The ThinkCancer! Intervention: results and lessons learned from a phase II feasibility trial in Wales

Problem

Early diagnosis is key to improving cancer outcomes. “ThinkCancer!” is a novel complex behaviour change intervention designed to reduce primary care diagnostic delays by improving stage shift in cancer diagnosis. ThinkCancer! is designed for primary care teams and consists of a series of online educational and quality improvement sessions, culminating in the design of a bespoke practice safety netting plan and nomination of a practice safety netting champion to support implementation and change. ThinkCancer! was tested in a feasibility trial to assess intervention feasibility and acceptability and to determine the most appropriate clinical outcome measures for a phase III trial.

Approach

This feasibility study incorporated a pragmatic, superiority pilot RCT with an embedded process evaluation and feasibility economic analysis. The unit of randomisation was the general medical practice, and the clinical outcome data were collected from practices. Practices also completed questionnaires on practice characteristics and cancer safety netting systems. Post-workshop, individual staff members completed evaluation and feedback forms, and a select group participated in qualitative interviews. The intervention was adapted and refined throughout the trial.

Findings

The trial recruited participating practices across Wales between March 2020 and May 2021, with a 5 month pause due to COVID; workshops were delivered between December 2020 and May 2021. Trial progression criteria for recruitment, intervention fidelity and routine data collection were met. Staff-level fidelity, retention and ability to collect individual level data were reviewed and processes amended for the newly funded phase III trial. Interviews highlighted positive participant views on all aspects of the ThinkCancer! intervention, all practices set out to liberalise referral thresholds appropriately, implement guidelines, and create detailed safety netting action plans.

Consequences

ThinkCancer! was found to be feasible and acceptable, and the results and lessons learned from the feasibility study have informed the final iteration of the ThinkCancer! workshop and the design and delivery of a definitive phase III trial to assess the effectiveness and cost effectiveness of this novel behaviour change intervention. Strategies have been designed to improve retention, staff-level fidelity and individual data collection, and delivery at scale to multiple practices will likely improve fidelity and reach and may allow for cross pollination of best practice between practice teams.