Decision-making for investment in early diagnosis interventions for cancer

An interview-based study for Cancer Research UK

by Natasha L. Elmore, Daniela Rodriguez-Rincon, Catherine A. Lichten, Adam Bertscher, Jon Sussex

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Research Questions

  1. How are decisions made at the local level about investment in early diagnosis interventions for cancer in England and Northern Ireland?
  2. What evidence and tools are used to support that local decision-making in England and Northern Ireland?
  3. How is the Long Term Plan Implementation Framework affecting that decision-making in England?
  4. What further resources or support would be most useful to aid local decision-making about investment in early diagnosis of cancer in England and Northern Ireland?

Cancer survival is lower and mortality rates are higher in the United Kingdom (UK) than in some other high-income countries. An important way to improve cancer survival in the UK is to increase the proportion of cases that are diagnosed early, as patients diagnosed at stages I and II have the best chance of successful treatment and long-term survival. Cancer Research UK awarded a grant to RAND Europe to undertake research with the purpose of helping Cancer Research UK's Early Diagnosis programme to better understand how National Health Service (NHS) commissioners of healthcare services and NHS Cancer Alliances make decisions about early diagnosis interventions at local level, with a particular focus on England and Northern Ireland. The decision-making landscape in England was shaped by the 2019 NHS Long Term Plan and the Implementation Framework that goes with it; meanwhile in Northern Ireland a new cancer strategy was under active development in 2019.

We gathered evidence through more than 30 interviews with stakeholders at Cancer Alliances and national bodies in England, and from six interviewees from national bodies and at local level in Northern Ireland.

Key Findings

  • The desire for more and better evidence to steer decision-making about investments in early cancer diagnosis in England and Northern Ireland was universal among the health service stakeholders we interviewed.
  • In England, the need to achieve the target of 75 per cent target of cancer diagnoses to be at Stages I and II by 2028—as set out in the Long Term Plan—has strengthened that desire for evidence and especially for evidence on how best to achieve that level of improvement in practice.
  • Data analytical capacity varies considerably across Cancer Alliances.
  • In Northern Ireland, the process of developing a new cancer strategy is focusing attention on how to improve cancer survival, and has stimulated new data analysis on pathways to cancer diagnosis and treatment.
  • Suggestions for supporting investment decisions around early diagnosis included: more access to information and analysis; providing, or helping development of, more data analytic capacity locally; more locally specific data by tumour site; and facilitating more primary care involvement in Cancer Alliances.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Decision-making on investment in early diagnosis interventions in England

  • Chapter Four

    Reactions to the Long Term Plan Implementation Framework and impact on local decisionmaking on investment in early diagnosis interventions in England

  • Chapter Five

    Decision-making on investment in early diagnosis interventions for cancer in Northern Ireland in the context of the development of a new cancer strategy

  • Chapter Six

    Concluding remarks

  • Appendix A

    Protocol for Cancer Alliance interviews in Phase one

  • Appendix B

    Protocol for national level key informant interviews in England

  • Appendix C

    Protocol for follow-up interviews with Cancer Alliances

  • Appendix D

    Protocol for Phase two Cancer Alliances (new respondents)

  • Appendix E

    Protocol for Northern Ireland interviews

Research conducted by

This research was prepared for Cancer Research UK and conducted by RAND Europe.

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