Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL, United Kingdom.
Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus Heavitree Road, Exeter, EX1 2LU, UK.
BMC Health Serv Res. 2023 Nov 27;23(1):1308. doi: 10.1186/s12913-023-10330-z.
The early detection and diagnosis of cancer to reduce avoidable mortality and morbidity is a challenging task in primary health care. There is a growing evidence base on how to enable earlier cancer diagnosis, but well-recognised gaps and delays exist around the translation of new research findings into routine clinical practice. Implementation research aims to accelerate the uptake of evidence by health care systems and professionals. We aimed to identify priorities for implementation research in early cancer diagnosis in primary care.
We used a RAND/UCLA modified Delphi consensus process to identify and rank research priorities. We asked primary care physicians, patients and researchers to complete an online survey suggesting priorities for implementation research in cancer detection and diagnosis. We summarised and presented these suggestions to an 11-member consensus panel comprising nine primary care physicians and two patients. Panellists independently rated the importance of suggestions on a 1-9 scale (9 = very high priority; 1 = very low priority) before and after a structured group discussion. We ranked suggestions using median ratings.
We received a total of 115 suggested priorities for implementation research from 32 survey respondents (including 16 primary care professionals, 11 researchers, and 4 patient and public representatives; 88% of respondents were UK-based). After removing duplicates and ineligible suggestions, we presented 37 suggestions grouped within 17 categories to the consensus panel. Following two rounds of rating, 27 suggestions were highly supported (median rating 7-9). The most highly rated suggestions concerned diagnostic support (e.g., access to imaging) interventions (e.g., professional or patient education), organisation of the delivery of care (e.g., communication within and between teams) and understanding variations in care and outcomes.
We have identified a set of priorities for implementation research on the early diagnosis of cancer, ranked in importance by primary care physicians and patients. We suggest that researchers and research funders consider these in directing further efforts and resources to improve population outcomes.
在初级保健中，早期发现和诊断癌症以降低可避免的死亡率和发病率是一项具有挑战性的任务。关于如何促进更早的癌症诊断，已经有越来越多的证据，但将新的研究发现转化为常规临床实践的过程中，仍然存在明显的差距和延迟。实施研究旨在加速医疗保健系统和专业人员采用证据。我们旨在确定初级保健中早期癌症诊断实施研究的优先事项。
我们使用 RAND/UCLA 改良 Delphi 共识过程来确定和优先考虑研究重点。我们要求初级保健医生、患者和研究人员在线完成一项调查，提出癌症检测和诊断实施研究的优先事项。我们总结并向由 9 名初级保健医生和 2 名患者组成的 11 名共识小组成员展示了这些建议。小组成员在进行结构化小组讨论之前和之后，独立地对这些建议进行了 1-9 分制的重要性评分（9=非常高优先级；1=非常低优先级）。我们使用中位数评分对建议进行排名。
我们从 32 名调查受访者（包括 16 名初级保健专业人员、11 名研究人员和 4 名患者和公众代表；88%的受访者来自英国）收到了总共 115 项实施研究的建议。在删除重复项和不合格的建议后，我们向共识小组展示了 37 项分组为 17 类的建议。经过两轮评分，27 项建议得到了高度支持（中位数评分 7-9）。评分最高的建议涉及诊断支持（例如，获得影像学检查）干预措施（例如，专业人员或患者教育）、医疗服务提供的组织（例如，团队内部和团队之间的沟通）以及了解护理和结果的差异。
我们确定了一组关于早期癌症诊断的实施研究优先事项，由初级保健医生和患者按重要性进行了排名。我们建议研究人员和研究资助者在指导进一步的努力和资源以改善人群结果时考虑这些优先事项。
