SAFER-C

SAFER-C is a Health Research Board-funded research programme led by Professor Patrick Redmond and the Primary Care Research into Cancer (PRiCAN) research team at the RCSI University of Medicine and Health Sciences to assess the feasibility and acceptability of delivering a structured, team-based intervention, adapted from the ThinkCancer! programme, to improve recognition, follow-up and referral of patients with potential cancer symptoms in Irish general practice.

ThinkCancer! is a whole-practice programme developed in Wales to support the earlier recognition and diagnosis of cancer. It aims to improve cancer safety-netting by supporting practices to develop clear and reliable processes for monitoring symptoms, test results, referrals and follow-up actions, particularly for people presenting with non-specific symptoms. The programme includes educational workshops for clinical and non-clinical practice staff, support to develop a Cancer Safety Netting Plan, and the appointment of a Cancer Safety Netting Champion within each practice. The Champion will support the practice team to integrate structured safety-netting processes into its routine work.

SAFER-C will adapt ThinkCancer! for the Irish primary care context and then test it through a pilot cluster randomised controlled trial involving up to 20 general practices in Ireland. Participating practices will be randomly assigned either to receive the ThinkCancer! intervention or to continue with usual care. The study will examine whether general practices and patients can be successfully recruited and retained, whether ThinkCancer! can be delivered as intended, and how acceptable and practical the programme is for practice staff and patients. It will also assess how well the programme can be integrated into routine general practice workflows and whether the clinical, implementation and economic information needed for a future larger trial can be collected successfully. Process and economic evaluations will explore how the programme is implemented and the resources required to deliver it. 

SAFER-C will also host a Study Within a Trial, known as a SWAT. This will investigate whether a conversational, interactive electronic consent approach improves enrolment into a research cohort of patients presenting with non-specific symptoms. The SWAT will look not only at whether the enhanced approach affects enrolment, but also at how well participants understand the study, how confident and supported they feel in making their decision, and how manageable they find the consent process. Participants who join this research cohort will consent to future contact and to linking their study information with national cancer registry data. The National Cancer Registry Ireland (NCRI) will contribute to this work by using its established methods to link consenting participants’ study data with records held by the cancer registry and assess whether this process can be carried out successfully. This work will help establish a practical approach to using cancer registry data in future long-term studies involving patients presenting with non-specific symptoms in primary care. Furthermore, registry data linkage could provide a mechanism for following patients with non-specific symptoms over time to determine whether and when they later receive a cancer diagnosis, and to improve understanding of diagnostic trajectories in this patient group. 

SAFER-C addresses an important evidence gap in early cancer diagnosis by exploring how safety-netting, follow-up and referral processes can be strengthened for adults presenting with symptoms that could be associated with cancer. To support the successful implementation of ThinkCancer! in Irish general practice, the programme brings together a multidisciplinary team of national and international experts in cancer and primary care, including representatives from the National Cancer Registry Ireland and the National Cancer Control Programme. Through this collaborative approach, SAFER-C aims to contribute to national efforts to promote earlier cancer detection in primary care. The findings will be used to refine the adapted ThinkCancer! intervention and determine whether, and how, it should be evaluated in a larger trial assessing its impact on patient outcomes and its value for the health service.