title: The Improving Rural Cancer Outcomes (IRCO) Trial: a factorial cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural patients with cancer in Western Australia: a study protocol.
abstract: BACKGROUND
  While overall survival for most common cancers in Australia is improving, the rural-urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA).
  
  
  METHODS
  The community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness.
  
  
  BACKGROUND
  Ethics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA.
  
  
  RESULTS
  Results of this trial will be reported in peer-reviewed publications and in conference presentations.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12610000872033.
authors.affiliation: General Practice and Primary Health Care Academic Centre, Melbourne Medical School, The University of Melbourne, Melbourne, Australia School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Australia.
authors.forename: Jon D
authors.identifier: http://orcid.org/0000-0002-5274-6336
authors.initials: JD
authors.lastname: Emery
authors.affiliation: School of Primary, Aboriginal and Rural Health Cancer, The University of Western Australia, Crawley, Australia School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia Education and Research Division, Cancer Council Western Australia, Perth, Western Australia, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Gray
authors.affiliation: The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
authors.affiliation: School of Primary, Aboriginal and Rural Health Cancer, The University of Western Australia, Crawley, Australia.
authors.forename: Shelley
authors.initials: S
authors.lastname: Cheetham
authors.affiliation: Education and Research Division, Cancer Council Western Australia, Perth, Western Australia, Australia Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Western Australia, Australia.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Croager
authors.affiliation: Education and Research Division, Cancer Council Western Australia, Perth, Western Australia, Australia Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Western Australia, Australia.
authors.forename: Terry
authors.initials: T
authors.lastname: Slevin
authors.affiliation: School of Surgery, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Christobel
authors.initials: C
authors.lastname: Saunders
authors.affiliation: The Department of Health of Western Australia, Western Australia Cancer Registry, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Threlfall
authors.affiliation: Rural Clinical School of WA, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Auret
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Crawley, Australia.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Nowak
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.affiliation: Institute of Health and Rehabilitation Research, Notre Dame University, Freemantle, Australia.
authors.forename: Max
authors.initials: M
authors.lastname: Bulsara
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D058005:General Practitioners / Q000193:education; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors; D014904:Western Australia / Q000453:epidemiology
keywords: MEDICAL EDUCATION & TRAINING; PRIMARY CARE; PUBLIC HEALTH