We collaborate closely with leaders in the cancer behavioural science field to examine the acceptability and psychological impact of novel interventions under investigation, along with motivators and barriers to uptake. This facilitates the translation of trial interventions into standard practice and the development of modified interventions to expand access and reduce cancer inequalities. 

We have a strong partnership with the Cancer Behavioural Science Unit led by Dr Jo Waller. Her team has played an integral role in examining self-sampling and non-speculum clinician-sampling to increase cervical cancer screening uptake. Behavioural science projects have also been fully integrated into the NHS-Galleri trial to better understand psychological outcomes and communication needs in people receiving a positive cancer result. This will provide essential evidence to inform the optimal implementation of any future screening programme using a multi-cancer early detection (MCED) blood test. 

As part of the portfolio adoption and grant application processes, we can support investigators to plan and include work on acceptability and psychological outcomes. This complementary work may increase the likelihood of intervention success, lead to stand-alone publications and address funder strategic aims such as CRUK’s interest in understanding and addressing health inequities in cancer incidence.  

Clinical trials are becoming larger, more complex and more expensive. However, some trials fail to recruit to target and face high attrition, threatening the internal and external validity, ethical conduct and ability to fund the trials. Furthermore, many cancer trials lack representative samples, meaning results fail to benefit everyone in society and exacerbate existing cancer inequalities. 

The large-scale, population-based studies run by the CPTU provide a powerful opportunity to develop rigorous, evidence-based interventions to address these challenges. Large sample sizes are necessary to detect the small, expected effects of such interventions and the diversity of our trial samples will allow us to look at the effects within under-served groups such as those with low socioeconomic status or ethnic minority backgrounds. Trial conduct research is growing, but scientists are only now starting to use a behavioural science lens to underpin work in the field. 

To implement and generate evidence on effective strategies to improve recruitment, retention and inclusivity across clinical trials, we have a behavioural scientist based within the unit who works across all studies. For example, in the Galleri trial we have used evidence from cancer screening programmes to advise on key recruitment and retention strategies such as decentralised recruitment to reduce geographical barriers, a dynamic enrolment programme to ensure the sample is representative by age, sex and socioeconomic status and using electronic prompts to improve return to follow-up appointments and reduce non-attendance.

Addressing inequalities in research participation using behavioural science is a key priority within our unit. The CPTU always considers the appropriateness of recruitment strategies to reduce barriers to participation for under-served groups in clinical research. BEST3 worked with GP practices covering a diverse geography in England including both rural and urban areas and all five quintiles of multiple deprivation. YouScreen is taking place in Clinical Commissioning Groups (CCGs) with the lowest rates of cervical screening coverage in the country. We have translated all participant facing materials into five languages (Turkish, Bengali, Polish, Arabic and Somali). The YouScreen website has accessibility functionality (text to speech) and translation of website text into 100 languages. Women from different ethnic groups were included in the focus groups for the communications/branding activity and recently in reviewing the HPV self-sampling kits to provide feedback/quotes that can be used in social media etc. For FINESSE, we are planning to apply for additional funding (for FINESSE-B) to include two additional sites in areas with a high-proportion of black males of African descent to recruit 100 black men to the trial. 

We are interested in developing and evaluating interventions to improve trial conduct within each study supported by the CPTU and can help you determine the right level of approach for your project: 

Inform: Existing behavioural science evidence is used to inform recruitment and retention strategies. 

Incorporate: Qualitative or quantitative work is undertaken to examine potential strategies to improve recruitment or retention with a view to implementing successful approaches in the current trial. The qualitative work may include examining motivators and barriers to participation to select appropriate interventions. Quantitative work could include nested randomised controlled trials to evaluate existing interventions.

Innovate: Qualitative or quantitative work could be undertaken to develop new interventions for recruitment or retention such as the development and use of digital tools or staff-facing interventions. This may include qualitative work to examine motivators and barriers to taking part in clinical trial activities in addition to co-development projects to create new interventions based on the qualitative findings. Quantitative work could also include nested randomised controlled trials to evaluate the new interventions.