{
  "abstract": "Background The Needs Assessment Tool-Cancer (NAT-C) is a consultation guide to identify, triage and reduce unmet patient needs.Objectives We aimed to assess NAT-C fidelity, mechanisms of action and implementation issues in UK primary care as part of a clinical and cost-effectiveness cluster randomised controlled trial of the NAT-C for people with cancer compared with usual care (registration: ISRCTN15497400).Methods Design: a mixed-methods process evaluation informed by normalisation process theory (NPT). Setting: 21 participating general practices in England were randomised to be trained to conduct an NAT-C guided consultation with people with cancer (excluding those in remission). General practitioner fidelity of intervention and clinical action resulting from the NAT-C consultation was noted. Two Normalisation MeAsure Development Questionnaire surveys were distributed to trained clinicians before (Survey 1) and after delivery of ≥2 NAT-C consultations (Survey 2). Semi-structured interviews were conducted with clinicians (post delivery ≥2 NAT-C consultations) and key stakeholders in primary and cancer care. Fidelity, action and paired before/after survey data were analysed using descriptive statistics. Interview data were analysed using a deductive thematic framework approach (NPT-informed). Data were narratively synthesised with cross-tabulated key findings.Results Of the 360/376 (96%) NAT-C consultations delivered, 258/360 (72%) resulted in clinical action, including 50 (13%) external referrals. 14 paired before (Survey 1, n=53) and after (Survey 2, n=29) responses. Survey 1 showed positive responses across all NPT domains, but while continuing to see relevance, usefulness and legitimacy, Survey 2 highlighted concerns about insufficient resources and management support. 16 clinician participants (eight GPs, eight key stakeholders; 50% male) completed interviews. Following synthesis, we identified five themes: (1) the perceived value of the NAT-C; (2) ‘champions’ are important at all levels (practice, regionally and nationally); (3) research evidence is seen as important, but influences implementation indirectly through policy, clinical guidelines and resourced initiatives; (4) adequate resources are fundamental for implementation beyond practice level and (5) NAT-C practicalities; training is adequate, but robust functional information technology systems are needed.Conclusion Implementation requires champions and clinicians ‘buy-in’ to the patient value to legitimise use. In the context of current primary care pressures, resources were seen as essential to embed the NAT-C, but financial incentives were viewed with mixed feelings.Trial registration number ISRCTN15497400.",
  "authors": [
    {
      "affiliations": [
        "Wolfson Palliative Care Research Centre, University of Hull, Hull, UK"
      ],
      "name": "Flavia Swan"
    },
    {
      "affiliations": [
        "Wolfson Palliative Care Research Centre, University of Hull, Hull, UK"
      ],
      "name": "Joseph Clark"
    },
    {
      "affiliations": [
        "Oslo New University College, Oslo, Norway"
      ],
      "name": "John Blenkinsopp"
    },
    {
      "affiliations": [
        "Edinburgh Clinical Trials Unit, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK"
      ],
      "name": "Amanda J Farrin"
    },
    {
      "affiliations": [
        "Clinical Trials Research Unit, University of Leeds, Leeds, UK"
      ],
      "name": "Alexandra Wright-Hughes"
    },
    {
      "affiliations": [
        "Clinical Trials Research Unit, University of Leeds, Leeds, UK"
      ],
      "name": "Emma McNaught"
    },
    {
      "affiliations": [
        "Hull York Medical School, University of Hull, Hull, UK"
      ],
      "name": "Terry McCormack"
    },
    {
      "affiliations": [
        "Hull York Medical School, University of Hull, Hull, UK"
      ],
      "name": "Miriam J Johnson"
    }
  ],
  "title": "Mixed methods process theory evaluation to explore the implementation issues of the Needs Assessment Tool-Cancer (NAT-C) in primary care for people with cancer",
  "uid": "31782615-ad88-5eb5-8905-ac9000903b5a"
}