The qualitative component of the ‘WICKED’ (Wales Interventions and Cancer Knowledge about Early Diagnosis) programme: The development and evaluation of primary care interventions to expedite the diagnosis of symptomatic cancer in Wales

Problem

The UK has relatively poor cancer outcomes. Late diagnosis is a major contributor to this and early diagnosis leads to better survival. The problem is to understand how earlier diagnosis in primary care can be achieved and develop an intervention to address it.The ‘WICKED’ research programme addresses the early diagnosis of cancer, concentrating on the primary care interval: the time between presentation of symptoms by patients and referral, an important contributor to overall diagnostic time.

Approach

The WICKED programme includes a review of reviews, realist review, survey of primary care practitioners, health economics discrete choice experiment and qualitative research, all of which will be used to develop and pilot the intervention. In this paper the qualitative research component will be presented. The aim of the WICKED qualitative research is to obtain an in-depth understanding from both GPs and practice teams to understand how best to focus the intervention.Qualitative component objectives:1. To explore GPs personal beliefs and behaviour about identifying, investigating and referring cancer signs and symptoms2. To explore practice team systems and norms about identifying, investigating and referring cancer signs and symptomsA qualitative approach is used to obtain rich, in-depth data about explicit and underlying personal motivations and practice team systems, norms and culture. This is to ensure that the design of the intervention does not ignore these factors which will be important to its successful implementation. Objective 1 seeks individual perspectives, so interviews are being used. Twenty GPs will be interviewed, purposively sampled by rurality, deprivation and years since qualification. Practice based focus groups are best placed to meet Objective 2 to obtain the interactive, systemic and team culture aspects. Focus groups will be conducted with four practice teams purposively sampled by practice characteristics (rurality and training practice status).The qualitative, as well as other components of WICKED are underpinned by the Behaviour Change Wheel (BCW). The BCW is a model of behaviour change based on an integrated framework of existing theories, which provides a comprehensive multi-phase process guide for developing complex behaviour change interventions. The BCW forms the basis of the topic guides and is being used throughout the WICKED programme to identify what needs to change and to identify intervention functions.

Findings

The qualitative data will be gathered in Spring 2017. The analysis (using Framework) will be presented and discussed.

Consequences

WICKED explores how earlier diagnosis of cancer in primary care can best be achieved. It will use the findings to develop and test a complex intervention to contribute to the improvement of cancer outcomes.The importance of the knowledge generated by WICKED also extends beyond cancer diagnosis, providing an in-depth understanding of the influences on primary care diagnosis and referral more generally.