ABSTRACT
BACKGROUND: UK cancer survival rates are much lower compared with other high-income countries. In primary care, there are opportunities for GPs and other healthcare professionals to act more quickly in response to presented symptoms that might represent cancer. ThinkCancer! is a complex behaviour change intervention aimed at primary care practice teams to improve the timely diagnosis of cancer. AIM: To explore the costs of delivering the ThinkCancer! intervention to expedite cancer diagnosis in primary care. DESIGN & SETTING: Feasibility economic analysis using a micro-costing approach, which was undertaken in 19 general practices in Wales, UK. METHOD: From an NHS perspective, micro-costing methodology was used to determine whether it was feasible to gather sufficient economic data to cost the ThinkCancer! INTERVENTION: Owing to the COVID-19 pandemic, ThinkCancer! was mainly delivered remotely online in a digital format. Budget impact analysis (BIA) and sensitivity analysis were conducted to explore the costs of face-to-face delivery of the ThinkCancer! intervention as intended pre-COVID-19. RESULTS: The total costs of delivering the ThinkCancer! intervention across 19 general practices in Wales was £25 030, with an average cost per practice of £1317 (standard deviation [SD]: 578.2). Findings from the BIA indicated a total cost of £34 630 for face-to-face delivery. CONCLUSION: Data collection methods were successful in gathering sufficient health economics data to cost the ThinkCancer! INTERVENTION: Results of this feasibility study will be used to inform a future definitive economic evaluation alongside a pragmatic randomised controlled trial (RCT).
ABSTRACT
BACKGROUND: The COVID-19 pandemic has resulted in the majority of public engagement with research work moving online. This shift to online engagement is likely to affect inclusivity and diversity in such events and this requires further consideration as a result of the pandemic. Through comparing case-studies both pre-dating and during the pandemic, we are able to discern areas for ongoing improvement and learning in the public engagement sphere. MAIN BODY: The public engagement work of the Wellcome Centre for Ethics and Humanities has sought to include a broad discussion on its research from a range of demographics, attempting to be inclusive in the engagement work of the Centre. However such efforts have not always been successful and we reflect here on two different pre-pandemic 'in-person' case studies assessing public views on vaccination and medical data sharing. In contrast we compare these pre-pandemic activities to a fully online case study coordinated and completed during the pandemic. These three case studies are compared and assessed for evidence of their efficacy in a post-pandemic world. CONCLUSION: Research and public awareness benefit when multiple views are included in engagement events. Broader demographics enrich our ways of understanding societal responses to healthcare issues such as vaccination, data sharing and social responsibility. The move to online engagement as a result of the pandemic may open opportunities to widening engagement geographically, but it could also pose a threat to inclusivity with certain public groups on a more local level. Enabling access to online engagement is key, but considerations must be made regarding the new barriers created by a solely online world and the many groups of people inadvertently excluded from this work.
It is widely recognised that research is improved when public groups are informed or consulted in this work. In university research settings, academics are actively encouraged to engage the public and seek their input and opinion. However, in order for this work to be of benefit to all involved, the public groups included should be diverse and represent a wide range of society.The Wellcome Centre for Ethics and Humanities is a Wellcome Trust funded research centre at the University of Oxford. The Centre aims to assess and interpret some of the major ethical questions of our time, essentially questioning what it means to be human in a world of rapid technological change. The public engagement work of the Centre strives to include public opinion on its research and raise awareness of the many ethical issues we face as a species.Before the onset of the pandemic in March 2020, the Centre held a range of 'in-person' events, where public groups and researchers were able to communicate in the same space. However, since the pandemic, this engagement work has moved fully online. Through evaluating these activities, we have been able to interpret which groups of people have participated. Through capturing this information, the Centre can monitor both the reach of its work and whether diverse groups of people have been included. We have found that there are a range of barriers and complications involved in solely online engagement and that future online work must address these issues, should it continue.
ABSTRACT
BACKGROUND: Compared to the rest of Europe, the UK has relatively poor cancer outcomes, with late diagnosis and a slow referral process being major contributors. General practitioners (GPs) are often faced with patients presenting with a multitude of non-specific symptoms that could be cancer. Safety netting can be used to manage diagnostic uncertainty by ensuring patients with vague symptoms are appropriately monitored, which is now even more crucial due to the ongoing COVID-19 pandemic and its major impact on cancer referrals. The ThinkCancer! workshop is an educational behaviour change intervention aimed at the whole general practice team, designed to improve primary care approaches to ensure timely diagnosis of cancer. The workshop will consist of teaching and awareness sessions, the appointment of a Safety Netting Champion and the development of a bespoke Safety Netting Plan and has been adapted so it can be delivered remotely. This study aims to assess the feasibility of the ThinkCancer! intervention for a future definitive randomised controlled trial. METHODS: The ThinkCancer! study is a randomised, multisite feasibility trial, with an embedded process evaluation and feasibility economic analysis. Twenty-three to 30 general practices will be recruited across Wales, randomised in a ratio of 2:1 of intervention versus control who will follow usual care. The workshop will be delivered by a GP educator and will be adapted iteratively throughout the trial period. Baseline practice characteristics will be collected via questionnaire. We will also collect primary care intervals (PCI), 2-week wait (2WW) referral rates, conversion rates and detection rates at baseline and 6 months post-randomisation. Participant feedback, researcher reflections and economic costings will be collected following each workshop. A process evaluation will assess implementation using an adapted Normalisation Measure Development (NoMAD) questionnaire and qualitative interviews. An economic feasibility analysis will inform a future economic evaluation. DISCUSSION: This study will allow us to test and further develop a novel evidenced-based complex intervention aimed at general practice teams to expedite the diagnosis of cancer in primary care. The results from this study will inform the future design of a full-scale definitive phase III trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04823559 .