Development of an intervention to expedite cancer diagnosis through primary care: a protocol

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Abstract

Background

GPs can play an important role in achieving earlier cancer diagnosis to improve patient outcomes, for example through prompt use of the urgent suspected cancer referral pathway. Barriers to early diagnosis include individual practitioner variation in knowledge, attitudes, beliefs, professional expectations, and norms.

Aim

This programme of work (Wales Interventions and Cancer Knowledge about Early Diagnosis [WICKED]) will develop a behaviour change intervention to expedite diagnosis through primary care and contribute to improved cancer outcomes.

Design & setting

Non-experimental mixed-method study with GPs and primary care practice teams from Wales.

Method

Four work packages will inform the development of the behaviour change intervention. Work package 1 will identify relevant evidence-based interventions (systematic review of reviews) and will determine why interventions do or do not work, for whom, and in what circumstances (realist review). Work package 2 will assess cancer knowledge, attitudes, and behaviour of GPs, as well as primary care teams’ perspectives on cancer referral and investigation (GP survey, discrete choice experiment [DCE], interviews, and focus groups). Work package 3 will synthesise findings from earlier work packages using the behaviour change wheel as an overarching theoretical framework to guide intervention development. Work package 4 will test the feasibility and acceptability of the intervention, and determine methods for measuring costs and effects of subsequent behaviour change in a randomised feasibility trial.

Results

The findings will inform the design of a future effectiveness trial, with concurrent economic evaluation, aimed at earlier diagnosis.

Conclusion

This comprehensive, evidence-based programme will develop a complex GP behaviour change intervention to expedite the diagnosis of symptomatic cancer, and may be applicable to countries with similar healthcare systems.

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Most cited references 46

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Three approaches to qualitative content analysis.

Hsiu-Fang Hsieh, Sarah Shannon (2016)

Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.

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Using the framework method for the analysis of qualitative data in multi-disciplinary health research

Nicola K Gale, Gemma Heath, Elaine Cameron … (2013)

Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.

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The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

Susan Michie, Michelle Richardson, Marie Johnston … (2014)

CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.

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Author and article information

Journal

Journal ID (nlm-ta): BJGP Open

Journal ID (iso-abbrev): BJGP Open

Journal ID (publisher-id): bjgpoa

Journal ID (hwp): bjgpoa

Title: BJGP Open

Publisher: Royal College of General Practitioners (London )

ISSN (Electronic): 2398-3795

Publication date (Electronic): 05 September 2018

Publication date Collection: October 2018

Publication date PMC-release: 05 September 2018

Volume: 2

Issue: 3

Electronic Location Identifier: bjgpopen18X101595

Affiliations

[1 ]deptResearch Officer, North Wales Centre for Primary Care Research , Bangor University , Wrexham, UK

[2 ]deptResearch Officer, North Wales Centre for Primary Care Research , Bangor University , Wrexham, UK

[3 ]deptResearch Project Support Officer, North Wales Centre for Primary Care Research , Bangor University , Wrexham, UK

[4 ]deptResearch Fellow, North Wales Centre for Primary Care Research , Bangor University , Wrexham, UK

[5 ]deptResearch Fellow, Centre for Health Economics and Medicines Evaluation (CHEME) , Bangor University , Bangor, UK

[6 ]deptResearch Fellow, North Wales Centre for Primary Care Research , Bangor University , Wrexham, UK

[7 ]deptResearch Fellow in Health Sciences Research, North Wales Centre for Primary Care Research , Bangor University , Wrexham, UK

[8 ]deptProfessor of Health Economics, Centre for Health Economics and Medicines Evaluation (CHEME) , Bangor University , Bangor, UK

[9 ]deptProfessor in Primary Care, Department of Health Services Research , University of Liverpool , Liverpool, UK

[10 ]deptProfessor, Division of Population Medicine , School of Medicine, Cardiff University , Cardiff, UK

[11 ]deptProfessor in Health Services Research, North Wales Organisation for Randomised Trials in Health , Bangor University , Bangor, UK

[12 ]deptClinical Reader, Division of Population Medicine , School of Medicine, Cardiff University , Cardiff, UK

[13 ]deptSenior Clinical Lecturer, Division of Population Medicine , School of Medicine, Cardiff University , Cardiff, UK

[14 ]deptProfessor of Primary Care Cancer Research, Department of General Practice and Centre for Cancer Research , University of Melbourne , Melbourne, Australia

[15 ]deptProfessor of Primary Care Diagnostics, Discovery Research Group , University of Exeter , Exeter, UK

[16 ]deptPrincipal Trial Statistician, North Wales Organisation for Randomised Trials in Health , Bangor University , Bangor, UK

[17 ]deptProfessor of Cancer Epidemiology, Department of Behavioural Science and Health , University College London , London, UK

[18 ]deptProfessor of General Practice and Primary Care, Institute of Health and Society , University of Newcastle , Newcastle, UK

[19 ]deptResearch Associate, Division of Population Medicine , School of Medicine, Cardiff University , Cardiff, UK

[20 ]deptProfessor, Research Director, Department of Public Health , Research Centre for Cancer Diagnosis, Research Unit for General Practice, Aarhus University , Aarhus, Denmark

[21 ]deptProfessor, Research Director, Department of Clinical Medicine , University Clinic for Innovative Health Care Delivery, Silkeborg Hospital, Aarhus University , Aarhus, Denmark

[22 ]deptPrincipal Researcher in Primary Care Cancer Research, Primary Care Unit, Department of Public Health and Primary Care , University of Cambridge , Cambridge, UK

[23 ]deptProfessor of General Practice, North Wales Centre for Primary Care Research , Bangor University , Wrexham, UK

[24 ]deptProfessor of Primary Care Oncology, Academic Unit of Primary Care , Institute of Health Sciences, University of Leeds , Leeds, UK

[25 ]deptNorth Wales Centre for Primary Care Research , Bangor University , Wrexham, Wales

Author notes

*For correspondence: r.d.neal@ 123456leeds.ac.uk

Article

Publisher ID: 01595

DOI: 10.3399/bjgpopen18X101595

PMC ID: 6189786

PubMed ID: 30564728

SO-VID: fb12f218-eb1a-46ee-94a8-49a6a39bea1d

License:

This article is Open Access: CC BY 4.0 license ( https://creativecommons.org/licenses/by/4.0/)

Development of an intervention to expedite cancer diagnosis through primary care: a protocol

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Abstract

Background

Aim

Design & setting

Method

Results

Conclusion

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 46

Three approaches to qualitative content analysis.

Using the framework method for the analysis of qualitative data in multi-disciplinary health research

The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

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