Table 5 Summary of planned alterations to improve the success of the study
| Issue | Solution |
|---|---|
| Improved recruitment numbers |
Investigate a service level intervention whereby individual patients are not recruited, i.e. a clustered roll out across multi-centres Enact the strategies used within this pilot study e.g. workshops and meetings at regular intervals, identify local clinical champions, but allow a longer lead-in time for each centre before they are recruited into the study Have clear accountability for recruitment numbers to the study team Increase the number of potentially eligible participants by including a wider range of cancer types Have three defined points at which patients are recruited 1) pre-elective surgery outpatient clinics as part of standard care, 2) at pre-operative MDM, and 3) at point or referral to medical oncology assessment, if not already recruited at point 1) or 2) |
| Pre-operative recruitment and CMA |
Include pre-operative recruitment as a study criteria with allowance for point 3) above Develop processes so that the CMA intervention is delivered pre-operatively |
| Variability observed between the patient groups minimised | Ensure mechanisms are in place to ensure balanced invitation processes e.g. randomisation of services (using a cluster approach) and/or recruitment of consecutive patients over a defined period |
| Screening tool with greater specificity | Carry out a literature review and iterative design of a screening tool applicable for the NZ context |
| Intervention modified to better integrate into clinical pathways | Consider other models of intervention e.g. CMA carried out by cancer specialist nursing, surgical or oncology team with referrals as needed; CMA carried out and oncology team provided with results to take necessary action; primary care practitioner provided with results to take necessary action |
| Screening tool and intervention well accepted and used in practice |
Provide patients with more information about the intervention at point-of-referral Enable participatory research approaches with key hospital staff including clinicians, nursing, service managers |