Start date: June 2026 | Expected completion date: December 2027 | Contact: Michelle Richardson
What do we want to know?
The digital evidence and gap map, produced in Stage 1, provided a broad overview of the intervention evaluations aimed at reducing missed diagnostic opportunities (MDOs) in cancer within primary care. It also supported discussion with our English policy and practice stakeholder group regarding appropriate focus for in-depth systematic review in Stage 2 of this program of work.
As a result, Stage 2 will focus on the prioritisation of Clinical Decision Support (CDS) tools (including digital and non-digital approches) and direct test access which had a moderate evidence base. There is particular interest in evidence on effectiveness of these interventions and how they are used in practice.
Who wants to know?
This independent research report was commissioned by the National Institute for Health Research Policy Research Programme for the Department of Health and Social Care. The findings may be of interest to national and local policymakers and commissioners (including NHS England), clinicians, researchers and patients and public.
What are the research questions?
- To what extent do clinical decision support (CDS) tools and direct test access in primary care have beneficial, neutral, harmful or mixed effects on diagnostic performance, provider management behaviours, timeliness, and patient clinical outcomes for cancer?
- Where data permit, are there identifiable patterns in intervention, implementation and contextual features that appear to explain why some interventions are more effective than others?
- How are CDS and direct test access used and integrated within real-world primary care clinical workflows for cancer diagnoses?
How will we answer these questions?
Analysis 1 – effectiveness: We will conduct effectiveness syntheses using either meta-analysis or SWiM (Synthesis Without Meta-analysis).
Analysis 2 – intervention, implementation and contextual characteristics: Supplementary exploratory synthesis will explore patterns of effectiveness across different design features where data permit.
Analysis 3 – Usage of CDS and direct test access: we will synthesise textual data (e.g., from process evaluations) and descriptive statistics (e.g., survey/ observational data) about how CDS and direct test access are used and integrated within real-world clinical workflows.
