Patients who have agreed to participate in the study after receiving a postal invitation

The purpose of this study is to investigate what patients think about increasing provision of advice about how to detect cancer early and how to reduce their future cancer risk after they are discharged from a two-week wait referral pathway for suspected cancer. This study will send a postal survey to patients living in the UK who were recently referred onto the suspected cancer pathway and were discharged without a cancer diagnosis (i.e. a negative diagnosis). Patients will be presented with different types of support and patients' views of the burden, benefits, understanding and perceived effectiveness of each one will be measured.

In England, over 2 million patients are referred each year on urgent two-week wait (TWW) pathways to rule-out cancer of a single anatomical site. Referrals have increased by around 10% per year since 2015 (with the exception of 2020, due to the COVID-19 pandemic). The vast majority of those referred (93%) do not have cancer diagnosed. There is mounting evidence that patients who have previously experienced a symptom that after investigation turned out to be benign, often delay seeking help for subsequent symptoms. This is thought to occur because of over-reassurance from the previous 'all-clear' result leading to subsequent symptoms being interpreted as benign (extending the appraisal interval), concern about appearing hypochondriacal, not wanting to further bother the doctor or about the appropriate next actions. This is likely to be compounded by the impact of COVID-19 on help-seeking decisions and has implications for service provision. There may be scope to provide tailored support to those who are initially discharged without a cancer diagnosis to avoid missing cancers at other anatomical sites and to ensure subsequent cancers are diagnosed in a timely manner, at an early stage, or even prevented. For instance, patients could be offered information on common cancer signs, when/how to seek help for ongoing or new symptoms, facilitation to take part in cancer screening, and preventative advice. Indeed, referral for suspected cancer may be an under-utilised 'teachable moment' when people are more responsive and receptive to health information. There is currently a lack of support for those with a negative diagnosis after a TWW referral. Qualitative work indicates that there is currently no standardised approach to the information patients receive from healthcare professionals about future cancer risk or how to respond to new or recurring symptoms. It is important to assess feasibility and acceptability of interventions prior to evaluation of effectiveness. This allows implementation strategies to be incorporated into the design of interventions that will increase adoption and sustainment as well as being appropriate to the setting, providers and recipients. Yet at present it is not known what the feasibility and acceptability is of interventions linked to the TWW pathway. The objective of the proposed research is to obtain this information.

ORCA: Opportunities to Raise Cancer Awareness After Referral: Survey of Patient Views

We will obtain consent for electronic copies of anonymised non-personally identifiable data (e.g. questionnaire responses) to be archived, shared and available for secondary analysis via a data sharing repository (e.g. King's College London (KCL) data repository). Data will be uploaded to the repository upon acceptance of publication or within 3 months of the end of the funding, whichever occurs earliest.

Prospective acceptability (perceived acceptability prior to intervention participation) of different cancer advice and support interventions, will be compared using scores obtained from a 13-item scale reflecting the domains of the Theoretical Framework of Acceptability (Scott et al 2021).

Comparison of the willingness of participants from different two week wait pathways to receive different types of advice/ support. Willingness will be assessed using a one-item measure (Stevens et al 2019, Prev Med; Stevens et al, 2019, Lung Cancer).

Guy's and St Thomas' NHS Trust

King's College London

Behavioral Intervention: Education and Training on Cancer Prevention and Education

To educate catchment area residents on modifiable risk factors for cancer (e.g., screening, behavior, vaccination) and the importance of participation in cancer research. Provide participants with educational materials on cancer prevention, screening, and vaccination.

Education

Alex Gori, B.S.

Neha Singh, B.S.

Julie Dang, Ph.D.

The University of California Davis, Comprehensive Cancer Center's (UCDCCC) Office of Community Outreach and Engagement (OCOE) serves the 19 catchment counties which approximately consists of 5 million residents. Currently, the overall catchment population cancer screening rates fall below 80%. The aim of OCOE is to increase cancer education (prevention, screening, and vaccination) and training. Through education, and encouraging participation in routine screening for early detection, this can help increase cancer knowledge. In addition to cancer education, OCOE wants to educate community members regarding modifiable risk factors which include tobacco usage, being overweight/obese (physical inactivity/poor nutrition), and lack of immunizations. By increasing knowledge of cancer prevention, screening, and vaccination this will help community members become more aware of their cancer risk.

