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BJGP Open. 2018 Sep 5;2(3):bjgpopen18X101595. doi: 10.3399/bjgpopen18X101595. eCollection 2018 Oct.

Development of an intervention to expedite cancer diagnosis through primary care: a protocol.

Author information

1
Research Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.
2
Research Project Support Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.
3
Research Fellow, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.
4
Research Fellow, Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK.
5
Research Fellow in Health Sciences Research, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.
6
Professor of Health Economics, Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK.
7
Professor in Primary Care, Department of Health Services Research, University of Liverpool, Liverpool, UK.
8
Professor, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
9
Professor in Health Services Research, North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK.
10
Clinical Reader, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
11
Senior Clinical Lecturer, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
12
Professor of Primary Care Cancer Research, Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Australia.
13
Professor of Primary Care Diagnostics, Discovery Research Group, University of Exeter, Exeter, UK.
14
Principal Trial Statistician, North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK.
15
Professor of Cancer Epidemiology, Department of Behavioural Science and Health, University College London, London, UK.
16
Professor of General Practice and Primary Care, Institute of Health and Society, University of Newcastle, Newcastle, UK.
17
Research Associate, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
18
Professor, Research Director, Department of Public Health, Research Centre for Cancer Diagnosis, Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
19
Professor, Research Director, Department of Clinical Medicine, University Clinic for Innovative Health Care Delivery, Silkeborg Hospital, Aarhus University, Aarhus, Denmark.
20
Principal Researcher in Primary Care Cancer Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
21
Professor of General Practice, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.
22
Professor of Primary Care Oncology, Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Leeds, UK.

Abstract

Background:

GPs can play an important role in achieving earlier cancer diagnosis to improve patient outcomes, for example through prompt use of the urgent suspected cancer referral pathway. Barriers to early diagnosis include individual practitioner variation in knowledge, attitudes, beliefs, professional expectations, and norms.

Aim:

This programme of work (Wales Interventions and Cancer Knowledge about Early Diagnosis [WICKED]) will develop a behaviour change intervention to expedite diagnosis through primary care and contribute to improved cancer outcomes.

Design & setting:

Non-experimental mixed-method study with GPs and primary care practice teams from Wales.

Method:

Four work packages will inform the development of the behaviour change intervention. Work package 1 will identify relevant evidence-based interventions (systematic review of reviews) and will determine why interventions do or do not work, for whom, and in what circumstances (realist review). Work package 2 will assess cancer knowledge, attitudes, and behaviour of GPs, as well as primary care teams' perspectives on cancer referral and investigation (GP survey, discrete choice experiment [DCE], interviews, and focus groups). Work package 3 will synthesise findings from earlier work packages using the behaviour change wheel as an overarching theoretical framework to guide intervention development. Work package 4 will test the feasibility and acceptability of the intervention, and determine methods for measuring costs and effects of subsequent behaviour change in a randomised feasibility trial.

Results:

The findings will inform the design of a future effectiveness trial, with concurrent economic evaluation, aimed at earlier diagnosis.

Conclusion:

This comprehensive, evidence-based programme will develop a complex GP behaviour change intervention to expedite the diagnosis of symptomatic cancer, and may be applicable to countries with similar healthcare systems.

KEYWORDS:

discrete choice experiment; early cancer diagnosis; general practitioners; hospital referral; primary care; qualitative; realist synthesis; survey

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