Background
Methods
Study design
Study patients and recruitment
I-CaPP intervention
Practice set-up and training
Data collection
1. Audio/video recordings of patient consultations
2. Patient and HCP interviews
3. Patient questionnaires
4. Process data from the intervention website
Consent
Patient consent
HCP consent
Analysis
Audio/video recordings of patient consultations
Patient and HCP interviews
Patient questionnaires
Process data from the intervention website
Results
Feasibility of recruitment
n | NHS Health check or chronic disease review plus I-CaPP intervention (n = 50) | n | Standard NHS Health Check or chronic disease review (n = 12) | n | Interview Group (n = 12) | |
---|---|---|---|---|---|---|
Age | 50 | 12 | 12 | |||
Mean (sd) | 56.2 (11.8) | 55.0 (8.3) | 62.5 | |||
Range | 40–84 | 40–75 | 40–83 | |||
Sex (n, % female) | 50 | 26 (52) | 12 | 9 (75) | 12 | 6 (50) |
Ethnicity (n, % white) | 50 | 44 (88) | 12 | 11 (92) | 12 | 11 (92) |
Family history of cancer (n, %) | 50 | 22 (44) | – | – | 7 (58) | |
Education (n, %) | 50 | 12 | 12 | |||
No formal education or Primary Education | 1 (2) | 2 (17) | 0 (0) | |||
Secondary Education | 27 (54) | 6 (50) | 8 (67) | |||
University Education | 22 (44) | 4 (33) | 4 (33) | |||
Deprivation (n, %) | 50 | 11 | 12 | |||
Least deprived 1 | 11 (22) | 1 (9) | 2 (17) | |||
2 | 18 (36) | 7 (64) | 6 (50) | |||
3 | 11 (22) | 1 (9) | 2 (17) | |||
4 | 10 (20) | 2 (18) | 2 (17) | |||
5 | 0 (0) | 0 (0) | 0 (0) | |||
Perceived General Health (n, %) | 50 | 12 | 12 | |||
Very Good / Quite Good | 39 (58) | 10 (92) | 10 (83) | |||
Neither Good nor Poor | 8 (16) | 0 (0) | 2 (17) | |||
Quite Poor / Poor | 3 (6) | 1 (8) | 0 (0) | |||
Numeracy (n, %) | 44 | 11 | 12 | |||
High numeracy (≥2) | 31 (70) | 5 (45) | 7 (58) | |||
Low numeracy (< 2) | 13 (30) | 6 (55) | 5 (42) | |||
Estimated risk (mean, sd)* | ||||||
RRI | 50 | 1.7 (0.9) | 12 | 1.7 (0.8) | 12 | 1.7 (1.2) |
RR | 50 | 1.0 (0.4) | 12 | 1.1 (0.33) | 12 | 1.01 (0.5) |
Absolute risk | 50 | 3.6 (2.3) | 12 | 4.4 (2.2) | 12 | 3.86 (2.33) |
Smoking status (n, %) | 50 | 12 | 12 | |||
Never smoker | 28 (56) | 4 (33) | 7 (58) | |||
Ex-smoker | 19 (38) | 7 (58) | 5 (42) | |||
Current smoker | 3 (6) | 1 (8) | 0 (0) | |||
Lifestyle (mean, sd) | ||||||
BMI (kg/m2) | 50 | 27.5 (5.6) | 12 | 29.7 (8.0) | 26.6 (3.2) | |
Alcohol (units/week) | 50 | 9.8 (13.6) | 12 | 6.2 (8.7) | 12.1 (17.5) | |
Physical Activity (hours/week) | 50 | 5.7 (7.7) | 12 | 5.1 (8.0) | 8.4 (8.3) | |
Fruit (portions/day) | 50 | 2.1 (1.4) | 12 | 2 (0.9) | 1.5 (1.2) | |
Vegetables (portions/day) | 50 | 2.6 (1.3) | 12 | 2.1 (0.7) | 2.8 (1.3) | |
Red meat (portions/week) | 50 | 2.1 (1.3) | 12 | 1.3 (1.1) | 2.7 (1.6) | |
Processed meat (portions/week) | 50 | 1.6 (1.6) | 12 | 1 (0.7) | 1.6 (1.3) | |
Cancer risk perception (mean, sd) | ||||||
Perceived absolute risk | 45 | 29.3 (22.8) | – | – | 10 | 41 (17.9) |
Conviction of perceived absolute risk | 48 | 3.58 (1.7) | – | – | 11 | 3.27 (1.6) |
Perceived comparative risk | 50 | 3.48 (1.2) | – | – | 12 | 3.41 (0.9) |