Objective: To determine the effects of health education, outreach, and training activities on cancer control and prevention knowledge, attitudes, beliefs, and behaviors among the University of California Davis, Comprehensive Cancer Center's (UCDCCC) catchment area residents. There are 3 Specific Aims for EDUCATE.

Specific Aim 1: To educate catchment area residents on modifiable risk factors for cancer (e.g., screening, behavior, vaccination) and the importance of participation in cancer research.

Specific Aim 2: Provide participants with educational materials on cancer prevention, screening, and vaccination.

Specific Aim 3: Evaluate the effectiveness of the health education, outreach, and training through the analyses of quantitative and qualitative data collected from the health education activities.

Engaging Diverse and Underserved Communities in Cancer Awareness Training and Education

Engaging Diverse and Underserved Communities in Cancer Awareness Training and Education (EDUCATE)

Assessment of participant's experience with cancer screening (Breast, Colorectal, Cervical, Lung or Prostate)

Assessment of participant's likelihood to get a cancer screening (Breast, Colorectal, Cervical, Lung or Prostate)

University of California, Davis

Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

All Conditions

Uterine Cervical Neoplasms

Uterine Neoplasms

Genital Neoplasms, Female

Urogenital Neoplasms

Uterine Cervical Diseases

Uterine Diseases

Genital Diseases, Female

Genital Diseases

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

All Drugs and Chemicals

Vaccines

Within the scope of the mobile application, information modules on cervical cancer screening tests, cervical cancer risk factors, ways to prevent cervical cancer, types of HPV, and HPV vaccine will be provided. A parallel-group pretest-posttest randomized controlled trial design will be used in the second stage of the study.

The relevant brochures of the Ministry of Health on the prevention of cervical cancer will be given to the experimental and control groups.

The mobile application will be designed as a health assistant for women aged between 30-65 to encourage healthy choices and positively develop their behaviors regarding the prevention of cancer. Within the scope of the mobile application, information modules on cervical cancer screening tests, cervical cancer risk factors, ways to prevent cervical cancer, types of HPV, and HPV vaccine will be provided. A parallel-group pretest-posttest randomized controlled trial design will be used in the second stage of the study

Mobile application

Sena F Karakışla, Msc

Kamile Kabukcuoğlu, PHD

Sena F Karakışla, MSc

Cervical cancer is one of the most common cancer types affecting women in our country and in the world and causing morbidity. However, the availability of a vaccine for cervical cancer, preventable risk factors and early diagnosis tests offer a unique opportunity to reduce the rate of cervical cancer. In this context, there are studies showing that the practices developed by policies differ and that the classical health approach is insufficient. The effectiveness of the trainings given may vary according to time, place, trainer and personal characteristics of the individual. At the same time, in order to improve the attitudes and behaviours of individuals in terms of prevention and early diagnosis of cervical cancer, awareness of individuals about cervical cancer should be increased. In this way, women will have a say about their own health and their conscious participation in health care services will be realised. Therefore, the aim of this project is to apply cervical cancer awareness training to women and to examine its effect on women's cervical cancer prevention and early diagnosis behaviours. Original value; The fact that there is no mobile application developed for cervical cancer in Turkey reveals the national value of the research. In addition, the mobile application has international unique value as it is the first mobile application structured to provide awareness on cervical cancer prevention and early diagnosis behaviours. The project method was planned for the development and implementation of the mobile application programme. The research design will be a randomised controlled study. The 120 women who meet the inclusion criteria and who apply to more than one family health centre will be randomly assigned to the intervention and control groups. The effect of the mobile application programme on women's attitudes and behaviours towards cervical cancer prevention and early diagnosis will be evaluated at the 6th and 12th weeks. In the evaluation of the data, t-test for independent groups, anova and chi-square tests will be used to measure the effect of the intervention. Widespread effect; In this way, it is planned to reduce the time spent by professionals for care-related activities, to strengthen time management, to provide advantages and improvements in the performance of nurses in patient care management by using technological resources in the health care provided.

