CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT

Susannah Fleming; Brian D Nicholson; Afsana Bhuiya; Simon de Lusignan; Yasemin Hirst; Richard Hobbs; Rafael Perera; Julian Sherlock; Ivelina Yonova; Clare Bankhead

doi:10.1136/bmjopen-2020-038562

CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT

BMJ Open. 2020 Aug 24;10(8):e038562. doi: 10.1136/bmjopen-2020-038562.

Authors

Susannah Fleming¹, Brian D Nicholson², Afsana Bhuiya³, Simon de Lusignan^{1

4

5}, Yasemin Hirst⁶, Richard Hobbs¹, Rafael Perera¹, Julian Sherlock^{1

4}, Ivelina Yonova^{1

4

5}, Clare Bankhead¹

Affiliations

¹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
² Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK brian.nicholson@phc.ox.ac.uk.
³ North Central and East London Cancer Alliance, London, UK.
⁴ Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK.
⁵ Research and Surveillance Centre, Royal College of General Practitioners, London, London, UK.
⁶ Research Department of Behavioural Science and Health, University College, London, UK.

Abstract

Introduction: Safety-netting in primary care is the best practice in cancer diagnosis, ensuring that patients are followed up until symptoms are explained or have resolved. Currently, clinicians use haphazard manual solutions. The ubiquitous use of electronic health records provides an opportunity to standardise safety-netting practices.A new electronic safety-netting toolkit has been introduced to provide systematic ways to track and follow up patients. We will evaluate the effectiveness of this toolkit, which is embedded in a major primary care clinical system in England:Egerton Medical Information System(EMIS)-Web.

Methods and analysis: We will conduct a stepped-wedge cluster RCT in 60 general practices within the RCGP Research and Surveillance Centre (RSC) network. Groups of 10 practices will be randomised into the active phase at 2-monthly intervals over 12 months. All practices will be activated for at least 2 months. The primary outcome is the primary care interval measured as days between the first recorded symptom of cancer (within the year prior to diagnosis) and the subsequent referral to secondary care. Other outcomes include referrals rates and rates of direct access cancer investigation.Analysis of the clustered stepped-wedge design will model associations using a fixed effect for intervention condition of the cluster at each time step, a fixed effect for time and other covariates, and then include a random effect for practice and for patient to account for correlation between observations from the same centre and from the same participant.

Ethics and dissemination: Ethical approval has been obtained from the North West-Greater Manchester West National Health Service Research Ethics Committee (REC Reference 19/NW/0692). Results will be disseminated in peer-reviewed journals and conferences, and sent to participating practices. They will be published on the University of Oxford Nuffield Department of Primary Care and RCGP RSC websites.

Trial registration number: ISRCTN15913081; Pre-results.

Keywords: health informatics; oncology; primary care.

Publication types

Clinical Trial Protocol
Research Support, Non-U.S. Gov't

MeSH terms

Electronic Health Records*
Electronics
England
Humans
Neoplasms* / diagnosis
Neoplasms* / therapy
Primary Health Care
Randomized Controlled Trials as Topic
State Medicine

Associated data

ISRCTN/ISRCTN15913081

Abstract

Publication types

MeSH terms

Associated data

Grants and funding