Conviction of perceived comparative risk | 47 | 3.86 (1.6) | – | – | 12 | 3.08 (1.7) |
Absolute risk accuracy (n, %) | 45 | – | 10 | |||
Accurate (±5%) | 8 (18) | – | 0 (0) | |||
Underestimate | 2 (4) | – | 0 (0) | |||
Overestimate | 35 (78) | – | 10(100) | |||
Comparative risk accuracy (n, %) | 50 | – | 12 | |||
Accurate | 18 (36) | – | 4 (33) | |||
Underestimate | 24 (48) | – | 7 (58) | |||
Overestimate | 8 (16) | – | 1 (8) | |||
Cancer Worry (mean, sd) | 46 | 4.8 (2.0) | – | – | 10 | 5.4 (2.1) |
Anxiety (mean, sd) | 45 | 13.1 (2.2) | – | – | 11 | 13.81 (2.0) |
Cancer risk factor awareness | 43 | 40.9 (5.5) | – | – | 10 | 42.8 (4.9) |
Feasibility of delivering the intervention
Practice A | Practice B | Practice C | Practice D | Practice E | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n | Mean (SD) range / n (%) | n | Mean (SD) range / n (%) | n | Mean (SD) range / n (%) | n | Mean (SD) range / n (%) | n | Mean (SD range / n (%) | n | Mean (SD) range / n (%) | |
Length of I-CaPP intervention delivery within NHS Health Check (min) | 32 | 9.6 (3.2) 3.1–15.1 | 6 | 7.5 (2.5) 4.9–12.3 | 17 | 10.4 (3.0) 6.1–15.1 | 4 | 11.5 (1.9) 8.8–13.0 | 5 | 7.6 (3.8) 3.1–13.5 | – | – |
Length of I-CaPP intervention delivery within chronic disease review (min) | 14 | 9.0 (3.6) 4.5–15.5 | – | – | – | – | – | – | 2 | 6.8 (0.7) 6.3–7.3 | 12 | 9.4 (3.7) 4.5–15.5 |
Lifestyle pages viewed in consultation | 49 | 6 | 18 | 5 | 8 | 13 | ||||||
0 | 17 (35) | 1 (17) | 6 (33) | 0 (0) | 2 (0) | 8 (62) | ||||||
1 | 10 (20) | 1 (17) | 2 (11) | 2 (40) | 3 (43) | 2 (15) | ||||||
2–3 | 19 (39) | 4 (67) | 10 (56) | 1 (20) | 1 (14) | 3 (23) | ||||||
> 3 | 3 (6) | 0 (0) | 0 (0) | 2 (40) | 1 (14) | 0 (0) | ||||||
Targets set during consultation | 49 | 6 | 18 | 5 | 7 | 13 | ||||||
0 | 5 (10) | 3 (50) | 0 (0) | 0 (0) | 1 (14) | 1 (8) | ||||||
1 | 19 (38) | 1 (17) | 11 (61) | 3 (60) | 3 (43) | 1 (8) | ||||||
2–3 | 17 (35) | 1 (17) | 6 (33) | 0 (0) | 1 (14) | 9 (69) | ||||||
> 3 | 8 (16) | 1 (17) | 1 (6) | 2 (40) | 2 (29) | 2 (15) | ||||||
Goals set during consultation | 49 | 6 | 18 | 5 | 7 | 13 | ||||||
0 | 44 (90) | 4 (67) | 17 (94) | 5 (100) | 7 (100) | 2 (15) | ||||||
1 | 5 (10) | 2 (33) | 1 (6) | 0 (0) | 0 (0) | 11 (85) |
Acceptability of the intervention to HCPs
Qualitative theme | Illustrative quotes |
---|---|
Delivery of the intervention | “I think because initially you tell them, it’s not them, it’s people like them, they take that nicer than if you said this is your risk of cancer, so yeah, a lot better than I ever thought that they would ever accept that risk” HCP 2 |
Patient engagement | “It was good to share the information and to be able to actually see it on the screen. The patients appreciated being able to see everything and being able to change different bits to show them how their risk was going to change” HCP 3 It’s nice to both sit there together and share the screen, sort of discuss what we could see” HCP 1 |
