Cluster randomised feasibility trial to test the routine use of the Needs Assessment Tool: Cancer (NAT:-C) in primary care to reduce unmet patient and carer needs and determine the feasibility of a definitive trial

Abstract

BackgroundPeople with cancer commonly have unidentified palliative care needs. The NAT-C is a validated tool to identify and triage unmet needs.AimTo assess the feasibility and acceptability of a primary care cRCT of the NAT-C: 1) recruiting four GP-practices and 40–60 patients, 2) uptake of NAT-C, 3) questionnaire completion 4) acceptability of measures.MethodA non-blinded cRCT with process evaluation. Patients with active cancer were identified through cancer registries or opportunistically. Carers were nominated by patient-participant. Participants completed measures at baseline, 1, 3, and 6 months. Patients booked a 20-minute GP-assessment post-baseline. Patients, carers, and GP practice staff participated in interviews and focus groups.ResultsFive GP practices were approached, four recruited and trained in the use of the NAT-C. Practices were randomised (1:1) to provide a consultation with a known NAT-C trained clinician, or a clinician as usual. Forty-seven patients and 17 carers were recruited. Process evaluation informed refinement of study invitations. Recruitment rate showed a trial was feasible. Forty-three (94%) patients received a study appointment, 42/43 (95%) attended and 32/43 (76%) a NAT-guided consultation. The proposed primary outcome measure (Supportive Care Needs Survey) was completed by 43 (91%) at 1 month and the proportion with ≥1 moderate–severe unmet need fell from 72% (baseline) to 45%. Fifteen patient interviews and four focus groups with GP practices were conducted. Participants supported the definitive trial and found measures acceptable.ConclusionA definitive cRCT is feasible based on the recruitment rate, intervention uptake, and data collection.