Incorporating a very brief intervention for personalised cancer risk assessment to promote behaviour change in primary care: a pilot study

Problem

Literature reviews and qualitative exploration with healthcare professionals (HCPs) highlight the potential for delivery of personalised cancer risk information in primary care consultations. We developed a very brief intervention and demonstrated acceptability and potential feasibility on usability testing with HCPs. We report the pilot study of the intervention in primary care consultations.

Approach

Patients due an NHS Health Check or chronic disease review are recruited from GP practices in the East of England and complete an online risk assessment questionnaire. Patients are then shown their estimated 10-year risk of developing one of the most common cancers on a website, followed by a discussion with a healthcare professional about behaviour changes to reduce risk. This includes provision of a visual estimate comparing their current risk to their risk if they followed all recommended lifestyle guidance. With consent, consultations are video/audio recorded. Immediately afterwards, and after 3-months, patients complete questionnaires concerning lifestyle, perceived risk, and intention to change behaviour. Fidelity of the intervention delivery is also assessed. Two researchers independently review the recordings and assess fidelity based on a checklist identifying the intervention’s key elements. Patients and HCPs are also asked about the acceptability of the intervention and invited to take part in face-to-face interviews. Interviews are analysed using a thematic approach.

Findings

We will complete recruitment at the end of April 2019. To date 43 individuals (54% female, mean age 54.5 years +/- 11.1) from 5 GP practices (33 NHS Health Checks, 10 annual chronic disease reviews) have participated. The majority of participants (85%) were White British, 97.5% had secondary education or above.Fidelity assessment of consultations showed that the majority of the key components of the intervention were delivered: 92.3% risk factor information review, 76.9% risk communication, 51.8% personalised lifestyle advice, 61.4% goals for behaviour change to promote risk reduction, 63.5% follow-up. However, there was variability in the of length of time taken to deliver the intervention (mean length 9 min. 26 sec. +/- 3 mins. 7 secs). Preliminary analysis of 13 face-to-face interviews (n=9 patients, n=4 HCPs) indicates that patients and HCPs hold positive views on the risk presentation format and risk information delivery. For many patients it acted as a motivator to change behaviour and prompted discussion with significant others. All HCPs believed its potential for inclusion into NHS Health Checks and diabetes annual reviews. A few made recommendations for its integration into risk conversations about cardiovascular disease.Follow- up data collection is ongoing and will be presented at the conference.

Consequences

Preliminary data from this pilot study suggest that the intervention is feasible and acceptable in primary care consultations. Follow-up questionnaire data will indicate whether the intervention has potential to promote behaviour change to prevent cancer.