Behaviour changes | “It seemed to ping in their heads and they thought, “actually no, I can do this and there’s a good reason for doing it”, which with years of talking to them about diabetes I haven’t noticed that reaction so quickly.” HCP 6 “We had a patient that within one of those health checks we did, that actually gave up smoking. I gave them an inhalator in the consultation, and I’ve seen them since and they’ve actually quit smoking” HCP 2 “I think it is a good backup. I think something written is always good as what you say in your consultation they don’t always remember. So even if it is just a case of the front page and starring “quitting smoking” and “reducing alcohol” then it is something for them to go back to. Or if it was someone else asked them they would get it out and produce it” HCP 7 “I think when you tell people about cardiovascular health and then you explain it’s about heart attacks and strokes, I don’t think they necessarily take that on board as much because they assume it’s the people who smoke and drink. So they just brush over the cardiovascular and then when you go into cancer, they go right okay, and they sit up and pay attention” HCP 2 |
Implementation into normal practice | “I found it worked really well, and I also felt that actually it really enhanced what you were doing with the diabetes” HCP 6 “Because the patients (diabetics), they really want to know about their sugar and their cholesterol, or the management of the blood sugars and treatment. So I think you’d have to introduce that (intervention) at the beginning of the consultation.” HCP 4 “…pulling it out of thin air would be scary but I think if you’re putting it in context with something else, you can get away with it. So if it’s within a different type of check that they’re having, I don’t know COPD or for something else” HCP 2 “So, when you talk about alcohol, it would sort of incorporate both the Health Check and the cancer part of it. It would be nice if it flowed more in that way, because you’re saying one minute that this is what you can drink is okay for the NHS Health Check, but actually this (intervention) is saying ideally you wouldn’t be drinking (alcohol)” HCP 1 “I think it does separate it a little bit. I suppose if it was integrated into the actual template and health check, if they could be done in some way, then perhaps that would be easier” HCP 4 |
Risk presentation | “I think the colours work more than the numbers to be honest. Yes, if you see red you think “right ok I’m in trouble and need to do something here” HCP 7 “I think the patients just go “Oh that’s alright then, it’s only one of 2 %”, even it’s red on the picture and you’re trying to say that you need to work on it. When you get the percentages up, they’re like, “Ah, I’m not worried”. HCP 1 |
Acceptability of the intervention to patients
Qualitative theme | Illustrative quotes |
---|---|
Knowledge of the risk factors for cancer | “I mean well from my knowledge of cancer and probably the general public knowledge of cancer, I know there are certain things that you can do to help lower your risk” Patient 6 “I knew that I didn’t smoke and I don’t drink a lot (alcohol) so I knew the ones most people get because of their lifestyle” Patient 1 |
