","year":"2025","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.33","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1158\/1078-0432.CCR-24-3271","article-title":"Update on Retinoblastoma Predisposition and Surveillance Recommendations for Children","volume":"31","author":"Kamihara","year":"2025","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.34","doi-asserted-by":"crossref","first-page":"3137","DOI":"10.1158\/1078-0432.CCR-24-0237","article-title":"Neuroblastoma Predisposition and Surveillance\u2014An Update from the 2023 AACR Childhood Cancer Predisposition Workshop","volume":"30","author":"Kamihara","year":"2024","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.35","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.1158\/1078-0432.CCR-23-4033","article-title":"Update on Cancer Predisposition Syndromes and Surveillance Guidelines for Childhood Brain Tumors","volume":"30","author":"Hansford","year":"2024","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.36","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1158\/1078-0432.CCR-24-3278","article-title":"Update on Cancer and Central Nervous System Tumor Surveillance in Pediatric NF2-, SMARCB1-, and LZTR1-Related Schwannomatosis","volume":"31","author":"Perrino","year":"2025","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.37","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-24-1611"},{"key":"2026080504552078000_16.8.e120576.38","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1158\/1078-0432.CCR-24-2171","article-title":"Update on Cancer Screening in Children with Syndromes of Bone Lesions, Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome, and Other Rare Syndromes","volume":"31","author":"Michaeli","year":"2025","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.39","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1158\/1078-0432.CCR-24-1947","article-title":"Update on Pediatric Surveillance Recommendations for PTEN Hamartoma Tumor Syndrome, DICER1- Related Tumor Predisposition, and Tuberous Sclerosis Complex","volume":"31","author":"Schultz","year":"2025","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.40","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1158\/1078-0432.CCR-24-2488","article-title":"Update on Surveillance Guidelines in Emerging Wilms Tumor Predisposition Syndromes","volume":"31","author":"Brzezinski","year":"2025","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.41","doi-asserted-by":"crossref","first-page":"5260","DOI":"10.1158\/1078-0432.CCR-24-2100","article-title":"Update on Surveillance for Wilms Tumor and Hepatoblastoma in Beckwith\u2013Wiedemann Syndrome and Other Predisposition Syndromes","volume":"30","author":"Kalish","year":"2024","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.42","doi-asserted-by":"crossref","first-page":"3983","DOI":"10.1158\/1078-0432.CCR-24-1165","article-title":"Update on Genetic Counselor Practice and Recommendations for Pediatric Cancer Predisposition Evaluation and Surveillance","volume":"30","author":"Zelley","year":"2024","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.43","doi-asserted-by":"crossref","first-page":"5021","DOI":"10.1158\/1078-0432.CCR-24-1374","article-title":"Update on Whole-Body MRI Surveillance for Pediatric Cancer Predisposition Syndromes","volume":"30","author":"Greer","year":"2024","journal-title":"Clin Cancer Res"},{"key":"2026080504552078000_16.8.e120576.44","doi-asserted-by":"crossref","first-page":"3638","DOI":"10.1158\/1078-0432.CCR-25-0597","article-title":"Radiation Concepts and Considerations for Pediatric Cancer Predisposition Syndrome Surveillance: A Report from the 2023 AACR Childhood Cancer Predisposition Workshop","volume":"31","author":"Voss","year":"2025","journal-title":"Clinical Cancer Research"},{"key":"2026080504552078000_16.8.e120576.45","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.02636"},{"key":"2026080504552078000_16.8.e120576.46","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)30249-2"},{"key":"2026080504552078000_16.8.e120576.47","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.Ccr-24-1532"},{"key":"2026080504552078000_16.8.e120576.48","unstructured":"Jacks T , Jaffe E , Singer D . Cancer Moonshot Blue Ribbon Panel Report: National Cancer Institute. 2016. Available: https:\/\/www.cancer.gov\/research\/key-initiatives\/moonshot-cancer-initiative\/blue-ribbon-panel\/blue-ribbon-panel-report-2016.pdf2019"},{"key":"2026080504552078000_16.8.e120576.49","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1503523"},{"key":"2026080504552078000_16.8.e120576.50","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60140-3"},{"key":"2026080504552078000_16.8.e120576.51","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.18.2251"},{"key":"2026080504552078000_16.8.e120576.52","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.47.8313"},{"key":"2026080504552078000_16.8.e120576.53","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdm481"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-120576","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:39Z","timestamp":1785930939000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-120576"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":53,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,5]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjopen-2026-120576"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-120576","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}