ideasIdea
Randomised trials of how to spread proven cancer treatments, not just what works
Fund proper trials of the methods used to get new evidence into practice (training, reminders, feedback, incentives), measured by whether patients actually receive the better treatment.
Implementation science in oncology is small and mostly observational. The proposal is a dedicated programme of cluster-randomised implementation trials, each testing strategies (audit and feedback, EHR defaults, champions, payment nudges) to accelerate uptake of a specific practice change, with structured-data outcomes and a common design so results generalise. NCI's Implementation Science programme is a base; the scale and randomisation are new.
Hypothesis
A portfolio of implementation trials will identify strategies that halve the time to majority uptake for specific practice changes, and those strategies will transfer across at least some other practice changes.
Rationale
Cardiology's Get With The Guidelines and similar programmes showed that structured implementation measurably improves guideline adherence; oncology lacks equivalent evidence about what works.
What would test it
Fund five cluster-randomised implementation trials on current practice changes; report effect sizes and cost per additional patient receiving guideline-concordant care.
Maturity
early clinical
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
- Knowledge reaches practice too slowly · Knowledge diffusion is slow: it takes years for a proven result to change what most patients receive, and no one can keep up with the literature.
- Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.