Expectations of their risk | “I suppose that’s roughly where I probably thought I would be. But when it’s actually stuck in front of you like that, it focuses the mind a bit more.” Patient 8 “While I was aware of the sort of things I should be doing in my lifestyle I didn’t really appreciate what the cancer impact of those choices could have” Patient 9 |
Risk presentation | “I found it very easy to understand. It shows you- projected, what you could do, and it tells you that in a very straightforward way, I thought” Patient 11 “So, by showing you in a chart, you can understand it better, even if you haven’t got a technical mind” Patient 5 |
Risk modification | “It’s made me more aware of trying to do these things, especially the losing weight, side of it, which is the most difficult part, to be quite honest” Patient 2 “That’s the thing that really hit me more than anything when that came up. And by just discussing with me a little bit, if I change my lifestyle a bit this way, that way, she showed me how it would head more towards green” Patient 8 |
Behaviour change | “I think that merely going through this exercise has helped to push my motivators in the right direction” Patient 7 “I’d been smoking, prior to then, when I came out of there, I made a change straight away” Patient 5 “Now I’m aware, it’s on my mind all the time. Like when we were away, I tried to eat chicken as opposed to steaks and that sort of thing” Patient 10 |
Provision of cancer risk information | “…there’s a good advice about your healthy lifestyle or your choices about getting a healthy lifestyle which will benefit both your cardiovascular and the chances of getting cancer. So I think it compliments each other really well. I was happy to have the information in one go because you can look at the way you’re living and your life and then you can make decisions” Patient 11 |
N | Strongly disagree n (%) | Disagree n (%) | Neither n (%) | Agree n (%) | Strongly agree n (%) | |
---|---|---|---|---|---|---|
Lifestyle Advice | ||||||
1 Understandable | 34 | 0 (0) | 1 (3) | 4 (12) | 17 (50) | 12 (35) |
2 Trustworthy | 34 | 0 (0) | 0 (0) | 8 (24) | 15 (44) | 11(32) |
3 Useful | 34 | 0 (0) | 0 (0) | 6 (18) | 17 (50) | 11 (32) |
4 Motivating | 30 | 0 (0) | 1 (3) | 5 (17) | 14 (47) | 10 (33) |
5 Important | 29 | 0 (0) | 1 (3) | 7 (24) | 9 (31) | 12 (41) |
6 Well presented | 29 | 0 (0) | 2 (7) | 4 (14) | 12 (41) | 11 (38) |
Risk Information | ||||||
1 Understandable | 35 | 1 (3) | 0 (0) | 1 (3) | 21 (60) | 12 (34) |
2 Trustworthy | 35 | 1 (3) | 0 (0) | 3 (9) | 21 (60) | 10 (29) |
3 Useful | 35 | 1 (3) | 1 (3) | 1 (3) | 19 (54) | 13 (37) |
4 Motivating | 32 | 0 (0) | 1 (3) | 4 (13) | 17 (53) | 10 (31) |
5 Important | 32 | 0 (0) | 1 (3) | 5 (16) | 16 (50) | 10 (31) |
6 Well presented | 32 | 0 (0) | 2 (6) | 4 (13) | 14 (44) | 12 (38) |
Potential effects of the intervention
