JMIR Publications

ABSTRACT

Background:

Delays in the diagnosis of cancer can occur when abnormal test results are not adequately followed-up in general practice. Quality improvement (QI) tools including auditing and clinical decision support (CDS), have been developed to support the diagnostic process. We conducted a process evaluation of a pragmatic, cluster randomised trial which evaluated the effectiveness of a QI intervention, on the appropriate follow-up of patients with abnormal test results associated with undiagnosed cancer (FHT cancer module).

Objective:

Understand implementation gaps, explore differences between the general practices involved, provide context to the trial effectiveness outcomes, and understand the mechanisms behind the intervention successes and failures.

Methods:

The intervention included the QI tool (with CDS, audit and recall components), training and educational sessions, benchmarking reports, and practice support. Data were collected using interviews, surveys, and measures of engagement with intervention components. Process data were explored using the Medical Research Council’s Framework for Developing and Evaluating Complex Interventions.

Results:

Uptake of the supporting components of the intervention (training and education sessions, benchmarking reports) was low. Access to a study coordinator and ongoing practice support facilitated the sustained involvement of practices in the trial, while contextual factors, such as the COVID-19 pandemic and staff turnover impacted their level of participation. The number of patients who were flagged for further investigation by the FHT cancer module varied between practices, impacting the relevance of intervention.

Conclusions:

The use of QI and clinical decision support tools for cancer diagnostic care in general practice is acceptable, but addressing the key barriers to uptake may optimise the implementation process. While some components of the implementation process worked well, future work is needed to determine if a scaled-back approach, which meets the time and resource availability of a busy general practice, could be as effective. Given the variation in the relevance and usefulness between practices, the use of the FHT cancer module may be better targeted to certain practices based on size, location and patient demographics. Clinical Trial: Australia and New Zealand Clinical Trial Registry (ACTRN12620000993998)