title: Adolescent Cancer Education (ACE) to increase adolescent and parent cancer awareness and communication: study protocol for a cluster randomised controlled trial.
abstract: BACKGROUND
  Raising cancer awareness among adolescents has potential to increase their knowledge and confidence in identifying cancer symptoms and seeking timely medical help in adolescence and adulthood. Detecting cancer at an early stage is important because it reduces the risk of dying of some cancers and thereby contributes to improved cancer survival. Adolescents may also play an important role in increasing cancer communication within families. However, there are no randomised controlled trials (RCT) of the effectiveness of school-based educational interventions to increase adolescents' cancer awareness, and little is known about the role of adolescents in the upward diffusion of cancer knowledge to parents/carers. The aim of this study is to determine the effectiveness of a school-based educational intervention to raise adolescent and parent cancer awareness and adolescent-parent cancer communication.
  
  
  METHODS
  The Adolescent Cancer Education (ACE) study is a school-based, cluster RCT. Twenty secondary schools in the area covered by Glasgow City Council will be recruited. Special schools for adolescents whose additional needs cannot be met in mainstream education are excluded. Schools are randomised to receive a presentation delivered by a Teenage Cancer Trust educator in Autumn 2013 (intervention group) or Spring 2014 following completion of six-month follow-up measures (control group). Participants will be students recruited at the end of their first year of secondary education (S1) (age 12 to 13 years) and one parent/carer for each student, of the student's choice. The primary outcome is recognition of cancer symptoms two weeks post-intervention. Secondary outcomes are parents' cancer awareness and adolescent-parent cancer communication. Outcomes will be assessed at baseline (when adolescents are in the final term of S1), two-week, and six-month follow-up (when adolescents are in S2, age 13 to 14 years). Differences in outcomes between trial arms will be tested using multiple regression methods, adjusted for clustering by school. An audit of cancer-related and health-promotion activity within the school curriculum and environment during the RCT will be conducted at six-month follow-up to contextualise the intervention effect.
  
  
  CONCLUSIONS
  Results from the ACE study will provide evidence about the public health effectiveness of a school-based intervention designed to increase adolescent and parent cancer awareness and adolescent-parent cancer communication.
  
  
  BACKGROUND
  ISRCTN75542411.
authors.affiliation: Cancer Care Research Centre, School of Nursing, Midwifery and Health, University of Stirling (Highland Campus), IV2 3JH Inverness, UK. richard.kyle@stir.ac.uk.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Kyle
authors.forename: Iona
authors.initials: I
authors.lastname: Macmillan
authors.forename: Petra
authors.initials: P
authors.lastname: Rauchhaus
authors.forename: Ronan
authors.initials: R
authors.lastname: O'Carroll
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
authors.forename: Liz
authors.initials: L
authors.lastname: Forbat
authors.forename: Sally
authors.initials: S
authors.lastname: Haw
authors.forename: Gill
authors.initials: G
authors.lastname: Hubbard
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001364:Awareness; D002648:Child; D003142:Communication; D055088:Early Detection of Cancer; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D010353:Patient Education as Topic; D011379:Prognosis; D021641:Recognition, Psychology; D012107:Research Design; D012572:School Health Services; D012606:Scotland; D013997:Time Factors