Creating robust safety netting systems to expedite cancer diagnosis: The progress of a phase III RCT

Problem

Early diagnosis of cancer in crucial to improving patient outcomes and has the potential to reduce NHS costs. With over 70% of cancers presenting in primary care and almost 50% of avoidable delays in cancer diagnosis occurring in primary care, it makes it a desirable setting to make improvements to diagnostic pathways. Evidence suggests that robust safety netting systems can lead to an improvement in patient outcomes and that avoidable harms can be mitigated by good communication among general practice staff and a supportive administrative system. It has been found that safety netting systems vary widely between general practices and improvements to these systems could ultimately reduce diagnostic error and delayed referral in primary care.

Approach

‘ThinkCancer!’ is a theoretically driven, novel, complex behavioural intervention delivered to a whole practice team and consists of a series of online educational and quality improvement sessions, culminating in the design of a bespoke practice safety netting plan to support implementation and change.ThinkCancer! was rigorously developed and tested in a feasibility randomised trial in Wales which revealed that a whole practice workshop to expedite cancer diagnosis in primary care is timely and very much appreciated by general practices across Wales. Findings from the feasibility study have informed progression to a phase III multicentre, pragmatic randomised controlled trial with embedded economic evaluation and process evaluation which will measure whether ThinkCancer! can really achieve earlier cancer diagnosis and whether it is cost-effective when compared to usual care. With the unit of randomisation being the general practice, the aim is to recruit 76 practices from across Wales and the North West region of England.

Findings

With phase III now in progress, all practices within the study sites have been approached and invited to participate. To date, a total of 88 practices have expressed interest in taking part and 38 of these (half of the target number of practices) have been recruited to the trial.ThinkCancer! is currently being delivered to several whole practice teams and those who have completed the series of sessions have created detailed safety netting action plans and have put in place the appointment of a cancer safety netting champion. Positive written feedback has been received from individuals who have taken part in the intervention.

Consequences

ThinkCancer! is a tailored multidimensional educational intervention which can empower whole practice teams to create and actively engage in more robust cancer safety netting systems, with the potential to reduce delays in the diagnostic pathway and improve referral practices within primary care and ultimately patient survival.