Cervical cancer is one of the most common cancer types affecting women in our country and in the world and causing morbidity. However, the availability of a vaccine for cervical cancer, preventable risk factors and early diagnosis tests offer a unique opportunity to reduce the rate of cervical cancer. The World Health Organization launched the "global strategy to accelerate the elimination of cervical cancer as a public health problem" programme in 2020 to eliminate cervical cancer by 2030. In this context, there are studies showing that the practices developed by policies differ and that the classical health approach is insufficient. The effectiveness of the trainings given may vary according to time, place, trainer and personal characteristics of the individual. At the same time, in order to improve the attitudes and behaviours of individuals in terms of prevention and early diagnosis of cervical cancer, awareness of individuals about cervical cancer should be increased. In this way, women will have a say about their own health and their conscious participation in health care services will be realised. Therefore, the aim of this project is to apply cervical cancer awareness training to women and to examine its effect on women's cervical cancer prevention and early diagnosis behaviours. Original value; the fact that there is no mobile application developed for cervical cancer in our country reveals the national value of the research. In addition, the mobile application has an international unique value as it is the first mobile application structured to provide awareness about cervical cancer prevention and early diagnosis behaviours. It is thought that the mobile application programme to be developed has a unique content that provides knowledge and skills to increase the health culture and participation in health decisions thanks to its educational content such as cervical cancer risk factors, prevention methods, diagnostic tests, test results, treatment methods. In addition, it is the first mobile application developed in the national/international field regarding cervical cancer prevention and early diagnosis attitudes and behaviours in line with the deficiencies identified in the literature. The project method was planned for the development and implementation of the mobile application programme. The research design will be a randomised controlled study. A total of 120 women who meet the inclusion criteria and apply to more than one family health centre will be randomly assigned to the intervention (women who use the mobile application programme) and control groups (women who receive the standard education booklet). The mobile application programme includes a total of 12 interfaces for cervical cancer prevention and early diagnosis of cervical cancer. The content of the interfaces and the developed mobile application will be evaluated with the opinion of experts and pre-application. The effect of the mobile application programme on women's attitudes and behaviours towards cervical cancer prevention and early diagnosis will be evaluated in the 6th and 12th weeks. In the evaluation of the data, t-test, anova and chi-square tests for independent groups will be used to measure the effect of the intervention. Widespread effect; In this way, it is planned to reduce the time spent by professionals for care-related activities, to strengthen time management, to provide advantages and improvements in the performance of nurses in patient care management by using technological resources in the health care provided.

Since cervical cancer is seen in women, the study was based on gender.

The Effect of Cervical Cancer Awareness Education Based on Mobile Application

The Effect of Cervical Cancer Awareness Education Based on Mobile Application on Women's Attitudes and Behaviors Regarding Cervical Cancer Prevention and Early Diagnosis

The effectiveness of the mobile application created for cervical cancer awareness will be evaluated with the Mobile Application Usability Scale-MAUS Scale (Mobile Application Usability Scale-MAUS Scale at Week 12). It has a total of 40 items and 7-point Likert type (1=strongly disagree, 7=completely agree). The range of points that can be obtained from the scale is 42-294. The increase in the score indicates that the usability level of the mobile application is high. There are no items that need to be reverse coded in the scale.

The difference between the attitudes towards early diagnosis of cervical cancer of women who use and do not use the mobile application created for cervical cancer awareness will be compared with the mean scores with the Attitude Towards Early Diagnosis of Cervical Cancer Scale. The scale consists of 30 items and is a Likert-type scale. Of the 30 items in the scale, 22 are positive and 8 are negative statements. The scoring of negative statements is reversed. The highest score to be obtained from the scale is 150 and the lowest score is 30.

Attitude Scale for Cervical Cancer Prevention: consists of 23 items and three sub-dimensions. The items in the scale using Likert-type. The highest score to be obtained from the scale is 115 and the lowest score is 23. The high score obtained from the scale indicates that the individual has high attitudes towards the prevention of cervical cancer

Cervical cancer awareness behaviors of women using mobile applications will be measured with- Cervical cancer awareness behaviour questionnaire- an 18-question survey prepared by the researcher in line with the literature. Internal consistency tests for the survey were conducted and the Cronbach alpha value was found to be 0.88-0.98.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
ORCA: Opportunities to Raise Cancer Awareness After Referral: Survey of Patient Views	NCT05479851	Cancer		18 Years -	King's College London
Engaging Diverse and Underserved Communities in Cancer Awareness Training and Education	NCT05761782	Cancer Awarenes...	Education	18 Years - 80 Years	University of California, Davis
The Effect of Cervical Cancer Awareness Education Based on Mobile Application	NCT06252012	Cervix Cancer Cancer Awarenes... Mobile Applicat... HPV Nurse's Role	Mobile applicat...	35 Years - 60 Years	Kutahya Health Sciences University

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