N | NHS Health Check or chronic disease review plus I-CaPP intervention (N = 50) | n | Standard NHS Health Check or chronic disease review (N = 12) | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Strongly disagree/ disagree n (%) | Neither agree nor disagree n (%) | Agree/ strongly agree n (%) | N/A n(%) | Strongly disagree/ disagree n (%) | Neither agree nor disagree n (%) | Agree/ strongly agree n(%) | N/A n(%) | |||
Increase physical activity | 34 | 1 (3) | 7 (21) | 24 (71) | 2(6) | 9 | 0(0) | 3 (33) | 6 (67) | 0 (0) |
Increase fruit and vegetables | 34 | 2 (6) | 3 (9) | 27 (79) | 2 (6) | 9 | 0(0) | 3 (33) | 6 (67) | 0 (0) |
Decrease alcohol | 34 | 1 (3) | 9 (26) | 18 (53) | 6 (18) | 9 | 1 (11) | 1 (11) | 3 (33) | 4 (44) |
Decrease red meat | 35 | 1 (3) | 8 (23) | 21 (60) | 5 (14) | 9 | 1 (11) | 1 (11) | 4 (44) | 3 (33) |
Decrease processed meat | 35 | 1 (3) | 6 (17) | 22 (63) | 6 (17) | 9 | 1 (11) | 0 (0) | 5 (56) | 3 (33) |
Stop smoking | 34 | 0 (0) | 1 (3) | 3 (9) | 30 (88) | 7 | 1 (11) | 0 (0) | 0 (0) | 6 (86) |
Lose weight | 34 | 0 (0) | 3 (9) | 25 (74) | 6 (18) | 9 | 1 (11) | 1(11) | 7 (67) | 1(11) |
NHS Health Check or chronic disease review plus I-CaPP intervention | Standard NHS Health Check or chronic disease review | |||||||
Baseline (n = 50) | 3 month follow-up (n = 30) | Baseline (n = 12) | 3 month follow-up (n = 7) | |||||
n | Mean (SD) | n | Change from baseline Mean (95% CI) | n | Mean (SD) | n | Change from baseline Mean (95% CI) | |
Lifestyle | ||||||||
BMI (kg/m2) | 50 | 27.5 (5.6) | 30 | 1.14 (−0.46 to 2.74) | 12 | 29.7 (8.0) | 7 | −0.61 (−2.82 to 1.59) |
Alcohol (units/week) | 50 | 9.8 (13.6) | 30 | −2.8 (−4.9 to −0.66) | 12 | 6.2 (8.7) | 7 | 0 (−1.60 to 1.60) |
Physical Activity (hours/week) | 50 | 5.7 (7.7) | 30 | 1.65 (− 0.95 to 4.25)) | 12 | 5.1 (8.0) | 7 | 0.21 (−0.91 to 1.34) |
Fruit (portions/day) | 50 | 2.1 (1.4) | 30 | 0.67 (0.1 to 1.23) | 12 | 2 (0.9) | 7 | −0.14 (−0.97 to 0.69) |
Vegetables (portions/day) | 50 | 2.6 (1.3) | 30 | 0.1 (−0.30 to 0.50) | 12 | 2.1 (0.7) | 7 | 1.00 (0.08 to 1.92) |
Red meat (portions/week) | 50 | 2.1 (1.3) | 30 | −0.47 (−0.84 to − 0.09) | 12 | 1.3 (1.1) | 7 | 0.14 (−0.85 to 1.13) |
Processed meat (portions/week) | 50 | 1.6 (1.6) | 30 | −0.35 (− 0.68 to − 0.02) | 12 | 1 (0.7) | 7 | 0.43 (− 0.30 to 1.16) |
Risk Estimates* | ||||||||
RRI | 50 | 1.66 (0.9) | 30 | −0.34 (− 0.56 to − 1.28) | 12 | 1.7 (0.8) | 7 | − 0.25 (− 0.77 to 0.26) |
RR | 50 | 1.0 (0.4) | 30 | −0.005 (− 0.11 to 0.10) | 12 | 1.1 (0.33) | 7 | −0.07 (− 0.15 to 0.001) |
AR | 50 | 3.6 (2.3) | 30 | 0.49 (−0.36 to 1.34) | 12 | 4.4 (2.2) | 7 | −0.14 (− 0.96 to 0.69) |
% (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | |||||
Smoking status | 50 | 30 | 12 | 7 | ||||
Non-smoker | 56.0 (41.6 to 69.4) | 63.3 (44.0 to 79.2) | 33.3 (10.9 to 67.1) | 38.6 (4.2 to 78.5) | ||||
Ex-smoker | 38.0 (25.3 to 52.5) | 36.7 (20.8 to 56.0) | 58.3 (26.7 to 84.3) | 57.1 (15.0 to 90.9) | ||||
Current smoker | 6.0 (1.9 to 17.6) | 0 (0) | 8.3 (0.8 to 50.1) | 14.3 (1.0 to 74.3) |