The ThinkCancer! Feasibility Study

Introduction

In comparison with other Western countries, Wales has relatively poor cancer outcomes (CRUK, 2018) and late diagnosis is a major factor (Wales Cancer Network, 2016). Recent evidence from the International Cancer Benchmarking Partnership has shown GPs in Wales are less likely to refer or investigate (Rose et al., 2015) and adherence to cancer guidelines is lower (Nicholson, Mant, Neal et al., 2016). This has a negative effect on cancer outcomes.

We have developed an intervention which aims to change primary health professionals’ knowledge, attitudes and clinical behaviour with regards to cancer. We hope that by doing so, the time between a patient first presenting symptoms to being referred to a specialist can be reduced. In addition, we believe that by targeting GP behaviour, we can improve cancer outcomes.

The ThinkCancer! intervention will be delivered as a workshop to general medical practice teams. All staff at general practices will be invited to join in. The first two components will be educational, consisting of separate, themed clinical and non-clinical sessions. The final part of the workshop will bring together all practice staff and will explore safety-netting, a process where patients and their symptoms are monitored until an explanation is found. The aim of this final session is for the practice to develop a bespoke Cancer Safety Netting Plan, tailored to the specific needs of their practice. Finally, the practice team will appoint their own Cancer Safety Netting Champion (CSNC); this voluntary role is open to anyone in the practice team. The CSNC will support and have responsibility for the implementation of practice’s Cancer Safety Netting Plan and encourage a supportive environment for all staff in which concerns or cases where cancer is suspected can be discussed.

The workshops will be delivered in general practices over a half day protected time session by a GP Educator, who is also a member of our core research team. Two further research team members will support the delivery of the workshop.

CRUK. (2018). Cancer Research UK position paper: The diagnostic workforce in Wales. London.

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Wales Cancer Network. (2016). Cancer Delivery Plan for Wales 2016-2020, from http://www.walescanet.wales.nhs.uk/sitesplus/documents/1113/161114cancerplanen.pdf

Rose, P. W., Rubin, G., Perera-Salazar, R., Almberg, S. S., Barisic, A., Dawes, M., . . . Hamilton, W. (2015). Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey. BMJ Open, 5. doi: 10.1136/bmjopen-2014-007212

Nicholson, B. D., Mant, D., Neal, R. D., Hart, N., Hamilton, W., Shinkins, B., . . . Rose, P. W. (2016). International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data. British Journal of General Practice, 66(643), 106-113. doi: https://doi.org/10.3399/bjgp16X683449

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The Study

The aim of the ThinkCancer! study is to determine the feasibility of a future definitive randomised controlled trial (RCT) of this complex intervention compared with usual primary care. A feasibility study explores whether a future, larger-scale definitive trial can be done. This incorporates testing practice recruitment, the delivery of the intervention and also the outcome measures so that we can refine the intervention as we go along. This will in turn guide the design for a future trial. These are important steps in the development of successful randomised controlled trials and the implementation of their findings into practice.

The ThinkCancer! feasibility study will begin in the autumn of 2019. We will be looking for practice teams to take part in this study to test the intervention. For more information, please contact the study team on wicked@bangor.ac.uk

WICKED (Wales Interventions and Cancer Knowledge about Early Diagnosis)

 

 

The ThinkCancer! Study comprises Work Package 4 of a programme of research called the Wales Interventions and Cancer Knowledge about Early Diagnosis (WICKED). The overall aims of the WICKED Programme are to improve the quality and consistency of primary care approaches in order to improve timely diagnosis of cancer. Ultimately, this feasibility study will inform Work Package 5, which will encompass the planning phase for a future definitive Phase III Trial.

Work Packages 1 and 2 informed the development of the ThinkCancer! Intervention. We used a variety of methods to collect and integrate data from different sources:

  • Comprehensive reviews of published literature, relevant reports and web pages,
  • Online survey including a Discrete Choice Experiment (DCE) sent to all GPs in Wales
  • Twenty telephone interviews with GPs
  • Focus groups held with four practice teams. 

A target behaviour – GPs thinking of and acting on clinical presentations* that could be cancer - was agreed on based on the findings from the first two Work Packages.

The work was underpinned by Behaviour Change Theory and informed by stakeholder consultation at every stage. Patients and the public have been and remain involved at all stages of the project. 

Read more about the WICKED Programme and the previous Work Packages by clicking here to read our publication in the BJGP.

 *clinical presentations: symptoms, clinical signs and the context (e.g. past medical history, risk factors, previous consultations) during a primary care consultation.

 

Patient and Public Involvement

Janice Rose has worked with us throughout the WICKED programme and is a key member of the ThinkCancer! Team.

‘I got involved with researchers working in the field of cancer after my breast cancer diagnosis and my mum’s diagnosis of Cancer of Unknown Primary (CUP).  Both happened in 2009.  Since then I have worked locally, regionally and nationally with researchers representing the patient perspective in various research studies taking place and generally helping research into cancer where I can.

My link to the Wales Interventions and Cancer Knowledge about Early Diagnosis (WICKED) Programme came through my link to the NCRI Primary Care Group.  I have worked with the researchers since the study started.

I am pleased to be one of the patients working with the research team looking at ways to help doctors and other staff in GP practices in Wales to help improve early cancer diagnosis for their patients.  The project is very worthwhile as early diagnosis of cancer is so important for patients in terms of the outcomes after their diagnosis.

Having patients working with the research team allows for the voice of the patient to be listened to and considered throughout the research project.  Very important.'

  • Janice Rose, ThinkCancer! PPI Representative

This project has been funded by Cancer Research Wales

For more information about this study, please contact the study team on wicked@bangor.ac.uk

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