ThinkCancer! Feasibility trial - to phase 3 or not phase 3?

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

4B.3

Presenter:

Alun Surgey

Twitter:

@AlunSurgey

Co-authors:

Alun Surgey, Stefanie Disbeschl, Annie Hendry, Nia Goulden, Bethany Anthony, Daniel Walker, Nefyn Williams, Richard Neal, Clare Wilkinson

Author institutions:

Bangor University (AS, SD, DW, AH, BA, NG, CW), University of Liverpool (NW), University of Exeter (RN)

Problem

Poorer cancer outcomes are associated with delayed diagnosis. Lowering referral thresholds and improving both consultation and practice system level safety netting may reduce diagnostic intervals. ThinkCancer! is a novel behaviour change intervention developed with behaviour change wheel theory, delivered as a workshop with educational and quality improvement components focussed on the whole practice team.

Approach

A phase 2 randomised controlled feasibility trial with embedded process and economic evaluation was undertaken with 30 practices in Wales. Key aims included testing usual feasibility criteria, outcome measures and costs compared to usual care. Due to Covid 19 the intervention was delivered remotely.

Findings

Recruitment and retention criteria were met and 19/21 intervention workshops delivered. Baseline and follow up data collection was acceptable but practically more time consuming than expected. Intervention fidelity and reach improved with time due to dissemination of information through the practice. Findings from qualitative interviews, workshop feedback, NoMAD results (questionnaires based on Normalisation Process Theory to evaluate the embedding of new safety netting plans into usual practice) and data regarding outcome measures will be presented in further detail. Key themes identified by practices to improve safety netting included formalisation of safety netting plans, improved patient follow up and more focussed learning from cancer audits and significant event analysis.

Consequences

The intervention was adapted and improved in response to group discussions and post workshop feedback. Feasibility criteria were broadly met and encouraging for consideration of a larger phase 3 trial. Primary Care Interval (PCI) remains the primary outcome measure though a move from participant self-reporting to independent/researcher collection of data is proposed due to time constraints and concerns over accuracy and reporting bias. A proposal for a definitive phase 3 trial is currently being prepared.

Submitted by:

Alun Surgey

Funding acknowledgement:

The WICKED programme and ThinkCancer! feasibility trial were fully funded by Cancer Research Wales.