Article Figures & Data
Figures
- Figure 1. Development of the ‘ThinkCancer!’ intervention for general practices.
- Figure 2. Logic model for design of the intervention.
- Figure 3. CONSORT diagram of study participant (general practices) flow.
Tables
Outcome measure Source Group Level Time points 2WW CRF Intervention and control Practice level Baseline and 6 months follow up PCI Conversion rate Detection rate Feasibility measures Recruitment Recruitment log Intervention and control Practice level Monitored throughout until end of recruitment period Retention Recruitment log Intervention and control Monitored throughout until end of follow up Adherence Feedback forms, interviews, post-workshop reflections Intervention Monitored throughout until end of follow up Fidelity Monitored throughout until end of follow up Data collection Completed CRF forms returned; completion of feedback forms and NoMAD surveys Intervention and control Practice level and individual staff level End of follow up Descriptive measures Practice characteristics Practice questionnaire, interviews Intervention and control Practice level Baseline and 6 months follow up Reflective notes Intervention Existing safety-netting practices Staff interviews, feeback forms Intervention and control Practice level Baseline and 6 months follow up Process evaluation measures Acceptability Staff interviews,
Feedback formsIntervention Individual participants 2 months post-workshop Implementation NoMAD survey, interviews Intervention Individual participants 2 months post-workshop Health economic measures Intervention delivery costs Health economics data collection sheets Intervention Intervention deliverers Immediately following each workshop Staff attendee time Intervention deliverer workshop notes Intervention Individual participants Notes recorded during each workshop 2WW = 2-week wait. CRF = Case reporting form. PCI = Primary care interval.
Criterion Stop Review Go Result Confirmation of adequate recruitment for a definitive trial at practice level <15 practices recruited 15–19 recruited ≥20 general medical practices recruited 30/30 recruited (100%)
GOConfirmation of adequate retention for the definitive trial at practice level <65% practices retained 65–79% practices retained ≥80% practices retained 22/30 remained in study at follow up (73%)
REVIEWConfirmation of adequate fidelity of the intervention <50% of interventions delivered 50–79% of all interventions delivered ≥80% of all intervention sessions delivered 19/21 interventions delivered (90%)
GOConfirmation of adequate fidelity at individual practice staff level ≥50% of the clinical staff per practice should attend the workshops; Session 1: 6/19 (32%)
Session 3: 4/19 (21%)
REVIEW≥50% of the administrative staff per practice should attend the workshops, comprising ≥50% of the reception and secretarial staff as well as the practice manager. Administrative
Session 2: 7/19 (37%)
Session 3 – 4/19 (21%)
REVIEWReception
Session 2: 2/19 (11%)
Session 3: 0/19 (0%)
REVIEW≥75% of the staff should receive the training either directly or indirectly.a Session 1: 3/9 (33%)
Session 2: 3/9 (33%)
Session 3: 3/9 (33%)
REVIEWProgression criteria relating to obtaining data regarding completion of outcome measures was be assessed using the following criteria: Obtaining routine data Data from <70% of practices obtained Data from ≥70% practices obtained 22/30 returned follow up data (73%)
GOObtaining individual data Data from <70% of individuals from each practice obtained Data from ≥70% of individuals of each practice obtained Workshop evaluation form
Completed by 67 participants <70%
Adapted NoMAD
Completed by 39 participants <70%
REVIEWa Data only available from 9 practices.
Outcome measure Source Descriptive Control baseline Control follow up Intervention baseline Intervention follow up PCI Raw data n 53 patients, 6 practices 190 patients, 6 practices 235 patients,
18 practices159 patients, 15 practices Mean
(SD)8.5
(22.7)14.0
(37.4)15.4
(47.6)25.6
(94.9)Median
[IQR]0
[0 4]1
[0 10]1
[0 11]2
[0 22]Minimum, maximum 0, 128 0, 373 0, 582 0, 1106 Analysis model Multilevel Mixed Effects Generalised Linear Model with cancer type and health board as factors, allocated group, time, and a time*group interaction with GP practice as a random effect, with a negative binomial distribution and log link function Adjusted mean 4.6 19.3 15.0 17.8 2WW referral rate Raw data n 6 6 18 16 Mean
(SD)1,158
(730.6)1710.7
(626.3)1538.5
(516.5)1636.8
(806.4)Median
[IQR]991
[789 1959]1571.5
[1514 1,724]1364.5
[1226 2018]1386.5
[1189.5 1986]Minimum, maximum 154, 2064 999, 2884 770, 2343 380, 3364 Analysis model Analysis of covariance with follow-up results as the dependent variable, baseline result included as a covariate, and health board and allocated group as factors Adjusted mean 1882.5 1572.4 Conversion rate Raw data n 6 6 18 15 Mean
(SD)0.11
(0.04)0.11
(0.05)0.14
(0.06)0.22
(0.22)Median
[IQR]0.11
[0.07 0.11]0.12
[0.08 0.15]0.14
[0.09 0.17]0.18
[0.13 0.19]Minimum, maximum 0.07, 0.18 0.03, 0.15 0, 0.26 0.06, 1 Analysis model Fractional response regression, with follow-up value as dependent variable, the baseline value as covariate, and allocated group and health board as factors Adjusted mean 0.12 0.22 Detection rate Raw data n 5 6 18 15 Mean
(SD)0.95
(0.11)0.94
(0.13)0.73
(0.26)0.72
(0.25)Median
[IQR]1
[1 1]1
[0.98 1]0.81
[0.45 0.93]0.75
[0.64 1]Minimum, maximum 0.75, 1 0.67, 1 0.23, 1 0.10, 1 Analysis model Fractional response regression, with follow-up value as dependent variable, the baseline value as covariate, and allocated group and health board as factors Adjusted mean 0.96 0.74 IQR = Interquartile range. PCI = Primary care interval. SD = standard deviation.
Supplementary Data
- SLJD_10.3399BJGPO.2023.0220_supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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‘ThinkCancer!’: randomised feasibility trial of a novel practice-based early cancer diagnosis intervention
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