ThinkCancer! The multi-method development of a complex behaviour change intervention to improve the early diagnosis of cancer in primary care

Abstract

BackgroundRelatively poor UK cancer outcomes are blamed upon late diagnosis. Despite most cancer patients presenting to their GP with symptoms, diagnostic delay remains a common theme, with many clinical and non-clinical factors responsible. Early diagnosis is key to improving outcomes and survival. This paper reports the multi-method process to design a complex intervention to improve the timely diagnosis of symptomatic cancer.MethodsA review of reviews, survey, discrete choice experiment, qualitative interviews and focus groups, all informed a realist evidence synthesis. This in turn informed the design of a complex intervention, guided by the Behaviour Change Wheel framework using a multi-step process.ResultsKey themes from the realist evidence synthesis included effective safety netting at practitioner and practice system level, increased vigilance and lowering referral thresholds. Qualitative findings explored the tensions, barriers and facilitators affecting suspected cancer referral. The Think Cancer! intervention is an educational and quality improvement workshop directed at the whole primary care team. Bespoke cancer safety netting plans and appointment of cancer champions are key components.ConclusionsThink Cancer! is a novel primary care early cancer diagnosis intervention, requiring evaluation through a cluster randomised control trial.

A Multi-Domain Group-Based Intervention to Promote Physical Activity, Healthy Nutrition, and Psychological Wellbeing in Older People with Losses in Intrinsic Capacity: AMICOPE Development Study

“…To date, the few examples found using the GUIDED checklist include two peer-reviewed articles reporting interventions aimed at improving mental health help-seeking behaviors for male students [ 73 ] and anxiety and depression management in patients with chronic obstructive pulmonary disease (COPD) [ 74 ], two pre-prints reporting interventions aimed to improve early diagnosis of cancer in primary care [ 75 ] and targeting antipsychotic prescription to nursing home residents with dementia [ 76 ], and one doctoral thesis reporting an arts-based intervention for patients with kidney disease [ 77 ]. However, some researchers have used the Consensus on Exercise Reporting Template (CERT) [ 78 ] to characterize physical activity programs for older adults in Latin America [ 36 ] and assess the feasibility of an enhanced prescribed exercise program in older acute medical patients [ 79 ] and the effectiveness of falls prevention interventions on reducing falls in hospitalized adults [ 80 ].…”

A Multi-Domain Group-Based Intervention to Promote Physical Activity, Healthy Nutrition, and Psychological Wellbeing in Older People with Losses in Intrinsic Capacity: AMICOPE Development Study

“…To date, the few examples found using the GUIDED checklist includes two peer-reviewed articles reporting interventions aimed to improve mental health help-seeking behaviours for male students [73], and anxiety and depression management in patients with chronic obstructive pulmonary disease (COPD) [74]; two pre-prints reporting interventions aimed to improve early diagnosis of cancer in primary care [75] and targeting antipsychotic prescription to nursing home residents with dementia [76]; and one doctoral thesis reporting an arts-based intervention for patients with kidney disease [77]. However, some researchers have used the Consensus on Exercise Reporting Template (CERT) [78] to characterize physical activity programs for older adults in Latin America [36], and assess the feasibility of an enhanced prescribed exercise program in older acute medical patients [79] and the effectiveness of falls prevention interventions on reducing falls in hospitalized adults [80].…”

A Multi-Domain Group-Based Intervention to Promote Physical Activity, Healthy Nutrition, and Psychological Wellbeing in Frail Older People: AMICOPE Development Study

“…Scientific literature is scarce for published intervention development studies. To date, the few examples found using the GUIDED checklist includes two PubMed peer-reviewed articles reporting interventions aimed to improve mental health help-seeking behaviours for male students [57], and tamoxifen adherence in breast cancer [58]; two preprints reporting interventions aimed to improve early diagnosis of cancer in primary care [59] and targeting antipsychotic prescribing to nursing home residents with dementia [60]; and one doctoral thesis reporting an arts-based intervention for patients with kidney disease [61].…”