What are the priorities for implementation in the early detection and diagnosis of cancer?

Problem

There is well-documented variation in the diagnosis and detection of cancer in the United Kingdom. A proportion of this can be considered ‘unwarranted variation’ insofar as it cannot be solely attributed to differences in patients or resources. There are recognised gaps in the implementation of clinical guidelines, in referral rates and the use of investigations, although the extent and impacts of unwarranted variations are not fully known. Implementation research is the scientific study of methods to promote the translation of research evidence into routine practice, and thereby improve care quality and patient outcomes. We aimed to identify and prioritise opportunities for implementing evidence-based practice in the early detection and diagnosis of cancer within primary care.

Approach

We conducted a consensus exercise to identify and then prioritise implementation opportunities. In Stage 1, we generated a list of potential implementation priorities by approaching stakeholders and experts for their suggestions. Participants responded by email, with opportunity for follow-up telephone discussion to clarify issues and rationale. The list was then discussed and filtered by the research team. In Stage 2, we established a consensus panel of primary care representatives to consider the list generated in Stage 1. Panel members rated the proposals against specific criteria and scores were discussed at a facilitated meeting. Participants were then invited to complete a second round of rating.

Findings

This remains work in progress, with initial list generation underway. The completed process will result in a ranked list of the leading candidate clinical policies and practices for implementation (i.e. introduced or increased) and de-implementation (i.e. ceased or reduced) to consider for further investigation and intervention development.

Consequences

Clinical research can only benefit patient and population health if findings are incorporated into routine care. We will highlight those priorities with most scope to improve earlier diagnosis and detection of cancer as targets for quality improvement and further implementation research.