通过初级保健加速癌症诊断的干预措施开发：一项方案。

Development of an intervention to expedite cancer diagnosis through primary care: a protocol.

作者信息

Stanciu Marian Andrei, Law Rebecca-Jane, Nafees Sadia, Hendry Maggie, Yeo Seow Tien, Hiscock Julia, Lewis Ruth, Edwards Rhiannon T, Williams Nefyn H, Brain Katherine, Brocklehurst Paul, Carson-Stevens Andrew, Dolwani Sunil, Emery Jon, Hamilton William, Hoare Zoe, Lyratzopoulos Georgios, Rubin Greg, Smits Stephanie, Vedsted Peter, Walter Fiona, Wilkinson Clare, Neal Richard D

机构信息

Research Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.

Research Project Support Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.

出版信息

BJGP Open. 2018 Sep 5;2(3):bjgpopen18X101595. doi: 10.3399/bjgpopen18X101595. eCollection 2018 Oct.

DOI:10.3399/bjgpopen18X101595

PMID:30564728

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6189786/

Abstract

BACKGROUND

GPs can play an important role in achieving earlier cancer diagnosis to improve patient outcomes, for example through prompt use of the urgent suspected cancer referral pathway. Barriers to early diagnosis include individual practitioner variation in knowledge, attitudes, beliefs, professional expectations, and norms.

AIM

This programme of work (Wales Interventions and Cancer Knowledge about Early Diagnosis [WICKED]) will develop a behaviour change intervention to expedite diagnosis through primary care and contribute to improved cancer outcomes.

DESIGN & SETTING: Non-experimental mixed-method study with GPs and primary care practice teams from Wales.

METHOD

Four work packages will inform the development of the behaviour change intervention. Work package 1 will identify relevant evidence-based interventions (systematic review of reviews) and will determine why interventions do or do not work, for whom, and in what circumstances (realist review). Work package 2 will assess cancer knowledge, attitudes, and behaviour of GPs, as well as primary care teams' perspectives on cancer referral and investigation (GP survey, discrete choice experiment [DCE], interviews, and focus groups). Work package 3 will synthesise findings from earlier work packages using the behaviour change wheel as an overarching theoretical framework to guide intervention development. Work package 4 will test the feasibility and acceptability of the intervention, and determine methods for measuring costs and effects of subsequent behaviour change in a randomised feasibility trial.

RESULTS

The findings will inform the design of a future effectiveness trial, with concurrent economic evaluation, aimed at earlier diagnosis.

CONCLUSION

This comprehensive, evidence-based programme will develop a complex GP behaviour change intervention to expedite the diagnosis of symptomatic cancer, and may be applicable to countries with similar healthcare systems.

摘要

背景

全科医生在实现癌症早期诊断以改善患者预后方面可发挥重要作用，例如通过及时使用紧急疑似癌症转诊途径。早期诊断的障碍包括个体从业者在知识、态度、信念、职业期望和规范方面的差异。

目的

本工作计划（威尔士早期诊断干预措施与癌症知识 [WICKED]）将开发一种行为改变干预措施，以通过初级保健加快诊断，并有助于改善癌症预后。

设计与背景

对威尔士的全科医生和初级保健实践团队进行的非实验性混合方法研究。

方法

四个工作包将为行为改变干预措施的开发提供信息。工作包 1 将确定相关的循证干预措施（综述的系统评价），并确定干预措施为何有效或无效、对谁有效以及在何种情况下有效（务实评价）。工作包 2 将评估全科医生的癌症知识、态度和行为，以及初级保健团队对癌症转诊和调查的看法（全科医生调查、离散选择实验 [DCE]、访谈和焦点小组）。工作包 3 将使用行为改变轮作为总体理论框架，综合早期工作包的结果，以指导干预措施的开发。工作包 4 将测试干预措施的可行性和可接受性，并确定在随机可行性试验中测量后续行为改变的成本和效果的方法。