How can the whole practice approach to training and education foster a healthy system in facilitating early cancer diagnosis in primary care? Qualitative findings from a feasibility RCT.

Problem

Almost half of avoidable delay in cancer diagnosis occurs in primary care. As most cancers are first presented in primary care, general practice is the ideal setting for interventions to reduce delay and improve outcomes. Previous work has shown that good communication and teamwork among practice staff has the potential to facilitate earlier diagnosis, however, often interventions and education are aimed at clinical staff only. This study aimed to take a ‘whole practice’ approach to promote inclusivity and teamwork in cancer detection.

Approach

ThinkCancer! is a behaviour change intervention for whole practice teams consisting of educational workshops for all staff. Qualitative interviews with practice staff were conducted to assess acceptability of the intervention and gain insight into the views and experiences of practice staff regarding their role within cancer diagnosis. All interviews were conducted by telephone, audio recorded and fully transcribed. Transcripts were analysed using the Framework method.

Findings

A key issue was the importance of teamwork within general practice and ThinkCancer! was described as facilitating such teamwork. The whole practice approach was met with appreciation by participants as they found it inclusive, particularly for non-clinical staff who felt underrepresented in research and education. Non-clinical staff reported enjoying the workshop and having the opportunity to learn and make their own recommendations for practice. Good communication regarding cancer was found to be important and participants reported improvements, particularly between clinical and non-clinical staff, since the workshops. Perceived barriers to communication and teamwork included heavy workloads, less opportunity for shared discussions during breaks or meetings, increased part time working and staff absences. Participants from smaller practices reported having more regular meetings and higher levels of communication. The whole practice approach taken by ThinkCancer! is key to its’ implementation. All general practice staff have a vital role in facilitating earlier diagnosis and good teamwork facilitates healthy systems with potential to improve patient outcomes.

Consequences

Following the feasibility study, the ThinkCancer! Phase III RCT is now in progress. A process evaluation running alongside utilises qualitative methodology to allow understanding of the intervention in context, inform trial processes and findings and facilitate implementation. The process evaluation will also aim to capture patient voices and experiences through qualitative interviews.